Osteoarthritis is the most prevalent form of arthritis in the

United States,1 affecting over 20 million adults.2,3 More than

half of all people age 65 and over have evidence of

osteoarthritis,3 and it is the leading cause of disability in

this age group.4 Research funded by the Agency for

Healthcare Research and Quality (AHRQ) indicates that

treatment involving patient self-management, occupational

therapy, pharmaceutical therapy, and surgery can reduce

pain, maintain or improve joint mobility, and limit

functional disability. AHRQ’s research shows how elderly

patients with osteoarthritis can become more active and

responsible for their own care, make more informed

decisions, help to control the costs of health care, and

improve their quality of life.

Background

Research funded by AHRQ shows that the effects of

osteoarthritis accumulate as people age. The presence of

osteoarthritis significantly predicts whether or not elderly

people will become functionally limited in their ability to

care for themselves.5 According to AHRQ’s Healthcare Cost

and Utilization Project (HCUP), 250,000 people ages 65-79

were hospitalized in 1997 because of osteoarthritis.6 There

is no known cure for osteoarthritis, and therapy becomes

more and more complicated as people age.1,4,7-9

Osteoarthritis of the knee and hip joints causes the most

difficulty for the elderly because it significantly impacts

their ability to conduct their normal activities of daily

living, such as walking, cooking, bathing, dressing, using

the toilet, and performing household chores.1,3,7,9 Joints can

become painful, stiff, and swollen.3 The resulting pain

causes limited motion, reduced physical capability,

restriction of social activities, and compromised work

capacity.1,4 The interaction of these factors—pain, loss of

social contact, and diminished income—can create

emotional distress, which further reduces physical activity.4

Increased disability results when the affected joints are

exercised less, and the elderly begin to lose muscle tone,

leading to reduced strength.4 Because there is no cure, the

therapeutic goal of treatment for osteoarthritis is to

minimize the effects of the disease and its consequences

over time.4

AHRQ research has improved osteoarthritis

management 

AHRQ has funded studies devoted to helping patients

become partners in their own care. These studies have

contributed to improved functional ability among older

adults. For example:

• The Chronic Disease Self-Management Program

(CDSMP) has helped patients manage their symptoms

and reduce health care use. The CDSMP is discussed in

Research in Action Issue 3.10

Managing Osteoarthritis: Helping the Elderly

Maintain Function and Mobility

Making a Difference

• Self-management of osteoarthritis helps patients

improve their health...Page 2

• Occupational therapy helps the elderly improve their

quality of life...Page 3

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

contributes to high costs...Page 3

• Educating health care providers reduces NSAID

use...Page 4

• Knee surgery has benefits and risks...Page 5

• Surgeons and hospitals that perform more knee

surgeries have fewer complications...Page 8

RESEARCH IN ACTION

Agency for Healthcare Research and Quality • www.ahrq.gov

Issue #4 May 2002
• The Well Elderly Study showed that providing

preventive occupational therapy to the elderly helps

improve their personal and social relationships as well

as their health status.

Researchers funded by AHRQ were instrumental in

identifying the high costs of treatment for osteoarthritis

with nonsteroidal anti-inflammatory drugs (NSAIDs) and

suggesting alternatives to that treatment. Specifically,

AHRQ studies revealed that:

• NSAIDS provided very little relief of pain or

improvement in function, and they were associated with

ulcers, bleeding, and gastrointestinal perforation.

• Patients who used NSAIDs utilized more hospital and

emergency services than nonusers, resulting in increased

medical care costs.

• An educational program for physicians and nursing

home staff resulted in a significant reduction of NSAID

use and increased the use of acetaminophen without any

increase in pain.

AHRQ research revealed that the elderly face higher risks

of complications and mortality than younger people when

they have surgery, including surgical knee repair. However,

AHRQ studies also showed:

• The elderly reported better quality of life, less pain, and

better physical function after knee replacement surgery. 

• Surgical complications and mortality rates were lower

for surgeons and hospitals that performed more knee

replacement surgeries.

Physician-patient partnership improves 

physical functioning 

AHRQ research shows that patients have better outcomes

when they receive education and training about their

condition because they become more involved in their care.

Two ways to achieve improved outcomes are through selfmanagement and occupational therapy.

Self-management of osteoarthritis

AHRQ researchers indicate that the key to good

management of osteoarthritis is an effective physicianpatient partnership. This partnership should:

• Promote proper use of medications.

• Encourage patients to change their behavior to improve

symptoms or slow disease progression.

2 www.ahrq.gov

• Improving Chronic Disease by Self-Management Education, Stanford University: This study developed, operated, and

evaluated the Chronic Disease Self-Management Program and assessed its effectiveness in improving health while lowering

costs for patients with chronic disease.

• Effectiveness of Two Occupational Therapy Treatments for the Elderly, University of Southern California: AHRQ co-sponsored

this study with the National Institute on Aging and the National Center for Medical Rehabilitation Research. It provided an

occupational therapy service to low-income elderly and evaluated the program’s cost effectiveness and its impact on quality

of life.

• Assessing and Improving Outcomes: Total Knee Replacements, Indiana University: Also referred to as the Total Knee

Replacement Patient Outcomes Research Team (TKR PORT), this study investigated the variation in total knee replacement

rates and outcomes and constructed a decision model to help physicians and patients make decisions regarding surgery. 

• Effectiveness and Outcomes of Noncardiac Surgery, Brigham and Women’s Hospital: This study investigated adverse

outcomes among patients undergoing major noncardiac surgery, identified the factors that predict adverse outcomes,

evaluated the impact of adverse outcomes on length of postoperative stay, and assessed the long-term effectiveness of highvolume procedures. 

• Improving Outcomes in Elderly NSAID Users, Vanderbilt University: This study developed and tested an educational program

that encouraged physicians to reassess elderly NSAID users with osteoarthritis who were at high risk of peptic ulcer disease.

AHRQ-Funded/Sponsored Research on Osteoarthritis and Elderly Health Care
• Instruct patients on how to interpret and report

symptoms accurately.

• Help patients adjust to new social and economic

circumstances and cope with emotional consequences. 

• Support patients’ efforts to participate in treatment

decisions and maintain normal activities.4

Creating patient education programs helps patients achieve

this role by giving them the knowledge and skills they need

for self-management. AHRQ funded the development of

the Chronic Disease Self-Management Program, which is

based on changes in diet, exercise, and compliance with

treatment regimens. The CDSMP has been shown to

improve health status and reduce costs. Specifically, the

CDSMP helps patients interpret and report symptoms

accurately and has led to substantial reductions in pain,

depression, and the use of health services in patients with

chronic disease.4

Changing the patient’s health behaviors and perception of

symptoms can improve the symptoms or slow the

progression of osteoarthritis.4 Regular exercise helps

patients retain mobility and counteracts loss of muscle

strength.1,4 Exercise such as walking or aquatics improves

aerobic capacity and stamina while decreasing depression

and anxiety.1,7 If patients attribute pain to the progression

of osteoarthritis, then they may avoid activities that increase

pain. However, if patients attribute pain to loss of muscle

tone and strength, then they may increase physical activity.4

Patients can be referred to organizations in their

community that offer exercise programs, swimming

facilities, information meetings, social activities, self-help

education, support groups, and mobile services for

transportation and meals.4 Finally, research sponsored by

AHRQ indicates that patients can be supported from the

physician’s office by telephone with no significant increase

in costs to either the patients or physicians.1 These

telephone conversations can be used to discuss joint pain,

medications, treatment compliance, drug toxicities, date of

next scheduled visit, and barriers to receiving care.1

Occupational therapy

Occupational therapists can evaluate a person’s ability to

perform daily living activities and recommend devices such

as elevated toilet seats or wall bars for bathtubs. They also

teach joint protection and energy conservation. For

example, living on one floor of the home helps to avoid

painful step climbing and avoiding kneeling or squatting

helps to protect the joints.1,7

AHRQ cofunded the Well Elderly Study with the National

Institute on Aging and the National Center for Medical

Rehabilitation Research. This study evaluated the

effectiveness of preventive occupational therapy as a way to

avoid functional disability in people age 60 and over.

During a 9-month period, one group of participants

received weekly group and individual occupational therapy.

This therapy focused on home and community safety,

shopping, mastering the public transportation system, joint

protection, adaptive equipment, energy conservation,

exercise, and nutrition. A second group of patients

attended a program that focused only on social activities,

such as community outings, craft projects, films, games,

and dances. At the end of the study, those who were in the

occupational therapy study group reported:

• Better quality of interaction with other people.

• Improved health status.

• More satisfaction with life.

• Improved mental health, physical functioning, role

functioning, vitality, and social functioning.

• Less pain.

• Fewer emotional problems.11

Six months after the initial study, the patients who received

preventive occupational therapy were reassessed. These

elderly participants continued to experience:

• Better quality of interaction with other people.

• Improved mental health, physical functioning, role

functioning, vitality, and social functioning.

• Less pain.

• Fewer emotional problems.12

Use of NSAIDs contributes to high costs

Medications do not cure osteoarthritis but are intended to

relieve pain.1,7 AHRQ studies indicate that nonsteroidal

anti-inflammatory drugs were the medications of choice for

osteoarthritis pain until research showed that they affect

joint cartilage metabolism, have greater risk of toxicity than

acetaminophen, can cause upper gastrointestinal bleeding,

and may cause or aggravate peptic ulcer disease.1,7,13,14 One

www.ahrq.gov 3
AHRQ-funded study showed that 30-40 percent of all

elderly use NSAIDs each year and 10-13 percent of the

elderly use NSAIDs every day.14 A majority of these

elderly have a primary diagnosis of osteoarthritis.14 AHRQ

research further showed that NSAIDs provided only a

modest decrease in osteoarthritis pain and little

improvement in function, and their association with ulcers,

bleeding, and perforation caused a four- to five-fold

increase in hospitalizations due to gastrointestinal

complications.14

An AHRQ study of Medicaid recipients who were age 65

and over showed that NSAID users were hospitalized and

used the emergency room more often than nonusers (Figure

1). As the elderly increased their use of NSAIDS, medical

care costs also increased (Figure 2).15

Educating health care providers reduces

NSAID use

An educational intervention supported by AHRQ resulted

in about a 70-percent reduction in the use of NSAIDs

among nursing home patients. Physicians and nursing staff

4 www.ahrq.gov

25.4%

19.3%

33.1%

27.4%

24.1%

16.9%

Hospitalization Emergency room visit

0

5

10

15

20

25

30

35

Percent

Nonuser Occasional Regular

Figure 1. Percent of elderly Medicaid recipients

hospitalized or using emergency room services

annually, by NSAID use

Note: NSAID is nonsteroidal anti-inflammatory drug. Occasional users used NSAIDs less

than 75% of the time and regular users used them at least 75% of the time.

Source: Smalley WE, Griffin MR, Fought RL, et al. Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs. J Gen Intern Med

1996;11(8):461-9.

Nonuser Occasional Regular

$105.05

$26.53

$112.73

$244.31

$66.43

$26.44

$86.76

$179.63

$50.42

$18.39

$64.96

$133.78

Hospital admissions Outpatient visits Prescription medications All medical care

0

50

100

150

200

250

300

Dollars

Figure 2. Annual Medicaid/Medicare payments per person-year for gastrointestinal disorders among the elderly,

by NSAID use

Note: NSAID is nonsteroidal anti-inflammatory drug. Occasional users used NSAIDs less than 75% of the time and regular users used them at least 75% of the time.

Source: Smalley WE, Griffin MR, Fought RL, et al. Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs. J Gen Intern Med 1996;11(8):461-9.
participated in an educational program focused on the best

treatments for muscle and joint pain, which included

information on osteoarthritis, recognizing pain in patients,

and various methods to control pain. These health care

providers were asked to stop regular NSAID therapy in all

patients age 65 and over and substitute acetaminophen. If

the acetaminophen did not control the patient’s pain, the

providers were allowed to add ibuprofen to the patient’s

treatment regimen. If this regimen did not control the

patient’s pain, the providers were to begin using their

standard NSAID therapy again.16

After 3 months, nursing home residents reduced their

NSAID use from an average of 7 days a week to less than 2

days per week and increased their use of acetaminophen

from 2 days per week to 5 days per week. These patients

did not report any significant increase in pain or disability.

It is expected that, over the long term, these patients will

also decrease their risk for gastrointestinal problems caused

by NSAIDs and the costs associated with them.16

Researchers sponsored by AHRQ have indicated that

acetaminophen (up to 4,000 milligrams per day) is the

recommended drug of choice for osteoarthritis. NSAIDs

can be prescribed if acetaminophen fails to relieve pain.1,7,13

Adverse effects from acetaminophen were limited but

included liver toxicity in patients who were fasting or

consumed large amounts of alcohol and renal failure from

long-term use.1,13 Opioids have been shown to be effective

for short-term treatment of acute exacerbation of pain, but

the elderly have difficulty tolerating codeine on a long-term

basis.1,13

Topical therapy, such as capsaicin cream, has been shown

to be appropriate for patients with knee osteoarthritis who

did not respond to or did not want to take oral

analgesics.7,9,13 Corticosteroid injections into the joint were

helpful in diminishing symptoms in patients with knee

osteoarthritis who had swelling and inflammation,4,7 but

they were not recommended for hip osteoarthritis because

of progressive cartilage damage from repeated injections.1

Patients who do not respond to medical therapy1 or who

require more than three or four joint injections each year to

control symptoms of knee osteoarthritis are candidates for

surgical intervention.7

Knee surgery has benefits and risks

Surgical repair and replacement of the knee joints provide

durable pain relief and functional improvement in patients

with osteoarthritis.7,17 However, the elderly need to consider

certain factors, such as surgical complications and the pros

and cons of having surgery performed on both knees at the

same time. 

www.ahrq.gov 5

14.0%

5.8% 9.7%

4.3% 6.3%

77.4%

58.5%

52.6%

24.3%

30.4%

Using stairs Walking on flat ground Standing upright Sitting or lying down At night in bed

0

20

40

60

80

100

Percent

Before replacement After replacement

Figure 3. Percent of elderly patients in severe pain before and after knee replacement surgery, by type of activity

Source: Hawker G, Wright J, Coyte P, et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am 1998;80(2):163-73.
Knee replacement surgery improves quality of life 

The AHRQ total knee replacement Patient Outcomes

Research Team (TKR PORT) showed that, despite the risk

of complications, quality of life improves for the elderly

after knee replacement surgery.18 Elderly patients reported

less pain and better physical function (Figures 3 and 4). 

Additional AHRQ-funded research confirmed the value of

total knee replacement surgery in a study of patients whose

average age was 65 years. After 4 years, nearly 90 percent

of patients had a good to excellent outcome. After 5 years:

• 75 percent had no pain.

• 20 percent had mild pain.

• 3.7 percent had moderate pain.

• Only 1.3 percent had severe pain.19

Complications from surgery increase with age

AHRQ research has indicated that the elderly face more

risks of major or fatal complications when undergoing

noncardiac surgery, including orthopedic surgery, than

younger patients (Figure 5). Specifically, older patients

have a significantly higher risk of pulmonary edema, heart

attack, abnormal heart rhythms, bacterial pneumonia,

respiratory failure, and in-hospital mortality.20

6 www.ahrq.gov

50.7%

47.6%

36.1% 34.0% 34.6%

7.5% 6.1%

10.5%

14.1%

8.7%

65-69 years 70-74 years 75-79 years 80-84 years 85 years and over

0

10

20

30

40

50

60

Percent

Before replacement After replacement

Figure 4. Elderly patients’ ability to walk more than 10 blocks before and after knee replacement surgery, by age

Source: Hawker G, Wright J, Coyte P, et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am 1998;80(2):163-73.

50-59 60-69 70-79 80 and over

0

5

10

15

4.3%

5.7%

9.6%

12.5%

Percent

Age in years

Figure 5. Major or fatal postoperative complications

in patients undergoing noncardiac surgery, by age

Source: Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative

complications and length of stay in patients undergoing noncardiac surgery. Ann Intern

Med 2001;134(8):637-43.
www.ahrq.gov 7

50-59 60-69 70-79 80 and over

0

2

4

6

8

10

7.6

8.3

8.8

9.3

Days

Age in years

Figure 6. Average length of stay in days among

patients undergoing noncardiac procedures, by age

Source: Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative

complications and length of stay in patients undergoing noncardiac surgery. Ann Intern

Med 2001;134(8):637-43.

Table 1. Estimated rates and ranges of

complications following total knee replacement

surgery

Average Range

Complication rate (%) (%)

Superficial infections 3.9 0-14.8

Deep infections 1.7 0-11.4

Pulmonary embolism 2.0 0-9.7

Deep venous thrombosis 6.5 0-56.6

Peripheral nerve damage 2.1 0-18.8

Source: Callahan CM, Drake BG, Heck DA, et al. Patient outcomes following

tricompartmental total knee replacement. JAMA 1994;271(17):1349-57.

Patients ages 70-79 were twice as likely and patients 80

years and over were three times as likely to suffer

postoperative complications or death when compared to

patients ages 50-59.20 Older patients also had longer

hospital stays (Figure 6) regardless of sex, ethnicity,

preoperative clinical characteristics, functional status, and

type of procedure.20

AHRQ research showed that about 18 percent of patients

undergoing knee replacement surgery, whose average age

was 65, had complications (Table 1). The mortality rate

was 7.1 percent at 30 days but dropped to 1.5 percent after

1 year.19

Patients who require surgical repair (arthroplasty) on both

knees often face a choice whether to have the procedure

Mortality rate (%) Median

Average 

Surgery Surgical intensive Length of Total

groups complication (%) 30-day 2-year care days stay (days) charges

Simultaneous 2.4 0.99 3.75 2.11 12 $20,562

Staged:

6 weeks 3.5 0.48 4.05 1.35 20 $24,343

3 months 3.5 0.29 3.27 1.03 20 $23,753

6 months 3.4 0.31 3.42 1.09 21 $24,589

1 year 3.9 0.36 2.98 1.28 21 $25,009

Source: Ritter M, Mamlin LA, Melfi CA, et al. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop 1997;345:99-105.

Table 2. Comparisons between simultaneous and staged bilateral knee arthroplasties among Medicare beneficiaries
done on one knee at a time (staged) or both knees at once

(simultaneous). The AHRQ-funded TKR PORT found that

patients who had surgical repair on both knees at the same

time experienced more days in intensive care than those

who chose staged procedures (Table 2). Although the total

length of stay and costs were less for patients receiving

simultaneous surgical repair,21 these patients have been

found to have an increased risk of complications overall.22

Mortality at 30 days was highest for the simultaneous

procedure group but by 2 years, it was nearly the same for

all groups. Researchers concluded that staging the

procedure 3 to 6 months appeared to offer the fewest

disadvantages, was only slightly more expensive than

simultaneous arthroplasty, and had the lowest mortality

rate.21

Surprisingly, AHRQ studies show that patients who

reported having worse knee function prior to surgery were

the least likely to suffer complications.22 Other factors that

help reduce complications include having surgery during

the middle of the week and having surgery performed by

surgeons or in hospitals that perform more knee

replacement surgeries.22-24

High-volume hospitals and surgeons have

lower complication rates

AHRQ-funded studies conducted as a part of the TKR

PORT indicated that patients generally have fewer

complications when their surgeons perform more than 20

knee replacements per year22 or patients have their surgery

in hospitals that perform at least 40 operations per year.23

One study showed that average surgical complication and

mortality rates declined as the hospital performed more

knee replacement surgeries (Figures 7 and 8).24 These

reductions were consistent in both medium- and large-size

hospitals.24

Arthritis research continues

AHRQ funded a Center for Education and Research on

Therapeutics (CERTs) focused on musculoskeletal

disorders at the University of Alabama at Birmingham. By

having an arthritis center collaborate with private-sector

entities, the researchers hope to identify variations in

musculoskeletal therapy and explore the causes of these

variations. They will also develop a facility to disseminate

8 www.ahrq.gov Percent

Surgical complication rate Mortality rate

Number of knee replacement surgeries

performed annually

0.8% 0.6% 0.5% 0.4% 0.4% 0.3%

3.0% 2.8%

2.3% 2.3% 2.2%

1.2%

1-12 13-24 25-50 51-75 76-100 101 or more

0

1

2

3

4

5

Figure 7. Surgical complication and mortality rates for knee replacement surgery in medium-size hospitals 

(100-399 beds)

Source: Gutierrez B, Culler SD, Freund DA. Does hospital procedure-specific volume affect treatment costs? A national study of knee replacement surgery. Health Serv Res

1998;33(3):489-511.
new knowledge about musculoskeletal therapy, including

minimizing adverse effects, cost effectiveness, and effects

on quality of life. 

With new funding, researchers can make a

difference

AHRQ’s program announcement “Patient-Centered Care:

Customizing Care to Meet Patients’ Needs” is intended to

support the redesign and evaluation of new care processes

that lead to greater patient empowerment, improved patientprovider interaction, easier navigation through health care

systems, and improved access, quality, and outcomes.

Examples of specific strategies include electronic clinical

communication, self-management programs, Web-based

applications for patients and/or health care providers, and

shared decisionmaking programs. AHRQ encourages

projects that emphasize chronic illness, episodes of care

that extend beyond hospitalization, longitudinal care, and

priority populations. For more information, see the AHRQ

Web site at <http://grants1.nih.gov/grants/guide/pa-files/PA01-124.html>.

Conclusion

AHRQ research has shown that the disabling effects of

osteoarthritis can be reduced or prevented through the use

of patient self-management, physical and occupational

therapy, and surgery. As a result of AHRQ-sponsored

research, self-management programs have helped prevent

disability and improve health status. Although the elderly

suffer proportionately more complications and adverse

effects from surgical therapy than younger patients, AHRQ

research has indicated that hospitals that perform more

surgeries have lower complication rates. Finally, surgical

knee repair helps the elderly gain improved functional

ability and quality of life. 

For more information

This synthesis was written by Barbara L. Kass-Bartelmes,

M.P.H., CHES (bkass@ahrq.gov). For further information

on osteoarthritis or elderly health care, please contact

AHRQ’s Center for Outcomes and Effectiveness Research

at 301-594-1485.

www.ahrq.gov 9

0.8%

0.5% 0.5% 0.5% 0.3%

4.2%

1.8%

2.2% 2.1%

1.8% 1.8%

1-12 13-24 25-50 51-75 76-100 101 or more

0

1

2

3

4

5

Percent

Number of knee replacement surgeries

performed annually

Surgical complication rate Mortality rate

*

Figure 8. Surgical complication and mortality rates for knee replacement surgery in large hospitals 

(400 beds or more)

*Not applicable.

Source: Gutierrez B, Culler SD, Freund DA. Does hospital procedure-specific volume affect treatment costs? A national study of knee replacement surgery. Health Serv Res

1998;33(3):489-511.
References

*1. Hochberg MC, Altman RD, Brandt KD, et al.

Guidelines for the medical management of

osteoarthritis. Part I. Osteoarthritis of the hip. Arthritis

Rheum 1995;38(11):1535-40.

2. Arthritis Foundation. Osteoarthritis. Web site:

http://www.arthritis.org/conditions/

DiseaseCenter/oa.asp

3. National Institute of Arthritis and Musculoskeletal and

Skin Diseases. Handout on health: osteoarthritis. Web

site: http://www.niams.nih.gov/hi/topics/arthritis/

oahandout.htm

*4. Holman H, Lorig K. Overcoming barriers to successful

aging: self management of osteoarthritis. West J Med

1997;167(4):265-68.

5. Boult C, Kane RL, Louis TA, et al. Chronic conditions

that lead to functional limitation in the elderly. J

Gerontol 1994;49(1):M28-36.

*6. Elizhauser A, Yu K, Steiner C, Bierman AS.

Hospitalization in the United States, 1997. Rockville

(MD): Agency for Healthcare Research and Quality;

2000. HCUP Fact Book No. 1. AHRQ Pub. No. 

00-0031. 

*7. Hochberg MC, Altman RD, Brandt KD, et al.

Guidelines for the medical management of

osteoarthritis. Part II. Osteoarthritis of the knee.

Arthritis Rheum 1995;38(11):1541-46.

8. Nash DB, Koenig JB, Chatterton ML. Why the elderly

need individualized pharmaceutical care. Philadelphia

(PA): Office of Health Policy and Clinical Outcomes,

Thomas Jefferson University, April 2000.

*9. Puett DW, Griffin MR. Published trials of nonmedicinal

and noninvasive therapies for hip and knee

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*10. Agency for Healthcare Research and Quality. Preventing

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(MD); 2002. Research in Action Issue 3. AHRQ Pub.

No. 02-0018.

*11. Clark F, Azen SP, Zemke R, et al. Occupational therapy

for independent-living older adults. JAMA

1997;278(16):1321-6.

*12. Clark F, Azen SP, Carlson M, et al. Embedding healthpromoting changes into the daily lives of independentliving older adults: long term follow-up of occupational

therapy intervention. J Gerontol 2001;56B(1):P60-3.

*13. Griffin MR, Brandt KE, Liang MH, et al. Practical

management of osteoarthritis. Integration of

pharmacologic and nonpharmacologic measures. Arch

Fam Med 1995;4(12):1049-55.

*14. Griffin MR. NSAID use in the elderly: prevalence and

problems. In: Baker JR and Brandt KD, editors.

Reappraisal of the management of patients with

osteoarthritis. New Jersey: Scientific Therapeutics

Information, Inc. p. 35-7.

*15. Smalley WE, Griffin MR, Fought RL, et al. Excess

costs from gastrointestinal disease associated with

nonsteroidal anti-inflammatory drugs. J Gen Intern

Med 1996;11(8):461-9.

*16. Stein CM, Griffin MR, Taylor JA, et al. Educational

program for nursing home physicians and staff to reduce

use of non-steroidal anti-inflammatory drugs among

nursing home residents. Med Care 2001;39(5):436-45.

*17. Wright JG, Coyte P, Hawker G, et al. Variation in

orthopedic surgeons’ perceptions of the indications for

and outcomes of knee replacement. Can Med Assoc J

1995;152(5):687-97.

*18. Hawker G, Wright J, Coyte P, et al. Health-related

quality of life after knee replacement. J Bone Joint Surg

Am 1998;80(2):163-73.

*19. Callahan CM, Drake BG, Heck DA, et al. Patient

outcomes following tricompartmental total knee

replacement. JAMA 1994;271(17):1349-57.

*20. Polanczyk CA, Marcantonio E, Goldman L, et al.

Impact of age on perioperative complications and length

of stay in patients undergoing noncardiac surgery. Ann

Intern Med 2001;134(8):637-43.

* AHRQ-funded/sponsored research

10 www.ahrq.gov
www.ahrq.gov 11

*21. Ritter M, Mamlin LA, Melfi CA, et al. Outcome

implications for the timing of bilateral total knee

arthroplasties. Clin Orthop 1997;345:99-105.

*22. Heck DA, Robinson RL, Partridge CM, et al. Patient

outcomes after knee replacement. Clin Orthop

1998;356:93-110.

*23. Norton EC, Garfinkel SA, McQuay LJ, et al. The effect

of hospital volume on the in-hospital complication rate

in knee replacement patients. Health Serv Res

1998;33(5):1191-210.

*24. Gutierrez B, Culler SD, Freund DA. Does hospital

procedure-specific volume affect treatment costs? A

national study of knee replacement surgery. Health Serv

Res 1998;33(3):489-511.

* AHRQ-funded/sponsored research
U.S. Department of

Health and Human Services

Public Health Service

Agency for Healthcare Research and Quality

2101 East Jefferson Street, Suite 501

Rockville, Maryland 20852

www.ahrq.gov

AHRQ Pub. No. 02-0023

May 2002

Previous issues of Research in Action are available for free from the AHRQ Publications Clearinghouse: 1-800-358-9295.

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Issue Title Publication Number

3 Preventing Disability in the Elderly With Chronic Disease AHRQ 02-0018

2 Improving Care for Diabetes Patients Through Intensive

Therapy and a Team Approach AHRQ 02-0005

1 Reducing and Preventing Adverse Drug Events To Decrease 

Hospital Costs AHRQ 01-0020