Table 1

Examples of evidence-based statements and patient-centred messages.

Evidence-based statements	Grade	Patient-centred messages
Exercise

There is strong evidence that both strengthening and cardiovascular for exercise were effective for reducing pain and improving function in the short-term in knee osteoarthritis.4^,5^,48–50^,52^,53^,82^,84^,85	***	We now know that inactivity and excessive rest is bad hip or knee joints with osteoarthritis. Research confirms that once you have osteoarthritis, regular moderate exercise does not make it worse — quite the reverse. Movement is good for you — and for your joints. Your whole body must keep active to stay healthy. Regular physical activity: strengthens and stretches muscles around your joints, keeps you supple by getting stiff joints moving and stopping them seizing up, makes your bones stronger, works your heart and lungs to make you fit, releases natural chemicals that reduce pain and make you feel good, and puts you in control. That is why exercise is one of the core treatments for osteoarthritis. It is a way to treat yourself.

There is moderate evidence that no difference in effectiveness was found between different intensities of exercise for knee osteoarthritis.51	**

There is strong evidence that integrating self-management strategies with exercise was effective for reducing pain and improving function in knee osteoarthritis.54^,55	***

There is limited evidence that integrating self-management strategies with exercise was effective for reducing pain and improving function in hip OA.54	*

There is limited evidence that both strengthening and cardiovascular exercise were effective for reducing pain and improving function in the short term in hip osteoarthritis.4^,5^,48^,50^,52	*

Weight loss

There is strong evidence that a 5% weight reduction will result in moderate improvement in disability in overweight patients with knee osteoarthritis.5^,81	***	If you are overweight, losing weight is very beneficial for your joints. Most people will notice an improvement in joint pain and function after losing 5% of their body weight.

Paracetamol

There is strong evidence that paracetamol has a small effect on pain and has few adverse reactions in osteoarthritis of the hip or knee compared with placebo, in the short term.5^,33	***	There are many treatments that can help the pain. They may not remove the pain completely, but they can control it enough to let you get moving and active. Paracetamol is the simplest and safest painkiller. Take a regular dose rather than waiting for the pain to get too bad.

Topical non-steroidal anti-inflammatory drugs (NSAIDs)

There is moderate evidence that topical NSAIDs have a small effect on pain in knee osteoarthritis compared with placebo, and few adverse effects in the short term.5^,32^,34^,83^,85	**	Try massaging an anti-inflammatory gel directly over the painful joint — up to three times a day. It tends to be more effective for knee pain.

Key: evidence grade for the strength of scientific evidence:25 ***strong — generally consistent findings provided by systematic review(s) of multiple high-quality studies. **moderate — generally consistent findings provided by review(s) of fewer or lower-quality studies. *weak — limited evidence: provided by a single high-quality study; conflicting evidence: inconsistent findings provided by review(s) of multiple studies.