Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study

Tang, Clarice Y; Pile, Rebecca; Croft, Anna Jane Elizabeth; Watson, Narelle J

doi:10.1093/ptj/pzaa049

Cited by 18 publications

(11 citation statements)

References 24 publications

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“…After removal of duplicates and exclusion of articles based on title or abstract, 93 potentially relevant articles remained for full-text screening. Ultimately, 36 articles were included in the qualitative synthesis 27–62…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

et al. 2022

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ObjectiveTo provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA).DesignScoping review.Data sourcesThe databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021.Eligibility criteriaPrimary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded.Data extraction and synthesisBarriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist.ResultsThirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients’ negative attitude towards LIs, patients’ low health literacy and HCPs’ lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs’ own role in implementing LIs, the content or structure of LIs and HCPs’ positive attitude towards LIs.ConclusionsMultiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs.PROSPERO registration numberCRD42019129348.

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Section: Resultsmentioning

confidence: 99%

“…Lack of knowledge or skills around LIs or promoting behavioural change 27 29 33 41 42 45 47 49–51 56 60 61…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

et al. 2022

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“… 39 40 Moreover, physiotherapists do not seem to be up-to-date when it comes to OA CPGs. 41–43 In two recent studies, 44 Italian physiotherapists showed a significant evidence-to-practice gap towards OA CPGs and a lack of Scientific English comprehension skills, which can result in suboptimal care for people with OA and may foster an incorrect perception of non-surgical treatments among patients. 45 46 This is in line with what was found in these interviews, in which participants believed that physiotherapy was helpful ‘to walk again after surgery’ but that it had no or minimal role in the pre-surgical care process.…”

Section: Discussionmentioning

confidence: 99%

Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study

Battista

Dell’Isola

Manoni³

et al. 2021

BMJ Open

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ObjectiveTo examine the experience of the COVID-19 pandemic as lived by people with hip and knee osteoarthritis (OA), in Italy.DesignA qualitative study based on semi-structured interviews.SettingUrban and suburban areas in northern Italy.ParticipantsA total of 11 people with OA were enrolled through a purposeful sampling and completed the study.Primary outcome measureThe experience of Italian people with OA during the COVID-19 pandemic.ResultsFour themes were brought to the forefront from the analysis of the interviews. (1) Being Stressed for the Limited Social Interactions and for the Family Members at High Risk of Infection, as the interviewees were frustrated because they could not see their loved ones or felt a sense of apprehension for their relatives. (2) Recurring Strategies to Cope with the Pandemic such as an active acceptance towards the situation. (3) Being Limited in the Possibility of Undergoing OA Complementary Treatments and Other Routine Medical Visits. (4) Being Unaware of the Importance of Physical Activity as First-Line Interventions which was an attitude already present before the pandemic.ConclusionThe COVID-19 pandemic and related restrictions impacted the quality of life and the care of individuals with hip and knee OA. The social sphere seemed to be the most hindered. However, the interviewees developed a good level of acceptance to deal with the pandemic. When it came to their care, they faced a delay of routine medical visits not related to OA and of other complementary treatments (eg, physical therapies) to manage OA. Finally, a controversial result that emerged from these interviews was that first-line interventions for OA (ie, therapeutic exercise) was not sought by the interviewees, regardless of the restrictions dictated by the pandemic. Policy-making strategies are thus necessary to support the awareness of the importance of such interventions.

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“…For example, physiotherapists should provide patient education and exercise-therapy to people with knee osteoarthritis (24). Yet, they do not always provide this care (25,26), and doctors report frustration about the lack of standardised care in Australia (22,27).…”

Section: Introductionmentioning

confidence: 99%

Program Evaluation of GLA:D® Australia: Physiotherapist Training Outcomes and Effectiveness of Implementation for People With Knee Osteoarthritis

Barton

Kemp

Roos

et al. 2021

Preprint

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BackgroundThe Good Life with osteoArthritis from Denmark (GLA:D®) program incorporates guideline-based patient education and exercise-therapy for osteoarthritis to implement guidelines into practice. We evaluated the implementation of GLA:D® for knee osteoarthritis within Australian physiotherapy practice using the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, Maintenance Qualitative Evaluation for Systematic Translation) framework.MethodsAustralian physiotherapists were trained and supported to deliver GLA:D® (2017-2019) and completed surveys before and after training to assess practices, beliefs about capabilities and confidence, and barriers and enablers to implementation. Patients participating in GLA:D® completed online baseline, 3-month (immediately post-treatment) and 12-month patient reported outcomes. Effective implementation was defined as within-subject moderate effect size (ES, ≥0.50) for average pain (100mm visual analogue scale) and knee osteoarthritis outcome score quality of life scores (KOOS-QoL), and small effect size (≥0.20) for health-related quality of life (EQ-5D-5L).ResultsReach: 1,064 physiotherapists (73% private) and 1,945 (79% private) from all states and territories consented to participation. Key barriers included out-of-pocket cost to patients, and program suitability for culturally and linguistically diverse communities. Effectiveness: Following training, more physiotherapists discussed treatment goals and the importance of weight management, and prescribed supervised, neuromuscular exercise. Patient outcomes at 3- and 12 months (n = 1,044 [54%] and 927 [48%]) reflected effective implementation, including reduced pain intensity (ES, 95%CI = 0.72, 0.62-0.84; and 0.65, 0.54-0.77), improved KOOS-QoL scores (0.79, 0.69-0.90; and 0.93, 0.81-1.04), and improved EQ-5D-5L scores (0.43, 0.31-0.54; and 0.46, 0.35-0.58). Seventy-three percent of participants reported minimal important changes for at least one of pain severity (≥ 15 mm), KOOS-QoL (≥ 15 points) or EQ-5D-5L (≥ 0.07 points). Adoption: GLA:D® was implemented at 297 sites (264 private, 33 public). Implementation: Most patients completed at least one education (90%), and 10 exercise-therapy (78%) sessions. Adequate staffing to support program delivery was a key enabler. Maintenance: Ninety-nine percent of sites (293/297) continued to offer the program in July 2020.ConclusionsTraining was associated with practice changes and widespread implementation of GLA:D® in Australia. Effective implementation, and clinically meaningful improvements in pain and quality of life for most participant, supports further work to scale up GLA:D® in Australia.

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Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study

Abstract: Abstract Objective The authors aimed to understand how physical therapists used practice guidelines to manage patients with knee osteoarthritis (OA) in Australia. Methods This study used a concurrent triangulation mixed-method approach to explore how physical ther… Show more

Cited by 18 publications

References 24 publications

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study

Program Evaluation of GLA:D® Australia: Physiotherapist Training Outcomes and Effectiveness of Implementation for People With Knee Osteoarthritis

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