Physical Therapists’ Use of Therapeutic Exercise for Patients With Clinical Knee Osteoarthritis in the United Kingdom: In Line With Current Recommendations?

Abstract

The measure of physical therapists' current clinical practice was self-reported clinical behavior on the basis of a vignette. Although this is a valid measure of clinical behavior, in practice, physical therapists may use therapeutic exercise differently. There are disparities between physical therapists' current use of therapeutic exercise for clinical knee OA and recent recommendations. Identifying potential ways to overcome these disparities is an important step toward optimizing the outcome from therapeutic exercise for patients with clinical knee OA.

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

“…11 Therefore, researchers need to know how physical therapists actually treat people with knee osteoarthritis so that they can design representative trials and identify gaps between evidence and practice and therefore understand where changes in PT education are needed. Although previous studies have been conducted in the United Kingdom, 12,13 it is unclear how physical therapists in Florida currently treat people with knee osteoarthritis and whether they use current best evidence in their clinical decision making. The purpose of this study was, therefore, to conduct a survey to understand how physical therapists treat people with knee osteoarthritis and what drives their clinical decision making.…”

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…Our ABC knee study described usual UK physiotherapy practice and formed the basis for the BEEP trial protocol for UC. 199 …”

“…l We wanted our UC intervention to reflect UC in the UK and our national survey of physiotherapists in the UK 199 showed that only 10% of 538 responding physiotherapists used group-based treatments for knee OA patients, whereas 90% treat patients in a series of one-to-one sessions. l We wanted to ensure that, if one intervention in the trial was offered in one-to-one sessions, then all interventions should offer care similarly in one-to-one sessions so that different modes of delivery of treatment could not bias the results of the trial.…”

“…15 Key components of the first day included the primary care (clinical) diagnosis of knee OA, the central role of exercise as a 'core' treatment for older adults with knee pain, current physiotherapy practice for knee pain in older adults and OA, and the comparison between current practice and guidelines. 15,32,199,220 The second and third days were attended by physiotherapists delivering the ITE and TEA interventions and focused on how to improve outcomes from exercise for older adults with knee pain. The importance of individualisation, progression and supervision of lower limb exercise was highlighted from both physiological and psychological perspectives.…”

“…Previous studies have shown that older adults with knee pain and the physiotherapists involved in their treatment have concerns about the safety of exercise, do not consider exercise as an effective treatment for pain, do not focus on issues of exercise adherence and fail to translate traditional lower limb-focused exercise into sustainable lifestyle changes. 199 Our previous Treatment Options for Pain in the Knee (TOPIK) trial 34 tested two primary care services for knee pain in older adults, an enhanced pharmacy review and community physiotherapy (based on advice and exercise) and compared these with usual GP-led care and advice. At 3 months, pain reduction was three times greater and functional improvement four times greater in those patients randomised to physiotherapy than to GP-led care and advice, and more people obtained clinically meaningful changes than those in the other two groups.…”