Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists

Barton, Christian J; Pazzinatto, Marcella Ferraz; Crossley, Kay M; Dundules, K.; Lannin, Natasha A.; Francis, Matt; Wallis, Jason; Kemp, Joanne L

doi:10.1016/j.bjpt.2021.08.001

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…The findings regarding clinical practice are comparable to recent findings from Italy [ 19 ], Australia [ 40 ], Canada [ 18 ], Belgium [ 20 ] and the UK [ 24 ], showing that the majority of therapists provide or advise exercise therapy, education and/or self-management advice for patients with hip and knee OA. However, although weight management for obese or overweight individuals with OA (especially for knee OA) is also considered a first-line treatment in CPGs, German physiotherapists are least likely to address this aspect as part of patient education.…”

Section: Discussionsupporting

confidence: 82%

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Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Bahns

Kopkow

2023

BMC Musculoskelet Disord

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Background Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use. Methods A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen. Results In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline. Conclusions In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice. Trial registration German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

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Section: Discussionsupporting

confidence: 82%

“…In addition, some physiotherapists may consider weight management to be outside their clinical scope and physiotherapy skills. Findings from other studies have shown that physiotherapists feel they lack knowledge and confidence to appropriately initiate and support weight loss [ 40 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Bahns

Kopkow

2023

BMC Musculoskelet Disord

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“…A recent survey of over 1000 Australian physical therapists about their perceived capability to provide first-line care to adults with knee OA showed that approximately 25% did not have the skills, knowledge, or confidence to provide guideline-recommended education and exercise. 3 Similarly, this was found in a qualitative study of primary care physicians, as they did not feel prepared to prescribe exercises to adults with knee OA. 4 Hence, the HCP resource tables 1 are a practical one-stop shop to help fill the gap in knowledge for treating OA.…”

Section: White and Jakiela Replymentioning

confidence: 81%

White and Jakiela reply

White,

Jakiela

2023

J Rheumatol

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We would like to thank Dr. Fallon and coauthors1for their thoughtful comments on our review,2and we completely agree with all the points made. We regret our omission of the important work the Centers for Disease Control and Prevention, the Osteoarthritis Action Alliance, the Arthritis Foundation, and others perform on a daily basis to ease the burden of osteoarthritis (OA) for the millions of adults with this chronic long-term disease.

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Use of Implementation Strategies to Promote the Uptake of Knee Osteoarthritis Practice Guidelines and Improve Patient Outcomes: A Systematic Review

Ramirez,

Fillipo,

Allen

et al. 2024

Arthritis Care & Research

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OBJECTIVETranslation of knee osteoarthritis (KOA) clinical practice guidelines (CPGs) to practice remains suboptimal. The primary purpose of this systematic review was to describe the use of implementation strategies to promote KOA CPG recommended care.METHODSMEDLINE (via PubMed), Embase, CINAHL, and Web of Science were searched from inception to February 23, 2023, and subsequently updated and expanded on January 16, 2024. Implementation strategies were mapped per the Expert Recommendations for Implementing Change taxonomy. Risk of bias (RoB) was assessed using the Cochrane Effective Practice and Organization of Care criteria. The review was registered prospectively (CRD42023402383).RESULTSNineteen studies were included in the final review. All (100% (n=4) studies that included the domains of provide interactive assistance, train and educate stakeholders (89%(n=18)), engage consumers (87%(n=15)) and support clinicians (79%(n=14)) reported change to provider adherence. Studies that reported a change to disability included train and educate stakeholders, engage consumers and adapt and tailor to context. Studies that used train and educate stakeholders, engage consumers, and support clinicians reported a change in pain and quality of life. Most studies had a low to moderate RoB.CONCLUSIONImplementation strategies have the potential to impact clinician uptake of CPG's and patient reported outcomes (PROs). The implementation context, using an active learning strategy with a patient partner, restructuring funding models, and integrating taxonomies to tailor multifaceted strategies should be prioritized. Further experimental research is recommended to determine which implementation strategies are most effective.image

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Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists

Cited by 7 publications

References 38 publications

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

White and Jakiela reply

Use of Implementation Strategies to Promote the Uptake of Knee Osteoarthritis Practice Guidelines and Improve Patient Outcomes: A Systematic Review

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