Utilising the perspectives of patients with lower-limb osteoarthritis on prescribed physical activity to develop a theoretically informed physiotherapy intervention

Abstract

Background Lower-limb osteoarthritis (OA) causes high levels of pain and disability. Physiotherapists are the primary healthcare provider of non-pharmacological treatments, and incorporate strategies to optimise physical activity (PA) to aid patients with lower-limb OA to moderate their clinical symptoms. However, patients with lower-limb OA have low adherence to PA recommendations both during treatment and after discharge. This study aimed to use knowledge of identified barriers and facilitators to physiotherapy prescribed PA (during treatment and post-discharge) to develop a theoretically informed intervention to optimise adherence to PA for patients with lower-limb OA during treatment and post-discharge. Methods 1) A purposive sample of 13 patients with lower-limb OA participated in semi-structured interviews following physiotherapy treatment. Inductive analysis identified themes/subthemes reflecting barriers and facilitators to physiotherapist prescribed PA, which were organised deductively according to personal factors, treatment and post-discharge phases. 2) Themes/subthemes were mapped onto the theoretical domains framework (TDF). 3) Behaviour change techniques (BCTs) were coded from the key identified domains and a theoretically informed physiotherapy intervention addressing barriers and using facilitators, was developed. Results Themes of patient confidence, mind-set, motivation, OA symptoms and PA experiences were primary personal factors that influenced PA adherence; with the TDF domain ‘Beliefs about capabilities’ most important to target. During treatment, the theme of routine formation was the major driver of personal factors; and primarily influenced by developing a positive physiotherapist-patient relationship. Post-discharge, physical factors, psychosocial factors and ongoing access to resources were important themes influencing PA maintenance. ‘Environmental context and resources’ and ‘social influences’ emerged as the key TDF domains to target during treatment and post-discharge. The proposed theoretically informed intervention included 26 BCTs delivered across conceptual phases of adoption, routine formation, and maintenance. Conclusion A theoretically informed physiotherapy intervention was proposed to optimise PA adherence in patients with lower-limb OA. The included BCTs primarily target patients’ perceived beliefs about their capabilities, by developing a PA routine during treatment and facilitating appropriate psychosocial support and access to resources for PA maintenance post-discharge. The feasibility of delivering the intervention in clinical practice will now be evaluated.

Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

“…While not all HCPs were expected to assume the same level of responsibility for musculoskeletal care, diabetes HCPs typically see their patients at frequent intervals and thus are in an important position to evaluate and direct care for issues that come up that influence T2DM self-management. Our sample size was similar to other studies that have assessed other HCP behaviours using the TDF [ [41] , [42] , [43] ]. Limitations of this study include less specificity of the target behaviour than in other TDF studies, and thus some important nuances to aspects of assessing and treating OA may have been missed.…”

Understanding the behavioural determinants of seeking and engaging in care for knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the theoretical domains framework

“…Participants described the importance of having others around to support their health behaviours, which included OA management. Other qualitative work has shown social influences to be an important determinant of adherence to physiotherapist-prescribed physical activity for OA [ 36 ]. Harnessing peer support, such as peer support groups and/or peer health ambassadors, may be an effective additional strategy to improve complex health behaviours required in disease management [ 37 ].…”

Peoples' beliefs about their chronic hip pain and its care: a systematic review of qualitative studies. “I'm just getting old and breaking down”

“…59,114,115,120 Others avoided exercise because they were confused or unsure whether they were doing the "right thing"-people were unsure whether exercise for hip pain is beneficial, whether it is ok to experience hip pain during exercise, or whether some exercises are "bad" for hips. 59,114,115,120 Finally, people who feared falling or were embarrassed about their walking ability also avoided activities, such as walking, sport, and gardening. 82,84,96,119,120 Except for one example, 42 it seemed that avoiding or modifying activities and resting failed to provide adequate pain relief, reinforcing peoples' frustration and distress.…”

“…People typically wanted to avoid using medications because they were concerned about addiction, tolerance, and adverse effects, such as suppressing pain's "normal" function. 14,83,84,96,106,114,120 Some people with hip osteoarthritis were also reluctant to seek or use general practice care. They were dissatisfied with past general practice care, believed that general practitioners lacked condition expertise and effective treatments, and perceived that osteoarthritis was not a healthcare priority relative to other conditions.…”