Direct access to physiotherapist in primary healthcare for patients with knee osteoarthritis – an interview study with patient perspective

To explore expectations and experiences of patients who have consulted a physiotherapist in primary healthcare for initial assessment and treatment of KOA, as well as exploring if this initial contact affected patients' perceived health status and views of future self-management.

Fifteen participants seeking care for suspected KOA at five rehabilitation centres in Swedish primary healthcare were interviewed. An inductive approach was used. Data material was analysed using qualitative content analysis according to Graneheim and Lundman, aiming at identifying patterns in order to describe the participants’ perspectives and experiences of direct access to physiotherapists in primary healthcare.

Preliminary results of the analysis resulted in one overarching theme: “I want to be physically active as long as I live”, and three main categories: “I believe it is common knowledge that you should go to a physiotherapist first”, “I want to know how to get back to my usual physical activities” and “It’s up to me to get better”. When participants sought primary healthcare for their knee pain, they felt it natural to have direct access to a physiotherapist. The participants wanted the freedom to move freely and without pain and to return to the physical activities they used to perform  before the knee pain. Patients who received individualized exercise programs and patient education from a physiotherapist as part of their core treatment experienced that they had knowledge about self-management of KOA. 

Participants saw the physiotherapist as a natural first option. Exercise was believed to be the primary symptom-relieving treatment option, and self-management was perceived as essential. The participants were hopeful that they would be able to resume their usual physical activity. 

Preliminary results indicate that direct access to physiotherapists seems to be acceptable among patients with KOA. This healthcare process could contribute to faster access to evidence-based care for patients with KOA and may increase the accessibility to a physician for patients with more severe disorders. Patients with KOA expected an exercise program for self-management, and the core treatment, comprising patient education and individual exercise program delivered by physiotherapists, helped patients with KOA to self-manage their symptoms.