This study aimed to evaluate the extent to which physiotherapists meet the latest evidence in the treatment of different patient cases (with comorbidities, and different key symptoms) using the recommendations of the OARSI guideline for the non-surgical management of knee, hip, and polyarticular osteoarthritis.
A cross-sectional study was conducted using a vignette-based online survey. Physiotherapists working in outpatient practices in Germany were recruited through press releases, newsletters, email campaigns, and social media. Eligible participants were required to hold a physiotherapy degree, and have treated patients with hip or knee osteoarthritis in the past year. The survey included four case vignettes depicting osteoarthritis scenarios with or without comorbidities, followed by a list of all treatment modalities mentioned in the OARSI guideline (recommended and not recommended ones). Participants evaluated, per case, for each modality if they would apply it (yes/no). Correct selections matched high-evidence recommendations from the guideline. A total quality score was calculated based on the number of correct selections over all vignettes. A general questionnaire on guideline knowledge and demographic data was also included. Descriptive statistics were used to analyse demographic characteristics and modality selections per vignette. A linear regression analysis was conducted to examine the influence of professional degree and work experience on overall quality scores. Data analysis was performed using SPSS (version 29.0) and Microsoft Excel 2016.
Of the 612 eligible physiotherapists, 335 (54.7%) completed the survey. The sample had a mean age of 35.9 ± 11.9 years and included 201 women (60%). Only 74 physiotherapists (22%) selected all recommended treatment modalities across all vignettes. The most frequently chosen modalities were structured exercise programs (96%), arthritis education (95%), self-management programs (88%), and aquatic exercise (88%). However, there was also notable selection of modalities with limited or conflicting evidence, such as massage and taping. Both work experience (p .001) and professional degree (p .001) significantly influenced overall quality scores. A total of 164 participants (49%) reported awareness of at least one osteoarthritis guideline, while 104 (31%) mentioned a specific CPG in their responses.
Physiotherapists in Germany generally selected recommended modalities for treating hip and knee osteoarthritis, but many chose for modalities with limited evidence. Higher education and less experience were associated with better quality scores. Implementing the OARSI guideline in Germany through structured protocols could help address knowledge gaps and enhance evidence-based practice.
This study highlights the critical need for targeted strategies, such as (de-)implementation protocols to improve evidence-based practice. Further, data from patient records could provide insight into real-world data. The combination of the findings can inform educational programs and ongoing professional development efforts aimed at closing the evidence-to-practice gap in German osteoarthritis management.
evidence-based practice
vignettes
