Allison K1, Delaney C2, Setchell J3, Egerton T1, Holden M4, Quicke J4, Bennell K1
1University of Melbourne, Department of Physiotherapy, Melbourne, Australia, 2University of Melbourne, Department of Medical Education, Melbourne, Australia, 3The University of Queensland, Brisbane, Australia, 4Keele University, Research Institute for Primary Care & Health Sciences, Staffordshire, United Kingdom
Background: Knee osteoarthritis (OA) is a leading cause of disability globally. International guidelines include exercise and, if relevant, weight loss as pillars of treatment. Physiotherapists are at the forefront of OA management and are arguably well-placed to communicate with patients about weight. However, weight-loss is complex and requires a bio-psychosocial approach incorporating health behavior change skills. How patients perceive, and the extent to which they trust their health care practitioner influences whether they adopt suggested health behaviours. While physiotherapists are broadly seen to be trustworthy professionals, little is known about how patients perceive physiotherapists' possible role in weight management. Understanding patient perspectives is needed to create and deliver treatment paradigms that are acceptable to patients with knee OA.
Purpose: To explore patient perspectives regarding the role of physiotherapists in weight management in knee OA.
Methods: A qualitative semi-structured telephone interview study based on the paradigm of interprevitism. Participants included 13 purposively-sampled, individuals with knee OA (based on the National Institute for Health and Care Excellence diagnostic criteria) who were overweight or obese by body mass index. Each participated in a telephone interview exploring their perspectives regarding the potential role of physiotherapists in weight management. Data were transcribed and analyzed using a thematic approach.
Results: Three main themes and associated subthemes (italics) were identified.
(1) Complexity of weight in knee OA
Most participants discussed the 'influence of weight on knee OA' in simple causal terms related to their OA experience. However, all participants spoke extensively about the personal and complex nature of weight including psychological, motivational and behavioral elements ('weight management is complex').
(2) Special skill set required by clinicians for weight management
Related to the complexity of weight, the need for a practitioner with highly developed expertise to support weight loss was highlighted. The associated sub-themes were: 'additional expertise', 'personal rapport' and 'whole person treatment', highlighting the importance of the therapist-patient relationship.
(3) Ambivalence towards physiotherapists' role in weight management
There was a dominant theme in the data that patients were ambivalent about physiotherapists as providers of weight management treatment. Patients situated physiotherapists within a hierarchy of authority, whereby their role was 'part of a General Practitioner-led team', with a predominant 'exercise prescription role'. This positioning was related in part to being 'unaware of physical therapy scope of practice' and expressing 'uncertainty in the skill set of physiotherapists'.
Conclusion(s): Although participants were open to physiotherapists taking on a weight management role within a multidisciplinary team, they were uncertain about physiotherapists' skills to address this complex issue. Future work is required to investigate whether physiotherapists can deliver weight management interventions in a manner which is acceptable to patients.
Implications: The findings highlight the importance of physiotherapists' engaging in meaningful dialogues with patients to better understand their experiences and preferences to establish if and how to integrate weight management discussions in the treatment plan for their knee OA. Development of weight training resources for physiotherapists should include a focus on communication skills. Any change to physiotherapists role in weight management should be evaluated for patient acceptability and effectiveness.
Keywords: Obesity, scope of practice, osteoarthritis
Funding acknowledgements: This work was supported by a University of Melbourne School of Health Sciences Early Career Seeding Grant.
Purpose: To explore patient perspectives regarding the role of physiotherapists in weight management in knee OA.
Methods: A qualitative semi-structured telephone interview study based on the paradigm of interprevitism. Participants included 13 purposively-sampled, individuals with knee OA (based on the National Institute for Health and Care Excellence diagnostic criteria) who were overweight or obese by body mass index. Each participated in a telephone interview exploring their perspectives regarding the potential role of physiotherapists in weight management. Data were transcribed and analyzed using a thematic approach.
Results: Three main themes and associated subthemes (italics) were identified.
(1) Complexity of weight in knee OA
Most participants discussed the 'influence of weight on knee OA' in simple causal terms related to their OA experience. However, all participants spoke extensively about the personal and complex nature of weight including psychological, motivational and behavioral elements ('weight management is complex').
(2) Special skill set required by clinicians for weight management
Related to the complexity of weight, the need for a practitioner with highly developed expertise to support weight loss was highlighted. The associated sub-themes were: 'additional expertise', 'personal rapport' and 'whole person treatment', highlighting the importance of the therapist-patient relationship.
(3) Ambivalence towards physiotherapists' role in weight management
There was a dominant theme in the data that patients were ambivalent about physiotherapists as providers of weight management treatment. Patients situated physiotherapists within a hierarchy of authority, whereby their role was 'part of a General Practitioner-led team', with a predominant 'exercise prescription role'. This positioning was related in part to being 'unaware of physical therapy scope of practice' and expressing 'uncertainty in the skill set of physiotherapists'.
Conclusion(s): Although participants were open to physiotherapists taking on a weight management role within a multidisciplinary team, they were uncertain about physiotherapists' skills to address this complex issue. Future work is required to investigate whether physiotherapists can deliver weight management interventions in a manner which is acceptable to patients.
Implications: The findings highlight the importance of physiotherapists' engaging in meaningful dialogues with patients to better understand their experiences and preferences to establish if and how to integrate weight management discussions in the treatment plan for their knee OA. Development of weight training resources for physiotherapists should include a focus on communication skills. Any change to physiotherapists role in weight management should be evaluated for patient acceptability and effectiveness.
Keywords: Obesity, scope of practice, osteoarthritis
Funding acknowledgements: This work was supported by a University of Melbourne School of Health Sciences Early Career Seeding Grant.
Topic: Health promotion & wellbeing/healthy ageing; Health promotion & wellbeing/healthy ageing; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: University of Melbourne
Ethics committee: Psychology Health and Applied Sciences Human Ethics Sub-Committee
Ethics number: HREC 1748917.1
All authors, affiliations and abstracts have been published as submitted.
