FACTORS INFLUENCING INDIAN PHYSIOTHERAPISTS’ TREATMENT CHOICE IN THE MANAGEMENT OF OSTEOARTHRITIS KNEE: A QUALITATIVE STUDY

H. Patel¹, S. Shah¹, V Prakash¹

¹Charotar University of Science and Technology, Ashok and Rita Patel Institute of Physiotherapy, Anand, Gujarat, India

Background: Various evidence-based guidelines have recommended first line of intervention for managing knee osteoarthritis(OA) as patient education, self-management strategies, exercise in form of strengthening and aerobic and weight loss. Yet, several previous studies suggest these interventions were not routinely implemented in clinical practice. Research on what might help or hinder physiotherapists in delivering evidence recommended care in the management of knee OA is limited. Additionally, implementing evidence within the health care delivery systems of low- and middle-income countries may pose unique context-specific challenges.

Purpose: To explore physiotherapists’ perceptions about factors influencing their choice of interventions in the management of knee OA.

Methods: We conducted qualitative descriptive study based on phenomenological approach. We interviewed fifteen Indian physiotherapists working in various physiotherapy settings (Academic, private clinics and hospitals). Individual face-to-face semi-structured interviews were conducted via video conferencing platform (Zoom). Data were transcribed verbatim and initially analyzed using thematic content analysis and later, mapped to Theoretical domain framework (TDF).

Results: We identified four general themes from the data relating to physiotherapists’ barriers and facilitators in implementing evidence recommended care in managing patients with OA knee: 1) Physiotherapist’s beliefs about strengthening exercise and its benefits in OA knee 2) Knowledge about current evidence 3) Influence of patient perceptions, demands and preferences 4) Setting and organization-specific challenges. Seven TDF domains were mapped to the barriers identified by physiotherapists. Participants had low awareness about evidence recommended care in OA knee management. Contrasting views about the value of strengthening exercises were expressed. Wide variations in the perceptions of what constitute strengthening exercise and when to administer were also identified. Physiotherapists perceived patient preferences for passive interventions and a lack of infrastructure to deliver structured strengthening and aerobic exercises as one of the significant factors that determined choice of their interventions. These factors can act as a barrier or facilitator (enablers) for choosing the evidence recommended interventions in the management of knee OA within Indian clinical settings.

Conclusions: The findings highlight that physiotherapists choice of interventions in OA knee management was influenced by a complex interaction between physiotherapists beliefs about strengthening exercises and it benefit, patients’ preferences for passive interventions and lack of infrastructure in the clinical settings. These factors need to be accounted in developing behavior change interventions targeting clinical practice behaviors of Indian physiotherapists.

Implications: This study has given us an insight into factors that influence the implementation of recommended intervention for osteoarthritis knee. The study results can guide future development of knowledge translation interventions to improve Indian physiotherapists’ adherence to evidence recommended interventions in the management of Knee OA.

Funding acknowledgements: Funded by the post graduate student research fund from Charotar University of Science and Technology (CHARUSAT), Anand, Gujarat, India

Keywords:
Osteoarthritis knee
Knowledge translation
Behavior change

Topics:
Pain & pain management
Musculoskeletal: lower limb
Professional issues

Did this work require ethics approval? Yes

Institution: Charotar University of Science and Technology (CHARUSAT)

Committee: Institutional ethics committee of Charotar university of science and technology

Ethics number: IEC/CHARUSAT/21/33