To understand physiotherapists’ and orthopedic surgeons’ knee osteoarthritis management practices in Nepal and determine if they are consistent with internationally recommended clinical practice guidelines.
Physiotherapists and orthopedic surgeons who were registered with their respective professional councils, and actively involved in the treatment of knee osteoarthritis were invited to complete two separate surveys. The survey questionnaires were designed to capture specialty specific treatment practices and were pre-tested before finalizing. The recommended core treatments for osteoarthritis are exercise, education for self-management, and weight management. Questions about non-recommended treatments, such as opioid use and arthroscopy, were directed only to orthopedic surgeons. Participants rated their treatment practices using a 5-point Likert scale: always, mostly, sometime, rarely, and never. Awareness of clinical practice guidelines was also recorded. To ensure high response rates, both online and pen-and-paper survey methods were offered. Participants who rated ‘always’ or ‘mostly’ for guideline-recommended core treatments and ‘rarely’ or ‘never’ for non-recommended treatments were classified as guideline-concordant.
A total of 145 physiotherapists (50% female) and 85 orthopedic surgeons (1% female) participated. Among physiotherapists, 98% were guideline-concordant for exercise recommendations, 70% for self-management, and 74% for weight management. Among orthopedic surgeons, 100% were guideline-concordant for referrals to physiotherapy for exercises, 59% for self-management, and 99% for weight management. For the use of opioids, 55% were guideline- concordant and 68% for arthroscopy. Only 30% physiotherapists and 45% orthopedic surgeons were aware of knee osteoarthritis clinical practice guidelines.
A high percentage of physiotherapists and orthopedic surgeons in Nepal were classified as ‘guideline-concordant’ in exercise and advice for weight management for knee osteoarthritis. However, the lower percentage observed in self-management practices suggests that there is still room for improvement in adherence to knee osteoarthritis clinical practice guidelines. The greatest variations from guideline-concordant care were seen in the use of opioids and arthroscopic surgery indicating an urgent need for strategies to support changes in clinical practice.
Continued professional activities that include evidence-based OA care including clinical practice guidelines may improve the uptake of evidence-based interventions and avoidance of non-evidence-based interventions. Changes at multiple levels—clinician, institutional, and systemic—are needed to improve outcomes for knee osteoarthritis in Nepal.
orthopedic
physiotherapy
