Quicke J.1, Rimmer Y.2, Beasley J.2, White N.2, Stevenson K.3, Duffy H.1, Evans N.1, Dziedzic K.1
1Keele University, Primary Care and Health Sciences, Staffordshire, United Kingdom, 2National Health Service, Shropshire, United Kingdom, 3National Health Service, Staffordshire, United Kingdom
Background: Joint pain attributed to osteoarthritis (OA) is a leading cause of disability worldwide. In the UK, with an ageing population and rising levels of obesity, the burden of OA on both the individual and society is increasing. The UK National Institute for Health and Care Excellence (NICE) guidelines for OA recommend core treatments of condition-specific education and advice, exercise (such as aerobic and strengthening exercise), and weight loss management (for those who are overweight). However, not all physiotherapists are currently delivering these core treatments and some are uncertain regarding the benefits of exercise for this patient group. As a result, many people with OA are not receiving optimum care.
An existing UK implementation study- JIGSAW (Joint Implementation of Guidelines for oSteoArthritis in the West Midlands) targeted and trained family physicians and practice nurses to implement NICE OA core treatments in primary care settings and support patients with OA self-management. Focussed implementation strategies are also required to support physiotherapists in delivering evidence based OA care. This implementation work expands JIGSAW by targeting physiotherapists to deliver best-practice OA care.
An existing UK implementation study- JIGSAW (Joint Implementation of Guidelines for oSteoArthritis in the West Midlands) targeted and trained family physicians and practice nurses to implement NICE OA core treatments in primary care settings and support patients with OA self-management. Focussed implementation strategies are also required to support physiotherapists in delivering evidence based OA care. This implementation work expands JIGSAW by targeting physiotherapists to deliver best-practice OA care.
Purpose: To address unmet needs and improve the quality of care for patients with OA, and support physiotherapists in delivering NICE OA quality standards in the West Midlands region of the UK.
Methods: A physiotherapist Community of Practice was formed supported by academics from centres of excellence in primary care and physiotherapy research. A range of local OA clinical champions including Consultant and Extended Scope Practitioners, research facilitators, service commissioners and patient representatives were invited to shape the physiotherapy model of care. A physiotherapy OA workshop day was designed, advertised and delivered covering NICE core interventions including communication and explanations of OA, myth busting around OA, supported goal setting, individualised exercise and physical activity, advice regarding diet, and medication information. Guest lectures were delivered at local services covering OA epidemiology, NICE guidelines for OA (including talks on exercise, weight loss and medication), primary care management of OA and physiotherapy management of OA. Local family physician practices were negotiated with to deliver physiotherapy led OA best practice services.
Results: A new primary care OA specialist service has been set up in a family physician practice by a physiotherapy OA champion, 19 physiotherapists have undertaken a one day workshop covering OA education and best practice. Three existing physiotherapy primary care services have embedded NICE quality standards into their services. Local OA stakeholders including physiotherapists, patient representatives, health professionals and service commissioners have been engaged with via local networking and a series of OA lectures.
Conclusion(s): An OA Community of Practice, including a broad range of physiotherapy stakeholders, has identified and facilitated clinical and service development to address the unmet needs of adults with OA. A multi-level engagement strategy has supported local physiotherapists in implementing national guidelines for OA. Future service evaluation of new and existing services will provide data on quality of care.
Implications: Similar Communities of Practice could be set up to support the implementation of clinical guidelines in other areas of physiotherapy practice.
Funding acknowledgements: JQ is funded by the NIHR. KD is funded by NIHR, West Midlands Academic Health Science Network and EIT Health.
Topic: Research methodology & knowledge translation
Ethics approval: Ethics approval was not required for this implementation work.
All authors, affiliations and abstracts have been published as submitted.
