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Pile R1, Croft A1, Tang C1,2
1Western Health, Physiotherapy, Footscray, VIC, Australia, 2Western Sydney University, Physiotherapy, Penrith, NSW, Australia
Background: Physical therapy has been shown to be effective in reducing pain and improving physical function among people with knee osteoarthritis (OA). While there are currently numerous international and national clinical guidelines for assessment and management of knee OA, the level of adherence among physical therapists to clinical guidelines remains to be poor. An in-depth understanding of physical therapist's perception of the guidelines and barriers to adherence of guidelines need to be established in order to improve the translation of evidence into clinical practice.
Purpose: The primary aim of this study is to explore the lived experiences of physical therapists assessing and treating people with knee OA. Secondary aim of the study is to identify the barriers to adherence of guidelines.
Methods: This qualitative study used a phenomenologically-oriented approach to explore the experiences of participants who were physical therapists employed within a metropolitan tertiary hospital in Melbourne, Australia. All participants were registered physical therapists who had current clinical experiences in management of knee OA within the outpatient hospital setting . A semi-structured interview was conducted with each participant via a face-to-face or phone interview. Data was thematically analysed by two investigators using an inductive approach.
Results: Eighteen participants were included in this study. Participants had an average of 9.3 years (SD=9.4) of clinical experience, with seven of the 18 participants completing further post graduate physical therapy studies. Improving range of movement and muscle strength were the focus of physical therapy when treating people with knee OA was identified as the main theme. While participants were highly confident in incorporating the guideline recommendations related to these two aspects into their clinical practice, they had reduced confidence in prescription of aerobic exercises, weight and pain management for people with knee OA. This led to identification of two further sub-themes. Firstly, despite the recognition of the importance of incorporating aerobic exercises, weight and pain management as part of the treatment, participants had reduced knowledge in these areas and often questioned if these areas fell within their scope of practice. Secondly, the fear of causing more pain for their clients often hindered the participant's ability to prescribe exercises at the recommended intensity and duration according to the clinical guidelines.
Conclusion(s): The findings from this study highlights that physical therapy management for people with knee OA tend to revolve around improving knee range of movement and lower limb strength. It is debatable if the scope of physical therapy should include prescription of aerobic exercises, weight and pain management. Further studies evaluating the effect of providing additional training in the aforementioned areas for physical therapists on optimising physical therapy management for people with knee OA are required. Moreover, the scope of practice for physical therapists in knee OA management needs further definition.
Implications: Physical therapists are highly equipped in improving the range of movement and muscle strength for people with knee OA. However, further up-skilling may be required in areas of prescription of aerobic exercises, weight and pain management to optimise the effectiveness of physical therapy for people with knee OA.
Keywords: Knee Osteoarthritis, Physical therapy, Perception
Funding acknowledgements: This study has not received any funding.
Purpose: The primary aim of this study is to explore the lived experiences of physical therapists assessing and treating people with knee OA. Secondary aim of the study is to identify the barriers to adherence of guidelines.
Methods: This qualitative study used a phenomenologically-oriented approach to explore the experiences of participants who were physical therapists employed within a metropolitan tertiary hospital in Melbourne, Australia. All participants were registered physical therapists who had current clinical experiences in management of knee OA within the outpatient hospital setting . A semi-structured interview was conducted with each participant via a face-to-face or phone interview. Data was thematically analysed by two investigators using an inductive approach.
Results: Eighteen participants were included in this study. Participants had an average of 9.3 years (SD=9.4) of clinical experience, with seven of the 18 participants completing further post graduate physical therapy studies. Improving range of movement and muscle strength were the focus of physical therapy when treating people with knee OA was identified as the main theme. While participants were highly confident in incorporating the guideline recommendations related to these two aspects into their clinical practice, they had reduced confidence in prescription of aerobic exercises, weight and pain management for people with knee OA. This led to identification of two further sub-themes. Firstly, despite the recognition of the importance of incorporating aerobic exercises, weight and pain management as part of the treatment, participants had reduced knowledge in these areas and often questioned if these areas fell within their scope of practice. Secondly, the fear of causing more pain for their clients often hindered the participant's ability to prescribe exercises at the recommended intensity and duration according to the clinical guidelines.
Conclusion(s): The findings from this study highlights that physical therapy management for people with knee OA tend to revolve around improving knee range of movement and lower limb strength. It is debatable if the scope of physical therapy should include prescription of aerobic exercises, weight and pain management. Further studies evaluating the effect of providing additional training in the aforementioned areas for physical therapists on optimising physical therapy management for people with knee OA are required. Moreover, the scope of practice for physical therapists in knee OA management needs further definition.
Implications: Physical therapists are highly equipped in improving the range of movement and muscle strength for people with knee OA. However, further up-skilling may be required in areas of prescription of aerobic exercises, weight and pain management to optimise the effectiveness of physical therapy for people with knee OA.
Keywords: Knee Osteoarthritis, Physical therapy, Perception
Funding acknowledgements: This study has not received any funding.
Topic: Musculoskeletal: lower limb; Disability & rehabilitation; Research methodology & knowledge translation
Ethics approval required: Yes
Institution: Western Health
Ethics committee: Western Health Low Risk Human Research Ethics Panel
Ethics number: QA2017.88
All authors, affiliations and abstracts have been published as submitted.
