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Allison K1, Setchell J2, Delaney C3, Egerton T4, Bennell K4
1The University of Melbourne, Department of Physiotherapy, Melbourne, Australia, 2University of Queensland, Brisbane, Australia, 3University of Melbourne, Department of Medical Education, Melbourne, Australia, 4University of Melbourne, Department of Physiotherapy, Melbourne, Australia
Background: The burden of obesity is increasing globally with a subsequent increase in the requisite scope of healthcare practitioner skills in weight management. Obesity is associated with many musculoskeletal conditions including knee osteoarthritis (OA). International guidelines for treatment of knee OA include exercise, and for patients who are overweight, weight-loss. Given that physiotherapists are at the front-line of OA management, there is a need for physiotherapists to effectively communicate about weight. It is unknown whether or how Australian physiotherapists are integrating weight-loss into the management of knee OA. Understanding current physiotherapy practice and physiotherapists' attitudes to their role in weight management will help inform interventions to optimize physiotherapy management of knee OA.
Purpose: To explore physiotherapists attitudes and perceptions towards their current and potential future role in weight management for people with knee OA.
Methods: The study design was based on the qualitative research paradigm of interpretivism. Thirteen physiotherapists were purposively recruited from Australia for age, gender, geographic location and practice type to participate in a qualitative semi-structured telephone interview exploring their attitudes towards their role in weight management. Data were recorded, transcribed and thematically analysed by two researchers for themes and associated subthemes. To enhance credibility and trustworthiness of the results all themes were reviewed by two experienced qualitative researchers, who confirmed the analysis was credible, and themes rooted in the data.
Results: The analysis identified three major themes, with supporting subthemes (italics):
(1) Role in weight-loss
All participants were confident that physiotherapists have a role in addressing overweight/obesity during knee OA management. This assuredness was derived from a 'Professional responsibility' to address weight in line with evidence-based guidelines, confidence in the 'Physical therapy paradigm', and social opportunity afforded by the 'Professional standing' of physiotherapists.
(2) Uncertainty about how to integrate weight-loss into management
Despite being confident they had a role in weight-loss, physiotherapists were uncertain how to implement this role due to 'Lack of knowledge' and perceived 'Surface level competence' in weight discussions. To deal with uncertainty, participants expressed a 'Preference for simple solutions'.
(3) Treading cautiously in weight-loss
Irrespective of whether participants felt they had the skills to engage in weight management, they felt the need to tread cautiously in this role. This was related to beliefs about 'Weight and identity' and 'Personal comfort' engaging in weight conversations and fear of 'Threatening patient rapport'.
Conclusion(s): Australian physiotherapists believe weight management falls within their role in knee OA treatment, however do not feel equipped to fulfill this role. Findings highlight the need for greater education and support for physiotherapists to be able to help patients with knee OA who are overweight to lose weight. Research is needed to understand whether physiotherapists can be up-skilled appropriately, and to understand patient perspectives regarding the acceptability of physiotherapists addressing weight.
Implications: This study highlights the need for training opportunities to develop physiotherapists' skills and confidence in weight management, including consideration of the potential harms and benefits of this aspect of care. Any change to physiotherapists' role in weight management should be evaluated for acceptability and effectiveness.
Keywords: Obesity, osteoarthritis, physiotherapy role
Funding acknowledgements: This work was supported by a University of Melbourne School of Health Sciences Early Career Seeding Grant.
Purpose: To explore physiotherapists attitudes and perceptions towards their current and potential future role in weight management for people with knee OA.
Methods: The study design was based on the qualitative research paradigm of interpretivism. Thirteen physiotherapists were purposively recruited from Australia for age, gender, geographic location and practice type to participate in a qualitative semi-structured telephone interview exploring their attitudes towards their role in weight management. Data were recorded, transcribed and thematically analysed by two researchers for themes and associated subthemes. To enhance credibility and trustworthiness of the results all themes were reviewed by two experienced qualitative researchers, who confirmed the analysis was credible, and themes rooted in the data.
Results: The analysis identified three major themes, with supporting subthemes (italics):
(1) Role in weight-loss
All participants were confident that physiotherapists have a role in addressing overweight/obesity during knee OA management. This assuredness was derived from a 'Professional responsibility' to address weight in line with evidence-based guidelines, confidence in the 'Physical therapy paradigm', and social opportunity afforded by the 'Professional standing' of physiotherapists.
(2) Uncertainty about how to integrate weight-loss into management
Despite being confident they had a role in weight-loss, physiotherapists were uncertain how to implement this role due to 'Lack of knowledge' and perceived 'Surface level competence' in weight discussions. To deal with uncertainty, participants expressed a 'Preference for simple solutions'.
(3) Treading cautiously in weight-loss
Irrespective of whether participants felt they had the skills to engage in weight management, they felt the need to tread cautiously in this role. This was related to beliefs about 'Weight and identity' and 'Personal comfort' engaging in weight conversations and fear of 'Threatening patient rapport'.
Conclusion(s): Australian physiotherapists believe weight management falls within their role in knee OA treatment, however do not feel equipped to fulfill this role. Findings highlight the need for greater education and support for physiotherapists to be able to help patients with knee OA who are overweight to lose weight. Research is needed to understand whether physiotherapists can be up-skilled appropriately, and to understand patient perspectives regarding the acceptability of physiotherapists addressing weight.
Implications: This study highlights the need for training opportunities to develop physiotherapists' skills and confidence in weight management, including consideration of the potential harms and benefits of this aspect of care. Any change to physiotherapists' role in weight management should be evaluated for acceptability and effectiveness.
Keywords: Obesity, osteoarthritis, physiotherapy role
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; Musculoskeletal: lower limb; Professional issues
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.
