Patient experiences with physiotherapy for knee osteoarthritis in Australia-a qualitative study

Pek Ling Teo, Kim L Bennell, Belinda Lawford, T Egerton, Krysia Dziedzic, Rana S Hinman, Pek Ling Teo, Kim L Bennell, Belinda Lawford, T Egerton, Krysia Dziedzic, Rana S Hinman

Abstract

Objective: Physiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA.

Design: Qualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard.

Setting: Participants were recruited from around Australia via Facebook and our research volunteer database.

Participants: Interviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee.

Results: Six themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery.

Conclusion: Patients' experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.

Keywords: adult orthopaedics; musculoskeletal disorders; qualitative research.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. NICE . Clinical guideline: osteoarthritis care and management in adults. National Institute for Health and Care Excellene, 2014.
    1. Bannuru RR, Osani MC, Vaysbrot EE, et al. . OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019;27:1578–89. 10.1016/j.joca.2019.06.011
    1. Kolasinski SL, Neogi T, Hochberg MC, et al. . 2019 American College of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol 2020;72:220–33. 10.1002/art.41142
    1. Australian Institue of Health and Welfare . Use of health services for arthritis and osteoporosis. Canberra, 2010.
    1. Papandony MC, Chou L, Seneviwickrama M, et al. . Patients’ perceived health service needs for osteoarthritis (OA) care: a scoping systematic review. Osteoarthritis Cartilage 2017;25:1010–25. 10.1016/j.joca.2017.02.799
    1. Dobson F, Bennell KL, French SD, et al. . Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory. Am J Phys Med Rehabil 2016;95:372–89. 10.1097/PHM.0000000000000448
    1. Teo PL, Bennell KL, Lawford BJ, et al. . Physiotherapists may improve management of knee osteoarthritis through greater psychosocial focus, being proactive with advice, and offering longer-term reviews: a qualitative study. J Physiother 2020;66:256–65. 10.1016/j.jphys.2020.09.005
    1. Australian Commission on Safety and Quality in Health Care . Osteoarthritis of the knee clinical care standard Sydney: ACSQHC2017. Available:
    1. Mann C, Gooberman-Hill R. Health care provision for osteoarthritis: concordance between what patients would like and what health professionals think they should have. Arthritis Care Res 2011;63:963–72. 10.1002/acr.20459
    1. Nyvang J, Hedström M, Gleissman SA. It’s not just a knee, but a whole life: a qualitative descriptive study on patients' experiences of living with knee osteoarthritis and their expectations for knee arthroplasty. Int J Qual Stud Health Well-being 2016;11:30193. 10.3402/qhw.v11.30193
    1. Smith TO, Purdy R, Lister S, et al. . Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography. Rheumatol Int 2014;34:299–313. 10.1007/s00296-013-2905-y
    1. Pouli N, Das Nair R, Lincoln NB, et al. . The experience of living with knee osteoarthritis: exploring illness and treatment beliefs through thematic analysis. Disabil Rehabil 2014;36:600–7. 10.3109/09638288.2013.805257
    1. Spitaels D, Vankrunkelsven P, Desfosses J, et al. . Barriers for guideline adherence in knee osteoarthritis care: a qualitative study from the patients' perspective. J Eval Clin Pract 2017;23:165–72. 10.1111/jep.12660
    1. Wallis JA, Taylor NF, Bunzli S, et al. . Experience of living with knee osteoarthritis: a systematic review of qualitative studies. BMJ Open 2019;9:e030060. 10.1136/bmjopen-2019-030060
    1. Hall M, Migay A-M, Persad T, et al. . Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty. Physiother Theory Pract 2008;24:167–81. 10.1080/09593980701588326
    1. Allison K, Delany C, Setchell J, et al. . A qualitative study exploring the views of individuals with knee osteoarthritis on the role of physiotherapists in weight management: a complex issue requiring a sophisticated skill set. Musculoskeletal Care 2019;17:206–14. 10.1002/msc.1391
    1. Lawford BJ, Delany C, Bennell KL, et al. . “I was really sceptical…But it worked really well”: a qualitative study of patient perceptions of telephone-delivered exercise therapy by physiotherapists for people with knee osteoarthritis. Osteoarthritis Cartilage 2018;26:741–50. 10.1016/j.joca.2018.02.909
    1. Campbell R, Evans M, Tucker M, et al. . Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health 2001;55:132–8. 10.1136/jech.55.2.132
    1. Law R-J, Nafees S, Hiscock J, et al. . A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: a qualitative study. Musculoskeletal Care 2019;17:145–51. 10.1002/msc.1382
    1. Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qualitative Report 2008;13:544.
    1. Greenhalgh T. What have the social sciences ever done for equity in health policy and health systems? Int J Equity Health 2018;17:124. 10.1186/s12939-018-0842-9
    1. Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet 2001;358:397–400. 10.1016/S0140-6736(01)05548-9
    1. Ong BN, Richardson JC. The contribution of qualitative approaches to musculoskeletal research. Rheumatology 2006;45:369–70. 10.1093/rheumatology/kel022
    1. O'Brien BC, Harris IB, Beckman TJ, et al. . Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014;89:1245–51. 10.1097/ACM.0000000000000388
    1. Moser A, Korstjens I. Series: practical guidance to qualitative research. Part 3: sampling, data collection and analysis. Eur J Gen Pract 2018;24:9–18. 10.1080/13814788.2017.1375091
    1. Judith ES, Kathleen JH. Comparing telephone and face-to-face qualitative interviewing: a research note. Qualit Res 2004;4:107–18.
    1. Morse JM, Field P-A. Nursing research. [electronic resource]: the application of qualitative approaches. 2nd edn. Chapman & Hall, 1996.
    1. Arthritis Australia . Time to move: osteoarthritis Australia, 2014. Available:
    1. La Trobe University . Gla:D australia La Trobe University, 2017. Available:
    1. Kieser Australia . About kieser South Melbourne, 2020. Available:
    1. Australian Government Department of Health . Chronic disease management - individual allied health services under medicare - patient information, 2014. Available:
    1. Hush JM, Yung V, Mackey M, et al. . Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison. J Man Manip Ther 2012;20:201–8. 10.1179/2042618612Y.0000000009
    1. Bath B, Jakubowski M, Mazzei D, et al. . Factors associated with reduced perceived access to physiotherapy services among people with low back disorders. Physiother Can 2016;68:260–6. 10.3138/ptc.2015-50
    1. Arthritis Australia . The ignored majority: the voice of arthritis 2011 Australia, 2011. Available:
    1. Brand CA, Ackerman IN, Bohensky MA, et al. . Chronic disease management: a review of current performance across quality of care domains and opportunities for improving osteoarthritis care. Rheum Dis Clin North Am 2013;39:123–43. 10.1016/j.rdc.2012.10.005
    1. Institute of Medicine . Crossing the quality chasm. [electronic resource] : a new health system for the 21st century. Washington: National Academy Press, 2001.
    1. National Osteoarthritis Strategy Project Group . National osteoarthritis strategy NSW, 2018. Available:
    1. Victorian Musculoskeletal Clinical Leadership Group . Victorian model of care for osteoarthritis of the hip and knee. Melbourne MOVE muscle, bone & joint health, 2018.
    1. Ackerman IN, Livingston JA, Osborne RH. Personal perspectives on enablers and barriers to accessing care for hip and knee osteoarthritis. Phys Ther 2016;96:26–36. 10.2522/ptj.20140357
    1. Cottrell E, Foster NE, Porcheret M, et al. . Gps’ attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey. BMJ Open 2017;7:e014999. 10.1136/bmjopen-2016-014999
    1. Egerton T, Nelligan RK, Setchell J, et al. . General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care. BMC Rheumatol 2018;2:30. 10.1186/s41927-018-0037-4
    1. Egerton T, Diamond LE, Buchbinder R, et al. . A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis. Osteoarthritis Cartilage 2017;25:625–38. 10.1016/j.joca.2016.12.002
    1. MacKay C, Hawker GA, Jaglal SB. How do physical therapists approach management of people with early knee osteoarthritis? A qualitative study. Phys Ther 2020;100:295–306. 10.1093/ptj/pzz164
    1. Tang CY, Pile R, Croft A, et al. . Exploring physical therapist adherence to clinical guidelines when treating patients with knee osteoarthritis in Australia: a mixed methods study. Phys Ther 2020;100:1084–93. 10.1093/ptj/pzaa049
    1. Bunzli S, O'Brien P, Ayton D, et al. . Misconceptions and the acceptance of evidence-based nonsurgical interventions for knee osteoarthritis. A qualitative study. Clin Orthop Relat Res 2019;477:1975–83. 10.1097/CORR.0000000000000784
    1. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 2008;9:116. 10.1186/1471-2474-9-116
    1. Kinds MB, Welsing PMJ, Vignon EP, et al. . A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee. Osteoarthritis Cartilage 2011;19:768–78. 10.1016/j.joca.2011.01.015
    1. Skou ST, Derosche CA, Andersen MM, et al. . Nonoperative treatment improves pain irrespective of radiographic severity. A cohort study of 1,414 patients with knee osteoarthritis. Acta Orthop 2015;86:599–604. 10.3109/17453674.2015.1029392
    1. Juhl C, Christensen R, Roos EM, et al. . Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol 2014;66:622–36. 10.1002/art.38290
    1. Egerton T, Nelligan R, Setchell J, et al. . General practitioners’ perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017;18:85. 10.1186/s12875-017-0656-7
    1. Selten EMH, Vriezekolk JE, Nijhof MW, et al. . Barriers impeding the use of non-pharmacological, non-surgical care in hip and knee osteoarthritis: the views of general practitioners, physical therapists, and medical specialists. J Clin Rheumatol 2017;23:405–10. 10.1097/RHU.0000000000000562
    1. Hinman RS, Allen KD, Bennell KL, et al. . Development of a core capability framework for qualified health professionals to optimise care for people with osteoarthritis: an OARSI initiative. Osteoarthritis Cartilage 2020;28:154–66. 10.1016/j.joca.2019.12.001
    1. Royal Australian College of General Practitioners . Guideline for the management of knee and hip osteoarthritis. East Melbourne, Victoria: RACGP, 2018.
    1. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice-challenges and opportunities. Phys Ther 2011;91:790–803. 10.2522/ptj.20100326
    1. Australian Bureau of Statistics . 2016 census: multicultural census reveals a fast changing, culturally diverse nation. Australia, 2016.
    1. Ackerman IN, Busija L. Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status. Best Pract Res Clin Rheumatol 2012;26:561–83. 10.1016/j.berh.2012.08.002
    1. Henschke N, Lorenz E, Pokora R, et al. . Understanding cultural influences on back pain and back pain research. Best Pract Res Clin Rheumatol 2016;30:1037–49. 10.1016/j.berh.2017.08.004

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