Physical therapists' use of therapeutic exercise for patients with clinical knee osteoarthritis in the United kingdom: in line with current recommendations?

Abstract

Background and purpose: Physical therapists have an important role in the management of clinical knee osteoarthritis (OA) through designing and supervising exercise programs. This study explored whether their current use of therapeutic exercise for patients with this condition is in line with recent recommendations.

Subjects and methods: A cross-sectional survey was conducted with a random sample of chartered (licensed) physical therapists (N=2,000) practicing in the United Kingdom. This survey included a vignette describing a patient with clinical knee OA as well as clinical management questions relating to the respondents' use of therapeutic exercise.

Results: The questionnaire response rate was 58% (n=1,152), with 538 respondents stating they had treated a patient with clinical knee OA in the preceding 6 months. In line with recent recommendations, 99% of the physical therapists stated they would use therapeutic exercise for this patient population, although strengthening exercises were favored over aerobic exercises. Although nearly all physical therapists would monitor exercise adherence, only 12% would use an exercise diary. Seventy-six percent of physical therapists would provide up to 5 treatment sessions, and only 34% would offer physical therapy follow-up after discharge.

Discussion and conclusion: The measure of physical therapists' current clinical practice was self-reported clinical behavior on the basis of a vignette. Although this is a valid measure of clinical behavior, in practice, physical therapists may use therapeutic exercise differently. There are disparities between physical therapists' current use of therapeutic exercise for clinical knee OA and recent recommendations. Identifying potential ways to overcome these disparities is an important step toward optimizing the outcome from therapeutic exercise for patients with clinical knee OA.

Appendix 1.

Ten Propositions Included in Recent Exercise Recommendations for Hip and Knee Osteoarthritis (OA)^{a a} eprinted with permission from: Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee: the MOVE consensus. Rheumatology (Oxford). 2005;44:67–73. Copyright 2005, Oxford University Press.

Appendix 2.

Clinical Vignette Included in the Cross-Sectional Survey

Appendix 3.

Questions Included in the Cross-Sectional Survey Instrument^{a a} The authors request that appropriate acknowledgment of the source be given if any of the survey questions are replicated. ^b “Exercise on prescription” involves a health care professional, typically a family practitioner, referring a patient to a fitness instructor, who will prescribe an individually tailored exercise program.

Appendix 3.

Questions Included in the Cross-Sectional Survey Instrument^{a a} The authors request that appropriate acknowledgment of the source be given if any of the survey questions are replicated. ^b “Exercise on prescription” involves a health care professional, typically a family practitioner, referring a patient to a fitness instructor, who will prescribe an individually tailored exercise program.

Figure 1.

Treatment approaches used by physical therapists for clinical knee osteoarthritis. In the United Kingdom, injection therapy can be used by physical therapists who have received appropriate training. Injections may be administered to peripheral intra-articular or periarticular lesions of the upper and lower extremities, without a prescription from a physician. Electrotherapy is the use of electrical, electromagnetic, and acoustic energy for therapeutic purposes. Modalities include ultrasound, pulsed shortwave diathermy, interferential current, and transcutaneous electrical nerve stimulation. Manual therapy is the use of hands-on interventions, typically including joint mobilization, manipulation, and massage.

Figure 2.

Types of exercises prescribed by physical therapists for clinical knee osteoarthritis. Functional tasks include the replication of a functional activity (eg, rising from a sitting position) in the exercise program. Range of movement includes specific exercises to improve the functional range of movement of a joint. These exercises are usually performed throughout the whole joint range and can be completed actively, passively, or with active assistance. Data for hydrotherapy were from the main study only because of changes in questions between the pilot study and the main study.