Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study

Abstract

Background: Osteoarthritis (OA) is a common musculoskeletal condition that often leads to pain, stiffness and disability. Physiotherapy plays an important role in the management of knee OA, however we hypothesize discordance between physiotherapists' practice and existing guideline recommendations.

Objectives: This study aimed to measure physiotherapists' guideline adherence for knee OA. Additionally, determinants for guideline adherence at the professional and organizational level were explored, to find clues for improvement.

Method: A survey was performed among Belgian physiotherapists. Guideline adherence was measured with a set of 9 quality indicators, developed for the Belgian primary healthcare system, applicable for physiotherapists and extracted from evidence-based guidelines. Treatment modalities that do not contribute to high quality care were also examined.

Results: 284 Physiotherapists responded to the survey. Compliance to the quality indicators varied between 27% and 98%. Quality indicator compliance above 80% was found for: education on the importance of exercise, delivering functional and strength exercise therapy, patient tailored exercise program, instruction of patients in appropriate exercises and referral for sports activities after therapy. Quality indicator compliance less than 50% was found for: education on the importance of weight loss, providing self-management strategies, spreading treatment session over longer periods and regular evaluations of the exercise therapy. For treatment modalities that do not contribute to high quality care, massage (49%) and cold application (24%) were most frequently applied.

Conclusions: This study showed large variations in adherence to quality indicators in OA management by physiotherapists. Improvement strategies should focus on quality indicators related to long-term treatment options.

Keywords: Decision making; Exercise therapy; Guideline adherence; Osteoarthritis; Physiotherapy.