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How Do Physical Therapists Approach Management of People With Early Knee Osteoarthritis? A Qualitative Study
Crystal MacKay1, Gillian A Hawker2, Susan B Jaglal3
1Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada, and West Park Healthcare Centre, 82 Buttonwood Avenue, Toronto, Ontario M6M 2J5, Canada.
Background:
Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists' perceptions and clinical behaviors related to early knee OA management.
Objective:
The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population.
Design:
We used a qualitative, descriptive research design.
Methods:
Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis.
Results:
Five main themes were constructed: (1) Physical therapists' experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist "toolbox:" participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating "buy-in" to management: physical therapists used a range of strategies to gain "buy-in."
Limitations:
Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years.
Conclusions:
Participants' accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).
