Weight Management in Physiotherapy-Led Triage for Knee Osteoarthritis: A Mixed-Methods Service Evaluation

To explore how weight is assessed and addressed for patients with knee osteoarthritis (KOA) by Advanced Practice Physiotherapists (APPs) in the Musculoskeletal Clinical Assessment and Triage Service (MCATS) at Mid Cheshire NHS Foundation Trust (MCHFT).

A sequential mixed-methods service evaluation. Electronic patient records from all MCAT APPs (n = 8) between April and September 2023 were reviewed to identify care episodes for patients with KOA. Anonymised data on patient characteristics and care provision were extracted and analysed descriptively. APPs were invited to virtual semi-structured interviews exploring their knowledge of current guidelines, approaches to and confidence in, assessing and addressing weight. Interview transcripts were analysed thematically.

Of 167 patient records included in the medical record review, 28% (n = 47) had a recorded Body Mass Index (BMI) and 23% (n = 38) had a weight management discussion. Five APPs consented and were interviewed (n = 5). Findings confirmed that the assessment and management of weight were limited. Weight was typically addressed through brief dietary and exercise advice. Barriers to optimising weight management included limited confidence, knowledge, skills, and perceptions of scope of practice. Complex issues were raised with local BMI thresholds for surgical referral for joint replacement.

Weight is not routinely assessed or addressed in patients with KOA in MCATS at MCHFT.

With appropriate training and improved knowledge of local resources, APPs could enhance weight management by optimising brief advice provision and signposting to relevant services.