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"A very good program … but I still have the knee problem": A qualitative study exploring patient acceptability of
Alison J Gibbs1,2,3, Allison M Ezzat4,1, Jason A Wallis2,5
1La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.
Objective:
What is the acceptability of community-based physiotherapy-led osteoarthritis services, including advanced practice assessment and an exercise and education program, for patients with knee osteoarthritis?
Design:
Interpretive descriptive qualitative study. Patients with knee osteoarthritis who attended a community-based advanced practice physiotherapy assessment, followed by physiotherapy management, including an osteoarthritis-specific education and exercise program (Good Life osteoArthritis:Denmark (GLA:D®)) were eligible. Semi-structured interviews, informed by the Theoretical Framework of Acceptability, were completed either online or via telephone. Interview data were independently coded by 2 researchers. Other team members reviewed a random sample of interview data. Data were analysed inductively using thematic analysis.
Results:
Twenty participants (mean 70 years, 60% women) were included. Three main themes were identified: 1. Physiotherapy-led osteoarthritis services were acceptable to most participants; 2. Physiotherapy care received was typically perceived as insufficient to fully address all ongoing knee osteoarthritis management needs and 3. Effective clinical and non-clinical communication was strongly linked to acceptability of physiotherapy-led osteoarthritis services.
Conclusion:
Assessment by community-based advanced practice physiotherapists and participating in a physiotherapy-led exercise-and-education-program were acceptable to most patients, providing a viable alternative to hospital-based models. However, several barriers were identified, including patient uncertainty regarding addressing their education needs and ongoing management needs. Prioritising ongoing management, communication and a strong therapeutic alliance can enhance acceptability. Our findings highlight challenges and enablers for implementing physiotherapy-led care in a community-based setting, and may guide implementation of these services in alternative healthcare settings.
