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Adherence to and perceptions of a Peruvian osteoarthritis clinical practice guideline among physiatrists and
Roger De la Cerna-Luna1, Paula Arnillas Brigneti1, Nieves Zeta-Ruiz2,3
1Department of Physical Medicine and Rehabilitation, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru.
Background:
Osteoarthritis (OA) is a leading cause of disability worldwide. To standardize management, Peru's Social Health Insurance (EsSalud) approved its Clinical Practice Guideline (CPG) for OA in 2018, updated in 2024. However, adherence to these recommendations among physiatrists and physical medicine and rehabilitation (PM&R) residents is unknown.
Objective:
To assess adherence and perceptions regarding the Peruvian OA CPG among physiatrists and PM&R residents.
Methods:
A cross-sectional survey (May-July 2025) was conducted via two national WhatsApp groups. Sociodemographic and professional data were collected, along with agreement levels for 10 CPG recommendations using a 5-point Likert scale. For five prioritized recommendations, stages of implementation were assessed using the transtheoretical model. Factors associated with agreement on ≥6 recommendations were analyzed with Poisson regression and robust variance.
Results:
Eighty-eight participants completed the survey; 55.7% were physiatrists and 44.3% residents. Awareness of the OA CPG was reported by 42.1%, and only 3.4% had received prior training. Agreement was highest for oral nonsteroidal anti-inflammatory drugs and avoidance of tramadol and lowest for avoidance of hyaluronic acid, prolotherapy, and acupuncture. Most respondents were in early stages of implementation. Employment in national specialized institutes was significantly associated with higher agreement (prevalence ratio, 2.53; 95% confidence interval: 1.20-5.36). Main reasons for disagreement included perceived clinical effectiveness and positive experience. Suggested strategies to improve adherence were workshops and educational meetings.
Conclusions:
Awareness and training on the Peruvian OA CPG are limited, with heterogeneous adherence across recommendations. Educational strategies are needed to enhance evidence-based OA management in Peru.
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