A snapshot of primary care physiotherapy management of knee osteoarthritis in an Australian setting: does it align with evidence-based guidelines?

ABSTRACT

Background

Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector.

Objective

To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained.

Methods

A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines.

Results

Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was −3.4 (−5.5 to −1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring.

Conclusion

Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes.

KEYWORDS:

• Osteoarthritis
• knee
• physiotherapy
• physical therapy specialty
• practice guideline
• professional practice
• private practice

Acknowledgments

We acknowledge the clinicians, patients and reception staff who generously provided their time and/or data for this study. We acknowledge the SPHERE Consumer Community Council for their input into the design of this study. RL was provided with a PhD scholarship from SPHERE. SS received salary support from The National Health and Medical Research Council of Australia (1105040).

Disclosure statement

JN and KM have a financial relationship with one or more of the physiotherapy practices where the study was undertaken. There were no other conflicts of interest related to the study.

Additional information

Funding

This work was supported by the Sydney Partnership for Health, Education, Research and Enterprise [1].