Approaches to osteoarthritis: a qualitative study among physical therapists in Maharashtra, India

Figures & data

Table 1. Characteristics of the 19 participating physical therapists.

Recruited from, Ahmednagar/Aurangabad/Mumbai, n (%)	8 (42)/8 (42)/3 (16)
Sex, male/female, n (%)	10 (53)/9 (47)
Age, years, median (range)	30 (24–40)
Highest education, PhD/Master/Bachelor of physiotherapy, n (%)	3 (16)/15 (79)/1 (5)
Employed as physical therapist, years, median (range)	8 (0–15)
Current workplace, n
University + university hospital	14
University + community	1
Private practice	3
Other^a	1
Area of specialization, n (%)
Musculoskeletal	13 (68)
Community	2 (11)
Neurology	3 (16)
Sports	1 (5)
Experience of patients with unspecific hip/knee pain, years, median (range)	9 (2–15)
Managing patients with unspecific hip/knee pain, n (%)
Daily	10 (53)
Weekly	6 (32)
Monthly	2 (10)
More seldom	1 (5)
Managing patients with OA, n (%)
Daily	8 (42)
Weekly	10 (53)
Monthly	1 (5)
More seldom	0 (0)
Physical activity level, n (%)
Sedentary	3 (16)
Low	5 (26)
Moderate	10 (53)
High	1 (5)

^aMaster of physical therapy student

Table 2. Interview guide used for semi-structured interviews.

Main areas

OA

Management of OA

Entry question

- Tell me a little about patients with unspecific hip/knee pain. What is the first thing that comes to mind?

- Tell me a little about OA. How would you describe a typical patient diagnosed with OA?

Questions

- Can you tell me how you understand OA – what is it?

- What are the core elements in your management of patients diagnosed with OA? Why do you use these elements?

- What are the core elements in your management of patients with unspecific hip/knee pain? Why do you use these elements?

-Tell me – are there any other management strategies that you would like to try for these conditions, but have not yet tried?

- Tell me something positive you have experienced from working with patients with OA.

- Can you tell me about a situation when management has failed in some way?

- Describe a dialogue or communication you have had with a patient with OA that has taught you something about the condition – either positive or negative.

- Describe your role and the patient’s role in the total management of OA.

- Using your knowledge and experience – what advice about managing OA would you give to an inexperienced physical therapist?

- Tell me about your expectations for the future when it comes to managing patients with OA.

- How would you describe your ideal of total management – if you could make a wish?

- Is there anything else you would like to add?

Follow-up questions/probing questions

Repetition, request for clarification/confirmation and summaries

For example:

- Could you tell me something more about … ?

- Can you tell me how you thought … ?

- How do you mean?

- Do you mean … ?

- You have told me about … Is there anything you would like to add?

Table 3. Description of the data analysis.

Familiarization	To familiarize and to gain an overview of the material, all the transcribed individual interviews were initially read several times by the principal author (ES).
Open coding and meaning units	Open coding was performed iteratively for all interviews by one of the authors (ES) by writing manual notes and headings in the margins describing the participants’ approaches to OA in the text while reading it. Parts of the text (meaning units) containing different aspects related to these codes were then identified. To ensure trustworthiness, another author (CT) independently analyzed five of the interviews.
Creating descriptive themes	The various codes were compared regarding differences and similarities. Codes representing similar meaning units were manually grouped into descriptive themes. Three of the authors (ES, CT, CHO) discussed and compared the emerging descriptive themes until consensus was reached.
Refining and labeling	Discussions with the author who acted as the peer reviewer (CHO) were held on an ongoing basis. The descriptive themes were labeled by ES, CT and CHO.
Creating a theme of meaning	The final step of the analysis – identifying a meaningful underlying essence that runs through the material – resulted in an overarching theme of meaning.
Quotes	Quotes are provided in the findings section for illustration and trustworthiness.

Figure 1. Overarching theme of meaning and four descriptive themes derived from the analysis of 19 interviews.