Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

Abstract

IntroductionInternational evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands.Materials and MethodsWe performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments.ResultsMost barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription.ConclusionsStrategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient’s environment in OA treatment.

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

“…Our results are in line with previous studies that reported an underuse of non‐surgical treatment options in patients with knee OA (Brand et al, ; Hoogeboom et al, ; Smink et al, ; Snijders et al, ). In addition, Hofstede et al found similar barriers for referral to non‐surgical treatment for OA patients in orthopaedic practice (Hofstede et al, ). Egerton et al described in a systematic review similar barriers to the management of osteoarthritis in primary care GPs: GPs tend to trivialize the problem and believe OA to be inevitable and lower priority than other health conditions which may lead to under management of the condition; a lack of knowledge regarding OA guidelines; clinicians' perceptions about the disease, patient adherence and the treatment effectiveness may all lead to variable practice at odds with the recommendations (Egerton, Diamond, Buchbinder, Bennell, & Slade, ).…”

Implementation and de-implementation: two sides of the same coin?

“…We use empirical data here from two previously published studies, which are performed at different moments in time: one involving implementation28 29 and one involving de-implementation30 31 among Dutch orthopaedic surgeons. The implementation study aimed to identify factors influencing the implementation of a step-wise strategy of non-surgical therapy for patients with hip and knee osteoarthritis (OA) (including medication and referral guidelines) before undertaking surgical therapy 14.…”

Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

“…The qualitative analysis was performed using the software program ATLAS.ti (version 7.5.16). A total of 55 factors were identified from the literature [21,22,25,36,46] for orthopaedic surgeons and patients. Besides, four factors were added based on the interviews among orthopaedic surgeons and patients.…”