Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study

Abstract

Objective. To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care.Methods. Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high-and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses).Results. A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data.Conclusion. Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.

Can the Pain Attitudes and Beliefs Scales be adapted for use in the context of osteoarthritis with general practitioners and physiotherapists?

“…While previous reports of the internal consistency (Cronbach's alpha) of the biomedical subscale have been acceptable (ranging from 0.75-0.84), the behavioural subscale is less consistent, ranging from 0.54-0.73 in the context of LBP [35,40]. Of interest, recently, Briggs et al [29] used the PABS in their study of clinicians' osteoarthritis beliefs but only used the Other employment settings were: aged care (n = 1), community care service (n = 2), hospice care (n = 1), Māori health trust (n = 2), occupational health service (n = 1,) primary health organisation (n = 2) and university clinic (n = 2) biomedical subscale. The low internal consistency of the behavioural subscale may be attributable to three factors.…”

“…Clinicians' beliefs and attitudes are known to affect the advice and education they offer their patients, and researchers have suggested that clinicians with biomedical or biomechanical beliefs about osteoarthritis may transfer these beliefs to their patients, thus affecting their treatment choices [6,24,25]. However, in contrast to patients' beliefs about osteoarthritis, less is known about clinicians' beliefs about the disease and its treatment, how clinicians' beliefs may affect clinical practice, or how to best measure these beliefs [26][27][28][29].…”

“…Few studies have explicitly explored clinicians' osteoarthritis health, illness and treatment beliefs using a valid and reliable quantitative measure underpinned by a health beliefs model. Most existing measures or questionnaires about clinicians' beliefs primarily focus on beliefs about low back pain (LBP), few questionnaires have been developed for use in the context of osteoarthritis [29,[35][36][37]. The most rigorously tested of these questionnaires is the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT).…”

“…The PABS-PT has previously performed well in terms of internal consistency, reliability and validity testing, and the scale has the potential to be adapted for application in the osteoarthritis context [35,[37][38][39][40]. Recently, the questionnaire has been used to measure clinicians' beliefs about osteoarthritis [29], but it is unclear if the questionnaire is appropriate in this context. This study aimed to determine if the PABS-PT is suitable for adaption for use in the context of osteoarthritis with general practitioners and physiotherapists.…”

Can the Pain Attitudes and Beliefs Scale be adapted for use in the context of osteoarthritis with general practitioners and physiotherapists?

“…Clinicians' beliefs and attitudes are known to affect the advice and education they offer their patients, and researchers have suggested that clinicians with biomedical or biomechanical beliefs about osteoarthritis may transfer these beliefs to their patients, thus affecting their treatment choices (6,24,25). However, in contrast to patients' beliefs about osteoarthritis, less is known about clinicians' beliefs about the disease and its treatment, how clinicians' beliefs may affect clinical practice, or how to best measure these beliefs (26)(27)(28)(29).…”