Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons

Abstract

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.

Evaluation of the strategy for implementing the GLA:D programme in Switzerland: protocol for an implementation-effectiveness hybrid type 3 design study with a mixed-method approach

“…Additionally, contextual factors were analysed in a policy brief and a stakeholder dialogue. 17 28 29 …”

“… 17 The results showed that the estimated referral rate to exercise was of some 54% only and, thus, indicated an evidence-performance gap in the conservative management of knee OA. 17 The study demonstrated that guideline recommendations were not applied systematically in clinical practice and there was a need to implement a structured exercise and education programme to close this evidence-performance gap. Furthermore, there is missing transparency in the management of knee OA assuming that patients with knee OA are usually treated with hands-on techniques in physiotherapy.…”

“…However, even though data from the outpatient setting are missing, clinical observations and the high number of surgeries indicated that the prevalence of knee OA is high. Therefore, a survey among medical specialists, working in primary care, was performed to gain insight on the conservative management of knee OA in the outpatient setting of Switzerland 17. The results showed that the estimated referral rate to exercise was of some 54% only and, thus, indicated an evidence-performance gap in the conservative management of knee OA 17.…”

“…Therefore, a survey among medical specialists, working in primary care, was performed to gain insight on the conservative management of knee OA in the outpatient setting of Switzerland 17. The results showed that the estimated referral rate to exercise was of some 54% only and, thus, indicated an evidence-performance gap in the conservative management of knee OA 17. The study demonstrated that guideline recommendations were not applied systematically in clinical practice and there was a need to implement a structured exercise and education programme to close this evidence-performance gap.…”

Applicability of Exercise and Education Programmes for Knee Osteoarthritis Management to Switzerland

“…According to national data, knee OA is the most common diagnosis in Swiss hospitals (12). However, both research and observation of clinical practise have shown that the guidelines recommendations are not being systematically applied in knee OA management and exercise and education appear to be underexploited in Switzerland, which results in an evidence-performance gap (13). In accordance with experience from other countries, the implementation of a national exercise and education programme in Switzerland would contribute to overcoming this evidence-performance gap (9,10).…”