How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

Abstract

Purpose: It is unclear how physical therapists in Florida currently treat people with knee osteoarthritis and whether current best evidence is used in clinical decision making. Methods: We conducted a survey of physical therapists in Florida. We assessed the perceived effectiveness and actual use of physical therapy (PT) interventions and quantified the association between the actual use of interventions and different characteristics of physical therapists. Results: A total of 413 physical therapists completed the survey. Most respondents perceived therapeutic exercise (94%) and education (93%) as being effective or very effective. Interventions least perceived as effective or very effective were electrotherapy (28%), wedged insole (20%), and ultrasound (19%). Physical therapists who followed the principles of evidence-based practice were more likely to use therapeutic exercise (OR 3.89; 95% CI: 1.21, 12.54) and education (OR 3.63; 95% CI: 1.40, 9.43) and less likely to use ultrasound (OR 0.32; 95% CI: 0.16, 0.63) and electrotherapy (OR 0.32; 95% CI: 0.17, 0.58). Results also indicated that older physical therapists were more likely to use ultrasound (OR 3.57; 95% CI: 1.60, 7.96), electrotherapy (OR 2.53; 95% CI: 1.17, 5.47), kinesiology tape (OR 3.82; 95% CI: 1.59, 9.18), and ice (OR 1.95; 95% CI: 1.02, 3.73). Conclusions: In line with clinical guidelines, most physical therapists use therapeutic exercise and education to treat people with knee osteoarthritis. However, interventions that lack scientific support, such as electrotherapy and ultrasound, are still used. A modifiable therapist characteristic, adherence to evidence-based practice, is positively associated with the use of interventions supported by scientific evidence.Key Words: knee; osteoarthritis; survey. RÉ SUMÉObjectif : on ne sait pas comment les physiothé rapeutes de la Floride traitent les personnes atteintes d'arthrose du genou et s'ils tiennent compte des meilleures donné es probantes dans leur prise de dé cisions cliniques. Mé thode : nous avons mené un sondage auprè s des physiothé rapeutes de la Floride. Nous avons é valué l'efficacité perç ue et le recours ré el aux interventions de physiothé rapie (PT) et avons quantifié le lien entre le recours ré el aux interventions et diffé rentes caracté ristiques des physiothé rapeutes. Ré sultats : au total, 413 physiothé rapeutes ont ré pondu au sondage. La plupart des ré pondants croient que les exercices thé rapeutiques (94 %) et l'é ducation (93 %) sont efficaces ou trè s efficaces. Les interventions les moins perc¸ues comme é tant efficaces ou trè s efficaces sont l'é lectrothé rapie (28 %), les orthè ses plantaires (20 %) et les ultrasons (19 %). Les physiothé rapeutes qui suivent les principes de la pratique fondé e sur des donné es probantes sont plus susceptibles d'avoir recours aux exercices thé rapeutiques (rapport des cotes [RC] ¼ 3,89; IC à 95 % 1,21; 12,54) et à l'é ducation (RC 3,63; IC à 95 % 1,40; 9,43) et sont moins susceptibles d'utiliser l'ultrason (RC 0,32; IC à 95 % ...

Improving Adherence to Exercise: Do People With Knee Osteoarthritis and Physical Therapists Agree on the Behavioral Approaches Likely to Succeed?

“…Compared to responders to a UK survey , a higher proportion of physical therapist responders to our survey worked exclusively in private practice (68% versus 23%), and more treated people with knee OA at least once per week (53% versus 33%). Use of therapeutic exercise in managing knee OA was lower (78% said they would usually or always prescribe exercise to people with knee OA) among our cohort than has been reported in other surveys of physical therapist practice . However, comparing responses is difficult, as none of those studies took place in Australia or New Zealand, so therefore differences in health care settings may exist, and the questions asked had different wording to those questions in our survey.…”

Patient-reported quality indicators to evaluate physiotherapy care for hip and/or knee osteoarthritis- development and evaluation of the QUIPA tool

“…Despite international OA guidelines recommending exercise and weight loss [1,6,7] as first line treatments for OA, their uptake is suboptimal in physiotherapy practice [8][9][10][11]. Quality indicators (QIs) can be used to assess physiotherapists' adherence to clinical guidelines recommendations and are accepted tools for assessing OA care [12][13][14].…”

Associação entre qualificação profissional de fisioterapeutas e a percepção sobre o tratamento de osteoartrite de joelho: um estudo transversal

“…A tomada de decisão clínica é um tópico de frequente interesse entre clínicos e pesquisadores. Da Costa et al investigaram como fisioterapeutas decidiam sobre as intervenções utilizadas e identificaram que profissionais que seguiam os princípios da PBE eram mais propensos a utilizar exercícios terapêuticos e educação e menos propensos a utilizar ultrassom e eletroterapia 10 .…”

“…Holden et al notaram que pouco mais da metade dos profissionais (56%) concordaram que exercícios melhoram as condições do joelho e consideravam sua prática uma reponsabilidade do paciente 9 . Em outra pesquisa, observou-se que apesar da maioria dos fisioterapeutas utilizarem exercícios e educação do paciente, recursos como a eletroterapia e ultrassom ainda são utilizados 10 . Foi demonstrado também que fatores relacionados ao profissional podem ter relação com essas decisões clínicas, a idade do profissional esteve associada com a sua escolha terapêutica para o tratamento de OA de joelho em dois estudos anteriores, onde fisioterapeutas mais velhos foram mais prováveis de utilizar intervenções não recomendadas para esta condição 10,11 .…”