How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed‐methods study

Abstract

Background: Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA.Methods: We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semistructured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically.Results: There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness.Conclusions: UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss.However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.

Do comorbidities predict pain and function in knee osteoarthritis following an exercise intervention, and do they moderate the effect of exercise? Analyses of data from three randomized controlled trials

“…For instance, for patients with anxiety/depression who are beginning an exercise programme, signposting for additional mental health assessment, talking therapies and tailored medication may improve clinical outcomes. For those who are obese, signposting to additional lifestyle programmes and actively addressing weight loss as part of the exercise programme may also be of benefit, although how effectively this is addressed currently can be variable (Holden et al, ; Quicke, Holden, Bennell, et al, ).…”

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“…Further, there are relatively few weight loss services in Norway that the GP can refer to, and the GPs may not be aware of those. In a previous study, a large proportion of PTs reported that they would address weight by the provision of advice, but some lacked confidence in addressing weight loss [33]. While PTs believe they have a role in addressing weight loss, they felt inadequately equipped to integrate weight loss in their management approach [56].…”

“…Also, observational studies have revealed low pass rates for weight management uncovering a large scope for improvement [31,51,[53][54][55]. The low pass rates may be related to health professionals' barriers towards discussing weight issues and their prioritizing to review other aspects of health [32,33,35]. Further, there are relatively few weight loss services in Norway that the GP can refer to, and the GPs may not be aware of those.…”

“…In order to provide best value OA care, it is important to both implement evidence based cost-effective care and reduce the use of care with no or limited evidence and at the same time rationalize resource use (e.g., use group-based treatments). Previous research indicate that both general practitioners (GPs) and PTs are reluctant to discuss weight issues with their patients [32][33][34]. It has also been shown that GPs favoured monitoring patients' physical function, pain and analgesia use over body mass index (BMI), self-management plans and exercise advice [35].…”

Effects of an Online Education Program on Physical Therapists' Confidence in Weight Management for People With Osteoarthritis: A Randomized Controlled Trial

“…Physical therapists may be well placed to upskill to engage in basic caloric restriction guidance as part of integrated weight management practice for people with OA, given their skills in exercise prescription and health behavior change and the length of time spent with patients. However, research globally indicates that most physical therapists lack the knowledge and skills to integrate weight management into their treatment paradigm (17)(18)(19)(20). Australian physical therapists describe difficulty managing patients with comorbid obesity, and if they do provide education about weight loss, they predominantly advise about why weight loss is important rather than advise about how to lose weight (17,18,20,21).…”