Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Abstract

Background Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use. Methods A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen. Results In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline. Conclusions In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice. Trial registration German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

Physiotherapy management of rotator cuff-related shoulder pain in Germany is broadly consistent with recommended practice: An observational study

“…At worst, the probability of conservative treatment success is reduced, symptom and impairment duration are prolonged, and interventional care (imaging, injections, surgery) may become more likely (ref). Findings show similarity to the results of the studies of physiotherapeutic management of nonspeci c low back pain and hip and knee osteoarthritis in Germany (17,41).…”

“…Both studies found evidence of the high use of passive treatment strategies, such as massage, kinesio-taping, or manual therapy, which are not recommended by clinical practice guidelines for the respective patient group (17,41). Given that there is a signi cant risk of low value care being recommended more often in non-academically trained physiotherapists, differences in therapist education may be signi cantly impacting patient care.…”

Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel

“…In December 2021, the survey among German physiotherapists was completed, and results on the management of patients with hip and knee osteoarthritis and guideline adherence were published [50] (part 1 of the research project). Ethics approval for the second part of the research project was obtained in August 2022, and the semistructured interviews were conducted between January and September 2023.…”

Assessment of the quality of life of patients with gonarthrosis treated with a prosthesis of synovial fluid of domestic production

“…Как показывает наша практика и исследования, проводимые специалистами разных стран, в настоящее время сохраняются проблемы диагностики, маршрутизации, качества лечения пациента с ОА на амбулаторном приеме [20]. Соответственно, можно говорить о том, что КЖ пациентов с ОА остается не на самом высоком уровне в силу различных причин, в частности отсутствия немедикаментозных методов терапии или ограничения их перечня исключительно физиотерапевтическими процедурами, нарушения алгоритмов помощи пациентам с ОА (рассмотрены в 2014 г. на Всемирном конгрессе по остеопо розу, остеоартриту и мышечно-скелетным заболеваниям, Се вилья (Испания) (World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases -WCO-IOF-ESCEO), постоянно корректируются в современных клинических рекомендациях) [14,21,22].…”