The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review

Abstract

BackgroundJoint pain, specifically chronic knee pain (CKP), is a frequent cause of chronic pain and limitation of function and mobility among older adults. Multiple evidence-based guidelines recommend exercise as a first-line treatment for all patients with CKP or knee osteoarthritis (KOA), yet healthcare practitioners' attitudes and beliefs may limit their implementation. This systematic review aims to identify the attitudes, beliefs and behaviours of General Practitioners (GPs) regarding the use of exercise for CKP/KOA.MethodsWe searched four electronic databases between inception and January 2008, using subject headings to identify studies examining the attitudes, beliefs or behaviours of GPs regarding the use of exercise for the treatment of CKP/KOA in adults aged over 45 years in primary care. Studies referring to patellofemoral pain syndrome or CKP secondary to other causes or that occurring in a prosthetic joint were excluded. Once inclusion and exclusion criteria were applied, study data were extracted and summarised. Study quality was independently reviewed using two assessment tools.ResultsFrom 2135 potentially relevant articles, 20 were suitable for inclusion. A variety of study methodologies and approaches to measuring attitudes beliefs and behaviours were used among the studies. Quality assessment revealed good reporting of study objective, type, outcome factors and, generally, the sampling frame. However, criticisms included use of small sample sizes, low response rates and under-reporting of non-responder factors. Although 99% of GPs agreed that exercise should be used for CKP/KOA and reported ever providing advice or referring to a physiotherapist, up to 29% believed that rest was the optimum management approach. The frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies (exercise advice 9%-89%; physiotherapy referral 44%-77%) than reviews of actual practice (exercise advice 5%-52%; physiotherapy referral 13-63%). Advice to exercise and exercise prescription were not clearly differentiated.ConclusionsAttitudes and beliefs of GPs towards exercise for CKP/KOA vary widely and exercise appears to be underused in the management of CKP/KOA. Limitations of the evidence base include the paucity of studies directly examining attitudes of GPs, poor methodological quality, limited generalisability of results and ambiguity concerning GPs' expected roles. Further investigation is required of the roles of GPs in using exercise as first-line management of CKP/KOA.

What Do People With Knee or Hip Osteoarthritis Need to Know? An International Consensus List of Essential Statements for Osteoarthritis

“…The suboptimal use of evidence-based nondrug therapies in primary care settings for the management of osteoarthritis highlights the need for patients to have access to a list of patient-friendly, plain-language, patient messages (8). Furthermore, time available for face-to-face education by health professionals is usually limited in most health care consultations (5). Out of all the potential evidence-based information that clinicians could give to patients with osteoarthritis, we have identified the most important statements in order to ensure patients are not overloaded with information of lesser importance.…”

“…There are many barriers to achieving optimal primary care management of osteoarthritis (5). With respect to the transmission of evidence-based messages regarding selfmanagement, most barriers reside at the level of the health care provider.…”

“…However, there are a number of barriers to self-management, including competing health and life priorities, patient difficulties in setting personal goals, costs of and access to health care services, and that educational information is not presented in appropriate languages or at an appropriate reading level (5,6). Clinical guidelines emphasize that management of osteoarthritis should focus on conservative nondrug treatments, particularly exercise, and weight loss for patients who are overweight or obese (7).…”

Exercise, Gait Retraining, Footwear and Insoles for Knee Osteoarthritis

“…A recent systematic review found that although 99 % of general practitioners agreed that exercise should be used for chronic knee pain/knee OA and had provided advice or referred to a physiotherapist at some stage, up to 29 % believed that rest was the optimum management approach [15]. The frequency of actual provision of exercise advice or physiotherapy referral was lower.…”

Sport and exercise medicine: a hot topic thanks to the Olympics

“…1 In those that are aware, there may be a blurring of the line between 'exercise advice' and 'exercise prescription'. 8 Moreover, some healthcare professionals may demonstrate confidence and enthusiasm for giving advice, but this may not be supported by the knowledge of what to actually recommend. 9 Arming healthcare professionals with more knowledge on what, when, and how much could result in significantly better results.…”