Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis.
OBJECTIVE
To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis.


METHODS
Questionnaire survey of chartered physiotherapists.


METHODS
300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery.


RESULTS
Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1-2 hours, whilst most group interventions lasted 5-6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy.


CONCLUSIONS
Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated.
Walsh
Nicola E
NE
School of Allied Health Professions, Glenside Campus, University of the West of England, Blackberry Hill, Bristol, BS16 1DD, UK. Nicola.Walsh@uwe.ac.uk
Hurley
Michael V
MV
D055317:Evidence-Based Practice; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D020370:Osteoarthritis, Knee / Q000534:rehabilitation* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D006113:United Kingdom