UK-based physical therapists' attitudes and beliefs regarding exercise and knee osteoarthritis: findings from a mixed-methods study.
OBJECTIVE
Within the UK, differences exist between physical therapists' use of exercise for patients with knee osteoarthritis (OA) and recent exercise recommendations. This may be explained by their underlying attitudes and beliefs. We aimed to describe UK physical therapists' attitudes and beliefs regarding exercise and knee OA, and understand and explain them.


METHODS
A survey was mailed to 2,000 UK-based chartered physical therapists that included 23 attitude statements derived from recently published recommendations. Semistructured telephone interviews were conducted with a purposeful sample of questionnaire respondents (n = 24), and were recorded and analyzed thematically.


RESULTS
The questionnaire response rate was 58% (n = 1,152); 538 respondents reported treating a patient with knee OA in the last 6 months. The survey highlighted uncertainty about potential benefits of exercise for knee OA: only 56% largely/totally agreed that knee problems are improved by local exercise. Although exercise adherence was deemed important, it was seen as the patient's, not the therapist's, responsibility. Interviews revealed an underlying biomedical model of care of knee pain, with knee OA viewed as a progressive degenerative condition. A paternalistic treatment approach was evident. Health care systems presented a number of barriers to best practice, including limited opportunity to provide followup.


CONCLUSIONS
Although the attitudes and beliefs of physical therapists may help to explain differences between current practice and recent exercise recommendations, the wider health care system also plays a part. Further research is needed to support meaningful shifts in physical therapy care in line with the best practice recommendations.
Holden
Melanie A
MA
Arthritis Research Campaign National Primary Care Centre, Keele University, Staffordshire, UK. m.holden@cphc.keele.ac.uk
Nicholls
Elaine E
EE
Young
Julie
J
Hay
Elaine M
EM
Foster
Nadine E
NE
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D026761:Physical Therapy Specialty; D011795:Surveys and Questionnaires; D006113:United Kingdom