Management recommendations for knee osteoarthritis: how usable are they?
OBJECTIVE
Despite the availability of practice guidelines for the management of knee osteoarthritis, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. Literature has shown that simply disseminating management recommendations does not lead to adherence. Research suggests that barriers to use should be identified and addressed to improve adherence. The objective of this study was to identify barriers to use of conservative management recommendations for knee osteoarthritis by patients, general practitioners and physiotherapists.


METHODS
Following systematic reviews of evidence and guidelines, 12 key management recommendations were elaborated on four themes: medication, exercise, self-management and occupation. Focus groups were separately done with patients with knee osteoarthritis, general practitioners and physiotherapists to assess barriers to the use of recommendations.


RESULTS
Patients and general practitioners appeared generally fatalistic with regards to knee osteoarthritis, with physiotherapists being more positive regarding long-term improvement of knee osteoarthritis. For medication, discrepancies were found between recommendations and views of clinicians. Both patients and general practitioners appeared ambivalent towards exercise and activity, recognizing its usefulness but identifying it at the same time as a cause of knee osteoarthritis. Patients and general practitioners appeared to consider weight loss particularly difficult.


CONCLUSIONS
Barriers specific to each knee osteoarthritis management recommendation and stakeholder group were identified. Recommendations to address these barriers were elaborated. Results of this study can be used to develop implementation strategies to overcome identified barriers, with the goal of facilitating the use of guideline recommendations and improving outcomes.
Poitras
Stéphane
S
School of Rehabilitation, University of Ottawa, Ottawa, Canada. stephane.poitras@uottawa.ca
Rossignol
Michel
M
Avouac
Jérôme
J
Avouac
Bernard
B
Cedraschi
Christine
C
Nordin
Margareta
M
Rousseaux
Chantal
C
Rozenberg
Sylvie
S
Savarieau
Bernard
B
Thoumie
Philippe
P
Valat
Jean-Pierre
JP
Vignon
Eric
E
Hilliquin
Pascal
P
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001294:Attitude to Health; D019468:Disease Management; D005260:Female; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D010349:Patient Compliance; D005082:Physical Exertion; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015431:Weight Loss
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen