title: Management recommendations for knee osteoarthritis: how usable are they?
abstract: 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.
authors.affiliation: School of Rehabilitation, University of Ottawa, Ottawa, Canada. stephane.poitras@uottawa.ca
authors.forename: Stéphane
authors.initials: S
authors.lastname: Poitras
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.forename: Bernard
authors.initials: B
authors.lastname: Avouac
authors.forename: Christine
authors.initials: C
authors.lastname: Cedraschi
authors.forename: Margareta
authors.initials: M
authors.lastname: Nordin
authors.forename: Chantal
authors.initials: C
authors.lastname: Rousseaux
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rozenberg
authors.forename: Bernard
authors.initials: B
authors.lastname: Savarieau
authors.forename: Philippe
authors.initials: P
authors.lastname: Thoumie
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Valat
authors.forename: Eric
authors.initials: E
authors.lastname: Vignon
authors.forename: Pascal
authors.initials: P
authors.lastname: Hilliquin
mesh_terms: 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
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen