title: Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.
abstract: BACKGROUND
  International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands.
  
  
  METHODS
  We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments.
  
  
  RESULTS
  Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription.
  
  
  CONCLUSIONS
  Strategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient's environment in OA treatment.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, RC Leiden, The Netherlands.
authors.forename: Stefanie N
authors.initials: SN
authors.lastname: Hofstede
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, RC Leiden, The Netherlands.
authors.forename: Perla J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
authors.affiliation: Department of Orthopaedics, Leiden University Medical Center, RC Leiden, The Netherlands.
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek Nijmegen, Hengstdal 3, Ubbergen, The Netherlands.
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
authors.affiliation: Department of Orthopaedics, Leiden University Medical Center, RC Leiden, The Netherlands.
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, RC Leiden, The Netherlands.
authors.forename: Leti
authors.initials: L
authors.lastname: van Bodegom-Vos
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009985:Orthopedics / Q000706:statistics & numerical data; D015207:Osteoarthritis, Hip / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen