title: Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study.
abstract: Osteoarthritis (OA) is a common musculoskeletal condition that often leads to pain, stiffness and disability. Physiotherapy plays an important role in the management of knee OA, however we hypothesize discordance between physiotherapists' practice and existing guideline recommendations.
  
  
  
  This study aimed to measure physiotherapists' guideline adherence for knee OA. Additionally, determinants for guideline adherence at the professional and organizational level were explored, to find clues for improvement.
  
  
  
  A survey was performed among Belgian physiotherapists. Guideline adherence was measured with a set of 9 quality indicators, developed for the Belgian primary healthcare system, applicable for physiotherapists and extracted from evidence-based guidelines. Treatment modalities that do not contribute to high quality care were also examined.
  
  
  
  284 Physiotherapists responded to the survey. Compliance to the quality indicators varied between 27% and 98%. Quality indicator compliance above 80% was found for: education on the importance of exercise, delivering functional and strength exercise therapy, patient tailored exercise program, instruction of patients in appropriate exercises and referral for sports activities after therapy. Quality indicator compliance less than 50% was found for: education on the importance of weight loss, providing self-management strategies, spreading treatment session over longer periods and regular evaluations of the exercise therapy. For treatment modalities that do not contribute to high quality care, massage (49%) and cold application (24%) were most frequently applied.
  
  
  
  This study showed large variations in adherence to quality indicators in OA management by physiotherapists. Improvement strategies should focus on quality indicators related to long-term treatment options.
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium. Electronic address: david.spitaels@kuleuven.be.
authors.forename: David
authors.initials: D
authors.lastname: Spitaels
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium; IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: rosella.hermens@radboudumc.nl.
authors.forename: Rosella
authors.initials: R
authors.lastname: Hermens
authors.affiliation: Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium. Electronic address: dieter.vanassche@uzleuven.be.
authors.forename: Dieter
authors.initials: D
authors.lastname: Van Assche
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium. Electronic address: sabine.verschueren@kuleuven.be.
authors.forename: Sabine
authors.initials: S
authors.lastname: Verschueren
authors.affiliation: Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: frank.luyten@uzleuven.be.
authors.forename: Frank
authors.initials: F
authors.lastname: Luyten
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium. Electronic address: patrik.vankrunkelsven@kuleuven.be.
authors.forename: Patrik
authors.initials: P
authors.lastname: Vankrunkelsven
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D005081:Exercise Therapy / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D059825:Physical Therapists / Q000523:psychology*; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Decision making; Exercise therapy; Guideline adherence; Osteoarthritis; Physiotherapy