Research Article
13 September 2016

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

Publication: Physiotherapy Canada
Volume 69, Number 1

Abstract

Abstract

Purpose: It is unclear how physical therapists in Florida currently treat people with knee osteoarthritis and whether current best evidence is used in clinical decision making. Methods: We conducted a survey of physical therapists in Florida. We assessed the perceived effectiveness and actual use of physical therapy (PT) interventions and quantified the association between the actual use of interventions and different characteristics of physical therapists. Results: A total of 413 physical therapists completed the survey. Most respondents perceived therapeutic exercise (94%) and education (93%) as being effective or very effective. Interventions least perceived as effective or very effective were electrotherapy (28%), wedged insole (20%), and ultrasound (19%). Physical therapists who followed the principles of evidence-based practice were more likely to use therapeutic exercise (OR 3.89; 95% CI: 1.21, 12.54) and education (OR 3.63; 95% CI: 1.40, 9.43) and less likely to use ultrasound (OR 0.32; 95% CI: 0.16, 0.63) and electrotherapy (OR 0.32; 95% CI: 0.17, 0.58). Results also indicated that older physical therapists were more likely to use ultrasound (OR 3.57; 95% CI: 1.60, 7.96), electrotherapy (OR 2.53; 95% CI: 1.17, 5.47), kinesiology tape (OR 3.82; 95% CI: 1.59, 9.18), and ice (OR 1.95; 95% CI: 1.02, 3.73). Conclusions: In line with clinical guidelines, most physical therapists use therapeutic exercise and education to treat people with knee osteoarthritis. However, interventions that lack scientific support, such as electrotherapy and ultrasound, are still used. A modifiable therapist characteristic, adherence to evidence-based practice, is positively associated with the use of interventions supported by scientific evidence.

Résumé

Objectif : on ne sait pas comment les physiothérapeutes de la Floride traitent les personnes atteintes d'arthrose du genou et s'ils tiennent compte des meilleures données probantes dans leur prise de décisions cliniques. Méthode : nous avons mené un sondage auprès des physiothérapeutes de la Floride. Nous avons évalué l'efficacité perçue et le recours réel aux interventions de physiothérapie (PT) et avons quantifié le lien entre le recours réel aux interventions et différentes caractéristiques des physiothérapeutes. Résultats : au total, 413 physiothérapeutes ont répondu au sondage. La plupart des répondants croient que les exercices thérapeutiques (94 %) et l'éducation (93 %) sont efficaces ou très efficaces. Les interventions les moins perçues comme étant efficaces ou très efficaces sont l'électrothérapie (28 %), les orthèses plantaires (20 %) et les ultrasons (19 %). Les physiothérapeutes qui suivent les principes de la pratique fondée sur des données probantes sont plus susceptibles d'avoir recours aux exercices thérapeutiques (rapport des cotes [RC]=3,89; IC à 95 % 1,21; 12,54) et à l'éducation (RC 3,63; IC à 95 % 1,40; 9,43) et sont moins susceptibles d'utiliser l'ultrason (RC 0,32; IC à 95 % 0,16; 0,63) et l'électrothérapie (RC 0,32; IC à 95 % 0,17; 0,58). Les résultats indiquent aussi que les physiothérapeutes plus âgés sont plus susceptibles d'utiliser l'ultrason (RC 3,57; IC à 95 % 1,60; 7,96), l'électrothérapie (RC 2,53; IC à 95 % 1,17; 5,47), le ruban kinésiologique (RC 3,82; IC à 95 % 1,59; 9,18) et la glace (RC 1,95; IC à 95 % 1,02; 3,73). Conclusions : conformément aux normes de pratique clinique, la plupart des physiothérapeutes ont recours aux exercices thérapeutiques et à l'éducation pour traiter les personnes atteintes d'arthrose du genou. Cependant, des interventions peu appuyées par la science, comme l'électrothérapie et l'ultrason, sont toujours utilisées. Une caractéristique modifiable du thérapeute, l'adhésion à la pratique fondée sur des données probantes, est associée de manière positive au recours aux interventions appuyées par les données scientifiques.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Altman R, Brandt K, Hochberg M, et al. Design and conduct of clinical trials in patients with osteoarthritis: recommendations from a task force of the Osteoarthritis Research Society. Osteoarthritis Cartilage. 1996;4(4):217–43. https://doi.org/10.1016/S1063-4584(05)80101-3. Medline:11048620
2.
Rosemann T, Wensing M, Joest K, et al. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses. BMC Musculoskelet Disord. 2006;7(1):48. https://doi.org/10.1186/1471-2474-7-48. Medline:16749935
3.
Nüesch E, Dieppe P, Reichenbach S, et al. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ. 2011;342:d1165. https://doi.org/10.1136/bmj.d1165. Medline:21385807
4.
Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56. Medline:14710506
5.
Pavelka K. Symptomatic treatment of osteoarthritis: paracetamol or NSAIDs? Int J Clin Pract Suppl. 2004;(144):5–12. Medline:16035397
6.
Brakke R, Singh J, Sullivan W. Physical therapy in persons with osteoarthritis. PM R. 2012;4(5 Suppl):S53–8. https://doi.org/10.1016/j.pmrj.2012.02.017. Medline:22632703
7.
Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376. Medline:25569281
8.
Fibel KH, Hillstrom HJ, Halpern BC. State-of-the-art management of knee osteoarthritis. World J Clin Cases. 2015;3(2):89–101. https://doi.org/10.12998/wjcc.v3.i2.89. Medline:25685755
9.
Hochberg MC, Altman RD, April KT, et al.; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465–74. https://doi.org/10.1002/acr.21596. Medline:22563589
10.
Hauk L. Treatment of knee osteoarthritis: a clinical practice guideline from the AAOS. Am Fam Physician. 2014;89(11):918–20. Medline:25077402
11.
Bennell KL, Egerton T, Pua YH, et al. Building the rationale and structure for a complex physical therapy intervention within the context of a clinical trial: a multimodal individualized treatment for patients with hip osteoarthritis. Phys Ther. 2011;91(10):1525–41. https://doi.org/10.2522/ptj.20100430. Medline:21817012
12.
Holden MA, Nicholls EE, Hay EM, et al. Physical therapists' use of therapeutic exercise for patients with clinical knee osteoarthritis in the United Kingdom: in line with current recommendations? Phys Ther. 2008;88(10):1109–21. https://doi.org/10.2522/ptj.20080077. Medline:18703675
13.
Walsh NE, Hurley MV. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskelet Care. 2009;7(1):45–56. https://doi.org/10.1002/msc.144. Medline:18972322
14.
Pham T, van der Heijde D, Altman RD, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage. 2004;12(5):389–99. https://doi.org/10.1016/j.joca.2004.02.001. Medline:15094138
15.
Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393. https://doi.org/10.1136/bmj.b2393. Medline:19564179
16.
Mortimer R, Privopoulos M, Kumar S. The effectiveness of hydrotherapy in the treatment of social and behavioral aspects of children with autism spectrum disorders: a systematic review. J Multidiscip Healthc. 2014;7:93–104. Medline:24520196
17.
Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord. 2011;12(1):123. https://doi.org/10.1186/1471-2474-12-123. Medline:21635746
18.
Rutjes AW, Nüesch E, Sterchi R, et al. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010;(1):CD003132. Medline:20091539
19.
Rutjes AW, Nüesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823. Medline:19821296
20.
Brosseau L, Yonge KA, Robinson V, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(4):CD004522. Medline:14584019
21.
Jevsevar DS. Treatment of osteoarthritis of the knee: Evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013; 21(9): 571–6
22.
McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363–88. https://doi.org/10.1016/j.joca.2014.01.003. Medline:24462672
23.
Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786–805. Medline:12940766
24.
Bernhardsson S, Johansson K, Nilsen P, et al. Determinants of guideline use in primary care physical therapy: a cross-sectional survey of attitudes, knowledge, and behavior. Phys Ther. 2014;94(3):343–54. https://doi.org/10.2522/ptj.20130147. Medline:24179140
25.
Nilsen P, Bernhardsson S. Towards evidence-based physiotherapy—research challenges and needs. J Physiother. 2013;59(3):143–4. https://doi.org/10.1016/S1836-9553(13)70178-4. Medline:23896329
26.
Tilson JK, Mickan S. Promoting physical therapists' of research evidence to inform clinical practice: part 1—theoretical foundation, evidence, and description of the PEAK program. BMC Med Educ. 2014;14(1):125. https://doi.org/10.1186/1472-6920-14-125. Medline:24965501
27.
Tilson JK, Mickan S, Sum JC, et al. Promoting physical therapists' use of research evidence to inform clinical practice: part 2—a mixed methods evaluation of the PEAK program. BMC Med Educ. 2014;14(1):126. https://doi.org/10.1186/1472-6920-14-126. Medline:24965574
28.
Craig P, Dieppe P, Macintyre S, et al.; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. https://doi.org/10.1136/bmj.a1655. Medline:18824488
29.
Alexandre NM, Nordin M, Hiebert R, et al. Predictors of compliance with short-term treatment among patients with back pain. Rev Panam Salud Publica. 2002;12(2):86–94. https://doi.org/10.1590/S1020-49892002000800003. Medline:12243693

Information & Authors

Information

Published In

Go to Physiotherapy Canada
Physiotherapy Canada
Volume 69Number 1Winter 2017
Pages: 30 - 37

History

Published online: 13 September 2016
Published in print: Winter 2017

Key Words

  1. knee
  2. osteoarthritis
  3. survey

Mots clés

  1. arthrose
  2. physiothérapie
  3. sondages en soins de santé

Authors

Affiliations

Bruno R. da Costa, MScPT, PhD
Department of Physical Therapy, Florida International University, Miami
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
Edgar Ramos Vieira, MScPT, PhD
Department of Physical Therapy, Florida International University, Miami
Inae Caroline Gadotti, MScPT, PhD
Department of Physical Therapy, Florida International University, Miami
Conner Colosi, DPT
Department of Physical Therapy, Florida International University, Miami
James Rylak, DPT
Department of Physical Therapy, Florida International University, Miami
Travis Wylie, DPT
Department of Physical Therapy, Florida International University, Miami
Susan Armijo-Olivo, MScPT, PhD
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton

Notes

Contributors: All authors designed the study; or collected, analyzed, or interpreted the data; and drafted or critically revised the article and approved the final draft.
Competing Interests: None declared.
Correspondence to: Bruno R. da Costa, Institute of Primary Health Care (BIHAM), University of Bern, Gesellschaftstrasse 49, 3012 Bern, Switzerland; [email protected].

Metrics & Citations

Metrics

VIEW ALL METRICS

Related Content

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

Format





Download article citation data for:
Bruno R. da Costa, Edgar Ramos Vieira, Inae Caroline Gadotti, Conner Colosi, James Rylak, Travis Wylie, and Susan Armijo-Olivo
Physiotherapy Canada 2017 69:1, 30-37

View Options

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF

View PDF

EPUB

View EPUB

Full Text

View Full Text

Figures

Tables

Media

Share

Share

Copy the content Link

Share on social media

About Cookies On This Site

We use cookies to improve user experience on our website and measure the impact of our content.

Learn more

×