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Open Access 01-12-2023 | Osteoarthrosis | Research

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Authors: Carolin Bahns, Christian Kopkow

Published in: BMC Musculoskeletal Disorders | Issue 1/2023

Abstract

Background

Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use.

Methods

A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen.

Results

In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline.

Conclusions

In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice.

Trial registration

German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2013;2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858. https://doi.org/10.1016/S0140-6736(18)32279-7.CrossRef

Hunter DJ, Bierma-Zeinstra S, Osteoarthritis. Lancet. 2019;393(10182):1745–59. https://doi.org/10.1016/S0140-6736(19)30417-9.CrossRefPubMed

Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 2008;34(3):623–43. https://doi.org/10.1016/j.rdc.2008.05.004.CrossRefPubMedPubMedCentral

Turkiewicz A, Petersson IF, Björk J, Hawker G, Dahlberg LE, Lohmander LS, et al. Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032. Osteoarthr Cartil. 2014;22(11):1826–32. https://doi.org/10.1016/j.joca.2014.07.015.CrossRef

Fuchs J, Rabenberg M, Scheidt-Nave C. [Prevalence of selected musculoskeletal conditions in Germany: Results of the German Health Interview and Examination Survey for Adults (DEGS1).]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2013;56:678–86. doi: https://doi.org/10.1007/s00103-013-1687-4.

Swain S, Sarmanova A, Mallen C, Kuo CF, Coupland C, Doherty M, et al. Trends in incidence and prevalence of osteoarthritis in the United Kingdom: findings from the clinical Practice Research Datalink (CPRD). Osteoarthr Cartil. 2020;28(6):792–801. https://doi.org/10.1016/j.joca.2020.03.004.CrossRef

Postler A, Ramos AL, Goronzy J, Günther K-P, Lange T, Schmitt J, et al. Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data. Clin Interv Aging. 2018;13:2339–49. https://doi.org/10.2147/CIA.S174741.CrossRefPubMedPubMedCentral

IOM (Institute of Medicine). Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.

Deutsche. Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). Koxarthrose. AWMF online. 2019. https://www.awmf.org/uploads/tx_szleitlinien/033-001l_S2k_Koxarthrose_2019-07_1.pdf. Accessed 18 Jan 2021.

10.

Deutsche. Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). Gonarthrose. AWMF online. 2018. https://www.awmf.org/uploads/tx_szleitlinien/033-004l_S2k_Gonarthrose_2018-01_1-verlaengert.pdf. Accessed 18 Jan 2021.

11.

Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89. https://doi.org/10.1016/j.joca.2019.06.011.CrossRef

12.

Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125. https://doi.org/10.1136/annrheumdis-2012-202745.CrossRefPubMed

13.

Kampshoff C, Peter W, van Doormaal M, Knoop J, Meerhoff G, Viliet Vlieland T. KNGF guideline for osteoarthritis of the hip-knee. Conservative, pre-operative and post-operative treatment. 2018. https://www.kngf.nl/binaries/content/assets/kennisplatform/onbeveiligd/guidelines/artrose-heup-knie-2018-prl-en-toelichting-eng_def.pdf. Accessed 25 Oct 2022.

14.

Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the management of Osteoarthritis of the Hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220–33. https://doi.org/10.1002/art.41142.CrossRefPubMedPubMedCentral

15.

NICE. Osteoarthritis in over 16s: diagnosis and management. 2022. https://www.nice.org.uk/guidance/ng226. Accessed 21 Dec 2022.

16.

El-Khoury J, Orozco T, Bernatsky S, Desmeules F, Perreault K, Woodhouse LJ, et al. Do Quebec physiotherapists follow evidence-based guidelines for treating knee osteoarthritis? Physiother Can. 2020;72(4):374–81. https://doi.org/10.3138/ptc-2019-0012.CrossRefPubMedPubMedCentral

17.

da Costa BR, Vieira ER, Gadotti IC, Colosi C, Rylak J, Wylie T, et al. How do physical therapists treat people with knee osteoarthritis, and what drives their clinical decisions? A Population-Based cross-sectional survey. Physiother Can. 2017;69(1):30–7. https://doi.org/10.3138/ptc.2015-83.CrossRefPubMedPubMedCentral

18.

Tittlemier B, Wittmeier K, Robinson D, Webber S. Knee osteoarthritis: an investigation into the clinical practice of physiotherapists in Canada. Physiother Can. 2020;73:e20190068. https://doi.org/10.3138/ptc-2019-0068.CrossRef

19.

Battista S, Salvioli S, Millotti S, Testa M, Dell’Isola A. Italian physiotherapists’ knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study. BMC Musculoskelet Disord. 2021;22(1):380. https://doi.org/10.1186/s12891-021-04250-4.CrossRefPubMedPubMedCentral

20.

Spitaels D, Hermens R, Van Assche D, Verschueren S, Luyten F, Vankrunkelsven P. Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study. Musculoskelet Sci Pract. 2017;27:112–23. https://doi.org/10.1016/j.math.2016.10.010.CrossRefPubMed

21.

French HP. Physiotherapy management of osteoarthritis of the hip: a survey of current practice in acute hospitals and private practice in the. Repub Irel Physiotherapy. 2007;93(4):253–60. https://doi.org/10.1016/j.physio.2006.12.008.CrossRef

22.

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.CrossRef

23.

Ayanniyi O, Egwu RF, Adeniyi AF. Physiotherapy management of knee osteoarthritis in Nigeria-A survey of self-reported treatment preferences. Hong Kong Physiother J. 2017;36:1–9. https://doi.org/10.1016/j.hkpj.2016.07.002.CrossRefPubMed

24.

Holden MA, Bennell KL, Whittle R, Chesterton L, Foster NE, Halliday NA, et al. How do physical therapists in the United Kingdom manage patients with hip osteoarthritis? Results of a cross-sectional survey. Phys Ther. 2018;98(6):461–70. https://doi.org/10.1093/ptj/pzy013.CrossRefPubMed

25.

Ackah M, Boakye H, Yeboah CO, Bello AI. Physiotherapy practice patterns in the management of patients with knee osteoarthritis: A national survey on the use of clinical practice guidelines. Physiother Res Int. 2022:e1964. doi: https://doi.org/10.1002/pri.1964.

26.

Naylor JM, Gibson K, Mills K, Schabrun SM, Livings R, Dennis S, et al. A snapshot of primary care physiotherapy management of knee osteoarthritis in an australian setting: does it align with evidence-based guidelines? Physiother Theory Pract. 2022;1–10. https://doi.org/10.1080/09593985.2022.2114816.

27.

Zadro J, O’Keeffe M, Maher C. Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review. BMJ Open. 2019;9(10):e032329. https://doi.org/10.1136/bmjopen-2019-032329.CrossRefPubMedPubMedCentral

28.

Sorondo D, Delpierre C, Côté P, Salmi L-R, Cedraschi C, Taylor-Vaisey A, et al. Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord. 2021;22(1):507. https://doi.org/10.1186/s12891-021-04204-w.CrossRefPubMedPubMedCentral

29.

Mota da Silva T, da Cunha Menezes Costa L, Garcia AN, Costa LOP. What do physical therapists think about evidence-based practice? A systematic review. Man Ther. 2015;20(3):388–401. https://doi.org/10.1016/j.math.2014.10.009.CrossRef

30.

Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and strategies in Guideline Implementation-A scoping review. Healthc (Basel Switzerland). 2016;4(3):36. https://doi.org/10.3390/healthcare4030036.CrossRef

31.

Paci M, Faedda G, Ugolini A, Pellicciari L. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis. Int J Qual Health Care. 2021;33(2):mzab093. https://doi.org/10.1093/intqhc/mzab093.CrossRefPubMed

32.

Bahns C, Happe L, Thiel C, Kopkow C. Physical therapy for patients with low back pain in Germany: a survey of current practice. BMC Musculoskelet Disord. 2021;22(1):563. https://doi.org/10.1186/s12891-021-04422-2.CrossRefPubMedPubMedCentral

33.

Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of mobility after stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey. BMC Neurol. 2022;22(1):284. https://doi.org/10.1186/s12883-022-02780-5.CrossRefPubMedPubMedCentral

34.

Dreier G, Hasselblatt H, Antes G, Schumacher M. Das Deutsche Register Klinischer Studien: Begründung, technische und inhaltliche aspekte, internationale Einbindung. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2009;52(4):463–8. https://doi.org/10.1007/s00103-009-0833-5.CrossRefPubMed

35.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008.CrossRef

36.

Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based checklist for reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87. https://doi.org/10.1007/s11606-021-06737-1.CrossRefPubMedPubMedCentral

37.

Harmsen M, Peters M, Wensing M. Barriers and facilitators assessment instrument introduction, instructions and instrument. IQ Scientific Institute for Quality of Healthcare Radboud University Medical Center Nijmegen; 2005.

38.

Bahns C, Scheffler B, Kopkow C. Hip and knee osteoarthritis guidelines in physiotherapy in Germany: study protocol for an implementation research project using the theoretical domains Framework and the Behaviour Change Wheel. JMIR Preprints. 2023. https://doi.org/10.2196/preprints.47834.CrossRef

39.

Rice WR, ANALYZING TABLES OF STATISTICAL TESTS. Evolution. 1989;43(1):223–5. https://doi.org/10.1111/j.1558-5646.1989.tb04220.x.CrossRefPubMed

40.

Barton CJ, Pazzinatto MF, Crossley KM, Dundules K, Lannin NA, Francis M, et al. Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 australian physical therapists. Braz J Phys Ther. 2021;25(6):854–63. https://doi.org/10.1016/j.bjpt.2021.08.001.CrossRefPubMedPubMedCentral

41.

Allison K, Setchell J, Egerton T, Delany C, Bennell KL. In Theory, Yes; in Practice, Uncertain: A Qualitative Study Exploring Physical Therapists’ Attitudes Toward Their Roles in Weight Management for People With Knee Osteoarthritis. Phys Ther. 2019;99(5):601 – 11. doi: https://doi.org/10.1093/ptj/pzz011.

42.

Holden MA, Waterfield J, Whittle R, Bennell K, Quicke JG, Chesterton L, et al. How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed-methods study. Musculoskelet Care. 2019;17(1):133–44. https://doi.org/10.1002/msc.1383.CrossRef

43.

Zadro JR, Ferreira G. Has physical therapists’ management of musculoskeletal conditions improved over time? Braz J Phys Ther. 2020;24(5):458–62. https://doi.org/10.1016/j.bjpt.2020.04.002.CrossRefPubMedPubMedCentral

44.

Braun T, Ehrenbrusthoff K, Bahns C, Happe L, Kopkow C. [Adherence to and influencing factors of evidence-based practice in physiotherapeutic care in Germany: a cross-sectional study]. Z Evid Fortbild Qual Gesundhwes. 2022;168:8–20. https://doi.org/10.1016/j.zefq.2021.10.004.CrossRefPubMed

45.

World Physiotherapy. Italian Association of Physiotherapy. 2021. https://world.physio/membership/italy. Accessed 21 Dec 2022.

46.

PhysioDeutschland Deutscher Verband für Physiotherapie (ZVK) e. V. Zahlen, Daten, Fakten zur Physiotherapie. 2022. https://www.physio-deutschland.de/fileadmin/data/bund/Dateien_oeffentlich/Beruf_und_Bildung/Zahlen__Daten__Fakten/Zahlen_Daten_Fakten14.1.22.pdf. Accessed 01 Nov 2022.

47.

Konrad R, Konrad A, Geraedts M. Ausbildung von Physiotherapeutinnen und Physiotherapeuten in Deutschland: Bereit für den Direktzugang? Das Gesundheitswesen. 2017;79(07):e48–e55.CrossRefPubMed

48.

Husted M, Rossen CB, Jensen TS, Mikkelsen LR, Rolving N. Adherence to key domains in low back pain guidelines: a cross-sectional study of danish physiotherapists. Physiother Res Int. 2020;25(4):e1858. https://doi.org/10.1002/pri.1858.CrossRefPubMedPubMedCentral

49.

Schiek S, Moritz K, Seichter SJ, Ghanem M, von Salis-Soglio G, Frontini R, et al. Standardising analgesic administration for nurses: a prospective intervention study. Int J Clin Pharm. 2016;38(6):1497–504. https://doi.org/10.1007/s11096-016-0311-8.CrossRefPubMed

50.

Ajimsha MS, Kooven S, Al-Mudahka N. Adherence of physical therapy with clinical practice guidelines for the rehabilitation of stroke in an active inpatient setting. Disabil Rehabil. 2019;41(15):1855–62. https://doi.org/10.1080/09638288.2018.1449257.CrossRef

51.

Skou ST, Roos EM. Good life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord. 2017;18(1):72. https://doi.org/10.1186/s12891-017-1439-y.CrossRefPubMedPubMedCentral

52.

Barton CJ, Kemp JL, Roos EM, Skou ST, Dundules K, Pazzinatto MF, et al. Program evaluation of GLA:D® Australia: physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis. Osteoarthr Cartil Open. 2021;3(3):100175. https://doi.org/10.1016/j.ocarto.2021.100175.CrossRefPubMedPubMedCentral

Title: Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice
Authors: Carolin Bahns
Christian Kopkow
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Osteoarthrosis
Osteoarthrosis
Exercise Therapy
Exercise Therapy
Published in: BMC Musculoskeletal Disorders / Issue 1/2023
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-023-06464-0

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Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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