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Several barriers block use of nonpharmacological, nonsurgical OA care
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Providers face various obstacles that prevent the use of non-pharmacological, non-surgical care for patients with knee and hip osteoarthritis, according to recently published findings.
In the qualitative study, researchers conducted semi-structured interviews with 24 health care providers (rheumatologists, n= 5; orthopedic surgeons, n=7; physical therapists, n=7; and general practitioners, n=5). Providers were required to be involved in OA care, speak fluent Dutch and provide informed consent.
Half of the respondents were women, with an age range of 24 years to 64 years and a range of 1 year to 35 years of experience with patients with OA. Interviews lasted for a mean of 44.7 minutes.
Through the process of analysis and repeat comparison, researchers identified eight themes that represented three main barriers to administering non-pharmacological, non-surgical care. The following were identified as themes: the patient’s difficulties with weight loss; (mis)trust for dietician management to achieve weight loss; health care providers’ role in weight loss; advice about physical activity; (mis)trust of approaches to physical therapy; the recommendation of non-surgical, non-pharmacological treatment as a means of forestalling surgery; discussion between specialties; and perception of the roles of health care provides.
The three barriers to the use of non-pharmacological, non-surgical care were as follows: perceived dearth of experience of the health care provider (including a lack of knowledge and skills needed for patient report); perceived absence of evidence-based treatment (in terms of weight management; as well as the treatment (regarding weight management, as well as the difficulty and amount of physical exercise); and inferior organization of care (including hindered discussion between medical disciplines and confusion about the roles and responsibilities of these disciplines). The two most commonly recommended non-surgical, non-pharmacological approaches recommended by respondents were weight loss and physical therapy.
“The eight themes that were identified in the data provided by [general practitioners] GPs, physical therapists, rheumatologists and orthopedic surgeons reflected three general barriers to providing nonpharmacological, non-surgical treatment modalities in knee and hip OA: perceived lack of expertise of the health care provider to support patients in behavioral change, perceived lack of evidence-based treatment and suboptimal organization,” the researchers wrote. “In this discussion, based on these themes and barriers, considerations for improving the use of non-pharmacological, non-surgical care in knee and hip OA are proposed.” -by Jennifer Byrne
Disclosures: The authors report no relevant financial disclosures.
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Selten EMH, et al. J Clin Rheumatol. 2017; doi:10.1097/RHU.0000000000000562.
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