Background Evidence-based recommendations have the potential to improve the quality of health care by promoting interventions of proven benefit and discouraging unnecessary, ineffective, or harmful interventions. Osteoarthritis (OA) treatment recommendations are generally addressing strength training and training to increase aerobic capacity together with referral to, or treatment by, physiotherapists. Previous research has revealed that treatment of patients with OA by medical doctors show low adherence with recommendations (1). Little is not known about the treatment provided by physiotherapists in Norway and whether the treatment provided is in concordance with general recommendations for OA treatment.
Objectives To investigate knee OA treatment performed by physiotherapists in Norway and its concordance with EULAR recommendations for non-pharmacological treatment modalities.
Methods Patient records in the hospital region of middle Norway were searched to identify patients with knee OA. A letter was sent to the identified patients (N=87) asking for information about which physiotherapist they had seen for treatment. A letter was sent to the physiotherapists asking for the discharge summary, in which they are obliged to send to the referring doctor. A survey of the discharge summaries was conducted independently by 3 health professionals (two physiotherapists, one physician) to categorise and group the treatment given.
Results Response rate from patients was 93% (N=81). Of the 81, 13 (15%) had not been referred to physiotherapy treatment. Response rate from physiotherapists (N=68) was 38 (56%). Of the treatment described in the discharge summaries 7 (10%) was partly in line with EULAR recommendations; of these, all 7 used strengthening exercises and 0 used improvement of aerobic capacity as their choice of therapeutic modality.
Conclusions According to our findings it may seem that physiotherapy treatments are not always in line with recommendations for knee OA treatment. The incidence of total knee replacement is increasing, raising costs personal and societal. Physiotherapy treatment in line with recommendations may help prevent OA from progression and prevent prosthesis operations to further increase. There seems to be a need for further work to make physiotherapists implement the EULAR guidelines in their day to day work with knee OA patients.
Østerås N, Garratt A, Grotle M, Natvig B, Kjeken I, Kvien TK, Hagen KB. Patient-reported quality of care for osteoarthritis: development and testing of the osteoarthritis quality indicator questionnaire. Arthritis Care Res (Hoboken). 2013 Jul;65(7):1043-51.
Acknowledgements This study was given economic support from the central norway regional heath authority.
Disclosure of Interest None declared