Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study
BMC Health Services Research
Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study
Gro Jamtvedt 1 2
Kristin Thuve Dahm 2
Inger Holm 0 3
Signe Flottorp 2
0 Section of Health Science, Faculty of Medicine, University of Oslo , Norway
1 Centre for Evidence Based Practice, Bergen University College , Bergen , Norway
2 Norwegian Knowledge Centre for the Health Services , P.O. Box 7004, St. Olavs plass, 0103 Oslo , Norway
3 Rikshospitalet University Hospital , 0027 Oslo , Norway
Background: Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods: We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results: A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion: Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.
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ing synovial joints [1]. The number of persons affected by
OA in the western world will increase because its
prevalence increases with age [1]. Patients with knee OA are
managed in primary care, and they represent a large group
seen by physiotherapists. An overview of systematic
reviews covering physiotherapy interventions for patients
with osteoarthritis of the knee demonstrates that exercise
can reduce pain and improve function in patients with
knee OA [2]. It also indicates that low-level laser,
transcutaneous electrical nerve stimulation and acupuncture can
reduce pain, and that psychoeducation, including patient
education and self-management programmes, can
improve psychological outcomes. Thus, physiotherapy
can improve pain and function and play an important
role in the management of patients with knee OA.
Improving the quality of care is a major issue for all health
care systems, and measuring performance is essential for
the planning and evaluation of quality improvement
strategies [3-5]. Measuring performance means
comparing actual clinical practice to desired clinical practice.
Patient perspectives of care and patient outcomes can also
be included in performance measurements [3]. Most
performance studies in physiotherapy have described
management of low back pain [6-9]. Although OA is a highly
prevalent disease, little is known about the performance,
including physiotherapy for patients with OA [10].
The aim of this study was to measure physiotherapy
performance in patients with knee OA by comparing actual
clinical practice to evidence from systematic reviews.
Methods
The study was conducted among private physiotherapy
practitioners in Norway, who are integrated into primary
health care. The National Committees for Research Ethics
in Norway approved the protocol for the study.
Data collection form
For the purpose of this study, we developed a paper-based
data-collection form to register actual clinical practice for
patients with knee OA. We started the development by
visiting several practices, observing physiotherapists treating
patients with knee OA. In two one-day meetings, ten
clinicians invited through The Norwegian Physiotherapy
Association developed, piloted and revised the
data-collection form in collaboration with the researchers. We
piloted the form among 10 physiotherapists and assessed
the reliability of the form using 15 independent
observations of treatment sessions. We e (...truncated)