Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Newcastle-under-Lyme, UK.
BMC Fam Pract. 2010 Jan 18;11:4. doi: 10.1186/1471-2296-11-4.
Joint pain, specifically chronic knee pain (CKP), is a frequent cause of chronic pain and limitation of function and mobility among older adults. Multiple evidence-based guidelines recommend exercise as a first-line treatment for all patients with CKP or knee osteoarthritis (KOA), yet healthcare practitioners' attitudes and beliefs may limit their implementation. This systematic review aims to identify the attitudes, beliefs and behaviours of General Practitioners (GPs) regarding the use of exercise for CKP/KOA.
We searched four electronic databases between inception and January 2008, using subject headings to identify studies examining the attitudes, beliefs or behaviours of GPs regarding the use of exercise for the treatment of CKP/KOA in adults aged over 45 years in primary care. Studies referring to patellofemoral pain syndrome or CKP secondary to other causes or that occurring in a prosthetic joint were excluded. Once inclusion and exclusion criteria were applied, study data were extracted and summarised. Study quality was independently reviewed using two assessment tools.
From 2135 potentially relevant articles, 20 were suitable for inclusion. A variety of study methodologies and approaches to measuring attitudes beliefs and behaviours were used among the studies. Quality assessment revealed good reporting of study objective, type, outcome factors and, generally, the sampling frame. However, criticisms included use of small sample sizes, low response rates and under-reporting of non-responder factors. Although 99% of GPs agreed that exercise should be used for CKP/KOA and reported ever providing advice or referring to a physiotherapist, up to 29% believed that rest was the optimum management approach. The frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies (exercise advice 9%-89%; physiotherapy referral 44%-77%) than reviews of actual practice (exercise advice 5%-52%; physiotherapy referral 13-63%). Advice to exercise and exercise prescription were not clearly differentiated.
Attitudes and beliefs of GPs towards exercise for CKP/KOA vary widely and exercise appears to be underused in the management of CKP/KOA. Limitations of the evidence base include the paucity of studies directly examining attitudes of GPs, poor methodological quality, limited generalisability of results and ambiguity concerning GPs' expected roles. Further investigation is required of the roles of GPs in using exercise as first-line management of CKP/KOA.
关节疼痛，特别是慢性膝关节疼痛（CKP），是老年人慢性疼痛和功能及活动受限的常见原因。多项基于证据的指南建议将运动作为所有 CKP 或膝骨关节炎（KOA）患者的一线治疗方法，然而医疗保健从业者的态度和信念可能会限制其实施。本系统评价旨在确定全科医生（GP）对使用运动治疗 CKP/KOA 的态度、信念和行为。
我们在 2008 年 1 月之前在四个电子数据库中进行了搜索，使用主题词来确定研究全科医生在初级保健中使用运动治疗 CKP/KOA 的态度、信念或行为的研究。排除髌股疼痛综合征或由其他原因引起的 CKP 或发生在假体关节中的 CKP。一旦应用了纳入和排除标准，就提取和总结了研究数据。使用两种评估工具对研究质量进行了独立审查。
从 2135 篇可能相关的文章中，有 20 篇适合纳入。研究中使用了各种研究方法和测量态度、信念和行为的方法。质量评估显示，研究目标、类型、结果因素以及总体抽样框架的报告良好。然而，批评包括使用小样本量、低应答率和未报告非应答者因素。尽管 99%的全科医生认为运动应该用于 CKP/KOA，并报告曾提供过建议或转介给物理治疗师，但多达 29%的人认为休息是最佳管理方法。实际提供运动建议或物理治疗转介的频率较低。基于案例的研究中提供运动建议和物理治疗转介的估计值通常较高（运动建议 9%-89%；物理治疗转介 44%-77%），而实际实践的综述则较低（运动建议 5%-52%；物理治疗转介 13-63%）。运动建议和运动处方没有明确区分。
全科医生对 CKP/KOA 运动的态度和信念差异很大，运动在 CKP/KOA 的治疗中似乎使用不足。证据基础的局限性包括直接检查全科医生态度的研究数量较少、方法学质量差、结果的普遍性有限以及关于全科医生预期角色的模糊性。需要进一步研究全科医生在将运动作为 CKP/KOA 的一线治疗中的作用。
