Orthopaedic Department, Liverpool Hospital, Liverpool, Australia.
Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia.
Physiother Theory Pract. 2024 Feb;40(2):347-356. doi: 10.1080/09593985.2022.2114816. Epub 2022 Aug 27.
Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector.
To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained.
A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines.
Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was -3.4 (-5.5 to -1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring.
Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes.
在澳大利亚，针对初级保健物理治疗师管理膝骨关节炎（OA）的循证临床实践指南的系统实施仍处于起步阶段。临床实践指南已以多学科计划的形式在州一级的公共医疗保健部门中实施，但在私营部门，以物理治疗为主的 OA 管理计划的覆盖面远远不够。
提供澳大利亚私人物理治疗实践中 OA 患者管理的快照。主要目的是确定所提供的治疗与基于指南的管理之间的一致性。次要目标包括在 3 个月后患者报告的改善情况和对治疗的满意度。还确定是否常规使用患者报告的结局测量指标（PROM）。
一项前瞻性、观察性研究，纳入了 9 家初级保健物理治疗诊所的年龄≥45 岁的膝 OA 成年患者。研究人员收集了膝关节损伤 OA 结局评分（KOOS）和常规评估患者指数 3（RAPID3）（基线；3 个月），以及对治疗的满意度。从物理治疗记录审核和患者访谈中获取治疗细节和 PROM 的使用情况。所提供的治疗与 OA 管理指南规定的最低核心管理要素进行了比较。
26 名成年人（58%为女性，平均年龄 60[9]岁，54%超重或肥胖）参与了研究。100%的患者被开具了≥1 种适当的运动；42%接受了 OA 教育；12%接受了体重管理建议。KOOS 疼痛的平均改善（95%CI）为 9.8（3.4 至 16.1），RAPID3 为-3.4（-5.5 至-1.3）。对治疗的满意度很高（8.3/10）。没有使用任何 PROM 进行评估或监测。
初级保健物理治疗师治疗膝 OA 不符合临床实践指南的最低标准。然而，患者在三个月时的改善达到了患者报告测量的最小重要变化阈值，并且满意度很高。这些数据提供了有用的见解，了解了不足之处，因此，应该为未来旨在改善护理提供和常规测量患者报告结果的实施策略提供信息。
