L.K. King, MD, MSc, G.A. Hawker, MD, MSc, Department of Medicine, University of Toronto, and Women's College Research Institute, Women's College Hospital.
E.J. Waugh, PhD, BScPT, Department of Physical Therapy, University of Toronto.
J Rheumatol. 2022 Dec;49(12):1365-1371. doi: 10.3899/jrheum.220535. Epub 2022 Sep 15.
Delivering person-centered care in individuals with knee osteoarthritis (OA) necessitates consideration of other chronic conditions that frequently co-occur. We sought to understand the extent to which arthritis therapists consider type 2 diabetes mellitus (T2DM) when treating persons with knee OA and concomitant T2DM, and barriers to doing so.
We conducted 18 semistructured telephone interviews with arthritis therapists working within a provincially funded arthritis care program (Arthritis Society Canada) in Ontario, Canada. We first analyzed interviews deductively using the Theoretical Domains Framework (TDF) to comprehensively identify barriers and enablers to health behaviors. Then, within TDF domains, we inductively developed themes.
We identified 5 TDF domains as prominently influencing the behavior of arthritis therapists considering concomitant T2DM when developing a knee OA management plan. These were as follows: therapists' perceived lack of specific knowledge around comorbidities including diabetes; the lack of breadth in skills in behavioral change techniques to help patients set and reach their goals, particularly when it came to physical activity; variable intention to factor a patient's comorbidity profile to influence their treatment recommendations; the perception of their professional role and identity as joint focused; and the environmental context with lack of formalized follow-up structure of the current Arthritis Society Canada program that limited sufficient patient monitoring and follow-up.
Within the context of a Canadian arthritis program, we identified several barriers to arthritis therapists considering T2DM in their management plan for persons with knee OA and T2DM. These results can help inform strategies to improve person-centered OA care and overall health outcomes.
在患有膝骨关节炎（OA）的个体中提供以患者为中心的护理需要考虑经常同时发生的其他慢性疾病。我们旨在了解关节炎治疗师在治疗同时患有膝 OA 和 2 型糖尿病（T2DM）的患者时，在多大程度上考虑到 2 型糖尿病，以及存在哪些障碍。
我们在加拿大安大略省一个省级资助的关节炎护理计划（加拿大关节炎协会）中进行了 18 次半结构化电话访谈，采访了关节炎治疗师。我们首先使用理论领域框架（TDF）对访谈进行演绎分析，以全面识别影响健康行为的障碍和促进因素。然后，在 TDF 领域内，我们进行了归纳主题开发。
我们确定了 5 个 TDF 领域，这些领域明显影响着关节炎治疗师在制定膝 OA 管理计划时考虑同时患有 T2DM 的行为。这些领域如下：治疗师对包括糖尿病在内的合并症缺乏特定知识；行为改变技术技能的广度不足，无法帮助患者设定和实现目标，特别是在体力活动方面；根据患者的合并症情况来影响其治疗建议的意愿存在差异；将患者的专业角色和身份视为专注于关节；以及当前加拿大关节炎协会计划缺乏正式的后续结构，这限制了对患者的充分监测和随访，从而导致环境背景不佳。
在加拿大关节炎计划的背景下，我们确定了关节炎治疗师在考虑同时患有膝 OA 和 T2DM 的患者的管理计划时存在一些障碍。这些结果可以帮助制定策略，以改善以患者为中心的 OA 护理和整体健康结果。
