Barriers impeding the use of non-pharmacological, non-surgical care in hip and knee osteoarthritis: The views of general practitioners, physiotherapists and medical specialists

Abstract

Background: Non-pharmacological, non-surgical treatment modalities are underused in the management of knee and hip osteoarthritis (OA). One possible explanation for this could be healthcare providers’ opinions about these treatment modalities. The objective of this qualitative study was to identify healthcare providers’ views on non-pharmacological, non-surgical care for OA. Methods: Semi-structured in-depth interviews with 24 healthcare providers (rheumatologists, orthopedic surgeons, physical therapists and general practitioners) were held. Interviews were transcribed verbatim and analyzed using a three-step thematic approach. Two independent researchers continuously reflected upon, compared, discussed, and adjusted the codings. Results: Eight themes were identified reflecting three main barriers to the provision of non-pharmacological, non-surgical care: perceived lack of expertise of the healthcare provider (including a lack of knowledge and skills that are required to support patients), perceived lack of evidence-based treatment (regarding weight management, and the intensity and dosage of physical exercise), and suboptimal organization of care (including hampered dialogue between disciplines and lack of clarity about the roles and responsibilities of disciplines). Conclusions: Healthcare providers report multiple barriers impeding non-pharmacological, non-surgical care for patients with knee and hip OA. To overcome these barriers, education focused on initiating and supporting lifestyle changes, promotion of interventions according to evidence-based recommendations, and improved organization of care are proposed.