Knee osteoarthritis: a critical appraisal of clinical practice guidelines and an investigation into the self-reported clinical practice of physiotherapists working in Canada

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Tittlemier, Brenda
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Background: As the incidence of knee osteoarthritis (OA) increases, physiotherapists can help people manage OA by utilizing clinical practice guidelines (CPGs) to recommend treatment options. Purposes: 1) assess the quality of newly developed or recently updated CPGs for knee OA, 2) summarize the non-pharmacological recommendations in the CPGs, 3) establish self-reported clinical practice of physiotherapists in Canada, 4) investigate beliefs, barriers and facilitators pertaining to CPGs and 5) compare the clinical practice of physiotherapists with recommendations in the CPGs. Methods: Two pairs of evaluators used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to appraise CPGs with non-pharmacological recommendations for people with knee OA. The included CPGs were published between January 2014 and January 2019. We conducted an online survey to investigate the clinical practice of physiotherapists and gather information on CPGs. Physiotherapists who were licensed to practice in Canada and treated people with knee OA were eligible to participate. Results: A total of 10 clinical practice guidelines were included in the critical appraisal and six of those were deemed to be high quality. Nearly all guidelines recommended education, exercise and weight management for individuals with knee OA. Data from physiotherapists who responded to the survey (n = 388) indicated that almost all respondents provided education and strengthening exercises. Less than 60% offered aerobic exercise and weight-management advice. Of the respondents, 271 individuals were aware of CPGs and 253 reported they followed CPGs. As well, 204 respondents reported barriers and 117 reported facilitators to utilizing CPGs. Conclusion: Most CPGs we appraised were high quality and agreed that education, exercise and weight-management advice should be standard recommendations offered to people with knee OA. Physiotherapists provided aspects of care that aligned with the core recommendations found in the CPGs, such as offering education and leg strengthening exercises. We recommend that physiotherapists who treat people with knee OA in Canada assess their clinical practice to ensure the care they provide is aligned with evidence-based research for people with knee OA thus helping people maximize their quality of life, mobility and function. Key words: care-maps, knee osteoarthritis, knee osteo-arthritis, non-pharmacological/ non- surgical clinical practice guidelines, pathways, physiotherapy, recommendations
Knee Osteoarthritis, Physiotherapy, Practice Guidelines, Survey