Managing osteoarthritis: a qualitative study of novice physical therapists’ perceptions, experiences and learning needs

Abstract

Purpose: Exercise is recommended as first line management for osteoarthritis (OA) in all clinical guidelines. Physical therapists (PTs) play a critical role in OA management, mainly through the design and delivery of exercise programs. However, there is some evidence that PT practice is not always in line with recommended guidelines. Entry-to-practice PT training is critical to ensure PTs develop the requisite knowledge and skills to enact evidence-based management of OA. Novice PTs rely more on their entry-to-practice education for clinical decision making and treatment planning relative to experienced PTs and are more likely to be able to reflect on their learning gaps now that they are practising clinicians. Yet, little is known about the perceptions, experiences or learning needs of novice PTs related to OA and OA management. Methods: Ten novice PTs (PTs working for approximately two years or less) participated in this qualitative descriptive study. Semi-structured interviews were conducted in person or over the phone with PTs across Canada. Sampling was purposive to achieve variation in university programs and geographic locations across Canada. The DEPICT model, an approach to collaborative qualitative data analysis, was followed, including dynamic reading of transcripts, development of a coding framework, participatory coding, summarizing of codes and collaborative analysis of codes. Themes were developed from the coded data. Results: Five themes were identified: i) Beliefs about OA: participants’ beliefs about OA pathophysiology and prognosis varied but most participants indicated OA was a disease linked to aging and “wear and tear”; ii) Role of chronic pain in OA management: managing chronic OA pain was perceived to be a challenge and participants expressed difficulty prescribing and progressing exercise in the face of persistent pain; iii) Communication with patients: participants reported low confidence in communicating a diagnosis, choosing language to discuss OA and motivating patients to adhere to exercise; iv) Appraisal of the OA curriculum: participants perceived a gap in transferring theoretical knowledge learned in their courses to clinical application on patients (clinical internships had the most significant influence on their OA knowledge); and v) Perceptions of preparedness to manage OA: participants confidence in managing OA after graduation varied; however, the majority felt inadequately prepared to manage OA. Conclusions: This research highlights novice PTs’ learning needs related to OA and OA management. Addressing these learning needs in entry-to-practice training may enhance novice PTs’ skills and confidence to manage OA, and ultimately enhance the quality of OA care.