Physiotherapy practice patterns in the management of patients with knee osteoarthritis: A national survey on the use of clinical practice guidelines.

Abstract

Most published clinical practice guidelines (CPGs) endorsed therapeutic exercises, education, and body weight management as the gold standard for managing knee osteoarthritis (OA). However, it is difficult to ascertain whether the physiotherapy practice pattern in Ghana uniformly conforms to the generally accepted standard. Our aim was to describe the patterns of physiotherapists' practice with respect to Knee OA in a low-resource setting. A web-based nationwide cross-sectional survey was performed among registered members of the Ghana Physiotherapy Association. Consented participants were sampled into the study through a purposive sampling method. A self-designed and validated questionnaire was administered to obtain the participants' awareness of CPGs, while the selection of modalities by the physiotherapists was based on a clinical vignette. Exploratory analysis of data was performed for the association of the age, sex, education, and the number of patients managed per week with the awareness of CPGs, using the Chi-square test at a significance level of p<0.05. Of the total 165 participants, only 148 responded and were included for data analysis. Sixty-one (41.2%) of the 148 respondents were aware of specific CPGs for knee OA management, even though 98 (66.2%) utilized OA-specific outcome measures for management evaluation. Majority of the participants (90.5%) commonly selected therapeutic exercises, and 83.8% utilized education for weight management. Transcutaneous electrical nerve stimulation and ice therapy were selected by 68.2% and 66.2% of the respondents, respectively. The number of patients managed per week was not significantly associated (p>0.05) with the awareness of CPGs. Our findings show high utilization of therapeutic exercises and patients' education in the management of knee OA despite the low awareness of OA-specific CPGs. The inclusion of passive modalities coupled with the physiotherapists' low awareness underpins the need for continuing education on condition-specific CPGs.