Stakeholder opinion of care pathways to increase physical activity in individuals with knee osteoarthritis in Saudi Arabia

Abstract

Purpose: In our prior research in Saudi Arabia, we have found that individuals with Knee Osteoarthritis (OA) and healthy controls were physically inactive with high body composition. This finding was not expected since there are recommendations on physical activity levels for adults. However, the utilisation of such recommendation and organisation of care by the healthcare providers in this setting, as well as the attitude and awareness of members of society to physical activity has not been addressed yet. Therefore, this study aimed to explore: 1. Stakeholder perspectives on the opportunities and barriers to physical activity in Saudi Arabia for individuals with knee osteoarthritis.2. Stakeholder perspectives on healthcare delivery for individuals with knee osteoarthritis in Saudi Arabia. Methods: A qualitative design using semi-structured telephone interviews. Recruitment of a purposive sample was carried out by social media posts and advertisements at local hospitals in the three main regions in Saudi Arabia (Western, Central and Eastern). The interview schedule was guided by the literature around knee OA management and healthcare system in Saudi Arabia, physical activity studies and the findings of a prior study. Interviews were digital audio recorded and were transcribed verbatim and translated from Arabic to English. Data were analysed using thematic analysis. After familiarisation with data, two researchers coded 40% of the interviews independently and agreed on the coding in discussion with a 3rd reviewer. All of the manuscripts were coded by the lead researcher. Codes were grouped into categories and themes inductively by the lead applicant and discussed and agreed upon with the rest of the team. Data were managed using NVIVO software. Ethical approval was obtained from the School of Healthcare Sciences at Cardiff University. Results: 26 interviews were carried out with stakeholders; 6 physiotherapists, five physicians, eight people with knee OA, five healthy members of the society without knee pain, one personal trainer and one teacher. Data analysis revealed four themes, which are displayed in Figure 1. Theme 1) Organisation of care for individuals with knee OA. This theme detailes the perspective of people with knee OA and stakeholders on the journey within the healthcare system in Saudi Arabia for the management of knee OA, from the time of the first contact with a healthcare professional to discharge. Key findings from this theme are an uncoordinated multidisciplinary team or organised system for the management of knee OA. The journey pathways and treatments choices were mainly dependant on the available resources, the choices of the individual with knee OA and the decisions of their physician. Theme 2) Physiotherapy service and International guidelines practice for knee OA. This theme focuses on the different issues related to the physiotherapy service such as the number and organisation of clinics, treatments protocols and adherence to treatment guidelines for knee osteoarthritis. Key findings are lack of physiotherapy clinics, delayed referrals, limited autonomy and limited use of treatment guidelines by physiotherapists. Theme 3) The Culture of Physical Inactivity. This explores the stakeholder perception of physical activity while identifying barriers to physical activity and suggestions to increase it. Key findings were several barriers that led to the state physical inactivity, especially with females. Theme 4) Stakeholders views of the healthcare system for individuals with knee OA. This theme describes the experience of individuals with knee OA with the healthcare service. The key findings were the limitations in healthcare service that led to the individuals with knee OA reporting a negative experience such as the delayed care and the repetition of care by physicians. Moreover, it revealed an issue of lack of awareness of the role physiotherapy in knee OA management. Conclusions: The findings provide insight into the healthcare provision from the perspective of stakeholders and individuals with knee OA. There was a consensus amongst all stakeholders that there was poor engagement with physical activity as part of the care for people with knee OA. Limitations and challenges were identified that could be addressed to improve the service and organisation of care. A coordinated approach to care amongst members of the multi-disciplinary team is required, with all members recognising the role that the different professions have to play. Better links with facilities within the community that can support the individuals to become more physically active and the need to promote physical activity in children's education are recommended.