What do physiotherapists believe is important to educate people with knee osteoarthritis about? A concept mapping study

Abstract

Introduction: Patient education is recommended by guidelines for people with knee osteoarthritis, and is commonly provided by physiotherapists. However, guidance on what patient education topics to provide is limited. This study aims to identify and categorise education topics that physiotherapists think should be provided to people with knee osteoarthritis, including perceived importance of, and capability to provide, each topic. Methods: Physiotherapists working in Australia participated in this mixed-methods concept mapping study to (i) generate (brainstorm) education topics they thought were important for people with knee osteoarthritis; (ii) group (sorted into clusters) topics into themes; and (iii) rate each topic on perceived importance and capability to provide (0–5 Likert: 0 = lowest/least; 5 = highest/most)). Multidimensional scaling and hierarchical cluster analysis were used to produce a cluster map of related topics from participant sorting data. Overall domains were identified. Rating outcomes were reported descriptively. Results: Brainstorming by 41 physiotherapists identified 56 unique patient education topics. Thirteen additional topics were added from published clinical practice guidelines and previous expert consensus, resulting in 69 topics to sort and rate. Sorting and rating led to an eight-cluster map emerging as the most appropriate representation of the data: Exercise-therapy (23 statements), Radiology misconceptions (5), Understanding and managing pain and disability (12), Lifestyle modification and general health (9), Weight management (4), General beliefs and understanding about osteoarthritis (8), Surgery (6), and Medications (2). Statements in the ‘Exercise-therapy’ cluster received the highest mean importance (3.84/5) and perceived capability to provide (4.00) ratings. Statements in the ‘Medications’ and ‘Weight management’ clusters received the lowest average importance (2.54) and capability to provide (2.82) ratings. Overarching domains were; i) first-line care, ii) knowledge formation and countering misconceptions and, iii) decision making for medical management. Most statements added from clinical practice guidelines and clinical research were rated below the all-statement average for importance (61%, 8/13) and capability (69%, 9/13). Discussion: Australian physiotherapists in this study believe a diverse range of patient education topics are important for people with knee osteoarthritis. Education about exercise-therapy was considered most important and was also the topic participants reported they were most capable at providing. Conversely, education about other commonly recommended osteoarthritis treatments including medications and weight management were considered least important, and participants felt least capable to provide. In future, clinical practice guidelines should consider including guidance on how to implement patient education to cover topics identified by physiotherapists in this study. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.