Abstract
BackgroundExercise is a recommended ‘core’ treatment for chronic knee pain (CKP), however it appears to be underused by general practitioners (GPs). While behavioural theories suggest that attitudes and beliefs influence behaviours, no single theory reliably predicts GPs’ behaviours. A theoretical analysis framework, developed from sociocognitive theories, was used to underpin investigation of the key influences associated with GPs’ use of exercise for patients with CKP, to inform future interventions to optimise GPs’ use of exercise.MethodsA cross-sectional postal questionnaire survey investigated UK GPs’ reported use of exercise based on a patient case vignette. Factors influencing GPs’ exercise use (behaviour) were examined using attitude statements, free-text questions and multiple response option questions related to factors within the analysis framework. Unadjusted logistic regression analyses explored the associations between GPs’ attitudes/beliefs and behaviour.ResultsFrom a total sample of 5000 GPs, 835 (17%) returned a questionnaire. Most respondents (n = 729, 87%) reported that they would use exercise. Factors significantly associated with exercise use (OR (95% CI)) included GPs’ beliefs about their role (belief that GPs should give information on type, duration and frequency of exercise (30.71 (5.02,188.01)), beliefs about consequences (agreement that knee problems are improved by local (3.23 (1.94,5.39)) and general exercise (2.63 (1.38,5.02))), moral norm (agreement that GPs should prescribe all patients local (3.08 (1.96,4.83)) and general exercise (2.63 (1.45,4.76))), and GP-related beliefs about capabilities (prior experience of insufficient expertise to give detailed exercise information (0.50 (0.33,0.76)). Whilst perceived time limitations were not associated with exercise use (1.00 (0.33,3.01)), GPs who disagreed that they experienced time limitations were more likely to suggest general (2.17 (1.04,4.55)), or demonstrate local (2.16 (1.06,4.42)), exercises.ConclusionGPs’ attitudes and beliefs are associated with their use of exercise for patients with CKP, particularly beliefs about role, responsibilities and skills in initiating exercise, and about the efficacy of exercise. Although the low response risks response bias, these results can inform future interventions to optimise GPs’ behaviour. The role of GP uncertainty and influences on clinical decision-making need further exploration, thus an amended analysis framework is suggested, which should be tested in future research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0570-4) contains supplementary material, which is available to authorized users.
Highlights
Exercise is a recommended ‘core’ treatment for chronic knee pain (CKP), it appears to be underused by general practitioners (GPs)
Given that the predictive ability of existing theoretical models is reduced among doctors when compared with nurses and other healthcare professionals (HCPs) [12], and that GPs have significantly different attitudes about clinical guidelines when compared with other doctors [15], a specific focus on GPs, rather than Healthcare professional (HCP) in general, is appropriate
The aim of the current study was to investigate the key influences associated with GPs’ reported exercise use for patients with CKP using a cross-sectional questionnaire survey informed by an analysis framework developed using sociocognitive theories
Summary
Exercise is a recommended ‘core’ treatment for chronic knee pain (CKP), it appears to be underused by general practitioners (GPs). Chronic knee pain (CKP) in older adults, defined in this work as being synonymous with clinical knee osteoarthritis (OA) [1], is a common presentation to general practitioners (GPs) [2, 3] Exercise, including both general aerobic and local strengthening exercise [4], is recommended as ‘core’ treatment for CKP [1] and empirical research evidence unequivocally demonstrates that exercise improves pain and functioning in affected patients [5]. Most recent theories recognise the non-linear association between attitudes, beliefs and behaviours resulting from multiple potential influences on an individuals’ behaviour This is complicated further when a second person (e.g. a patient) is involved in the behaviour, as is the case for GPs’ clinical behaviours (the ways GPs act in the clinical context). None of these studies explicitly referenced behavioural theory, some alluded to this, for example acknowledging that clinical behaviours can be influenced by GP factors such as beliefs and ‘cognitive rationales’ [16,17,18,19], patient-
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
