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Management recommendations for knee osteoarthritis: how usable are they?

Poitras, Stéphane
Rossignol, Michel
Avouac, Jérôme
Avouac, Bernard
Nordin, Margareta
Rousseaux, Chantal
Rozenberg, Sylvie
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Published in Joint, Bone, Spine. 2010, vol. 77, no. 5, p. 458-465
Abstract OBJECTIVES: Despite the availability of practice guidelines for the management of knee osteoarthritis, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. Literature has shown that simply disseminating management recommendations does not lead to adherence. Research suggests that barriers to use should be identified and addressed to improve adherence. The objective of this study was to identify barriers to use of conservative management recommendations for knee osteoarthritis by patients, general practitioners and physiotherapists. METHODS: Following systematic reviews of evidence and guidelines, 12 key management recommendations were elaborated on four themes: medication, exercise, self-management and occupation. Focus groups were separately done with patients with knee osteoarthritis, general practitioners and physiotherapists to assess barriers to the use of recommendations. RESULTS: Patients and general practitioners appeared generally fatalistic with regards to knee osteoarthritis, with physiotherapists being more positive regarding long-term improvement of knee osteoarthritis. For medication, discrepancies were found between recommendations and views of clinicians. Both patients and general practitioners appeared ambivalent towards exercise and activity, recognizing its usefulness but identifying it at the same time as a cause of knee osteoarthritis. Patients and general practitioners appeared to consider weight loss particularly difficult. DISCUSSION/CONCLUSIONS: Barriers specific to each knee osteoarthritis management recommendation and stakeholder group were identified. Recommendations to address these barriers were elaborated. Results of this study can be used to develop implementation strategies to overcome identified barriers, with the goal of facilitating the use of guideline recommendations and improving outcomes.
Keywords Acetaminophen/therapeutic useAgedAged, 80 and overAnalgesics, Non-Narcotic/therapeutic useAnti-Inflammatory Agents, Non-Steroidal/therapeutic useAttitude to HealthDisease ManagementFemaleGeneral PracticeGuideline AdherenceHumansMaleMiddle AgedOsteoarthritis, Knee/drug therapy/rehabilitation/*therapyPatient CompliancePhysical ExertionPhysical Therapy ModalitiesPhysician's Practice PatternsPractice Guidelines as TopicWeight Loss
PMID: 20851659
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POITRAS, Stéphane et al. Management recommendations for knee osteoarthritis: how usable are they?. In: Joint, Bone, Spine, 2010, vol. 77, n° 5, p. 458-465. doi: 10.1016/j.jbspin.2010.08.001 https://archive-ouverte.unige.ch/unige:21223

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Deposited on : 2012-05-23

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