Perceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise withoneexercise-only in patients with severe knee osteoarthritis: A qualitative interview study nested in the QUADX-1 trial

Abstract

AbstractAimClinical guidelines recommend non-surgical treatment before surgery is considered in patients eligible for knee replacement (KR). Surgical treatment is provided by orthopedic surgeons and exercise therapy is provided by physical therapists. This study aimed to investigate key stakeholder perspectives on pre-operative, home-based exercise therapy withoneexercise-only in patients eligible for KR.MethodsThis qualitative study is embedded within the QUADX-1 randomized trial that investigates a model of coordinated non-surgical and surgical treatment for patients eligible for KR. Physical therapists and orthopedic surgeons working with patients with knee osteoarthritis in their daily clinical work were interviewed (one focus group and four single interviews) to explore their perceived facilitators and barriers related to pre-operative home-based exercise therapy withoneexercise-only in patients eligible for KR. Interviews were analyzed using content analysis.ResultsFrom the content analysis three main themes emerged: 1)Physical therapists’ and orthopedic surgeons’ ambivalence in their professional roles, 2)Orthopedic surgeons view on exercise, and 3)Coordinated non-surgical and surgical care.ConclusionWe found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. The physical therapists were skeptical towards over-simplified exercise therapy. The orthopedic surgeons were skeptical towards the potential lack of (long-term) effect of exercise therapy in patients eligible for KR. The consequence of these barriers and ambivalence in the professional role is important to consider when planning implementation of the model of coordinated non-surgical and surgical treatment.Trial registrationClinicalTrials.gov, ID:NCT02931058.