Management of mild to moderate osteoarthritis : an insight into the perspectives of physiotherapists and general practitioners

Abstract

Research question: How do General Practitioners and Physiotherapists manage mild to moderate osteoarthritis in the local primary health care? Design: A complementarity mixed method design using surveys, an interview and a focus group. Methods: A vignette-based survey was sent to all general practitioners and physiotherapists working in Malta. The quantitative data was analysed via descriptive statistics and the open-ended questions were analysed through a thematic analysis. A semi-structured interview was conducted with a key-person who bridges primary and secondary care. The data collected was analysed using thematic analysis. Data convergence labels were also used to merge the two data sets, from which topics were developed as discussion points for a focus group, in which three general practitioners and three physiotherapists participated. A thematic analysis was then carried out for the data collected from the focus group. Results: In this study it was observed that although general practitioners and physiotherapists take a detailed history and a thorough clinical examination, there is nonetheless a significant reliance on the use of medical imaging for diagnosing osteoarthritis. Although pharmacological treatment is prescribed according to guidelines, such treatment is generally being offered before non-pharmacological treatment, at odds with recommended guidance. A sub-optimal level of communication between professionals was also perceived. Conclusion: The findings from this research study suggest a need for further professional education for general practitioners and physiotherapists on diagnosing and conservative treatment approaches in osteoarthritis. Although many professionals are aware of the recommended guidelines, there is lack of congruency in clinical practice, in the information that is being imparted to the patients together with a sub-optimal level of communication between professionals. With an increasing aging population, it is crucial to target osteoarthritis at its earliest stages as this will have an impact on the long-term quality of life of the patient.