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Abstract
Introduction Physiotherapists provide non-pharmacological conservative treatment for osteoarthritis (OA) using a wide spectrum of interventions. Previous surveys have identified global physiotherapy OA management practices. However, no review to date summarises the scope and findings of these studies. This article describes a scoping review protocol to map the surveys investigating physiotherapeutic interventions offered to patients with OA to identify the treatment interventions currently used for OA, the physiotherapists’ attributes and organisational practice factors potentially associated with the choice of these interventions and to detect knowledge-practice gaps in the provision of physiotherapeutic interventions in OA treatment, contributing to guiding future research on this topic.
Methods and analysis This is a protocol for a scoping review that will be based on Arksey and O’Malley scoping review methodology and the methodological guidance for conducting scoping reviews published by the Joanna Briggs Institute (JBI). Relevant articles will be searched using the following databases: Medline (PubMed), Embase, Web of Science and Google Scholar. Surveys studies addressing physiotherapeutic interventions offered to patients with OA will be included. Study will be selected through title/abstract and full-text screening stages and data will be extracted using an instrument based on the model available in the JBI Manual. The findings will be summarised using descriptive statistics according to our research questions. This review will be reported in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.
Ethics and dissemination Ethical approval is not required for this scoping review. Review findings will be disseminated through peer-reviewed publications, scientific conference presentations and scientific meetings.
Study registration This protocol has been registered with the Open Science Framework (DOI 10.17605/OSF.IO/J3RBT).
- Rheumatology
- Surveys and Questionnaires
- Physical Therapy Modalities
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Strengths and limitations of this study
Our scoping review has a broad overview regarding survey research on physiotherapeutic interventions for patients with osteoarthritis (OA).
This study will provide current information on what has been offered to patients with OA and highlight the areas of knowledge gaps that require further attention.
As this scoping review will focus only on one study type, the data related to other study types on the topic will not be analysed.
Introduction
Osteoarthritis (OA) is a leading cause of disability worldwide,1 with a high prevalence and a constant increase in cases over the years.2 Various joints in the body can be affected by this condition, leading to serious physical and socioeconomic repercussions for individuals affected by the disease.3 4
The importance of conservative, non-pharmacological treatment in the management of the disease is widely described and supported in the current literature. High-quality evidence indicates positive effects on function, pain and quality of life for patients through the use of therapeutic exercise5–7 and education,8 both of which are considered the first-line treatments for this condition.9 Clinical practice guidelines (CPGs) focused on various joints affected by OA are regularly published,10 11 aiming to facilitate clinicians’ use of the best evidence by providing a summary of recommendations for effective therapies for the condition.12
However, the level of adherence to recommendations among physiotherapists, who play a crucial role in the conservative treatment of the disease, varies given the diverse therapeutic options available in clinical practice.13 Several studies have been conducted to explore the therapeutic preferences of physiotherapists for OA. Among the most common study types are survey studies,14 15 defined as a research methodology that collects data from a group of individuals in the form of responses to questions.16
With increasing use in various research fields, this methodology offers advantages, such as low cost and, through media channels, provides extensive contact with people worldwide, thus characterising itself as a valuable tool for collecting information about attitudes and behaviours in a target population.17 In musculoskeletal conditions, such as OA, these studies play a crucial role in understanding clinical practices related to the treatment of this disease. They are useful for identifying gaps between scientific knowledge and the implementation of therapeutic interventions in the practices of professionals directly dealing with the condition. Additionally, they explore other relevant aspects related to the clinical practice, such as factors related to physiotherapists’ attributes (eg, age, gender, experience) and organisational practice (eg, type of setting) influencing therapeutic choices and professionals’ awareness of current CPGs.18 19
However, until now, no study has systematically synthesised and analysed the physiotherapeutic interventions used currently in clinical practice for the treatment of OA nor the factors that influence the choice of these interventions for treating OA, identified through surveys, as well as identified the extent of this type of research regarding geographical location, joints affected by OA investigated and level of healthcare covered. Thus, conducting a scoping review is deemed appropriate to synthesise this information, identify gaps and potential limitations in the literature and contribute to guiding future studies in the field. Additionally, it facilitates the development of strategies to enhance the use of the best available evidence by identifying the clinical care provided to OA patients globally and the personal and organisational-level factors of the professionals involved with this decision-making process about therapeutic interventions.
Therefore, the aim of this study is to map the surveys investigating physiotherapeutic interventions offered to patients with OA, identify the treatment interventions currently used for the disease, the physiotherapists’ attributes and organisational practice factors potentially associated with the choice of these interventions and contribute to guiding future research by identifying knowledge gaps in this type of study.
Methods
The study design is following the methodological framework for scoping reviews recommended by Arksey and O’Malley20 and methodological guidance for conducting scoping reviews published by Joana Briggs Institute (JBI).21 The Arksey and O’Malley framework includes five main stages: (1) identification of the research question; (2) identification of relevant studies; (3) study selection; (4) data charting; and (5) collating, summarising and reporting the results. The final publication will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR),22 a guideline developed to guide the reporting of scoping reviews using a minimum set of items to be included for enhanced transparency of methodological aspects and research findings. This protocol is registered on the Open Science Framework (OSF) platform (DOI 10.17605/OSF.IO/J3RBT). This scoping review started in March 2024 with a planned completion date of December 2024.
Patient and public involvement
None.
Identifying the research question
This review will be guided by the following research questions.
What is the context of the surveys? (including geographical location, joints affected by OA and level of healthcare covered).
What are the main interventions offered to patients with OA in the surveys?
What are the physiotherapists’ attributes and organisational practice factors associated with the choices of interventions offered for patients with OA in the surveys?
Identifying relevant studies
The eligible articles in this scoping review study will follow the population–concept–context framework.
Population
The review will include studies conducted with physiotherapists who treat patients with OA, regardless of the inclusion of professionals from other healthcare fields in the study.
Concept
Studies aiming to identify interventions offered to patients with any joint affected by OA will be included. Physiotherapeutic interventions will be considered as techniques and methods administered by physiotherapists to improve deficiencies in bodily systems, enhance functional performance, and promote health and well-being.23
Context
The publication date of included studies will range from 2001 to 2024, considering the publication date of the first CPG from the European League Against Rheumatism (EULAR) on OA in 2000.24
Source type
Only survey studies will be included, defined as a method of collecting information from a sample of individuals through their responses to questions,16 and using questionnaires administered by a professional or self-administered to investigate interventions offered by physiotherapists for OA patients. The grey literature will also be included. Opinion articles, editorials, commentaries and conference abstracts will be excluded as they do not align with the objectives proposed by this review.
The search will be conducted using the Medline (PubMed), Embase and Web of Science databases. The grey literature search will be performed using Google Scholar. There will be no language restriction, and the search will be rerun before final publication to obtain the most recent results for inclusion.
For the development of the search strategy, two researchers (NROM and APM) initially conducted a preliminary search in the Medline and EMBASE databases. Then, the titles and abstracts of the studies found were screened to identify relevant terms. After that, another search was conducted using the identified terms. The reference lists of the included studies for full-text reading will be analysed for the inclusion of additional results. The search strategy for the Medline (PubMed) database is shown in table 1 and will be adapted for the other databases.
Search strategy in the Medline (PubMed) database; Search conducted on 14 April 2024
Study selection
After the search stage, all identified studies will be imported into the Rayyan management software (https://www.rayyan.ai/), and duplicated studies will be excluded. The study selection will occur in two phases. First, titles and abstracts will be evaluated by two independent reviewers to identify inclusion criteria. In the second phase, all potentially relevant studies will be selected for full-text reading to be included in the final review. Disagreements will be resolved by a third independent researcher.
To enhance the study selection process, a pilot test will be conducted initially, where 25 studies will be randomly selected and independently analysed by the reviewers. The selection process will only commence once a consensus of >75% has been achieved. Disagreements will be resolved by a third independent researcher.
The exclusion of articles selected for full-text reading that do not meet the inclusion criteria will be documented, and the reasons will be reported in the review. The search results will be fully reported in the final review and presented through a PRISMA-ScR flowchart.
Data charting
After the full reading of the included articles, data extraction will be carried out by two independent reviewers using a form developed in Microsoft Excel (box 1), which adheres to the recommendations of the data extraction instrument from the JBI manual.21
Data extraction instrument
Scoping review details
Scoping review title
Review objective/s
Review question/s
Inclusion/exclusion criteria
Population: physiotherapists who treat patients with osteoarthritis (OA).
Concept: studies aiming to identify interventions offered to patients with any joint affected by OA.
Context: period between 2001 and 2024, considering the publication date of the first Clinical Practice Guideline from the European League Against Rheumatism on OA in 2000.
Types of evidence source: surveys study design.
Evidence source details and characteristic
Citations details (eg, author/s, date, title, journal, volume issue and pages)
Country
Study objective
Participants and sample size
Details/results extracted from source of evidence
Joint affected by OA investigated.
Level of healthcare included.
Methods used to identify interventions offered for patients with OA.
Interventions offered by physiotherapists for patients with OA.
Physiotherapists’ attributes and organisational practice factors associated with the choices of interventions offered for patients with OA.
Other relevant questions included in the survey related to the clinical practice of physiotherapists in OA treatment.
The data extraction form will be pilot tested on three included studies. Primary data extraction will only commence when >75% concordance between reviewers has been achieved. The data extraction form will be modified and reviewed as needed. The changes made will be described in the final version of the review. The authors of the studies will be contacted to request missing data or additional information. If there are disagreements between reviewers, they will be resolved by a third independent researcher.
Collating, summarising and reporting the results
For data synthesis and presentation, graphs, tables and narrative descriptions will be developed. Information regarding the country where the survey was conducted, joints affected by the OA and interventions used by physiotherapists for OA treatment according to the type of affected joint will be illustrated graphically.
The authors plan to present the physiotherapists’ attributes and organisational practice factors associated with the choices of interventions in a tabular format, indicating the nature of the association (positive or negative) with the interventions, where applicable. Data regarding authorship, year of publication, publication type (grey or peer-reviewed literature), study objective, population and sample size, level of healthcare included, methods used to identify interventions offered for patients with OA and results of the analysis of the quality of reporting of included studies will also be presented in tabular form.
Narrative descriptions will quantitatively present additional relevant issues included in the studies and will accompany the information provided by the graphs and tables, in accordance with the objectives and scope of this review. If we find qualitative data in any of these studies, we will describe it in a narrative form.
Assessment of reporting quality
The quality of reporting in the included surveys will be assessed using the consensus-based checklist for reporting of survey studies tool,25 a checklist consisting of 19 sections with 40 items that includes the evaluation of reporting quality in the title and abstract, introduction, methods, results, discussion and other items.
Study limitations and strengths
This study will contribute to a comprehensive understanding of interventions offered by physiotherapists for OA and the professionals’ attributes and organisational practice factors influencing the choices of interventions. However, although it may provide valuable insights, this study will be limited to survey-type research. Therefore, it may lack information from other study designs with similar objectives. Additionally, the inherent limitations and biases of this type of study (eg, self-report bias, nonresponse bias) should be considered. The authors chose to synthesise information from this type of study because it is one of the most commonly used methods to identify physiotherapeutic clinical practice in musculoskeletal conditions and, thus, contribute to identifying the scope of this type of research in the literature and to consider implications for future research.
Conclusion
This scoping review will map the existing body of evidence from survey research focused on physiotherapeutic interventions for OA. The results will contribute to scientific evidence regarding this research field worldwide and synthesise the currently most cited and used interventions for treatment, along with potential factors associated with the professionals’ choices of interventions. It will also identify knowledge gaps in this research and interventions offered to patients for OA treatment.
Ethics and dissemination
Ethical approval is not required for this scoping review. All data will be obtained from publicly available documents and no human research participants will be involved. Review findings will be disseminated through peer-reviewed publications, scientific conference presentations and scientific meetings.
Ethics statements
Patient consent for publication
References
Footnotes
Contributors NROM, APM and GCSdA developed the idea and methodology of the scoping review protocol. NROM, APM and ACP contributed to the development of the search strategy. All authors have contributed to the study drafting and revision of the protocol. All authors approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.