Factors with sample quotes
| Factors | Sample quotes |
| Availability of community infrastructure and programmes | “That’s a great resource….certainly a lot of people keep going at the [community centre].”—PC10 “I think would be helpful, free access to the pool, free access to the gym. I think those things would really help people with early signs of OA.”—PC20 |
| Access to timely physical therapy | “If they’re chronic, they could wait 4–6 months.”—H01 “Some people we can’t get in or some people are under 65 and are not eligible for the funding and don’t want to pay. So that’s one barrier.”—OO01 “Here I have the luxury of its hospital funded so they don’t have to pay so I can see them longer. In a private clinic I have to be considerate of they’re paying, they have benefits, they have three more visits and their benefits are done so we try and finish up then or as best we can if they can’t pay more.”—PC07 |
| Access to other healthcare providers | “We have a dietician on staff. It’s an easy referral if they would like to lose weight to help their knee pain.”—FHT2 “We don’t have one [dietician], and generally, I believe the family doctors will refer to a dietician.”—PC14 |
| Physical therapists’ confidence and perceived capability to manage early knee OA | “I have all the tools I need at my fingertips, my education and exercise components.”—FHT2 “ I feel very confident in treating the population. So, in that sense, I think my background helps me. I’m an experienced PT.”—PC02 “ I really believe that we can really help the people with OA, especially early on, to try to avoid going down that road.”—PC24 |
| Physical therapists’ beliefs about the consequences of OA | “Some do amazing, and so I don’t know if that is the history of their disease process, anyway, or if it is because they are quite motivated to make a change.”—PC23 “There are things we can do. I tell everyone that we can’t undo any change that has occurred already but we can try to prevent further degenerative change.” —PC02 |
| Physician’s role in referral and messaging to clients about OA | “Their doctor says you’ve got arthritis, there’s nothing you can do. The patient decides that they’re going to stop physio.”—PC4 “GPs don’t have knowledge on what physios do or what other medical practitioners do, and they’re still the gatekeepers.”—PC09 “Well, the one frustrating thing that I find or challenging really is the somewhat inaccurate or dismissive approach from the family doctors based on x-rays. I find that very frustrating when people would come with obvious signs of osteoarthritis, symptomatically and in a clinical examination.”—PC18 |
| Scope of practice | “I think it’s helped me. I work within my scope of practice and anything that is outside of that, again, I refer them too. So, if patients are asking me about, exactly how do I lose weight, I can touch on the exercise part and give them a lot of advice about that. But if they’re asking me about specific medications or drugs or supplements, I’ll refer them to their family doctor or pharmacist.”—PC13 “If I need an MRI, I don’t often need one, but the odd time I think it may be helpful, I work under a medical directive for that.”—H01 |
| Time per Client | “I’m really fortunate to have the time to treat people.”—PC02 “Time is always an issue. I guess I just put it in the background. Sometimes you just have to, well I have to manage my time with each patient so sometimes somebody has to get less and somebody more…”—OO01 |
| Access to scientific evidence | “Unless you’re working in an institution, where you do have access, private clinics are left by the wayside… It costs a lot money to get an article sometimes.”—PC19 “We have access through the healthcare library, so I will do searches through that to find articles on whatever topic I’m looking for. But then I physically have to go to the library at [university] to get the articles. Most of the ones in the health library that you want to read, you can’t read the whole article.”—PC12 |
| Client engagement in therapy | “Well, depends on the patient, there’s patient personality, there’s people who like passive treatment as opposed to active treatment, that becomes a huge challenge.”—FHT01 “I try to educate them on the importance of doing it, but some people just don’t … they don’t want to do exercises. You can only … you can bring the cow to the water, but you can’t make it drink.”—PC08 “The compliance with their active exercise program, that’s a huge barrier. The fact that they will start feeling better and then they quit doing stuff, which is pretty much everybody I see that’s come back, that’s the reason, usually.”—PC19 |
| Client beliefs about OA | “So, I think that’s public perception of what arthritis is and its potential to do well actually. Everybody thinks they’re doomed for a joint replacement or to suffer.”—PC22 “Then that might be a barrier in terms of their reluctance to exercise and to challenge that knee because they’re worried that things are going to deteriorate.”—H04 “I would say that the most frequent barrier that I come across is people’s preconceived ideas about either they’ve had someone in their family or they’ve seen another health professional before, a physio, chiro, doctor, who has basically told them that they, you know, once you’ve had, quote/unquote, “arthritis”, you never get rid of it. Arthritis is forever, it just gets worse and worse.”—PC01 |
| Client characteristics and context | “English is a second language or they haven’t mastered English or French. We have clinicians that speak French. That’s a bit of a barrier.”—PC03 “Some patients who just are experiencing such great poverty or other issues in their lives that they’re not able to do it. I have a lot of patients who live in the shelter system so they don’t have anywhere to exercise, which is just really tough.”—CHC1 “People whose general outlook on life due to psychosocial influences. If they’re depressed, if they’ve got poor coping and poor support at home, and their attitude towards pain, their lack of understanding. Education will take you so far, but if someone is really depressed, they’re going to need help in other aspects of their life before they can focus.”—H04 |
GP, general practitioner; OA, osteoarthritis.