Table 4

Alignment of participant experiences of physiotherapy care with the national Clinical Care Standard for knee OA

Domains of careKey elements of carePatient experiences receiving care
Comprehensive assessmentAssess history of presenting symptoms and other health conditionsPatients expected their physiotherapists to provide treatments for relief of knee pain, to strengthen muscles and to return them to activities they previously enjoyed or were now unable to do.
Conduct a physical examinationPatients described being typically assessed for functional ability (eg, walking, squatting, getting in/out of a chair, negotiating stairs). Some were timed when performing functional tests, and others were asked to repeat the tests as they progressed through their treatment sessions.
Evaluate psychosocial factorsPatients rarely described any psychosocial evaluation by their physiotherapist.
DiagnosisDiagnose knee OA clinicallyPatients generally had received a knee OA diagnosis from their doctor prior to seeing their physiotherapist. They often had knee imaging results to bring to their physiotherapy consultations.
Consider imaging for alternative diagnosis onlyPatients did not touch on this aspect as they typically went to their physiotherapist with imaging results from their doctor.
Education and self-managementProvide education about knee OA and available treatmentsPatients perceived they had adequate pre-existing knowledge and understanding about OA.
Individualised self-management plan based on physical and psychosocial needsPatients felt that their physiotherapist generally provided care that was tailored to their needs. Patients rarely mentioned any psychosocial considerations when discussing self-management plans with the physiotherapist.
Weight loss and exerciseSupport people who are overweight or obese to lose weightSome patients did not perceive their weight as an issue. For those with weight problems, some described having a discussion with their physiotherapist about the importance of weight loss/maintenance.
Tailor exercise according to needs and preferencesPatients received advice about various exercises (eg, strengthening, cardiovascular, stretching, balance, functional movement programmes) for their OA. Some used elastic resistance bands and/or weights for exercises. Some attended supervised group exercise classes (eg, gym or fitness-based programme, Pilates, hydrotherapy, balance, strengthening classes). Some also received adjunctive treatments (eg, massage, dry needling/acupuncture, manual techniques, transcutaneous electrical nerve stimulation, electronic muscle stimulator machines, ultrasound, heat/cold pack and taping).
Establish weight and exercise goals, and refer to other services for assistance as requiredExercise goals and programmes were routinely established with physiotherapists. Patients rarely described establishing weight loss goals or being referred to other healthcare providers for weight loss support.
Medications to manage symptomsOffer appropriate medicines to manage symptoms, considering clinical condition and preferencesPatients did not expect information about medications and knee injections from their physiotherapist.
Patient reviewAgree on regular reviews according to patient’s needsPatient attendance at physiotherapy services often relied on funding being available to subsidise cost of care. Reviews would often cease when funding ran out.
Refer to specialist if knee OA symptoms worsen and severe functional impairment persists despite conservative managementPatients generally sought care from a physiotherapist to postpone, or prepare for, knee surgery.
SurgeryOffer timely joint surgery to patients not responding to conservative managementPatients generally sought care from a physiotherapist to postpone, or prepare for, knee surgery.
Provide surgical information to inform treatment decisionPatients did not expect information about knee surgery from their physiotherapist.
Only offer arthroscopy to patients with true mechanical lockingPatients rarely mentioned discussing knee arthroscopy with their physiotherapist.
  • OA, osteoarthritis.