Alignment of participant experiences of physiotherapy care with the national Clinical Care Standard for knee OA
| Domains of care | Key elements of care | Patient experiences receiving care |
| Comprehensive assessment | Assess history of presenting symptoms and other health conditions | Patients 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 examination | Patients 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 factors | Patients rarely described any psychosocial evaluation by their physiotherapist. | |
| Diagnosis | Diagnose knee OA clinically | Patients 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 only | Patients did not touch on this aspect as they typically went to their physiotherapist with imaging results from their doctor. | |
| Education and self-management | Provide education about knee OA and available treatments | Patients perceived they had adequate pre-existing knowledge and understanding about OA. |
| Individualised self-management plan based on physical and psychosocial needs | Patients 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 exercise | Support people who are overweight or obese to lose weight | Some 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 preferences | Patients 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 required | Exercise 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 symptoms | Offer appropriate medicines to manage symptoms, considering clinical condition and preferences | Patients did not expect information about medications and knee injections from their physiotherapist. |
| Patient review | Agree on regular reviews according to patient’s needs | Patient 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 management | Patients generally sought care from a physiotherapist to postpone, or prepare for, knee surgery. | |
| Surgery | Offer timely joint surgery to patients not responding to conservative management | Patients generally sought care from a physiotherapist to postpone, or prepare for, knee surgery. |
| Provide surgical information to inform treatment decision | Patients did not expect information about knee surgery from their physiotherapist. | |
| Only offer arthroscopy to patients with true mechanical locking | Patients rarely mentioned discussing knee arthroscopy with their physiotherapist. |
OA, osteoarthritis.