Perceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise with one exercise-only in patients eligible for knee replacement: A qualitative interview study nested in the QUADX-1 trial · SciRah
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Perceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise with one exercise-only in patients eligible for knee replacement: A qualitative interview study nested in the QUADX-1 trial
aClinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
bPhysical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
cDepartment of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
dDepartment of Orthopedic Surgery, Clinical Orthopedic Research Hvidovre (CORH), Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
eDepartment of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
fDepartment of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
gResearch Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
hDepartment of Health Science and Technology, Aalborg University, Denmark
iClinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Abstract
AIM: Clinical guidelines recommend non-surgical treatment before surgery is considered in patients eligible for knee replacement. Surgical treatment is provided by orthopedic surgeons and exercise therapy is provided by physical therapists. The aim of this study was to identify perceived facilitators and barriers-among orthopedic surgeons and physical therapists-towards coordinated non-surgical and surgical treatment of patients eligible for knee replacement using pre-operative home-based exercise therapy with one exercise. METHODS: This qualitative study is embedded within the QUADX-1 randomized trial that investigates a model of coordinated non-surgical and surgical treatment for patients eligible for knee replacement. Physical therapists and orthopedic surgeons working with patients with knee osteoarthritis in their daily clinical work were interviewed (one focus group and four single interviews) to explore their perceived facilitators and barriers related to pre-operative home-based exercise therapy with one exercise-only in patients eligible for knee replacement. Interviews were analyzed using thematic analysis. RESULTS: From the thematic analysis three main themes emerged: 1) Physical therapists' dilemma with one home-based exercise, 2) Orthopedic surgeons' dilemma with exercise, and 3) Coordinated non-surgical and surgical care. CONCLUSION: We found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. The physical therapists were skeptical towards over-simplified exercise therapy. The orthopedic surgeons were skeptical towards the potential lack of (long-term) effect of exercise therapy in patients eligible for knee replacement. The consequence of these barriers and ambivalence in the professional role is important to consider when planning implementation of the model of coordinated non-surgical and surgical treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02931058.
TL;DRIt is found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. (Semantic Scholar)
