AB0777 Knee osteoarthritis: widespread use of treatments that are not considered essential for high quality care
Authors: L. Grypdonck, R. Hermens, P. Vankrunkelsven, F. Luyten
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Knee OA puts a major burden on quality of life in the elderly (1). Multiple treatment modalities are available, which have demonstrated to decrease pain or improve functional impairment. However, research shows that current care doesn't fit with recent exercise recommendations (2) and treatment modalities with poor or no research evidence are often used (3). A first step in quality improvement includes a clear insight in current care. <h3>Objectives</h3> This study aimed to measure current care in physiotherapy practice by a broad set of evidence based quality indicators and by registering the use of treatments that are not considered essential for high quality care. <h3>Methods</h3> A set of evidence based quality indicators was extracted from international guidelines and literature by a multidisciplinary expert panel. Those indicators, as well as treatments that were not considered essential for high quality knee OA care were incorporated in a digital questionnaire. Members of the Belgian professional organization of physiotherapists were addressed by a message in their electronic newsletter to complete the questionnaire. The results were analyzed using SPSS 19. Two-sided 95% confidence intervals were used to calculate the mean performance of both indicated and no essential treatments. Mutual relations between treatments that were not considered essential for high quality care were explored by calculating spearman's rho correlations. P-values &lt; 0.01 were considered significant. <h3>Results</h3> The questionnaire was completed by 276 physiotherapists. The average performance on quality indicators ranged between 27% and 98%. Treatments that were not considered to be essential for high quality care were used in 1% to 59% of a physiotherapist's patients. Six of them were used in more than 20%; electrostimulation of the muscles (23%), application of cold or warmth (35% and 29%), TENS (24%), ultratones (24%), and massage (53%). Whether a physiotherapist used a treatment modality or not, turned out to be related to the use of other modalities. Electrostimulation of the quadriceps, ultratones, interferential streams, TENS and shortwave-, ultrashortwave- and radartherapy were mutually correlated with significant spearman's correlations &gt;0.350. Massage and the application of warmth were correlated too. <h3>Conclusions</h3> Guideline adherence on knee OA care among physiotherapists appears to be suboptimal. Indeed, treatments that are not particularly recommended seem to be widespread and may limit the time to be spent to interventions that have proved to be more effective, particularly when they are mutually correlated and more than one of those treatments is used at once. A clear insight into the barriers and facilitators for guideline adherence is needed in order to develop a well-targeted quality improvement strategy. <h3>References</h3> Guccione AA, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994;84:351. Holden MA, et al. Physical therapists' use of therapeutic exercise for patients with clinical knee osteoarthritis in the United kingdom: in line with current recommendations? Phys Ther 2008;88:1109-21. Walsh NE, et al. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care 2009;7:45-56. <h3>Disclosure of Interest</h3> None Declared