Patients' Perceptions of Assessment and Treatment of Knee Osteoarthritis on the First Visit in Primary Care - a Qualitative Study

Background:

To diagnose osteoarthritis (OA), Swedish guidelines recommend an overall assessment with patient history, symptoms, and clinical findings, and diagnostic radiography is not recommended when assessing OA. The recommended core treatment should consist patient education, exercising, self-care and if necessary, weight loss, whereas assessing and giving core treatments of knee OA (KOA) is included in physiotherapists area of expertise. Former study show that there is no statistic significant difference in health-related quality of life for patients with KOA assessed by physiotherapists compared to being assessed by a physician in primary care. Furthermore, costs can be reduced with the model "physiotherapists first". A task-shifting care model with physiotherapists as the primary assessor can result in a faster track to recommended treatment for patients with KOA and increase the accessibility to physicians in primary care for patients with more severe health conditions.

Qualitative studies show that patients generally are skeptical to physiotherapists competence compared to physicians regarding assessing musculoskeletal disorders, and a physician assessment could be experienced as an assurance before being assessed and treated by physiotherapist. At the same time, one of these studies shows that there is an acceptance that advanced physiotherapy practitioner can be primary assessor for patients with musculoskeletal disorders. Previous patient experiences of physician assessment could affect patient's expectation of a physician to assess and diagnose their musculoskeletal disorder again, and a belief in need of further examinations with radiography could be another cause to consult a physician first.

Overall, patients with OA have had a negative view on conservative OA treatment and experienced that health care have trivialized their symptoms. Patients with KOA could feel hesitant to seek help due to beliefs of physicians' attitude regarding joint pain as a normal ageing symptom. This patient group have reported that their complaints were not taken seriously, and want more focus on the individual rather than the joint. Many patients assessed and treated by physicians report lack of understanding of OA and experience pain avoidance. Patients want other treatment options than drugs, and urge for more time for counselling and information about OA. Physicians experience difficulties in OA management due to time constraints, priorities, and in presenting and choosing treatments. Exercise was reported as an important factor in the management of OA. Referred patients with KOA treated with physiotherapy reported receiving treatments that was recommended for this patient group and the relationship between physiotherapists and patients are important for exercise adherence.

To the best of our knowledge, there are no studies of how patients with KOA, have experienced the health care, when being referred directly to a physiotherapist for assessment and treatment. To offer person-centred care for patients with suspected KOA, it is of value to get a deeper understanding of what expectations patients have and what possible meaning a primary assessment by physiotherapists have on patient's future self-care and experienced health status.