Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons.
Lea Ettlin, Irina Nast, Erika O Huber and 1 others
PMID 36188839WHAT IT FOUND
Swiss doctors rarely refer knee OA patients to exercise, estimating only 54% of their patients receive it.
Patient disinterest is the top barrier. Doctors rely on clinical judgment and patient suffering rather than guidelines when deciding to refer to exercise.
Key findings
01Participants estimated they referred only 54% of their knee OA patients to exercise treatment.
02The most significant barriers to referring patients to exercise were perceived patient disinterest (46.3%) and patients who were already physically active (31.1%).
03Guidelines were ranked last among reasons for referral to exercise, behind patient suffering, clinical expertise, and the clinical picture of OA.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The response rate was very low (4.4% overall), raising the possibility that only doctors already interested in exercise or conservative management participated, which could bias the results toward higher adherence to guidelines than actually exists. The study relies on self-reported estimates of referral rates rather than objective patient records. The survey included retired persons and specialists who do not treat knee OA (e.g., paediatricians) in the initial invitation, though they were excluded from analysis if they did not answer the core questions.
Declared interests
The authors declared no commercial or financial conflicts of interest. The work was funded by the Swiss Learning Health System project, University Lucerne, and ZHAW University of Applied Sciences, Zurich.
The easy way to misread this
Do not interpret the 83.2% rate of 'referral to physiotherapy' as evidence that most patients receive guideline-recommended exercise. The same participants estimated that only 54% of their patients were referred to exercise, indicating that a physiotherapy referral does not always result in a structured exercise programme.