Barriers, facilitators and referral patterns of general practitioners, physiotherapists, and people with osteoarthritis to exercise

Abstract

Background

Barriers and facilitators of general practitioners (GPs), physiotherapists (PTs), and people with hip and knee osteoarthritis (PwOA) may influence uptake of and referral to guideline-based exercise treatments for OA.

Objective

To identify barriers and facilitators of GPs, PTs and PwOA to uptake of and referral to exercise treatments for OA.

Methods

An online survey was circulated to GPs, PTs, and PwOA in Ireland from March to September 2021. Data were collected on demographics, barriers and facilitators, and referral patterns to exercise treatments for OA. Frequency distributions were used to illustrate demographics, barriers and facilitators, and referral patterns to exercise treatments for OA.

Results

388 stakeholders responded (GPs = 148; PTs = 154; PwOA = 86). Barriers and facilitators were related to (1) stakeholder (e.g., patient tiredness and fatigue), (2) healthcare setting (e.g., appropriate referrals from GP or other sources), and (3) treatment (e.g., low-cost community-based exercise programmes) factors. While 91% of GPs would refer PwOA to physiotherapy if no barriers existed, only 60% would in their current practice. Only 33% of PwOA reported receiving a GP referral to physiotherapy.

Conclusion

Stakeholder, healthcare setting and treatment barriers and facilitators of GPs, PTs, and PwOA influence uptake of and referral to exercise treatments for OA. Future strategies Future strategies addressing these factors may improve implementation of guideline-based management for OA.

Contribution of the Paper

• •
  Despite an established evidence-based consensus, uptake of and referral to exercise as a first-line treatment for OA is suboptimal, partly influenced by the barriers and facilitators of stakeholders (e.g., GPs, PTs, and PwOA).
• •
  Barriers and facilitators that influence uptake of and referral to exercise treatments for OA are related to stakeholder, healthcare setting, and treatment factors.
• •
  Majority of PwOA are not receiving GP referrals to physiotherapy, and a mismatch between GPs intentions to and actual referrals to physiotherapy exists, primarily due to long waitlists to access services.
• •
  These findings may be adapted to inform strategies for the successful implementation of exercise treatments that are effective in encouraging guideline-based management of OA.