Implementation of a physiotherapy led, multidisciplinary model of care for the management of knee osteoarthritis in community practice: a pilot study

The intervention will be co-designed in consultation with the physiotherapists and physiotherapy practices over a 2-month period. Further feedback will be gained from community representatives from the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Community and Consumer Council (CCC) for Musculoskeletal Health. Consultation will occur face to face within the physiotherapy practices in small group sessions conducted by the lead researcher, with each session running for approximately 1 hour. The first round of focus groups will highlight what the current guidelines are for the conservative management of knee osteoarthritis (OA), and aspects of practice that deviate or align with these recommended guidelines (based on data obtained from pre-intervention interviews). De-identified patient commentary will be provided on how individuals with knee OA perceived the treatment they received. Discussion regarding the benefits and limitations of Patient reported outcome measures (PROMs) and their availability for use will be included. The current use of exercise therapy and multidisciplinary input will be reviewed, and consensus sought on appropriate practice changes to be implemented if necessary, to align with current guidelines. The draft model will be presented for further feedback at a second round of focus sessions. The intervention will be based on current guidelines regarding the management of knee OA, education, exercises, self-management and weight loss (if indicated). Information on these guidelines will be provided for patients verbally and in writing by the physiotherapists. A proforma will be developed for the physiotherapists to use during assessments of the recruited patients. A third round of focus sessions will be conducted to discuss strategies for implementation of the intervention, provide training, and include role play to develop the physiotherapists confidence to deliver the intervention and improve knowledge. A ‘champion’ will be identified at each practice, as a key contact for physiotherapists and the lead researcher. The lead researcher will also be in contact with all physiotherapy practices throughout the project, to provide ongoing support. All consultation will be conducted by the lead researcher, face to face, in small groups, within the physiotherapy practices. The intervention will be delivered by physiotherapists with a range of experience levels, across nine Sydney metropolitan-based, community physiotherapy practices. Each participant will take part in the intervention over a 6-week period. The physiotherapist will personalise the delivery of the intervention to suit the patients need, including number of physiotherapy sessions, duration and intensity. Each physiotherapy session will have a duration of approximately 30 mins, the number of sessions will be determined by the patient’s preference, capability, and availability of resources. Exercises will be prescribed in line with current guidelines for the management of knee OA, and will be tailored to each patients level of ability. The exercises prescribed will include strengthening (particularly quadriceps), active range of movement, stretching, and aerobic activity. The intensity of exercises will be measured using a visual analogue scale of 0-10, working at an intensity of 0-5, with pain subsiding to the patients normal pain level (same level their pain was prior to exercising) the day after. Exercises will be assessed by the physiotherapist at each session, so that dosage can be progressed. Adherence to the intervention will be monitored by exercise frequency checklists at each physiotherapy session.