LOGIN TO YOUR ACCOUNT

Username
Password
Remember Me
Or use your Academic/Social account:

CREATE AN ACCOUNT

Or use your Academic/Social account:

Congratulations!

You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.

Important!

Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message

CREATE AN ACCOUNT

Name:
Username:
Password:
Verify Password:
E-mail:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Cottrell, E; Roddy, E; Foster, NE (2010)
Publisher: BioMed Central
Journal: BMC Family Practice
Languages: English
Types: Article
Subjects: Research article, R5-920, Medicine (General), RA

Abstract

Background

Joint pain, specifically chronic knee pain (CKP), is a frequent cause of chronic pain and limitation of function and mobility among older adults. Multiple evidence-based guidelines recommend exercise as a first-line treatment for all patients with CKP or knee osteoarthritis (KOA), yet healthcare practitioners' attitudes and beliefs may limit their implementation. This systematic review aims to identify the attitudes, beliefs and behaviours of General Practitioners (GPs) regarding the use of exercise for CKP/KOA.

Methods

We searched four electronic databases between inception and January 2008, using subject headings to identify studies examining the attitudes, beliefs or behaviours of GPs regarding the use of exercise for the treatment of CKP/KOA in adults aged over 45 years in primary care. Studies referring to patellofemoral pain syndrome or CKP secondary to other causes or that occurring in a prosthetic joint were excluded. Once inclusion and exclusion criteria were applied, study data were extracted and summarised. Study quality was independently reviewed using two assessment tools.

Results

From 2135 potentially relevant articles, 20 were suitable for inclusion. A variety of study methodologies and approaches to measuring attitudes beliefs and behaviours were used among the studies. Quality assessment revealed good reporting of study objective, type, outcome factors and, generally, the sampling frame. However, criticisms included use of small sample sizes, low response rates and under-reporting of non-responder factors. Although 99% of GPs agreed that exercise should be used for CKP/KOA and reported ever providing advice or referring to a physiotherapist, up to 29% believed that rest was the optimum management approach. The frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies (exercise advice 9%-89%; physiotherapy referral 44%-77%) than reviews of actual practice (exercise advice 5%-52%; physiotherapy referral 13-63%). Advice to exercise and exercise prescription were not clearly differentiated.

Conclusions

Attitudes and beliefs of GPs towards exercise for CKP/KOA vary widely and exercise appears to be underused in the management of CKP/KOA. Limitations of the evidence base include the paucity of studies directly examining attitudes of GPs, poor methodological quality, limited generalisability of results and ambiguity concerning GPs' expected roles. Further investigation is required of the roles of GPs in using exercise as first-line management of CKP/KOA.

  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. McAlindon TE, Cooper C, Kirwan JR, Dieppe PA: Knee pain and disability in the community. Br J Rheumatol 1992, 31(3):189-92.
    • 2. O'Reilly SC, Muir KR, Doherty M: Screening for pain in knee osteoarthritis: which question?. Ann Rheum Dis 1996, 55(12):931-3.
    • 3. Peat G, McCarney R, Croft P: Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 2001, 60(2):91-7.
    • 4. Mamlin LA, Melfi CA, Parchman ML, Gutierrez B, Allen DI, Katz BP, Dittus RS, Heck DA, Freund DA: Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med 1998, 7(6):563-7.
    • 5. NICE: Osteoarthritis: the care and management of osteoarthritis in adults. NICE Guideline London: NICE 2008.
    • 6. Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, Carr A, Chakravarty K, Dickson J, Hay E, Hosie G, Hurley M, Jordan KM, McCarthy C, McMurdo M, Mockett S, O'Reilly S, Peat G, Pendleton A, Richards S: Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee - the MOVE consensus. Rheumatology (Oxford) 2005, 44(1):67-73.
    • 7. Baker K, McAlindon T: Exercise for knee osteoarthritis. Curr Opin Rheumatol 2000, 12(5):456-63.
    • 8. Scott DL: Guidelines for the diagnosis, investigation and management of osteoarthritis of the hip and knee. Report of a Joint Working Group of the British Society for Rheumatology and the Research Unit of the Royal College of Physicians. J R Coll Physicians Lond 1993, 27(4):391-6.
    • 9. Lane NE, Thompson JM: Management of osteoarthritis in the primarycare setting: an evidence-based approach to treatment. Am J Med 1997, 103(6A):25S-30S.
    • 10. Altman RD, Lozada CJ: Practice guidelines in the management of osteoarthritis. Osteoarthritis Cartilage 1998, 6(Suppl A):22-4.
    • 11. Felson DT, Lawrence RC, Hochberg MC, McAlindon T, Dieppe PA, Minor MA, Blair SN, Berman BM, Fries JF, Weinberger M, Lorig KR, Jacobs JJ, Goldberg V: Osteoarthritis: new insights. Part 2: treatment approaches. Ann Intern Med 2000, 133(9):726-37.
    • 12. Jordan K, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, ZimmermanGorska I, Dougados M, Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT: EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003, 62(12):1145-55.
    • 13. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000, 43(9):1905-15.
    • 14. Fransen M, McConnell S: Exercise for osteoarthritis of the knee. The Cochrane Library 2009, 2http://mrw.interscience.wiley.com/cochrane/ clsysrev/articles/CD004376/pdf_standard_fs.html.
    • 15. Porcheret M, Jordan K, Croft P, Primary Care Rheumatology Society: Treatment of knee pain in older adults in primary care: development of an evidence-based model of care. Rheumatology (Oxford) 2007, 46(4):638-48.
    • 16. Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, Cluzeau F, Cooper C, Dieppe PA, Gunther KP, Hauselmann HJ, HerreroBeaumont G, Kaklamanis PM, Leeb B, Lequesne M, Lohmander S, Mazieres B, Mola EM, Pavelka K, Semi U, Swoboda B, Verbruggen AA, Weseloh G, Zimmermann-Gorska I: EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2000, 59(12):936-44.
    • 17. Li LC, Maetzel A, Pencharz JN, Maguire L, Bombardier C, Community Hypertension and Arthritis Project (CHAP) Team: Use of mainstream nonpharmacologic treatment by patients with arthritis. Arthritis Rheum 2004, 51(2):203-9.
    • 18. Dexter PA: Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee. Performance patterns, medical support patterns, and the relationship between exercising and medical care. Arthritis Care Res 1992, 5(1):36-41.
    • 19. The Newcastle Critical Appraisal Worksheet. http://www.pitt.edu/~super1/ lecture/lec3211/index.htm.
    • 20. Critical Appraisal Skills Programme Qualitative Research Assessment Tool. http://www.phru.nhs.uk/Doc_Links/Qualitative%20Appraisal%20Tool. pdf.
    • 21. Bedson J, Croft PR: The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskelet Disord 2008, 9:116-26.
    • 22. Pearsall J: The Concise Oxford Dictionary. Oxford: Oxford University Press, 10 2001.
    • 23. de Bock GH, Kaptein AA, Mulder JD: Dutch general practitioners' management of patients with distal osteoarthritic symptoms. Scand J Prim Health Care 1992, 10(1):42-6.
    • 24. Chevalier X, Marre JP, de Butler J, Hercek A: Questionnaire survey of management and prescription of general practitioners in knee osteoarthritis: a comparison with 2000 EULAR recommendations. Clin Exp Rheumatol 2004, 22(2):205-12.
    • 25. Coyte PC, Hawker G, Croxford R, Attard C, Wright JG: Variation in rheumatologists' and family physicians' perceptions of the indications for and outcomes of knee replacement surgery. J Rheumatol 1996, 23(4):730-8.
    • 26. Denoeud L, Mazieres B, Payen-Champenois C, Ravaud P: First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Ann Rheum Dis 2005, 64(1):70-4.
    • 27. Glazier RH, Dalby DM, Badley EM, Hawker GA, Bell MJ, Buchbinder R, Lineker SC: Management of common musculoskeletal problems: a survey of Ontario primary care physicians. CMAJ 1998, 158(8):1037-40.
    • 28. Hendry M, Williams NH, Markland D, Wilkinson C, Maddison P: Why should we exercise when our knees hurt? A qualitative study of primary care patients with osteoarthritis of the knee. Fam Pract 2006, 23(5):558-67.
    • 29. Mazieres B, Scmidely N, Hauselmann HJ, Martin-Mola E, Serni U, Verbruggen AA, Le Bars M: Level of acceptability of EULAR recommendations for the management of knee osteoarthritis by practitioners in different European countries. Ann Rheum Dis 2005, 64(8):1158-64.
    • 30. Bedson J, Jordon K, Croft P: How do GPs use x rays to manage chronic knee pain in the elderly? A case study. Ann Rheum Dis 2003, 62(5):450-4.
    • 31. Chard J, Dickson J, Tallon D, Dieppe P: A comparison of the views of rheumatologists, general practitioners and patients on the treatment of osteoarthritis. Rheumatology (Oxford) 2002, 41(10):1208-10.
    • 32. Dexter P, Brandt K: Relationships between social background and medical care in osteoarthritis. J Rheumatol 1993, 20(4):698-703.
    • 33. Günaydin I, Maleitzke R, Göttl KH, Tschirdewahn B: Therapeutic approaches of general practitioners and rheumatologists in treating rheumatoid arthritis and gonarthrosis. Z Rheumatol 1997, 56(2):80-8.
    • 34. Jordan KM, Sawyer S, Coakley P, Smith HE, Cooper C, Arden NK: The use of conventional and complementary treatments for knee osteoarthritis in the community. Rheumatology (Oxford) 2004, 43(3):381-4.
    • 35. Linsell L, Dawson J, Zondervan K, Randall T, Rose P, Carr A, Fitzpatrick R: Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee. Fam Pract 2005, 22(1):118-25.
    • 36. Mazzuca SA, Brandt KD, Katz BP, Dittus RS, Freund DA, Lubitz R, Hawker G, Eckert G: Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee. Arthritis Care Res 1997, 10(5):289-99.
    • 37. McHugh GA, Luker KA, Campbell M, Kay PR, Silman AJ: A longitudinal study exploring pain control, treatment and service provision for individuals with end-stage lower limb osteoarthritis. Rheumatology (Oxford) 2007, 46(4):631-7.
    • 38. Mitchell HL, Carr AJ, Scott DL: The management of knee pain in primary care: factors associated with consulting the GP and referrals to secondary care. Rheumatology (Oxford) 2006, 45(6):771-6.
    • 39. Pavelka K, Olejárová M, Stehlíkova M, Dvoráková T, Šmeralová V: Epidemiological study of treatment of osteoarthritis of the knee joints in the Czech Republic. Ceska Revmatologie 1995, 3(3):115-21.
    • 40. Porcheret M, Jordan K, Jinks C, Croft P, Primary Care Rheumatology Society: Primary care treatment of knee pain - a survey in older adults. Rheumatology (Oxford) 2007, 46(11):1694-700.
    • 41. Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Marcolongo R: Do physicians treat symptomatic osteoarthritis patients properly? Results of the AMICA experience. Semin Arthritis Rheum 2005, 35(1 Suppl 1):38-42.
    • 42. Scarpa R, Sarzi-Puttini P, Cimmino MA, Caporali R, Parazzini F, Zaninelli A, Canesi B: Analysis of pharmacologic and nonpharmacologic prescription patterns of general practitioners and specialists in the AMICA study. Semin Arthritis Rheum 2005, 35(1 Supp 1):24-30.
    • 43. Department of Health: Musculoskeletal Services Framework. London 2006http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/ @en/documents/digitalasset/dh_4138412.pdf.
    • 44. Glazier RH, Badley EM, Wright JG, Coyte PC, Williams JI, Harvey B, Wilkins AL, Hawker GA: Patient and provider factors related to comprehensive arthritis care in a community setting in Ontario, Canada. J Rheumatol 2003, 30(8):1846-50.
    • 45. Mazzuca SA, Brandt KD, Katz BP, Li W, Stewart KD: Therapeutic strategies distinguish community based primary care physicians from rheumatologists in the management of osteoarthritis. J Rheumatol 1993, 20(1):80-6.
    • 46. Arthritis Research Campaign: Exercise 'needs to be prescribed for chronic back pain'. 2009http://www.arc.org.uk/news/DirectNews/Article.asp? ID=19032975&Year=2009&Mo.
    • 47. Rao A, Evans MF: Does a structured exercise program benefit elderly people with knee osteoarthritis. Can Fam Physician 1998, 44:283-4.
    • 48. Mazieres B, Hauselmann H, Martin-Mola E, Serni U, Verbruggen A, Schmidely N: A European survey among 4,204 physicians Part 2. The management of knee osteoarthritis treatment. Ann Rheum Dis 2002, 61(suppl 1):119.
    • 49. Iversen MD, Eaton HM, Daltroy LH: How rheumatologists and patients with rheumatoid arthritis discuss exercise and the influence of discussions on exercise prescription. Arthritis Rheum 2004, 51(1):63-72.
    • 50. Davis P, Suarez-Almazor M: An assessment of the needs of family physicians for a rheumatology continuing medical education program: results of a pilot study. J Rheumatol 1995, 22(9):1762-5.
    • 51. Østbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL: Is there time for management of patients with chronic diseases in primary care. Ann Fam Med 2005, 3:209-14.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article