Open AccessPerceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise with one exercise-only in patients eligible for knee replacement: A qualitative interview study nested in the QUADX-1 trial
Author(s) -
Rasmus Skov Husted,
Thomas Bandholm,
Michael Skovdal Rathleff,
Anders Troelsen,
Jeanette Wassar Kirk
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0241175
Subject(s) - medicine , orthopedic surgery , physical therapy , thematic analysis , knee replacement , qualitative research , intervention (counseling) , randomized controlled trial , surgery , nursing , social science , sociology
Aim Clinical guidelines recommend non-surgical treatment before surgery is considered in patients eligible for knee replacement. Surgical treatment is provided by orthopedic surgeons and exercise therapy is provided by physical therapists. The aim of this study was to identify perceived facilitators and barriers–among orthopedic surgeons and physical therapists–towards coordinated non-surgical and surgical treatment of patients eligible for knee replacement using pre-operative home-based exercise therapy with one exercise. Methods This qualitative study is embedded within the QUADX-1 randomized trial that investigates a model of coordinated non-surgical and surgical treatment for patients eligible for knee replacement. Physical therapists and orthopedic surgeons working with patients with knee osteoarthritis in their daily clinical work were interviewed (one focus group and four single interviews) to explore their perceived facilitators and barriers related to pre-operative home-based exercise therapy with one exercise-only in patients eligible for knee replacement. Interviews were analyzed using thematic analysis. Results From the thematic analysis three main themes emerged: 1) Physical therapists’ dilemma with one home-based exercise , 2) Orthopedic surgeons’ dilemma with exercise , and 3) Coordinated non-surgical and surgical care . Conclusion We found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. The physical therapists were skeptical towards over-simplified exercise therapy. The orthopedic surgeons were skeptical towards the potential lack of (long-term) effect of exercise therapy in patients eligible for knee replacement. The consequence of these barriers and ambivalence in the professional role is important to consider when planning implementation of the model of coordinated non-surgical and surgical treatment. Trial registration ClinicalTrials.gov, ID: NCT02931058.