Promoting and inhibiting factors for the implementation of evidence-based non-invasive treatment programs for patients with knee- and/or hip-osteoarthritis: a rapid review

Osteoarthritis of the knee and/or hip joint are common conditions among older adults. Although multimodal therapy combining patient education, exercises and weight loss has proven effective, only a few countries offer implemented treatment programs. While some Scandinavian countries have achieved nationwide implementation, similar initiatives remain limited to research settings elsewhere. To date, limited evidence exists on factors that facilitate or hinder the successful implementation of these programs. This study therefore aims to synthesize scientific evidence on the implementation of evidence-based, non-invasive treatment programs for osteoarthritis of the knee and/or hip joint. What is the current state of international research on the implementation of evidence-based, non-invasive treatment programs for osteoarthritis of the knee and/or hip joint, and, which promoting and inhibiting factors regarding implementation have been reported? Rapid review. The search term was derived using the PICo-scheme. Searches were conducted in PubMed, PEDro, Embase and Cochrane in September 2022. Reference lists of included titles were screened manually for relevant publications. Eligible studies reported on the implementation of non-invasive treatment programs for patients with osteoarthritis of the knee and/or hip joint including education and training and were published between 2008 and 2022 with full-text-availability. Studies focusing on in-patient services, competitive sports or languages other than English or German were excluded. Screening was supported by Rayyan and ASReview LAB. A qualitative content analysis according to Kuckartz using MAXQDA was performed. The search identified 5,948 records. After screening, 40 studies were assessed in full text, of which 11 studies were included for data extraction. Four key dimensions relevant to implementation were identified: The scientific, political, organizational, and financial dimension. Promoting factors included scientific monitoring during implementation, central program support, cooperation between implementation teams, gradual implementation, free patient access to lower participation barriers, broad availability and efficient referral. Inhibiting factors comprised restrictive health policy frameworks, missing public funding for implementation costs and service provision, insufficient staff, incompatibility with existing care structures, insufficient coordination and management and limited authority of healthcare professionals in regional contexts. The rapid review highlights the multifactorial nature of the factors influencing the implementation of treatment programs and underscores the need to link practice and research.