From treating hips and knees to considering societal-level actions: physiotherapists’ conceptions of hip and knee osteoarthritis management

BACKGROUND: Physiotherapists' choices of management methods for hip and knee osteoarthritis reflect their conceptions of the condition and how it should be managed. To be able to provide recommended, consistent, first-line methods, physiotherapists should have a common, up-to-date understanding of the condition and how to effectively manage it. OBJECTIVE: In this qualitative study, we aimed to explore physiotherapists' conceptions of the management of hip and knee osteoarthritis, and to identify the critical differences between their conceptions. METHODS: We followed a phenomenographic methodology and data-driven approach. The data were from semi-structured in-depth interviews of 20 physiotherapists (mean age 42 years) who were involved in managing hip and knee osteoarthritis. The data were transcribed verbatim and analyzed using a phenomenographic analysis method. RESULTS: The analysis yielded four hierarchically broadening categories describing the management of hip and knee osteoarthritis: 1) a symptom-focused approach, 2) a functionality-oriented approach, 3) a whole-person approach, and 4) societal level approach. These conceptions covered five themes of expanding awareness and several critical aspects. CONCLUSIONS: Narrow conceptions of the management of hip and knee osteoarthritis may lead to passive, symptom-focused approaches and surgery, whereas broader perspectives can lead to holistic, proactive, evidence-based management that emphasizes sustainable health and societal actions. Identifying unhelpful conceptions and unraveling them is important for promoting effective osteoarthritis management and for enhancing professional education that supports person-centered, sustainable, and evidence-based management of osteoarthritis.