Supporting the Uptake of Evidence‐Based Care for Degenerative Meniscal Tears and Early Knee Osteoarthritis: A Collaborative Approach to the Development of an Intervention Using Stakeholder Perspectives and Integrating Behaviour Change Theory

BACKGROUND: Management of a degenerative meniscal tear (DMT) or symptoms consistent with early knee osteoarthritis (OA) frequently deviates from international clinical practice guidelines, which recommend education and exercise as first-line treatments and strongly advise against arthroscopic partial meniscectomy. There is a need for implementation strategies to support the uptake of evidence-based care. METHODS: A systematic, four-step intervention development process was used to guide development of a multi-faceted implementation intervention targeting both individuals with a DMT or early knee OA and their general practitioners (GPs). The process integrated behavioural theory, stakeholder perspectives and evidence on intervention effectiveness. Target behaviours were identified through a literature review and stakeholder consultation. Previously conducted qualitative interviews with 17 GPs and 11 people with DMT were re-analysed and mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and enablers to the targeted behaviours. Behaviour change techniques (BCTs) and intervention components were then selected to address these determinants. Stakeholder input was incorporated to enhance acceptability and feasibility. RESULTS: The resulting intervention aims to promote guideline-concordant management of a DMT and early knee OA. A programme theory to guide implementation was developed to describe hypothesised mechanisms of action, and candidate outcome measures were identified to support future evaluation and assess the mediating mechanisms of behaviour change. CONCLUSION: Using a systematic, theory-informed and stakeholder-engaged approach, we developed a multi-faceted intervention to support delivery and uptake of evidence-based care for DMT and early knee OA. The intervention comprised GP educational workshops and resources to support an 'enhanced consultation', alongside referral to an early 'best practice' physiotherapy session. Patients received both components. The intervention was designed to be feasible, acceptable and locally relevant, but requires further testing to assess implementation and potential for scale-up in clinical practice. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: Stakeholder contributions played a central role in this study. People with lived experience of degenerative meniscal tears and/or knee OA (n = 6) and healthcare professional stakeholders (n = 15) were consulted during group discussions and individual meetings. Stakeholders informed every step of the development process, aiming to ensure the final intervention was feasible, acceptable and adapted to the local context.