"I feel more confident": a mixed methods evaluation of the influence of Good Life with osteoarthritis Denmark (GLA:D®) on physical activity participation, capability, barriers, and facilitators in people with knee osteoarthritis.

BACKGROUND: A mixed methods study which aimed to evaluate the influence of Good Life with osteoArthritis Denmark (GLA:D®) on physical activity participation, including perceived capability, barriers, and facilitators in people with knee osteoarthritis. OBJECTIVE: Quantify changes in physical activity participation at 3- and 12-months for people with knee osteoarthritis who participated in an education and exercise-therapy program (GLA:D®). METHODS: A mixed-methods study involving 44 participants with knee osteoarthritis who completed GLA:D®. Guided by the Theoretical Domains Framework, 19 were interviewed, with transcripts analysed using reflexive thematic analysis. University of California Los Angeles physical activity scores were dichotomised as 'more' (≥7) or 'less' active (≤6), and compared between baseline and 3- and 12-months using McNemar's test. Motivation and confidence to exercise (0-10 scale); fear of knee joint damage with exercise (yes/no); and Knee Osteoarthritis Outcome Scores (KOOS) were evaluated. RESULTS: Four overarching themes were identified: prior to GLA:D® 1) fear of knee joint damage, and scarcity of exercise and physical activity information prior to GLA:D®; and following GLA:D® 2) varied exercise-therapy and physical activity participation; 3) facilitators including reduced fear of knee damage, increased confidence, routine, strategies, and support; and 4) ongoing barriers including persistent knee pain, comorbidities, cost, and lack of opportunity and motivation. There was no difference in the proportion of 'more' active participants between baseline (41%) and at 3-months (37%, p = 0.774) or 12-months (35%, p = 0.375). The proportion with fear of damage reduced from baseline (50%) to 3-months (5%) and 12-months (21%). Self-reported motivation (9.1/10) and confidence (9.1/10) to exercise at 3-months were high, and all KOOS subscales improved from baseline to 3-months (effect sizes = 0.41-0.58) and 12-months (effect sizes = 0.29-0.66). CONCLUSION: Varied and often inadequate physical activity participation following GLA:D® indicates more targeted interventions to address ongoing barriers may be required.

The relationship between kinesiophobia and self-reported outcomes and physical function differs between women and men with femoroacetabular impingement syndrome.

BACKGROUND: There is no evidence whether kinesiophobia affects women and men with femoroacetabular impingement (FAI) syndrome differently. OBJECTIVE: To explore the association between kinesiophobia, quality of life (QoL), pain, and physical function in people with FAI syndrome, and to compare the level of kinesiophobia between women and men with FAI syndrome. METHODS: One-hundred-fifty participants with FAI syndrome (51% women) completed assessment of the following: kinesiophobia with the Tampa Scale for Kinesiophobia; patient reported outcome measures (PROMs) (pain, physical function, health- and hip-related QoL); physical function (side bridge, hop for distance, and one leg rise); and active hip range of motion (flexion, external rotation, internal rotation). RESULTS: Greater kinesiophobia was correlated with worse hip-related QoL (rho=-0.58; p<0.001), self-reported physical function (rho=-0.42; p<0.001), health-related QoL (rho=-0.46; p<0.001), and pain levels (rho=-0.46; p<0.001). In women, kinesiophobia was also associated with worse physical function (hop for distance r=-0.38; p=0.001 and side bridge rho=-0.24; p=0.036) explaining 36% of the variation of the hip-related QoL, 29% of the health-related QoL, and 27% of the self-reported physical function. In men, kinesiophobia explained 35%, 12%, and 10%, respectively. CONCLUSION: In people with FAI syndrome, greater kinesiophobia was associated with worse PROMs, but not with hip range of motion. No sex-related differences in mean kinesiophobia scores were found. In women, an association was found between kinesiophobia and worse performance in physical tests. These findings might indicate that kinesiophobia plays a more important role in the clinical presentation of women with FAI syndrome than men.

Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists.

BACKGROUND: Physical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy. OBJECTIVES: Describe Australian physical therapists' awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence. METHODS: An online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework. RESULTS: 1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23-24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so. CONCLUSION: Australian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.