导言:《国际准则》建议练习,教育和体重管理(如果合适)作为膝骨关节炎(OA)患者的一线保守治疗,以增强其自我管理能力。这项研究的目的是调查瑞士膝关节OA患者保守非药物治疗的现状,并探讨应用指南建议的障碍和促进因素。材料和方法:对选定的全科医生(GP)进行11次半结构化访谈,执行风湿病学家和整形外科医生。基于这些结果,开发了一项在线调查,并发送给三个科学医学协会的成员。问题涉及诊断措施的频率,治疗方案,推荐锻炼的原因以及障碍和促进者。结果:共有234名成员做出了回应。他们指出,患者通常由于疼痛(n=222,98.2%)和膝关节功能受限(n=151,66.8%)而出现。除了临床评估,X线(n=214,95.5%)和MRI(n=70,31.3%)是最常用的诊断措施。治疗方案通常包括患者的诊断教育(n=223,98.6%)和适当的活动(n=217,96%)。药物治疗(n=203,89.8%)和物理治疗转诊(n=188,83.2%).参与者估计,他们已将54%的膝关节OA患者转诊为特定运动。运动转诊是由“患者期望/高水平的痛苦”(n=73,37.1%)和他们的“自己的临床经验”(n=49,24.9%)驱动的。专家将推荐运动的最重要障碍评为“患者不感兴趣”(n=88,46.3%)和“身体活跃的患者”(n=59,31.1%)。作为最重要的推动者,他们将“尽管咨询时间较短,但提及运动的重要性”(n=170,89.4%)和“身体活动不足的患者”(n=165,86.9%)。讨论:瑞士似乎存在膝关节OA患者管理方面的大量证据-表现差距。对于将锻炼作为一线干预的系统转诊,医生建议对膝关节OA患者进行结构化的锻炼计划可能是有用的,而不仅仅是建议一般的锻炼。
Introduction: The International
Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the
guideline recommendations. Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators. Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by \"patient expectation/high level of suffering\" (n = 73, 37.1%) and their \"own clinical experience\" (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as \"disinterest of patient\" (n = 88, 46.3%) and \"physically active patient\" (n = 59, 31.1%). As the most important facilitators, they rated \"importance to mention exercise despite the short time of consultation\" (n = 170, 89.4%) and \"insufficiently physically active patient\" (n = 165, 86.9%). Discussion: A substantial evidence-performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.