Background
Methods
The analysis framework
Sample and sample size
Data collection
Data analyses
Results
Response
Variable | Category | Response type | Statistic (95% CI) | |
---|---|---|---|---|
MDS (n = 470) | Completed questionnaire (n = 835) | |||
Gender | Male | 247 (53%) | 401 (49%) | OR 1.00 |
Female | 219 (47%) | 417 (51%) | OR 1.17 (0.93,1.47) | |
Practice area deprivation | Most deprived | 121 (26%) | 181 (22%) |
OR 0.63 (0.45,0.89)
|
Second most deprived | 106 (23%) | 156 (19%) |
OR 0.62 (0.44,0.88)
| |
Mid-deprived | 85 (18%) | 202 (24%) | OR 1.00 | |
Second least deprived | 84 (18%) | 160 (19%) | OR 0.80 (0.56,1.16) | |
Least deprived | 73 (16%) | 135 (16%) | OR 0.78 (0.53,1.14) | |
Practice type | Urban | 254 (56%) | 449 (54%) | OR 1.00 |
Semi-rural | 155 (34%) | 275 (33%) | OR 1.00 (0.78,1.29) | |
Rural | 43 (10%) | 103 (13%) | OR 1.36 (0.92,2.00) | |
Mean (SD) years since qualification | 21.6 (10.0) | 18.4 (10.3) | Mean difference = -3.24 (−4.41,-2.07) | |
Mean (SD) no of GPs in respondent’s practice | 6.4 (3.7) | 6.4 (3.2) | Mean difference = <0.01 (−0.38,0.39) | |
Information only requested in questionnaire | ||||
Type of GP | GP partner | - - - | 656 (79%) | |
Salaried GP | - - - | 151 (18%) | ||
Locum GP | - - - | 20 (2%) | ||
Other | - - - | 5 (1%) | ||
GP with special interest in musculoskeletal conditions | - - - | 50 (6%) | ||
Received postgraduate education which contained education about CKP | - - - | 319 (39%) | ||
Personal experience of CKP | - - - - | 166 (20%) |
Theme | Concepts | Given as a response option | Example of coded response |
---|---|---|---|
Service-related | Insufficient time in consultations | ✓ | [Nil additional free text comments given] |
Difficulty accessing physiotherapy | ✓ | “Takes 18 weeks to see a physio” | |
Limitations to accessing services | ✗ | “Pressure on reducing referrals” “Loss of local fitness initiative” “Lack of any facilities in our local area for people to group exercise - no sports or leisure facility.” “Cost of exercise to patient e.g. Gym membership” | |
My GP colleagues do not use or value exercise | ✓ | [Nil additional free text comments given] | |
Services do not meet expectations | ✗ | “…some patients wait for 3/12 and once they’ve seen they’ve been given a leaflet to do exercise at home, this does not meet patients’ expectations” “Only get 2 physio sessions if we refer them” “Physiotherapy appointments are not long enough” | |
Geographical problems | ✗ | “Remote location of practice deters patients from travelling to a gym” “Patients are too scared to walk in local area” | |
GP-related | Insufficient expertise to give detailed information | ✓ | [Nil additional free text comments given] |
Uncertainty about the most appropriate type of exercise | ✓ | [Nil additional free text comments given] | |
Uncertainty about the effects of exercise | ✓ | [Nil additional free text comments given] | |
Uncertainty about the safety of exercise | ✓ | [Nil additional free text comments given] | |
Cannot access necessary resources | ✗ | “Lack of structured approach I know the info is out there somewhere - don’t have time or energy to search” “Detailed leaflet sounds good - if I have time I will look at arthritis UK website” | |
GP does not prioritise exercise | ✗ | “Perhaps I should give it a higher priority” | |
Unclear what physio offers | ✗ | “Little feedback from physiotherapy about advice offered/range of services” | |
Patient-related | Patients prefer other management options | ✓ | “When mention physiotherapy and exercise most patients don’t want this - ‘they just give you exercises and it makes the pain worse’” |
Exercise does not match patient needs/expectations | ✗ | “Patients want a ‘quick fix’ losing weight and increasing exercise is more difficult” “Patients so overweight that they cannot even consider exercise - in fact this annoys them” “Patient appearing so debilitated by chronic pain that exercise cannot be tolerated” “Patient refusal to engage with regular exercise due to perceived time constraints and fear of harming themselves” “I advise on quad strengthening, patients often sceptical this is enough to help relieve their symptoms” “Specialist colleagues appear to always want MRI/CT/xray/arthroscopy + people talk to each other (I had this + the specialist did….)” | |
Achieving patient behaviour change is difficult | ✗ | “Very difficult to get many patients to change lifestyle sufficiently to effect enough real change to help knee pain” “Many pts are lazy!” “patient reluctance” “Requires significant patient re-education and elements of motivational interviewing so potentially v time consuming” | |
Other | Other | ✓ | “physiotherapy (referral) needs to be prioritised” |
Influences on the use of exercise
Beliefs about role
Role | Use of exercise for vignette patient | OR (95% CI) for use of exercise | ||
---|---|---|---|---|
No n (%) | Yes n (%) | |||
GPs’ beliefs about their role in managing people with CKP in general | ||||
It is part of my job to manage people with CKP | Neither agree nor disagree | 1 (10%) | 9 (90%) | 1.00 |
(Strongly) disagree | 0 (0%) | 8 (100%) |
- - - -
| |
(Strongly) agree | 103 (13%) | 710 (87%) | 0.77 (0.10,6.11) | |
It is part of my job to provide patients with CKP with a written management plan | Neither agree nor disagree | 53 (15%) | 309 (85%) | 1.00 |
(Strongly) disagree | 31 (16%) | 159 (84%) | 0.88 (0.54,1.43) | |
(Strongly) agree | 20 (7%) | 258 (93%) |
2.21 (1.29,3.80)
| |
GPs’ beliefs about their role in including exercise | ||||
It is part of my job to reassure patients about the safety of exercise for CKP | Neither agree nor disagree | 17 (30%) | 39 (70%) | 1.00 |
(Strongly) disagree | 4 (33%) | 8 (67%) | 0.87 (0.23,3.29) | |
(Strongly) agree | 83 (11%) | 679 (89%) |
3.57 (1.93,6.59)
| |
Which statement best describes your role in including exercise in the management plan of a patient with CKP? | I have no role in including exercise in the management plan | 5 (42%) | 7 (58%) | 1.00 |
I inform patients that exercise is a management option | 35 (34%) | 67 (66%) | 1.37 (0.40,4.62) | |
I advise patients to use exercise to manage their knee pain | 37 (14%) | 238 (87%) |
4.60 (1.39,15.24)
| |
I recommend the types of exercise patients could use | 24 (7%) | 329 (93%) |
9.79 (2.89,33.17)
| |
I give information on the type, frequency and duration of specific exercises | 2 (2%) | 86 (98%) |
30.71 (5.02,188.01)
|
Attitude statement | Response to attitude statement | Used exercise for the vignette patient | Odds ratio (95% CI) for use of exercise | |
---|---|---|---|---|
Yes | No | |||
Exercise for CKP is most beneficial when it is tailored to meet individual patient needsa | Neither disagree or agree | 13 (18%) | 60 (82%) | 1.00 |
(Strongly) disagree | 0 (0%) | 9 (100%) | - - - - | |
(Strongly) agree | 91 (12%) | 650 (88%) | 1.55 (0.82,2.93) | |
A standard set of exercises is sufficient for every patient with chronic knee problemsa | Neither disagree or agree | 38 (13%) | 254 (87%) | 1.00 |
(Strongly) disagree | 54 (13%) | 367 (87%) | 1.02 (0.65,1.59) | |
(Strongly) agree | 9 (8%) | 99 (92%) | 1.65 (0.77,3.53) | |
GPs should educate CKP patients about how to change their lifestyle for the betterb | Neither disagree or agree | 12 (24%) | 38 (76%) | 1.00 |
(Strongly) disagree | 3 (33%) | 6 (67%) | 0.63 (0.14,2.92) | |
(Strongly) agree | 88 (12%) | 676 (89%) |
2.43 (1.22,4.82)
| |
It is important that people with CKP increase their overall activity levelsa | Neither disagree or agree | 17 (22%) | 62 (79%) | 1.00 |
(Strongly) disagree | 5 (50%) | 5 (50%) | 0.27 (0.07,1.06) | |
(Strongly) agree | 82 (11%) | 653 (89%) |
2.18 (1.22,3.91)
| |
How well a patient complies with their exercise programme determines how effective it will bea | Neither disagree or agree | 12 (13%) | 79 (87%) | 1.00 |
(Strongly) disagree | 7 (32%) | 15 (68%) |
0.33 (0.11,0.96)
| |
(Strongly) agree | 85 (12%) | 627 (88%) | 1.12 (0.59,2.14) | |
GPs should follow-up patients to monitor extent of continuation of exercisesb | Neither disagree or agree | 37 (12%) | 265 (88%) | 1.00 |
(Strongly) disagree | 33 (13%) | 212 (87%) | 0.90 (0.54,1.48) | |
(Strongly) agree | 33 (12%) | 243 (88%) | 1.03 (0.62,1.70) | |
It is the patient’s own responsibility to continue doing their exercise programmeb | Neither disagree or agree | 6 (13%) | 42 (88%) | 1.00 |
(Strongly) disagree | 2 (29%) | 5 (71%) | 0.36 (0.06,2.27) | |
(Strongly) agree | 96 (12%) | 675 (88%) | 1.00 (0.42,2.43) |
Beliefs about consequences: knowledge and attitudes about the efficacy of exercise
Attitude statement | Response to attitude statement | Used exercise for the vignette patient | Odds ratio (95% CI) for use of exercise | |
---|---|---|---|---|
No | Yes | |||
GPs should prescribe quadriceps strengthening exercises to every patient with CKPa | Neither disagree or agree | 42 (23%) | 142 (77%) | 1.00 |
(Strongly) disagree | 12 (18%) | 56 (82%) | 1.38 (0.68,2.81) | |
(Strongly) agree | 50 (9%) | 520 (91%) |
3.08 (1.96,4.83)
| |
GPs should prescribe general exercise, for example, walking or swimming, for every patient with CKPa | Neither disagree or agree | 17 (25%) | 50 (75%) | 1.00 |
(Strongly) disagree | 3 (13%) | 21 (88%) | 2.38 (0.63,8.99) | |
(Strongly) agree | 84 (11%) | 649 (89%) |
2.63 (1.45,4.76)
| |
Knee problems are improved by quadriceps strengthening exercisesb | Neither disagree or agree | 26 (28%) | 67 (72%) | 1.00 |
(Strongly) disagree | 0 (0%) | 3 (100%) | - - - - | |
(Strongly) agree | 78 (11%) | 650 (89%) |
3.23 (1.94,5.39)
| |
Knee problems are improved by general exercise, for example, walking or swimmingb | Neither disagree or agree | 14 (26%) | 40 (74%) | 1.00 |
(Strongly) disagree | 0 (0%) | 4 (100%) | - - - - | |
(Strongly) agree | 90 (12%) | 676 (88%) |
2.63 (1.38,5.02)
| |
Quadriceps strengthening exercises for the knee are safe for everybody to dob | Neither disagree or agree | 44 (18%) | 200 (82%) | 1.00 |
(Strongly) disagree | 15 (13%) | 105 (88%) | 1.54 (0.82,2.90) | |
(Strongly) agree | 45 (10%) | 412 (90%) |
2.01 (1.29,3.15)
| |
General exercise, for example, walking or swimming, is safe for everybody to dob | Neither disagree or agree | 26 (20%) | 106 (80%) | 1.00 |
(Strongly) disagree | 14 (13%) | 91 (87%) | 1.59 (0.79,3.24) | |
(Strongly) agree | 64 (11%) | 519 (89%) |
1.99 (1.21,3.28)
| |
Exercise is effective for patients if an x-ray shows severe knee osteoarthritisb | Neither disagree or agree | 42 (16%) | 219 (84%) | 1.00 |
(Strongly) disagree | 24 (18%) | 108 (82%) | 0.86 (0.50,1.50) | |
(Strongly) agree | 38 (9%) | 391 (91%) |
1.97 (1.24,3.15)
| |
Exercise works just as well for everybody, regardless of the amount of pain they haveb | Neither disagree or agree | 32 (13%) | 207 (87%) | 1.00 |
(Strongly) disagree | 55 (14%) | 349 (86%) | 0.98 (0.61,1.57) | |
(Strongly) agree | 17 (9%) | 163 (91%) | 1.48 (0.80,2.76) | |
Increasing the strength of the muscles around the knee stops the knee problem getting worseb | Neither disagree or agree | 37 (15%) | 203 (85%) | 1.00 |
(Strongly) disagree | 19 (15%) | 109 (85%) | 1.05 (0.57,1.91) | |
(Strongly) agree | 48 (11%) | 408 (90%) | 1.55 (0.98,2.46) | |
Increasing the overall activity levels stops the knee problem getting worseb | Neither disagree or agree | 39 (13%) | 270 (87%) | 1.00 |
(Strongly) disagree | 28 (18%) | 130 (82%) | 0.67 (0.40,1.14) | |
(Strongly) agree | 37 (10%) | 318 (90%) | 1.24 (0.77,2.00) |
Beliefs about consequences: awareness of management recommendations
Beliefs about consequences: factors that may be perceived to influence efficacy of exercise
Risk factor | Agreement with item being risk factor | Not using exercise (%) | Using exercise (%) | Odds ratio (95% CI) for use of exercise |
---|---|---|---|---|
Non-modifiable | ||||
Hereditary/runs in the family | Neither agree or disagree | 30 (12%) | 212 (87%) | 1.00 |
(Strongly) disagree | 25 (13%) | 163 (87%) | 0.92 (0.52,1.63) | |
(Strongly) agree | 47 (12%) | 338 (88%) | 1.02 (0.62,1.66) | |
Ageing | Neither agree or disagree | 8 (13%) | 53 (87%) | 1.00 |
(Strongly) disagree | 1 (5%) | 18 (95%) | 2.72 (0.32,23.24) | |
(Strongly) agree | 95 (13%) | 653 (87%) | 1.04 (0.48,2.25) | |
Changes consistent with OA seen on x-ray | Neither agree or disagree | 22 (10%) | 207 (90%) | 1.00 |
(Strongly) disagree | 9 (12%) | 67 (88%) | 0.79 (0.35,1.80) | |
(Strongly) agree | 73 (14%) | 447 (86%) | 0.65 (0.39,1.08) | |
Modifiable | ||||
Accident or injury | Neither agree or disagree | 7 (22%) | 25 (78%) | 1.00 |
(Strongly) disagree | 2 (22%) | 7 (78%) | 0.98 (0.17,5.82) | |
(Strongly) agree | 94 (12%) | 693 (88%) | 2.06 (0.87,4.90) | |
A person’s own mental attitude | Neither agree or disagree | 23 (14%) | 140 (86%) | 1.00 |
(Strongly) disagree | 17 (22%) | 61 (78%) | 0.59 (0.29, 1.18) | |
(Strongly) agree | 64 (11%) | 518 (89%) | 1.33 (0.80,2.22) | |
A person’s emotional state | Neither agree or disagree | 19 (14%) | 115 (86%) | 1.00 |
(Strongly) disagree | 12 (17%) | 59 (83%) | 0.81 (0.37,1.79) | |
(Strongly) agree | 73 (12%) | 549 (88%) | 1.24 (0.72,2.14) | |
Sport | Neither agree or disagree | 18 (14%) | 108 (86%) | 1.00 |
(Strongly) disagree | 7 (10%) | 60 (90%) | 1.43 (0.57,3.62) | |
(Strongly) agree | 79 (13%) | 553 (88%) | 1.17 (0.67,2.03) | |
Being overweight/obese | Neither agree or disagree | 0 (0%) | 3 (100%) | - - - |
(Strongly) disagree | 0 (0%) | 3 (100%) | - - - | |
(Strongly) agree | 103 (13%) | 719 (88%) | - - - | |
Manual work | Neither agree or disagree | 18 (11%) | 144 (89%) | 1.00 |
(Strongly) disagree | 9 (15%) | 53 (86%) | 0.74 (0.31,1.74) | |
(Strongly) agree | 77 (13%) | 527 (87%) | 0.86 (0.50,1.48) |