Background: A structured, tailored exercise therapy strategy was found to significantly improve physical functioning, reduce pain and was safe for patients with knee OA and severe comorbidity. The intervention was performed in a specialized, secondary care center. Before the intervention can be implemented in primary care, appropriate education of physiotherapists (PTs) as well as insight into barriers and facilitators for using the protocol in primary care is needed.

Objectives: This study aimed to 1) evaluate the effect of an interactive course on the exercise therapy strategy for patients with OA and comorbidity for PTs working in primary care; and 2) map facilitators and barriers for applying the protocol in primary care.

Methods: A pre-posttest study was performed among PT’s who were working in primary care. PTs were offered a postgraduate blended educational course consisting of an e-learning lecture (7 hours study load) and two interactive workshops (each 3 hours study load). Measures of effectiveness included a questionnaire on knowledge (60 multiple choice questions) before (T0) and two weeks after the course (T1) and a patient vignette to measure clinical reasoning (nine open questions) before the course (T0) and six months after the course (T2). Facilitators and barriers for using the protocol were measured at T2 by means of a 27 item questionnaire (each item was scored on a 5-point Likert scale, ranging from 0 totally agree to 4 totally disagree).

Results: Thirty-four PTs were included. Fourteen out of 34 PTs had treated at least one patient with knee OA and comorbidity according the protocol. Statistically significant improvements were found, both for knowledge levels between baseline and T1 (N=34)(p<0.00), and for clinical reasoning between baseline and T2 (N=34) (p<0.00). With regard to facilitators to implement the protocol, the majority of PTs found the protocol feasible in daily practice (68%) and to be supportive regarding clinical reasoning and clinical decision making (77%). Perceived barriers for implementation included the small number of patients with OA and severe comorbidity being referred or referring themselves. Of the therapist who actually treated patients according to the protocol, 86% indicated that the protocol was applicable in their daily clinical practice and that they perceived to have sufficient knowledge (71%) and skills (64%) to apply the protocol. Other barriers indicated by PTs were the limited number of treatment reimbursement by the insurance companies (65%) and a suboptimal collaboration with general practitioners and physicians (65%).

Conclusions: An interactive educational course on exercise therapy for knee OA patients with comorbidity proved to be effective in improving knowledge and clinical reasoning skills of primary care PTs. Main barriers for protocol use included limited referrals of patients with knee OA and severe comorbidity to PTs, and limited number of treatment reimbursement by insurance companies. For larger scale implementation these barriers should be solved.

Disclosure of Interest: None declared