Exploring Knowledge, Attitudes and Practices of Physical Therapists Regarding Lateral Wedge Insole in Patients with Mild to Moderate Knee Osteoarthritis
Purpose/Hypothesis: The implementation of lateral wedge insole (LWI) as a conservative treatment strategy for knee Osteoarthritis (OA) may be influenced by the knowledge, attitudes and beliefs of healthcare providers, including physical therapists (PTs). Although the literature has identified the biomechanical function of insoles, little is known about the PTs’ perceptions and the likelihood of LWI adoption in their clinical practices. Therefore, the purpose of this study was three-fold. The first aim was to validate and test for reliability a Principal Investigator (PI) created survey instrument, entitled "Exploring Knowledge, Attitudes and Practices of PTs Regarding LWI among Patients with Mild to Moderate Knee OA". The second aim was to use the valid and reliable survey tool to identify and understand the relationships that might exist between PTs’ perceptions and LWI as a cost-effective treatment approach. The third aim was to identify perceived barriers associated with prescribing LWI by PTs when treating knee OA. We hypothesized that a significant relationship would exist between PTs’ perceptions and the likelihood of LWI adoption. Information gleamed from this investigation would aide PT educators and clinical faculty in promoting knowledge translation (KT) specific to LWI usage in managing knee OA.
Number of Subjects: 107 licensed PTs, 62 females and 45 males completed the online survey.
Materials and Methods: The study design was a mixed methods design, utilizing a PI-created survey. The survey was developed to assess the knowledge, attitudes and, practices of PTs regarding the use of LWIs among patients with mild to moderate knee OA and was administered online. Face and content validity of the survey were established through the expert panel Delphi review process, and the reliability for each survey construct was above .8. A letter of solicitation was emailed to all PT programs chairpersons listed on the American Physical Therapy Association (APTA) website requesting that the letter of solicitation which contained a link to the survey be emailed to all PT faculty members. Also, the letter of solicitation was posted on social media (Facebook™ PT groups, Twitter™ and LinkedIn®).
Results: 107 PTs voluntarily completed the survey. 34.6% of respondents were between 41 to 50 years of old. 30.8% of respondents had more than 25 years of experience in PT sector. The results of this study showed that only 5.6% of the respondents were extremely familiar with a LWI as a means to manage mild to moderate knee impairments. LWIs were reported as a "never been used therapeutic modality" by 52% of the respondents when treating mild to moderate knee OA patients. LWIs adoption was moderately correlated with PTs’ knowledge and practice (rho (107) = .518, p <.05, rho (107) = .423, p <.05), but PTs’ attitude was weakly correlated with LWI adoption (rho (107) = .394, p <.05). Lack of funding, resource, knowledge and patient compliance were the most reported barriers by PTs in the qualitative analysis and provide further insight into the quantitative findings.
Conclusions: This study findings support that promoting evidenced based knowledge translation specific to LWI mechanism for treating patients with mild to moderate knee OA is needed. PT educators both in the didactic and clinical setting must infuse knowledge of LWI into the curriculum to enhance evidence-based practice.
Clinical Relevance: Conservative treatment approaches such as LWI can positively assist in the management of knee OA issues. PTs must acquire knowledge and be able to translate that knowledge into clinical practice. The Academy must promote knowledge acquisition and critical thinking skills needed for KT. Educators must employ teaching and learning strategies that promote knowledge translation and bridges the gap between research and clinical practice.