Bridging the implementation gap: a contextual approach to promote implementation of guideline-based management for osteoarthritis

Background

International and national efforts to promote musculoskeletal (MSK) health for healthy aging recommend guideline-based management for osteoarthritis (OA). However, slow uptake of and low adherence to evidence-based guidelines globally has been attributed to innovation, individual and healthcare setting (inner and outer) characteristics that may influence implementation across stakeholders.

Aim

This doctoral thesis aimed to explore the contextual determinants for uptake of and adherence to guideline-based management for OA.

Methods

A mixed-methods design in an observational cohort was applied, using a participatory health research (PHR) approach and guided by the Consolidated Framework for Implementation Research (CFIR). Firstly, a mixed-methods systematic review was conducted to synthesise the contextual determinants of people with chronic MSK conditions and healthcare professionals (HCPs) to uptake of online guideline-based management for chronic MSK conditions. Secondly, a cross-sectional survey was administered to explore the contextual determinants of general practitioners (GPs), physiotherapists (PTs) and people with hip and knee OA (PwOA) to uptake of in-person and online guideline-based management for OA. Thirdly, a qualitative framework analysis study was conducted to explore the contextual determinants of PTs and PwOA to implementation of an osteoarthritis management programme (OAMP) (GLA:D Ireland, Good Life with osteoArthritis in Denmark). Lastly, a secondary analysis of data from the GLA:D International Network Registry was conducted to investigate the contextual determinants of stakeholders for adherence to OAMPs.

Results

Findings from the review highlighted that the majority of determinants across different stakeholders are common, with 70% facilitating uptake of online guideline-based management for chronic MSK conditions. The cross-sectional survey study found determinants related to stakeholders (e.g., pain or other joint symptoms), healthcare settings (e.g., appropriate referrals from GP or other sources) and treatments (e.g., low-cost community-based exercise programmes) influence uptake of in-person and online guideline-based management for OA. The qualitative framework analysis study illustrated that stakeholders and healthcare settings valued the implementation of OAMPs, with determinants related to organising, planning and funding influencing uptake across public healthcare settings. The secondary analysis of the GLA:D International Network Registry data reported high adherence to OAMPs, with demographic (e.g., older age), joint-related (e.g., fear of movement) and OAMP-related (e.g., in-person treatment methods) characteristics and better baseline health outcomes found to positively influence adherence.

Conclusion

Greater knowledge generated from the findings and unique contributions of this doctoral thesis provide a nuanced contextual insight into the uptake of and adherence to guideline-based management for OA. Researchers, policymakers, stakeholders and healthcare settings may benefit from a contextualised approach that considers key innovation, individual and healthcare settings (inner and outer) characteristics to promote optimal implementation of evidence-based guidelines for the management of OA universally.