Helen is a Clinical Specialist Physiotherapist at University Hospital Kerry where she works part-time in a musculoskeletal triage role. She is also a post-doctoral researcher at the School of Allied Health, University of Limerick where she holds a Health Research Board Clinician Scientist Fellowship. Her current research is focused on implementing evidenced based care for chronic knee pain, degenerative meniscal tears and osteoarthritis into clinical practice.
Non-surgical approaches such as exercise therapy are recommended as first-line therapy for a degenerative meniscal tear (DMT); a common knee pain presentation in Irish orthopaedic clinics. Despite strong recommendations against surgery, arthroscopy remains a common orthopaedic procedure for DMTs. We aimed to develop an intervention and implementation strategy to improve non-surgical management of DMTs in the primary care setting that would target both health care practitioners (HCPs) and patient barriers to evidence based care.
The Behaviour Change Wheel (BCW) was used to guide the intervention development process. First, we identified target behaviours through a review of current evidence. Next, we drew on baseline qualitative data with patients (n = 10), GPs (n = 30) and physiotherapists (n=12) to identify determinants of behaviour using the Theoretical Domains Framework (6), mapping these to behaviour change techniques (BCTs) to develop intervention content. Finally, we carried out stakeholder consultation with groups of patients (n = 6) and HCPs (n=12) regarding the feasibility, acceptability, and local relevance of intervention components.
The final intervention, targeting both HCPs and patients, incorporated a range of BCTs. The implementation strategy compromised of an outreach visit with GP training, provision of a GP resource pack for patient consultations, and support from a bespoke online resource. This strategy also facilitated early access to a physiotherapy session, focused on boosting patients’ self-efficacy and self-management skills. Patient behaviours were also targeted with a non-surgical management plan agreed at the first consult, and provision of extra supports around exercise adherence.
This study used a systematic theory-based approach, incorporating multiple stakeholder perspectives, to develop an intervention for DMT. Implementing evidence-based approaches, and thereby reducing low value surgical care, could help sustain a health system under increasing strain to provide care for chronic musculoskeletal conditions.