Exploring How Physiotherapists Consider Falls Risk During the Clinical Management of People With Osteoarthritis

Abstract

Introduction. Falls and the number of people diagnosed with osteoarthritis are on the rise. In Aotearoa New Zealand (AoNZ), physiotherapists are well-positioned to incorporate falls screening of people with osteoarthritis into their routine practice. Early identification of falls risk presents an opportunity to implement preventive measures that could reduce the incidence of future falls. The literature suggests a link between osteoarthritis and an increased risk of falls, but the connection is not yet fully understood. Despite this, people with osteoarthritis have been consistently shown to be at risk of falls; therefore, considering falls in assessment and offering appropriate treatment should be routine. I wanted to explore how physiotherapists in AoNZ conceptualised the relationship between falls risk and osteoarthritis.

Objective. To explore how physiotherapists consider falls risk during the clinical management of people with osteoarthritis, if they are screening for falls, or if they include falls-prevention strategies in their practice. Methods. I used a qualitative descriptive approach, collecting data via 10 semi-structured interviews and analysing them using directed content analysis. Participants were eligible if they were physiotherapists in AoNZ who worked in musculoskeletal practice and commonly managed people with lower limb osteoarthritis.

Results. Three themes were conceptualised from the data. Theme one: ‘What is the risk of a fall?’, this theme explores the physiotherapists reasoning about falls risk. Theme two: ‘Making assumptions about patients’ explores physiotherapists’ assumptions when deciding whether a person with osteoarthritis is at risk of a fall. Theme three: ‘Gatekeeper of treatment’ looks at factors influencing behaviour behind assessment which direct the treatment plan of people with osteoarthritis.

Conclusion. A physiotherapist’s decision to assess falls risk is influenced by their assumptions about perceived falls risk and beliefs about their clinical role. These factors appear to shape their clinical reasoning and decision-making. My findings suggest that some physiotherapists practice reactively rather than proactively when assessing people with osteoarthritis. They provide assessment and treatment only if the patient indicates a fall or fits a preconceived notion of what constitutes a falls risk. Work is needed to raise physiotherapists’ awareness of falls risk in people with osteoarthritis. Achieving this could include formal teaching and updating guidelines, recommendations, and assessment forms.