EC Orthopaedics

Background: Osteoarthritis (OA) is a chronic degenerative joint condition and is the 15^th major cause of disability worldwide. Family physicians play a significant role in managing these patients; their up-to-date knowledge is essential for evidence-based management.

Objective: This study assesses family physicians’ knowledge, attitude, and practice toward OA management. Furthermore, it explores knowledge gaps and discrepancies in practice and compares them with similar studies in the Arabian Peninsula.

Methods: We conducted a cross-sectional online survey at Primary Healthcare Corporation (PHCC), Qatar. We sent a targeted online survey link via PHCC intranet email to 724 family physicians working across twenty-eight health centers in Qatar.

Results: About 100 family physicians responded to the survey. Out of 100, 75 (75%) were male, 59 out of 100 (59%) were consultants, and the average age of respondents was 48 (SD 7.1). Overall knowledge of family physicians was 76.7%, exhibiting a positive attitude and good practice. A substantial majority of family physicians, 78 out of 100 (78%), acknowledged that OA adversely affects patients’ mental well-being, leading to anxiety and concern. 75 out of 100 (75%) of the participants believed they had adequate training to manage OA. 88 out of 100 (88%) family physicians frequently recommended non-pharmacological management approaches, particularly weight loss. Oral non-steroidal anti-inflammatory drugs (NSAIDs) were offered (75%) most of the time by general practitioners compared to specialists (16.7%) (P = .019). Notably, female physicians exhibited significantly higher utilization rates of pharmacological treatments, which include topical capsicum (P = .013), topical NSAIDs (P = .048), and oral NSAIDs (P = .049), and non-pharmacological treatment like thermotherapy (P = .011).

Conclusion: Overall, this study found that PHCC family physicians’ knowledge, attitude, and practice in managing OA were good. However, targeted educational interventions are required, along with professional development programs, to promote evidence-based practices and address gender disparities in prescribing. Future research is necessary to delve deeper into the factors that contribute to the existing gaps in prescribing behavior between male and female physicians. Enhancing OA management further can lead to better patient outcomes and improved quality of care.

 Keywords: Family Physicians; Osteoarthritis; Knowledge, Attitude, and Practice

1. Leifer VP., et al. “The burden of OA-health services and economics”. Osteoarthritis and Cartilage1 (2022): 10-16.
2. Long H., et al. “Prevalence trends of site‐specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019”. Arthritis and Rheumatology7 (2022): 1172-1183.
3. “Musculoskeletal health”. World Health Organization (2023).
4. Alenazi AM., et al. “Prevalence and incidence of osteoarthritis among people living in the Gulf Cooperation Council countries: a systematic review and meta-analysis”. Clinical Rheumatology 9 (2021): 3523-3531.
5. Gerber LM., et al. “Health-related quality of life in midlife women in Qatar: relation to arthritis and symptoms of joint pain”. Menopause (New York, NY) 3 (2016): 324-329.
6. Jin X., et al. “Economic and humanistic burden of osteoarthritis: an updated systematic review of large sample studies”. PharmacoEconomics 11 (2023): 1453-1467.
7. Garriga M. “Definition, etiology, classification and presentation forms”. Aten Primaria1 (2014): 3-10.
8. Szilagyi IA., et al. “Towards sex-specific osteoarthritis risk models: evaluation of risk factors for knee osteoarthritis in males and females”. Rheumatology2 (2022): 648-657.
9. Conaghan PG., et al. “Therapeutic options for targeting inflammatory osteoarthritis pain”. Nature Reviews Rheumatology 6 (2019): 355-363.
10. Almaawi A., et al. “Awareness about total knee replacement among Saudi population”. Journal of Family Medicine and Primary Care 4 (2022): 1308-1313.
11. Berenbaum F and Walker C. “Osteoarthritis and inflammation: a serious disease with overlapping phenotypic patterns”. Postgraduate Medicine 4 (2020): 377-384.
12. Hunter DJ and Felson DT. “Clinical review-osteoarthritis”. BMJ-British Medical Journal-International Edition7542 (2006): 639-642.
13. Zakaria ZF., et al. “Health-related quality of life in patients with knee osteoarthritis attending two primary care clinics in Malaysia: a cross-sectional study”. Asia Pacific Family Medicine 1 (2009): 1-7.
14. Homoud AH. “Knowledge, attitude, and practice of primary health care physicians in the management of osteoarthritis in Al-Jouf province, Saudi Arabia”. Nigeria Medical Journal: Journal of the Nigeria Medical Association4 (2012): 213-219.
15. Tawfeeq AK., et al. “Knowledge, attitude and practice regarding osteoarthritis management among physicians of primary health care centers Al-rusafa/Baghdad/2017”. AL-Kindy College Medical Journal 1 (2019): 15-25.
16. Henry‐Blake C., et al. “The use of plain radiography in diagnosing osteoarthritis: A systematic review and time trend analysis”. Musculoskeletal Care2 (2022): 462-477.
17. Kolasinski SL., et al. “2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee”. Arthritis and Rheumatology 2 (2020): 220-233.
18. Lopes C., et al. “On physical examination, what are the best clinical findings to diagnose hip osteoarthritis”. Evidence-Based Practice 5 (2023): 23-24.
19. Ross A and Conaghan PG. “Optimising the management of osteoarthritis”. The Practitioner1863 (2022): 21-24.
20. Al-Mohrej OA., et al. “Pharmacological treatment in the management of glenohumeral osteoarthritis”. Drugs Aging2 (2022): 119-128.
21. Nissen N., et al. “Clinicians’ beliefs and attitudes to physical activity and exercise therapy as treatment for knee and/or hip osteoarthritis: a scoping review”. Osteoarthritis and Cartilage2 (2022): 260-269.
22. El Miedany Y and Elwakil W. “Multidisciplinary patient-centred model of care for osteoarthritis: scoping review protocol—an initiative by the Egyptian Academy of Bone Health”. Egyptian Rheumatology and Rehabilitation1 (2023): 1-7.
23. Holden MA., et al. “Osteoarthritis year in review 2022: Rehabilitation”. Osteoarthritis and Cartilage2 (2023): 177-186.
24. Kroon FP., et al. “Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis”. RMD Open2 (2018): e000734.
25. Shugarman LR., et al. “Factors associated with clinician intention to address diverse aspects of pain in seriously ill outpatients”. Pain Medicine 9 (2010): 1365-1372.
26. Safdar B., et al. “Impact of physician and patient gender on pain management in the emergency department—a multicenter study”. Pain Medicine 2 (2009): 364-372.
27. Veldhuijzen DS., et al. “Impact of physicians' sex on treatment choices for low back pain”. Pain Practice 6 (2013): 451-458.
28. Lazkani A., et al. “Do male and female general practitioners differently prescribe chronic pain drugs to older patients?” Pain Medicine 4 (2015): 696-705.
29. Mishra A., et al. “Influence of physician sex and gender on prescribing practices among older adults”. Journal of the American Geriatrics Society 12 (2020): 2764-2767.
30. Osani MC and Bannuru RR. “Efficacy and safety of duloxetine in osteoarthritis: a systematic review and meta-analysis”. Korean Journal of Internal Medicine 5 (2019): 966-973.
31. Zhang X., et al. “Efficacy and safety of tramadol for knee or hip osteoarthritis: a systematic review and network meta‐analysis of randomized controlled trials”. Arthritis Care and Research 1 (2023): 158-165.