Keele Research Repository

Patients with chronic knee pain (CKP) frequently present to general practitioners (GPs). Exercise, a core management approach for CKP, reduces pain and improves functioning. To maximise patient outcomes, GPs should practise in line with best evidence recommendations. Using an underpinning model (developed using behavioural theory), this thesis describes the attitudes, beliefs and behaviours of GPs regarding the use of exercise for patients with CKP.
A systematic review revealed a paucity of published studies specifically examining this topic. Available data suggested that GPs’ attitudes and beliefs about exercise for CKP varied widely, exercise appeared to be underused and its implementation by GPs was unclear. The need to concurrently and specifically investigate the attitudes, beliefs and behaviours of GPs regarding exercise for CKP was identified.
A vignette-based pilot questionnaire survey of 800 UK GPs was undertaken to refine the survey tool and methods and to inform the required sample size for the main survey. The subsequent main survey of 5000 UK GPs revealed that exercise was used by most GPs for CKP. However, methods employed to initiate exercise within an individual patient’s management plan were variable and imperfectly aligned with evidence-based recommendations. Attitudes and beliefs about exercise for CKP were generally positive; however GPs expressed some uncertainty about safety and efficacy, particularly regarding local exercise (e.g. strengthening, range-of-movement, stretching). Although some elements of the underpinning model (e.g. role and identity) predicted GPs’ behaviour, others (e.g. beliefs about capabilities) performed less well.
To maximise the clinical outcomes of patients with CKP, recommendations from this research include: development of educational, organisational change and/or behaviour change strategies to improve initiation of individualised exercise, and clarification of GPs’ role, in this context. Approaches to better understand the key influences on GPs’ behaviour are required; a greater focus on decision-making theory may be valuable.