PT  - JOURNAL ARTICLE
AU  - Lauren K.  King
AU  - Esther J.  Waugh
AU  - Crystal MacKay
AU  - Ian Stanaitis
AU  - Owen Krystia
AU  - Jane Stretton
AU  - Susan Ross
AU  - Shawn Brady
AU  - Alanna Weisman
AU  - Lorraine Lipscombe
AU  - Gillian A.  Hawker
TI  - Formulating Knee Osteoarthritis Management Plans Taking Type 2 Diabetes into Account: Qualitative Study of Arthritis Therapists Using Theoretical Domains Framework
AID  - 10.3899/jrheum.220535
DP  - 2022 Sep 15
TA  - The Journal of Rheumatology
PG  - jrheum.220535
4099  - http://www.jrheum.org/content/early/2022/09/11/jrheum.220535.short
4100  - http://www.jrheum.org/content/early/2022/09/11/jrheum.220535.full
AB  - Objective Delivering person-centered care in individuals with knee osteoarthritis (OA) necessitates consideration of other chronic conditions that frequently co-occur. We sought to understand the extent to which arthritis therapists' (ATs') consider type 2 diabetes (T2DM) when treating persons with knee OA and concomitant T2DM, and barriers to doing so. Methods We conducted 18 semi-structured telephone interviews with ATs working within a provincially-funded arthritis care program (Arthritis Society) in Ontario, Canada. We first analyzed interviews deductively using the Theoretical Domains Framework (TDF) to comprehensively identify barriers and enablers to health behaviours. Then, within TDF domains, we inductively developed themes. Results We identified five TDF domains as prominently influencing the behaviour of ATs considering concomitant T2DM when developing a knee OA management plan: therapists' perceived lack of specific knowledge around comorbidities including diabetes; there was lack of breadth in skills in behavioural change techniques to help patients set and reach their goals, particularly when it came to physical activity; therapists generally had no intention for a patient's comorbidity profile to influence their treatment recommendations; they saw their professional role and identity as joint focused; and lack of formalized follow-up structure of the current Arthritis Society program limited sufficient patient monitoring and follow-up (environmental context and resources). Conclusion Within the context of a Canadian arthritis program, we identified several barriers to ATs considering T2DM in their management plan for persons with knee OA and T2DM. These results can help inform strategies to improve person-centered OA care and overall health outcomes.