Category: Nevin Manimala

JAMA Netw Open. 2025 Jun 2;8(6):e2517095. doi: 10.1001/jamanetworkopen.2025.17095.

ABSTRACT

IMPORTANCE: Many US communities face a crisis of people experiencing unsheltered homelessness often intertwined with opioid use. Jurisdictions seek policy options for managing unsanctioned encampments of this population, but their various outcomes are unclear.

OBJECTIVE: To evaluate policy options and their health and economic outcomes for an encampment of people experiencing homelessness and opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study conducted a closed-cohort state-transition simulation using the Researching Effective Strategies to Prevent Opioid Death (RESPOND) model from October 2021 to October 2022. The study was based primarily on data from Massachusetts and simulated an urban encampment with a population experiencing homelessness and high-risk opioid use. Data analysis was performed from December 2022 to October 2024.

EXPOSURE: The following encampment management strategies were modeled: (1) status quo (no sweep); (2) sweep, a sudden disruption of all residents, followed by no additional resources; (3) housing with medication for opioid use disorder (MOUD) requirement; or (4) housing without MOUD requirement.

MAIN OUTCOMES AND MEASURES: The primary outcomes were overdose and all-cause mortality per 1000 person-years, weeks spent in housing and taking MOUD, and economic cost from a modified government payer perspective. Sensitivity analyses were conducted by varying uncertain parameters.

RESULTS: The simulated cohort included 400 adults (mean [SD] age, 48 [17] years; 232 males [58.0%]). Under the status quo strategy, there were 50.4 (95% uncertainty interval [UI], 48.9-52.2) deaths per 1000 person-years, 15.5 (95% UI, 14.0-17.2) deaths from overdose per 1000 person-years, and 2990 (95% UI, 2897-3081) person-weeks spent taking MOUD for a total cost of $6 583 000 (95% UI, $6 502 000-$6 660 000). A sweep strategy resulted in 53.1 (95% UI, 51.3-55.2) deaths per 1000 person-years, 16.4 (95% UI, 18.2-20.2) deaths from overdose per 1000 person-years, and 1694 (95% UI, 1625-1764) person-weeks spent taking MOUD at a total cost of $6 820 000 (95% UI, $6 736 000-$6 899 000). The housing with medication requirement strategy resulted in 51.2 (95% UI, 49.4-53.0) deaths per 1000 person-years, 16.3 (95% UI, 14.6-18.1) deaths from overdose per 1000 person-years, and 3050 (95% UI, 3025-3075) person-weeks spent taking MOUD and in housing, for a total cost of $7 264 000 (95% UI, $7 188 000-$7 336 000). A housing without MOUD requirement strategy resulted in 49.2 (95% UI, 47.6-51.1) deaths per 1000 person-years, 14.3 (95% UI, 12.7-16.2) deaths from overdose per 1000 person-years, and 5014 (95% UI, 4942-5085) person-weeks spent taking MOUD and 14 511 (95% UI, 14 461-14 562) person-weeks spent in housing, for a total cost of $8 822 000 (95% UI, $8 774 000-$8 868 000).

CONCLUSIONS AND RELEVANCE: In this decision analytical model study of approaches to homeless encampments involving individuals with OUD, sweeps increased mortality and spending. Housing without MOUD requirement was the most costly strategy but saved more lives.

PMID:40577017 | DOI:10.1001/jamanetworkopen.2025.17095

JAMA Netw Open. 2025 Jun 2;8(6):e2517103. doi: 10.1001/jamanetworkopen.2025.17103.

ABSTRACT

IMPORTANCE: The number of people experiencing homelessness (PEH) in the US has increased substantially in recent years. The leading cause of death among PEH is drug overdose, with opioids accounting for the majority of such deaths.

OBJECTIVE: To assess the costs and health outcomes of providing stable housing to PEH who have opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation conducted a model-based cost-effectiveness analysis of PEH with OUD in the US.

EXPOSURE: Provision of stable housing, with no requirement to enter OUD treatment.

MAIN OUTCOMES AND MEASURES: Primary outcomes were overdoses and deaths over 5 years, lifetime per-person discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios (ICERs) compared with the status quo (no housing provision).

RESULTS: In a model of 1000 PEH (700 male; mean [SD] age, 46.4 [14.0]; 300 female; mean [SD] age, 46.5 [14.3]), under the status quo, 191 (95% CI, 152-237) deaths occurred over 5 years (58 [95% CI, 44-78] from overdose and 133 [95% CI, 101-167] from other causes). With the housing intervention, 140 (95% CI, 114-185) deaths occurred (53 [95% CI, 39-76] from overdose and 87 [95% CI, 73-110] from other causes). The housing intervention was associated with a gain of 3.59 (95% CI, 3.13-3.98) lifetime QALYs per person at an incremental cost of $26 800 (95% CI, $21 200-$32 300) per QALY gained compared with the status quo. Over extensive sensitivity analyses, the ICER remained less than $90 000 per QALY gained.

CONCLUSIONS AND RELEVANCE: This economic evaluation found that investing in stable housing for this marginalized population, even with no requirement to enter OUD treatment, was associated with cost-effectiveness, fewer deaths, and improved health outcomes. Efforts are urgently needed to improve the health of PEH with OUD; it is essential to understand the outcomes and cost-effectiveness of housing provision for this marginalized population because housing status is a key social determinant of health.

PMID:40577016 | DOI:10.1001/jamanetworkopen.2025.17103

JAMA Netw Open. 2025 Jun 2;8(6):e2517760. doi: 10.1001/jamanetworkopen.2025.17760.

ABSTRACT

IMPORTANCE: Accurate estimation of surgical transfusion risk is important for perioperative planning and effective resource allocation. Most machine learning models in health care are not validated or perform poorly in external settings.

OBJECTIVE: To externally validate a publicly available machine learning algorithm (Surgical Personalized Anticipation of Transfusion Hazard [S-PATH]) to estimate red cell transfusion during surgery within a national sample of hospitals.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated all surgical cases performed in 2020 or 2021 at 45 US hospitals participating in the Multicenter Perioperative Outcomes Group. Obstetric and nonoperative cases were excluded. Data analysis was performed from February 2023 to March 2025.

EXPOSURES: At each hospital, S-PATH was used to estimate surgical transfusion risk using patient- and procedure-specific characteristics without local retraining. A baseline model representing the standard-of-care maximum surgical blood ordering schedule (MSBOS) approach, which omits patient factors, was used for comparison. Risk thresholds above which a type and screen would be recommended were set for 96% sensitivity. Performance was evaluated at each hospital separately.

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of patients with type and screen order recommendations between S-PATH and MSBOS at each hospital. The secondary outcome was area under the receiver operating characteristic curve (AUROC).

RESULTS: In this cohort study of 3 275 956 surgical cases (median [IQR] age, 57 [40-69] years; 53.1% female) performed at 45 hospitals (28 of 45 academic [62.2%]), S-PATH recommended type and screen orders for a median (IQR) of 32.5% (25.8%-42.0%) of cases, whereas the MSBOS approach recommended type and screens for a median (IQR) of 51.6% (46.9%-61.1%) of cases for the same sensitivity (median [IQR] difference, 17.9 [14.8-24.9] absolute percentage points). The median (IQR) S-PATH AUROC was 0.929 (0.915-0.946), whereas the median (IQR) MSBOS AUROC was 0.857 (0.822-0.884).

CONCLUSIONS AND RELEVANCE: In this cohort study of 45 hospitals, a personalized surgical transfusion risk prediction algorithm demonstrated external validity and discrimination. S-PATH was consistently more effective than standard care, suggesting its potential for use as a perioperative clinical decision support tool.

PMID:40577014 | DOI:10.1001/jamanetworkopen.2025.17760

JAMA Netw Open. 2025 Jun 2;8(6):e2517825. doi: 10.1001/jamanetworkopen.2025.17825.

ABSTRACT

IMPORTANCE: Surgeon training with a specific implant is often not considered in implant registry-based studies, which may lead to unobserved confounding bias. Discrepancies between registry and clinical trial outcomes for patellofemoral arthroplasty (PFA) may originate from differences in surgeon training levels.

OBJECTIVE: To compare revision rates for knees operated on by knee surgeons specifically trained for PFA and knee surgeons who were not.

DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, the framework of a target trial was used to compare outcomes for 2 patient groups: patients who underwent PFA performed by knee surgeons who had (trial surgeons) vs who had not (nontrial surgeons) received focused PFA training as part of a randomized clinical trial. All primary PFA procedures from January 1, 2008, through December 31, 2015, were identified using Danish registries and individual hospital notes with 6 years’ follow-up. Data were analyzed from January 24 to March 1, 2024.

EXPOSURE: Focused PFA training.

MAIN OUTCOMES AND MEASURES: The primary outcome was 6-year risk of revision. Analyses were conducted according to a prespecified statistical analysis plan, using multiple logistic regression to estimate marginal risk ratios for 6-year risks of revision, reoperation, and mortality, adjusting for potential confounders.

RESULTS: Of 482 eligible knees of patients who had undergone PFA, 274 (57%; 206 female [75%]; mean [SD] age, 61 [13] years) were operated on by trial surgeons, and 208 (43%; 142 female [68%]; mean [SD] age, 57 [12] years) by nontrial surgeons. Trial surgeons operated on knees with higher patellofemoral Kellgren-Lawrence osteoarthritis grade (range 0-4, with 0 indicating no osteoarthritis and 4 indicating severe osteoarthritis) than nontrial surgeons (79% vs 53% with grade 3 to 4) and higher tibiofemoral Kellgren-Lawrence osteoarthritis grades (37% vs 17% with grade 2 to 4). The 6-year revision rate for trial surgeons was 8% (22 of 274 knees) vs 26% (54 of 208 knees) for nontrial surgeons, corresponding to an adjusted relative risk (RR) of 0.35 (95% CI, 0.22-0.56; P < .001). The reoperation rate was 12% (33 of 274 knees) for trial surgeons vs 19% (40 of 208 knees) for nontrial surgeons, with an adjusted RR of 0.71 (95% CI, 0.42-1.18; P = .19). There was no difference in mortality for trial vs nontribal surgeon groups (18 of 274 knees [7%] vs 12 of 208 knees [6%]; adjusted RR, 1.11 [95% CI, 0.53-2.33; P = .79).

CONCLUSIONS AND RELEVANCE: In this cohort study using a target trial emulation approach to assess the association of surgeon training with PFA outcomes, the cumulative 6-year revision rate for PFA was lower for knees operated on by PFA-trained knee surgeons, suggesting that such surgeon training was associated with a better outcome. This suggests that the level of training may be an important confounder for registry-based comparisons of implant outcome, and that this confounder may even obscure inherent implant outcomes.

PMID:40577013 | DOI:10.1001/jamanetworkopen.2025.17825

JAMA Netw Open. 2025 Jun 2;8(6):e2517965. doi: 10.1001/jamanetworkopen.2025.17965.

ABSTRACT

IMPORTANCE: Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits.

OBJECTIVE: To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality.

DATA SOURCES: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024.

STUDY SELECTION: Randomized clinical trials of interventions to address potentially inappropriate prescribing for older primary care patients (aged ≥65 years) residing in the community or in long-term care facilities, such as nursing homes or assisted-living facilities, were included.

DATA EXTRACTION AND SYNTHESIS: Two researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using random-effects models.

MAIN OUTCOMES AND MEASURES: The planned outcomes were the number of medications, nonserious adverse drug reactions, injurious falls, quality of life, medical visits, emergency department visits, hospitalizations, and all-cause mortality. Random-effects meta-analyses were performed using the inverse variance method for similar studies, reporting risk ratios (RRs) or standardized mean differences (SMDs). Heterogeneity was assessed with I2 values, and publication bias was assessed with funnel plots and the Egger regression test.

RESULTS: Of the 14 649 records identified, 118 randomized clinical trials (comprising 417 412 patients) were included in this review. Interventions to address potentially inappropriate prescribing were associated with a reduction in the number of medications prescribed (SMD, -0.25 [95% CI, -0.38 to -0.13]), equivalent to approximately 0.5 fewer medications per patient. However, there were no substantial differences in the other outcomes, including nonserious adverse drug reactions (RR, 0.92 [95% CI, 0.58-1.46]), injurious falls (SMD, 0.01 [95% CI, -0.12 to 0.14]), quality of life (SMD, 0.09 [95% CI, -0.04 to 0.23]), medical visits (SMD, 0.02 [95% CI, -0.02 to 0.07]), emergency department admissions (RR, 1.02 [95% CI, 0.96-1.08]), hospitalizations (RR, 0.95 [95% CI, 0.89-1.02]), or all-cause mortality (RR, 0.94 [95% CI, 0.85-1.04]).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, interventions to address potentially inappropriate prescribing were associated with reductions in the number of medications prescribed, with no substantial change in other outcomes. These findings suggest that inappropriate prescribing interventions may be implemented to safely reduce the number of medications prescribed to older adults in the primary care setting. Future studies should continue to evaluate these interventions using standardized criteria and consistently report potential harms to support data synthesis and capture key outcomes such as quality of life, hospitalization, and mortality.

PMID:40577011 | DOI:10.1001/jamanetworkopen.2025.17965

JAMA Health Forum. 2025 Jun 7;6(6):e251467. doi: 10.1001/jamahealthforum.2025.1467.

ABSTRACT

IMPORTANCE: Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals.

OBJECTIVE: To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn.

DESIGN, SETTING, AND PARTICIPANTS: This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024.

MAIN OUTCOMES AND MEASURES: Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage.

RESULTS: The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn.

CONCLUSIONS AND RELEVANCE: In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.

PMID:40577007 | DOI:10.1001/jamahealthforum.2025.1467

JAMA Health Forum. 2025 Jun 7;6(6):e251630. doi: 10.1001/jamahealthforum.2025.1630.

ABSTRACT

IMPORTANCE: The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown.

OBJECTIVES: To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included.

EXPOSURE: A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021.

MAIN OUTCOMES AND MEASURES: Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care.

RESULTS: There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits.

CONCLUSIONS AND RELEVANCE: Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.

PMID:40577006 | DOI:10.1001/jamahealthforum.2025.1630

Eur J Gen Pract. 2025 Dec;31(1):2520218. doi: 10.1080/13814788.2025.2520218. Epub 2025 Jun 27.

ABSTRACT

BACKGROUND: Emergency room (ER) utilisation by ambulatory patients with low urgency medical problems leads to ER-capacity use and long waiting times. Establishing General Practice (GP)-led urgent care practices (UCP) adjacent to ERs allows to triage patients from the ER to the UCP. However, patients may perceive themselves as ER-cases and expect ER-treatment including extensive diagnostics.

OBJECTIVES: To assess UCP-patients’ satisfaction compared to ambulatory ER-patients.

METHODS: Sub-analysis (11/2019-01/2020) of a prospective, monocentric observational study at the University Medical Centre Hamburg-Eppendorf ER and co-located UCP focusing on patient survey data including demographics, waiting time and diagnoses. Satisfaction, uncertainty and appropriateness of waiting time was assessed with 4-point Likert-scales.

RESULTS: Analysing 1196 UCP- and 597 ER-patients, patient satisfaction correlated positively with perceived appropriate waiting time in both groups. But more UCP-patients deemed their waiting time appropriate (76.7% vs. 70.4%; p = 0.004) and reported to be very satisfied with the treatment (64.7% vs. 55.8%; p < 0.001). Time until the first physician contact was nearly equal, but the entire length of stay was shorter in the UCP (104 ± 88.0 min vs. 179 ± 301 min; p < 0.001). In both groups, satisfaction was reduced by on-going uncertainty after the visit, but uncertainty was higher among UCP-patients (32% vs. 25%; p = 0.003). Age, gender or diagnosis had no influence on patients’ satisfaction. More UCP-patients stated that today’s problem could have been treated by a GP (57% vs. 15%; p < 0.001) and were advised to follow up in an outpatient setting.

CONCLUSIONS: Treating patients in an UCP does not lead to overall dissatisfaction.

PMID:40577002 | DOI:10.1080/13814788.2025.2520218

JMIR Med Inform. 2025 Jun 27;13:e65913. doi: 10.2196/65913.

ABSTRACT

BACKGROUND: The digitalization of health care has advanced significantly in recent years. Consequently, physicians have needed to increasingly adopt new digital health technologies such as electronic health record systems and other health information systems. Digitalization has changed physicians’ clinical work, work environment, management work, and use of tools for leadership. Many physician leaders have been critical of the capabilities of health information systems (HISs) to support leadership, management, and knowledge management.

OBJECTIVE: We aimed to examine the association between leadership position and perceived changes in clinical work due to digitalization among a nationally representative sample of Finnish physicians and physician leaders. In addition, we examined physician leaders’ perceptions of HISs as a support for management and whether their opinions differed based on their perceptions on changes in clinical work due to digitalization.

METHODS: Altogether 4630 Finnish physicians (2960/4586, 64% women) responded to a cross-sectional nation-wide web-based survey conducted in spring 2021. Perceptions of improved preventive work, facilitated access to patient information, progressed interprofessional collaboration, and accelerated clinical encounters were used as measures of changes due to digitalization. First, we examined with multivariable logistic regression analyses whether being in a leadership position was associated with perceived changes in work due to digitalization (improved preventive work, facilitated access to patient information, progressed interprofessional collaboration, and accelerated clinical encounters in separate analyses) in the total sample. Second, we examined with analyses of covariance whether the variables related to perceived changes in work due to digitalization were associated with perceived management support from HISs among those who had administrative or management responsibilities (n=817). All analyses were adjusted for gender, age, and sector.

RESULTS: Physician leaders had greater odds of agreeing that digitalization had improved preventive work (odds ratio [OR] 1.62, 95% CI 1.33-1.98), facilitated access to patient information (OR 1.28, 95% CI 1.09-1.51), progressed interprofessional collaboration (OR 1.81, 95% CI 1.53-2.14), and accelerated clinical encounters (OR 1.31, 95% CI 1.01-1.70) than those in nonleadership positions. Furthermore, leaders who perceived these changes in work due to digitalization positively also considered that health information systems supported their management work.

CONCLUSIONS: Physician leaders appeared to view the changes in work due to digitalization more positively than other physicians. In addition, those leaders who perceived these changes positively also perceived that HISs supported their management work. Thus, leaders should thoroughly evaluate and address physicians’ perceptions of their routine clinical work and its evolving nature. Doing so ensures access to up-to-date and accurate insights, enabling more effective planning of staffing, training programs, and future implementations. Furthermore, our results show that to guarantee positive views about digitalization among physician leaders, information systems should also support managerial work. This highlights the need to focus on the quality, utility, and usability of information systems.

PMID:40576972 | DOI:10.2196/65913

Phys Ther. 2025 Jun 18:pzaf083. doi: 10.1093/ptj/pzaf083. Online ahead of print.

ABSTRACT

IMPORTANCE: Conservative, non-pharmacological interventions are the recommended first-line treatment for hip and knee osteoarthritis (OA). Clinical practice guidelines (CPGs), such as those from the Osteoarthritis Research Society International (OARSI), guide evidence-based care by physical therapists. However, no studies in Germany have examined physical therapists’ treatment choices across patient cases and compared them with the latest evidence.

OBJECTIVE: The objective of this study was to investigate to what extent physical therapists meet the latest evidence when treating different type of people with hip or knee OA.

DESIGN AND SETTING: A cross-sectional vignette-based online survey was conducted among physical therapists working in outpatient practices.

PARTICIPANTS: Eligible participants had adequate German language skills, internet access, and recent experience treating patients with hip or knee OA.

MEASURES: The survey included 4 case vignettes of hip or knee OA, with and without comorbidities, and a list of treatment modalities from the OARSI guideline. Correct selections matched high-evidence recommendations. Descriptive statistics analyzed demographics and treatment choices; linear regression assessed the influence of professional degree and work experience on meeting the latest evidence.

RESULTS: Of 612 eligible therapists, 335 (54.7%) completed the survey (mean age 35.9 +/- 11.9 years; 60% female). Only 22% selected all recommended modalities across vignettes. Structured exercise (96%) and arthritis education (95%) were the most frequently chosen. However, many therapists also selected interventions with limited or conflicting evidence, such as massage and taping. Both professional degree and work experience significantly influenced the extent to which the latest evidence was met. Additionally, 49% were aware of at least 1 OA guideline.

CONCLUSIONS AND RELEVANCE: While many physical therapists aligned with evidence-based practices, inappropriate modality selection remained common. De-implementation is needed where evidence suggests a lack of benefit or potential safety concerns. Translating and implementing the OARSI guideline into various languages, specifically for physical therapists, is recommended to close knowledge gaps.

IMPACT STATEMENT: The study’s findings underscore the importance of understanding the treatment modalities used by physical therapists in managing hip or knee OA worldwide. This insight is crucial for addressing the evidence-to-practice gap and ensuring the effective implementation of high-quality physical therapy, a need that is equally relevant in other countries. Additionally, this knowledge is vital for developing targeted strategies, such as the creation and integration of (de-)implementation protocols into the education and ongoing professional development of physical therapists globally.

PMID:40576964 | DOI:10.1093/ptj/pzaf083