Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions

Background Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients’ needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386


Relationship
This code is used when talking about the changes in the relationship between the physiotherapist and the patient from the patient's point of view due to the use of blended care and when stating which conditions must be fulfilled so the relationship does not change negatively despite the use of blended care.

Competences
This code is used to indicate which competences the patient needs to have at a personal level in order to use blended care.

Time
This code is used when considering whether the implementation of blended care gives the user more or less time for the treatment process.

Costs/ expenses
This code is used to identify the costs of implementing blended care and who or what system is responsible for covering the costs. Furthermore, it is also included if it is a precondition for the implementation of blended care that the costs are covered.

Data security and patient rights
This code is used if subjects talk about privacy within blended care and if factors are named that require the patient's consent.

Structural (pre-)conditions/ framework conditions
Code is used when talking about changes in work, therapy and acceptance of digital media due to the pandemic and when talking about preconditions for use and structural preconditions for implementing blended care at a system level.

Intervention-related factors
Digital elements Quality This code is used when talking about factors that influence the implementation of blended care and when subjects describe how the quality of care changes because of blended care.

Technical factors
This code is used when it generally concerns technical requirements for implementation of blended care.

Software
This code is used when talking about formats (video, text form, video chat, etc.), which content should be offered, the functional structure of the online program and which functions it should have. It is also used when talking about the need for WLAN access in order to be able to use blended care.

Hardware
This code is used when it comes to access to digital devices and when it comes to the allocation of digital components to the end devices.

Usability
This code is used when it comes to the requirements that must be fulfilled in order to use digital tools within the blended care intervention and to simplify the usability of the technology.

Organisational factors
Practical setting Cooperation/ collaboration

Working conditions
Personal structure

Therapist-related factors
Treatment approach This code is used when the participant talks about, how he/she is currently treating his/her patients and when he/she talks about how his/her therapy is changing due to the use of blended care.

Relationship
This code is used when talking about changes in the relationship between therapists and patients from the therapist's point of view due to the use of blended care and when stating which conditions have to be fulfilled so that the relationship does not change negatively despite the use of blended care.

Competences
This code is used when talking about which competences the therapist requires on a personal level in order to apply blended care.