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-5905501905Kingdom of Saudi Arabia
Saudi Commission of Health Specialties
Joint Program of Family Medicine, Jazan Region
00Kingdom of Saudi Arabia
Saudi Commission of Health Specialties
Joint Program of Family Medicine, Jazan Region

Knowledge, Attitude, and Practice of Primary Health Care Physicians in the Management of Osteoarthritis in Jazan Region, Saudi Arabia
This thesis proposal approved for submission in partial fulfillment of the Saudi Board of Family Medicine
By:
Dr. Khaled Ahmed M. Jammal, MBBS
Family Medicine Resident
Supervisors:
Dr. Husameldin Elsawi Khalafalla, FCM, MHPE
Assistant Professor, Department of Family and Community Medicine
Faculty of Medicine – Jazan UniversityDr. Amani Osman Abdelmola, MBBS, MPH, MD Community Medicine
Assistant Professor, Department of Family and Community Medicine
Faculty of Medicine – Jazan University
1439-2018

Proposal contents:
No. Content Page
1 Introduction 1
2 Rationale of the study 2
3 Aim 3
4 Objectives 3
5 Research questions 3
6 Literature review 4
7 Methods and materials 8
8 Study design 8
9 Study area and population 8
10 Inclusion criteria and exclusion criteria 8
11 Sample size and sampling technique 9
12 Data collection tools 9
13 Data entry and statistical analysis 11
14 Ethical consideration 11
15 Work plan and time schedule 12
16 Budget 12
17 Relevance of the study 12
18 References 13
19 Appendices (Informed consent and questionnaire) 16
List of abbreviations:
Abbreviation Meaning
OA Osteoarthritis
PHC Primary health care
PHCCs Primary health care centers
ROM Range of motion
NSAIDs Nonsteroidal anti-inflammatory drugs

Introduction:
Osteoarthritis (OA) is a degenerative form of arthritis that is the usual result of inflammation, breakdown, and finally loss of cartilage in the joint. 1 It is the most prevalent form of arthritis; it is affecting millions of people and it is considered a leading cause of pain and disability globally. 2
OA can affect people of all ages, but the individuals who older than 65 years are most affected. Elderly, obesity, history of prior joint injury or trauma, overuse of the joint, weak thigh muscles and genetic predisposition are common risk factors for OA. It can affect any joint, but the most commonly affected joints are knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. 3
It has a huge burden on the population globally, as the pain in the knee and hip joints is giving rise to a significant disability that needs a surgical intervention. Also, it has a psychological burden, as the pain in small hand joints creates difficulties in doing the daily activities in older patients. Additionally, it has a high economic burden, as the patients need more medications and possible surgical interventions. 4
The diagnosis of OA can usually be made clinically (clinical features include joint pain with activity, transient stiffness in the morning or after rest, reduced ROM, joint crepitus, periarticular tenderness and bony swelling) and then confirmed by radiography. 5
OA is one of the most common problems faced by PHC physicians. 6,7 PHC physicians are frequently the first and sometimes the only health-care providers for OA. 6,8,9 PHC physicians can manage most of the cases of OA and only minority of OA may need a referral. 9
Regarding the management of OA, American and British specialty societies recommended clinical practice guidelines in a form of a stepped-care approach to treating osteoarthritis. Pharmacologically, treatment must start on acetaminophen and then step up to NSAIDs if acetaminophen is ineffective. Non-pharmacologically, regular physical activity is a useful adjunct throughout treatment and it is helpful in reducing pain and disability. Corticosteroid injections can be considered in a case of acute exacerbation of OA. Hyaluronic acid is helpful if OA is persistent. Consider total joint replacement if all steps are unsuccessful. 10
Rationale of the study:
Osteoarthritis (OA) is the most common arthritis, a common cause of disability and a frequent cause of consultation with PHC physicians.

Worldwide estimates are that 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis (WHO).

PHC physicians play an important role in the care and education of people with OA.

To maximize the role of primary health care physicians in the management of OA, it is very important to build up their level of knowledge, attitude and practice regarding the management of OA.

Up to the knowledge of researcher, there are no previous studies were conducted at Jazan region to assess knowledge, attitude, and practice of primary health care physicians in the management of OA. Therefore, I will conduct a study about this topic in Jazan region.

Aim:
To study knowledge, attitude, and practice of primary health care physicians in the management of osteoarthritis in Jazan region, Saudi Arabia.

Objectives:
To assess the knowledge of primary health care physicians regarding osteoarthritis.

To assess the attitude of primary health care physicians toward osteoarthritis.

To determine the management practice of primary health care physicians regarding osteoarthritis.

Research questions:
1. What is the level of knowledge on osteoarthritis among primary health care physicians in Jazan, Saudi Arabia?
2. What is the attitude of primary health care physicians towards osteoarthritis in Jazan, Saudi Arabia?
3. What is the level of practice regarding osteoarthritis management among primary health care physicians in Jazan, Saudi Arabia?
Literature review:
Osteoarthritis (OA) is the most common arthritis, a common cause of disability and a frequent cause of consultation with PHC physicians who play an important role in the care and education of people with OA. In this section, we provided a result of an extensive search of the English language literature. The following studies were cited concerning Knowledge, Attitude, and Practice of Primary Health Care Physicians in the Management of Osteoarthritis:
Regarding the prevalence of osteoarthritis, a Saudi study included 5,894 participants reviewed the prevalence of OA was 13%. 11 Another study was carried out in Canada reported that OA constituted 37% of all cases of arthritis in adults who are 20 years or older. 12 A recent study was conducted in England included over 26 000 adults who are 50 years or older, showed about half of them having OA and about 22% of them reported disabling OA. 13
Regarding the knowledge of physicians about osteoarthritis, a cross-sectional study was conducted in Al-Jouf province showed incorrect knowledge was reported among 50.3 % of participants. 14 Another recent study was done in Jeddah revealed the highest level of knowledge was detected in the physicians with Board-certified family (86.4%), followed by physicians with family medicine Diploma (70%), compared to physicians with Bachelor degree (53.7%). Also, it showed the level of knowledge was around 51.3% in physicians who had experience for less than five years and around 72.3% in physicians who had experience for ten years or more. 15 When asked physicians about their knowledge regarding the cause of primary OA, studies concluded that over 60% of participants strongly agreed that OA is multifactorial in origin. 14,15 Regarding the joints that are commonly affected in OA, a study reported 27.3% of participants strongly agreed that OA shoulders are not affected. 14 More than 70% of participants reported OA can be diagnosed by history and physical examination only. 14,15 About the item (Plain radiography helps in confirming the diagnosis), a study showed most of the participants agreed that plain radiography helps in confirming the diagnosis. 15 Only 39% of participants correctly answered the question (Radiographs; OA changes include all of the following changes except). 14
About attitudes of physicians toward osteoarthritis, a Saudi study was done by Al-Hazmi found appropriate attitudes among the participants. 14 The Answer of the question (Do you think Osteoarthritis; is a common heath problem in Saudi Arabia?), the vast majority of participants (75.3%) agreed that OA is a common health problem in Saudi Arabia. 14 Regarding the item (Do you think osteoarthritis is a part of growing old), more than two-thirds of participants (67.5%) agreed that OA is a part of growing old. 14 Another study revealed the prevalence of OA was 30.8% in adults who are 46-55 years and 60.6% in adults who are 66-75 years and this means the prevalence of OA increased with increasing age. 11 When asked the physicians if they perceived their training prepare them adequately to manage patients with OA, only 44.2 % of them consider their training is adequate. 14 A study found both anxiety and/or depression were highly prevalent among patients with OA. 16 Additionally, most of the participants (93.5%) reported collaborations with other health professionals, especially trained nurses, dietitians, and physiotherapists are very important tools for care of patients with OA. 14 Another study reviewed 99% of physicians reported ever providing advice or referring to a physiotherapist. 17 Result reported by a study regarding if the physicians perceive non-drug therapy would be more beneficial than drug therapy for most patients with osteoarthritis showed approximately more than half of participants (58.4 %) agreed that non-drug therapy would be more beneficial than drug therapy for most patients with osteoarthritis. 14 Another study showed positive attitudes of physicians about non-pharmacological therapy including physiotherapy compared to pharmacological therapy. 18 Regarding the recommendations to establish ” Saudi guidelines to care and manage osteoarthritis “, a study revealed more than 80% of participants recommended establishment of ” Saudi guidelines to care and manage osteoarthritis “. 14
Regarding the practice of physicians toward management of osteoarthritis, in 2012 a study carried out in Al-Jouf province in Saudi Arabia concluded inappropriate management of OA by physicians. 14 Another study conducted in America showed a need for further education for physicians on the management of OA. 19 Regarding the item (patient education and self-management programs), the vast majority of participants (71.4%) educated their patients about OA. 14 The self-management programs reduced the anxiety of patients, but it had no significant effect on pain and physical functioning. 20 About strengthening exercises, a study conducted in Jeddah concluded 80.7 % of participants advised their patients about strengthening exercises most of the time, while 10.2% of them advised their patients occasionally and only 9.1 % of them did not advise their patients at all. 15 In another study, only less than half of participants always advised their patients regarding ROM and strengthening exercises. 14 About the role of exercise in the treatment of OA, studies demonstrated the exercise is regarded as the corner-stone of conservative management for the disease. 21-23 Regarding physicians’ advice to their patients, most of them advised their patients to reduce weight and only approximately 26.3% of them prescribed assistive devices for their patients. 14,15 About prescription of acetaminophen, studies revealed acetaminophen is prescribed by more than two thirds of participants most of the time. 14,15 Another study found acetaminophen in practice was not the first-line drug preferred by primary care physicians. 24 Regarding NSAIDs’ prescription, a study carried-out in Al-Jouf showed 59.7% of participants prescribed these medications most of the time, while 31.2% and 7.8% of them prescribed these medications occasionally and not at all respectively. 14 Another study reported PHC physicians are most likely to treat OA with an oral NSAID regimen. 19 Only minority of participants advised their patients to use intraarticular steroid injections. 14
Methods and materials:
Study design:
Descriptive cross-sectional study.

Study area and population:
This study will be conducted in Jazan region. Jazan region is located in south-western part of Saudi Arabia. It is bounded to the north by Aseer region and to the south by the Republic of Yemen and from the east Aseer region and the Republic of Yemen, and the Red Sea to the west.

The target population will be the primary care physicians who are working in Jazan region. There are 170 primary health care centers with a total population of 443 physicians belonged to Ministry of health.

Eligibility criteria:
Inclusion criteria:
– The inclusion criteria for participation in the study will be physicians in primary health care centers in Jazan region who sign the consent, available on the duration of the study and willing to participate in the study.

– Eligible physicians will be male and female primary care physicians of any age in addition to nationality.

Exclusion criteria:
– The exclusion criteria for participation in the study will be physicians in primary health care centers in Jazan region who are not available on the duration of the study and not willing to participate in the study.

Sample size and sampling technique:
All provinces in Jazan will be included in this study. A list of all names of primary health care physicians in each province will be provided by Jazan Directorate of Health. The total number of physicians of primary health care centers in Jazan region is 443 physicians and the number of PHCCs is 170.

The researcher will follow a full coverage technique for all physicians who are working at PHCCs in Jazan region.

Data collection tools:
– A self-administered valid questionnaire will be utilized for data collection. It is adopted from a questionnaire used in a study conducted in Al-Jouf province, 2012. Permission to utilize the questionnaire was requested through an e-mail communication with the corresponding author.

– The questionnaire was pretested during a pilot study that was conducted by the corresponding researcher. This was done to ensure clarity, relevance and to determine the time needed to answer all items. The results of the pretest were evaluated critically. The average time needed to fill all items in the questionnaire was about 10-15 minutes. Results of the pilot study were not included in the final analysis.- The questionnaire consisted of four parts:
Part one: Demographic profile, which contains name, gender, age, nationality, marital status, qualification, working place, and years in practice.
Part two: Primary care physicians’ knowledge about osteoarthritis including 12 questions.

Part three: Primary care physicians’ attitudes toward osteoarthritis including 19 questions.

Part four: Practices of primary health care physicians toward osteoarthritis including options in the management of patients with osteoarthritis.

– Face to face interview to complete the questionnaire.

– After taking the written consent of the physicians to participate, then they will be instructed to answer all the questions included in the questionnaire.

Pilot study:
Pilot study will be conducted on 40 PHC physicians to ensure clarity and to determine the time needed to fill the questionnaire. The results of the pilot study will not be included in the final analysis.

Data entry and statistical analysis:
– Data entry and analysis will be done by using the Statistical Package of the Social sciences (SPSS) statistical program version 24.

– Descriptive statistics will be applied in the form of frequencies and percentages for categorical variables and mean with standard deviation (SD) for normally distributed continuous variables, while the median and interquartile range will be used for the non-normally distributed continuous variables.

– Association between 2 categorical variables will be investigated using Chi-square test will. If the assumption of Chi-square test violated; Fischer exact will be used.

– P-value of less than 0.05 will be considered statistically significant throughout the study.

Ethical considerations:
Approval will be obtained from Ethical Committee in Jazan region.

Approval will be taken by Directorate of primary health care centers, Jazan region for doing the study.

Informed consent from each physician to participate in the study will be taken.

All collected data will be kept confidential.

Every participant has a right to withdraw from the study at any time.

Work plan and time schedule:
Months
Tasks Mar 2018 April 2018 May 2018 Jun 2018 Jul 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019
Research proposal submission and approval Data collection Data entry Data analysis Thesis writing Finalize thesis and
submission Publication Budget:
The study will be self-funded.

Relevance of the study:
This study can be used in the future as baseline information regarding Management of Osteoarthritis by Primary Health Care Physicians in Jazan Region, Saudi Arabia. Hence, the researcher believes that the results of this study will have important practical implications, and will give some directions for future researches.

References:
1. Nordqvist, C. (2017, July 10). “Everything you need to know about osteoarthritis.” Medical News Today. Retrieved from: https://www.medicalnewstoday.com/kc/osteoarthritis-causes-symptoms-treatments-27871.

2. Osteoarthritis – Overview – Mayo Clinic. Available from: http://www.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-201982483. What is Osteoarthritis? Available from: https://www.arthritis.org/about-arthritis/types/osteoarthritis/what-is-osteoarthritis.php.

4. Cross, M., Smith, E., Hoy, D., Nolte, S., Ackerman, I., Fransen, M., … March, L. (2014). The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(7), 1323–1330.

5. Hunter, D. J., & Felson, D. T. (2006). Osteoarthritis. BMJ (Clinical Research Ed.), 332(7542), 639–642.
6. Rosemann, T., Wensing, M., Joest, K., Backenstrass, M., Mahler, C., & Szecsenyi, J. (2006). Problems and needs for improving primary care of osteoarthritis patients: The views of patients, general practitioners and practice nurses. BMC Musculoskeletal Disorders, 7, 1–9.

7. Axford J, Heron C, Ross F, Victor CR. Management of knee osteoarthritis in primary care: Pain and depression are the major obstacles. J Psychosom Res. 2008;64:461–7
8. Zakaria, Z. F., Bakar, A. A., Hasmoni, H. M., Rani, F. A., & Kadir, S. A. (2009). 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, 8(1), 1–7.

9. Jordan, K. P., Kadam, U. T., Hayward, R., Porcheret, M., Young, C., & Croft, P. (2010). Annual consultation prevalence of regional musculoskeletal problems in primary care: An observational study. BMC Musculoskeletal Disorders, 11.

10. Sinusas, K. (2012). Osteoarthritis: Diagnosis and Treatment. American Family Physician, 1(86), 49–56.

11. Al-Arfaj AS, Alballa SR, Al-Saleh SS, Al-Dalaan AM, Bahabry SA, Mousa MA, et al. Knee osteoarthritis in Al-Qaseem, Saudi Arabia. Saudi Med J. 2003 Mar; 24(3): 291–293.

12. Kerr RG, Al-Kawan RH. Osteoarthritis. A primary care approach for physicians in 2000 and beyond. Saudi Med J. 2001;22:403–6.

13. Thomas, E., Peat, G., & Croft, P. (2014). Defining and mapping the person with osteoarthritis for population studies and public health. Rheumatology (United Kingdom), 53(2), 338–345.

14. Homoud AH. Knowledge, attitude, and practice of primary health care physicians in the management of osteoarthritis in Al-Jouf province, Saudi Arabia. Niger Med J. 2012 Oct ;53(4):213.

15. Alqutub, S. T., & Ibrahim, A. M. (2018). Assessment of Knowledge about Knee Osteoarthritis Diagnosis and Management among Primary Health Care Physicians in Jeddah 2017, 4(1).

16. Sharma, A., Kudesia, P., Shi, Q., & Gandhi, R. (2016). Anxiety and depression in patients with osteoarthritis: Impact and management challenges. Open Access Rheumatology: Research and Reviews, 8, 103–113.

17. Cottrell, E., Roddy, E., & Foster, N. E. (2010). The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review. BMC Family Practice, 11, 4.

18. De Bock, G. H., Kaptein, A. A., & Mulder, J. D. (1992). Dutch general practitioners’ management of patients with distal osteoarthritic symptoms. Scandinavian Journal of Primary Health Care, 10(1), 42–46.

19. Glauser, T. A., Salinas, G. D., Roepke, N. L., Chad Williamson, J., Reese, A., Gutierrez, G., ; Abdolrasulnia, M. (2011). Management of mild-to-moderate osteoarthritis: A study of the primary care perspective. Postgraduate Medicine, 123(1), 126–134.

20. Buszewicz, M., Rait, G., Griffin, M., Nazareth, I., Patel, A., Atkinson, A., … Haines, A. (2006). Self management of arthritis in primary care: Randomised controlled trial. British Medical Journal, 333(7574), 879–882.

21. Farr JN, Going SB, Lohman TG, et al. Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthritis Rheum 2008;59(9):1229–36.

22. Messier S, Loeser R, Miller G, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum 2004;50(5):1501–10.

23. Vogels E, Hendriks H, van Baar M, et al. Clinical practice guidelines for physical therapy in patients with osteoarthritis of the hip or knee. Royal Dutch Society for Physical Therapy; 2003.

24. Kartal M, Maral I, Coskun O. Prescribing pattern of general practitioners for osteoarthritis in primary care settings in Bolu, Turkey. Saudi Med J 2007;28:1885-9.

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Demographic characteristics of Physicians (the study volunteers):
Name: …………………………………………………………….(Optional).

Gender: a. Male……………….. , b. Female…………………
Age:
; 30 years………………………………………..
30-40 years………………………………………
41-50 years………………………………………
51-60 years……………………………………….

; 60 years…………………………………………

Nationality:
Saudi…., b. Egyptian…., c. Sudanese…., d. Syrian…………
e. Jordanian……., f. Indian…………, g. Pakistani….

h. Bangladeshi………, Other nationality, specify (…………………)
Marital status:
Single (Never married) …………………….

Married…………………………………………..

Divorced…………………………………………..

Widowed………………………………………….

Qualification:
MBBs…………………………………………..

Diploma …………………………………….

Master Degree………………………………

Board ………………………………………….

PhD……………………………………………..

Workplace:
Urban …………………………………….

Rural ………………………………….
Years in practice:
? 5 years …………………………………….

5- 10 years ………………………………….
;10- 20 years ……………………………….
;20- 30 years ……………………………….

; 30 years …………………………………….
Primary care physicians’ knowledge about osteoarthritis:
The cause of primary OA:
Trauma …………………………………………….….

Metabolic …………………………………….….……
Multifactorial in origin…………………………….

Autoimmune …………………………………………
Infectious ….……………………….……………….

How would you diagnose osteoarthritis?
By history taking from the patients only……………………….

By history and physical examination only………………………

By history, physical examination, and clinical investigations………………
Not sure………………………………………….……….……………

All of the following joints are commonly affected in OA except:
Shoulders……………………………………………….……….

Hips, ……………………………………………………………….

Knees, ………………………………………………….…….…….

Spine, ……………………………………………………………….

Distal interphalangeal (DIP) joints…………………………….

All of the following joints are often spared in OA except:
The wrists, …………………………….………………….

The ankles (except in ballet dancers), …….……….

Elbows, …………………………….………………………

The metacarpals, ……………………………….……….

Proximal interphalangeal pip joints. …….……….

Radiographs; OA changes include all of the following changes except:
Symmetric joint space narrowing……………………….……….

Subchondral sclerosis…………………………………………….

Osteophyte formation……… ……………………….…….…….

Lateral femoral condyle………………………………………….

Selected key recommendations for the management of knee osteoarthritis include all of the followings except:
Pharmacologic therapy is the cornerstone of OA management. ……….

Paracetamol should be used first for pain relief of knee osteoarthritis….

NSAID dosage should be minimal to achieve pain relief satisfactory to the patient…….

Celecoxib is recommended for patients in whom simple analgesics are ineffective or unable to be used………………………………………………….
Alternative therapies are recommended for patients in whom simple analgesics are ineffective or unable to be used…………………………….

An osteoarthritis variant affecting primarily the hands runs in families and is inflammatory:
True……………………………………….…….

False…………………………….…….….……

Not sure …………………………………….….….
Radiographs are generally the first-line confirmation of the presence of OA:
True……………………………………….…….

False…………………………….…….….……

Not sure …………………………………….….….
Treatment should not be based solely on radiographic abnormalities:
True……………………………………….…….

False…………………………….…….….……

Not sure …………………………………….….….
Primary and secondary osteoarthritis must be differentiated:
True……………………………………….…….

False…………………………….…….….……

Not sure …………………………………….….….
Patients with OA usually experience all of the following symptoms except:
Joint pain…………………….…………………………………………..

Joint stiffness……………………………………………………………

Moderate Joint hotness……………………………………………….

Tenderness ……………………………………………………………..

Cracking noise with joint movement……………………………

Pathological features of OA include all of the followings except:
Increase the viscosity of the synovial fluid …………….…….
Degeneration and fragmentation of cartilage. ……..….……
Sclerosis of the subchondral bone. ……………………….……

Cartilage ossification. ………………………….………………….

Joint space narrowing. ………………………………………….III. Primary care physicians’ attitudes toward osteoarthritis:
1) Do you think Osteoarthritis; is a common heath problem in Saudi Arabia?
Yes …………………….……………………….

No …………………….…………………………

Not sure ……………………………………….

2) Do you feel Osteoarthritis; is an underestimated in Saudi Arabia?
Yes ……………………………………………

No ……………………………………………….

Not sure ………………………….…………

3) Do you perceive an osteoarthritis in Saudi Arabia has reached a level of public health significance and requires urgent actions:
Agree …………………………………………….

Disagree …………………………….……………

Not sure ………………………………………….
4) Do you think osteoarthritis is a part of growing old?
Yes……………………………………………………………….
No………………………………………………………………..
Not sure ………………………………………………………..
5) More attention should be offered to osteoarthritic patients:
Agree …………………………………………….

Disagree …………………………….……………

Not sure ………………………………………….
6) Do you think osteoarthritis causes patients excessive anxiety and concern?
True……………………………………….……..

False…………………………….…….….……

Not sure …………………………………….….….
7) Would you prescribe medications for asymptomatic patients, but x-ray positive OA findings?
Yes …………………………………
No …………………………….……
Not sure …………….……………
8) Do you have an interest to involve the family in management of patient with osteoarthritis?
Agree …………………………………………….

Disagree …………………………….……………

Not sure ………………………………………….
9) Did your training prepare you adequately to manage patients with osteoarthritis?
Yes ……………………….……………………….

No …………………………………….……………

Not sure ………………………………………….
10) Do you feel yourself a useful person to support a patient with osteoarthritis:
Yes ……………………….……………………….

No …………………………………….……………

Not sure ………………………………………….
11) Dealing with osteoarthritis patients is heavy going:
Agree …………………………………………….

Disagree …………………………….…….………

Not sure …………………………………….…….
12) Do you perceive the statement that an osteoarthritis is not amenable to change:
Agree …………………………………………….

Disagree …………………………….…….………

Not sure …………………………………….…….
During counselling of patients with osteoarthritis treatment for weight loss should be offered only to adults who are obese (BMI;30 kg/m2):
Agree ………………………………………………

Disagree …………………………….…….………

Not sure …………………………………….…….
Collaborations with other health professionals, especially trained nurses, dietitians, and physiotherapists is very important tools for care of patients with osteoarthritis:
Agree ………………………………………………

Disagree …………………………….…….………

Not sure …………………………………….…….
Do you perceive of screening programs for osteoarthritis is favorable to improve care of osteoarthritis patients:Agree ……………………………………………….

Disagree …………………………….…….….……
Not sure ………………………………………….….
Do you feel that Oral non-opioid analgesics (e.g., acetaminophen) usually produce a satisfactory results in the treatment of osteoarthritis patients in general practice:Yes ………………………………………………….

No ……….………………………………….….……

Not sure …………………………………….….….

Do you perceive the physicians in the primary care centers are capable of achieving a major role in control of osteoarthritis:Agree ……………………………………………….

Disagree …………………………….……….…….

Not sure ……………………………………….….

Do you recommend to establish ” Saudi guidelines to care and mange osteoarthritis ”
Agree …………………………………………….

Disagree …………………………….……………

Not sure ………………………………………….
Do you perceive that non-drug therapy would be more beneficial than drug therapy for most osteoarthritis patients:Agree ………………………………….………….

Disagree …………………………….…….….……

Not sure …………………………………….….….
IV. Practices of primary health care physicians toward osteoarthritis:
1) In your clinic; Options in the management of patients with osteoarthritis includes the following as needed:
In your clinic; options in the care of patients with osteoarthritis, includes the following as needed: Most of the time Occasionally Not at all
Patient education and self-management programs Social support through telephone contact Physical and occupational therapy Range of motion (ROM) and strengthening exercises Aerobic conditioning Weight loss Assistive devices for ambulation and activities of daily living Oral non-opioid analgesics (e.g., acetaminophen) Topical analgesics (e.g., capsaicin cream) Nonsteroidal anti-inflammatory drugs (NSAIDs) Intra-articular steroid injections Opioid analgesics