“Joint protection first”: understanding physiotherapists’ implementation of evidence-based interventions in osteoarthritis knee management—a qualitative study

To explore the factors that influence physiotherapists’ adherence to evidence-recommended interventions in the management of knee osteoarthritis. Using a qualitative descriptive design, we conducted semi-structured interviews with 15 physiotherapists across India. Participants were selected using purposive sampling to ensure diversity in experience and setting. We used inductive thematic analysis to explore emerging themes from the data, which were subsequently related to physiotherapists’ adherence to evidence-recommended interventions in knee OA management. We identified three main themes influencing physiotherapists’ adherence to evidence-based care: biomechanical bias in decision-making, the influence of patient perceptions and preferences, and systemic challenges specific to healthcare settings. A significant biomechanical bias led to an emphasis on prioritizing joint protection strategies. Patient perceptions and demands, often influenced by trust in medical professionals over physiotherapists, pose significant challenges in aligning treatment with evidence-based practices. Systemic issues, including workload and infrastructural limitations, further complicate the delivery of effective OA care. This study illustrates the multifaceted barriers to implementing evidence-based interventions for knee OA among Indian physiotherapists. Addressing these challenges through context-specific knowledge translation strategies is critical for advancing evidence-based, patient-centered OA knee management. Understanding why physiotherapists deviate from evidence-based recommendations in knee osteoarthritis (OA) management remains a critical gap in the literature A predominant biomechanical focus, rooted in traditional physiotherapy education, may limit OA management decisions Patients’ understanding and beliefs about treatment significantly impact adherence to evidence-based interventions. High workload and inadequate infrastructure are key constraints that necessitate systemic changes to support evidence-based practice.