The experiences of physical therapists delivering a very low energy diet and exercise intervention for weight loss in people with knee osteoarthritis: A qualitative study

Exercise and weight loss are core treatments for knee osteoarthritis (OA). While physical therapists are considered well placed to engage in weight management alongside exercise (not replacing dietician care), evidence surrounding physical therapist-delivered weight loss interventions is sparse. To understand the experiences and perceptions of physical therapists delivering a very low energy diet (VLED) and exercise intervention to people with knee OA and overweight or obesity in a randomized controlled trial (RCT). Qualitative interview study involving six physical therapists (mean age 34 years, median experience 3.5 years) who completed 20 hours of training and delivered a six-month diet+exercise intervention via telehealth to people with knee OA and overweight or obesity in the POWER RCT. Physical therapists participated in semi-structured individual telephone interviews on completion of RCT involvement. Data were audio-recorded, transcribed, and independently thematically analysed by two researchers. Three themes emerged. Physical therapists felt that delivering a weight loss intervention alongside exercise enabled holistic OA management. Enacting this role within a supportive research environment was considered unique and physical therapists felt the training and resources facilitated care. They felt that, with training, weight loss may be within scope of physical therapy practice for some patients with less complex needs although required alternate models of care including extended consult times, medical or dietician oversight and acknowledging physical therapist supervised weight loss would not be appropriate for all patients. Findings provide preliminary insight into potential barriers and facilitators to, and acceptability of, physical therapists delivering a VLED and exercise intervention for weight loss in people with knee OA and overweight or obesity.