# Barriers and facilitators to uptake of non-surgical interventions for knee osteoarthritis: a protocol for a systematic review of qualitative studies

## TL;DR

This paper outlines a systematic review protocol to understand why patients and providers adopt or avoid non-surgical treatments for knee osteoarthritis.

## Contribution

It introduces a structured approach to synthesize qualitative evidence on barriers and facilitators to non-surgical intervention uptake for knee osteoarthritis.

## Key findings

- The review will use thematic synthesis to identify key barriers and facilitators to non-surgical treatment uptake.
- Findings will inform strategies to improve implementation of evidence-based care for knee osteoarthritis.
- The study will assess confidence in synthesized findings using the CERQual framework.

## Abstract

Knee osteoarthritis affects millions globally, causing pain, functional limitations, and reduced quality of life. Clinical guidelines recommend non-surgical interventions including exercise, weight management, and education as first-line treatments. However, uptake and adherence to these evidence-based interventions remain suboptimal, with many patients not receiving recommended care. While effectiveness evidence is robust, understanding of factors influencing implementation from patient and provider perspectives remains fragmented. Qualitative research provides rich insights into barriers and facilitators but lacks systematic synthesis to inform implementation strategies.

This systematic review protocol aims to synthesize qualitative evidence on barriers and facilitators to uptake of guideline-recommended non-surgical interventions for knee osteoarthritis, examining perspectives of patients, healthcare providers, and other stakeholders across diverse healthcare contexts.

Following PRISMA-P and ENTREQ guidelines, we will search seven databases (MEDLINE, Embase, CINAHL, PsycINFO, AMED, Scopus, and Web of Science) from inception to December 2025. The PICo framework guides eligibility criteria focusing on adults with knee osteoarthritis, their experiences with non-surgical interventions, and contextual factors influencing uptake. Covidence will facilitate study screening and selection. Quality assessment will employ the Critical Appraisal Skills Program (CASP) qualitative checklist. Thematic synthesis following Thomas and Harden’s approach will identify descriptive and analytical themes. CERQual will assess confidence in synthesized findings.

This protocol establishes methodology for comprehensive synthesis of qualitative evidence on non-surgical intervention uptake for knee osteoarthritis. Findings will inform development of implementation strategies, clinical pathways, and patient support programs addressing identified barriers while leveraging facilitators. The synthesis will guide healthcare providers, policymakers, and researchers in improving delivery and uptake of evidence-based osteoarthritis care.