{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:38:27Z","timestamp":1790098707587,"version":"4.0.1"},"reference-count":83,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"G-BA Innovationsfond","award":["01NVF20010"],"award-info":[{"award-number":["01NVF20010"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Despite growing evidence and specific guidelines, people with knee and hip osteoarthritis often do not receive appropriate care. This review aims to identify healthcare utilisation and its predictors to optimise existing services and identify unmet needs across different healthcare systems using Andersen\u2019s Healthcare Utilisation Model as a reference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a scoping review and included studies published between 2010 and 2023 that assessed the healthcare utilisation in people with osteoarthritis. We examined general practitioner and orthopaedist consultations, physiotherapy, medication, hospitalisation and emergency department visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Livivo, Cochrane Library, CINAHL Complete and Web of Science were searched from January 2010 until November 2023. An updated literature search was conducted in December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>We analysed the included studies by means of thematic analysis and descriptive representation of quantitative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The literature search identified 4228 articles, of which 2380 articles were included in the title\/abstract screening after excluding duplicates. After the full-text screening of 97 articles, we included 39 (n=4 233 566) publications for data extraction and data synthesis. Most studies were conducted in the USA, Australia, Germany and the UK\u2014few from Asia, Middle and South America and other European countries. Utilised healthcare services are general practitioner consultations (mean use: 43% of participants, n=6), opioid (36%, n=8) and non-steroidal anti-inflammatory drug use (42%, n=7), emergency department visits (27%, n=3), orthopaedic surgeon consultations (26%, n=4), total joint replacement surgery (26%, n=3), physiotherapy (14%, n=8), hospitalisation (11%, n=7) and psychotherapy (6%, n=2). Among predisposing characteristics, older age, female gender, ethnicity, high socioeconomic status, social support and fear of certain treatment options were related to higher healthcare utilisation. In those, gender (n=8 studies) and age (n=6 studies) were primarily discussed. Regarding enabling and need factors, increased healthcare utilisation is associated with urban residence and being insured as well as having pain and comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Results vary between countries. Against the background of existing guidelines, there is a need for promoting the utilisation of non-surgical and non-pharmacological treatments, such as physiotherapy, which have proven to be effective. Special attention should be given to predictors when promoting appropriate healthcare utilisation. Addressing the identified predictors associated with healthcare utilisation may lead to more appropriate osteoarthritis care. Further research is needed to address healthcare stakeholders\u2019 (physiotherapists, insurers, patients and practitioners) needs and roles in the process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Protocol registration on PROSPERO (CRD42023475803).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-116170","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T15:25:42Z","timestamp":1779981942000},"page":"e116170","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring utilisation of knee and hip osteoarthritis healthcare services and its predictors: a scoping review"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0200-0018","authenticated-orcid":false,"given":"Sara","family":"Neumann","sequence":"first","affiliation":[{"name":"Corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Berlin, Germany"},{"name":"Division of Physiotherapy, Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Weber","sequence":"additional","affiliation":[{"name":"Division of Physiotherapy, Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany"},{"name":"UMC Utrecht Brain Center, University Medical Center Utrecht, Department of Rehabilitation, Physiotherapy Science & Sports, Utrecht University, Utrecht, The Netherlands"},{"name":"Institute of Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Gr\u00fcneberg","sequence":"additional","affiliation":[{"name":"Division of Physiotherapy, Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane","family":"Schenk","sequence":"additional","affiliation":[{"name":"Corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Thiel","sequence":"additional","affiliation":[{"name":"Division of Physiotherapy, Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7492-7210","authenticated-orcid":false,"given":"Paul","family":"Gellert","sequence":"additional","affiliation":[{"name":"Corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Peschke","sequence":"additional","affiliation":[{"name":"Division of Physiotherapy, Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"2026052808252775000_16.5.e116170.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00163-7"},{"key":"2026052808252775000_16.5.e116170.2","first-page":"344","article-title":"Osteoarthritis: what\u2019s new?","volume":"147","author":"Krasselt","year":"2022","journal-title":"Dtsch Med Wochenschr"},{"key":"2026052808252775000_16.5.e116170.3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12961-018-0325-x","article-title":"Addressing overuse of health services in health systems: a critical interpretive synthesis","volume":"16","author":"Ellen","year":"2018","journal-title":"Health Res Policy Sys"},{"key":"2026052808252775000_16.5.e116170.4","doi-asserted-by":"publisher","DOI":"10.3138\/ptc.2012-45BC"},{"key":"2026052808252775000_16.5.e116170.5","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1002\/acr.24131","article-title":"2019 American College of Rheumatology\/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee","volume":"72","author":"Kolasinski","year":"2020","journal-title":"Arthritis Care & Research"},{"key":"2026052808252775000_16.5.e116170.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2019.06.011"},{"key":"2026052808252775000_16.5.e116170.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2023.05.015"},{"key":"2026052808252775000_16.5.e116170.8","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.berh.2016.09.003","article-title":"Osteoarthritis: Models for appropriate care across the disease continuum","volume":"30","author":"Allen","year":"2016","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026052808252775000_16.5.e116170.9","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s00132-018-3629-1","article-title":"Prescription frequency of physical therapy and analgesics before total hip and knee arthroplasy\u202f: An epidemiological analysis of routine health care data from Germany","volume":"47","author":"Lange","year":"2018","journal-title":"Orthopade"},{"key":"2026052808252775000_16.5.e116170.10","first-page":"11","article-title":"Physical Therapy Use and Associated Factors in Adults with and without Osteoarthritis-An Analysis of the Population-Based German Health Update Study","volume":"9","author":"Sussmann","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"2026052808252775000_16.5.e116170.11","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzab053","article-title":"Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview","volume":"101","author":"Seron","year":"2021","journal-title":"Phys Ther"},{"key":"2026052808252775000_16.5.e116170.12","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.2147\/CIA.S174741","article-title":"Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data","volume":"13","author":"Postler","year":"2018","journal-title":"Clin Interv Aging"},{"key":"2026052808252775000_16.5.e116170.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-023-06406-w","article-title":"High and low value care recommended and undertaken prior to knee or hip arthroplasty: a survey study","volume":"24","author":"Mills","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"2026052808252775000_16.5.e116170.14","first-page":"10","article-title":"Determinants of Healthcare Use Based on the Andersen Model: A Systematic Review of Longitudinal Studies","volume":"9","author":"Hajek","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"2026052808252775000_16.5.e116170.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002949","article-title":"Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial","volume":"16","author":"\u00d8ster\u00e5s","year":"2019","journal-title":"PLoS Med"},{"key":"2026052808252775000_16.5.e116170.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-3470-6","article-title":"Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain","volume":"18","author":"Lentz","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2026052808252775000_16.5.e116170.17","doi-asserted-by":"publisher","DOI":"10.1055\/a-0667-8008"},{"key":"2026052808252775000_16.5.e116170.18","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-14-195","article-title":"What influences patients with osteoarthritis to consult their GP about their symptoms? A narrative review","volume":"14","author":"Paskins","year":"2013","journal-title":"BMC Fam Pract"},{"key":"2026052808252775000_16.5.e116170.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-07045-4","article-title":"Driving factors for the utilisation of healthcare services by people with osteoarthritis in Portugal: results from a nationwide population-based study","volume":"21","author":"Costa","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2026052808252775000_16.5.e116170.20","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1093\/pm\/pnaa424","article-title":"Long-Term Pain Management and Health Care Resource Use Among an Employed Population in Japan with Knee Osteoarthritis Combined with Low Back Pain","volume":"22","author":"Ueda","year":"2021","journal-title":"Pain Med"},{"key":"2026052808252775000_16.5.e116170.21","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.puhe.2015.11.018","article-title":"Factors associated with the health care cost in older Australian women with arthritis: an application of the Andersen\u2019s Behavioural Model of Health Services Use","volume":"134","author":"Lo","year":"2016","journal-title":"Public Health"},{"key":"2026052808252775000_16.5.e116170.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2017.12.007"},{"key":"2026052808252775000_16.5.e116170.23","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"2026052808252775000_16.5.e116170.24","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2026052808252775000_16.5.e116170.25","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"2026052808252775000_16.5.e116170.26","unstructured":"Programme, C.A.S . CASP (Qualitative Studies, Case-Controll Studies, Cohort Studies) Checklists, 2023. Available: https:\/\/casp-uk.net\/casp-tools-checklists"},{"key":"2026052808252775000_16.5.e116170.27","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20120423"},{"key":"2026052808252775000_16.5.e116170.28","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20140357"},{"key":"2026052808252775000_16.5.e116170.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.03.044"},{"key":"2026052808252775000_16.5.e116170.30","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.reuma.2013.07.013","article-title":"Characterization of knee osteoarthritis in Latin America. A comparative analysis of clinical and health care utilization in Argentina, Brazil, and Mexico","volume":"10","author":"Burgos-Vargas","year":"2014","journal-title":"Reumatol Clin"},{"key":"2026052808252775000_16.5.e116170.31","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/03009742.2022.2058168","article-title":"Impact of osteoarthritis disease severity on treatment patterns and healthcare resource use: analysis of real-world data","volume":"52","author":"Conaghan","year":"2023","journal-title":"Scand J Rheumatol"},{"key":"2026052808252775000_16.5.e116170.32","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/acr.25192","article-title":"Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry","volume":"77","author":"Desilet","year":"2025","journal-title":"Arthritis Care & Research"},{"key":"2026052808252775000_16.5.e116170.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2010.05485.x"},{"key":"2026052808252775000_16.5.e116170.34","doi-asserted-by":"crossref","unstructured":"Dros JT , van Dijk CE , Bos I , et al . Healthcare utilization patterns for knee and hip osteoarthritis before and after changes in national health insurance coverage: a data linkage study from the Netherlands. Health Policy 2023;133. doi:10.1016\/j.healthpol.2023.104825","DOI":"10.1016\/j.healthpol.2023.104825"},{"key":"2026052808252775000_16.5.e116170.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533-2500.2012.00532.x"},{"key":"2026052808252775000_16.5.e116170.36","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3111\/13696998.2011.594347","article-title":"Clinical comorbidities, treatment patterns, and direct medical costs of patients with osteoarthritis in usual care: a retrospective claims database analysis","volume":"14","author":"Gore","year":"2011","journal-title":"J Med Econ"},{"key":"2026052808252775000_16.5.e116170.37","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1515\/sjpain-2021-0212","article-title":"Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study","volume":"23","author":"Hallberg","year":"2023","journal-title":"Scand J Pain"},{"key":"2026052808252775000_16.5.e116170.38","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/j.arth.2022.04.033","article-title":"Socioeconomic Disparities in the Utilization of Total Knee Arthroplasty","volume":"37","author":"Hartnett","year":"2022","journal-title":"J Arthroplasty"},{"key":"2026052808252775000_16.5.e116170.39","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1016\/j.arth.2023.08.030","article-title":"Utilization of Total Joint Arthroplasty by Rural-Urban Designation in Patients With Osteoarthritis in a Universal Coverage System","volume":"38","author":"Hinman","year":"2023","journal-title":"J Arthroplasty"},{"key":"2026052808252775000_16.5.e116170.40","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.joca.2012.03.003","article-title":"Prevalence and predictors of health care use in patients with early hip or knee osteoarthritis: two-year follow-up data from the CHECK cohort","volume":"20","author":"Hoogeboom","year":"2012","journal-title":"Osteoarthr Cartil"},{"key":"2026052808252775000_16.5.e116170.41","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1093\/ptj\/pzy052","article-title":"Sociodemographic and Clinical Correlates of Physical Therapy Utilization in Adults With Symptomatic Knee Osteoarthritis","volume":"98","author":"Iversen","year":"2018","journal-title":"Phys Ther"},{"key":"2026052808252775000_16.5.e116170.42","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18073777","article-title":"Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian","volume":"18","author":"Kamsan","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026052808252775000_16.5.e116170.43","doi-asserted-by":"crossref","DOI":"10.1186\/ar4286","article-title":"How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the Osteoarthritis Initiative","volume":"15","author":"Kingsbury","year":"2013","journal-title":"Arthritis Res Ther"},{"key":"2026052808252775000_16.5.e116170.44","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1002\/acr.23695","article-title":"Effects of Osteoarthritis Pain and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults","volume":"71","author":"Liu","year":"2019","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026052808252775000_16.5.e116170.45","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.2020.1841988"},{"key":"2026052808252775000_16.5.e116170.46","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1002\/acr.23831","article-title":"Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients","volume":"71","author":"Power","year":"2019","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026052808252775000_16.5.e116170.47","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-021-04180-1","article-title":"The burden of chronic pain for patients with osteoarthritis in Germany: a retrospective cohort study of claims data","volume":"22","author":"Schild","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"2026052808252775000_16.5.e116170.48","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-055468","article-title":"What is the healthcare utilisation and out-of-pocket expenditure associated with osteoarthritis? A cross-sectional study","volume":"12","author":"Sibbritt","year":"2022","journal-title":"BMJ Open"},{"key":"2026052808252775000_16.5.e116170.49","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1080\/13696998.2023.2245298","article-title":"Racial variation in healthcare resource utilization and expenditures in knee\/hip osteoarthritis patients: a retrospective analysis of a Medicaid population","volume":"26","author":"Silverman","year":"2023","journal-title":"J Med Econ"},{"key":"2026052808252775000_16.5.e116170.50","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e3181df4de4"},{"key":"2026052808252775000_16.5.e116170.51","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2022.0419"},{"key":"2026052808252775000_16.5.e116170.52","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1002\/acr.21925","article-title":"Race, sex, and total knee replacement consideration: role of social support","volume":"65","author":"Vina","year":"2013","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026052808252775000_16.5.e116170.53","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.joca.2019.01.010","article-title":"Social & psychological factors associated with oral analgesic use in knee osteoarthritis management","volume":"27","author":"Vina","year":"2019","journal-title":"Osteoarthr Cartil"},{"key":"2026052808252775000_16.5.e116170.54","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1080\/13696998.2017.1377717","article-title":"Healthcare resource utilization and costs by age and joint location among osteoarthritis patients in a privately insured population","volume":"20","author":"Wang","year":"2017","journal-title":"J Med Econ"},{"key":"2026052808252775000_16.5.e116170.55","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1002\/art.41878","article-title":"Osteoarthritis Care and Risk of Total Knee Arthroplasty Among Medicare Beneficiaries: A Population-Based Study of Regional Covariation","volume":"73","author":"Ward","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"2026052808252775000_16.5.e116170.56","first-page":"957","article-title":"Impact of Pain Severity and Opioid Use on Health Care Resource Utilization and Costs Among Patients with Knee and Hip Osteoarthritis","volume":"25","author":"Wei","year":"2019","journal-title":"J Manag Care Spec Pharm"},{"key":"2026052808252775000_16.5.e116170.57","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1002\/acr.22360","article-title":"Trends in prescription of opioids from 2003-2009 in persons with knee osteoarthritis","volume":"66","author":"Wright","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026052808252775000_16.5.e116170.58","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/MLR.0b013e3181e419b1","article-title":"Impact of knee osteoarthritis on health care resource utilization in a US population-based national sample","volume":"48","author":"Wright","year":"2010","journal-title":"Med Care"},{"key":"2026052808252775000_16.5.e116170.59","doi-asserted-by":"crossref","DOI":"10.1016\/j.artd.2024.101353","article-title":"Lower Income and Nonheterosexual Orientation Are Associated With Poor Access to Care in Patients With Knee Osteoarthritis","volume":"27","author":"Boddu","year":"2024","journal-title":"Arthroplast Today"},{"key":"2026052808252775000_16.5.e116170.60","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/acr.25192","article-title":"Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry","volume":"77","author":"Desilet","year":"2025","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026052808252775000_16.5.e116170.61","article-title":"The Effect of Sex, Race\/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study","volume":"9","author":"Woolley","year":"2025","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"2026052808252775000_16.5.e116170.62","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-7-169","article-title":"Health service utilization patterns of primary care patients with osteoarthritis","volume":"7","author":"Rosemann","year":"2007","journal-title":"BMC Health Serv Res"},{"key":"2026052808252775000_16.5.e116170.63","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s40744-022-00448-7","article-title":"Associations of Healthcare Utilization and Costs with Increasing Pain and Treatment Intensity Levels in Osteoarthritis Patients: An 18-Year Retrospective Study","volume":"9","author":"Graham","year":"2022","journal-title":"Rheumatol Ther"},{"key":"2026052808252775000_16.5.e116170.64","doi-asserted-by":"crossref","DOI":"10.1016\/j.physio.2024.101416","article-title":"Barriers, facilitators and referral patterns of general practitioners, physiotherapists, and people with osteoarthritis to exercise","volume":"125","author":"Bhardwaj","year":"2024","journal-title":"Physiotherapy"},{"key":"2026052808252775000_16.5.e116170.65","doi-asserted-by":"crossref","DOI":"10.1186\/1471-244X-13-121","article-title":"Depression treatment patterns among individuals with osteoarthritis: a cross sectional study","volume":"13","author":"Agarwal","year":"2013","journal-title":"BMC Psychiatry"},{"key":"2026052808252775000_16.5.e116170.66","doi-asserted-by":"crossref","first-page":"105750","DOI":"10.1016\/j.jbspin.2024.105750","article-title":"Chronic pain for rheumatological disorders: Pathophysiology, therapeutics and evidence","volume":"91","author":"Chen","year":"2024","journal-title":"Joint Bone Spine"},{"key":"2026052808252775000_16.5.e116170.67","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.rbr.2015.03.001","article-title":"Investigation of depression, anxiety and quality of life in patients with knee osteoarthritis: a comparative study","volume":"55","author":"Ferreira","year":"2015","journal-title":"Rev Bras Reumatol (English Edition)"},{"key":"2026052808252775000_16.5.e116170.68","doi-asserted-by":"crossref","DOI":"10.1111\/acel.12861","article-title":"Trends in age-related disease burden and healthcare utilization","volume":"18","author":"Atella","year":"2019","journal-title":"Aging Cell"},{"key":"2026052808252775000_16.5.e116170.69","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2024.04.002"},{"key":"2026052808252775000_16.5.e116170.70","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1038\/s41584-022-00810-7","article-title":"Sex- and gender-related differences in psoriatic arthritis","volume":"18","author":"Tarannum","year":"2022","journal-title":"Nat Rev Rheumatol"},{"key":"2026052808252775000_16.5.e116170.71","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1765-y"},{"key":"2026052808252775000_16.5.e116170.72","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/art.40834","article-title":"Association of Geography and Access to Health Care Providers With Long-Term Prescription Opioid Use in Medicare Patients With Severe Osteoarthritis: A Cohort Study","volume":"71","author":"Desai","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2026052808252775000_16.5.e116170.73","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.apmr.2015.02.006","article-title":"Receipt of physical therapy among osteoarthritis patients and its influencing factors","volume":"96","author":"Yeh","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"2026052808252775000_16.5.e116170.74","doi-asserted-by":"crossref","first-page":"6392","DOI":"10.3390\/ijerph19116392","article-title":"Rural\u2013Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors","volume":"19","author":"Liu","year":"2022","journal-title":"IJERPH"},{"key":"2026052808252775000_16.5.e116170.75","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1515\/sjpain-2019-0143","article-title":"Association between health care utilization and musculoskeletal pain. A 21-year follow-up of a population cohort","volume":"20","author":"Emilson","year":"2020","journal-title":"Scand J Pain"},{"key":"2026052808252775000_16.5.e116170.76","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.bjpt.2020.08.004","article-title":"Knee osteoarthritis: key treatments and implications for physical therapy","volume":"25","author":"Dantas","year":"2021","journal-title":"Braz J Phys Ther"},{"key":"2026052808252775000_16.5.e116170.77","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10995-3","article-title":"Sex differences in health status, healthcare utilization, and costs among individuals with elevated blood pressure: the LARK study from Western Kenya","volume":"21","author":"Sikka","year":"2021","journal-title":"BMC Public Health"},{"key":"2026052808252775000_16.5.e116170.78","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10773-1","article-title":"Determinants of rural-urban differential in healthcare utilization among the elderly population in India","volume":"21","author":"Banerjee","year":"2021","journal-title":"BMC Public Health"},{"key":"2026052808252775000_16.5.e116170.79","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303212"},{"key":"2026052808252775000_16.5.e116170.80","unstructured":"Ministerium f\u00fcr Arbeit, G.u.S.d.L.N.-W . Sehr gefragt und fest etabliert: Minister Laumann zieht positive Zwischenbilanz nach f\u00fcnf Jahren Landarztquote in Nordrhein-Westfalen, Available: https:\/\/www.mags.nrw\/minister-laumann-zieht-positive-zwischenbilanz-nach-fuenf-jahren-landarztquote-nordrhein-westfalen [Accessed 4 Nov 2024]."},{"key":"2026052808252775000_16.5.e116170.81","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2022.e09812","article-title":"Health care in rural areas: proposal of a new telemedicine program assisted from the reference health centers, for a sustainable digitization and its contribution to the carbon footprint reduction","volume":"8","author":"Maria","year":"2022","journal-title":"Heliyon"},{"key":"2026052808252775000_16.5.e116170.82","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00482-021-00615-9","article-title":"The care of people with chronic pain benefits greatly from the academization of physiotherapy-the facts speak for themselves","volume":"36","author":"Probst","year":"2022","journal-title":"Schmerz"},{"key":"2026052808252775000_16.5.e116170.83","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2016.02.010"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-116170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T15:25:51Z","timestamp":1779981951000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-116170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":83,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2025-116170"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-116170","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}