How do we explain painful chronic non-traumatic knee conditions to children and adolescents? A multiple-method study to develop credible explanations

Abstract

INTRODUCTION Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand ″what′s wrong with me″. Our aim is to develop credible explanations (trustworthy and understandable explanation of the condition) for adolescents suffering from chronic non-traumatic knee pain. METHODS This multiple-method study integrated findings from a systematic literature search of qualitative studies, an Argumentative Delphi with international experts (n=16) and think-aloud sessions with adolescents (n=7). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents′ needs. We analyzed feedback using thematic analysis before tailoring explanations to end-users. RESULTS We screened 3.239 titles/abstracts and included 16 papers which explored diagnostic uncertainty from adolescents′ and parents′ perspectives. Five themes emerged: (1) Understanding causes and contributors to the pain experience, (2) Feeling stigmatized for having an invisible condition, (3) Having a name for pain, (4) Controllability of pain, and (5) Worried about something being missed. The Argumentative Delphi revealed the following themes: (1) Multidimensional perspective, (2) Tailored to adolescents, (3) Validation and reassurance, and (4) Careful wording. Merging findings from the systematic search and the Delphi revealed three essential domains to address in credible explanations: ″What is non-traumatic knee pain and what does it mean?″, ″What is causing my knee pain?″ and ″How do I manage my knee pain?″. CONCLUSIONS Six credible explanations for the six most common diagnoses of chronic non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain.

Co-creating aChoosing WiselyLeaflet Supporting the Reduction of Imaging Usage in Low Back Pain Management - A Multi-Method Study

“…This fostered a deeper understanding of the rationale behind the Choosing Wisely leaflet's design choices and its anticipated impacts, such as reducing diagnostic uncertainty and enhancing imaging accuracy. By incorporating diverse perspectives and fostering iterative refinement, our methodology may help future research and clinical settings to optimize their delivery of relevant health information to end-users [14]. These efforts must be sustained and adapted over time to ensure that both patients and clinicians are equipped to make informed decisions.…”

Development of a clinical decision-support tool for Management of Adolescent knee Pain (The MAP-Knee Tool)

“…The credible explanations were developed using an iterative process of three steps, and the complete methods are published elsewhere. (28) This consisted of 1) two systematic searches of qualitative and quantitative literature (see supplementary file xx) that aimed to answer the “what information needs to be included in a credible explanation?” , 2) a two-round Argumentative Delphi process to explore “what do expert clinicians consider important in a credible explanation” among clinicians, researchers, and psychologists, and 3) think-aloud exercises with end-users (children, adolescents, and medical doctors). Based on themes from the synthesis of the qualitative literature search and the Argumentative Delphi process, including 16 international experts, we identified three key domains to consider when tailoring credible explanations to adolescents experiencing chronic non-traumatic knee pain.…”

“…The three key domains were “What is ( diagnosis ) and what does it mean?”, “What is causing my knee pain” and “How do I manage my knee pain?”. (28)…”

SurgeRy and physiothErapy Versus physIotherapy only for chronic paTellofemorAL paIn: study protocol for a randomiSed controllEd trial (REVITALISE)

“…The PT is developed by a team of experienced physiotherapists who are specialized in treating patients with PFP and based upon the most recent physiotherapeutic insights (7). In addition to training, education about PFP is incorporated into the PT according to the most recent insights regarding pain mechanisms (22,23). Physiotherapists who participate as self-chosen treating health care professionals by patients will be requested to follow the instructional video developed by the REVITALISE study team.…”