Living with osteoarthritis is a balancing act: an exploration of patients’ beliefs about knee pain

Abstract

Background: This study aimed to explore the beliefs of people with knee osteoarthritis (OA) about the disease, and how these beliefs had formed and what impact these beliefs had on activity participation, health behaviour, and self-management. Methods: Semi-structured interviews were conducted with 13 people with knee OA recruited from general practices, community physiotherapy clinics, and public advertisements in two provinces of New Zealand. Data were analysed using Interpretive Description. Results: Two key themes emerged. 1) Knowledge: certainty and uncertainty described participants' strong beliefs about anatomical changes in their knee. Participants' beliefs in a biomechanical model of progressive joint degradation often appeared to originate within clinical encounters and from literal interpretation of the term 'wear and tear'. These beliefs led to uncertainty regarding interpretation of daily symptoms and participants' ability to influence the rate of decline and certainty that joint replacement surgery represented the only effective solution to fix the damaged knee. 2) Living with OA described broader perspectives of living with OA and the perceived need to balance competing values and risks when making decisions about activity participation, medication, attentional focus, accessing care, and making the most of today without sabotaging tomorrow. Misunderstandings about knee OA negatively impacted on activity participation, health behaviours, and self-management decisions. Conclusion: Biomechanical models of OA reduced participant exploration of management options and underpinned a perceived need to balance competing values. Improved information provision to people with knee OA could help guide positive health behaviour and self-management decisions and ensure these decisions are grounded in current evidence.

The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study

“…The transcribed data were imported to NVIVO software version 10 as means of data management and were analyzed using thematic content analysis based on Braun and Clark (2006) framework ( Table 2). Given the extensive amount of literature in this field, familiarization and initial code extraction were informed by reviewing previous studies on understanding of and information needs about KOA [30,34,35]. Inductive approach was then undertaken to identify any new codes, categories and themes.…”

“…Literature related to the knowledge of and information about KOA among older persons remains scarce [34,35], especially in a country with multiethnic population such as Malaysia. Given that KOA is a global issue, more studies of diverse population background are needed as these population groups may have different perspectives due to geographical, cultural and lifestyles differences.…”

Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation

“…Physical activity, including therapeutic exercise, patient education and weight control are recommended in key OA treatment guidelines 2. Nevertheless, the belief that therapeutic exercise may harm knee joint cartilage remains common among people with knee OA, and health professionals treating the condition, creating a prevailing barrier to implementing evidence-based care 3–5. The current discord between evidence and persistent beliefs highlights the need for better education.…”

Nonsurgical Management of Cartilage Defects of the Knee: Who, When, Why, and How?

“…58 In spite of this, many patients may be reluctant to pursue regular exercise for fear of causing damage or further degradation to cartilage. 59,60 However, cartilage is mechanosensitive and requires appropriate amounts of loading to maintain its structural integrity. Reduced loading conditions involving prolonged immobilization or paraplegia that are characteristic of sedentary lifestyles have been associated with atrophic cartilage.…”