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Rucinski K, Leary E, Royse LA. Factors Important to Patients when Making Treatment Decisions for Knee Osteoarthritis. J Knee Surg 2023; 36:1413-1421. [PMID: 37072026 DOI: 10.1055/s-0043-56998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment options may be medically appropriate, it is imperative that the patient's voice be considered to better facilitate patient-centered treatment decisions. Concordance between physicians and patients on optimal treatment can vary, with few studies identifying the factors important to patients when making treatment decisions for knee OA. The goal of this analysis is to identify and synthesize subjective factors in the literature found to influence patient decision-making in a presurgical knee OA population, such that physicians and health care teams can become better equipped to help patients realize their specific treatment goals. This review was registered with PROSPERO and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A systematic search was completed in four databases for search terms related to knee OA and decision-making. Articles were eligible for inclusion when they discussed (1) patients' thoughts, feelings, goals, and perceptions that factored into treatment deliberation and decision-making; and (2) related to knee OA. Twenty-four articles were identified, 11 qualitative studies and 13 quantitative studies. Synthesis of the included articles revealed three main themes that drive patient treatment decisions: (1) individual catalysts to pursue treatment including pain and mobility limitations, (2) interpersonal factors including social networks and clinician trust, and (3) risks versus benefits assessment including patients' beliefs and expectations. Only a few studies looked at nonoperative treatment decisions, and no studies looked at cohorts considering knee preservation surgeries. This study was completed to synthesize literature related to patient treatment decisions for nonoperative and surgical management of knee OA, finding that patients consider multiple subjective factors when choosing whether to move forward with treatment. Understanding how patients' beliefs determine their preferences for treatment can improve shared decision-making.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emily Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Lisa A Royse
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Healy S, Dorflinger E, Michaleff ZA, Marks D. Patient preferences and decision-making when considering surgery for musculoskeletal disorders: A mixed methods systematic review. Musculoskeletal Care 2023; 21:312-337. [PMID: 37316969 DOI: 10.1002/msc.1705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The burden of Musculoskeletal disorders (MSD) is large. Surgery is an important management option but the factors that shape patients' surgical decisions are not well understood. As prior reviews have explored only single data types or conditions, a mixed methods appraisal across the musculoskeletal spectrum was undertaken. METHODS A mixed-methods systematic, convergent segregated approach was used, with PubMed, Cumulated Index to Nursing and Allied Health Literature (CINHAL), Embase and PsycINFO searched to identify studies of adult patients' decisions about whether to undergo surgery. A narrative synthesis was conducted, with identified themes integrated across quantitative, qualitative and mixed-methods studies. RESULTS Forty-six studies were included (24 quantitative, 19 qualitative and three mixed methods), with four decision-making themes identified (symptoms, sociodemographic and health factors, information and perceptions). Decision-making involves a complex interaction of individual sociodemographic, health and symptom information, integrated with individual perceptions of candidacy and surgical expectations. While most studies investigated hip and knee surgery, across all included conditions, patients are more likely to favour surgery if symptoms and/or dysfunction are higher, and if perceptions of surgical candidacy and processes (outcomes, inconvenience, and risk) are favourable. Other factors including age, general health, race, financial context, professional and non-professional communication, and information sources also impact decision-making but exert a less consistent impact upon the propensity to prefer surgery. CONCLUSION Patients are more likely to choose surgery for MSD when they have higher levels of symptoms or dysfunction and positive perceptions of surgical suitability and expectations. Other factors important to individuals, have a less consistent impact upon the propensity to prefer surgery. These findings have potential to aid the efficient referral of patients to orthopaedics. More research is needed to validate these findings across the spectrum of MSD.
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Affiliation(s)
- Sarah Healy
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
| | - Eric Dorflinger
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
| | - Zoe A Michaleff
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia
| | - Darryn Marks
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100355. [PMID: 37020788 PMCID: PMC10068262 DOI: 10.1016/j.ocarto.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.
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Gravås EMH, Kjeken I, Nossum R, Eide REM, Klokkeide Å, Matre KH, Olsen M, Andreassen Ø, Haugen IK, Østerås N, Tveter AT. Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery. Hand (N Y) 2022; 17:723-729. [PMID: 32988234 PMCID: PMC9274894 DOI: 10.1177/1558944720940063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery. METHODS This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses. RESULTS The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, P = .008), living alone (OR = 3.18, P = .007), and a young age (OR = 0.94, P = .002). CONCLUSIONS Decisions on CMCJ OA surgery should be based on assessment and discussion of patients' life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.
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Affiliation(s)
| | | | - Randi Nossum
- St. Olavs Hospital, Trondheim University Hospital, Norway
| | | | | | | | | | | | | | | | - Anne Therese Tveter
- Diakonhjemmet Hospital, Oslo, Norway,Anne Therese Tveter, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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Nissen N, Holm PM, Bricca A, Dideriksen M, Tang LH, Skou ST. Clinicians' beliefs and attitudes to physical activity and exercise therapy as treatment for knee and/or hip osteoarthritis: a scoping review. Osteoarthritis Cartilage 2022; 30:260-269. [PMID: 34800632 DOI: 10.1016/j.joca.2021.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore clinicians' attitudes and beliefs about physical activity and exercise therapy as treatment for individuals with knee and/or hip osteoarthritis (OA). METHOD This was a scoping review, mapping available knowledge about the topic derived from qualitative research designs and methods. A comprehensive search of selected databases (MEDLINE, EMBASE; CINAHL; Web of Science) was conducted and data were analysed thematically. RESULTS Twelve articles met inclusion criteria. Thematic analysis identified three interrelated main themes: 1) Understandings of OA and its trajectory and management; 2) Attitudes to activity and exercise as part of OA management; 3) Clinicians' perceived knowledge of and expertise in OA management. Findings highlight that many clinicians involved in knee/hip OA management, particularly general practitioners and physiotherapists, perceive OA to be a low priority 'wear-and-tear' disease with expected progression of symptoms, making joint replacement surgery eventually inevitable. Further, many clinicians appear to lack knowledge about and interest in physical activity and exercise therapy in the management of knee/hip OA, and seem to show uncertainty about the effectiveness and safety of physical activity and exercise therapy on joint health. CONCLUSION Clinicians' attitudes and beliefs about physical activity and exercise therapy in OA seem to reflect an outdated narrative which describes OA as a wear-and-tear disease with inevitable disease progression to joint replacement surgery. Clinicians need to adopt a contemporary narrative, which accurately reflects current knowledge and evidence-based practice, thereby ensuring consistent utilisation of exercise therapy as first-line care as recommended in OA guidelines.
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Affiliation(s)
| | - P M Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - M Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - S T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Bruhn SM, Ingelsrud LH, Bandholm T, Skou ST, Schroder HM, Reventlow S, Møller A, Kjellberg J, Kallemose T, Troelsen A. Disentangling treatment pathways for knee osteoarthritis: a study protocol for the TREATright study including a prospective cohort study, a qualitative study and a cost-effectiveness study. BMJ Open 2021; 11:e048411. [PMID: 34233992 PMCID: PMC8264876 DOI: 10.1136/bmjopen-2020-048411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is associated with chronic knee pain and functional disability that negatively affect the ability to carry out normal daily activities. Patients are offered a large variety of non-surgical treatments, often not in accordance with clinical guidelines. This observational study will provide a comprehensive overview of treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon, including timing and order of treatment modalities, predictors of treatment outcomes, cost-effectiveness of treatment pathways and patients' views on different treatment pathways. METHODS AND ANALYSIS Patients with primary referrals to an orthopaedic surgeon due to knee OA are consecutively invited to participate and fill out a questionnaire prior to their consultation with an orthopaedic surgeon. Follow-up questionnaires will be obtained at 6 and 24 months after inclusion. Based on a prospective cohort study design, including questionnaires and register data, we will (1) describe treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon; (2) describe the characteristics of patients choosing different treatment pathways; (3) develop predictive models for patient-self-determined classifications of good and poor treatment outcomes; (4) evaluate the cost-effectiveness of treatment pathways that live up to clinical guidelines versus pathways that do not; based on a qualitative study design using semistructured individual interviews, we will (5) describe the patients' perspectives on treatment pathways for knee OA. ETHICS AND DISSEMINATION The study is approved by the Danish regional ethical committee (journal number H-17017295) and the Danish Data Protection Agency (journal number AHH-2017-072). Data will be anonymised and handled in line with the General Data Protection Regulation and the Danish Data Protection Act. The study results will be submitted to international open-access peer-reviewed journals and disseminated at conferences. TRIAL REGISTRATION NUMBER NCT03746184, pre-results.
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Affiliation(s)
- Simon Majormoen Bruhn
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lina Holm Ingelsrud
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Department Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Henrik M Schroder
- Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Reventlow
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Bunzli S, Taylor N, O'Brien P, Dowsey M, Wallis J, Choong P, Shields N. How Do People Communicate About Knee Osteoarthritis? A Discourse Analysis. PAIN MEDICINE 2021; 22:1127-1148. [PMID: 33502513 DOI: 10.1093/pm/pnab012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. DESIGN A qualitative synthesis using discourse analysis methods. METHODS Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers, and/or clinicians. Methodological quality was evaluated through the use of the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analyzed with inductive discourse analysis. RESULTS A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1,673 direct quotes) from people with knee osteoarthritis, carers, and clinicians in 16 countries. Two overarching discourses were identified-impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore down over time and required a doctor to repair. The overarching participatory discourse almost always coexisted alongside an impairment discourse. According to this discourse, a "busy body" was perceived as "healthy," and people could remain active despite knee osteoarthritis. CONCLUSION The prevailing impairment discourse may potentially discourage people from using knees that have passed their "use-by date" and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating that may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.
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Affiliation(s)
- Samantha Bunzli
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nicholas Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Michelle Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Jason Wallis
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nora Shields
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Australia
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Lenhard NK, Williams EE, Lape EC, MacFarlane LA, Losina E, Katz JN. Patient perspectives surrounding intra-articular injections for knee osteoarthritis: A qualitative study. Arthritis Care Res (Hoboken) 2020; 74:410-419. [PMID: 33026694 DOI: 10.1002/acr.24477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Intra-articular (IA) injections are used frequently for knee osteoarthritis (OA), but little is known about patients' attitudes towards these therapies. We aimed to better understand patients' perceptions of the facilitators of and barriers to IA injections for knee OA. METHODS We conducted a qualitative, descriptive/exploratory study and held focus groups and individual interviews with participants with knee OA, including some who had received IA injections and others who had not received IA injections. We conducted a thematic analysis to identify themes describing the factors participants found influential when deciding whether to try an IA injection. RESULTS We held three focus groups with 12 participants and conducted three individual interviews (15 participants total). We identified four themes that shaped participants' decisions to receive a specific injection: 1) the impact of OA on participants' lives; 2) participants' attitudes and concerns, including desire to avoid surgery, willingness to accept uncertain outcomes, and concerns about side effects and dependence; 3) the way participants gathered and processed information from physicians, peers, and the internet; and 4) availability of injectable products. Participants weighed the desire to regain function and delay surgery with concerns about side effects, uncertain efficacy, and costs. CONCLUSION Participants were concerned about the effectiveness, toxicity, availability, and cost of injectable products. They balanced disparate sources of information, uncertain outcomes, limited product availability, and other injection-related concerns with a desire to decrease pain. These findings can provide clinicians, investigators, and public health professionals with insights into challenges patients face when making injection decisions.
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Affiliation(s)
- Nora K Lenhard
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Emma E Williams
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Emma C Lape
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Lindsey A MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
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