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King L, Mahmoudian A, Waugh E, Stanaitis I, Gomes M, Hung V, MacKay C, Liew J, Wang Q, Turkiewicz A, Haugen I, Appleton C, Lohmander S, Englund M, Runhaar J, Neogi T, Hawker G. "You don't put it down to arthritis": A qualitative study of the first symptoms recalled by individuals with knee osteoarthritis. Osteoarthr Cartil Open 2024; 6:100428. [PMID: 38229918 PMCID: PMC10790080 DOI: 10.1016/j.ocarto.2023.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
Objective As part of the first phase of the OARSI Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) initiative, we explored the first symptoms and experiences recalled by individuals with knee osteoarthritis (OA). Design This qualitative study, informed by qualitative description, was a secondary analysis of focus groups (n = 17 groups) and one-on-one interviews (n = 3) conducted in 91 individuals living with knee OA as part of an international study to better understand the OA pain experience. In each focus group or interview, participants were asked to describe their first symptoms of knee OA. We inductively coded these transcripts and conducted thematic analysis. Results Mean age of participants was 70 years (range 47-92) and 68 % were female. We developed four overarching themes: Insidious and Episodic Onset, Diverse Early Symptoms, Must be Something Else, and Adjustments. Participants described the gradual and intermittent way in which symptoms of knee OA developed over many years; many could not identify a specific starting point. Participants described diverse initial knee symptoms, including activity-exacerbated joint pain, stiffness and crepitus. Most participants dismissed early symptoms or rationalized their presence, employing various strategies to enable continued participation in recreational and daily activities. Few sought medical attention until physical functioning was demonstrably impacted. Conclusions The earliest symptoms of knee OA are frequently insidious in onset, episodic and present long before individuals present to health professionals. These results highlight challenges to identifying people with knee OA early and support the development of specific classification criteria for EsSKOA to capture individuals at an early stage.
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Affiliation(s)
- L.K. King
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - A. Mahmoudian
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
- Department of Movement Sciences and Health, University of West Florida, FL, USA
| | - E.J. Waugh
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - I. Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - M. Gomes
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - V. Hung
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - C. MacKay
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- West Park Healthcare Centre, Toronto, Canada and Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - J.W. Liew
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Q. Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A. Turkiewicz
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - I.K. Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - C.T. Appleton
- Department of Medicine and Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
- Western Bone and Joint Institute, London, Canada
| | - S. Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - M. Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - J. Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - T. Neogi
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - G.A. Hawker
- Department of Medicine, University of Toronto, Toronto, Canada
| | - OARSI Early-stage Symptomatic Knee Osteoarthritis Initiative
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
- Department of Movement Sciences and Health, University of West Florida, FL, USA
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- West Park Healthcare Centre, Toronto, Canada and Department of Physical Therapy, University of Toronto, Toronto, Canada
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Department of Medicine and Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
- Western Bone and Joint Institute, London, Canada
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
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MacLeod MLP, Leese J, Garraway L, Oelke ND, Munro S, Bailey S, Hoens AM, Loo S, Valdovinos A, Wick U, Zimmer P, Li LC. Engaging with patients in research on knowledge translation/implementation science methods: a self study. Res Involv Engagem 2022; 8:41. [PMID: 35941661 PMCID: PMC9358643 DOI: 10.1186/s40900-022-00375-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In 2017, the British Columbia (Canada) SUPPORT (SUpport for People and Patient-Oriented Research) Unit created six methods clusters to advance methodologies in patient and public oriented research (POR). The knowledge translation (KT)/implementation science methods cluster identified that although there was guidance about how to involve patients and public members in POR research generally, little was known about how best to involve patients and public members on teams specifically exploring POR KT/implementation science methodologies. The purpose of this self-study was to explore what it means to engage patients and the public in studies of POR methods through the reflections of members of five KT/implementation science teams. METHODS Informed by a collaborative action research approach, this quality improvement self-study focused on reflection within four KT/implementation science research teams in 2020-2021. The self-study included two rounds of individual interviews with 18 members across four teams. Qualitative data were analyzed using a thematic analysis approach followed by a structured discussion of preliminary findings with the research teams. Subsequently, through two small group discussion sessions, the patients/public members from the teams refined the findings. RESULTS Undertaking research on POR KT/implementation science methodologies typically requires teams to work with the uncertainty of exploratory and processual research approaches, make good matches between patients/public members and the team, work intentionally yet flexibly, and be attuned to the external context and its influences on the team. POR methodological research teams need to consider that patients/public members bring their life experiences and world views to the research project. They become researchers in their own right. Individual and team reflection allows teams to become aware of team needs, acknowledge team members' vulnerabilities, gain greater sensitivity, and enhance communication. CONCLUSIONS The iterative self-study process provided research team members with opportunities for reflection and new understanding. Working with patients/public team members as co-researchers opens up new ways of understanding important aspects of research methodologies, which may influence future KT/implementation science research approaches.
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Affiliation(s)
- Martha L. P. MacLeod
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, The Ottawa Hospital Research Institute, Ottawa, Canada
- Arthritis Research Canada, Vancouver, BC Canada
| | - Leana Garraway
- Health Research Institute, University of Northern British Columbia, Prince George, BC Canada
| | - Nelly D. Oelke
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC Canada
- Rural Coordination Centre of BC, Vancouver, BC Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
| | - Sacha Bailey
- BC Centre for Ability, Vancouver, BC Canada
- Centre for Research on Children and Families, Montreal, QC Canada
| | - Alison M. Hoens
- Arthritis Research Canada, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
| | - Sunny Loo
- Patient Partner, Michael Smith Health Research BC, PaCER Certified, University of Calgary, Calgary, AB Canada
| | - Ana Valdovinos
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC Canada
| | - Ursula Wick
- University of British Columbia, Okanagan, Kelowna, BC Canada
| | - Peter Zimmer
- University of Northern British Columbia, Prince George, BC Canada
| | - Linda C. Li
- Arthritis Research Canada, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
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