Management of chronic knee pain: A survey of patient preferences and treatment received

Rehabilitation Research Unit (King's College London), Dulwich Community Hospital, London, UK.
BMC Musculoskeletal Disorders (Impact Factor: 1.9). 10/2008; 9:123. DOI: 10.1186/1471-2474-9-123
Source: PubMed

ABSTRACT A range of interventions exist for the management of knee pain, but patient preferences for treatment are not clear. In this study the management received by people with chronic knee pain, their management preferences and reasons for these preferences were recorded.
At baseline assessment of a clinical trial of rehabilitation for chronic knee pain, 415 participants were asked about their i) previous management, ii) preferred treatment, if any, iii) whether they would undergo knee surgery and iv) reasons for their preferences.
Previous management--Medication was the most common treatment, followed by physiotherapy, 39 participants had received no treatment. Preferences--166 patients expressed no treatment preference. Of those who expressed a preference the most popular option was physiotherapy, whilst not having surgery was the third most frequent response. The most common reason for preferring physiotherapy and not wanting surgery was prior experience.Willingness to accept surgery--390 participants were not waiting for knee replacement surgery, and overall 81% would not accept surgery if offered, usually because pain was not perceived to be severe enough to warrant surgery.
Most chronic knee pain is managed with medication despite concerns about safety, efficacy and cost, management guidelines recommendations and people's management preferences. Previous experience and perceptions of need were major determinants of people's preferences, but many people were unaware of management options. Appreciating patient preferences and provision of more information about management options are important in facilitating informed patient/clinician discussion and agreement.


Available from: Michael Hurley, Jan 14, 2015
1 Follower
  • Value in Health 11/2010; 13(7). DOI:10.1016/S1098-3015(11)72768-1 · 2.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Rheumatoid arthritis (RA) and osteoarthritis (OA) are important musculoskeletal diseases that the EUMUSC.NET project developed Standards of Care (SOC) for. The purpose was to explore factors to enable successful implementation of the SOC for RA and OA. A combined set of methods was used; a literature search, a European survey among patients, clinicians and policymakers; and focus groups. Potential facilitators were identified during a literature search. The online survey captured 282 responses from clinicians, patients and policymakers from 35 European countries, and focus groups from 5 countries contributed with knowledge about possible additional facilitators and strategies. Both the survey and the focus groups endorsed all 11 facilitators. The most important facilitators for implementing the SOC were motivation, agreement, knowledge and personal attitude. The focus groups underlined the lack of access to recommended care in some countries, that multidisciplinary teams should be strengthened and that some healthcare reimbursement systems need change to implement recommended clinical practice. Eleven facilitators key for the implementation of the SOC for RA and OA were endorsed by patients and clinicians from 35 European countries. This knowledge may contribute to improved care for patients with RA and OA in Europe.
    Annals of the rheumatic diseases 03/2014; 73(8). DOI:10.1136/annrheumdis-2013-204980 · 9.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In Germany, in comparison to occupational therapy and speech therapy, physiotherapy is the most often prescribed treatment, with a prescription volume of 3 billion Euro in 2009. The catalogue of prescribable therapies (CPT; "Heilmittelkatalog") is a matter of controversial discussion. It represents the rationale which should support the physician in adhering to the efficiency principle.To describe the coded indications used by physicians to justify a physiotherapy prescription for patients with back pain, in order to verify its plausibility. Furthermore, we aimed to describe the manner in which patient subgroups differ regarding factors given in the CPT to allocate patients to various domains of indication.A descriptive-exploratory secondary analysis of data from a prospective multicentre (84 private physiotherapy practices) observational trial was conducted. The Bother index of the Musculoskeletal Function Assessment Questionnaire (German, 16-Item version), the Work Ability Index and an 11-step box scale on pain intensity were measured as outcome.Coded indications related to dysfunction/pain due to joint-blockages dominated clearly (WS1a 30%, WS2a 35.3%). Patients who were allocated to the domains of indication WS1 and WS2 did not differ regarding botherment in daily life at the beginning of therapy (SES=0.05).It is hardly possible to identify clear prescription patterns. Results did not show any clear differences regarding major criteria for efficient prescription in line with the CPT. The weaknesses discussed should be targeted in future studies and should be considered during subsequent revisions of the CPT.
    Die Rehabilitation 12/2012; 52(2). DOI:10.1055/s-0032-1323668 · 0.95 Impact Factor