Patients' and Practitioners' Views of Knee Osteoarthritis and Its Management: A Qualitative Interview Study

Interlis, Université Paris Descartes, Paris, France.
PLoS ONE (Impact Factor: 3.23). 05/2011; 6(5):e19634. DOI: 10.1371/journal.pone.0019634
Source: PubMed


To identify the views of patients and care providers regarding the management of knee osteoarthritis (OA) and to reveal potential obstacles to improving health care strategies.
We performed a qualitative study based on semi-structured interviews of a stratified sample of 81 patients (59 women) and 29 practitioners (8 women, 11 general practitioners [GPs], 6 rheumatologists, 4 orthopedic surgeons, and 8 [4 GPs] delivering alternative medicine).
Two main domains of patient views were identified: one about the patient-physician relationship and the other about treatments. Patients feel that their complaints are not taken seriously. They also feel that practitioners act as technicians, paying more attention to the knee than to the individual, and they consider that not enough time is spent on information and counseling. They have negative perceptions of drugs and a feeling of medical uncertainty about OA, which leads to less compliance with treatment and a switch to alternative medicine. Patients believe that knee OA is an inevitable illness associated with age, that not much can be done to modify its evolution, that treatments are of little help, and that practitioners have not much to propose. They express unrealistic fears about the impact of knee OA on daily and social life. Practitioners' views differ from those of patients. Physicians emphasize the difficulty in elaborating treatment strategies and the need for a tool to help in treatment choice.
This qualitative study suggests several ways to improve the patient-practitioner relationship and the efficacy of treatment strategies, by increasing their acceptability and compliance. Providing adapted and formalized information to patients, adopting more global assessment and therapeutic approaches, and dealing more accurately with patients' paradoxal representation of drug therapy are main factors of improvement that should be addressed.

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    • "Fear of side effects is reported [24,32] and the presence of co-morbidities has also been described as contributing to patient hesitancy to take medication, in addition, again to suboptimal communication around prescriptions [34]. Throughout these studies is a recurring belief among patients that they receive inadequate information and communication around prescriptions, and Alami et al. describe this as leading to suspicion of drugs [24]. Alami et al. also describe patient expectations, with those with more chronic symptoms seeking ‘cure’. "
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    ABSTRACT: Osteoarthritis (OA) is a common cause of disability and consultation with a GP. However, little is known about what currently happens when patients with OA consult their GP. This review aims to compare existing literature reporting patient experiences of consultations in which OA is discussed with GP attitudes and beliefs regarding OA, in order to identify any consultation events that may be targeted for intervention. After a systematic literature search, a narrative review has been conducted of literature detailing patient experiences of consulting with OA in primary care and GP attitudes to, and beliefs about, OA. Emergent themes were identified from the extracted findings and GP and patient perspectives compared within each theme. Twenty two relevant papers were identified. Four themes emerged: diagnosis; explanations; management of the condition; and the doctor-patient relationship. Delay in diagnosis is frequently reported as well as avoidance of the term osteoarthritis in favour of 'wear and tear'. Both patients and doctors report negative talk in the consultation, including that OA is to be expected, has an inevitable decline and there is little that can be done about it. Pain management appears to be a priority for patients, although a number of barriers to effective management have been identified. Communication within the doctor patient consultation also appears key, with patients reporting a lack of feeling their symptoms were legitimised. The nature of negative talk and discussions around management within the consultation have emerged as areas for future research. The findings are limited by generic limitations of interview research; to further understanding of the OA consultation alternative methodology such as direct observation may be necessary.
    BMC Family Practice 03/2014; 15(1):46. DOI:10.1186/1471-2296-15-46 · 1.67 Impact Factor
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    • "The Delphi consensus method was used to generate and select items [22], with the initial development in French. For extracting items related to fears and beliefs, a detailed document reporting on the qualitative analysis of interviews with patients was sent to 10 experts (1 general practitioner, 5 rheumatologists, 1 sociologist, 1 orthopaedic surgeon, 1 physical therapist, and 1 physical and rehabilitation medicine physician) [23]. Experts were asked to read the documents and extract the most relevant items concerning patient fears and beliefs. "
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    ABSTRACT: We aimed to develop a questionnaire assessing fears and beliefs of patients with knee OA. We sent a detailed document reporting on a qualitative analysis of interviews of patients with knee OA to experts, and a Delphi procedure was adopted for item generation. Then, 80 physicians recruited 566 patients with knee OA to test the provisional questionnaire. Items were reduced according to their metric properties and exploratory factor analysis. Reliability was tested by the Cronbach α coefficient. Construct validity was tested by divergent validity and confirmatory factor analysis. Test-retest reliability was assessed by the intra-class correlation coefficient (ICC) and the Bland and Altman technique. 137 items were extracted from analysis of the interview data. Three Delphi rounds were needed to obtain consensus on a 25-item provisional questionnaire. The item-reduction process resulted in an 11-item questionnaire. Selected items represented fears and beliefs about daily living activities (3 items), fears and beliefs about physicians (4 items), fears and beliefs about the disease (2 items), and fears and beliefs about sports and leisure activities (2 items). The Cronbach α coefficient of global score was 0.85. We observed expected divergent validity. Confirmation factor analyses confirmed higher intra-factor than inter-factor correlations. Test-retest reliability was good, with an ICC of 0.81, and Bland and Altman analysis did not reveal a systematic trend. We propose an 11-item questionnaire assessing patients' fears and beliefs concerning knee OA with good content and construct validity.
    PLoS ONE 01/2013; 8(1):e53886. DOI:10.1371/journal.pone.0053886 · 3.23 Impact Factor
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    • "One challenge for GPs is that the management of many musculoskeletal conditions in primary care is about symptoms and function, movement and rehabilitation, activity, and positive attitudes rather than the traditional medical model of diagnosis and medical treatment. Previous studies confirm that patients with common musculoskeletal conditions such as osteoarthritis or back pain report GPs 'not taking their complaint seriously' [33] and therefore patients are left with the message that 'there is nothing to be done'. It seems sensible, therefore, to consider whether professional groups who actively embrace evidence-based care of patients with these conditions and who are actively engaged in leading training and research in these fields should be 'keeping the gate' for people who seek care for musculoskeletal problems. "
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    ABSTRACT: Musculoskeletal pain is common across all populations and costly in terms of impact on the individual and, more generally, on society. In most health-care systems, the first person to see the patient with a musculoskeletal problem such as back pain is the general practitioner, and access to other professionals such as physiotherapists, chiropractors, or osteopaths is still either largely controlled by a traditional medical model of referral or left to self-referral by the patient. In this paper, we examine the arguments for the general practitioner-led model and consider the arguments, and underpinning evidence, for reconsidering who should take responsibility for the early assessment and treatment of patients with musculoskeletal problems.
    Arthritis research & therapy 02/2012; 14(1):205. DOI:10.1186/ar3743 · 3.75 Impact Factor
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