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    ABSTRACT: Objective: While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This paper explores how people age 35-65 years manage knee symptoms. Methods: Six focus groups were conducted with 41 participants (mean age 50.9 years; 63% female) who self-reported a diagnosis of OA or reported knee symptoms (i.e. pain, aching or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. Results: Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather, a process that moved back and forth between searching for "solutions" and active management (ongoing use of strategies). During the process, participants consulted health care providers but often perceived that medical care offered limited options and guidance. Management was constructed as a "never-ending" process that entailed effort and personal resources. Conclusion: Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants' proactive approach and the reactive approach of the health care system that has focused on late stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across the lifespan. © 2013 American College of Rheumatology.
    07/2014; 66(7). DOI:10.1002/acr.22278
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    ABSTRACT: Medication is used to manage pain that results from both osteoarthritis and total joint replacement (TJR). Research has provided insight into how people living with osteoarthritis use pain relief medication. However, it is not known whether elective TJR affects existing attitudes and behaviours with regard to pain medications. Using qualitative methods, the present study explored patterns of pain relief use around the time of TJR. In-depth face-to-face qualitative interviews were carried out with 24 patients two to four weeks after they had undergone TJR for hip or knee osteoarthritis. Participants were asked to reflect on their use of pain medication pre-surgery, while in hospital and while recovering from their operation at home. Transcripts of the audio-recorded interviews were imported into Atlas.ti® and thematic analysis was used. Attitudes to pain relief medication and their use are not static. Many participants change their use of pain medication around the time of surgery. This shift was influenced by interactions with health professionals and changing views on the acceptability, necessity and value of pain relief in helping to manage an altered pain experience. Understanding reasons for medication-taking behaviour during the journey through joint replacement may be helpful to health professionals. Health professionals have a fundamental role to play in challenging or reinforcing different treatment beliefs, which is the basis for effective use of pain relief over the pre- to postoperative period. Copyright © 2013 John Wiley & Sons, Ltd.
    Musculoskeletal Care 06/2014; 12(2). DOI:10.1002/msc.1062

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May 23, 2014