A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

Abstract

BackgroundA patient’s experience with knee osteoarthritis (OA) is influenced by many psychosocial contributors that can influence the impact of pain. Such factors are known to explain some of the discordance between objective clinical parameters and patient-reported levels of disability and treatment effectiveness. However, few data are available to help clinicians understand the psychosocial factors that apply to the world’s many Asian populations. Insights gained from a qualitative study in such a population may support targeted interventions.Questions/purposesIn this qualitative study involving a group of Asian patients with knee OA in Singapore, we asked: (1) What psychologic factors contribute to patients’ experiences, rehabilitation, and recovery? (2) What social factors contribute to patients’ experiences, rehabilitation, and recovery?MethodsSemistructured interviews eliciting broad patient experiences of managing knee OA were conducted in an urban, referral-based tertiary hospital in central Singapore. Patients were recruited if they met either of the following criteria: Kellgren-Lawrence grade ≥ 3 (minimum of one knee); Knee Injury and Osteoarthritis Outcome Score ≤ 60; or the Pain average (P), interference with Enjoyment of life (E), and interference with General activity (G) (PEG) ≥ 5. All patients had a clinical diagnosis of knee OA, were ambulatory in the community with or without a walking aid, had not undergone partial arthroplasty or TKA, were prescribed nonsurgical treatment, and were conversant in either English or Mandarin. Forty-six patients (30 women and 16 men, mean age 64 years old) were recruited for this study. A thematic analysis with elements of grounded theory and framework analysis was performed using a deductive approach. Psychologic influences specific to patients’ behavioral and emotional responses to pain, as well as social factors known to have an impact on the experience of managing knee OA, were identified in the interview transcripts and coded according to established factors from earlier research. An inductive thematic analysis was then applied to the remaining transcripts to identify new themes that emerged from the data. Thematic saturation was attained when study team members agreed data and thematic sufficiency were met in the 46 transcripts. The study team discussed and deemed the 46 transcripts to contain sufficient insights for a reasonably clear understanding of the codes and development of themes to answer the study’s research questions.ResultsSix main themes related to psychosocial influences on pain emerged. Psychologic factors were “loss of face” because of knee OA, anticipation and avoidance of pain and suffering, and a vicious cycle of negative emotional experiences. The social factors we identified were social and family support, workplace environment and employment uncertainty, and built environment (patients’ ability to navigate manmade structures and facilities).ConclusionPsychosocial factors have an important impact on patients’ physical, psychologic...

CORR Insights®: A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

“…In addition, migration of ethnic groups to North America and Europe brings up the question of the degree to which cultural values and norms persist in individuals’ new countries after they emigrate from their places of origin. It would be interesting to ascertain whether the same findings observed here with respect to the patient experience [6] are still present in those contexts. Furthermore, although arthritis tends to affect older patients, it can occur in younger patients, and future studies might investigate this.…”

Effects of Radiofrequency Diathermy Plus Therapeutic Exercises on Pain and Functionality of Patients with Patellofemoral Pain Syndrome: A Randomized Controlled Trial

“…Previous studies have demonstrated that the presence of fear of movement may influence treatment outcome. Studies show that in people with chronic musculoskeletal pain, fear of physical exercise or movement is due to the common assumption of increased pain or injury, and this has been associated with increased pain intensity and disability [ 44 , 45 , 46 , 47 ]. There is no doubt that physical exercise has been an important component in the treatment of pain in both groups [ 48 ]; although, the diathermy group could have had better results in terms of pain and thus better function.…”

Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study

“…The selection of outcome measures was guided by a combination of (I) the themes identified from qualitative work by the study team on local knee OA patient population to identify the potential psychosocial factors that impact knee OA progression [30], (II) a review of international literature, and (III) consultation with local domain experts to ensure local contextualization. The themes identified from the qualitative study (i.e., social support; religion/spirituality; built environment; fear avoidance/ kinesiophobia; negative affect, depression/anxiety; and self-image and identity, loss of face) informed the selection of the psychosocial outcomes including social support, religiosity, built environment, fear of movement, etc.…”

“…The themes identified from the qualitative study (i.e., social support; religion/spirituality; built environment; fear avoidance/ kinesiophobia; negative affect, depression/anxiety; and self-image and identity, loss of face) informed the selection of the psychosocial outcomes including social support, religiosity, built environment, fear of movement, etc. [30].…”