Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography

Abstract

This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.

Most Important Frequently Asked Questions From Patients With Hip or Knee Osteoarthritis: A Best‐Worst Scaling Exercise

“…The highest ranked FAQ by both patients and health care professionals, “What can I do myself to decrease symptoms and to prevent the OA from getting worse?” highlights the importance of patients’ need for information about OA and to feel confident in managing their condition . This need is in concordance with the guideline recommendation that self‐management is important for patients with hip or knee OA .…”

Reasons for Treatment Choices in Knee and Hip Osteoarthritis: A Qualitative Study

“…Shared decision‐making models emphasize the importance of taking patients’ values and preferences into account. A recent meta‐synthesis indicated that patients with OA have mainly negative beliefs about the efficacy of conservative treatment options and prefer surgical treatment options . More in‐depth knowledge of patients’ reasons for choosing a specific OA treatment modality will aid shared decision making and might increase patients’ usage of conservative treatment modalities.…”

Why don’t patients take their analgesics? A meta-ethnography assessing the perceptions of medication adherence in patients with osteoarthritis

“…Such a recommendation has been seen within the medication adherence literature in hypertension [22], asthma [23] and depression [24]. However, this understanding is particularly valid in the osteoarthritis population given the acknowledged variability in health beliefs regarding the condition itself, irrespective of beliefs surrounding pharmacological management [25]. Future interventions therefore should consider the individualisation of behaviour change, adopting models such as the social ecological model, to provide a theoretical underpinning for long-term behaviour change promoting medicine adherence.…”

“…There is an understanding that osteoarthritis may be 'just ageing' rather than 'medicalising' the condition [25]. The realisation that osteoarthritis is not currently curative, and that medications for symptom management are long-term, can have a negative impact, particularly on the fear of additional and longer-term usage.…”