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

Abstract

Objective Conservative treatment modalities in osteoarthritis (OA) of the hip or knee are underused, whereas the demand for surgery is rising substantially. To improve the use of conservative treatment modalities, a more in‐depth understanding of the reasons for patients’ treatment choices is required. This study identifies the reasons for choice of treatment in patients with hip or knee OA. Methods Semistructured in‐depth interviews with 24 OA patients were held. Stratified purposive sampling was used to enrich data variation. Interviews were transcribed verbatim and subsequently coded using a thematic approach. Two independent researchers reflected on, compared, discussed, and adjusted the coding. Results Various treatment modalities were discussed by respondents: medication, exercise, physical therapy, injections, surgery, complementary, and alternative treatment. Four key themes underlying the choice for or against a treatment modality for OA were identified: 1) treatment characteristics: expectations about its effectiveness and risks, the degree to which it can be personalized to a patient's needs and wishes, and the accessibility of a treatment; 2) personal investment in terms of money and time; 3) personal circumstances: age, body weight, comorbidities, and previous experience with a treatment; and 4) support and advice from the patient's social environment and health care providers. Conclusion The 4 identified key themes enhance the insight of health care providers into the widespread reasons influencing patients’ treatment choices for knee or hip OA. This knowledge can be used in clinical practice to aid shared decision making, which may lead to optimized treatment choices for both conservative and surgical treatment.

“I've been to physical therapy before, but not for the knees.” A qualitative study exploring barriers and facilitators to physical therapy utilization for knee osteoarthritis

“…Our results were similar to those reported in the literature regarding the utilization of nonsurgical and nonpharmacological treatments for knee OA (Ackerman et al, 2016;Hofstede et al, 2016;E. M. Selten et al, 2016;Selten et al, 2017;Spitaels et al, 2017).…”

Development of the “Treatment beliefs in knee and hip OsteoArthritis (TOA)” questionnaire

“…A main strength of this study was the design used to generate the items. For the selection of items, we used two previous in-depth interview studies in which both patients and healthcare providers were asked about their beliefs and views regarding treatment modalities for knee and hip OA [ 17 , 23 ]. The item pool was generated very carefully in several consensus rounds by the project team, and selected items were assessed by patients.…”

“…For the development of a first draft of the TOA questionnaire an elaborated process was undertaken to generate and select items based on the findings of three previous studies among patients with knee and hip OA in the Netherlands. These were two qualitative studies [ 17 , 23 ] on treatment beliefs in patients and healthcare providers and a concept mapping study [ 24 ] to define the most important themes. A total of 2207 statements reflecting beliefs about treatment modalities of knee or hip OA (which could be potentially included as items in the TOA questionnaire) were extracted from the interviews.…”

Total hip and knee arthoplasty: on the issue of indications for surgery

“…Большинство исследователей, занимающихся заболеваниями крупных суставов, считают, что консервативные методы лечения применяют недостаточно [61,63,64]. Помимо этого в настоящее время в Великобритании уже ведется национальный регистр пациентов, перенесших операции на ТБС без артропластики (NAHR -Non-Arthroplasty Hip Registry).…”