Living with osteoarthritis is a balancing act: an exploration of patients' beliefs about knee pain
Living with osteoarthritis is a balancing act: an exploration of patients' beliefs about knee pain
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DOI：
10.1186/s41927-018-0023-x
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发表时间：
2018-01-01
期刊：
影响因子：
2.2
通讯作者：
Abbott, J. Haxby
中科院分区：
文献类型：
--
作者：
Darlow, Ben;Brown, Melanie;Abbott, J. Haxby
背景本研究旨在探讨膝骨关节炎（OA）患者对该疾病的信念，以及这些信念是如何形成的，以及这些信念对活动参与、健康行为和自我管理的影响。方法对从新西兰两个省的全科诊所、社区理疗诊所和公共广告中招募的 13 名膝骨关节炎患者进行半结构化访谈。使用解释性描述对数据进行分析。结果出现了两个关键主题。 1）知识：确定性和不确定性描述了参与者对其膝盖解剖变化的强烈信念。参与者对渐进性关节退化的生物力学模型的信念似乎常常源于临床遭遇和对“磨损”一词的字面解释。这些信念导致了对日常症状的解释以及参与者影响衰退速度的能力的不确定性，并确定关节置换手术是修复受损膝盖的唯一有效解决方案。 2) 与 OA 一起生活描述了与 OA 一起生活的更广泛的视角，以及在做出有关活动参与、药物治疗、注意力集中、获得护理以及充分利用今天而不破坏明天的决策时平衡竞争价值观和风险的感知需要。对膝关节 OA 的误解对活动参与、健康行为和自我管理决策产生了负面影响。 结论 OA 生物力学模型减少了参与者对管理选项的探索，并强化了平衡竞争价值观的感知需要。改善向膝关节骨关节炎患者提供的信息可以帮助指导积极的健康行为和自我管理决策，并确保这些决策基于当前的证据。
BackgroundThis study aimed to explore the beliefs of people with knee osteoarthritis (OA) about the disease, and how these beliefs had formed and what impact these beliefs had on activity participation, health behaviour, and self-management.MethodsSemi-structured interviews were conducted with 13 people with knee OA recruited from general practices, community physiotherapy clinics, and public advertisements in two provinces of New Zealand. Data were analysed using Interpretive Description.ResultsTwo key themes emerged. 1) Knowledge: certainty and uncertainty described participants' strong beliefs about anatomical changes in their knee. Participants' beliefs in a biomechanical model of progressive joint degradation often appeared to originate within clinical encounters and from literal interpretation of the term 'wear and tear'. These beliefs led to uncertainty regarding interpretation of daily symptoms and participants' ability to influence the rate of decline and certainty that joint replacement surgery represented the only effective solution to fix the damaged knee. 2) Living with OA described broader perspectives of living with OA and the perceived need to balance competing values and risks when making decisions about activity participation, medication, attentional focus, accessing care, and making the most of today without sabotaging tomorrow. Misunderstandings about knee OA negatively impacted on activity participation, health behaviours, and self-management decisions.ConclusionBiomechanical models of OA reduced participant exploration of management options and underpinned a perceived need to balance competing values. Improved information provision to people with knee OA could help guide positive health behaviour and self-management decisions and ensure these decisions are grounded in current evidence.