Hierarchical structure and importance of patients' reasons for treatment choices in hip and knee osteoarthritis: A concept mapping study

E.M.H. Selten*, R. Geenen, W.H. Van der Laan, R.G. van der Meulen-Dilling, H.J. Schers, M.W. Nijhof, C.H.M. van den Ende, J.E. Vriezekolk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives. To improve patients’ use of conservative treatment options of hip and knee OA, in-depth understanding of reasons underlying patients’ treatment choices is required. The current study adopted a concept mapping method to thematically structure and prioritize reasons for treatment choice in knee and hip OA from a patients’ perspective.

Methods. Multiple reasons for treatment choices were previously identified using in-depth interviews. In consensus meetings, experts derived 51 representative reasons from the interviews. Thirty-six patients individually sorted the 51 reasons in two card-sorting tasks: one based on content similarity, and one based on importance of reasons. The individual sortings of the first card-sorting task provided input for a hierarchical cluster analysis (squared Euclidian distances, Ward’s method). The importance of the reasons and clusters were examined using descriptive statistics.

Results. The hierarchical structure of reasons for treatment choices showed a core distinction between two categories of clusters: barriers [subdivided into context (e.g. the healthcare system) and disadvantages] and outcome (subdivided into treatment and personal life). At the lowest level, 15 clusters were identified of which the clusters Physical functioning, Risks and Prosthesis were considered most important when making a treatment decision for hip or knee OA.

Conclusion. Patients’ treatment choices in knee and hip OA are guided by contextual barriers, disadvantages of the treatment, outcomes of the treatment and consequences for personal life. The structured overview of reasons can be used to support shared decision-making.
Original languageEnglish
Pages (from-to)271-278
Issue number2
Publication statusPublished - Feb 2017


  • osteoarthritis
  • hip
  • knee
  • concept mapping
  • decision-making


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