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

BACKGROUND Non-surgical treatment modalities in osteoarthritis (OA) of hip or knee are underused1, whereas the demand for surgery is rising substantially2. Surgery is not always the most effective treatment option, as not all patients are satisfied with the outcomes3. To improve utilization of non-surgical treatment options, more in-depth understanding of reasons underlying patients' treatment choice is required. Knowing these reasons offers opportunities to optimize non-surgical treatment options and will aid to informed shared decision-making for patients with hip or knee OA and their healthcare providers.

OBJECTIVES To identify reasons underlying (surgical and non-surgical) treatment choices in patients with hip or knee OA.

METHODS Semi-structured in-depth interviews with 24 patients with OA were held. Stratified purposive sampling based on gender, age and affected joint (hip or knee) was used to enrich data variation. Recruitment took place in both primary and secondary care. Interviews were transcribed verbatim and subsequently coded using a thematic approach. Two independent researchers continuously reflected upon, compared, discussed and adjusted the coding.

RESULTS Various treatment modalities were discussed by respondents: medication, exercise, physiotherapy, injections, surgery, complementary and alternative treatment. Four key themes of reasons to choose or not to choose for a treatment modality of OA were identified: 1) characteristics of a treatment: expectations about the effectiveness and risks of a treatment, the degree to which a treatment can be individualized to patients' needs and desires, and the accessibility of a treatment; 2) personal investment: costs in terms of money and time; 3) individual characteristics: age, weight, comorbidities and previous experience with a treatment; and 4) social support: advice from patients' social environment and healthcare providers.

CONSLUSIONS The four key themes - characteristics of a treatment, personal investment, individual characteristics and social support - give healthcare providers more insight into possible reasons influencing patients' treatment choices for knee or hip OA. Healthcare providers can use this knowledge in clinical interviews to aid informed shared-decision making, leading to optimized treatment choices.