It's not just a knee, but a whole life: A qualitative descriptive study on patients' experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

Josefina Nyvang, Margareta Hedström, Sissel Andreassen Gleissman, Josefina Nyvang, Margareta Hedström, Sissel Andreassen Gleissman

Abstract

Aim: Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15-20% of the operated patients are dissatisfied and 20-30% have persistent pain after surgery. This study is aimed at describing patients' experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery.

Methods: We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis.

Findings: Three categories were formulated with an overriding theme: "It's not just a knee, but a whole life." The three categories were "Change from their earlier lives," "Coping with knee problems," and "Ultimate decision to undergo surgery." The main finding was that knee OA affects the whole body and self, ultimately affecting the patients' lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants' lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed.

Conclusions: The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients' assessment should be considered on individual basis with regard to each patient.

Keywords: Knee osteoarthritis; expectations; experiences; knee arthroplasty; pain; qualitative research.

References

    1. Alami S, Boutron I, Desjeux D, Hirschhorn M, Meric G, Rannou F, et al. Patients’ and practitioners’ views of knee osteoarthritis and its management: A qualitative interview study. PLoS One. 2011;6(5) 19634. doi: .
    1. Brooks R. G, Jendteg S, Lindgren B, Persson U, Bjork S. EuroQol: Health-related quality of life measurement. Results of the Swedish questionnaire exercise. Health Policy. 1991;18(1):37–48.
    1. Demierre M, Castelao E, Piot-Ziegler C. The long and painful path towards arthroplasty: A qualitative study. Journal of Health Psychology. 2011;16(4):549–560. doi: .
    1. Egberg L, Andreassen S, Mattiasson A. C. Experiences of living with intermittent claudication. Journal of Vascular Nursing. 2012;30(1):5–10. doi: .
    1. Gadow S. Body and self: A dialectic. The Journal of Medicine and Philosophy. 1980;5(3):172–185.
    1. Hall M, Migay A. M, Persad T, Smith J, Yoshida K, Kennedy D, et al. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty. Physiotherapy Theory and Practice. 2008;24(3):167–181. doi: .
    1. Koenen P, Bathis H, Schneider M. M, Frohlich M, Bouillon B, Shafizadeh S. How do we face patients’ expectations in joint arthroplasty? Archives of Orthopaedic and Trauma Surgery. 2014;134(7):925–931. doi: .
    1. Lööf H, Johansson U.-B, Henriksson E. W, Lindblad S, Bullington J. Body awareness in persons diagnosed with rheumatoid arthritis. International Journal of Qualitative Studies on Health and Well-being. 2014;9 24670. doi: .
    1. Lundblad H, Kreicbergs A, Soderlund V, Ulfgren A. K, Stiller C. O, Jansson K. A. The value of preoperative grade of radiographic and histological changes in predicting pain relief after total knee arthroplasty for osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2011;20(9):1815–1821. doi: .
    1. MacKay C, Jaglal S. B, Sale J, Badley E. M, Davies A. M. A qualitative study of the consequences of knee symptoms: ‘It's like you're an athlete and you go to a couch potato’. BMJ Open. 2014;4(10) 006006. doi: .
    1. Ohman M, Soderberg S, Lundman B. Hovering between suffering and enduring: The meaning of living with serious chronic illness. Qualitative Health Research. 2003;13(4):528–542.
    1. Ong B. N, Jinks C, Morden A. The hard work of self-management: Living with chronic knee pain. International Journal of Qualitative Studies on Health and Well-being. 2011;6(3) doi: .
    1. Patton M. Q. Qualitative research and evaluation methods: Integrating theory and practice. 4th ed. London: Sage; 2015.
    1. Pouli N, Das Nair R, Lincoln N. B, Walsh D. The experience of living with knee osteoarthritis: Exploring illness and treatment beliefs through thematic analysis. Disability and Rehabilitation. 2014;36(7):600–607. doi: .
    1. Power J. D, Badley E. M, French M. R, Wall A. J, Hawker G. A. Fatigue in osteoarthritis: A qualitative study. BMC Musculoskeletal Disorders. 2008;9 63. doi: .
    1. Price D. D, McGrath P. A, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56.
    1. Roos E. M, Roos H. P, Ekdahl C, Lohmander L. S. Knee injury and Osteoarthritis Outcome Score (KOOS)—Validation of a Swedish version. Scandinavian Journal of Medicine & Science in Sports. 1998;8(6):439–448.
    1. Sale J. E, Gignac M, Hawker G. How “bad” does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis. Arthritis und Rheuma. 2006;55(2):272–278.
    1. SKAR. Annual report 2013. Swedish Knee Arthroplasty Register. 2013. Retrieved from: .
    1. Small N, Bower P, Chew-Graham C. A, Whalley D, Protheroe J. Patient empowerment in long-term conditions: Development and preliminary testing of a new measure. BMC Health Services Research. 2013;13 263. doi: .
    1. Steinhoff A. K, Bugbee W. D. Knee Injury and Osteoarthritis Outcome Score has higher responsiveness and lower ceiling effect than Knee Society Function Score after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2014;23:1–7. doi: .
    1. Weinstein A. M, Rome B. N, Reichmann W. M, Collins J. E, Burbine S. A, Thornhill T. S, et al. Estimating the burden of total knee replacement in the United States. The Journal of Bone and Joint Surgery. American Volume. 2013;95(5):385–392. doi: .
    1. Woolhead G. M, Donovan J. L, Dieppe P. A. Outcomes of total knee replacement: A qualitative study. Rheumatology (Oxford) 2005;44(8):1032–1037. doi: .
    1. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. doi: .
    1. Wylde V, Dieppe P, Hewlett S, Learmonth I. D. Total knee replacement: Is it really an effective procedure for all? Knee. 2007;14(6):417–423. doi: .

Source: PubMed

3
Abonnieren