Patients' experiences of a clinical trial physiotherapy programme for hip or knee osteoarthritis

Abstract

Osteoarthritis (OA) is the most common form of joint disease and the leading cause of pain and physical disability in older adults. New Zealand's population is ageing and by the late 2040s, the proportion of the population aged 65 years and over will have doubled.

This study aimed to capture the experiences of patients with OA participating in a physiotherapy clinical trial programme designed to reduce disability and pain.

A qualitative interview study was conducted. Sixteen individuals were recruited from the four intervention arms of a randomised controlled trial (RCT) and interviewed twice: once in the early stages of the intervention and post-intervention. A further five individuals who chose not to participate in the RCT were also interviewed on one occasion. Data were collected from the face-to-face interviews using open-ended questions. The interviews were transcribed verbatim and analysed using interpretative analysis.

Interview data contained three main themes, each with two subordinate themes. Theme one, The OA Story, provided a broad narrative of participants' experience of their OA condition. The subordinate theme, No Way Back, reflected how they experienced living with a progressive, deteriorating, painful joint condition; Life Goes On embodied the stoicism and perseverance required to cope with normal daily activities in the face of worsening pain and increasing loss of function. Theme two, The Research Story, reflected on participants' experiences of being in the RCT; Give it a Go represented the uncertainty of what the trial intervention could offer; Shown a Signpost captured the positive impact from participating in the trial. Theme three, The Surgery Story described joint replacement surgery (JRS) and the health system. Light at the end of the Tunnel, symbolised surgery as the cure-all option; Waiting ‟n‟ Hoping signified the frustration with the health system and their OA.

In summary, the experience of living with a deteriorating and disabling condition shaped participants' beliefs about the necessity of JRS. The physiotherapy intervention “made a difference” in that participants felt more confident in coping and managing their OA. Despite this, for most, surgery was still perceived as the “fix it” for their condition.

Studying participants' stories provided some understanding of the lived experiences of people with OA and their expectations of a clinical trial physiotherapy programme. Osteoarthritis is a complex condition that presents with frequent discordance between the pathology, symptoms and disability. Physiotherapy interventions for OA are also complex in that they are made up of various interconnecting parts. This research has demonstrated that both quantitative and qualitative evidence is required to evaluate the complexities of living with OA and receiving physiotherapy interventions.