Several patients had positive attitudes toward conservative treatments, such as exercise and physical therapy, because these treatments could be personalized, enabling them to explore and expand their physical limits. “Patients preferred treatments that helped shift their physical limits so that they could increase their physical activity without increasing their symptoms,” write the authors.
A treatment’s accessibility was also considered—whether or not patients could easily fit a treatment into their daily schedules and carry out the treatment at home. But researchers note that “carrying out these exercises at home diligently was found to be difficult; patients indicated that they became less motivated over time.”
Additionally, researchers uncovered a tension between time spent on the treatment and time spent on the competing demands of daily life. “Treatment adherence and a better treatment outcome may be enhanced when the choice of an optimal therapy fits into patients’ daily lives,” write the authors. “Our study was the first to observe a patient’s fear of the long-term rehabilitation period because this surgery prevents them from performing their social roles (e.g., family caregiver).”
The authors conclude their research by noting that it not only adds to the literature on shared decision making for both conservative and surgical treatments of knee and hip OA, but it also identifies themes and subthemes for clinical use. Addressing some of the barriers to treatment, such as fear of exercise or opioid addiction, “is crucial to facilitate the consideration of conservative treatment.”
Although more research is needed, these findings may improve shared decision making by helping providers address the reasons that influence a patient’s treatment choice. “If healthcare providers identify reasons for not choosing specific treatment modalities, they can discuss them with their patients,” note the authors. “This may lead to better allocation of both conservative and surgical treatment modalities, and may improve successful referrals to conservative treatment modalities.”
Selten EM, Vriezekolk JE, Geenen R, et al. Reasons for treatment choices in knee and hip osteoarthritis: A qualitative study. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1260–1267. doi: 10.1002/acr.22841. Epub 2016 Jul 28.
