People with hip or knee osteoarthritis' expectations of physiotherapy: a qualitative study

Purpose (the aim of the study): Physiotherapy is effective in reducing pain and improving physical functioning in patients with hip or knee osteoarthritis (HOA or KOA). However, there is considerable variation in individual response to treatment. Literature shows that patients’ expectations of treatment can influence outcomes, knowledge on patient expectations of physiotherapy for HOA or KOA is scarce. This study aims to explore the expectations of patients with hip or knee OA with regard to physiotherapy treatment and factors influencing these expectations. Methods: Qualitative study using semi-structured interviews with patients clinically diagnosed with HOA or KOA, who were recently referred for physiotherapy. Participants were recruited via general practitioners and orthopaedic surgeons through purposive sampling. The interviews were conducted before starting treatment and performed by one trained researcher. A topic guide was used, comprising aspects of care such as outcomes, structure and process of physiotherapy and factors that possibly contributed to the expectations. Reflexive thematic analysis was performed by two researchers via open and axial coding. Results: Thirteen participants were interviewed. Their median age was 72 years, 9/13 participants were female, 8/13 had KOA, and 7/13 were referred by an orthopaedic surgeon. Six themes emerged from the analyses: 1) Personalized care; for patients had expectations about individuality of complaints and feasibility of the therapy. 2) Treatment outcome; for example participants expressed the hope of improvement in pain and functioning. 3) Treatment modality; for example patients expect exercises with aids such as stationary bikes and elastic bands and had expectations about content, frequency and duration of the therapy. 4) Personal responsibility; for example patients have expectations about taking matters into your own hands and that comprehensible explanations lead to action. 5) Professionality of the physiotherapist; for example patients have expectations about the physiotherapists’ theoretical knowledge and attitude. 6) Factors influencing and shaping expectations; expectations are shaped by lived experience, physical state, knowledge about HOA or KOA, former experiences, information gathered from others and information gathered elsewhere. Exemplary quotes for each theme are listed in Table 1. Conclusions: This study showed that patients with HOA or KOA who were referred to physiotherapy expected a personalized, collaborative approach together with a skilled therapist. Moreover, they expected the necessity of their own proactive attitude towards therapy. Participants emphasized that they expect treatment to be integrated into their everyday life in a manner that is both feasible and sustainable. Notably, expectations on outcome of treatment were often expressed as hope of improvement. Participants’ expectations were shaped by their physical condition, prior experiences, and information from professionals, social contacts, and online sources. These expectations are rooted in lived experience and personal understanding of HOA and KOA. Discussion of these expectations before treatment may help to manage them and tailor the treatment to individual patients’ needs and preferences. Funded by the Dutch Research Council (NWO); 023.018.039