title: Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. Home-based resistance training: predictors of participation and adherence. Beliefs about the causes of osteoarthritis among primary care patients. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty Personal models of osteoarthritis and their relation to self-management activities and quality of life
abstract: STUDY OBJECTIVES To underst and reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee . DESIGN A qualitative study , nested within a r and omised controlled trial , examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis . In the intervention arm , participants undertook a series of simple exercises and repositioning of the kneecap using tape . In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions , guided by a topic schedule , to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy . Interviews were audiotaped , fully transcribed and analysed thematically according to the method of constant comparison . A model explaining factors influencing compliance was developed . SETTING Patients were interviewed at home . The study was nested within a pragmatic r and omised controlled trial . PARTICIPANTS Twenty participants in the intervention arm of the r and omised trial were interviewed three months after they had completed the physiotherapy programme . Eight were interviewed again one year later . MAIN RESULTS Initial compliance was high because of loyalty to the physiotherapist . Reasoning underpinning continued compliance was more complex , involving willingness and ability to accommo date exercises within everyday life , the perceived severity of symptoms , attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis . A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms . CONCLUSIONS Non-compliance with physiotherapy , as with drug therapies , is common . From the patient 's perspective , decisions about whether or not to comply are rational but often can not be predicted by therapists or research ers . Ultimately , this study suggests that health professionals need to underst and reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention Osteoarthritis ( OA ) is a common and often disabling condition that predominately affects older adults . It is the commonest cause of locomotor disability and forms a major element of the workload in primary care . Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ' unmet ' information needs . This paper explores the patients ' perspective on the meaning and significance of living with arthritis , identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme . This paper draws on qualitative and quantitative data from : the baseline interview ( knowledge of arthritis , satisfaction with services and support received in primary care ) ; patient diaries ( individual goals and reflections on treatment ) ; and group teaching sessions ( themes describing the patient 's experience ) . The different data sources were interrogated for common and divergent themes . One hundred and ninety-four participants were identified and 170 completed baseline interviews . Participants were predominantly female ( 73 % ) , with a mean age of 63 and arthritis of long-st and ing ; 55 % reported that they had had it for 5 years or more .  Use of primary care services was high , with 41 % consulting their GP in the 2 weeks before interview . Levels of information were low , with less than 25 % receiving support/advice about the disease , pain management or its impact upon daily life . Set against negative perceptions of the quality of services , patients ' personal priorities were for improved pain management and enhanced mobility/functional ability . The combined quantitative and qualitative data provide insight into the patients ' perspective on the causes and impact of knee OA , individual goals desired from treatment and the quality of care . There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence . Even within a tightly defined study sample participating in the intervention , a diversity of experience and goals were revealed , which highlights the importance of taking account of context ual factors and individual differences when evaluating complex interventions This study identified factors associated with exercise participation  and  adherence  in a sample of 102 sedentary , functionally limited , community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program .  Stepwise regression analyses revealed that baseline physical factors ( i.e. , higher levels of mobility , weaker muscle strength , and fewer numbers of new medical conditions ) were associated with higher rates of participation in the home program .  Positive attitudes and a sense of control toward exercise , lower levels of confusion and depressive moods , and the development of fewer new medical problems during the program were related to higher levels of adherence to the program . Findings revealed that although physical health variables were the primary indicators of an older person 's overall participation in the program , it was the psychological factors that were most important to adherence to this home-based program OBJECTIVE Beliefs about the causes of osteoarthritis ( OA ) have been examined infrequently . The purpose of this study was to provide insight into patients ' beliefs about the causes of OA in a primary care population . METHODS This study involved 31 individuals with OA who were purposively sample d to reflect age , sex , and self-efficacy scores from the intervention arm of a r and omized controlled trial examining the effectiveness of an arthritis self-management program in primary care . Participants took part in face-to-face interviews . Data were analyzed using interpretative phenomenologic analysis . RESULTS A total of 31 patients with OA ( 17 [ 55 % ] men ) with a median age of 68 years ( range 56 - 84 years ) were recruited .  OA and painful joints were considered to be an inevitable aspect of aging rather than an indication of disease . Participants attributed the cause of OA to multiple factors , the most commonly reported being wear and tear . CONCLUSION Insight into beliefs about the causes of OA among older people may help explain attitudes towards the uptake of health care among this group of patients This study investigated the physical and psychosocial consequences of living with osteoarthritis ( OA ) in daily life and peoples ’ views of total knee arthroplasty ( TKA ) and the role of physiotherapy . In-depth interview data were used from a prospect i ve qualitative study conducted by the senior author ( KY ) . Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto . A modified grounded theory method approach was used to analyze the interview data . The findings showed that experiences for the participants with OA were conceptualized as a “ breakpoint . ” The breakpoint was centred on the experiences/processes of living with unremitting pain , the limitations of mobility , leisure and social activities , and the result ing consequences to the participant 's physical and psychological well-being . In addition to the above experiences , participants also discussed their perceptions of  TKA surgery .  The findings showed that expectations of TKA were linked to participants ’ knowledge of the procedure and its outcomes . The participants listed acquaintances , friends , family members , and doctors as the main sources of knowledge for TKA . On the basis of the above analysis , recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery We examined the personal models of osteoarthritis ( OA ) of 61 patients over 60 years of age .  Models were elicited using a structured interview . Shared beliefs included perceiving OA as a serious , painful , chronic , and incurable condition that can be managed by recommended medical treatment . Considerable individual differences were found on six personal-model constructs : Symptoms , Seriousness , Cause , Control , Helpfulness of Treatment , and Negative Feelings about Treatment . The constructs of Symptoms and Seriousness were consistently related to a variety of important outcomes . For example , participants with higher scores on Symptoms and Seriousness reported higher levels of self-management ( both concurrently and prospect ively ) , reported more utilization of medical services , and experienced a poorer quality of life . The implication s for the design of health-education material s and for patient-provider interactions are discussed
target: The overarching themes indicated people with osteoarthritis delay their diagnosis , opting for self-management and informal information gathering .
  This informal rather than health professional-led guidance is sought and maintained as an important re source throughout the care of this population and is valued .
  There remains uncertainty regarding when this is required , but the expected failure of conservative treatment to manage pain and symptoms is common .
  This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis
background: Abstract This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies .