Researchers identify factors in patients’ decision making for osteoarthritis management

Osteoarthritis is the most common joint disease worldwide and it affects 1 in 6 adults in Canada. Osteoarthritis occurs when joint cartilage between bones breaks down and can cause severe chronic pain. Currently, there is no cure for the disease, but interventions exist to decrease pain and improve quality of life. Guidelines for osteoarthritis management include exercise, weight management, medication, and in severe cases, surgery.

However, even with widespread knowledge of osteoarthritis management interventions, there is substantial underuse of non-surgical interventions, although only a fraction of people will go on to receive a joint replacement.

Researchers in Dr. Deborah Marshall’s lab are investigating the low uptake of non-surgical interventions for osteoarthritis by exploring patient preferences for management options in their osteoarthritis journey.

Underuse of non-surgical management for osteoarthritis

A recent study revealed that only 1 in 5 people with knee osteoarthritis used guideline-consistent treatments after a surgeon recommended non-surgical care.  This indicates a clear gap between recommended guidelines and the strategies patients use to manage knee osteoarthritis.

“Twenty percent is surprising, especially because guidelines for osteoarthritis management have consistently recommended education, exercise, and weight management for decades,” explains Darren Mazzei, a physiotherapist, PhD candidate in Health Economics and CIHR Health System Impact Fellow in Marshall’s lab and lead author of the study.

The findings indicated that 90% of participants implemented at least one non-surgical intervention, which is promising. However, evidence suggests that implementing all interventions has a compounding effect for yielding positive results.

“We have an opportunity to improve uptake of these proven treatments by addressing common myths and implementing structured programs that deliver evidence-based care,” explains Mazzei.

Factors that impact decision making

With the underuse of non-surgical interventions for osteoarthritis, there is a need to integrate patient preferences into research and modeling to improve care and management. Marshall was awarded CIHR funding to investigate patient preferences for non-surgical interventions to increase understanding of patients’ choices and identify areas for improvement in care.

The first step in this work is to gather insights into the patient experience of osteoarthritis management. Researchers from Marshall’s team, Bryanne Kennedy, and Dr. Gillian Currie, PhD, led a study published in The Patient, which focused on patients’ lived experiences to identify factors that they considered in their choice of non-surgical management for hip or knee osteoarthritis.

“A goal of our research is to improve uptake of non-surgical strategies because there’s good evidence that they are effective,” explains Kennedy, research associate and lead author of the study. “We hope our research will help increase awareness of osteoarthritis management options and break the assumption that an osteoarthritis diagnosis leads to a joint replacement.”

Currently, clinical guidelines recommend that all patients with osteoarthritis use non-surgical interventions, even for those who will eventually progress to surgery.

“Even if you can’t avoid surgery, trying non-surgical treatments first may help patients have a better outcome post-surgery,” states Currie.

The research team identified 16 factors that patients consider when making management decisions, including patients’ views on joint replacement surgery, whether they had a choice in managing their osteoarthritis care, knowledge of options, and overall costs.

“Some people were informed of their treatment options, but not about their disease, which made it difficult to decide on their best options,” explains Kennedy. “For some, individual costs to see specialized healthcare providers and travel time from smaller centers were key considerations.”

For Kennedy’s thesis focus, she took the research one step further to examine the role of locus of control in patient decision-making which refers to an individual’s beliefs on who and what influences their health. The study published in Musculoskeletal Care, explored patient beliefs about what influences osteoarthritis and management choices, including the causes, progression, and symptoms. Many participants believed that osteoarthritis was a normal part of aging, or the direct result of an injury and several participants stated the influence of others on their symptom management. The findings highlight opportunities for education on osteoarthritis, including causes, and evidence based non-surgical management options.

Future research will use the data to design a discrete choice experiment survey to quantitatively capture patient preferences to help inform the future development of osteoarthritis management strategies.