A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative
Ching, A.; Skou, S.T.; Thomas, S.A.; Batt, M.E.; Roos, E.M.; Edwards, K.L.
SHIRLEY THOMAS firstname.lastname@example.org
KIMBERLEY EDWARDS Kimberley.Edwards@nottingham.ac.uk
Professor of Sport, exercise and Nutrition Education
Purpose: The Good Life with osteoArthritis in Denmark (GLA:D) Initiative is an evidence-based treatment programme for patients with knee and hip osteoarthritis (OA). It incorporates training physiotherapists to deliver care in accordance with the clinical guidelines by educating patients on their condition and by delivering supervised neuromuscular exercises to relieve pain and improve function. The importance of self-efficacy, and confidence in exercise, to exercise adherence has not been reported for the GLA:D population. In addition, worse knee confidence in people with knee OA is associated with higher pain and greater perceived knee instability. The aims of this study were to investigate the association between knee confidence and self-efficacy in patients with knee OA in the GLA:D registry; and to explore patients’ perception of their experiences with the GLA:D programme, and whether confidence and self-efficacy has a role to play in continuing with the GLA:D exercises in the long-term.
Methods: This study used a mixed methods design. Patients with knee OA who were offered at least two educational sessions and six weeks of GLA:D exercise programme between January–March 2015 were identified from the GLA:D registry (n = 484) and sent an online survey. Ordinal regression analyses were performed. Knee confidence, assessed using the Knee injury and Osteoarthritis Outcomes Score (KOOS; quality of life subscale, question 3), was the dependent variable and self-reported measures for exercise self-efficacy; arthritis self-efficacy; multidimensional outcomes expectations for exercise; and KOOS pain and activities of daily living (ADL) were the independent variables. Knee confidence score ranged from 0–4 with 0 indicating higher knee confidence. The independent variables ranged from 0–10 or 0–100 with 0 indicating worse symptoms or confidence. Subsequently, semi-structured interviews (n = 4) were used to explore patients’ perceived confidence and adherence to the GLA:D exercises. Interviews were transcribed verbatim, and analysed using interpretative phenomenological analysis.
Results: 200 patients (41.3%) responded to the survey. At 7–10 months following treatment initiation, 9.5% of patients were not at all troubled by lack of knee confidence; 39.5% were mildly troubled; 31.5% were moderately troubled; 15.5% were severely troubled; and 4% were extremely troubled. Patients with higher arthritis self-efficacy score were more likely to have higher knee confidence (odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.63, 0.93; P = 0.007). Patients with higher KOOS ADL score were more likely to have higher knee confidence, although this association was small (OR = 0.96; 95% CI 0.93, 0.99; P = 0.006). No association was found between knee confidence and exercise self-efficacy (OR = 1.00; 95% CI 0.99, 1.01; P = 0.90). Patients reflected on seeing great improvements in their confidence, pain and mobility with the programme. They felt their symptoms got worse if they did not keep up with the exercises. Patients reflected on the importance of continued contact with their physiotherapist after the 6-week programme for further motivation and reassurance. One of the barriers that discouraged patients from continuing with the exercises in the long-term was the cost for additional GLA:D exercise classes with their physiotherapist.
Conclusions: Patients are troubled by the lack of knee confidence after the GLA:D exercise programme; they reflected this was due to their negative experiences prior to entering the GLA:D programme. Arthritis self-efficacy and KOOS ADL were significantly associated with knee confidence, but no association was found with exercise self-efficacy. Patients from the interview reflected that maintaining contact with their physiotherapist was an important factor to motivate them to continue exercising.
Ching, A., Skou, S., Thomas, S., Batt, M., Roos, E., & Edwards, K. (2016). A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative. Osteoarthritis and Cartilage, 24, https://doi.org/10.1016/j.joca.2016.01.892
|Journal Article Type||Article|
|Acceptance Date||Mar 1, 2016|
|Online Publication Date||Mar 20, 2016|
|Publication Date||Apr 1, 2016|
|Deposit Date||Apr 10, 2017|
|Publicly Available Date||Apr 10, 2017|
|Journal||Osteoarthritis and Cartilage|
|Peer Reviewed||Peer Reviewed|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0|
|Additional Information||Abstract belongs to special issue: Abstracts from the 2016 OARSI World Congress on Osteoarthritis — Promoting Clinical and Basic Research in Osteoarthritis. [Date of acceptance estimated.]|
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0