A qualitative study on patients with knee osteoarthritis to evaluate the influence of different pain patterns on patients’ quality of life and to find out patients’ interpretation and coping strategies for the disease

The objective of this qualitative study of patients with osteoarthritis (OA) of the knee was to evaluate the influence of different pain patterns on their quality of life and to investigate their interpretation and coping strategies for the disease using patient interviews. Patients were recruited by convenience sampling in a private general practice clinic in Hong Kong. Those screened positive for OA of the knee were asked to self-evaluate their average pain score and classify the severity of their OA before attending a semi-structured interview by a research assistant. Twenty patients were interviewed and 98 codes were identified. The content was analyzed independently by two researchers who were not doing the interviews. Codes and themes generated were analyzed based on the grounded theory. A wide range of symptoms was described by patients with OA of the knee, in which pain was the most prominent symptom. Most patients (80%) described two different types of pain, mechanical and inflammatory pain, each presenting with a different pain quality and onset pattern. Most patients self-graded their OA severity at a level higher than their corres­ponding pain score, indicating that there may be other variables that patients would consider during self-evaluation of severity. More than half of the participants seek medical assistance late because their health-seeking behavior was affected by their perception of the problem, concern, and expectation from treatment. The study findings can help healthcare providers to understand and be aware of the existence of two pain patterns, mechanical and inflammatory pain in knee OA, as well as to appreciate the great variations of symptoms, the different perspectives, and the different coping and health-seeking behaviors among knee OA patients during their management. Finally, this study also provides a useful basis for further research on topics like factors that affect patients’ self-evaluated disease severity and efficacy of interventions specific for the two different pain patterns associated with knee OA.