title: Help-seeking behaviour among people living with chronic hip or knee pain in the community.
abstract: BACKGROUND
  A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample.
  
  
  METHODS
  Health care utilization, defined as having seen a family doctor (GP) during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in a community based sample aged 35 or over and reporting pain in hip or knee. Adjusted odds ratios were determined for social deprivation, rurality, pain severity, mobility, anxiety/depression, co-morbidities, and body mass index.
  
  
  RESULTS
  Of 1119 persons reporting hip or knee pain, 52% had pain in both sites. Twenty-five percent of them had seen a doctor only, 3% an AHP only, and 4% an alternative therapist only. Thirteen percent had seen more than one category of health care professionals, and 55% had not seen any health care professional. In the multivariate model, factors associated with consulting a GP were mobility problems (OR 2.62 (1.64-4.17)), urban living (OR 2.40 (1.14-5.04) and pain severity (1.28 (1.13-1.44)). There was also some evidence that obesity was associated with increased consultation (OR 1.72 (1.00-2.93)). Factors were similar for consultation with a combination of several health care professionals. In contrast, seeing an alternative therapist was negatively associated with pain severity, anxiety and mobility problems (adjusting for age and sex).
  
  
  CONCLUSIONS
  Disability appears to be a more important determinant of help-seeking than pain severity or anxiety and depression, for adults with chronic pain in hip or knee. The determinants of seeking help from alternative practitioners are different from determinants of consulting GPs, AHPs or a combination of different health care providers.
authors.affiliation: Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden. carina.thorstensson@spenshult.se
authors.forename: Carina A
authors.initials: CA
authors.lastname: Thorstensson
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.forename: Joy
authors.initials: J
authors.lastname: Adamson
authors.forename: Susan
authors.initials: S
authors.lastname: Williams
authors.forename: Paul
authors.initials: P
authors.lastname: Dieppe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D018771:Arthralgia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D003153:Community Health Services / Q000706:statistics & numerical data*; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D007722:Health Knowledge, Attitudes, Practice; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D016015:Logistic Models; D008875:Middle Aged; D051346:Mobility Limitation; D009765:Obesity / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires