title: Patients' perceptions of the treatment and management of hand osteoarthritis: a focus group enquiry.
abstract: OBJECTIVE
  Osteoarthritis (OA) is the commonest reason for a musculoskeletal consultation in primary care in older adults. There is evidence that appropriate advice and management is sub-optimal. The aim of this study was to explore perceptions and experiences of the treatment and management of hand OA in older adults.
  
  
  METHODS
  Four focus groups were conducted with primary (n = 15) and secondary (n = 14) care participants aged 50-84 years (mean age 64.9 years; 3 males, 14 females) with a clinical diagnosis of hand OA. Data were tape-recorded, transcribed and analysed using thematic analysis and constant comparison method.
  
  
  RESULTS
  Participants described a lack of help and information with regards to management of their hand OA and also a perceived lack of understanding of the impact of hand OA on the individual. Some received contradictory advice about its management. Beliefs about treatment efficacy were balanced against perceived and actual side-effects and tolerance, and such perceptions appeared to influence the use of alternative therapies.
  
  
  CONCLUSIONS
  The study identified a perceived unmet need in people with hand OA presenting in primary and secondary care. This may be due to the clinical uncertainty of treatment, lack of high-quality randomised controlled trials evaluating therapeutic options, and the limited written information available incorporating the patient experience. The study emphasised the need to understand patient illness and treatment beliefs. A better understanding of illness and treatment beliefs will facilitate the use of evidence-based approaches in the management of hand OA.
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffs. ST5 5BG, UK. s.hill@cphc.keele.ac.uk
authors.forename: Susan
authors.initials: S
authors.lastname: Hill
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
authors.forename: Bie
authors.initials: B
authors.lastname: Nio Ong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019468:Disease Management; D004739:England; D005260:Female; D017144:Focus Groups; D050823:Hand Joints / Q000503:physiopathology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000523:psychology* / Q000628:therapy; D017060:Patient Satisfaction; D011320:Primary Health Care; D016896:Treatment Outcome