title: Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography.
abstract: This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK, toby.smith@uea.ac.uk.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Smith
authors.forename: Rachel
authors.initials: R
authors.lastname: Purdy
authors.forename: Sarah
authors.initials: S
authors.lastname: Lister
authors.forename: Charlotte
authors.initials: C
authors.lastname: Salter
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
mesh_terms: D000884:Anthropology, Cultural; D001294:Attitude to Health / Q000208:ethnology*; D057210:Delayed Diagnosis; D019468:Disease Management; D006801:Humans; D010003:Osteoarthritis / Q000208:ethnology* / Q000628:therapy*; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D012648:Self Care; D012649:Self Concept