title: Identification of adult knee primary bone tumour symptom presentation: A qualitative study.
abstract: OBJECTIVE
  The aim of this study was to identify the symptom presentation of adult knee primary bone tumours from onset to Consultant diagnosis, from combined patient and healthcare professional perspectives.
  
  
  METHODS
  A qualitative study using in-depth semi-structured interviews recruited a purposive sample of adult patients with a knee primary bone tumour (n = 8) and healthcare professionals with expertise in orthopaedic oncology (n = 6). Following informed consent, recorded interviews explored participants' experiences of symptom presentation. A grounded theory approach was utilised to analyse transcribed data, producing themes. Methods to increase rigour and trustworthiness were employed. Recruitment continued until data saturation was achieved.
  
  
  RESULTS
  Four key themes were established: 1] Symptoms started with intermittent pain which became more severe and more constant, 2] Pain was mechanical in nature but became more difficult to ease; 3] The pain story was unusual with a protracted symptom duration and failure to improve with conservative treatment; 4] Non-painful symptoms included swelling, and systemic signs were uncommon. More similarities between healthcare professionals' and patients' perceptions were found at Consultant diagnosis compared to onset.
  
  
  CONCLUSIONS
  New insights of symptom presentation, particularly in the early stages have been provided which are not reflected in current guidelines. Although starting similarly to routine musculoskeletal presentations, a number of distinctive features may enable earlier diagnosis.
authors: Department of Physiotherapy, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham B31 2AP, United Kingdom; School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom. Electronic address: lucie.gosling@nhs.net.
authors: Lucinda C C
authors: LCC
authors: Gosling
authors: School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
authors: Alison B
authors: AB
authors: Rushton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D063189:Symptom Assessment
keywords: Diagnosis; Diagnostic errors; Expansile bone lesion; Knee