title: Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study.
abstract: To improve patients' use of conservative treatment options of hip and knee OA, in-depth understanding of reasons underlying patients' treatment choices is required. The current study adopted a concept mapping method to thematically structure and prioritize reasons for treatment choice in knee and hip OA from a patients' perspective.
  
  
  
  Multiple reasons for treatment choices were previously identified using in-depth interviews. In consensus meetings, experts derived 51 representative reasons from the interviews. Thirty-six patients individually sorted the 51 reasons in two card-sorting tasks: one based on content similarity, and one based on importance of reasons. The individual sortings of the first card-sorting task provided input for a hierarchical cluster analysis (squared Euclidian distances, Ward's method). The importance of the reasons and clusters were examined using descriptive statistics.
  
  
  
  The hierarchical structure of reasons for treatment choices showed a core distinction between two categories of clusters: barriers [subdivided into context (e.g. the healthcare system) and disadvantages] and outcome (subdivided into treatment and personal life). At the lowest level, 15 clusters were identified of which the clusters Physical functioning, Risks and Prosthesis were considered most important when making a treatment decision for hip or knee OA.
  
  
  
  Patients' treatment choices in knee and hip OA are guided by contextual barriers, disadvantages of the treatment, outcomes of the treatment and consequences for personal life. The structured overview of reasons can be used to support shared decision-making.
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Nijmegen e.selten@maartenskliniek.nl.
authors.forename: Ellen M H
authors.initials: EM
authors.lastname: Selten
authors.affiliation: Department of Psychology, Utrecht University, Utrecht.
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Woerden.
authors.forename: Willemijn H
authors.initials: WH
authors.lastname: van der Laan
authors.affiliation: Physical Therapy and Manual Therapy Velperweg Partnership, Arnhem.
authors.forename: Roelien G
authors.initials: RG
authors.lastname: van der Meulen-Dilling
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.affiliation: Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Nijhof
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Nijmegen.
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Nijmegen.
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Vriezekolk
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D002755:Choice Behavior; D016000:Cluster Analysis; D000072700:Conservative Treatment; D003657:Decision Making; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019637:Orthopedic Procedures; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010358:Patient Participation; D026741:Physical Therapy Modalities; D036301:Qualitative Research
chemical_list: D000700:Analgesics
keywords: concept mapping; decision-making; hip; knee; osteoarthritis