How Do Individuals Perceive Diagnostic Labels and Explanations for Hip Pain? A Qualitative Study Among Adults With Persistent Hip Pain.

Abstract

Background: Depending on how clinicians label and explain hip pain, patients may form different beliefs about hip pain and its management. When clinicians describe hip pain as a problem of passive "wear and tear," patients may be more likely to believe that surgery is needed to "fix" hip pain than if it were explained as a dynamic, whole-joint condition or as a biopsychosocial problem. A qualitative study could inform health professionals on how to provide information about hip pain that meets patients' expectations for information while also guiding them to use recommended nonsurgical care.

Questions/purposes: Qualitative methodology was used to explore: (1) how adults with hip pain perceive different diagnostic labels and explanations relating to the treatment of hip pain and (2) whether the different labels and explanations satisfy their expectations for diagnostic information.

Methods: This was a qualitative study using individual, semistructured interviews with an interview guide. Participants were recruited from metropolitan and rural Australia by social media advertising. Participants self-reported activity-related hip pain on most days in the past 3 months, were 45 years of age or older, and read and spoke in English. We sought to purposively sample a range of educational and health literacy levels. We interviewed 18 adults with hip pain (mean ± SD age was 64 ± 7 years, 13 of 18 patients were women) via video conferencing or telephone (based on preference). The labels and explanations were (1) hip osteoarthritis (explaining it as a dynamic, whole-joint condition), (2) persistent hip pain (explaining it as a biopsychosocial problem), and (3) hip degeneration (explaining it as passive wear and tear). Interviews were audio recorded and transcribed verbatim. Participants engaged in a think-aloud activity, in which we asked them to share their thoughts about three diagnostic labels and explanations as they read the relevant written information. Reflexive thematic analysis was used to analyze the data. This involved two authors first coding and identifying early themes in the data relating to our research questions (treatment beliefs relating to, and satisfaction with, information). Interpretations of data, including codes and themes, were discussed, challenged, and finalized through discussions among the research team. We ceased recruitment when we believed that our data set reached thematic saturation-that is, when it provided a sufficient understanding of our research question and the latest round of data collection had not led to substantial theme development or new themes.

Results: Participants varied in how they perceived different diagnostic labels and explanations for hip pain, informing wide-ranging treatment beliefs. For diagnostic labels of hip osteoarthritis and hip degeneration, they expressed preexisting beliefs that certain exercises (such as those involving weightbearing) could harm the hip and that surgery was a likely treatment for it. When provided with an explanation of hip osteoarthritis, most participants thought that exercise could help manage hip pain, but that the "right" exercises were needed. Participants were generally satisfied with an osteoarthritis explanation because they felt that it was technical and comprehensive. Participants were often dissatisfied with a biopsychosocial explanation of hip pain. They thought that it contradicted their beliefs that hip pain is a problem of degeneration and perceived that it was not personalized to their experiences.

Conclusion: Clinicians should consider explaining to patients that hip osteoarthritis is a dynamic condition (that is, involving ongoing joint changes and joint repair processes) affecting the whole joint rather than framing it as age-related degeneration. However, perceptions of diagnostic information varied considerably between individuals, informing wide-ranging and sometimes unhelpful treatment expectations. It is thus vital to check patients' perceptions of this information (as with teach back) and address any unhelpful treatment beliefs that arise-particularly highlighting the potential benefits of all types of physical activity for hip osteoarthritis and that surgery is not an inevitable intervention for that diagnosis.

Clinical relevance: Using the label "hip osteoarthritis" (explaining osteoarthritis as a dynamic, whole-joint condition) may foster more favorable beliefs about nonsurgical care. Because shifting entrenched beliefs is challenging, clinicians are encouraged to foster accurate beliefs about hip osteoarthritis and its care early in the patient's healthcare journey. They should highlight the potential benefits of all types of physical activity and clarify that surgery is an optional, not inevitable, treatment for hip pain. Personalized education about biopsychosocial contributors to osteoarthritis hip pain (reflecting the patients' narratives and experiences) could enhance patients' openness to strategies that address these factors (such as improving sleep and mental health).