Editor's Spotlight/Take 5: Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study.

Many surgeons dislike or distrust methods-intensive research approaches like meta-analyses [14], and even experienced readers—including seasoned peer reviewers—head for the hills when it takes heavy computing power to grind data into answers [15], as is the case for studies using machine learning. So, let’s take a break this month from all that math, and luxuriate in the glow of some great qualitative research in this month’s Spotlight. Nary a decimal point or p value in sight. Did I hear someone say, “What’s qualitative research?” I’m not surprised. As far as I can recall, we’ve published only two papers [10, 12] in Clinical Orthopaedics and Related Research using qualitative or interview-based methods in the 7 years since I joined the team, and I’ve seen similarly sporadic deployment of these approaches in other leading generalinterest journals of our specialty [6, 8]. That’s too bad. The kinds of quantitative approaches that clinicians (and readers of clinical research) are most familiar with—case series, historically controlled studies, and even randomized trials—can tell us the what and the when, but they fall short on the why and the how. Specifically, they provide little or no insight into why our patients make the decisions they make, and how those patients perceive (and sometimes misunderstand) important facts about their own bodies. Facts that, in principle, their doctors have tried to explain. For these reasons, I’m excited to share a wonderful example of the genre in this month’s CORR from Dr. Jo-Anne Manski-Nankervis’s study group in Melbourne, Australia, which offers a number of penetrating insights into common misperceptions patients have about knee arthritis [2]. The authors, including first author, Samantha Bunzli PhD, performed indepth interviews with more than two dozen patients who were on a surgical waiting list to ascertain patients’ beliefs about what osteoarthritis is, what causes it, what may happen to it if left untreated, and how the condition can best be controlled or managed. The sample size—a question, no doubt, on every reader’s mind who is accustomed to seeing a larger number there—was determined by an a priori analytic approach that resulted in recruitment until no new themes emerged during these conversations. Some of the misunderstandings were staggering. Many patients’ (mis)understandings about the causes of their arthritis, their anticipation of worsening pain with time, and their beliefs about potential harms associated with choosing a non-surgical course, in particular, cannot be substantiated by any interpretation of the evidence on the topic of which I am aware. More importantly, those serious misapprehensions seem A note from the Editor-In-Chief: In “Editor’s Spotlight,” one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present “Take 5,” in which the editor goes behind the discovery with a oneon-one interview with an author of the article featured in “Editor’s Spotlight.” The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This comment refers to the article available at: DOI: 10.1097/CORR.0000000000000784. S. S. Leopold MD (✉), Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19013 USA, Email: sleopold@clinorthop.org