75. How do GPs Explain Chronic Knee Pain in Older Adults? Preliminary Results from a National Pilot GP Questionnaire Survey

Abstract

Background: Chronic knee pain (CKP) in older adults is generally synonymous in primary care with clinical knee OA. Although, traditionally, a colloquial term for OA has been wear and tear, current understanding of the pathological processes occurring in OA recognizes this description to be inaccurate and simplistic. The NICE OA Guideline describes OA as a metabolically active repair process, which is not caused by ageing and does not necessarily deteriorate. Arthritis Research UK suggest that the terms tear, flare and repair or wear and repair may better represent the underlying pathology. This pilot study utilized a patient case vignette in a national survey to establish the terms GPs use to explain CKP in older adults. Methods: A cross-sectional survey was posted to 800 UK GPs. A vignette described an obese patient, presenting for the first time with CKP. GPs were asked to report the diagnosis(es) they would give to the patient at that point and how they would describe the diagnosis(es) to the patient. Questionnaire responses were categorized. Descriptive analyses were undertaken to explore the frequency of use of different terms and concepts. Results: 172 (22%) GPs responded. 171 GPs responded to the diagnosis question: 20 (12%) provided more than one response. Of the diagnoses proffered, the most frequent was a medical label such as degenerative joint disease, arthritis or OA (n=146, 85%), second was the lay label wear and tear (n=17, 10%), and other diagnoses included patellofemoral or anterior knee pain (n=6, 4%), obesity (n=6, 4%), CKP (n=2, 1%) and wear and repair (n=1, 1%). 82 GPs detailed the descriptions they would give to the patient. These descriptions were broadly classified into underlying processes causing pain (n=74, 90%), factors associated with the diagnosis such as age, weight and occupation (n=35, 43%), structures involved (n=20, 24%), stage of the disease (n=7, 9%), extent of the underlying pathology (n=6, 7%) (un)certainty of the diagnosis (n=9, 11%) and other explanations (n=2, 2%). Most (n=63, 77%) descriptions included the term wear and tear. Conclusion: The majority of GPs responding to this survey used a medical term to give the diagnosis, but when describing their diagnosis to a patient with CKP most used the term wear and tear, and not terms describing the true nature of OA. Potential negative consequences of this term may be a reduced use of exercise: that the wear and tear will worsen with exercise. A better understanding of what GPs mean by, and reason for on-going use of the phrase wear and tear, could help to identify ways to reduce its use in everyday practice and to encourage GPs to explain the condition in terms more in keeping with the underlying pathophysiology.