Lay models of self-management: how do people manage knee osteoarthritis in context?

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Abstract
Objective: Current NICE guidelines for Osteoarthritis (OA) identify several core self-management recommendations (exercise and weight loss if overweight/obese) to be supported by Healthcare Professionals. Contemporary research stresses that a patient-centred model of self-management that builds upon existing patient action and belief is essential. The lay beliefs regarding self-management for OA have not been explicitly explored previously. Method: Of the participants, 22 people were recruited to undertake in-depth interviews and a diary study. The constant comparative method and narrative methods were utilized to analyse the data. Results: Making adaptations and using strategies to get on with ‘normal’ daily life is as much a part of caring for OA as easing painful symptoms. Moreover, participants ‘normal’ routines ensured that they were able to stay active and keep the knee joint moving. Thus, maintaining everyday social roles and valued activities parallels recommendations from policy and practice. Engaging in exercise is influenced by biography, preferred lifestyle and contextual need. Conclusion: Practitioners and policy need to embrace the complexities of managing chronic OA conditions, by taking onboard the needs and priorities of patients. The findings highlight the disease specific needs of self-management that may be omitted from programmes like the Expert Patients Programme.

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