Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal ResearchA

The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall

Zoe Paskins, Tom Sanders, Peter R. Croft and Andrew B. Hassell
The Annals of Family Medicine November 2015, 13 (6) 537-544; DOI: https://doi.org/10.1370/afm.1866
Zoe Paskins
1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
MRCP, MMedEd, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: z.paskins@keele.ac.uk
Tom Sanders
2Section of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter R. Croft
1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
MRCGP, MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew B. Hassell
3School of Medicine, Keele University, Staffordshire, United Kingdrom
FRCP, MMedEd, MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    Patient recruitment and selection of index consultations.

    GP = general practitioner; OA = osteoarthritis

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1

    Inclusion and Exclusion Criteria for Selection of Index Consultations

    Inclusion
    GP used terms wear and tear, arthritis, or osteoarthritis diagnostically.
    GP gave no diagnosis, but findings support diagnosis of OA based on criteria recommended by the UK National Institute for Health and Care Excellence (NICE) OA Guideline Development Group18:
     • Persistent joint pain worse with use
     • Patient aged 45 years and over
     • Morning stiffness lasting no more than 30 minutes
    Exclusion
    GP diagnosed a regional soft tissue problem or a generalized soft tissue problem such as fibromyalgia.
    GP gave no diagnosis, but the researcher felt a soft tissue diagnosis to be more likely than OA.
    Inflammatory arthritis (or suspected inflammatory arthritis) was apparent during consultation or present on medical record if the researcher’s clinical suspicion prompted a review of the record.
    Malignancy was apparent during consultation or present on the medical record.
    GP referred the patient to secondary care because of diagnostic uncertainty.
    Patient had only spinal symptoms.
    • GP = general practitioner; OA = osteoarthritis, UK = United Kingdom.

    • View popup
    Table 2

    Characteristics of Patients and Consultations

    Consultation No.Patient Demographics Joint(s) Discussed in Order Presented, Most Symptomatic in BoldaNew Problem or Follow-upbOA-Related Read CodecJoint Pain Primary or Secondary ComplaintdOther Problems Discussed, No.Consultation Length, min
    AgeSexTotalTime on OA (%)
    162FemaleHip, knee, backFollow-upNoPrimary314:1008:46 (61.9)
    265MaleHip, backFollow-upYesSecondary107:0005:56 (84.8)
    375FemaleShoulder, neck, kneeFollow-upYesPrimary016:1416:14 (100)
    469MaleKneeNewYesSecondary212:4401:00 (7.9)
    570MaleKneeFollow-upYesPrimary012:1712:17 (100)
    679MaleNeck, hipNewYesSecondary310:4401:51 (17.2)
    765FemaleKnee, hipNewNoSecondary213:3600:45 (5.5)
    849MaleKneeNewNoSecondary420:2310:72 (54.9)
    967FemaleHipFollow-upYesSecondary106:4001:15 (18.8)
    1075FemaleHip, kneeNewYesSecondary412:1600:50 (6.8)
    1174FemaleKneeFollow-upYesSecondary318:2901:49 (9.8)
    1279FemaleKnees, hipFollow-upYesPrimary008:3608:36 (100)
    1372FemaleKneeFollow-upYesSecondary109:2102:37 (28)
    1465MaleKneeNewNoPrimary210:058:05 (80.2)
    1565FemaleHipNewNoSecondary312:5301:10 (9.1)
    1661FemaleKneeFollow-upYesSecondary208:4906:00 (68.1)
    1784FemaleKneeFollow-upYesSecondary422:4200:25 (1.8)
    1862FemaleHands, feetNewNoPrimary009:4409:44 (100)
    1985FemaleKneeFollow-upYesPrimary120:2020:00 (98.4)
    • OA = osteoarthritis

    • ↵a Spinal pain was not the focus of the study, and patients with spinal pain only were excluded. It is mentioned here where spinal symptoms were discussed in conjunction with peripheral joint OA to illustrate how many patients had multisite pain. Areas of spinal pain listed in this column are italicized.

    • ↵b New in this column indicates that the patient had either not discussed the most symptomatic joint with the GP before (data derived from the medical record and patient report) or that the patient was seeing the GP for results following the first consultation.

    • ↵c Evidence of previous medical record entry of OA in any joint.

    • ↵d Primary complaint is defined as the first presenting complaint mentioned to the GP in the consultation.

    • View popup
    Table 3

    Barriers to Use of the Term Osteoarthritis and the Discussion of Osteoarthritis Identified in This Study

    The predominance of the societal construct of OA that suggests it is part of normal life/aging process
    Omission of OA in the UK government-led quality of care initiative
    Limited or uneven access to treatment resources such as physical therapy
    Lack of knowledge about the prognosis of OA
    Lack of clear language for positive diagnosis and explanation of OA
    Inconsistent interpretation of language in radiology reports
    Concern that diagnosis may result in harm or adoption of “sick role”
    • OA = Osteoarthritis; UK = United Kingdom

Additional Files

  • Figures
  • Tables
  • Supplemental Appendix

    Supplemental Appendix. Quotations to illustrate themes

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file
  • The Article in Brief

    The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall

    Zoe Paskins , and colleagues

    Background Both patients and physicians report dissatisfaction with primary care visits relating to osteoarthritis (OA), the most common cause of musculoskeletal pain in older adults. This study aims to identify how to improve care delivery for OA by investigating the language, explanations, and exchanges that occur in these visits. It does so by observing 19 real-life OA visits and interviewing physicians and patients using video-stimulated recall.

    What This Study Found There is confusion between patients and doctors about what OA is and its priority among patients' multiple medical conditions. There is little OA-related discussion during patient visits and minimal provision of information. Doctors frequently normalize symptoms of OA as part of life and reassure patients who are not seeking reassurance.

    Implications

    • The authors call for addressing OA's identity crisis by developing a clearer medical language with which to explain the condition in the primary care visit.
  • Annals Journal Club

    Nov/Dec 2015: The Identity Crisis of Osteoarthritis


    The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1

    HOW IT WORKS

    In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.

    CURRENT SELECTION

    Article for Discussion

    Paskins Z, Sanders T, Croft P, Hassell A. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13(6):537-544..

    Discussion Tips

    Rarely do we get a chance to reflect on both the patient and the clinician perspective on the care we provide. This study uses videotapes of visits between patients and their general practice physicians to stimulate interpretations from both parties, and then carefully draws the cross-cutting lessons.

    Discussion Questions

    • What question is asked by this study and why does it matter?
    • How does this study advance beyond previous research and clinical practice on this topic?
    • How strong is the study design for answering the question?
    • To what degree can the findings be accounted for by:
      1. How participants were selected?
      2. Saturation (additional sampling doesn't yield substantial new information)?
      3. How the data were analyzed?
      4. How the findings were interpreted?
    • What are the main study findings? What general and osteoarthritis-specific communication issues are identified?
    • How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
    • What contextual factors are important for interpreting the findings?
    • How might this study change your practice? Policy? Education? Research?
    • Who are the constituencies for the findings, and how might they might be engaged in interpreting or using the findings?
    • What are the next steps in interpreting or applying the findings?
    • What researchable questions remain?

    References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.

PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 13 (6)
The Annals of Family Medicine: 13 (6)
Vol. 13, Issue 6
November/December 2015
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall
Zoe Paskins, Tom Sanders, Peter R. Croft, Andrew B. Hassell
The Annals of Family Medicine Nov 2015, 13 (6) 537-544; DOI: 10.1370/afm.1866

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall
Zoe Paskins, Tom Sanders, Peter R. Croft, Andrew B. Hassell
The Annals of Family Medicine Nov 2015, 13 (6) 537-544; DOI: 10.1370/afm.1866
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Barriers and enablers to the management of osteoarthritis in primary care in Ireland from the perspective of healthcare professionals and individuals with osteoarthritis: a qualitative study using the Theoretical Domains Framework
  • Improving osteoarthritis care in family practice
  • "It ... doesnt always make it [to] the top of the list": Primary care physicians experiences with prescribing exercise for knee osteoarthritis
  • Patterns of routine primary care for osteoarthritis in the UK: a cross-sectional electronic health records study
  • In This Issue: Multilevel Effects
  • The Identity Crisis of Osteoarthritis
  • Google Scholar

More in this TOC Section

  • Performance-Based Reimbursement, Illegitimate Tasks, Moral Distress, and Quality Care in Primary Care: A Mediation Model of Longitudinal Data
  • Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease
  • Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Older adults
  • Methods:
    • Qualitative methods
  • Core values of primary care:
    • Coordination / integration of care
  • Other topics:
    • Communication / decision making

Keywords

  • osteoarthritis
  • arthralgia
  • primary care
  • clinic visits
  • physician-patient relations
  • multiple morbidities
  • diagnosis
  • prognosis

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine