The influence of GLA:D® on physical activity in people with knee osteoarthritis: A qualitative exploration

Abstract

Introduction: Knee osteoarthritis impacts 250 million people worldwide. Symptoms (pain/stiffness) are associated with impaired quality of life and activity participation, and reduced physical activity. Exercise-therapy and education programs such as Good Life with osteoArthritis: Denmark (GLA:D®) are associated with improved pain, function, and quality of life. Yet, their influence on physical activity is less well known. This qualitative study aims to explore the influence of GLA:D® on (i) physical activity participation; (ii) perceived capability and readiness to increase physical activity; and (iii) barriers and facilitators for physical activity participation in people with knee osteoarthritis. Methods: This qualitative study was conducted with La Trobe Human Ethics approval (#HEC18500). Semi-structured interviews were conducted with people with knee osteoarthritis following completion of GLA:D®. Guided by the Theoretical Domains Framework, Interview questions were developed by physiotherapy and psychology researchers. Interviews were audio recorded and transcribed verbatim. Data categories were developed using inductive thematic analysis by one researcher and refined with the assistance of two experienced qualitative researchers. Results: Nineteen people who completed GLA:D® (12 female, 7 male) were interviewed. Descriptive analysis revealed four overarching themes. Theme-1: ‘Beliefs about physical activity and exercise-therapy’ which included fear of knee pain and damage with exercise; and varying participation and knowledge/beliefs regarding safety and benefits of exercise and physical activity. Theme-2: ‘Influences on knowledge/beliefs about physical activity and exercise-therapy’ which included varied experiences with health professionals providing education; and online information emphasising surgery/pharmacology and was often confusing. Theme-3: ‘Reported changes in prescribed exercise-therapy and physical activity following GLA:D®’ which included varied physical activity and exercise-therapy engagement. Theme-4: ‘Barriers and facilitators of physical activity’ which included persistent pain, lack of opportunity, lack of motivation and comorbidities; change in knowledge/beliefs, increased confidence, varied motivation, and technology and other supports. Discussion: GLA:D® may address some existing barriers to physical activity in people with knee osteoarthritis including misinformed beliefs about the benefits and harms, and confidence to engage in, occupational and recreational exercise. Varying motivation to change, and actual change, following GLA:D® suggests that additional targeted behavioural interventions beyond exercise-therapy may be required to increase physical activity and exercise participation in people with knee osteoarthritis. Conflict of interest statement: Authors acknowledge that we have no conflicts of interest relevant to the submission of this abstract.