Ching, Angela
(2019)
Factors associated with arthritis self-efficacy in people living with knee osteoarthritis.
PhD thesis, University of Nottingham.
Abstract
Background: People living with knee osteoarthritis (OA) have unrelenting pain and functional limitations and are less likely to self-manage their knee OA through exercise, especially those with activity-related knee pain. Previous research has shown that self-efficacy has a consistent relationship with knee OA symptoms, depression, and physical limitations. Thus, it is important to target the determinants of sub-optimal self-efficacy perceptions, as it could be helpful for people living with knee OA to increase their self-beliefs in successful self-management of arthritis. There is a gap in the literature to investigate the relationship between the different variants of self-efficacy and psychosocial factors, and whether any of these are predictors of arthritis self-efficacy.
Aim: Investigate and explore which self-efficacy and psychosocial factors predict arthritis self-efficacy in people living with knee OA who have experienced participating in an OA-specific education and exercise programme and those who have not.
Methods: Sequential explanatory mixed methods design comprising of an initial quantitative phase followed by a qualitative phase was used. In the quantitative phase, the data was collected through questionnaires to investigate the relationship and predictors of exercise self-efficacy, multidimensional outcomes expectations for exercise, general health status, knee confidence, knee pain perception, depression with arthritis self-efficacy, using multiple linear regression models. In the qualitative phase, semi-structured interviews were used to explore the predictors of arthritis self-efficacy from the patients’ perspectives. Interviews were analysed using Thematic Analysis.
Results: The quantitative analyses identified that knee confidence, female sex, depression, knee pain perception, and exercise self-efficacy were statistically significant predictors of arthritis self-efficacy in people with knee OA who have not had recent experiences of participating in an OA-specific education and exercise programme. The strongest predictor of increased arthritis self-efficacy was higher knee confidence (unstandardized coefficient (β) = 1.037, p= .009). The questionnaire findings from participants who have been involved in an OA-specific education and exercise programme revealed that knee confidence, knee pain perception, general health status, and exercise self-efficacy were predictors of arthritis self-efficacy, again, with high knee confidence being the strongest predictor of increasing arthritis self-efficacy (β= .667, p= .001). The participants from the interviews reflected on the importance of receiving appropriate information on self-management of arthritis, the knowledge of exercises that are safe for their knee and receiving long-term follow-up with their clinician for them to perceive a better sense of successful self-management of arthritis. Similarly, participants with knee OA who had participated in the GLA:D® programme also reflected the importance of maintaining continue contact with their physiotherapist after the programme for support and reassurance that they were still performing their exercises in the correct manner and to help with motivation to maintain the GLA:D® exercises in the long-term. These comments suggested by participants in both studies of this thesis demonstrated components of BCTs which may benefit from inclusion in design of future intervention research aimed at enhancing arthritis self-efficacy in people living with knee OA. These BCTs include “Instruction on How to Perform the Behaviour” and “Demonstration of Behaviour” to gain knowledge on safe exercises and “Verbal Persuasion about Capability” and “Feedback on Outcomes of Behaviour” for regular follow-ups with clinicians.
Conclusion: This thesis has identified factors that can predict low arthritis self-efficacy (i.e. those who have less knee confidence/more incidences of their knee giving way, less self-beliefs in exercise, more depressed, severe knee pain, and being male). Participants perceived that receiving long-term follow-up with their clinician would provide them with reassurance and encouragement to maintain therapeutic exercises in the long-term.
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