Quality of Life Research

, Volume 24, Issue 10, pp 2423–2432 | Cite as

The concept of physical limitations in knee osteoarthritis: as viewed by patients and health professionals

  • Louise KlokkerEmail author
  • Richard Osborne
  • Eva E. Wæhrens
  • Ole Norgaard
  • Elisabeth Bandak
  • Henning Bliddal
  • Marius Henriksen



To comprehensively identify components of the physical limitation concept in knee osteoarthritis (OA) and to rate the clinical importance of these using perspectives of both patients and health professionals.


Concept mapping, a structured group process, was used to identify and organize data in focus groups (patients) and via a global web-based survey (professionals). Ideas were elicited through a nominal group technique and then organized using multidimensional scaling, cluster analysis, participant validation, rating of clinical importance, and thematic analyses to generate a conceptual model of physical limitations in knee OA.


Fifteen Danish patients and 200 international professionals contributed to generating the conceptual model. Five clusters emerged: ‘Limitations/physical deficits’; ‘Everyday hurdles’; ‘You’re not the person you used to be’; ‘Need to adjust way of living’; and ‘External limitations,’ each with sub-clusters. Patients generally found their limitations more important than the professionals did.


Patients and professionals agreed largely on the physical limitation concept in knee OA. Some limitations of high importance to patients were lower rated by the professionals, highlighting the importance of including patients when conceptualizing patient outcomes. These data offer new knowledge to guide selection of clinically relevant outcomes and development of outcome measures in knee OA.


Knee OA Physical limitations Patient perspective Concept mapping 



We would like to thank the patients and health professionals who participated in this study. This study was supported by grants from The Oak Foundation, The Danish Physiotherapy Association, and The Danish Rheumatism Association. Financial support was provided from The Parker Institute and Deakin University.

Conflict of interest

The authors declare that they have no conflict of interests that could influence their work and conclusions in relation to this manuscript.

Informed consent

Informed consent was obtained from all individual patients included in the study.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Rheumatology, The Parker InstituteCopenhagen University Hospital, Bispebjerg and FrederiksbergFrederiksberg, CopenhagenDenmark
  2. 2.Population Health Strategic Research Centre, School of Health and Social Development, Faculty of HealthDeakin UniversityBurwoodAustralia
  3. 3.The Research Initiative for Activity Studies and Occupational Therapy, Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
  4. 4.Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark

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