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International Journal of Behavioral Medicine

, Volume 25, Issue 2, pp 198–206 | Cite as

Treatment Beliefs Underlying Intended Treatment Choices in Knee and Hip Osteoarthritis

  • Ellen M. H. Selten
  • Rinie Geenen
  • Henk J. Schers
  • Frank H. J. van den Hoogen
  • Roelien G. van der Meulen-Dilling
  • Willemijn H. van der Laan
  • Marc W. Nijhof
  • Cornelia H. M. van den Ende
  • Johanna E. Vriezekolk
Article

Abstract

Purpose

Patients’ beliefs about treatment modalities for knee and hip osteoarthritis (OA) will underlie their treatment choices. Based on the Theory of Planned Behavior, it is hypothesized that patients’ beliefs, subjective norm, and perceived behavioral control guide their treatment choices. Also, symptom severity and one’s inherent tendency to approach or avoid situations are assumed to play a role. The objective of this study was to test whether these variables were associated with intended treatment choices in knee and hip OA.

Methods

Patients with knee and hip OA were randomly selected from hospital patient records. They completed the Treatment beliefs in OsteoArthritis questionnaire to assess positive and negative treatment beliefs regarding five treatment modalities: physical activities, pain medication, physiotherapy, injections, and arthroplasty. Other measures were intention, subjective norm, perceived behavioral control (ASES), symptom severity (WOMAC), and the person’s general tendency to approach or avoid situations (RR/BIS scales). Three models were tested using path analyses to examine the hypothesized associations.

Results

Participants were 289 patients. Positive treatment beliefs and subjective norm were consistently associated with intended treatment choice across all treatment modalities. Negative treatment beliefs were associated with intended treatment choices for pain medication and arthroplasty. Other associations were not significant.

Conclusions

This is the first study testing the Theory of Planned Behavior in the context of treatment choices in OA. Findings suggest that foremost positive beliefs about treatment modalities and the norms of one’s social environment guide a specific treatment choice. Unexpectedly, symptom severity was not related to intended treatment choices.

Keywords

Beliefs Decision-making Hip Knee Osteoarthritis Treatment 

Notes

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

All participants provided informed consent.

References

  1. 1.
    Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–35.CrossRefPubMedGoogle Scholar
  2. 2.
    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–88.CrossRefPubMedGoogle Scholar
  3. 3.
    Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16:137–62.CrossRefPubMedGoogle Scholar
  4. 4.
    McHugh GA, Luker KA, Campbell M, Kay PR, Silman AJ: A longitudinal study exploring pain control, treatment and service provision for individuals with end-stage lower limb osteoarthritis. Rheumatology (Oxford). 2007; 46: 631–637.Google Scholar
  5. 5.
    Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. “Beating osteoARThritis”: development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol. 2011;30:1623–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Snijders GF, den Broeder AA, van Riel PL, Straten VH, de Man FH, van den Hoogen FH, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Ajzen I. The Theory of Planned .Behavior. Organ Behav Hum Decis Process. 1991;50:179–211.CrossRefGoogle Scholar
  8. 8.
    O'Neill T, Jinks C, Ong BN. Decision-making regarding total knee replacement surgery: a qualitative meta-synthesis. BMC Health Serv Res. 2007;7:52.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Selten EM, Vriezekolk JE, Geenen R, Van der Laan WH, van der Meulen-Dilling RG, Nijhof MW et al.: Reasons for treatment choices in knee and hip osteoarthritis: a qualitative study. Arthritis Care Res (Hoboken) 2016; 68: 1260–1267.Google Scholar
  10. 10.
    Smith TO, Purdy R, Lister S, Salter C, Fleetcroft R, Conaghan PG. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography. Rheumatol Int. 2014;34:299–313.CrossRefPubMedGoogle Scholar
  11. 11.
    Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Godin G, Kok G. The Theory of Planned Behavior: a review of its applications to health-related behaviors. Am J Health Promot. 1996;11:87–98.CrossRefPubMedGoogle Scholar
  13. 13.
    Hagger MS, Chan DK, Protogerou C, Chatzisarantis NL. Using meta-analytic path analysis to test theoretical predictions in health behavior: an illustration based on meta-analyses of the theory of planned behavior. Prev Med. 2016;89:154–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Rich A, Brandes K, Mullan B, Hagger MS. Theory of planned behavior and adherence in chronic illness: a meta-analysis. J Behav Med. 2015;38:673–88.CrossRefPubMedGoogle Scholar
  15. 15.
    Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Hoogeboom TJ, Snijders GF, Cats HA, de Bie RA, Bierma-Zeinstra SM, van den Hoogen FH, et al. Prevalence and predictors of health care use in patients with early hip or knee osteoarthritis: two-year follow-up data from the CHECK cohort. Osteoarthr Cartil. 2012;20:525–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Smink AJ, Dekker J, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW et al.: Health care use of patients with osteoarthritis of the hip or knee after implementation of a stepped-care strategy: an observational study. Arthritis Care Res (Hoboken). 2014; 66: 817–827.Google Scholar
  18. 18.
    Carver CS, White TL. Behavioral Inhibition, Behavioral Activation, and affective responses to impending reward and punishment: the BIS/BAS scales. J Pers Soc Psychol. 1994;67:319–33.CrossRefGoogle Scholar
  19. 19.
    Gray JA. The psychophysiological basis of introversion-extraversion. Behav Res Ther. 1970;8:249–66.CrossRefPubMedGoogle Scholar
  20. 20.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–49.CrossRefPubMedGoogle Scholar
  21. 21.
    Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Dawes J. Do data characteristics change according to the number of scale points used? An experiment using 5-point, 7-point and 10-point scales. Int J Mark Res. 2008;50:61–77.CrossRefGoogle Scholar
  23. 23.
    Ajzen I. Constructing a TpB questionnaire: conceptual and methodological considerations. 2002.Google Scholar
  24. 24.
    Francis J, Eccles MP, Johnston M, Walker A, Grimshaw JM, Foy R et al.. Constructing questionnaires based on the theory of planned behaviour: a manual for health services researchers. Edited by Centre for Health Services Research. 2004. Newcastle upon Tyne, UK, University of Newcastle upon Tyne.Google Scholar
  25. 25.
    Taal E, Riemsma RP, Brus HL, Seydel ER, Rasker JJ, Wiegman O. Group education for patients with rheumatoid arthritis. Patient Educ Couns. 1993;20:177–87.CrossRefPubMedGoogle Scholar
  26. 26.
    Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32:37–44.CrossRefPubMedGoogle Scholar
  27. 27.
    Brand E, Nyland J, Henzman C, McGinnis M. Arthritis self-efficacy scale scores in knee osteoarthritis: a systematic review and meta-analysis comparing arthritis self-management education with or without exercise. J Orthop Sports Phys Ther. 2013;43:895–910.CrossRefPubMedGoogle Scholar
  28. 28.
    Knowles SR, Nelson EA, Castle DJ, Salzberg MR, Choong PF, Dowsey MM: Using the common sense model of illness to examine interrelationships between symptom severity and health outcomes in end-stage osteoarthritis patients. Rheumatology (Oxford). 2016.Google Scholar
  29. 29.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–40.PubMedGoogle Scholar
  30. 30.
    Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, et al. Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis. 2004;63:36–42.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Van den Berg I, Franken IH, Muris P. A new scale for measuring reward responsiveness. Front Psychol. 2010;1:239.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Franken IHA, Muris P, Rassin E. Psychometric properties of the Dutch BIS/BAS scales. Jounral of Psychopathology and Behavioral Assessment. 2005;27Google Scholar
  33. 33.
    Acock AC. Discovering structural equation modeling using Stata, revised edition 2013 edn. College Station, Texas: Stata Press; 2013.Google Scholar
  34. 34.
    Hooper D, Coughlan J, Mullen MR. Structural equation modelling: guidelines for determining model fit. The Electronic Journal of Business Research Methods. 2008;6:53–60.Google Scholar
  35. 35.
    De Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine, 1st ed. Edn. New York: Cambridge University Press; 2011.CrossRefGoogle Scholar
  36. 36.
    Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53–5.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Streiner DL. Finding our way: an introduction to path analysis. Can J Psychiatr. 2005;50:115–22.CrossRefGoogle Scholar
  38. 38.
    Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, et al. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016–22.CrossRefPubMedGoogle Scholar
  39. 39.
    Pellino TA. Relationships between patient attitudes, subjective norms, perceived control, and analgesic use following elective orthopedic surgery. Res Nurs Health. 1997;20:97–105.CrossRefPubMedGoogle Scholar
  40. 40.
    Pineles LL, Parente R. Using the theory of planned behavior to predict self-medication with over-the-counter analgesics. J Health Psychol. 2013;18:1540–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Ferreira G, Pereira MG. Physical activity: the importance of the extended theory of planned behavior, in type 2 diabetes patients. J Health Psychol. 2016;Google Scholar
  42. 42.
    Keats MR, Culos-Reed SN, Courneya KS, McBride M. Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior. Psychooncology. 2007;16:448–57.CrossRefPubMedGoogle Scholar
  43. 43.
    Mitchell HL, Carr AJ, Scott DL: The management of knee pain in primary care: factors associated with consulting the GP and referrals to secondary care.Rheumatology (Oxford). 2006; 45: 771–776.Google Scholar
  44. 44.
    Rosemann T, Joos S, Szecsenyi J, Laux G, Wensing M. Health service utilization patterns of primary care patients with osteoarthritis. BMC Health Serv Res. 2007;7:169.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Ellen M. H. Selten
    • 1
  • Rinie Geenen
    • 2
  • Henk J. Schers
    • 3
  • Frank H. J. van den Hoogen
    • 1
    • 4
  • Roelien G. van der Meulen-Dilling
    • 5
  • Willemijn H. van der Laan
    • 6
  • Marc W. Nijhof
    • 7
  • Cornelia H. M. van den Ende
    • 1
  • Johanna E. Vriezekolk
    • 1
  1. 1.Department of RheumatologySint MaartenskliniekNijmegenThe Netherlands
  2. 2.Department of PsychologyUtrecht UniversityUtrechtThe Netherlands
  3. 3.Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
  4. 4.Department of RheumatologyRadboud University Medical CenterNijmegenThe Netherlands
  5. 5.Physical Therapy and Manual Therapy Partnership VelperwegArnhemThe Netherlands
  6. 6.Department of RheumatologySint MaartenskliniekWoerdenThe Netherlands
  7. 7.Department of OrthopedicsSint MaartenskliniekNijmegenThe Netherlands

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