The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis

Background: The pain and disability of hip and knee osteoarthritis can be improved by exercise, but the best method of encouraging this is not known. Aim: To develop an evidence-based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity. Design of study: Systematic review of reviews and guidelines, then focus groups. Setting: Four general practices in North East Wales. Method: Evidence based messages were developed from a systematic review, synthesised into patient centred messages, and then incorporated into a narrative. A draft booklet was examined by three focus groups to improve the phrasing of its messages and discuss its usefulness. The final draft was examined in a fourth focus group. Results: Six evidence based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, whilst moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues. Conclusions: The booklet was readable, credible and useful to end-users. A RCT is planned to test whether it influences beliefs about osteoarthritis and exercise