Background/Purpose: An integrated exercise-based rehabilitation programme, Enabling Self-management and Coping with Arthritis knee Pain through Exercise (ESCAPE-knee pain), improves pain and physical disability of people with chronic knee pain. Qualitative interviews were used to understand how and why ESCAPE-knee pain works.

Methods: 29 people involved in the quantitative study evaluating the ESCAPE-knee pain programme, were interviewed before and after participation on the programme. Semi-structured interviews were used to explore participants’ experiences of living with knee pain, their understanding and beliefs about their condition, and management strategies adopted. The same participants were re-interviewed after completing the programme to explore their experiences of the programme, its impact on their beliefs about knee pain and their views about the management of their condition. A thematic analysis was conducted. Interviews were audio taped, transcribed verbatim, read several times by two researchers independently to familiarise themselves with the data, met to identifying themes and agree a coding scheme and resolve differences in coding and interpretation.

Results: Initially people had poor understanding and negative, fatalistic beliefs about the management or prognosis for knee pain. Following the programme the majority of participants had positive experiences, improvement in pain, physical and psychosocial functioning, greater knowledge and understanding of their condition and treatment options, and in their ability to use exercise to control symptoms. Beliefs about the causation and prognosis of knee pain were unchanged, but concerns about possible dangers of exercise decreased. They appreciated how exercise could reduce symptoms (treatment beliefs) and their confidence in their ability to use exercise to control symptoms (exercise self-efficacy) increased. These improvements were attributed to the content and structure of the programme, and the care and guidance of the physiotherapist.

Conclusion: ESCAPE-knee pain improves physical and psychosocial functioning of people with chronic knee pain by increasing people’s treatment belief in safety, the utility of exercise to control symptoms and exercise self-efficacy, rather than alteration in their beliefs about causation or prognosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/doing-is-believing-health-beliefs-before-and-after-an-exercised-based-rehabilitation-programme-for-chronic-knee-pain/