Toye Francine M, Barlow Julie, Wright Chris, Lamb Sarah E
Department of Physiotherapy, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
Soc Sci Med. 2006 Jul;63(1):43-53. doi: 10.1016/j.socscimed.2005.11.054. Epub 2006 Feb 10.
This study explores patients' personal meanings of knee osteoarthritis (OA) and total knee replacement (TKR). Personal meanings are important because decisions regarding the need for TKR do not seem to be explained by symptoms alone. A total of 18 semi-structured interviews were conducted with a purposive sample of respondents who were listed for TKR at one UK specialist orthopaedic hospital, and who had lower than average disease burden according to standard quantitative criteria. Data were analysed using interpretive phenomenological analysis. Several themes related to need for TKR emerged: adoption of the medical model, a person's social network, pain, functional loss, feelings of vulnerability, dependency, low mood and fatigue, ideas related to disease progression and expectations of TKR. Results suggest that the decision to undergo TKR is not related to symptoms alone, but to personal meanings. Some of these personal meanings may not be useful in accurately assessing the need for TKR, and may result in mis-targeting of treatment. It is important for health professionals to explore and tackle personal meanings when considering treatment. In particular, it may be important to consider gender differences that may influence when men and women are listed for TKR. For example: women may be less likely to discuss treatment options with their doctor; they may be more likely to have heard negative examples of TKR from friends or family; they may be more likely to discuss pain and mobility issues than activities requiring higher function; and they may be more likely to discuss the effect on their mood and the emotional impact of OA.
本研究探讨了患者对膝关节骨关节炎（OA）和全膝关节置换术（TKR）的个人理解。个人理解很重要，因为关于是否需要进行全膝关节置换术的决定似乎不能仅由症状来解释。我们对一家英国专业骨科医院中被列入全膝关节置换术名单、且根据标准定量标准疾病负担低于平均水平的受访者进行了有目的抽样，共进行了18次半结构化访谈。采用解释现象学分析方法对数据进行了分析。出现了几个与全膝关节置换术需求相关的主题：采用医学模式、个人社交网络、疼痛、功能丧失、脆弱感、依赖感、情绪低落和疲劳、与疾病进展相关的想法以及对全膝关节置换术的期望。结果表明，决定接受全膝关节置换术不仅仅与症状有关，还与个人理解有关。其中一些个人理解可能无助于准确评估全膝关节置换术的需求，可能导致治疗目标错误。对于医疗专业人员来说，在考虑治疗时探索和处理个人理解非常重要。特别是，考虑可能影响男性和女性何时被列入全膝关节置换术名单的性别差异可能很重要。例如：女性可能不太愿意与医生讨论治疗方案；她们可能更有可能从朋友或家人那里听说过全膝关节置换术的负面例子；她们可能更愿意讨论疼痛和活动能力问题，而不是需要更高功能的活动；而且她们可能更愿意讨论其情绪影响以及骨关节炎的情感影响。
