People’s Beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: a qualitative study / Claire J Robertson, Michael Hurley, Fiona Jones

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Background: A feature of patellofemoral pain is joint crepitus. Several causes of crepitus have been described, but previous research has focused on the pathological meaning of crepitus. No research has demonstrated a definitive link between noise and pathology and its importance and meaning to patients is unresearched.
Objective: To explore the beliefs of patients with non-osteoarthritic patellofemoral pain regarding their crepitus, and how this impacts on their behaviour.
Design: Qualitative design using semi-structured interviews.
Method: A general inductive approach was used as this is a previously unresearched topic. Underpinned by the health beliefs model, an interview schedule was used to reflect different elements. Inductive thematic analysis was used to generate themes to represent the dataset.
Participants were 11 patients diagnosed with non-osteoarthritic patellofemoral pain, crepitus as one of their symptoms, referred to an outpatient clinic.
Results/Findings: Three key themes emerged all with sub-themes within them. Firstly, belief about the noise had a sub-theme of search for and perceived meaning of noise. Symbolising ageing was another sub-theme whereby participants described feelings of premature ageing. The final subtheme was emotional response with participants feeling a range of negative emotions. The second theme of the influence of others reveals participants describing two distinctly different relationships, one with friends and family
and one with professionals. The final theme was avoiding the noise. A subtheme of altering movement shows participants describing fear-avoidant behaviour.
Conclusion: Crepitus is a poorly understood symptom that creates negative emotions, inaccurate etiological beliefs and ultimately leads to altered
behaviour.