Illness perceptions of people with hand problems : a population survey and focus group enquiry
Osteoarthritis (OA) is common in older people. The impact of lower limb OA is
well characterised, but little is known about hand OA. Illness perceptions are
known to influence health outcomes.
The aim of this thesis was to investigate illness perceptions in older people with
hand problems and their associations with outcome, and to investigate the impact
of hand problems on the individual.
Following a pilot reliability study a cross-sectional postal general health survey
was undertaken in three general practices involving people age ~50. In those who
responded with hand problems/pain a hand questionnaire was mailed, including
measures of illness perceptions (IPO-R), hand function, pain and medication use
(AIMS2), psychological morbidity (HADS) and consultation. Data were analysed
using logistic regression.
A second study conducted semi-structured interviews (n=29) and focus groups
(n=4) in primary and secondary care patients with a clinical diagnosis of hand OA.
Data were analysed using content and thematic analysis.
There was a 78.5 percent adjusted response rate with 2,113 people classified with
hand problems/pain (62.8 percent female, mean age 65.4 (SO 9.6)). Pain/ache
was the most commonly reported symptom (77.9 percent) and age perceived to be
the most common cause (71.4 percent). The most consistent and strongest
relationships with outcomes were consequences and identity (IPO-R), and
frustration.The qualitative findings described impact in terms of disruption of everyday tasks
and frustration. Hand OA patients described beliefs concerning treatment efficacy
in reducing symptoms that were weighed against actual or perceived side-effects.
Patients described a lack of understanding amongst health professionals
regarding hand OA and its impact on life, and that treatment needs were not
Illness perceptions can be measured using the IPQ-R in a general population of
older people with hand problems. Patients with hand OA described the frustration
and disruption that OA brings, and the lack of treatment available. Targeting
illness perceptions as part of an intervention package may improve outcome.