Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness

Abstract

Medical science and other sources, such as the media, increasingly inform the general public’s understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper – based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis – we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs’ use of medical images and models can inform patients’ understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients’ orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively.

Implications for Rehabilitation

• Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease.

• An individual’s understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care.

• Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively.

• Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients’ activity levels and return to social participation.

Keywords:

• Pathophysiology
• pain
• practitioner–patient communication
• patient information
• osteoarthritis

Acknowledgements

The authors would like to thank all participants for giving their time to take part in these studies and the research teams of the original studies from which the data were drawn.

Disclosure statement

The authors declare no conflict of interest. This report is independent research and the views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Additional information

Funding

This work was supported by National Institute for Health Research (NIHR) for Patient Benefit programme (PB-PG-1207–15240), a NIHR Programme Grant for Applied Research Programme (RP-PG-0407–10386), and the Arthritis Research UK Centre in Primary Care grant [18139].