72
Views
2
CrossRef citations to date
0
Altmetric
Original Research

Australians with osteoarthritis: satisfaction with health care providers and the perceived helpfulness of treatments and information sources

, , , &
Pages 387-394 | Published online: 22 Aug 2016

Abstract

Objective

The aim of this study was to evaluate the satisfaction of Australian patients who suffer from osteoarthritis (OA) with their health care providers and the perceived helpfulness of treatments and information sources.

Methods

A self-administered questionnaire was conducted with a sample of 560 Australian patients who suffer from OA with questions about satisfaction with health care providers and the helpfulness of different treatment options and information sources. Logistic regression models were used to assess potential predictors of satisfaction. Thematic analysis was undertaken for attitudinal factors associated with satisfaction.

Results

A total of 435 participants returned questionnaires (response rate 78%). Most respondents were highly satisfied with the care provided by their general practitioner (GP) (84%), communication with their GP (88%), time spent with their GP (84%), and their ability to talk freely with their GP about their medical problem (93%), but less satisfied with their ability to talk freely about associated emotional problems (77%). Satisfaction with pharmacists (80%), rheumatologists (76%), and orthopedic surgeons (72%) was high. Joint replacement surgery (91%), prescription anti-inflammatory medications (66%), aids and assistive devices (65%), intra-articular injections (63%), and prescription painkiller medications (62%) were perceived as effective treatments. Less highly rated treatments were exercise (48%), physiotherapy (43%), and complementary medicines (29%). A majority of patients were satisfied with the information to manage their OA (65%). From the multivariable logistic regression analysis, four GP satisfaction factors were found to be predictors of overall satisfaction with GP care: the amount of time that the GP spends with the patient (P=0.005), the information the GP provides about what to expect (P<0.001), the communication between patient and GP (P=0.001), and the information that the GP provides about medications (P=0.042).

Conclusion

The study showed that although patients with OA were generally satisfied with their health care providers, there was notable variation in the perceived helpfulness of therapeutic options. The importance to patients of having access to good quality information about their condition was emphasized.

Introduction

Health care that is responsive to individual patient preferences, needs, and values is now the dominant paradigm in health service delivery.Citation1 Within this framework, patient satisfaction has emerged as a key indicator of the quality of health care. Donabedian regards patient satisfaction as a “patient’s judgement on the quality of care in all its aspects, but particularly as concerns the interpersonal process”.Citation2 Satisfied patients are more likely to benefit from their health care and have improved quality of life.Citation3 Satisfaction with care has particular relevance to chronic conditions, such as osteoarthritis (OA), which are largely self-managed, and where adherence to recommended treatments is critical for successful health outcomes.Citation4

OA is a highly prevalent and costly condition, causing pain and disability for 1.9 million Australians.Citation5 Approximately half the population aged over 65 years have radiological evidence of OA, and it is expected that the prevalence of this condition will increase as the population ages and becomes increasingly obese.Citation6 While OA is incurable, there is a range of therapeutic options for symptomatic relief, including pharmacological and nonpharmacological treatments.

For many patients, however, effective interventions appear not to have been adopted. Many factors have been proposed as contributing to nonadherence, including a patient’s personal characteristics,Citation7 social factors,Citation8 the doctor–patient relationship,Citation9 and cognitive factors, including beliefs, attitudes, and perceptions.Citation10 Yet, there have been few studies in Australia that have investigated patients’ views about the management of their OA.

The aim of this study was to evaluate in Australian patients with OA their satisfaction with their health care providers, the determinants of that satisfaction, and the perceived helpfulness of treatments and information sources. An understanding of these perceptions may provide an insight into aspects of care that could be targeted for intervention with the objective of improving OA care.

Methods

Recruitment

A survey was conducted of 560 participants (293 in New South Wales, 267 in South Australia) who self-identified as having OA. These participants were sourced from the Care-Track Australia (CTA) study.Citation11 The CTA was a study conducted in 2009–2010 to assess the appropriateness of health care delivery in Australia. The study examined compliance with quality indicators for 22 common conditions, including OA, in a population-based sample. The quality indicators were taken from a previous US studyCitation12 and other sources, and modified after review by expert panels. For recruitment into the CTA study, residential telephone numbers in selected areas in New South Wales and South Australia were randomly selected from the online White Pages. Trained staff then conducted computer-assisted telephone interviews to recruit participants and obtain the required information. Full details of the recruitment method have been described elsewhere.Citation13

Survey instrument

A 19-page self-administered questionnaire comprising three parts was developed (see Supplementary material). A full description of the development and contents of the questionnaire has been previously published;Citation13 however, in brief, the first section was based on Stanford University’s Health Assessment Questionnaire,Citation14 the second section on the Patient Knowledge Questionnaire for Osteoarthritis,Citation15 and the final section explored the participants’ attitudes toward OA and its management. The questionnaire items for this latter section were developed by the authors and assessed for validity by sending the questionnaire to three experts in the field of OA who were asked to judge each question for validity. Reliability of the questions was assessed using a test–retest study. Responses to this final section formed the basis of this paper. Here, participants were given options to respond to yes/no questions, open-ended text, and 5-, 6-, and 10-point Likert scales about satisfaction with aspects of their general practitioner (GP) care, helpfulness of other health professionals in dealing with their OA, effectiveness of different treatment options, including complementary and alternative medicine (CAM), and knowledge and satisfaction with sources of information to manage OA.

Statistical considerations and analysis

The sample size was predetermined as this study was part of CTA. The total number of 435 respondents was sufficient to provide prevalence estimates to, at worst, ±5% accuracy with 95% confidence.

Initial analysis indicated that the majority of patients were satisfied or very satisfied with their GP, and so the question was dichotomized to 1= satisfied or very satisfied, or 0= not satisfied. Logistic regression models were used to assess a number of potential predictors of satisfaction. These included age, sex, level of education, and a number of GP-related questions, which can be found in . Those variables found to predict satisfaction at the P≤0.05 level were then entered into a multivariable model using backwards elimination. Descriptive results provided in are shown as percentages with 95% confidence intervals (CIs). All statistical analyses were undertaken using the Statistical Package for Social Scientists, version 21 (IBM Corporation, Armonk, NY, USA).

Table 1 Univariate and multivariate predictors of satisfaction with GP care

Table 2 Respondent satisfaction with other health professionals

Table 4 Helpfulness of information sources

Simple thematic analysis was applied to the open-ended responses to further illuminate factors related to respondent satisfaction with their health care provider and treatment and information sources, and a number of relevant quotations from this source were included in the results.

Ethical considerations

The study was approved by the Human Research Ethics Committee of the University of South Australia. All participants provided written informed consent.

Results

Study population

A total of 435 questionnaires were returned out of 560 sent, representing a response rate of 78%. The mean (standard deviation) age of the patients was 69 (10) years, and 308/435 (71%) were female. Approximately half the respondents (208/432; 48%) had some form of tertiary education, and the majority (309/435; 71%) was retired from the workforce.

Respondent satisfaction with their GP in managing their OA

In general, respondents were highly satisfied with the level of care provided by their GPs, with 356/426 (84%, 95% CI 80%–87%) reporting that they were satisfied or very satisfied. Similarly, 373/426 (88%, 95% CI 84%–90%) of respondents stated that they were satisfied or very satisfied with the communication with their GP. Eighty-four percent of respondents were highly satisfied with the time spent with their GPs and 93% reported high satisfaction with their ability to talk freely to their GP about their medical problems.

Respondents were slightly less satisfied with their ability to talk freely to their GPs about any emotional problems associated with their condition, with 325/423 (77%, 95% CI 73%–81%) stating that they were either satisfied or very satisfied with this aspect. The tendency of GPs to trivialize OA was the source of some frustration. A typical comment was “I dislike his tendency to put new symptoms down to getting older.” [Female, 50 years old]

Respondents were asked to rate the information provided to them by their GP. Responses were generally positive, with the proportion satisfied or very satisfied being 360/425 (85%, 95% CI 81%–88%) for information about their condition; 337/426 (79%, 95% CI 75%–83%) for information about their prognosis; and 368/427 (86%, 95% CI 83%–87%) for information about their medications.

We explored those factors associated with participants being satisfied or very satisfied with their GP care, and the results are presented in .

In the univariate model, patients who were older and, not unexpectedly, those who were satisfied with each component of GP care were more likely to express overall satisfaction with care. When all statistically significant variables from the univariate model were entered into the multivariable model, four GP satisfaction factors remained: the amount of time that the GP spends with the patient (P=0.005), the information the GP provides about what to expect (P<0.001), the communication between patient and GP (P=0.001), and the information that the GP provides about medications (P=0.042). Nagelkerke’s R-squared for the multivariable model was 0.734.

Notably, adherence with GP advice was extremely high with 408/425 (96%, 95% CI 94%–98%) of respondents always or usually following the guidance given. Where the GP’s advice was not followed, it was often related to anxiety about taking medications. In some instances, the condition itself limited adherence with GP advice: “I can’t do much exercise, my legs and my neck hurt too much”. [Female, 64 years old]

Respondent satisfaction with other health professionals

Respondents were asked to rate how helpful other health professionals were in dealing with their OA (). Satisfaction ratings for these other professionals rated less than that for their GP. The highest ranked professionals, with responses of either “very helpful” or “extremely helpful”, were pharmacists, rheumatologists, and orthopedic surgeons, while satisfaction ratings of less than 60% were reported for physiotherapists, occupational therapists, and dieticians.

Helpfulness of OA treatment

Of the common treatments for reducing pain and disability associated with OA, the most helpful (ratings of “helpful” and “extremely helpful”) were joint replacement surgery and prescription anti-inflammatory medications (). The least helpful therapies reported were weight loss, complementary medicines, and topical creams.

Table 3 Helpfulness of OA treatments

Some respondents expressed concern about the potential adverse effects of drugs with comments, such as the following, from a patient regarding non-steroidal anti-inflammatory drugs [NSAIDs]):

My GP prescribed Mobic (meloxicam) which I took daily. It helped quite a bit, but in retrospect I realized that I shouldn’t have taken it every day for two years. I became very ill with a bleeding stomach ulcer which went undiagnosed for several months despite 5 or 6 visits to 2 separate doctors. [Female, 66 years old]

Information sources

A majority of respondents were satisfied with the information to manage their OA, with 65% (274/420; 95% CI 61%–70%) reporting high overall satisfaction (“very satisfied” or “satisfied”). Ratings for the information sources that helped them to manage their condition were high for health professionals with responses of “helped a bit” to “extremely helpful” for GPs, rheumatologists, physiotherapists, and/or occupational therapists, podiatrists, and other health professionals (). Family and/or friends were also considered a helpful source of information.

Only a very small number of respondents reported using OA support groups. Several respondents expressed a lack of awareness about support services. Newspapers, magazines and books, and the Internet were helpful for most respondents, while television was the least helpful information source.

Despite general satisfaction with available sources of information, respondents still expressed a need for further material on their condition, with a considerable number wanting to know more about proven treatments. Many respondents expressed despondency about the inaccessibility of reliable information:

I do not know what is available and what information is worth taking notice of or is just rubbish or not scientifically accredited and can be more dangerous than helpful. [Female, 61 years]

Others found the format confusing.

A recurring theme for respondents was their concern about the adverse impact of medications and the need to know more about them, with comments, such as:

I find NSAIDs very helpful, but I do worry about long-term side effects. My husband was hospitalised a few years ago with a duodenal ulcer from taking Voltaren (diclofenac). He needed several blood transfusions because of internal bleeding and has now been advised to never again take anti-inflammatory medication. [Female, 64 years old]

Discussion

Most respondents were highly satisfied with the care provided by their GP, but less so with that provided by allied health professionals. The main predictors of satisfaction with their GP were the time spent with the patient, information provided about what to expect, communication with the patient, and information about medications. The treatment considered to be most helpful was joint replacement surgery. The GP, other health professionals, and the Internet were perceived as the most helpful sources of information.

OA is common and may cause considerable pain, discomfort, and disability. As it cannot be cured, optimizing the available treatments is important. This study sought to better understand patient satisfaction with their care provider and the management of their condition.

Satisfaction with GPs and other health care providers

GPs are the primary providers of care for patients with OA and so it is important that patient satisfaction is measured and evaluated as this has been linked to improved adherence to clinical recommendations, continuity of care, and clinical outcomes.Citation4 Despite this, little has been known about satisfaction with GP care for OA in Australia, as most studies have focused on satisfaction with primary care in general.Citation16Citation18 The mostly high patient satisfaction ratings reported in our study are consistent with more general research concerning primary care.

As reported elsewhere,Citation16 we found that patient satisfaction increased with the amount of time spent with their GP. While relieving the time pressures that many Australian GPs experienceCitation19 may not be a viable option, the recent recommendation made by Arthritis Australia in support of specialist OA practice nurses warrants further exploration,Citation20 as they are the health care professionals most likely to provide self-management support for patients with chronic disease.Citation21

The effectiveness of communication between GP and patient and the information provided by GPs about what to expect were shown in our study to be significant predictors of overall patient satisfaction. Numerous other studies of primary care have made similar findings.Citation22Citation24 The educational need for enhanced GP skills in lifestyle counseling for patients with OA, identified as an issue for Australian GPs over 10 years ago,Citation25 still needs to be addressed.

Although our study found that nearly all patients reported following the advice given by their GP, it is plausible that the actual rate of adherence may be lower than the rate reported. Other studies have suggested nonadherence among patients with OA represents an important and widespread issue,Citation26,Citation27 and it is possible that respondents to our survey understated their actual behavior.

Helpfulness of OA treatment

Several studies have investigated patient satisfaction with treatments for OA with consistently high satisfaction being reported for joint replacement surgery and prescribed medications. Given that an estimated 80%–90% experience pain relief and functional improvement with joint replacement surgery,Citation28 it is not surprising that this intervention was also rated highly by over 90% of our study participants. Other studies have reported similar satisfaction ratings.Citation29,Citation30

Our finding that nearly two-thirds of patients perceived prescription analgesics and prescription anti-inflammatories to be effective was similar to other studies that reported 50%–70% satisfaction with these medications.Citation30,Citation31 Many respondents expressed an awareness of the risks associated with NSAID use, but for some, as has been suggested by other authors, their potential seriousness may be underestimated.Citation32

Less than half the respondents considered over-the-counter medications, such as paracetamol (acetaminophen) and some NSAIDs, to be very or extremely helpful. Despite their accepted efficacy, patients may have viewed them as less credible, as they were not medically prescribed.Citation33 It has also been reported that patients are not always aware of the place that long-term regular paracetamol plays in the management of OA.Citation34 This was also reflected in our study, so better patient education by their GPs may be warranted. Intra-articular injections can provide rapid short-term relief of OA; however, not all GPs offer this treatment, possibly due to time limitations and/or having not been exposed to this approach during their medical training.

The finding that only 43% of respondents found physiotherapy helpful contrasted with other studies of satisfaction with physiotherapy for musculoskeletal conditions.Citation35,Citation36 It has been reported elsewhere that patients appear to evaluate care and outcome separately and for many, satisfaction with outcome is more important.Citation37 If this is so, low satisfaction with physiotherapy may be attributable to unrealistic expectations of treatment outcomes (eg, restoration of mobility).

CAM use among OA sufferers is widespreadCitation13 notwithstanding a paucity of evidence for effectiveness,Citation38 and this is affirmed by the low number of respondents in our survey who found CAM to be helpful. Previous studies have reported that CAM use is not attributable to dissatisfaction with conventional medicine per se, but rather to congruence with the user’s values, beliefs, and philosophical orientation toward health and life.Citation39

Information about OA

Studies have found that patients who are well informed about therapeutic options are more likely to adhere to recommended treatments,Citation40 which is particularly pertinent to OA because of its high sensitivity to patient preferences at all stages of severity.Citation41 Our finding that many respondents expressed a strong desire for improved information about OA, particularly about what to expect as their condition progressed, was consistent with the results reported by Mann and Gooberman-Hill.Citation42

Notably, many respondents in our study expressed a need to know more about the effectiveness of different treatments. However, providing information alone cannot ensure better health outcomes, and this has been recognized by studies which found self-management programs that combined behavioral modification with information provision are more effective than information alone.Citation43

A majority of respondents in our study chose the GP as their preferred information source for managing OA, consistent with findings from a Canadian survey of patients with arthritic conditions.Citation44 Many respondents obtained information from family and friends, although the reliability of this source has been questioned.Citation45

Of the media sources of information, the Internet was considered the most valuable. The unregulated nature of the Internet, however, means that much of the information may be unreliable and potentially biased. A literature review of OA websites reported that accurate and trustworthy information was more commonly found on government or education institution sponsored sites,Citation46 but the issue remains that patients may not have the experience, knowledge, or education to properly assess the credibility of available information.Citation47

There were several limitations to our study. First, we had limited information about health provider practices (practice size, age profile, number of practice nurses employed for clinical work, etc). We also had no clinical information on respondents, such as severity of OA, joints affected, duration of symptoms, and comorbidities. This made it difficult to contextualize the results.

Second, although the response rate was high, there was a possibility of selection bias. For example, those in the target population with OA of the hand may have found the physical completion of the questionnaire difficult, and so may not have responded to the survey. Similarly, those in the target population with cognitive impairment may also have had difficulty completing the survey.

In our study, OA was self-reported rather than diagnosed by a medical professional, which may impact on the findings. Finally, as with all self-reported questionnaires, there is a risk of social desirability bias. For example, patients may have overstated adherence to GP advice, because they did not wish to appear lazy or noncompliant.

Conclusion

The study showed that although patients with OA were generally satisfied with the management of their condition, there was notable variation in the perceived helpfulness of different therapeutic options. Given that better health outcomes in OA can be achieved if treatment recommendations are followed, future research should consider the relationship between adherence and perception of treatment. It would also be informative to further explore the influence of OA information on satisfaction with care.

Author contributions

MB conceived and performed the study, designed the questionnaire, analyzed and interpreted the data, and drafted the manuscript. TH coordinated the mail out and receipt of questionnaires and data entry, and critically revised the manuscript. TH, WR, PH, and AE analyzed and interpreted the data and critically revised the manuscript. All authors read and approved the final manuscript.

Acknowledgments

We thank all participants who generously gave their time. This study was funded by a National Health and Medical Research Council Program Grant (number 568612).

Disclosure

The authors report no conflicts of interest in this work.

References

  • Committee on Quality of Health Care in America, Institute of MedicineCrossing the Quality Chasm: A New Health System for the 21st CenturyWashington, DCNational Academy Press2001
  • DonabedianAThe quality of care: how can it be assessed?JAMA198826012174317483045356
  • ChowAMayerEKDarziAWAthanasiouTPatient-reported outcome measures: the importance of patient satisfaction in surgerySurgery2009146343544319715800
  • DonovanJLPatient decision making. The missing ingredient in compliance researchInt J Technol Assess Health Care19951134434557591546
  • Arthritis and Osteoporosis VictoriaA Problem Worth SolvingMelbourneArthritis and Osteoporosis Victoria2013
  • MarchLMBaggaHEpidemiology of osteoarthritis in AustraliaMed J Aust20041805 supplS6S1014984356
  • AggarwalBMoscaLLifestyle and psychosocial risk factors predict non-adherence to medicationAnn Behav Med201040222823320668975
  • MolloyGJPerkins-PorrasLBhattacharyyaMRStrikePCSteptoeAPractical support predicts medication adherence and attendance at cardiac rehabilitation following acute coronary syndromeJ Psychosom Res200865658158619027448
  • GelladWFGrenardJLMarcumZAA systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexityAm J Geriatr Pharmacother201191112321459305
  • FosterJMSmithLBosnic-AnticevichSZIdentifying patient-specific beliefs and behaviours for conversations about adherence in asthmaIntern Med J2012426e136e14421627747
  • RuncimanWBHuntTDHannafordNACareTrack: assessing the appropriateness of health care delivery in AustraliaMed J Aust20121971010010522794056
  • McGlynnEAAschSMAdamsJThe quality of health care delivered to adults in the United StatesN Engl J Med2003348262635264512826639
  • BasedowMRuncimanWMarchLEstermanAAustralians with osteoarthritis; the use of and beliefs about complementary and alternative medicinesComplement Ther Clin Pract201420423724225194303
  • FriesJFCellaDRoseMKrishnanEBruceBProgress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testingJ Rheumatol20093692061206619738214
  • HillJBirdHPatient knowledge and misconceptions of osteoarthritis assessed by a validated self-completed knowledge questionnaire (PKQ-OA)Rheumatology (Oxford)200746579680017178737
  • PotiriadisMChondrosPGilchristGHegartyKBlashkiGGunnJMHow do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment QuestionnaireMed J Aust2008189421521918707566
  • AllanJSchattnerPStocksNRamsayEDoes patient satisfaction of general practice change over a decade?BMC Fam Pract2009101319200400
  • YoungAFBylesJEDobsonAJWomen’s satisfaction with general practice consultationsMed J Aust199816883863899594948
  • JoyceCMSchurerSScottAHumphreysJKalbGAustralian doctors’ satisfaction with their work: results from the MABEL longitudinal survey of doctorsMed J Aust20111941303321449865
  • Arthritis Australia Models of Care Steering GroupTime to Move: Osteoarthritis A National Strategy to Reduce a Costly BurdenSydneyArthritis Australia2014
  • DziedzicKSHealeyEMainCJImplementing the NICE Osteoarthritis Guidelines in primary care: a role for practice nursesMusculoskeletal Care20131111223457010
  • LittlePEverittHWilliamsonIPreferences of patients for patient centred approach to consultation in primary care: observational studyBr Med J2001322728446847211222423
  • BeckRSDaughtridgeRSloanePDPhysician-patient communication in the primary care office: a systematic reviewJ Am Board Fam Pract2002151253811841136
  • RobertsonRDixonALe GrandJPatient choice in general practice: the implications of patient satisfaction surveysJ Health Serv Res Policy2008132677218416910
  • SaltmanDCO’DeaNASambrookPNManaging osteoarthritis in general practice: a long-term approachMed J Aust2001175SupplS92S9611795558
  • MarksRKnee osteoarthritis and exercise adherence: a reviewCurr Aging Sci201251728321762086
  • LabaT-LBrienJ-aFransenMJanSPatient preferences for adherence to treatment for osteoarthritis: the MEdication Decisions in Osteoarthritis Study (MEDOS)BMC Musculoskelet Disord20131416023647688
  • LosinaEWalenskyRPKesslerCLCost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volumeArch Intern Med2009169121113112119546411
  • BourneRBChesworthBMDavisAMMahomedNNCharronKDJPatient satisfaction after total knee arthroplasty: who is satisfied and who is not?Clin Orthop Relat Res20104681576319844772
  • JubyAGSkeithKDavisPPatients’ awareness, utilization, and satisfaction with treatment modalities for the management of their osteoarthritisClin Rheumatol200524553553816010447
  • TallonDChardJDieppePExploring the priorities of patients with osteoarthritis of the kneeArthritis Care Res200013531231914635301
  • MilderTYWilliamsKMRitchieJELipworthWLDayROUse of NSAIDs for osteoarthritis amongst older-aged primary care patients: engagement with information and perceptions of riskAge Ageing201140225425921187281
  • NunesVNeilsonJO’FlynnNClinical Guidelines and Evidence Review for Medicines Adherence: Involving Patients in Decisions about Prescribed Medicines and Supporting AdherenceLondonNational Collaborating Centre for Primary Care and Royal College of General Practitioners2009
  • BarozziNTettSEPerceived barriers to paracetamol (acetaminophen) prescribing, especially following rofecoxib withdrawal from the marketClin Rheumatol200928550951919132456
  • HushJYungVMackeyMPatient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparisonJ Man Manip Ther201220420120824179328
  • Casserley-FeeneySNPhelanMDuffyFRoushSCairnsMCHurleyDAPatient satisfaction with private physiotherapy for musculoskeletal painBMC Musculoskelet Disord200895018412974
  • HudakPLWrightJGThe characteristics of patient satisfaction measuresSpine200025243167317711124733
  • De SilvaVEl-MetwallyAErnstELewithGMacfarlaneGJEvidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic reviewRheumatology20115091192021169345
  • AstinJAWhy patients use alternative medicine: results of a national studyJAMA1998279154815539605899
  • LevesqueALiHZPahalJSFactors related to patients’ adherence to medication and lifestyle change recommendations: data from CanadaInt J Psychol Stud2012424255
  • Rivero-SantanaAPerestelo-PerezLPerez-RamosJGonzalez-LorenzoMSerrano-AguilarPTreatment preferences in patients with knee or hip osteoarthritis: an overviewChenQOsteoarthritis – Diagnosis, Treatment and SurgeryRijekaIn Tech2012 Available from: http://cdn.intechopen.com/pdfs-wm/30691.pdfAccessed October 1, 2015
  • MannCGooberman-HillRHealth care provision for osteoarthritis: concordance between what patients would like and what health professionals think they should haveArthritis Care Res2011637963972
  • RiemsmaRPTaalEKirwanJRRaskerJJSystematic review of rheumatoid arthritis patient educationArthritis Rheum20045161045105915593105
  • NevilleCFortinPRFitzcharlesMAThe needs of patients with arthritis: the patient’s perspectiveArthritis Care Res1999122859510513496
  • BowerKNFrailDTwohigPLPutnamWWhat influences seniors’ choice of medications for osteoarthritis?Can Fam Physician20065234234316926961
  • PietrzakECoteaCPullmanSCan the Internet Improve Health Outcomes in Osteoarthritis Patients and Provide Reliable Information about the Disease?BrisbaneCentre for Military and Veterans Health2012
  • WeberBADerricoDJYoonSLSherwill-NavarroPEducating patients to evaluate web-based health care information: the GATOR approach to healthy surfingJ Clin Nurs2010199–101371137719538561