Being careful: A grounded theory of emergent chronic knee problems

OBJECTIVE: To gain insight into the prediagnostic stages of knee osteoarthritis (OA) and identify the process whereby people recognize and address emergent chronic knee problems. METHODS: Twenty-six people (15 women, mean age 53.2 +/- 7.4 years) participated in a grounded theory study. Ten participants had a recent diagnosis of knee OA, and 16 had no diagnosis. The undiagnosed participants self-reported their symptoms, which had lasted at least 6 months and were consistent with knee OA. During semistructured, one-on-one interviews, participants reflected on the development and impact of their chronic knee problems. A constant comparative approach was used for analysis. RESULTS: Participants described uncertainty in understanding the meaning of intermittent knee symptoms for several years before becoming aware of the emergence of chronic knee problems. Once aware, participants engaged in a circular process of interpreting the meaning of knee symptoms and being careful. Being careful referred to the cycle of perceptions, intentions, and behaviors aimed at avoiding knee damage during physical activity. This cycle continued until participants experienced a disruption that challenged their participation in meaningful activities, at which time they decided to access health care. CONCLUSION: As a new construct, being careful unifies the complex set of experiences and behaviors that describe how participants protected their knee during physical activity. Participants interpret the experiences associated with emerging knee problems through interactions with others. These interactions enhance the participants' self-management, despite not having the benefits associated with diagnosis, such as justification for symptoms and formal assistance.