How Does Experiences and Perceptions Unfold in Adolescents with Longstanding Non-Traumatic Knee Pain

Background & Aims
Diagnostic uncertainty may develop during consultations because of miscommunication, potentially leaving adolescents confused and unable to understand ‘what’s wrong with me’ [3,6,7]. Adolescents’ uncertainty regarding the understanding of their knee pain, diagnosis, and its causes has been shown to be a significant barrier to the development of self-management skills and acceptance of the pain condition [4]. The repeated interview method is valuable to enable in-depth time-exploration of participants’ experiences and knowledge regarding complex topics [8]. This study aims to explore how adolescents with non-traumatic knee pain experience changes in their understanding of their knee pain, needs, and symptoms over time following a consultation in an orthopaedic department through a series of repeated interviews.

Methods
We included adolescents aged 10-19 years with longstanding non-traumatic knee pain and used semi-structured interviews conducted via Microsoft teams. The first interview was conducted 1-3 days after the consultation, followed by a second interview 11-17 days after the consultation. Data were analysed using reflexive thematic analysis by Braun and Clarke, separately in two sprints (i.e., timing of interviews) [2,5]. Both time points were synthesized via a matrix analysis, thus completing the final analysis [1].

Results
We included ten adolescents with longstanding non-traumatic knee pain. The impact of knee pain was multifaceted and manifested through emotional responses, daily life disruptions, and the struggle to return to sports and valued activities. The adolescents emphasized the importance of validating their experiences and the significance of social acceptance regarding the existence of ‘knee pain’. Their understanding of why they experienced knee pain was influenced by their past experiences with pain, their personal beliefs regarding pain, and their interpretation of the diagnosis they received. Adolescents who were referred for further examinations (e.g., imaging) described a feeling of complete halt in activities and a need to wait for clarification. Lastly, adolescents mentioned experiencing difficulties remembering what was said during the consultation, and some expressed a desire for additional examination, such as imaging.

Conclusions
Communication is crucial for reducing diagnostic uncertainty in adolescents with longstanding non-traumatic knee pain. The results indicate that knee pain is a complex and multifaceted experience, involving shifts in perceptions, interactions with medical professionals, emotional responses, and the need for effective pain management. Adolescents with knee pain have a significant need for validation and experience difficulties in remembering the information they receive during the consultation. This raises questions about how healthcare professionals should educate and communicate with adolescents to enhance their understanding of pain. These findings set the stage for future research to develop innovative and personalised communication strategies to better engage and educate adolescents about their condition.