Three steps to changing the narrative about knee osteoarthritis care: a call to action

Knee osteoarthritis (OA), characterised by knee pain and functional limitation,1 2 is widely understood to imply that symptoms are due to structural damage. This view leads to the belief that non-surgical approaches are futile and the structural damage needs to be ‘fixed’.3 4 In contrast, contemporary evidence supports knee OA as a ‘whole person condition’ in which knee health is influenced by the interaction of different biopsychosocial factors that modulate inflammatory processes and tissue sensitivity, as well as behavioural responses that lead to pain and disability.5 6 This contrasting view reinforces the critical role of non-surgical approaches to manage knee OA. To promote this conceptual shift in understanding knee OA, clinicians must take three key actions. Clinicians must explain that knee pain is a modifiable symptom related to sensitised knee structures and influenced by a variety of biopsychosocial factors, rather than solely related to damaged structures. This message is underpinned by knowledge that levels of pain and disability are often poorly explained by the degree of structural change on imaging; and that symptoms are influenced by a person’s individual context, including life stage, psychological, social, physical and lifestyle factors, and health comorbidities. Clinicians should deliver this message with a focus on the person’s own narrative and …