LAUSR

OBJECTIVE To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. DESIGN A qualitative synthesis using discourse analysis methods. METHODS Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers and/or clinicians. Methodological quality was evaluated using the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analysed using inductive discourse analysis. RESULTS A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1673 direct quotes) from people with knee osteoarthritis, carers and clinicians in 16 countries. Two overarching discourses were identified-impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore-down over time and required a doctor to repair. The overarching participatory discourse almost always co-existed alongside an impairment discourse. According to this discourse, a 'busy body' was perceived as 'healthy' and people could remain active despite knee osteoarthritis. CONCLUSION The prevailing impairment discourse may potentially discourage people from using knees that have passed their 'use-by-date' and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating, which may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.