Multiple perspectives on health promotion in individuals with knee pain

Abstract: Chronic musculoskeletal pain impacts the individual in multiple aspects of life (biological, psychological, and social). Individuals with knee pain have a higher risk of developingchronic widespread pain and knee osteoarthritis, compared to the general population, and the prevalence of chronic pain is estimated to rise. As a result, there is a global call for more health-promotive research in chronic pain. Hence, this thesis aimed to investigate multiple perspectives on health promotion by studying early factors associated with chronic pain and pain development as well as experiences of health-promoting activities and health literacy in individuals with knee pain. The studies are part of the Halland osteoarthritis (HALLOA) cohort, where 306 individuals with knee pain aged 30-65 years were included. Study I was a cross-sectional descriptive study (n=280), which aimed to investigate pain sensitivity and associations with radiographic knee osteoarthritis, chronic widespread pain, and overweight/obesity. Pain sensitivity was measured with pressure pain thresholds, and overweight was assessed using body mass index, visceral fat area and body fat percentage. Study II was a longitudinal study (n=251), aiming to examine whether or not health status and lifestyle habits have an impact on reporting chronic pain after two years. Lifestyle-related habits were overweight, physical activity, diet, alcohol intake, and tobacco use. Study III was an explorative qualitative study including 22 semi-structured interviews. The study aimed to explore health-promotive activities and was analysed with qualitative content analysis. Study IV had a convergent parallel mixed-methods design (n=221), including 19 interviews, and aimed to understand health literacy among individuals with knee pain. Quantitative variables were health literacy, health status, lifestyle habits, and pain distribution. The findings showed that higher pain sensitivity was associated with being female, having more pain sites, chronic widespread pain, higher body fat and visceral fat area (study I). Additionally, overweight/obesity and lower health status were associated with reporting chronic widespread pain after two years. Conversely, being normal-weighted and reporting better health status was associated with no chronic pain (study II). Striving for balance in everyday life was important to experiencing health among individuals with knee pain, and it was achieved by taking care of the body and managing life stressors (study III). Many reported sufficient health literacy, which was also associated with reporting better general health and less pain. How individuals found or received information, processed it, and took a stand based on trust and motivation, affected their decision-making processes (study IV). This thesis concludes that overweight/obesity and lower health status play an essential role in chronic pain. Health literacy and the everyday life of an individual are important when it comes to health promotion; and it is vital to consider what individuals with knee pain need in a given situation in order to prevent chronic pain.