Patients’ perspectives and experiences on physiotherapy care for knee osteoarthritis: A qualitative study

Abstract

Objective

To explore the perspectives and experiences of patients with knee osteoarthritis regarding physiotherapy care management in Hong Kong.

Design

Qualitative study using semi-structured, individual interviews.

Setting

Community.

Participants

Patients age 50 years or older with knee osteoarthritis, purposively recruited.

Intervention

Face-to-face semi-structured interviews were conducted with patients who had completed a physiotherapy rehabilitation programme in the past six months.

Main Measures

A 21-question interview guide encouraged participants to discuss their physiotherapy management, experiences, and recommended interventions, covering all non-pharmacological treatments outlined in local clinical guidelines. Questions also explored factors influencing adherence to care during and after physiotherapy. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Results

Fourteen patients participated. Five key themes emerged: (a) navigating pain and management strategies; (b) adapting daily life and the impact of knee osteoarthritis on activities; (c) complexities of treatment and the need for personalised care; (d) the role of exercise and mobility; and (e) barriers to access and resources. While patients reported receiving various physiotherapy interventions, gaps were noted in aquatic therapy, neuromuscular training, weight management, and assistive devices. Barriers included limited access, financial constraints, and lack of home exercise equipment. Although participants valued physical activity, maintaining an exercise routine was challenging.

Conclusions

A comprehensive, patient-centred approach is essential for effective physiotherapy care for knee osteoarthritis in Hong Kong. Addressing practical barriers and integrating patient feedback can enhance the accessibility and impact of evidence-based interventions.

Keywords

Knee osteoarthritis physiotherapy patient experiences qualitative study pain management

Introduction

Osteoarthritis is a prevalent joint disease affecting approximately 595 million people globally, with knee osteoarthritis being particularly common.¹ This condition causes significant pain, functional impairment, and a reduced quality of life.² In Hong Kong, knee osteoarthritis is a major health concern, with approximately 13% of women and 7% of men aged 50 and older diagnosed with this condition,³ representing 82% of all osteoarthritis cases.⁴ Its economic impact in Hong Kong was estimated at 3.9 billion Hong Kong dollars in 2003,⁴ affecting healthcare utilisation and overall well-being.⁵

Physiotherapy is a key component of knee osteoarthritis management and is recommended by clinical practice guidelines to alleviate symptoms.⁶ However, patient-related barriers often limit its utilisation. These include a lack of understanding of exercise benefits, fear of movement, doubts about treatment efficacy, and financial constraints.⁷ Additionally, patients often struggle to incorporate prescribed exercises into their daily lives, affecting adherence to physiotherapy programmes.⁷ While previous studies have explored the experiences of knee osteoarthritis care from multidisciplinary teams or physiotherapy,⁸ they mainly originate from Western contexts, limiting their applicability to other regions, especially Asia. highlighting barriers such as resource access and pain management.⁹ Cultural factors such as family support, cultural practices, and attitudes towards Western medicine significantly influence healthcare decisions in Asian communities.¹⁰ Furthermore, differences in healthcare-seeking behaviours may affect the adoption of strategies for managing knee osteoarthritis in Hong Kong.

Our team has previously adapted international guidelines for managing knee osteoarthritis to the local context,⁶ emphasising a multimodal physiotherapy approach that includes land- and water-based exercises, patient education, and self-management strategies. However, clinical guidelines alone are insufficient for ensuring adherence. Effective implementation requires considering the local context and strong engagement with stakeholders.¹¹ Identifying factors influencing clinician and patient adherence is crucial and can be mapped onto behavioural change techniques.¹² While our team has previously examined physiotherapists’ perspectives on adherence to clinical guidelines for knee osteoarthritis management,¹³ the patient perspective in Hong Kong remains underexplored. Patients’ lived experiences are essential to understanding the real-world uptake of evidence-based physiotherapy, as they directly shape treatment engagement, adherence, and outcomes. Without this insight, strategies to improve care risk overlooking key contextual and individual factors that influence patient behaviour. The current study investigates the experiences of people with knee osteoarthritis in Hong Kong who have received physiotherapy care, with a focus on identifying patient-perceived barriers and facilitators to effective, guideline-based management. By capturing these perspectives, we aim to generate actionable, patient-centred insights to inform the design of contextually appropriate interventions that enhance the delivery and uptake of evidence-based physiotherapy for knee osteoarthritis in Hong Kong.

Methods

Design

This qualitative descriptive study employed semi-structured individual interviews to comprehensively explore the experiences of individuals with knee osteoarthritis who had recently completed a physiotherapy rehabilitation programme. Qualitative methods are well suited to understanding the nuanced perspectives of patients, providing detailed insights into their attitudes, behaviours, and responses to physiotherapy interventions¹⁴ The semi-structured interview format allowed for an in-depth exploration of individual experiences, facilitating rich accounts of personal responses to both the physiotherapy programme and any associated lifestyle changes.

The study adhered strictly to the principles outlined in the Declaration of Helsinki, ensuring ethical conduct throughout the research process. Ethical approval was obtained from The Hong Kong Polytechnic University (Reference No: HSEARS20221027006). Furthermore, the Standards for Reporting Qualitative Research checklist¹⁵ guided the study's execution and reporting, ensuring transparency and rigour in all methodological aspects.

Participants

A purposive sampling strategy was employed to ensure a diverse and information-rich sample of patients with knee osteoarthritis who had recently completed a physiotherapy rehabilitation programme. Participants were selected to capture variation across key characteristics relevant to the transferability of findings, including age (≥50 years), gender, duration of knee osteoarthritis, laterality (unilateral or bilateral involvement), educational background (secondary or tertiary education), and geographic distribution across different districts in Hong Kong. This approach was intended to reflect the heterogeneity of the knee osteoarthritis population and to enhance the applicability of our findings to a broader patient group. All participants received individualised physiotherapy treatments from participating clinics.

To be included, participants had to be 50 years or older, have a medical diagnosis of unilateral or bilateral knee osteoarthritis, and have received physiotherapy treatment for knee osteoarthritis within the past 6 months. Participants were excluded if they had self-reported mental illness, inflammatory conditions (e.g. rheumatoid arthritis or gout), recent knee arthroplasty, or involvement in other research projects for knee exercises.

Participants were recruited from different geographical districts in Hong Kong through advertisements in physiotherapy clinics and social media platforms. Upon expressing interest, a trained research associate (Mandy Kan) with extensive experience in qualitative methodologies checked the eligibility of potential participants and arranged face-to-face, Zoom, or phone interviews.

Data collection

A semi-structured interview guide was developed and content validated by four experts (André Bussières, Aliki Thomas, Arnold Wong, and Fadi Al Zoubi) specialising in implementation science and the physiotherapy management of knee osteoarthritis (Table 1). This guide aimed to explore the experiences of patients with knee osteoarthritis who had undergone physiotherapy, focusing on non-pharmacological interventions administered by physiotherapists.

Table 1.

Semi-structured interview guide for knee osteoarthritis patients.

Level of evidence	Recommendations	Questions
	Introduction	1. Can you tell me about your management protocol with physiotherapy? Prompt: Why did you seek physiotherapy? 2. Who recommended physiotherapy to you? Prompt: Were you referred by a doctor or any other way? 3. What happens during your first physiotherapy session? Prompt: What kind of questions have you been asked? Have the physiotherapists physically examined you? Have you had to complete any questionnaires, surveys, or other forms?
✸✸✸	Land-based exercises	4. What kind of exercises did the physiotherapist suggest for your knee osteoarthritis? Prompt: Did you do any muscle strengthening, treadmill, stretching, sit-to-stand, one-leg stance, step-up, walking, Tai Chi, or cycling? 5. Were these exercises hard to do? If yes, did the physiotherapist change the number of repetitions or sets to make it proper for your ability? 6. Have you continued to perform these exercises after discharge from the physiotherapy programmes? If so, how long have you been doing them? Do you still do them?
✸✸✸	Aquatic exercises	7. Did your physiotherapist suggest water-based exercises in a swimming pool? If yes, which kinds of exercises did you do? What do you think about this kind of water-based exercise? Do you still do them after discharge?
✸✸✸	Patient education	8. Did your physiotherapist educate/give you information and advice about your knee osteoarthritis? Prompt: Can you tell me about the advice that your physiotherapists gave you for managing pain, limited movement, and doing your work? Any advice on using heat, canes, or doing exercises? Did your physiotherapist advise you to use a knee brace or walking aids or reduce your weight if you are overweight? Any other advice?
✸✸✸	Self-management	9. Did your physiotherapist teach you how to self-manage your knee? Prompt: Can you tell me which exercises you do at home? Did your physiotherapist give you these exercises on printed paper(s) or in an electronic version? Or do you have other sources, such as websites or YouTube? Which other treatments that your physiotherapists recommended to you do you use? What about heat, cold, canes, etc.? 10. Did you do these exercises at home as the physiotherapist suggested? 11. Do you still do them? Why?
✸✸	Neuromuscular training	12. Did your physiotherapist give you any training on balance, agility, or coordination? If yes, do you still do them after discharge?
✸✸	Weight management + exercises	13. Is weight an issue for you? If yes, did your physiotherapist suggest any weight loss program for you? Did your physiotherapist discuss with you how important it is to keep a healthy body weight for your knee osteoarthritis?
✸✸	Assistive devices	14. Do you use any assistive devices such as a cane? If yes, who did you prescribe it for you?
✸✸	Braces	15. Do you use any braces? If yes, who did you prescribe it for you?
✸	Massage, manual therapy, modalities (percutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, extracorporeal shockwave therapy, laser, or heat therapy), acupuncture, and cognitive behavioural therapy	16. Tell me, did your physiotherapist give you hands-on techniques such as massage or manual therapy (stretching, soft tissue and/or joint mobilisation and/or manipulation)? If yes, how many times? Do you still use any? What do you think about them? Are they helping? 17. Did your physiotherapist give you acupuncture? If yes, do you still use any? What do you think about them? Are they helping? 18. Did your physiotherapist give you any modalities such as percutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, extracorporeal shockwave therapy, laser, or heat therapy? If yes, do you still use any? What do you think about them? Are they helping? 19. Did your physiotherapists provide you any cognitive behavioural therapy, such as self-monitoring, group and individual goal setting, barrier problem solving, action planning, relaxation/pain management strategies, and sleep hygiene education
!	Therapeutic ultrasound, interferential therapy, cold therapy, Kensio taping, footwear	20. Did your physiotherapists provide you any therapeutic ultrasound, interferential therapy, cold therapy, Kinesio taping, or footwear? If yes, do you still use any? What do you think about them? Are they helping?
!!!	Shoe insole	21. Did your physiotherapists recommend/suggest to you any shoe insole? If yes, do you still use it? What do you think about it? Is it helping?
✸✸✸	Strongly recommended
✸✸✸	moderately recommended
✸	conditionally recommended
!	conditionally not recommended
!!!	Strongly not recommended

The interview guide was informed by previous studies on knee osteoarthritis management^9,16,17 and our prior work adapting these guidelines to the Hong Kong context.⁶ We included questions addressing challenges identified in global research, such as exercise adherence, perceptions of physiotherapy, and access to care. Additionally, we explored local issues that may be more pronounced, including the use of traditional therapies, family involvement, and the impact of urban living on physical activity. This approach enabled us to capture both universal and context-specific experiences, contributing to a more nuanced appraisal of knee osteoarthritis care in Hong Kong.

The interviews commenced with general, non-technical questions to gauge patients’ perceptions of physiotherapy management. The guide included 21 open-ended questions and prompts designed to encourage participants to discuss their management protocols, experiences during physiotherapy sessions, and the interventions recommended or delivered by their physiotherapists. The questions were designed to explore all potential non-pharmacological interventions that can be delivered by physiotherapists. These interventions were either strongly, moderately, or conditionally recommended for or against use by the locally adapted clinical practice guideline.⁶ Additionally, questions were crafted to investigate factors influencing adherence to recommended care during physiotherapy (adoption barriers) and after discharge (maintenance factors). The guide was translated into Cantonese, and the content was validated by two academicians and two clinicians who are native Cantonese speakers.

Participation in the study was voluntary, with participants required to complete an online or printed informed consent form before the interview. Individual interviews, lasting approximately 45 min, were conducted in person at a university in Hong Kong, recorded digitally, and transcribed verbatim by the same research associate (Mandy Kan). Interviews were conducted in Cantonese or English. After the first three sessions, the questions were reviewed and adjusted for clarity and comprehension. Participants received 100 Hong Kong dollars as compensation for their time.

Data analysis

The data analysis followed a six-step inductive thematic approach.¹⁸ Each patient was assigned an anonymous number by the research associate. Two research associates (Mandy Kan and another with a master's degree in nursing and extensive qualitative research experience) conducted the analysis as follows: They (a) independently read the transcripts line-by-line several times to familiarise themselves with the data; (b) generated codes for important statements; (c) collated codes with similar ideas into a subtheme; (d) reviewed the subthemes to identify the ones with linked nature; (e) created a theme for a group of subthemes; and (f) produced a final report. Any disagreements were systematically resolved at each stage through discussion. Data management was facilitated using Microsoft Excel.

We conducted a total of 14 interviews. Data collection and analysis were performed concurrently, allowing us to monitor the emergence of new themes. After 12 interviews, no new information was identified, and two additional interviews confirmed that data saturation had been achieved.¹⁹ In addition to data saturation, we considered the concept of information power,²⁰ which posits that the adequacy of sample size depends on the specificity of the sample, the quality of dialogue, the study aim, and the analysis strategy. Our purposive sampling ensured that all participants had direct experience relevant to our research question, and the interviews were in-depth and focused. Therefore, we believe that our sample size was sufficient to provide rich and meaningful insights into the phenomenon under investigation.

Researcher characteristics and reflexivity

Fadi Al Zoubi is a Middle Eastern male physiotherapist with clinical experience in the Middle East and North America. His research positionality is shaped by his diverse professional background and grounding in implementation science. Having practised in both low- and high-resource healthcare settings, he has developed a nuanced understanding of the contextual factors influencing rehabilitation service delivery. This experience, combined with his research work in Middle Eastern, North American, and Hong Kong contexts, has equipped him with a pragmatic and interpretive worldview that acknowledges the co-construction of knowledge and the need for culturally responsive approaches.

Arnold Wong is a male physiotherapist and clinical researcher of Chinese descent, trained in Hong Kong and Canada. His perspective is shaped by his professional training, work experiences, and sociocultural background. Recognising the significant impact of socioeconomic status, culture, and personal experiences on research participation, he embraces participatory approaches to foster mutual communication and learning through equitable partnerships.

Mandy Kan is a Chinese woman, registered nurse, and research associate based in a tertiary institution in Hong Kong, China. Her positionality is shaped by both her professional nursing experience and the socio-cultural context in which she conducts her research. As a fluent Cantonese speaker, she is able to communicate and interact with the research participants without language barriers, providing her with unique insights but also potential biases that require ongoing reflection.

Aliki Thomas is a white woman, occupational therapist, and researcher based in Canada. Her positionality reflects both her professional role and the socio-political context in which she conducts research. Working within post-positivist and constructivist paradigms, she views knowledge as co-constructed and shaped by multiple perspectives. Acknowledging the complexities of working in a northern context, she is mindful of how her background, biases, and professional identity may influence the design, implementation, and interpretation of the research.

André Bussières is a white settler with clinical training in nursing and chiropractic and research expertise in health services and implementation science in high- and middle-income countries. Acknowledging power dynamics and cultural sensitivities, he prioritises participatory approaches in his work, committed to advancing equitable access to high-value rehabilitation services to improve health outcomes in Canada and globally.

Results

Fourteen patients with knee osteoarthritis (five males and nine females) were interviewed between September 2023 and January 2024. The mean (standard deviation) age was 65.9 (5.0), with a mean (standard deviation) body mass index of 24.3 kg/m² (3.0). On average (standard deviation), participants had been diagnosed with knee osteoarthritis for 7.9 years (5.7). Knee osteoarthritis affected the left knee in four participants, the right knee in four, and both knees in six. Most participants had no significant medical history, except for one with a stroke, one with nasopharyngeal cancer, and another with breast cancer and thyroid disease. Twelve participants had secondary education, while two had tertiary education. Detailed participant characteristics are presented in Table 2.

Table 2.

Characteristics of knee osteoarthritis patients (n = 14).

Patient	Gender	Age	Body mass index (kg/m²)	Years diagnosed with knee osteoarthritis	Side of the knee osteoarthritis	Health History	Marital Status	Highest Education	Occupation	Family Income (Hong Kong Dollar)
Patient 1	F	68	24.3	25	Bilateral	None	Single	Secondary	Retired	0
Patient 2	M	66	24.0	1.5	Left	None	Married	Secondary	Retired	55,000
Patient 3	M	70	30.8	2.5	Bilateral	None	Married	Secondary	Retired	70,000
Patient 4	F	60	23.3	5	Bilateral	None	Divorced	Secondary	Retired	0
Patient 5	M	62	20.6	3	Right	None	Married	Secondary	Retired	0
Patient 6	F	65	19.6	10	Right	Stroke	Divorced	Secondary	Retired	25,000
Patient 7	F	62	22.7	7	Left	None	Married	Tertiary	Retired	40,000
Patient 8	F	61	29.3	10	Bilateral	Breast cancer and thyroid disease	Married	Tertiary	Financial consultant	50,000
Patient 9	F	66	25.5	6	Bilateral	None	Married	Secondary	Retired	50,000
Patient 10	F	63	22.8	6.5	Bilateral	None	Married	Secondary	Retired	15,000
Patient 11	F	70	26.7	10	Right	None	Married	Secondary	Retired	70,000
Patient 12	M	68	24.6	7.5	Left	Nasopharyngeal cancer	Divorced	Secondary	Campsite assistant	12,000
Patient 13	M	79	23.3	10	Left	None	Married	Secondary	Retired	30,000
Patient 14	F	62	23.0	6.5	Right	None	Single	Secondary	Seeking job	0

The thematic analysis resulted in five main themes (Table 3): navigating pain: experiences and strategies for management; adapting daily life: the multifaceted impact of knee osteoarthritis on activities and mobility; complexities of knee osteoarthritis treatment: from pain relief to personalised care; treatment and rehabilitation; exercise and mobility in knee osteoarthritis management; and barriers to access and resources in knee osteoarthritis management. Figure 1 visually presents the themes and subthemes of the patients’ insights regarding the physiotherapy management of knee osteoarthritis.

Table 3.

Themes, subthemes, and supporting quotes from participants’ interviews.

Themes	Subthemes	Participants’ supportive quotes
Navigating pain: experiences and strategies for management	Pain and discomfort during various activities	Patient 12: ‘I said I could walk for more than an hour if not carrying heavy objects. I can take a rest after an hour. But it is not the case for walking upstairs.’
		Patient 1: ‘Sometimes I feel pain when walking. Sometimes when I turn my body. Actually, the pain caused by suddenly turning my body is much more intense.’
		Patient 14: ‘I didn’t realise the puddle, and I fell. My underwear got wet. The legs started to be painful that night. I thought it could have recovered itself. Later, I found it painful when walking and sleeping.’
	Pain management strategies	Patient 10: ‘As I cannot do the exercises when my knees are in pain, he said I can sit down on the chair slowly, not too forcefully.’
		Patient 5: ‘He has suggested heat. If it was too painful, he asked me to return to locate him to teach me how to use heat.’
		Patient 9: ‘Heat compress. He told me that I could use it if I am in pain.’
	Diagnosis and assessment by healthcare professionals	Patient 2: ‘He noticed it was degeneration that caused the pain.’
		Patient 10: ‘He asked what causes pain, the aggravating factors, and whether pain occurs when walking up or down stairs.’
		Patient 1: ‘After he read my referral notes, he noticed my knee problem. He examined the range of motions and performed palpation manually.’
		Patient 11: ‘In the first session, they asked me my age, weight, and any other diseases I have.’
		Patient 14: ‘The first time I had to complete a questionnaire… it was about “how long you can stand, how long you need to take a break when doing housework”.’
		Patient 1: ‘After the last physiotherapy session, we had a questionnaire to complete. The questionnaire asked about my level of pain and if my condition had improved.’
Adapting daily life: the multifaceted impact of knee osteoarthritis on activities and mobility	Impact on daily life and mobility	Patient 8: ‘For me, the major influence comes from travelling to mainland China, where there are squatting toilets. It affects my life a lot. It is challenging for me to squat.’
		Patient 8: ‘Weather changes, as well as standing up after sitting for a while, have an impact on my knee.’
		Patient 10: ‘The knee swelled. I experienced pain when walking up and down stairs.’
	Inconvenience and hindrances to exercise	Patient 3: ‘You take out a (resistance) band, then you can exercise. You have to carry many things and travel to the pool. It hinders motivation… It is inconvenient. The shampoo and shower lotion. Towels, clothes, shoes… many things.’
		Patient 6: ‘I thought the water-based exercises could be effective, but I felt they were inconvenient. I have to change swimsuits. After the exercises, I have to change clothes again. I've got to do many things.’
		Patient 7: ‘Swimming is very inconvenient… I prefer to exercise at home.’
	Importance of weight management for knee osteoarthritis	Patient 14: ‘I discovered that when my body weight was reduced, the knee pain was reduced. I was motivated to maintain weight and eat less – less meat and more vegetables.’
	Importance of weight management for knee osteoarthritis	Patient 6: ‘He told me that weight loss is very important. The knee pain could be reduced if I were not that fat. The knee joint would be less likely to have inflammation… He asked me to eat less. I used to love eating desserts, but I no longer eat them.’
Complexities of knee osteoarthritis treatment: from pain relief to personalised care	Seeking professional advice and treatment	Patient 2: ‘I sought physiotherapy because of knee pain.’
		Patient 4: ‘I saw a physiotherapist three months ago due to pain. I will go to see a physiotherapist again later when the pain intensifies.’
		Patient 9: ‘The pain in my knee is so severe that it prevents me from walking. After imaging, it was determined that there was a cyst on my left knee. Then I went for physiotherapy.’
	Treatment methods and approaches	Patient 12: ‘I can get some pain relief and muscle strengthening through physiotherapy. Both are not the measures to cure the pain but to help to alleviate pain while I am awaiting surgery.’
		Patient 13: ‘I found physiotherapy is effective. At least I learnt that my knee should not extend beyond my toes when walking sideways downhill.’
		Patient 14: ‘The physiotherapy sessions helped to relieve my pain while I have been waiting for surgery. Physiotherapy is not a treatment method; it's a pain reliever.’
		Patient 6: ‘No, I still haven't used it. because silicone is heavy. I even felt heavier after the stroke. I now have to use soft pads. The insole was thick, half an inch.’
		Patient 10: ‘After electromagnetic field therapy was applied, it was still like nothing. I did not experience any changes in outcomes.’
	Rehabilitation and exercises	Patient 13: ‘At the beginning, I couldn't do it repeatedly or for extended periods of time. I can do it progressively. I gradually increased the number of repetitions.’
		Patient 12: ‘He asked me to perform a few movements. To step on an inclined board for stretching… and repeat for a few sessions.’
		Patient 1: ‘He also performed the 30-s sit-to-stand test to count how many times I can perform.’
	Effectiveness and comfort of knee braces	Patient 2: ‘Do you find it (knee braces) helping? I am not sure.’
		Patient 4: ‘I found it (the knee brace) not useful. Doctors prescribed it to me before. No. The doctor asked me to purchase it. I purchased it at home. However, I discovered that it was not useful, so I set it aside. It was so tight that I couldn't bend my knee.’
		Patient 6: ‘(The knee braces are) not so effective… I found the knee braces enormous and not comfortable. There were straps at the back. It is massive. Like people playing ‘war games’. Three straps at the back… It is not convenient for walking, and it is too big. It hindered the joint's flexibility.’
		Patient 7: ‘He didn't provide advice, but I bought one pair of knee braces myself. I found it was not effective.’
		Patient 7: ‘Knee brace… because previously I went hiking regularly. My knee felt pain if I walked for too long. I tried to use a knee brace when hiking. It didn’t work.’
		Patient 12: ‘I dislike it (knee brace). I feel uncertain about how to express my thoughts. The brace restricted my knee, causing itching and redness. But it wasn’t effective if I used it for a short time. Because I have to work, I sweat. It made me red and have an allergic reaction. He asked me not to use it. Due to the nature of my outdoor work, a knee brace is not suitable for me.’
		Patient 3: ‘He recommended using the one with a hole in the knee. This kind of knee brace is more comprehensive… Maybe it is more flexible for knee movements.’
		Patient 5: ‘For the knee, usually, I will use the knee brace. If the exercise is challenging, a more rigid brace will be used. Some of the braces allow you to squat… It won’t hurt that much if you fall. In case I fall, I won’t hurt that much.’
		Patient 5: ‘If going out cycling, in case of a fall, the brace can be a protector to protect you from injury, not to hurt the location that was already injured.’
		Patient 10: ‘He said I can use a knee brace when doing exercises. It is for… I forgot what he said. Its purpose is to restrict movement and maintain alignment. The joints lack support. The support was dislodged. Wearing a knee brace during exercise improved my comfort level. I use a knee brace when I perform exercises like squats.’
	Effectiveness of acupuncture	Patient 3: ‘I am keen on receiving different kinds of therapy. I asked the DHC to refer me to acupuncture… Sometimes it is good, sometimes not. The pain improved immediately after the acupuncture. After a period of time, the effect is similar to no acupuncture. Therefore, I'm not certain about its effectiveness.’
		Patient 4: ‘He (the physiotherapist) did the acupuncture, but I didn’t find anything different. He asked if I felt better after acupuncture, yet I found no difference. I assume it could help, as it was done along with other treatments.’
		Patient 6: ‘I think acupuncture is a little bit effective. I felt the pain was reduced afterwards.’
		Patient 10: ‘I think acupuncture helps.’
		Patient 2: ‘A little bit (effect). The physiotherapist I visited was not yet qualified to provide acupuncture. He is Taiwanese. He just got a physiotherapy licence to practise in Hong Kong, but he does not qualify to provide acupuncture yet.’
	Individualised treatment and quality of care	Patient 4: ‘The doctor referred me to the physiotherapy department in the hospital. But honestly speaking, I think the physiotherapists in the hospital are a bit ‘hea’ (not working up to standard). Furthermore, you have to get along with the physiotherapist who provided treatment to you. Physiotherapy is hard to do in public due to time and personality.’
	Individualised treatment and quality of care	Patient 10: ‘He asked me which leg was more painful. He then worked more on that side… Mainly, he focused on one side. I told him my right knee was more severe. He only treated my right side. He wasn't concerned about the left side… The doctor wrote ‘right knee’ in the referral letter, so only the right side was treated.’
Exercise and mobility in knee osteoarthritis management	Exercise recommendations and techniques	Patient 3: ‘Lunge, right hand holding the right ankle at the back. Cycling. Take 5 to 6 steps to ascend and descend the staircase. Squat while using a gym ball placed between your back and the wall. And adjust the weight and knee extension with a weight machine. For cycling, use a cycle machine.’
		Patient 6: ‘The recommended exercises were talk by mouth? He demonstrated them to you, and you showed them to him in return? yes.’
		Patient 13: ‘They taught us to kick sandbags and squat, and when bending the knee, the knee should not be over the toes. There was also fitness equipment available to assist us. Knee press. Adding weights.’
		Patient 6: ‘He asked me not to move the leg too high; just do it progressively.’
	Incorporating exercises into daily life	Patient 13: ‘Not on a specific schedule. Sometimes I exercise when I am watching television. However, I am mindful of maintaining a straight back when sitting on the couch.’
	Incorporating exercises into daily life	Patient 8: ‘I usually incorporate exercises into my daily life. When waiting for the bus on a slope, I will stretch my legs. I try to incorporate the exercises into my daily life, sometimes while watching TV or outdoors.’
	Importance of stretching and assistive devices	Patient 2: ‘He only taught me stretching…on an inclined board. The angle of inclination can be adjusted… This exercise is not hard.’
		Patient 3: ‘He suggested stretching. Also, use appropriate assistive devices, e.g., a knee brace, for exercises and jogging.’
		Patient 6: ‘He didn’t prescribe the cane. My family bought it for me. The physiotherapist said that I can walk slowly and don't necessarily need a cane, but I informed him that it's unstable. After my family bought me the cane, he thought I didn't need it… However, I continue to use the cane because there are times when the toilet lacks a handle. I felt safer.’
	Home-based exercise programmes	Patient 3: ‘The physiotherapist gave me a resistance band. He taught me how to do the same exercises at home without equipment.’
		Patient 13: ‘There were lots of pamphlets when you registered for the physiotherapy session. You can take them home and follow those exercise movements.’
		Patient 8: ‘Earlier, there was a sheet of paper. Later, the physiotherapist sent me the exercise video through the Hospital Authority Go App.’
	Motivation to continue exercising	Patient 2: ‘I found them [exercises] effective. Helping the knee pain, having progress.’
		Patient 11: ‘Because I hope I still exercise, keep the status, and not allow it to deteriorate further. I hope I keep doing it when I need to have a joint replacement, hoping for a better health status. Thus, after the surgery, better recovery time.’
		Patient 12: ‘I perceived simple walking was not targeting the quadriceps. Knee extension with weight cannot be replaced by walking. I think exercises can target specific muscles.’
	Utilising external resources for exercise guidance	Patient 5: ‘Yes, he taught me Tai Chi. I learnt a few lessons. The time didn’t fit. I have to be there at night. I learnt about the practice known as Ba-duan-jin, which involves eight sessions of brocade and Chinese qigong. I was a bit effective. When I'm unable to go outside or it's raining, doing it at home can help alleviate the pain.’
	Utilising external resources for exercise guidance	Patient 7: ‘The e-resources were provided by the workshop but not the physiotherapy. There were Facebook pages with videos uploaded. The workshop was organised by the Jockey Club with the elderly centre, targeting knee pain. Anyone who is experiencing problems related to knee pain can join.’
Barriers to access and resources in knee osteoarthritis management	Limited access to physiotherapy and healthcare services	Patient 3: ‘I heard from my friends that some physiotherapists would provide manual therapy. But we don’t have it. I'm not sure if it is a standard or whether it helps knee pain. I haven’t tried. Some patients may also use transcutaneous electric nerve stimulation, but this treatment was not available at the District Health Centre.’
	Limited access to physiotherapy and healthcare services	Patient 7: ‘Because the maximum number of the physiotherapy sessions was 8 sessions. Once there were 4 sessions. During my most recent therapy, I acquired a new set of skills and received my discharge. I didn’t perform the exercises there. He taught me the home exercises.’
	Lack of equipment and resources for home exercise	Patient 3: ‘He taught us light-intensity exercises, but it is difficult to do them at home. To use a big gym ball, squat with the ball between the back and the wall. It is difficult to squat if you don’t have a gym ball. There is a large friction force between the back and the wall. And you don’t have many walls at home to squat. It is the difference between exercise at home and at the District Health Centre. There is a lot of equipment at the District Health Centre you can use to do exercises targeting the knee. At home, it is limited.’
	Lack of equipment and resources for home exercise	Patient 4: ‘I cycled using the pedal machine in the physiotherapy clinic, but I don’t have it at home.’
	Financial constraints and costs of treatment	Patient 3: ‘I am not sure if it is subsidised by the government. We only have to pay 150 dollars for each physiotherapy session. I learnt from my friends that seeking a private physiotherapist may cost between 700 and 800 dollars. Each session costs approximately a thousand dollars. I listened to the nurse's advice.’
		Patient 3: ‘If you go for physiotherapy twice a week at 1000 dollars each, it is a huge financial cost for a normal family. We paid 150 dollars for each visit to the District Health Centre, attending twice a week. There is a limited number of sessions that you can attend. The maximum number of physiotherapy sessions for 1 leg is 10–12. The government has limited subsidies.’
		Patient 4: ‘Because it's quite expensive. It costs around 1000 dollars for one session, and not everyone is able to obtain full coverage from the insurance. These days, some sessions cost 800 dollars, some 900 dollars, and some 1200 dollars. If the physiotherapist has a poor attitude and charges a high fee, I will not choose him.’

Theme 1: Navigating pain: Experiences and strategies for management

This theme was prominent in the participants’ narratives, highlighting the multifaceted nature of their discomfort and the strategies they use to cope with it. Many participants reported experiencing pain during daily activities, such as walking or navigating stairs, with one highlighting the limitations imposed by his condition:

I said I could walk for more than an hour if not carrying heavy objects. I can take a rest after an hour. But it is not the case for walking upstairs. (Patient 12, male, 68 years old)

The pain was often exacerbated by sudden movements, as noted by another participant. Participants also described various management strategies, including the use of hot pads and modifications to their exercise routines, illustrating their proactive approaches to alleviate discomfort. For instance, one participant shared that their physiotherapist suggested sitting down slowly when experiencing pain, demonstrating individualised care.

As I cannot do the exercises when my knees are in pain, he said I can sit down on the chair slowly, not too forcefully. (Patient 10, female, 63 years old)

Furthermore, the importance of thorough diagnosis and assessment by healthcare professionals was evident, with participants recalling detailed evaluations and enquiries about their pain triggers. This comprehensive perspective on pain underscores the need for tailored management strategies that address the needs of patients with knee osteoarthritis.

Theme 2: Adapting daily life: The multifaceted impact of knee osteoarthritis on activities and mobility

This theme reveals how knee osteoarthritis significantly affects the participants’ everyday activities and mobility. Many individuals reported challenges that hinder their quality of life, including difficulties using squatting toilets while travelling, which one participant described as having a major impact on their life. Additionally, weather fluctuations or prolonged sitting were noted to exacerbate knee pain, further complicating daily tasks such as squatting or climbing stairs.

For me, the major influence comes from travelling to mainland China, where there are squatting toilets. It affects my life a lot. It is challenging for me to squat. Weather changes, as well as standing up after sitting for a while, have an impact on my knee. (Patient 8, female, 61 years old)

Furthermore, some daily tasks, such as climbing stairs, may increase the swelling.

Participants also highlighted the inconvenience of maintaining an exercise habit, particularly when it involved travelling to facilities for water-based exercises. The logistical challenges of carrying necessary items, changing attire, and ensuring comfort often deterred them from engaging in physical activity. Moreover, weight management emerged as a critical aspect of managing knee osteoarthritis symptoms, with obese participants recognising the direct correlation between weight loss and reduced knee pain. One participant underscored the importance of dietary choices and lifestyle modifications by sharing:

I discovered that when my body weight was reduced, the knee pain was reduced. I was motivated to maintain weight and eat less – less meat and more vegetables. (Patient 14, female, 62 years old)

This theme emphasises the multifaceted adjustments participants must make in response to their condition, illustrating the interplay between physical limitations, daily routines, and overall health management.

Theme 3: Complexities of knee osteoarthritis treatment: From pain relief to personalised care

This theme encompasses the diverse experiences and perceptions of participants seeking professional advice and therapeutic interventions for their knee osteoarthritis. Many individuals reported turning to physiotherapy as a crucial step in managing their pain. Participants expressed varying degrees of satisfaction with treatment methods, particularly noting the effectiveness of physiotherapy for pain relief and muscle strengthening, although many recognised it as a temporary solution rather than a cure. For instance, one participant remarked that physiotherapy provided relief while awaiting surgery.

The physiotherapy sessions helped to relieve my pain while I have been waiting for surgery. Physiotherapy is not a treatment method; it's a pain reliever.(Patient 14, female, 62 years old)

While some expressed scepticism about the efficacy of knee braces, citing discomfort and limited effectiveness, others found value in their use during specific activities, such as exercise or cycling.

I dislike it (knee brace). I feel uncertain about how to express my thoughts. The brace restricted my knee, causing itching and redness. But it wasn’t effective if I used it for a short time. Because I have to work, I sweat. It made me red and have an allergic reaction. He asked me not to use it. Due to the nature of my outdoor work, a knee brace is not suitable for me. (Patient 12, male, 68 years old)

For the knee, usually, I will use the knee brace. If the exercise is challenging, a more rigid brace will be used. Some of the braces allow you to squat… It won’t hurt that much if you fall. In case I fall, I won’t hurt that much. (Patient5, male, 62 years old)

Additionally, experiences with acupuncture varied, with some participants reporting immediate pain relief, while others remained uncertain about its overall effectiveness. The quality of care and the individualised approach taken by healthcare professionals were also highlighted, with participants emphasising the importance of tailored treatment plans that address their unique needs and preferences.

This theme underscores the complexity of managing knee osteoarthritis, where patients navigate a range of treatments while seeking relief and improved quality of life.

Theme 4: Exercise and mobility in knee osteoarthritis management

The theme of exercise and mobility highlights the crucial role that physical activity plays in the management of knee osteoarthritis among participants. Many individuals shared specific recommendations for exercises, such as lunges, squats, and cycling, often demonstrated by their physiotherapists to ensure proper technique. Physiotherapists emphasised to the patients the importance of correct movement to prevent further strain.

Participants expressed a commitment to integrating these exercises into their daily routines, with some opting to stretch while watching television or during idle moments, showcasing their adaptability. The significance of stretching and the use of assistive devices, such as knee braces and canes, was also evident, as these tools were recommended to enhance mobility and safety during activities.

Home-based exercise programmes further supported participants, with resources such as pamphlets and instructional videos facilitating continued practice outside of therapy sessions. Motivation to maintain an exercise regimen was driven by a desire for improved health and pain management, with one participant stating:

Because I hope I still exercise, keep the status, and not allow it to deteriorate further. I hope I keep doing it when I need to have a joint replacement, hoping for a better health status. Thus, after the surgery, better recovery time. (Patient 11, female, 70 years old)

Additionally, external resources, including community workshops and online videos, provided further avenues for participants to engage in beneficial exercises. This was exemplified by one participant:

The e-resources were provided by the workshop but not the physiotherapy. There were Facebook pages with videos uploaded. The workshop was organised by the Jockey Club with the elderly centre, targeting knee pain. Anyone who is experiencing problems related to knee pain can join. (Patient 7, female, 62 years old)

This theme underscores the multifaceted approach required to enhance mobility and overall well-being in individuals living with knee osteoarthritis.

Theme 5: Barriers to access and resources in knee osteoarthritis management

The theme of access and resources highlights significant barriers that participants face in obtaining effective physiotherapy or healthcare services for managing knee osteoarthritis. Many expressed frustrations over limited access to physiotherapy treatments. One participant illustrated the gaps in service availability:

Because the maximum number of the physiotherapy sessions was 8 sessions. Once there were 4 sessions. During my most recent therapy, I acquired a new set of skills and received my discharge. I didn’t perform the exercises there. He taught me the home exercises. (Patient 7, female, 62 years old)

Additionally, participants reported challenges in performing prescribed exercises at home due to a lack of necessary equipment.

Financial constraints further complicate access to care, with participants detailing the high costs associated with private physiotherapy sessions, which can range from 700 Hong Kong dollars to over 1200 Hong Kong dollars each. One participant stated:

Because it's quite expensive. It costs around 1000 dollars for one session, and not everyone is able to obtain full coverage from the insurance. These days, some sessions cost 800 dollars, some 900 dollars, and some 1200 dollars. (Patient 4, female, 60 years old)

Alignment of patient experiences with recommended physiotherapy care

Table 4 outlines patient experiences with various evidence-based interventions in the management of knee osteoarthritis, as highlighted in the adapted guidelines.⁶ Regarding land-based exercises, patients received a range of prescribed exercises, including stretching, strengthening, and aerobic activities. Compliance was generally higher among those who could incorporate the exercises into their daily routines and had a positive belief in their effectiveness. Aquatic exercises were only recommended to half the patients, and some found them effective but inconvenient to access.

Table 4.

Alignment of patient experiences of physiotherapy care with the adapted guidelines for knee osteoarthritis.

Level of evidence	Recommendation	Patient experiences receiving care
✸✸✸	Land-based exercises	Patients received a wide variety of land-based exercises from their physiotherapists, including stretching, muscle strengthening (e.g., squats and sit-to-stand), step-ups, stationary cycling, and treadmills. Some patients preferred Tai Chi, Ba-duan-jin, yoga, and dance. Compliance was generally higher in patients who were able to incorporate exercises into their daily routine and home environment and who held a positive belief in the exercise effectiveness.
✸✸✸	Aquatic exercises	Only half of the patients received advice on aquatic exercises from their physiotherapists. Even some of these patients felt aquatic exercises were effective; however, inconvenience (e.g., access to the pool, changing swimsuits) hindered their continuance.
✸✸✸	Patient education	Patients understood that knee osteoarthritis is a degenerative condition with no cure, but physiotherapy can help to minimise the symptoms. Patients were educated on pain management using heat/cold compresses and assistive devices (e.g., knee braces, canes). Some patients also received specific advice regarding their daily activities that required extensive knee movements, like pushing wheelchairs and hiking. In patients who had weight issues, their physiotherapists suggested they lose weight through exercise and diet.
✸✸✸	Self-management	Patients self-managed their knee osteoarthritis using heat/cold and performing exercises. Physiotherapists provided them with pamphlets and/or videos to help them learn exercises. Some patients actively searched for/learnt updated exercises on television or from the internet.
✸✸	Neuromuscular training	While patients named different types of land-based exercises learnt in physiotherapy, only a few were able to describe exercises that were related to balance, agility, and coordination, for example, single-leg stand and heel-to-toe walk. Besides, patients who engaged in yoga and Tai Chi believed that such exercise could help train their balance.
✸✸	Weight management + exercises	Few patients identified their weight problem as an issue. Their physiotherapists reminded them about the importance of weight loss/maintenance in dealing with knee osteoarthritis symptoms. One of the patients also sought a fitness instructor for a specific regime.
✸✸	Assistive devices	Canes were prescribed to and used by patients who were in severe pain and walking unsteadily. One patient preferred to use a cane for better balance even when his physiotherapist perceived it was unnecessary.
✸✸	Braces	Patients who were prescribed a knee brace by their physiotherapists held different views about it. Three patients who used knee braces during exercises found them effective. However, another three patients felt uncomfortable wearing a brace (for example, the size was too loose or too tight, and the surrounding skin was itchy or red). One patient purchased a knee brace and used it for hiking without a physiotherapist's prescription but found it did not help with the pain.
✸	Massage, manual therapy, modalities (such as percutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, extracorporeal shockwave therapy, laser therapy, or heat therapy), acupuncture, and cognitive behavioural therapy	Few patients learnt self-massage techniques from physiotherapists; they all found it effective. Only one patient received manual therapy, and three received acupuncture during their knee osteoarthritis physiotherapy treatment. Patients reported acupuncture helped in immediate pain relief, but the effect was not long-lasting.Some patients received modalities in their physiotherapy sessions, including transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, and extracorporeal shockwave therapy. Prior to such therapies, these patients also received heat therapy.Patients perceived that the role of physiotherapists was to provide strategies for managing physical pain and did not expect them to provide psychological interventions. Few patients reported that their physiotherapists educated them on relaxation techniques (e.g., deep breathing, listening to music) and sleep hygiene.
!	Therapeutic ultrasound, interferential therapy, cold therapy, Kensio taping, footwear	In their knee osteoarthritis physiotherapy treatment, one patient received ultrasound and the other received interferential therapy. While one patient found Kinesio taping helpful, he tried to learn knee taping from his physiotherapist but failed to master the technique. Patients did not receive recommendations on footwear.
!!!	Shoe insole	Only one patient received recommendations on shoe insoles, suggesting the use of softer and thicker ones. One patient wore a shoe insole prescribed by a prosthetist and orthotist for his high-arched feet, indirectly correcting the knee inward rotation issue.
✸✸✸	Strongly recommended
✸✸✸	Moderately recommended
✸	Conditionally recommended
!	Conditionally not recommended
!!!	Strongly not recommended

In terms of patient education, individuals understood the degenerative nature of knee osteoarthritis and the role of physiotherapy in managing symptoms. They were educated on pain management strategies and daily activity modifications. Patients also engaged in self-management, using heat/cold and performing exercises learnt from physiotherapists, with some actively seeking updated information.

While patients described various land-based exercises, only a few could articulate exercises targeting balance, agility, and coordination. However, those practising yoga and Tai Chi believed these activities helped improve their balance. Weight management was minimally addressed for patients who are obese, with physiotherapists only advising them about the importance of weight loss/maintenance.

The use of assistive devices, such as canes, was prescribed to and used by patients who were in severe pain and walking unsteadily. Patients had mixed experiences with knee braces; some found certain brands effective, while others experienced discomfort with different brands of braces. Few patients received manual therapy, acupuncture, or modalities like transcutaneous electrical nerve stimulation and pulsed electromagnetic field therapy, with variable outcomes.

Discussion

This study explored the perspectives of knee osteoarthritis patients regarding physiotherapy care in Hong Kong, identifying barriers and facilitators to effective care. The findings provide insights into the patient journey, highlighting successes and challenges in care delivery. Pain significantly affects daily activities, emphasising the need for individualised pain management.^21,22 Participants used coping strategies such as heat application, exercise modifications, and professional guidance, underscoring the importance of patient-centred care.²³

Experiences with physiotherapy, knee braces, and acupuncture reflect the complexity of managing knee osteoarthritis.^7–9 Physiotherapy was generally perceived as beneficial but temporary, indicating the need for ongoing support and accessible community-based solutions. Dissatisfaction with some interventions underscores the importance of shared decision-making and personalised treatment. Improved education and communication between patients and healthcare providers are essential for better adherence and outcomes.

Physical activity is a cornerstone of knee osteoarthritis management, with participants integrating land-based exercises and assistive devices into their routines.⁹ However, the limited emphasis on balance and coordination exercises suggests an area for further development to prevent falls and improve overall function.²⁴ To support these activities year-round, strategies to increase access to suitable public indoor pools in Hong Kong are required.

Lifestyle modifications are necessary to cope with osteoarthritis's impact on quality of life.^7,8 Participants reported challenges with daily tasks and noted the influence of weather and weight changes on symptoms, highlighting the need for holistic care addressing physical and broader life aspects.²⁵ Environmental factors, such as weather changes, were a recurring concern,²⁶ suggesting personalised adjustments may be beneficial, though this topic remains debated in the literature.²⁷

Access to affordable and comprehensive physiotherapy resources is essential,²⁸ yet patients encounter barriers such as limited access to specialised treatments, financial constraints, and lack of home-exercise equipment.^9,21,29,30 Long waitlists for public services delay timely treatment. Expanding support for home exercise and improving timely access to care are key.³¹ Community-based services, such as District Health Centres, can enhance resource access and management.³²

The alignment between patient experiences and adapted guidelines for knee osteoarthritis physiotherapy care⁶ highlights both successes and areas for improvement in implementing evidence-based recommendations. While many recommended interventions were highlighted, gaps in the consistent delivery of aquatic exercises, neuromuscular training, weight management, and assistive devices suggest further efforts are needed to enhance implementation and uptake in Hong Kong.³³

Our findings are broadly consistent with the international literature on patient experiences with knee osteoarthritis. Recent reviews^8,34 identified universal themes such as the pervasive impact of pain, functional limitations, emotional distress, and the struggle to maintain valued activities, experiences that were echoed by our Hong Kong participants. The review also highlighted the importance of individualised care, clear communication, and the need for healthcare providers to acknowledge patients’ lived experiences and preferences, which were similarly emphasised by our participants. Our findings are further supported by a mixed-methods review which identified similar barriers and facilitators to self-management across chronic musculoskeletal pain conditions, including uncertainty about the efficacy of treatments, motivational challenges, and the importance of tailored support.³⁵ Additionally, a qualitative systematic review on the experience of chronic disease found that patient capacity for self-management is influenced by the mobilisation of resources, managing competing healthcare and life priorities, and the supportive nature of their social networks and environment.³⁶ Echoing the challenges described by our participants, a systematic review on self-management support strategies in primary care also highlighted barriers to physical activity and exercise, such as pain, lack of motivation, and environmental constraints, as common issues across chronic pain populations.³⁷

Context-specific nuances, such as the high cost of private physiotherapy and the challenges in accessing aquatic therapy in Hong Kong. Cultural influences, including traditional Chinese medicine and family involvement, were particularly salient. These factors echo findings from non-Western contexts included in Mathieu et al.,³⁴ By situating our results within this robust global evidence base, our study contributes to a more nuanced understanding of both the universal and context-specific challenges faced by people living with knee osteoarthritis. This highlights the need for locally adapted strategies that address unique population needs.

Considering patients’ perspectives is essential for developing evidence-based care.³⁸ Incorporating these insights allows healthcare providers and policymakers to tailor strategies, improving treatment delivery and uptake.

The rigorous qualitative methodology ensures the transparency and trustworthiness of the findings. The purposive sampling strategy³⁹ enhances the transferability of the results. Concurrent data analysis and the involvement of multiple researchers in coding and theme development strengthen the credibility and dependability of the findings. However, several weaknesses exist. The findings may not fully represent the diversity of the knee osteoarthritis patient population in Hong Kong. The study's reliance on retrospective accounts may be subject to recall bias.⁴⁰ Real-time data collection methods could provide more immediate insights. The focus on patient perspectives may overlook healthcare provider factors. Conducting the study in different contexts could enhance understanding of contextual factors shaping patient experiences.

In conclusion, this study highlights the experiences of knee osteoarthritis patients in Hong Kong and the importance of patient-centred, tailored care. Addressing barriers and providing accessible resources can enhance self-management and improve quality of life.

Clinical messages

Patients’ experiences emphasise the need for shared decision-making and tailored treatment plans.

Improved education and communication between patients and healthcare providers are essential to addressing scepticism about interventions.

Focusing on balance and coordination exercises can prevent falls.

Weight management and exercise adherence should be integral to care plans.

Footnotes

Acknowledgements

The authors gratefully acknowledge the participants for their valuable contributions to this study.

ORCID iDs

Fadi M Al Zoubi

Arnold YL Wong

Mandy MP Kan

André E Bussières

Ethical approval

The study protocol was approved by the Ethics Committee at The Hong Kong Polytechnic University [reference number: HSEARS20221027006].

Consent to participate

The research participants received written and oral information about the study and provided written informed consent prior to data collection.

Author contributions

All authors contributed to the planning and design of the study. Mandy Kan conducted the interviews. Mandy Kan, Fadi Al Zoubi, and a research associate analysed the data. Fadi Al Zoubi wrote the first draft of the manuscript. All authors critically revised the manuscript and approved the final version for publication.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Health and Medical Research Fund (grant number: 20211271).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

All relevant data are presented within this article.

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