Health Promotion in Individuals with Knee Pain – Different Ways to Enable and Maintain a Balance in Everyday Life Based on the Abilities

Background: Most individuals with knee pain develop radiographic knee osteoarthritis over time [1], and up to 30% develop chronic widespread pain (CWP) [2]. Many studies only focus on physical activity or weight loss when it comes to managing knee osteoarthritis (KOA) and chronic pain. There is a challenge to get more individuals to follow the existing recommendations for KOA, including physical activity and weight loss [3]. However, the interaction between the various physical, mental, and social factors regarding health promotion is complex. More research is needed to understand health-promoting activities applied amongst individuals with knee pain. Objectives: To explore health-promoting activities in individuals with knee pain. Methods: The study was a part of the Halland Osteoarthritis cohort (ClinicalTrials.gov NCT04928170), including 306 individuals with knee pain without earlier diagnosed KOA, cruciate ligament injury or other rheumatological disorder. A purposeful sample of 22 individuals (13 women, 9 men; median age 52 years) participated in the study. Ten had radiographic KOA, 12 had chronic regional pain, 9 reported CWP, 16 were overweight, and 13 met the WHO recommendations for physical activity with moderate intensity. Semi-structured interviews were conducted and followed a pilot-tested interview guide initiated with open-ended questions such as “What do you do to maintain your health?” and “What enables you to keep health?”. The interviewers followed the participants reasoning, and to obtain depth in the data, the participant received follow-up questions such as “Please, can you tell me more about…?”. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed by latent qualitative content analysis and revealed an overall theme including two categories and six sub-categories. Results: Health-promoting activities in individuals with knee pain were interpreted in the overall theme; enabling and maintaining a balance in everyday life based on abilities. Two categories explored the content in health-promoting activities as 1) Using facilitators to take care of the body with the sub-categories: being physically active, having a healthy diet, and using external resources. For example, the participants took care of the body by being physically active to decrease pain, reducing sugar intake and using external resources such as online workouts or help from health care. 2) Managing stressors of everyday life with the sub-