Slow march to surgery: using the COM-B model to explore the lived experience of individuals with knee osteoarthritis,...

This study aimed to explore the lived experiences of people with knee osteoarthritis (KOA) awaiting Total Knee Replacement (TKR).

Fifteen semi-structured interviews were conducted with participants with a diagnosis of KOA. Transcripts were first analysed inductively with reflexive thematic analysis. Inductive themes were deductively aligned to the COM-B model ('Capability', 'Opportunity', 'Motivation' and 'Behaviour') to provide additional understanding of how people navigate the management of KOA and their experiences while awaiting surgery.

Four inductive themes were generated and mapped into the COM-B component. (1) 'Altered health beliefs drive a biomedical focus on KOA management' (Capability): participants largely understood KOA as an inevitably degenerative condition culminating in surgery. (2) 'Interactions with healthcare professionals reinforce surgical inevitability' (Opportunity): participants described clinical encounters that strengthened their biomedical interpretations and shaped expectations of surgery as the primary solution. (3) 'The emotional burden of KOA' (Motivation): emotional strain contributed to decisions to pursue surgery. (4) 'Coping strategies for managing KOA pain' (Behaviour): participants employed a range of self-directed strategies to manage symptoms while awaiting surgery, often with limited guidance.

This study provides a novel, theory-informed understanding of how people awaiting TKR make sense of, engage with, and manage KOA. Using the COM-B model to map these experiences illustrates how current pathways can unintentionally weaken motivation and opportunity to engage with evidence-based first-line interventions like exercise. These findings indicate the value of supporting people with KOA to better understand and access first-line options before considering surgery.