How do experiences and perceptions unfold in adolescents with longstanding non-traumatic knee conditions over time? A...

Adolescents' perceived uncertainty regarding diagnosis and its causes are significant barriers to acceptance of their knee pain and formation of self-management skills. This study uses a repeated interview design to explore how adolescents with longstanding non-traumatic knee pain experience and perceive changes over time in their condition, needs, understanding of knee pain, and self-management. Ten adolescents with longstanding, non-traumatic knee pain were included. Each adolescent participated in two semi-structured online interviews. The first interview took place 1-3 days after the consultation, followed by a second interview 11-17 days later. Data were analyzed using reflexive thematic analysis, and findings from both time points were synthesized using a matrix analysis. Ten adolescents aged 12 to 15 years were included in the study. Most were female (n= 8). The analysis generated five themes for each interview time point. The matrix analysis generated key areas that illustrated how adolescents' perceptions and experiences evolved over time: (1) Limited recall and understanding of medical information; (2) Seeking proof: validation, reassurance and diagnostic confirmation; (3) Diagnosis as normalization and validation over time; (4) Reinforced beliefs: a rigid dichotomy between activity and rest; (5) Trial-and-error approach to pain management strategies; (6) Uncertainty and frustration in the absence of a clear recovery timeline. Adolescents' experiences and perceptions are dynamic; they are maintained, reinforced, and changed over time. These findings raise questions about how healthcare professionals should communicate and support adolescents to enhance their understanding of pain and adapt recommended self-management strategies. PERSPECTIVE: The key areas illustrate how adolescents' uncertainty, experiences, perceptions, and trial-and-error self-management evolve over time. These processes become integrated into the trajectory of living with knee pain and lay the foundation for how adolescents understand and manage their pain. Findings may inform more personalized communication and interventions to support self-management.