Using the Theoretical Domains Framework (TDF) and COM-B model, this study aimed to determine the facilitators to a support tool for adolescent non-traumatic knee pain in general practice.

Many children and adolescents with non-traumatic knee pain consult their general practice. Currently, there are no tools to support general practitioners in the diagnosis and management of this group. There is a need to identify behavioural targets that would facilitate further development and implementation of such a tool.

This study was designed as a qualitative study using focus group interviews with 12 medical doctors working in general practice. The semi-structured focus group interviews conducted online and followed an interview guide based on the TDF and COM-B model. Data were analysed via thematic text analysis.

One of the biggest challenges from the general practitioner’s perspective was how to manage and guide adolescents with non-traumatic knee pain. The doctors had doubts in their capability to diagnose knee pain and saw opportunity to help structure the consultation. The doctors felt motivated to use a tool but considered access a potential barrier. Increasing opportunity and motivation by creating access in the community among general practitioners was considered important. We identified several barriers and facilitators for a support tool for the management of adolescent non-traumatic knee pain in general practice. To align with user needs, future tools should support diagnostic workup, structure the consultation and be easily available among doctors working in general practice.

Knee pain affects 25% of the population aged over 55 years and is the most common complaint of pain among those consulting for primary care. However, a large proportion do not seek help, with up to 50% of those with the most severe form of pain not consulting. Little is known about why this appears to be happening. Our aim was to examine whether consultations for concurrent comorbid disease had any influence on an individual's likelihood of consulting for knee-related problems in primary care.

This was a case–crossover control study of patients aged over 50 years from three North Staffordshire practices with knee pain followed over a three-year period. All comorbid consultations for the same period were identified. The date of knee consultation cases were identified, and within-subject control days for the same individual were determined for 12 months previously or later where there was no knee consultation. McNemar's test for matched pairs was then carried out to assess whether consultation for either a chronic or acute condition in the preceding three months was associated with knee consultation.

A total of 281 participants were included in the case–crossover analysis. There was a lower frequency of chronic comorbid consultations in the three months preceding knee consultation than in either the previous (OR = 0.30; 95% CI 0.11, 0.74) or later control windows (OR = 0.56; 95% CI 0.27, 1.09). There was no difference in the frequency of acute comorbid consultations.

This study suggests that consultations for knee problems are preceded by a period of relatively fewer consultations for other chronic comorbid conditions. Patients might choose to consult for their knee problem when comorbid issues are not a priority. Future research might investigate whether certain comorbid conditions have a greater effect than others, and whether a proactive approach such as screening for knee disorders might improve prognosis?

To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability.

Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged >25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI ≥ 25·0 kg/m2, moderate overweight as 25·0 kg/m2 ≤ BMI < 30·0 kg/m2 and obesity as BMI ≥ 30·0 kg/m2. Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (>3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D).

Moderate overweight was associated with self-reported OA of the hip or knee (OR = 1·7; 95 % CI 1·4, 2·1), chronic pain of the lower extremities at one or more location(s) (OR = 1·6; 95 % CI 1·3, 1·9) and disability in mobility (OR = 1.7; 95 % CI 1·4, 2·0). For obesity these odds were higher: 2·8 (95 % CI 2·1, 3·7), 2·5 (95 % CI 1·9, 3·2) and 3·0 (95 % CI 2·3, 3·9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility.

There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.