PAINSTORIES – Exploring the temporal developments in the challenges, barriers, and self-management needs of adolescents with longstanding knee pain: A qualitative, retrospective interview study with young adults experiencing knee pain since adolescence

Patient education is essential to enable rehabilitation and self-management of longstanding knee pain in adolescents. Currently, a lack of insights into the socio-cognitive processes governing adolescents' self-management remains an obstacle for enhancing treatment efficacy. This study developed a conceptual model for integrating adolescents' challenges and barriers into future treatments. We conducted semi-structured retrospective interviews with 14 young adults (age 21-25 years) with knee pain since adolescence (9 years mean duration). Temporal developments in participants' knee pain was captured through a memorization exercise. Data was analyzed via the General Inductive Approach. Themes were organized into a matrix, extracting a conceptual model, which was tested with eight new participants. The analysis identified seven themes. Further interpretation, via the matrix, organized these within a four-stage trajectory of; gaining awareness, knowledgeability, contextual application and reconceptualization, each with different challenges and dilemmas, participants had to overcome to progress their self-management. Testing the conceptual model, confirmed stages and highlighted acceptance as key to overcoming barriers. The study described adolescents' integration of self-management as proximal and inquiry-based, with acceptance, driving increasingly complex management behaviors. We hypothesize future interventions may benefit from exploring supporting adolescents' inquiries into their knee pain at different stages of the trajectory.