Will patients with meniscal tear who continue to experience pain following a course of Physical Therapy (PT) enroll in a trial comparing further nonoperative therapy with surgery? a qualitative study

BACKGROUND: We aimed to conduct a qualitative prospective preference assessment (PPA) to assess participants’ willingness to enroll in a planned randomized controlled trial (RCT). The planned RCT would enroll participants with meniscal tear with persistent knee pain following a course of physical therapy (PT) and would compare outcomes of arthroscopic partial meniscectomy (APM) vs. enhanced conservative care. METHODS: We identified participants 45–85 years old with suspected meniscal tear who were referred to PT. After 10 weeks of PT, participants were sent a questionnaire that assessed knee pain. We asked participants reporting persistent knee pain to participate in a follow-up interview. We conducted semi-structured interviews and coded and analyzed transcripts to identify themes related to enrollment in our planned RCT. RESULTS: We analyzed transcripts from twenty participants (mean age (SD): 61.6 (6.16); 60% male, 100% White). 70% said they would participate in the trial. Willingness to enroll was associated with participants’ preferences for treatment modality and most were willing to continue PT, despite reporting persistent pain. Of those unwilling to enroll, all were averse to surgery or did not believe they needed surgery. Others had concerns about oral medications and injections, but these were not “dealbreakers” for willingness to enroll. Provider trust was a dominant decision-making factor in respondents’ willingness to enroll. CONCLUSION: These findings suggest that investigators should consider additional education for participants regarding the benefits and risks of all treatment options at the time of enrollment invitation. Additionally, the trial should be introduced by a trusted provider.