Table 3 Key findings and illustrative quotes from physiotherapist interviews

Responding to pain

“If you can get pain management sorted and you can get sleep, …, then, everything else is much easier. So often those are the starting points to enable self-management”(P3, female)

“I try and get away from thoughts of ‘pain equals damage’ or ‘if you feel pain you must stop’ because that’s not a good message. If your knee is gently saying, ‘I’m here and its generally tolerable or it’s aching a little then that’s fine’, carry on and see how it goes” (P4, female)

“Usually, it’s not a ‘you have to stop doing this’, it’s a ‘you can find a way around it’ and trying to think of the whole spectrum of the condition and how it could be adapted to suit the patient” (P4, female)

Modifying activities seen as key to remain active in enjoyable and sociable activities

“I think pacing is quite important…so if they gardened all day and then, that night, they had disrupted sleep because of their overactivity, I would then go back to talking about how important it is that they introduce an activity and build up their levels of activity” (P3, female)

“I would say if somebody’s hobby has always been gardening, we need to ask how we can modify this with aids, or, for example reducing kneeling time, changing sitting positions etc.” (P4, female)

“Some activities like golf for example are very social, so it important to try and understand how we can keep them involved with these activities due to the other benefits, but modifying it to better suit them, such as using a buggy or an electric caddy”(P2, female)

Assessing the suitability of exercises

“So, I’d probably ask, initially, their impression of the class and how they felt. Did they come out feeling confident, did it challenge them, did they feel happy coming out of the class, so actually more of their emotional side of how they felt and then I’d look at questioning them really about how it was then affecting their, knees and the pain they are experiencing” (P5, male)

“So straight away, on the cardio list, I would say, generally, the ones that I would definitely say are ‘go-to’s’ are the swimming, the cross trainer and the Nordic walking, because they’re generally around the sort of low impact and you’ve got support as in the water” (P4, female)