# Experiences and perceptions of Chinese patients enrolled in a clinical trial assessing tuina and manual therapies for knee osteoarthritis: a nested qualitative study

## TL;DR

This study explores how Chinese patients with knee osteoarthritis experience and perceive manual therapies like Tuina, highlighting the role of doctor-patient interactions and treatment expectations.

## Contribution

The study introduces a patient-centered model of doctor-patient interactions in manual therapy for knee osteoarthritis, emphasizing contextual and experiential factors.

## Key findings

- Three key themes emerged: Understanding and Impact, Treatment Expectations and Satisfaction, and Treatment Goals and Outcomes.
- A doctor-patient interaction model was developed to guide manual therapy for knee osteoarthritis.
- Patient perceptions highlight both benefits and limitations of manual therapy interventions.

## Abstract

KOA is a prevalent joint disorder significantly impacting patients’ quality of life. Tuina and manual interventions are prioritized in clinical practice within the Chinese healthcare context. Current qualitative studies mostly focus on symptom management and basic disease perceptions, overlooking patient-centered treatment expectations, therapeutic process perceptions, and doctor-patient interaction impacts during manual therapy. This study aims to address these gaps by exploring Chinese KOA patients’ experiences, perceptions, and expectations of manual therapy, emphasizing contextual factors affecting therapeutic outcomes and interactions.

Participants with KOA were sampled using a simple sampling method from a randomized controlled trial of Tuina treatment versus manual physical therapy (MPT). The interviews were conducted by two researchers who have extensive experience interviewing KOA patients, and data were gathered through face-to-face, semi-structured interviews to ensure a high level of information power. Three experienced researchers subsequently analyzed employing thematic analysis to assess patient experiences and outcomes from both treatment modalities.

The study interviewed a total of 61 participants, thematic saturation was reached when interviewing 42 participants, and seven codes along with 5 sub-themes were utilized to depict potential doctor-patient interactions and influencing factors. This process led to the formation of three themes: Understanding and Impact, Treatment Expectations and Satisfaction, and Treatment Goals and Outcomes, which helped in constructing a model to understand the underlying influences among these themes.

Our study generated three themes—Understanding and Impact, Treatment Expectations and Satisfaction, and Treatment Goals and Outcomes, and developed a manual therapy model based on these themes. The generated model shows the important factors of doctor-patient interaction in KOA manual therapy management. Future research should expand to multidisciplinary and cross-cultural models to align standardized protocols with individualized patient needs.

The online version contains supplementary material available at 10.1186/s12906-025-04926-7.

Using a qualitative research design to explore various influencing factors in manual therapy for KOA, we generated a doctor-patient interaction model for manual therapy in KOA, aiming to identify key priorities for clinicians in optimizing treatment strategies and delivering holistic care. Employing a patient-centric approach, capturing diverse patient experiences and perceptions, including potential doctor-patient interactions, for application in medical practice. Providing an in-depth exploration of patient experiences with manual therapy interventions (e.g., Tuina and manual physical therapy), highlighting both perceived benefits (e.g., pain relief) and limitations (e.g., variability in treatment responses).

The sociocultural and clinical context of outpatient care in China may limit the transferability of results to populations in other healthcare systems or cultural environments. As a nested qualitative trial, this research inherits limitations from the parent trial, this may affect the flexibility of applying findings to diverse clinical practices.

The online version contains supplementary material available at 10.1186/s12906-025-04926-7.