Table 2 Main themes and their ranking by each respective nominal group for barriers to current treatments not working for knee osteoarthritis (OA)

 B. The weight loss would help, but it’s not easy.

6

 D. My insurance doesn’t allow me to do therapy as long as I would like to do it.

3

 G. Pills have side effects..

3

 A. Shots in my knees, have to be done repeatedly.

0

 C. Need to do physical therapy for a long time, 6 weeks at a time, it’s very hard.

0

 E. Pandemic caused a lot of problems, you can’t have anything done- getting physical therapy.

0

 F. Most of the medicines don’t work. It’s temporary; the pain comes back.

0

 D. Medicine helps some, but pain persists.

7

 E. Medicine has side effects.

4

 C. I got an injection that relieved my pain, and it lasted only 3 months.

4

 F. Weight loss is difficult.

3

 B. Exercise makes knee pain worse.

2

 G. Therapy: I am unable to do it, as I should.

2

 H. Therapy making OA symptoms worse.

2

 A. Problem doing exercise.

0

 C. Pain remedies only address pain: treatments are only prophylactic, and only for the most difficult days.

5

 E. Sometimes we have more weight that causes us to have more pain.

4

 B. The missing cartilage is still missing. Activity and weather still affect the pain. Until something is done for the cartilage, the pain will continue.

3

 F. We don’t exercise the way we should exercise.

3

 A. I feel like it’s not working, because I am not taking the right medicine. The pain is still there. I feel like my medicine should be changed.

2

 G. The weather—cold weather.

1

 D. In order to function, I have pain and swelling, so there is some trade-off.

0

 A. After your cartilage is gone, it’s just bone on bone, I don’t think any treatment other than the surgery will work.

21

 B. According to me, it’s just trial and error, some meds may work for some people, and some don’t; they don’t last a life time; I have taken medicine and I have had to go up my medicine, because half the time it doesn’t work and when it does work it does not last long.

8

 C. Medicine side effects to certain meds.

4

 G. I am not able to exercise because of pain/weak muscles.

4

 D. Being too overweight, the exercise can exacerbate the wear.

3

 F. I have had several injections that don’t work/need them more frequently.

3

 H. If the medication doesn’t work within the first couple of days, a lot of people will quit taking it, because they don’t see the benefit..

3

 I. You are not following the proper medicine regimen.

2

 E. Some medicines make the wear of the joint quicker.

0

 A. Medicine: the reason I think it doesn’t work very well, because I take other medications. And I have to take this medication to counteract the other medication, so that It won’t affect my liver or my kidney. That’s one of my opinion is why I think the mediation doesn’t work.

7

 B. Weight loss: MOTIVATION: I feel sometimes it is easy to get started losing weight. In the second week, it’s hard to move around and get tired and have to slow down. And getting depressed and getting something to eat, and weight loss, sometimes, you want to give up.

4

 L. By the time you start you start any treatment, it’s too late.

3

 C. Weight loss: difficulty getting adequate weight loss.

2

 D. Physical therapy: TOO MUCH, cause too much pain: which I experienced. I went to the therapy; it all depends on who you have. Some therapists don’t push you enough and some push you too hard. “You can do few more and sometimes it does more damage.”

2

 G. Exercises: lack of equipment.

2

 J. Injections: incorrect spot: first of all, the injections, I have had many. Most of them don’t work. Sometimes I think injections are not in the right place.

2

 K. Overall, the problem is hereditary. And nothing would work.

1

 E. Physical therapy: variable, varies by who you go to in PT.

1

 F. Exercises: not knowing: while I do feel like I am ok when joints loosen up, I feel like I am 17 and then go out there and overdo it.

0

 I. Exercises: temporary relief.

0

 H. Exercises worsen pain: again, the exercise. I have done exercises, but if I overextend, it makes it worse.

0

 A. I believe that the treatments work on a limited basis to treat the symptoms.

8

 C. Motivation/pain: it’s hard to get motivated when you are in pain.

8

 D. However, once you lose the cartilage or it is damaged, then these treatments do not do anything to regenerate the cartilage.

5

 G. I also have lupus and they say that’s part of my problem too—trouble with taking knee arthritis medications due to lupus.

1

 H. My arthritis gets worse with daily activities, because I am active, and that’s why meds don’t work well for me.

1

 I. My doctor has progressively gotten more aggressive with my meds based on my daily activities and my pain level; I don’t think that’s getting it.

1

 E. Like for me, it’s hard to lose weight to be able to take off some pressure off my joints.

0

 F. Medical profession should look at other alternatives, rather than man-made medicines, like natural medicines.

0

 B. Motivation/time: when you get back to the real life, you can’t put so much work into, then when you are off.

0

 C. Routine: exercise at least 15–20 min a day.

5

 H. Lack of motivation/it takes commitment.

5

 D. Weight loss may not work sometimes: watch your weight

3

 E. Personalized treatment with medicines: because medicines haven’t been tested enough.

3

 A. May be because I am not on the right diet—tomato, pasta.

3

 G. It doesn’t build your cartilage.

3

 B. Prepare your own food instead of eating out all the time.

1

 F. Personalized therapy, weight loss, and exercise plan

1

 I. Physical therapy can make you hurt

0

 H. I think there is a lot of natural remedies that can help rebuild without all of the medications that told us to take.

6

 B. It’s the general medication or regimen for everybody; like you are doing one pill for everybody.

3

 C. Individualized PT and exercise.

3

 A. Pain interferes with the ability to do therapy—no immediate relief with PT or meds.

2

 E. The damage is already done; there is nothing to help you healing of your knee, you have no cartilage.

2

 F. Side effects with medication.

1

 G. Injections only last 2–3 months.

1

 D. With exercising with medication together might give them a sense of relief.

0

 I. Strain of physical work is interfering with treatment effectiveness.

10

 E. Bone on bone cartilage is gone, treatments don’t work.

9

 A. Medication: the reason why medicine doesn’t work, you have to keep constantly taking and there is a price point.

3

 C. Paying for therapy, it does work, but you have constantly pay for that too.

1

 D. Weight loss may have some effect on pain, but pain is still there.

1

 B. No individualized medication treatment.

0

 F. No individualization of the strength training in your knees.

0

 G. Natural medicines, I believe, help; I believe vitamin D from Sun can also help.

0

 H. No plan how to go from physical therapy to exercises at home.

0

 J. Use hot and cold pack to improve effectiveness of these treatments.

0

 E. Weight loss is difficult to get and to maintain.

5

 F. Exercise may not work sometimes—a lot of people can’t do what I do- Motivation issues.

3

 A. No cartilage left in my knees (and hips).

3

 C. The pain; I had trouble with therapy and exercise with the pain.

1

 B. Prescribed medicines don’t work: I don’t think the medicines worked and did what they were supposed to do.

0

 D. I wasn’t making any progress after some time with therapy, I thought I could make more progress myself.

0

 G. Taking better care of yourself and your life.

0

 G. Cost/access to exercise and weight loss programs.

6

 L. Psychology/education for exercise: you have tried it before and sometimes you don’t know how to change your behavior.

4

 H. Exercise: this comes down to time availability.

2

 A. Weight loss: its daunting if you struggled with weight through your life, it could seem unachievable.

0

 B. Weight loss: lack of time to dedicate to weight loss.

0

 C. Weight loss: food prep.

0

 D. Weight loss: mental health aspects, depression, and body image issues.

0

 E. Confusion over contradicting diet plans.

0

 F. There is shor- term FU through medicine, and there is lack of modification effort—what was originally recommended doesn’t necessarily work.

0

 I. Exercise: pain especially and fatigue.

0

 J. Exercise: COVID, restricted access to weight training and other work-out facilities.

0

 K. Exercise: lack of motivation.

0

 C. Motivation for weight loss and exercise: exercise is very hard to do because of what you need to do exercising, due to difficulty in exercising due to the pain.

3

 H. Weight loss: challenges.

3

 A. Medicine: can be addicting, and unable to take for long periods.

2

 B. Medicines are usually only usually providing temporary relief of the pain.

2

 F. Side effects of medicines.

1

 G. Exercise: motivation due to pain in movement.

1

 D. Physical therapy: strengthens muscles but doesn’t help with pain.

0

 E. Injections: short-term and painful.

0

 I. Most of these are short-term solutions.

0

 A. Medicine: help a little bit, but the problem is that it doesn’t happen quickly enough, the different things I take.

6

 E. Lack of motivation for exercise.

4

 H. Damage is done, even with weight loss and therapy.

2

 B. The weight loss part is a big one for me, but can’t do.

0

 C. I can’t do exercises because of the knees.

0

 D. Talking therapy: pool, water therapy is good, but now, they have been shut down due to the COVID.

0

 F. Brace, which I have works, but I need help to put it on, but I have nobody here to help me to put it on.

0

 G. Creams are not strong enough for pain.

0

 I. Pool are good, but they are expensive, and the insurance does not cover it.

0

 A. Individual difference in response to Pills and creams: each individual is different, what might work for me, doesn’t work for another person.

6

 F. Weight loss and exercise: no instant gratification, as human beings a lot of times we don’t want to finish what we start if no gratification.

4

 G. Individual differences in disease: it strikes me as an important component of the individuals with pre-existing conditions, genetic predisposition to osteoarthritis.

4

 D. Will power to continue the weight loss: don’t have the will power to keep going.

3

 J. Difficulty in getting opioid Pain meds: Very difficult to get anything for actual pain, other than the anti-inflammatory agents.

3

 H. Pain with the physical therapy: did not seem to be beneficial for the length of time, I did go. I didn’t seem to feel that I was benefiting much from it, other than the pain from the exercises.

2

 K. Medicine works temporarily, because I feel that it numbs the information in your brain to stop hurting. Puts you in melatonin state to not feel the aching and hurting.

2

 B. You don’t complete the treatment. Once you feel better, you stop using the cream or stop using the pills.

0

 C. Adherence to pills: not consistent, not taking the meds the same time every day.

0

 E. Become lazy with exercise and just give up.

0

 I. Problem taking medications due to other diseases: I found that most of the medications I tried had limitations. For example, taking the anti-inflammatory agents, because of my liver and kidney damage, they were not advised for long-term use.

0

 L. You don’t incorporate the therapy into lifestyle, once you stop the therapy.

0