Building trust and increasing inclusion in public health research: co-produced strategies for engaging UK ethnic minority communities in research

Patient and public involvement and engagement (PPIE) is essential for improved research outcomes and reduced research waste. To be effective, PPIE should provide opportunities for diverse groups to contribute to all research stages. However, UK ethnic minority communities remain underrepresented in research. This article describes strategies adopted in a public health research project that were effective in building trust and increasing inclusion of ethnic minority communities. The study team of researchers and PPIE partners reflects lessons learnt during the project and describe six main strategies that built meaningful levels of trust and inclusion: 1) early start to recruitment of PPIE partners; 2) relationship-focused engagement; 3) co-production and consultation activities; 4) open communication and iterative feedback; 5) co-production of project closure activities, and; 6) diverse research team. Meaningful outcomes for the community included the involvement of people from ethnic minorities as research participants and PPIE partners, community wellbeing, co-production of public health recommendations co-presented at the UK Houses of Parliament, and consortium-wide impact evidenced by the enrolment of 51 active PPIE partners. PPIE partners reflect on their research involvement, offering advice to researchers and encouraging people from ethnic minority communities to take part in research. An important message from PPIE partners is that involvement should not be restricted to projects specific to ethnic minorities but become a routine part of general population research, recognising ethnic minorities as an integral part of UK society. In conclusion, this article demonstrates that with appropriate strategies, inclusion and diversity can be achieved in public health research. We recommend researchers, practitioners and policy makers adopt these strategies when planning their public health projects.

Musculoskeletal injury in military specialists: a 2-year retrospective study

BACKGROUND

Military specialists are elite personnel who are trained to work across diverse operational environments where a high level of physical conditioning is a prerequisite for their role. Anecdotally, personnel are acknowledged to be at high risk of developing musculoskeletal injuries (MSKIs). However, there are presently no published data on this UK military population to support this view. This is the first (2-year) retrospective epidemiological study to identify the MSKI sustained by this military population.

METHODS

All MSKI reported over a 2-year period (January 2018-December 2019) were recorded to identify the incidence, frequency, nature, onset, cause, location and reporting times. Injuries were described using injury count and relative frequency (percentage). Time at risk for each personnel day was calculated as 365 days.

RESULTS

A total of 199 personnel reported 229 injuries over the reporting periods. The injury incidence rates were 26.8 personnel per 100 person years (2018) and 27.7 personnel per 100 person years (2019), respectively. Military training accounted for the highest number of injuries (32%), followed by 'other injuries' (28%), personal training (28%) and sport (12%). The leading activity associated with injury was weight training (15%), followed by running (11%) and military exercise (10%). Lower extremity injuries accounted for the highest number of injuries (40%), followed by trunk (36%) and upper extremity (24%) injuries.

CONCLUSION

This study identifies the MSKI profile of a military specialist population over a 2-year period. Areas where modifiable risk factors may be identified to reduce risk of injury are highlighted. Recommendations for further research include investigating injury burden and the impact of injury on operational readiness.

Assessing injury risk in male and female Royal Navy recruits: does the Functional Movement Screen provide understanding to inform effective injury mitigation?

INTRODUCTION

Musculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk.

METHODS

The present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period.

RESULTS

Total FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01).

CONCLUSION

There was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.

Clinical Utility of Ultrasound Imaging for Measuring Anterior Thigh Thickness after Anterior Cruciate Ligament Injury in an Individual Patient to Assess Postsurgery Outcome

The present study investigated the clinical utility of ultrasound imaging (USI) for assessing changes in an individual's quadriceps muscle and subcutaneous fat (SF) thickness of the anterior thigh and their relative proportions. A patient was studied prior to and after anterior cruciate ligament reconstruction (ACLR) surgery and during rehabilitation. This case study involved an 18-year-old female recreational athlete with a complete tear of the anterior cruciate ligament (ACL). Tissue thickness (SF and quadriceps muscle) was measured from transverse USI of the anterior thigh before surgery, at weekly intervals during 12 weeks of postsurgery, and then every 2 weeks for the following 12 weeks (total of 21 measurement sets). Statistically significant differences presurgery to postrehabilitation were found for muscle thickness (p = 0.04) and SF tissue thickness (p = 0.04) measurements. There was no difference in muscle to fat ratio (p = 0.08). Changes in measurements greater than the reported minimal detectable change (MDC) demonstrate the sensitivity of the USI technique as an objective tool to assess clinically useful changes in an individual's anterior thigh muscle thickness post-ACLR surgery and during rehabilitation.

Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study

INTRODUCTION

Movement screening to identify abnormal movement patterns can inform development of effective interventions. The primary objective of this study was to evaluate the feasibility of using a movement screening tool in combination with a tailored movement control retraining programme in young soccer and rugby football players. A secondary objective was to investigate changes in movement control patterns post-intervention, to provide proof of concept (PoC) for movement retraining.

METHODS

52 male amateur players, including 34 soccer players (mean age 15 ± 2 years) and 18 rugby players (mean age 15 ± 1 years) participated. They were screened for movement control ability using a shortened version of the Hip and Lower Limb Movement Screening (Short-HLLMS) and completed an eight-week movement control retraining programme. Evaluation of feasibility included consent from players invited, adherence, attendance at the exercise sessions, drop-out and adverse events. Short-HLLMS total score and The Copenhagen Hip and Groin Outcome Score (HAGOS) were analysed to provide PoC for retraining movement control.

RESULTS

feasibility outcomes were favourable. Significant statistical changes occurred post-intervention in the Short-HLLMS total score (paired-samples t-test) and in three HAGOS subscales (symptoms, physical function in daily living and in sport and recreation) (Wilcoxon-Signed Rank Test) in both groups.

CONCLUSIONS

Feasibility of using the Short-HLLMS in combination with a movement control retraining programme in soccer and rugby players was promising. The data provided PoC for the potential application of a shortened version of the HLLMS to evaluate changes in movement control and to inform targeted motor control programmes.

P04-04 Non-invasive biomarkers with high discriminant ability indicative of musculoskeletal health with ageing

Background

The use of large-scale pooled analyses and data sharing is a potential source to generate evidence to address complex scientific challenges and develop strategies to promote healthy ageing. However, the success of such analyses depends on robust measurements of musculoskeletal (MSK) health in ageing. Simple tests indicative of MSK health and suitable for use with older people are required. This study aims to assess the discriminatory ability of a combination of routine physical function tests and novel measures, notably muscle mechanical properties and ultrasound imaging of thigh composition (relative contribution of muscle and subcutaneous adipose tissue) to classify healthy individuals according to their age and gender.

Methods

This cross-sectional study included 138 community-dwelling, self-reported healthy males and females (65 young, mean age±SD = 25.7±4.8 years; 73 older, 74.9±5.9 years). Handgrip strength; quadriceps strength; respiratory peak flow; timed up and go; stair climbing; anterior thigh tissue thickness (using ultrasound imaging), muscle mechanical properties (stiffness, tone and elasticity; Myoton technology); and self-reported health related quality of life (SF36) were assessed. Stepwise linear discriminant analysis was used to classify cases based on criterion variable derived from the known effects of age on physical function.

Results

Combining conventional physical function tests with novel measures, revealed two discriminant functions which significantly (Wilks's λ = 0.05, 0.34; p>0.001) classified 89% of grouped cases with 11% error rate using leave-one-out cross-validation. Seven variables associated with grip strength, peak flow, timed up and go, anterior thigh thickness, and muscle mechanical properties demonstrated high discriminant ability (p>0.05 correlation with discriminant functions) to classify healthy people.

Conclusions

The present study provides reference data for comparison with clinical populations and a comprehensive battery of non-invasive dry biomarkers with high discriminant ability indicative of musculoskeletal health. The most sensitive novel biomarkers require no volition, highlighting potentially useful tests for screening and monitoring effects of interventions on MSK health for vulnerable older people with pain or cognitive impairment. Older misclassified cases who appeared younger than predicted support the need for studies of older people with different habitual activity levels, to provide relevant reference values for assessment, so rehabilitation goals are targeted appropriately.

P04-05 Testing muscle strength and dynamic balance in older recreational golfers and healthy sedentary non-golfers in community settings

Background

Regular physical activity is known to reduce premature mortality, and help prevent and manage chronic diseases. Despite this, older people are not sufficiently active. Playing golf is associated with better aerobic fitness and mental wellbeing but evidence of a relationship with strength and balance is lacking. If the physical demands of golf are sufficient to meet the World Health Organisation recommendations for strength and balance, golf may qualify for exercise on prescription/social prescribing for people with long-term conditions. The hypothesis of this ongoing study is that playing recreational golf will be associated with better strength and balance in older people. Data are presented for grip strength and dynamic balance in golfers and sedentary older adults, tested using simple techniques suitable in community settings.

Methods

Seventy nine healthy older participants (aged 65-79 years) have been studied: 62 golfers (n = 31 females, 31 males) and 17 sedentary non golfers (9 males, 8 females). Difficulties in recruiting sedentary participants and then the outbreak of Covid-19 explain the discrepancy between group sizes. Golfers played 18 holes at least once a week for minimum of two years. Grip strength was tested for the right hand using the MIE hand-grip dynamometer, with results normalized to body weight. Dynamic balance was assessed using the Y-balance test, with reaching distance normalized to lower-limb length. Non-parametric statistics were used due to unequal group sizes.

Results

Grip strength was significantly greater in golfers than non-golfers (median and interquartile range); males and females combined; golfers 4.3±1.2; non-golfers 3.3±1.9 (p=0.039*; Mann-Whitney). The Y-balance performance was also significantly better in golfers than non-golfers (p=0.002*: Mann-Whitney). Normalised composite reach distance data (3 directions) for the right side were greater in golfers (81.7±13.3) than non-golfers (74.2±17.2).

Conclusions

These preliminary data indicate that playing recreational golf at least once a week is associated with greater grip strength and better dynamic balance in older golfers compared to sedentary non-golfers. These findings support further data collection (when permitted) to produce reference data. This will allow parametric statistical analysis to determine whether conclusive evidence will support the hypothesis, forming the basis of a randomised controlled trial.

Protocol and reference values for minimal detectable change of MyotonPRO and ultrasound imaging measurements of muscle and subcutaneous tissue

The assessment of muscle health is of paramount importance, as the loss of muscle mass and strength can affect performance. Two non-invasive tools that have been found to be useful in this are the MyotonPRO and rehabilitative ultrasound imaging, both have shown to be reliable in previous studies many of which conducted by the research team. This study aims to determine the reliability of previously unassessed local body structures and to determine their minimal detectable changes (MDC) to support both researchers and clinicians. Twenty healthy participants were recruited to determine the reliability of seven skin positions out of a previously established protocol. Reliability was determined between three independent raters, and day to day reliability was assessed with one rater a week apart. Intraclass Correlation Coefficients (ICC) between raters and between days for tissue stiffness, tone and elasticity range from moderate to excellent (ICC 0.52–0.97), with most good or excellent. ICCs for subcutaneous thickness between days was good or excellent (ICC 0.86–0.91) and moderate to excellent between raters (ICC 0.72–0.96), in muscles it was moderate to excellent between raters and days (ICC 0.71–0.95). The protocol in this study is repeatable with overall good reliability, it also provides established MDC values for several measurement points.

A-07 Initial Symptoms, Pre-Existing Emotional Factors, and Symptoms of Stress During Recovery from Concussion

Purpose: Investigate the association of initial symptoms, mechanism of concussion, and emotional state with symptoms of stress reported during recovery from concussion in high school students. Methods: Concussed High School students (n = 183) aged 13–18 were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic with 71% (n = 130) sport-related. Subjects completed a medical history, the Sport Concussion Assessment Tool-5 Symptom Evaluation (PCSS), General Anxiety Disorder (GAD-7), and Patient Health Questionnaire-8 (PHQ-8) at initial visit. At three-month follow-up subjects completed the PTSD Checklist for DSM-5 (PCL-5). A linear regression was conducted predicting total scores on the follow up PCL-5. Predictors included initial Total PCSS Symptom Score, GAD-7, PHQ-8, sex, mechanism of injury (sport vs non-sport) and history of treatment for anxiety/depression. Results: A multiple regression model predicting participant’s total PCL-5 score at three month follow-up (R2 = 0.40, p < 0.001) included PHQ-8 (β = 0.34, p < 0.001), GAD-7 (β = 0.20, p = 0.016), history of treatment for depression (β = 0.17, p = 0.015), severity of initial symptoms (β = 0.15, p = 0.045) and mechanism of injury (β = −0.14, p = 0.018). There was no significant difference in PCL-5 scores between sport vs non-sport injury groups. Conclusions: Pre-existing depression and higher levels of self-reported anxiety and/or depression at time of injury may be associated with increased symptoms of stress during concussion recovery. Severity of initial symptoms and mechanism of injury may also be related to feelings of stress during recovery. Further investigations should include baseline measure of stress prior to injury.

P-326 Current real-world patterns of care for women diagnosed with uterine fibroids (UF) and heavy menstrual bleeding (HMB) in a predominantly African American (AA) population database

Study question

What are the clinical characteristics and patterns of care in African American women diagnosed with UF and HMB compared to White women?

Summary answer

The majority of the women were African American. Though similar in age, there were significant differences between the groups in multiple comorbidities and therapies.

What is known already

UF (leiomyomas) are common, benign uterine tumors affecting approximately 80% of African American and 70% of White women by age 50. In the United States, marked differences exist in disease presentation, severity, treatment, outcomes, and quality of life for African American women compared with White women. African American women typically develop uterine leiomyomas at a younger age, progress to clinically significant disease at an earlier age, have larger uteri at diagnosis and are more likely to be anemic. Limited data exist on the current clinical real-world characteristics and patterns of care for African American women with UF and HMB.

Study design, size, duration

This retrospective observational study identified women 18-55 years, with UF and HMB from IBM-Watson’s MarketScan® Multi-state Medicaid claims database between 2010-2019. The focus was on women with diagnoses of UF (index) and HMB, appearing on the same or different claims, continuously enrolled for > 12 months pre- and post-index (censored on claim for hysterectomy). A total of ≥ 24 months of observation was available for most patients.

Participants/materials, setting, methods

A total of 27,122 women met the inclusion criteria, 16,776 African Americans, 7,353 Whites, and 2,993 others or race unknown. The statistical analyses were carried out on the African American and White patients only. Descriptive analyses of baseline demographics, pre-index comorbidities and post-index treatment were performed. Chi-square tests analyses were applied to counts and t-tests analyses were applied to means. All tests used an alpha value of 0.05 for significance.

Main results and the role of chance

The majority of the analytical cohort of 24,129 women was African American (AA:69.5%; W:30.5 %). The mean (SD) follow-up time was 40.5 (24.7) months. The mean age was similar for both groups (AA:39.6 ± 7.11 years; W: 40.2 ± 7.23 years, p < 0.1). There were 48 pre-indexed comorbidities identified for analyses. The groups significantly differed on 14(29%) comorbidities. For 11 of the comorbidities, African American women were less likely to be diagnosed than White women (all Ps < 0.0001). Many of these diseases were related to bulk symptoms (e.g., pelvic pressure/pain), anxiety and depression. More African American women had diagnoses for diabetes (p = 0.0143), hypertension, and obesity (Ps < 0.0001). Though bulk symptoms were common in both groups, again fewer African American women were diagnosed than White (AA: 68.4%; W:77.0%, p < 0.0001).

Post-index, African American women were more likely treated with hormone-based therapy (42.4% vs. 38.5%, p < 0.0001). Contraceptives were the most frequent form of hormonal treatment prescribed (AA:39.9%; W:35.6%). African American were on contraceptives slightly longer than White women (AA: 377.3 (522.2 days); W: 323.1 (460.2 days) (p < 0.001). Fewer African American women had a hysterectomy (AA:32.0%; W:46.8%, p < 0.001).

Limitations, reasons for caution

This study was observational and descriptive in nature, which limits the ability to make conclusions regarding causality or identify women beyond the age and time constraints within the study. Additionally, claims data may be subject to reporting errors. This data is specific to Medicaid populations and may not be generalizable.

Wider implications of the findings

In this Medicaid population differences in clinical characteristics and UF treatment were evident between African American and White women. The breakdown of some comorbidities did not match national prevalence by race for these conditions (e.g., depression). Further analyses are needed to determine if these differences are clinically and socially meaningful.

Trial registration number

NA

Feasibility and reliability of measuring muscle stiffness in Parkinson's Disease using MyotonPRO device in a clinical setting in Ghana

OBJECTIVES

To examine the feasibility and within-session reliability of Myoton technology to measure muscle stiffness objectively in people with Parkinson's disease in an outpatient setting.

DESIGN

An exploratory quantitative study design was used.

SETTING

The study was conducted in the outpatient physiotherapy department of a Teaching Hospital in Ghana. Participants were recruited from three sites.

PARTICIPANTS

Thirty adults with Parkinson's disease over 18 years with increased tone (muscle stiffness) and at Hoehn and Yahr Stages I-III were studied. Persons with severe comorbidities were excluded.

INTERVENTION

There was no intervention before testing. The MyotonPRO device measured the mechanical properties of the biceps brachii, flexor carpi radialis and tibialis anterior muscles in a relaxed supine position. The probe applied mechanical impulses to the skin, eliciting tissue oscillations. The muscles' three parameters (stiffness, non-neural tone and elasticity) were recorded bilaterally. The reliability of two sets (of 5 impulses) of Myoton data on all three muscles was examined.

RESULTS

All 30 participants (66.3±8.9 years) were recruited and tested within eight weeks. Intraclass correlation coefficients (ICC 3,2) were above 0.92 for biceps brachii and tibialis anterior and above 0.86 for flexor carpi radialis.

CONCLUSION

The MyotonPRO was reliable for measuring two sets of data within the same session, indicating that only one set of measurements is needed. The technique is feasible and easy to use in a clinical setting in Ghana, with the potential to assess the effect of medical and physiotherapy interventions on muscles in people with Parkinson's disease.

FUNDING

M.S discloses a grant from the Science and Technology Facilities Council Impact Acceleration Account at the University of Southampton to support this collaborative research (no personal finance received). All other authors, M.W.A, P.E.M, C.O.Y, B.E.A.S, S.A.-B, and A.A have no financial disclosure.

Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach

PURPOSE

Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system.

MATERIALS AND METHODS

Data from two focus groups with rehabilitation professionals, ten interviews with stroke survivors and a review of assessment tests were synthesized. In a two-stage process, suggested tasks were screened to exclude non-tasks and complex activities. Remaining tasks were screened for suitability and entered into a categorization matrix.

RESULTS

Of 83 suggestions, eight non-tasks, and 42 complex activities were rejected. Of the remaining 33 tasks, 15 were rejected: five required fine motor control; eight were too complex to standardize; one because the role of hemiplegic hand was not defined and one involved water. The review of clinical assessment tests found no additional tasks. Eleven were ultimately selected for testing with M-Mark.

CONCLUSIONS

Using a task categorization matrix, a set of training tasks was systematically identified. There was strong agreement between data from the professionals, survivors and literature. The matrix populated by tasks has potential for wider use in upper-limb stroke rehabilitation. IMPLICATIONS FOR REHABILITATIONRehabilitation technologies that provide feedback on quantity and quality of movements can support independent home-based upper limb rehabilitation.Rehabilitation technology systems require a library of upper limb tasks at different levels for people with stroke and therapists to choose from.A user-defined and evidence-based set of upper limb tasks for use within a wearable sensor device system have been developed.

Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID-19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting

AIM

To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID-19. To understand how patient preferences are constructed and organized.

METHODS

Semi-structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged.

RESULTS

Fifty-five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process.

CONCLUSIONS

This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID-19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations.

PATIENT AND PUBLIC CONTRIBUTION

The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.

Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review

Objective

This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings.

Methods

Searches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting.

Results

A total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in >50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour.

Conclusions

This review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.

A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations

OBJECTIVES

To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC.

METHODS

A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference.

RESULTS

Eight F2F and 5 VC participants were included. Shorter appointments were less 'worth' travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive.

CONCLUSIONS

This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Objective

Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.

Methods

Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.

Results

Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation.

Conclusions

This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

Validity of load rate estimation using accelerometers during physical activity on an anti-gravity treadmill

Introduction

A simple tool to estimate loading on the lower limb joints outside a laboratory may be useful for people who suffer from degenerative joint disease. Here, the accelerometers on board of wearables (smartwatch, smartphone) were used to estimate the load rate on the lower limbs and were compared to data from a treadmill force plate. The aim was to assess the validity of wearables to estimate load rate transmitted through the joints.

Methods

Twelve healthy participants (female n = 4, male n = 8; aged 26 ± 3 years; height: 175 ± 15 cm; body mass: 71 ± 9 kg) carried wearables, while performing locomotive activities on an anti-gravity treadmill with an integrated force plate. Acceleration data from the wearables and force plate data were used to estimate the load rate. The treadmill enabled 7680 data points to be obtained, allowing a good estimate of uncertainty to be examined. A linear regression model and cross-validation with 1000 bootstrap resamples were used to assess the validation.

Results

Significant correlation was found between load rate from the force plate and wearables (smartphone: R 2 = 0.71 ; smartwatch: R 2 = 0.67 ).

Conclusion

Wearables' accelerometers can estimate load rate, and the good correlation with force plate data supports their use as a surrogate when assessing lower limb joint loading in field environments.

Non-Invasive Biomarkers of Musculoskeletal Health with High Discriminant Ability for Age and Gender

A novel approach to ageing studies assessed the discriminatory ability of a combination of routine physical function tests and novel measures, notably muscle mechanical properties and thigh composition (ultrasound imaging) to classify healthy individuals according to age and gender. The cross-sectional study included 138 community-dwelling, self-reported healthy males and females (65 young, mean age ± SD = 25.7 ± 4.8 years; 73 older, 74.9 ± 5.9 years). Handgrip strength; quadriceps strength; respiratory peak flow; timed up and go; stair climbing time; anterior thigh tissue thickness; muscle stiffness, tone, elasticity (Myoton technology), and self-reported health related quality of life (SF36) were assessed. Stepwise feature selection using cross-validation with linear discriminant analysis was used to classify cases based on criterion variable derived from known effects of age on physical function. A model was trained and features selected using 126 cases with 0.92 accuracy (95% CI = 0.86–0.96; Kappa = 0.89). The final model included five features (peak flow, timed up and go, biceps brachii elasticity, anterior thigh muscle thickness, and percentage thigh muscle) with high sensitivity (0.82–0.96) and specificity (0.94–0.99). The most sensitive novel biomarkers require no volition, highlighting potentially useful tests for screening and monitoring effects of interventions on musculoskeletal health for vulnerable older people with pain or cognitive impairment.

Factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting: a qualitative study

OBJECTIVES

To identify, characterise and explain factors that influence patient preferences, from the perspective of patients and clinicians, for virtual consultations in an orthopaedic rehabilitation setting.

DESIGN

Qualitative study using semi-structured interviews and abductive analysis.

SETTING

A physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK.

PARTICIPANTS

Patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem. Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem.

RESULTS

Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation of care (the ways that patients understand and explain their clinical status, their treatment requirements and the care pathway), the expectations of care (influenced by a patients desire for contact, psychological status, previous care and perceived requirements), the demands on the patient (due to each patients respective social situation and the consequences of choice) and the capacity to allocate resources to care (these include financial, infrastructural, social and healthcare resources).

CONCLUSION

This study has identified key factors that appear to influence patient preference for virtual consultations in orthopaedic rehabilitation. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete. A series of questions, based on these factors, have been developed to support identification of preferences in a clinical setting.