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Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
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Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
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2
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Yabroudi MA, Aldardour A, Nawasreh ZH, Obaidat SM, Altubasi IM, Bashaireh K. Effects of the combination of pulsed electromagnetic field with progressive resistance exercise on knee osteoarthritis: A randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:55-65. [PMID: 37718773 DOI: 10.3233/bmr-220261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a common and disabling disease among the elderly population. The optimal conservative treatment for knee OA is not well established. OBJECTIVE This study aimed to assess the effectiveness of pulsed electromagnetic field (PEMF) combined with progressive resistance exercise (PRE) in improving physical function and pain in patients with knee OA. METHODS Thirty-four patients with knee OA (17 in each group) participated in a single-blind randomized control study. Patients were randomly assigned to receive 24 sessions of either combined PEMF and PRE (treatment group) or PRE only (control group). Patients were evaluated at pre-treatment, post-treatment (2 months), and at 3-month and 6-month follow-ups using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Pain Rating Scale (NPRS); walking speed and 5-times chair stand test. Mixed ANOVA was used for statistical analysis with Bonferroni adjustments. RESULTS There was no significant group-by-time interaction for any outcome (P> 0.05). However, both groups scored significantly higher on the NPRS and KOOS at post-treatment, 3-, and 6-month follow-up compared to their baseline. Further, both groups completed the 5-times chair stand test and walking speed test with significantly less time at all post-treatment time points than the pre-treatment. None of the study outcomes (NPRS, KOOS, walking speed, and 5 times chair stand) were significantly different between groups at any of the time points. CONCLUSION Both treatment options, PRE only versus PRE with PEMF, were equally effective in decreasing pain and improving physical function in patients with knee OA. This would suggest that the optimal parameters for PEMF that may show beneficial effects for knee OA when added to PRE training need to be determined.
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Affiliation(s)
- Mohammad A Yabroudi
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahmad Aldardour
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Zakariya H Nawasreh
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Sakher M Obaidat
- Department of Physical Therapy, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Ibrahim M Altubasi
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Khaldoon Bashaireh
- Department of Special Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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3
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Gwinnutt JM, Wieczorek M, Balanescu A, Bischoff-Ferrari HA, Boonen A, Cavalli G, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023; 82:48-56. [PMID: 35260387 DOI: 10.1136/annrheumdis-2021-222020] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A European League Against Rheumatism taskforce was convened to review the literature and develop recommendations on lifestyle behaviours for rheumatic and musculoskeletal diseases (RMDs). METHODS Six lifestyle exposures (exercise, diet, weight, alcohol, smoking, work participation) and seven RMDs (osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis, gout) were considered. The taskforce included health professionals in rheumatology, geriatricians, epidemiologists, public health experts, people with RMDs and exposure domain experts. Systematic reviews were conducted to gather available evidence, from which recommendations were developed. RESULTS Five overarching principles and 18 specific recommendations were defined based on available evidence. The overarching principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments. Exercise recommendations highlight the safety and benefits of exercise on pain and disability, particularly among people with osteoarthritis and axial spondyloarthritis. The diet recommendations emphasise the importance of a healthy, balanced diet for people with RMDs. People with RMDs and health professionals should work together to achieve and maintain a healthy weight. Small amounts of alcohol are unlikely to negatively affect the outcomes of people with RMDs, although people with rheumatoid arthritis and gout may be at risk of flares after moderate alcohol consumption. Smokers should be supported to quit. Work participation may have benefits on RMD outcomes and should be discussed in consultations. CONCLUSIONS These recommendations cover a range of lifestyle behaviours and can guide shared decision making between people with RMDs and health professionals when developing and monitoring treatment plans.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland.,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria.,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria.,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain.,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia.,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France.,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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4
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Berry A, McClellan C, Wanless B, Walsh N. A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change. JMIR Form Res 2022; 6:e32669. [PMID: 35258462 PMCID: PMC8941434 DOI: 10.2196/32669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Musculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey.
Objective
The aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines.
Methods
A range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented.
Results
The content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders.
Conclusions
This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations.
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Affiliation(s)
- Alice Berry
- University of the West of England, Bristol, United Kingdom
| | | | - Ben Wanless
- Musculoskeletal Department, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Nicola Walsh
- University of the West of England, Bristol, United Kingdom
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5
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Song Z, Li Y, Shang C, Shang G, Kou H, Li J, Chen S, Liu H. Sprifermin: Effects on Cartilage Homeostasis and Therapeutic Prospects in Cartilage-Related Diseases. Front Cell Dev Biol 2022; 9:786546. [PMID: 34970547 PMCID: PMC8712868 DOI: 10.3389/fcell.2021.786546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
When suffering from osteoarthritis (OA), articular cartilage homeostasis is out of balance and the living quality declines. The treatment of knee OA has always been an unsolved problem in the world. At present, symptomatic treatment is mainly adopted for OA. Drug therapy is mainly used to relieve pain symptoms, but often accompanied with adverse reactions; surgical treatment involves the problem of poor integration between the repaired or transplanted tissues and the natural cartilage, leading to the failure of repair. Biotherapy which aims to promote cartilage in situ regeneration and to restore endochondral homeostasis is expected to be an effective method for the prevention and treatment of OA. Disease-modifying osteoarthritis drugs (DMOADs) are intended for targeted treatment of OA. The DMOADs prevent excessive destruction of articular cartilage through anti-catabolism and stimulate tissue regeneration via excitoanabolic effects. Sprifermin (recombinant human FGF18, rhFGF18) is an effective DMOAD, which can not only promote the proliferation of articular chondrocyte and the synthesis of extracellular matrix, increase the thickness of cartilage in a dose-dependent manner, but also inhibit the activity of proteolytic enzymes and remarkedly slow down the degeneration of cartilage. This paper reviews the unique advantages of Sprifermin in repairing cartilage injury and improving cartilage homeostasis, aiming to provide an important strategy for the effective prevention and treatment of cartilage injury-related diseases.
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Affiliation(s)
- Zongmian Song
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chunfeng Shang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guowei Shang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Kou
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinfeng Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Songfeng Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongjian Liu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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6
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Sussmann KE, Jacobs H, Hoffmann F. Physical Therapy Use and Associated Factors in Adults with and without Osteoarthritis-An Analysis of the Population-Based German Health Update Study. Healthcare (Basel) 2021; 9:1544. [PMID: 34828591 PMCID: PMC8625513 DOI: 10.3390/healthcare9111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Physical therapy (PT) is recommended as first-line management for osteoarthritis (OA). The purpose of this study was to assess the PT use among adults with OA and those without (Non-OA) and subsequently identify associated factors among these populations. METHODS This cross-sectional study obtained national data from the population-based German Health Update (GEDA2014/2015-EHIS) study containing 24,016 participants aged 18 years and older. Analyses were stratified by sex, age, socioeconomic status (SES), residence, smoking behavior, body mass index, pain and general health. Multivariate regression analysis was conducted to evaluate factors associated with PT use within the past 12 months. RESULTS PT was used more frequently in the OA population compared with the Non-OA population (35.8% vs. 18.7%). In both populations, women, participants with high SES, residence in Eastern Germany, severe pain, poor general health and non-smokers received PT more frequently. Multivariate analysis confirmed these findings, in addition to people aged 80 years and older. The influence of SES was higher among OA participants. CONCLUSION The underutilization of PT in OA patients (35.8%) was particularly evident among males, people with a low SES and those being older than 60 years, which aids to develop strategies increasing PT use towards guideline-oriented OA management.
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Affiliation(s)
- Kim Elisa Sussmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (H.J.); (F.H.)
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7
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Xue Y, Dai S, Liang J, Ji W. Effect of reactive oxygen species of the psoas major muscle in complete Freund's adjuvant-induced inflammatory pain in rats. Mol Pain 2021; 16:1744806920929246. [PMID: 32552357 PMCID: PMC7303503 DOI: 10.1177/1744806920929246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lower limb pain is a common clinical disease that affects millions of
people worldwide. It is found in previous studies that reactive oxygen
species is closely related to neuropathic, cancer, chemotherapy, and
inflammatory pain, which can be relieved by reactive oxygen species
scavengers. Furthermore, acupuncture or electroacupuncture on the
psoas major muscle has a great effect on adjuvant-induced arthritis
and lower back pain. In our study, we investigated the function of
reactive oxygen species scavengers locally injecting into the
ipsilateral psoas major muscle on complete Freund’s adjuvant-induced
inflammatory pain. Our results demonstrated that in the development of
complete Freund’s adjuvant-induced inflammatory pain, early local
continuous application of N-tert-Butyl-α-phenylnitrone (PBN, 1 and
5 mg/kg/0.2 ml) on the ipsilateral psoas major muscle effectively
reduced mechanical and cold hyperalgesia. However, intraperitoneal
injection of PBN (1 and 5 mg/kg) or local injection of PBN (1 and
5 mg/kg/0.2 ml) into contralateral psoas major muscle, ipsilateral
quadratus lumborum, and ipsilateral erector spinae showed limited
effect. In the developed inflammatory pain model, local injection of
PBN into the ipsilateral psoas major muscle also alleviated pain and
paw edema. In addition, reactive oxygen species level increased in
ipsilateral psoas major muscle at seven days after complete Freund’s
adjuvant injection. In general, PBN reduces complete Freund’s
adjuvant-evoked inflammatory pain by inhibiting reactive oxygen
species in the psoas major muscle.
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Affiliation(s)
- Yan Xue
- Division of Anesthesiology, Department of Cardiovascular Surgery, Guangdong Institute of Cardiovascular, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.,Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sailin Dai
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jiexian Liang
- Division of Anesthesiology, Department of Cardiovascular Surgery, Guangdong Institute of Cardiovascular, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.,Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenjin Ji
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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8
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Berry A, McCabe CS, Halls S, Muir S, Walsh N. Beliefs, motives and gains associated with physical activity in people with osteoarthritis. Musculoskeletal Care 2021; 19:52-58. [PMID: 32890412 DOI: 10.1002/msc.1507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) affects approximately 8.75 million people in the United Kingdom. Physical activity is recommended as a core treatment, yet 44% of people with OA are inactive. Motivation and self-efficacy for exercise are considered to be key factors contributing to sustained engagement with physical activity. The aim of this study was to explore the beliefs, motives (what an individual aims to attain through participating in physical activity) and gains (what people feel they might get from participation) associated with physical activity engagement in a group of people with OA. DESIGN AND METHOD This study adopted a cross-sectional survey research design, using two validated questionnaires: the Exercise Motives and Gains Inventory and the Exercise Self-Efficacy Scale. RESULTS Data were gathered from 262 people with OA between August 2015 and January 2016. Those who were most active reported higher levels of both motivation and self-efficacy and were active for enjoyment, to avoid negative health, and for health and fitness reasons. A comparison of motives and gains revealed higher gain scores for social engagement and enjoyment, compared with associated motive scores. CONCLUSION This study provides evidence of the central role that motives, gains and self-efficacy play in facilitating engagement with physical activity in this population. Future interventions should aim to foster increased self-efficacy for physical activity and promote autonomous forms of motivation by emphasising the importance of choosing activities which are enjoyable, as well as highlighting the value of social engagement.
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Affiliation(s)
- Alice Berry
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Candy S McCabe
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Dorothy House Hospice Care, Winsley, UK
| | - Serena Halls
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sarah Muir
- Research Centre for Behaviour Change, Psychology Department, Bournemouth University, Bournemouth, UK
| | - Nicola Walsh
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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9
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Willett M, Greig C, Fenton S, Rogers D, Duda J, Rushton A. Utilising the perspectives of patients with lower-limb osteoarthritis on prescribed physical activity to develop a theoretically informed physiotherapy intervention. BMC Musculoskelet Disord 2021; 22:155. [PMID: 33557821 PMCID: PMC7871381 DOI: 10.1186/s12891-021-04036-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lower-limb osteoarthritis (OA) causes high levels of pain and disability. Physiotherapists are the primary healthcare provider of non-pharmacological treatments, and incorporate strategies to optimise physical activity (PA) to aid patients with lower-limb OA to moderate their clinical symptoms. However, patients with lower-limb OA have low adherence to PA recommendations both during treatment and after discharge. This study aimed to use knowledge of identified barriers and facilitators to physiotherapy prescribed PA (during treatment and post-discharge) to develop a theoretically informed intervention to optimise adherence to PA for patients with lower-limb OA during treatment and post-discharge. METHODS 1) A purposive sample of 13 patients with lower-limb OA participated in semi-structured interviews following physiotherapy treatment. Inductive analysis identified themes/subthemes reflecting barriers and facilitators to physiotherapist prescribed PA, which were organised deductively according to personal factors, treatment and post-discharge phases. 2) Themes/subthemes were mapped onto the theoretical domains framework (TDF). 3) Behaviour change techniques (BCTs) were coded from the key identified domains and a theoretically informed physiotherapy intervention addressing barriers and using facilitators, was developed. RESULTS Themes of patient confidence, mind-set, motivation, OA symptoms and PA experiences were primary personal factors that influenced PA adherence; with the TDF domain 'Beliefs about capabilities' most important to target. During treatment, the theme of routine formation was the major driver of personal factors; and primarily influenced by developing a positive physiotherapist-patient relationship. Post-discharge, physical factors, psychosocial factors and ongoing access to resources were important themes influencing PA maintenance. 'Environmental context and resources' and 'social influences' emerged as the key TDF domains to target during treatment and post-discharge. The proposed theoretically informed intervention included 26 BCTs delivered across conceptual phases of adoption, routine formation, and maintenance. CONCLUSION A theoretically informed physiotherapy intervention was proposed to optimise PA adherence in patients with lower-limb OA. The included BCTs primarily target patients' perceived beliefs about their capabilities, by developing a PA routine during treatment and facilitating appropriate psychosocial support and access to resources for PA maintenance post-discharge. The feasibility of delivering the intervention in clinical practice will now be evaluated.
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Affiliation(s)
- Matthew Willett
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK.
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - David Rogers
- Centre for Musculoskeletal Medicine, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- School of Physical Therapy, Western University, Elborn College, London, Canada
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10
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Walsh N, Jones L, Phillips S, Thomas R, Odondi L, Palmer S, Cramp F, Pollock J, Hurley M. Facilitating Activity and Self-management for people with Arthritic knee, hip or lower back pain (FASA): A cluster randomised controlled trial. Musculoskelet Sci Pract 2020; 50:102271. [PMID: 33068901 DOI: 10.1016/j.msksp.2020.102271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic musculoskeletal pain including osteoarthritis (OA) can significantly limit the functional independence of individuals. The spine and hip and knee are predominantly affected; management guidelines for each recommend exercise and education to support self-management. OBJECTIVES This study investigated the effectiveness of a generic exercise and self-management intervention for people over-50 with hip/knee OA and/or lower back pain compared to continued GP management. DESIGN Single blind, cluster randomised controlled trial. METHOD Participants who had previously consulted with hip/knee OA and/or chronic lower back pain were recruited from 45 GP practices in SW England. Practices were randomly allocated to receive continued GP care (control) or continued GP care and a 6-week group exercise and self-management intervention facilitated by a physiotherapist and located in a community-based physiotherapy department. The primary outcome measure was the Dysfunction Index of the Short Musculoskeletal Functional Assessment (DI-SMFA) measured at six month post-rehabilitation. RESULTS 349 participants were recruited and allocated to the intervention (n = 170) or control (n = 179) arms; the attrition rate was 13% at the 6 month primary end-point. One minor adverse event in the intervention group that required no medical input was reported. Intervention arm participants reported better function at 6 months compared with continued GP management alone (-3.01 difference in DI-SMFA [95%CI -5.25, -0.76], p = 0.01). CONCLUSIONS A generic exercise and self-management intervention resulted in statistically significant changes in function after six-months compared with GP management alone, but clinical significance of these findings is less clear. This may be an effective way of managing group interventions for lower limb OA and chronic lower back pain.
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Affiliation(s)
- Nicola Walsh
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Louise Jones
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sonia Phillips
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Rachel Thomas
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Lang'o Odondi
- Division of Cardiovascular Medicine, University of Nottingham, UK
| | - Shea Palmer
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jon Pollock
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Mike Hurley
- Faculty for Health, Social Care and Education. St George's University of London & Kingston University, UK
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Gomiero AB, Kayo A, Abraão M, Peccin MS, Grande AJ, Trevisani VF. Sensory-motor training versus resistance training among patients with knee osteoarthritis: randomized single-blind controlled trial. SAO PAULO MED J 2018; 136:44-50. [PMID: 29236934 PMCID: PMC9924172 DOI: 10.1590/1516-3180.2017.0174100917] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Osteoarthritis of the knee is defined as a progressive disease of the synovial joints and is characterized by failure of joint damage repair. The objective here was to compare the effectiveness of sensory-motor training versus resistance training among patients with knee osteoarthritis. DESIGN AND SETTING Randomized, single-blinded controlled trial conducted at the outpatient service of the University of Santo Amaro. METHODS A total of 64 patients were randomly assigned to sensory-motor training or resistance training. The evaluations were performed at baseline and 16 weeks after the intervention and included pain evaluation on a visual analogue scale, isometric quadriceps femoris force measurement using a dynamometer, Timed Up and Go test, Tinetti balance scale, Western Ontario and McMaster Universities osteoarthritis index, and the SF-36 quality-of-life questionnaire. Data analysis was performed using analysis of variance with repeated measurements and Cohen's effect size. RESULTS Sensory-motor training may be a plausible alternative and showed a small effect on pain and a medium effect on maximal voluntary isometric contraction. Resistance training showed a small effect on balance and a medium effect on mobility. CONCLUSION Resistance training and sensory motor training for the lower limbs among patients with knee osteoarthritis seemed to present similar effects on pain and function. However, because there was a considerable risk of type 2 error, further randomized clinical trials are still needed to provide a sound conclusion.
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Affiliation(s)
- Aline Bassoli Gomiero
- MSc. Physiotherapist, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Andrea Kayo
- PhD. Physiotherapist, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Marcelo Abraão
- MSc. Physiotherapist, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Maria Stella Peccin
- MSc. Physiotherapist, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Antonio Jose Grande
- PhD. Associate Professor, Department of Medicine, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Virginia Fernandes Trevisani
- MD, PhD. Associate Professor, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), and Full Professor, Discipline of Reumatology, Universidade de Santo Amaro (UNISA), São Paulo (SP), Brazil.
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