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Miller KA, Baier Manwell LM, Bartels CM, Yu TY, Vundamati D, Foertsch M, Brown RL. Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100452. [PMID: 38495347 PMCID: PMC10940781 DOI: 10.1016/j.ocarto.2024.100452] [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: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center. Design This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability. Results Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p = 0.002). BMI did not significantly change (p = 0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 h weekly) and serving 953 patients over four years demonstrated OAMP sustainability. Conclusions OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.
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Affiliation(s)
- Kathryn A. Miller
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M. Baier Manwell
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christie M. Bartels
- Division of Rheumatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tommy Yue Yu
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Divya Vundamati
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marley Foertsch
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Roger L. Brown
- Research Design and Statistics Unit, Schools of Nursing, Medicine, and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Perrot S, Roucoux G, Bertin P, Beauvais C, Alliot-Launois F, Chassany O, Duracinsky M. Cross-perspectives on care pathways for painful osteoarthritis: A qualitative analysis in patients and healthcare professionals. Musculoskeletal Care 2023; 21:1142-1153. [PMID: 37404113 DOI: 10.1002/msc.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To analyse and compare patients' and healthcare professionals' (HPs) perspectives concerning patient care pathways for painful osteoarthritis (OA). PATIENTS AND METHODS We performed a qualitative study of two focus groups corresponding to eight patients with painful OA and eight HPs involved in OA management. RESULTS Six key themes emerged from the interviews: (1) representations of OA, (2) OA pain, (3) quality of life, (4) care pathways, (5) actors involved in the care pathway, and (6) treatments. Both groups considered general practitioners, pharmacists and physiotherapists to be first-line HPs, and no well-defined OA specialist was identified. Patients and HPs reported similar difficulties concerning the adaptation of management to individual cases, late diagnosis and treatment, whereas only patients mentioned financial issues. Communication difficulties were identified as a major problem both between patients and HPs, and between HPs. Patients reported a lack of knowledge concerning pain and OA. The coordination between the various HPs is required, with education on both pain and OA. Several possible solutions were put forward by both patients and HPs. CONCLUSION The care pathways of patients with painful OA are complex, with an unclear definition of the roles of the various HPs and suboptimal coordination. The role of HPs should be defined and collaboration between HPs developed.
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Affiliation(s)
- Serge Perrot
- Pain Center, INSERM U987, Hôpital Cochin, Université Paris Cité University, Paris, France
| | - Guillaume Roucoux
- Patient-Reported Outcomes Unit (PROQOL), Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital, AP-HP, Paris, France
- ECEVE, INSERM UMR 1123, Paris Cité University, Paris, France
| | - Philippe Bertin
- Rheumatology Department, University Hospital, Limoges, France
| | | | | | - Olivier Chassany
- Patient-Reported Outcomes Unit (PROQOL), Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Martin Duracinsky
- Patient-Reported Outcomes Unit (PROQOL), Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital, AP-HP, Paris, France
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Özcan S, Yurten H. Difficulties Experienced by Patients with Knee Osteoarthritis during the Conservative Treatment Process: A Qualitative Study. J Clin Med 2023; 12:6523. [PMID: 37892660 PMCID: PMC10607485 DOI: 10.3390/jcm12206523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to investigate the difficulties faced by patients with knee osteoarthritis during the conservative treatment process. MATERIALS AND METHODS We included twenty-one patients who were diagnosed with knee osteoarthritis and admitted to the orthopedics and traumatology outpatient clinic of the hospital where the researcher worked between January 2022 and April 2022. We interviewed each patient using semi-structured face-to-face interviews. To analyze the interviews, the researcher used the directed content analysis method. Data were analyzed using the NVIVO 10 software package. The authors and the expert trained in qualitative research who generously supported the authors continued the analysis independently of each other until they reached a consensus. RESULTS After analysis of the interviews held with the participants, the following three main themes emerged: lack of information about conservative treatment, frequent change of physicians, and non-compliance with lifestyle changes. Two sub-themes were identified within the theme of frequent change of physicians: distrusting health personnel, and not being able to make an appointment. In addition, most of the patients were not knowledgeable enough about either the definition of the disease or the treatment process. These patients stated that they were confused because they had to change physicians frequently; thus, they distrusted physicians because each physician they visited made a different plan for the treatment process. CONCLUSIONS At the end of the study, we determined that during the conservative treatment process of patients with knee osteoarthritis, a multidisciplinary approach should be adopted, and orthopedic surgeons, physical therapy and rehabilitation physicians, dietitians, and physiotherapists should be in harmony with the patient. In addition, health personnel should provide patients with detailed information to eliminate questions they have during the conservative treatment process. In order for healthcare team members to establish a trusting relationship between the patients, they should allocate enough time to the patient.
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Affiliation(s)
- Seçkin Özcan
- Department of Orthopedics and Traumatology, Yalova Education and Research Hospital, 77100 Yalova, Turkey
| | - Hakan Yurten
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
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Gibbs AJ, Gray B, Wallis JA, Taylor NF, Kemp JL, Hunter DJ, Barton CJ. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage 2023; 31:1280-1292. [PMID: 37394226 DOI: 10.1016/j.joca.2023.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines. METHODS Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154). RESULTS Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty. CONCLUSION Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.
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Affiliation(s)
- Alison J Gibbs
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Physiotherapy Department, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 312 Victoria, Australia.
| | - Bimbi Gray
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jason A Wallis
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Public Health & Preventative Medicine, Monash University, Level 4/553 St Kilda Rd, Melbourne 3004, Australia; Physiotherapy Department, Cabrini Health, Malvern, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Joanne L Kemp
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Bouma SE, van Beek JFE, Alma MA, Diercks RL, van der Woude LHV, van den Akker-Scheek I, Stevens M. What affects the implementation of lifestyle interventions in patients with osteoarthritis? A multidisciplinary focus group study among healthcare professionals. Disabil Rehabil 2022; 44:8283-8293. [PMID: 34889696 DOI: 10.1080/09638288.2021.2011438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify factors affecting the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA) from the perspective of primary and secondary healthcare professionals (HCPs) in the Dutch healthcare system. METHODS Multidisciplinary focus groups were composed. Data analysis was performed following thematic analysis. The Tailored Implementation for Chronic Diseases checklist was used to guide data analysis. RESULTS Four focus groups meetings were conducted with 38 participating HCPs (general practitioners (or in-training), orthopedic surgeons (or in-training), physiotherapists, dieticians, a general practice assistant, lifestyle counselors, and nurse practitioners). Influencing factors were grouped into nine themes: (1) intervention factors; (2) individual HCP factors; (3) patient factors; (4) professional interactions; (5) incentives and resources; (6) capacity for organizational change; (7) social, political and legal factors; (8) patient and HCP interactions; and (9) disease factors. CONCLUSIONS A wide variety of factors affecting the implementation of LIs was identified in this study, where the importance of effective interdisciplinary collaboration was emphasized by the multidisciplinary group of participants. This thorough analysis of influencing factors is an important first step toward improved implementation of LIs within OA care. Further research is required to identify the most significant targets for change in daily practice.Implications for RehabilitationThe implementation of lifestyle interventions (LIs) by healthcare professionals (HCPs) in patients with hip and/or knee osteoarthritis (OA) is affected by both individual and environmental factors.The influencing factors identified in this study can support the development of interventions aimed at improving the implementation of LIs in OA care.A multilevel approach is required when developing interventions to improve the implementation of LIs in OA care.Continued efforts of both primary and secondary HCPs and policymakers are needed in order to promote the use of LIs within OA care.
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Affiliation(s)
- Sjoukje E Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Juliette F E van Beek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Manna A Alma
- Department of Health Sciences, Applied Health Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Gibbs AJ, Wallis JA, Taylor NF, Kemp JL, Barton CJ. Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services. Musculoskeletal Care 2022; 20:860-872. [PMID: 35403316 PMCID: PMC10084427 DOI: 10.1002/msc.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Hip and knee osteoarthritis guidelines internationally provide consistent first-line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline-based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care. METHODS Nineteen semi-structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n = 10; OsteoArthritis Chronic Care Programme n = 4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n = 5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis. RESULTS The overarching theme to emerge was that accessing first-line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co-morbidities is challenging. CONCLUSION Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first-line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.
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Affiliation(s)
- Alison J Gibbs
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Physiotherapy Department, Eastern Health, Box Hill, Victoria, Australia
| | - Jason A Wallis
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, School of Public Health & Preventative Medicine, Monash University, Melbourne, Australia.,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Joanne L Kemp
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia
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7
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Kennedy BL, Currie GR, Kania-Richmond A, Emery CA, MacKean G, Marshall DA. Factors That Patients Consider in Their Choice of Non-Surgical Management for Hip and Knee Osteoarthritis: Formative Qualitative Research for a Discrete Choice Experiment. THE PATIENT 2022; 15:537-550. [PMID: 35292937 DOI: 10.1007/s40271-022-00577-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Approximately half of patients with hip and knee osteoarthritis have tried non-surgical management before surgical consultation. Understanding the many factors affecting the uptake of recommended strategies is important to inform future development of such management strategies. OBJECTIVES The aim of this study was to explore and identify factors that patients with osteoarthritis consider when choosing non-surgical management for hip and knee osteoarthritis, as formative research for a study of patient preferences for non-surgical management programs for osteoarthritis. METHODS A qualitative research design was used. Participants were recruited using a combination of stratified and convenience sampling. Interviews were conducted, using a semi-structured interview guide, with English-speaking patients who had self-reported hip and/or knee osteoarthritis and at least one joint that had not undergone replacement surgery. Data were thematically analyzed. RESULTS Thirteen patients participated in these interviews. Sixteen factors that participants considered when choosing non-surgical osteoarthritis management were identified. Eleven were extrinsic, relating to features of programs and services, and are categorized as types of interventions, general program and service details, and program-specific details. Five were intrinsic to the individual and influenced how decisions for osteoarthritis management were approached and the options available to choose from. Three novel factors included participants' desire for further management, their views about joint replacement surgery, and whether they felt personal choice was available in osteoarthritis management strategies. CONCLUSION Key factors were identified that patients considered when making decisions about non-surgical management for their osteoarthritis that will be used to inform a discrete choice experiment (DCE) that aims to measure preferences for these factors.
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Affiliation(s)
- Bryanne L Kennedy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada
- O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
| | - Ania Kania-Richmond
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Carolyn A Emery
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada
- O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.
- O'Brien Institute of Public Health, University of Calgary, Alberta, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada.
- Health Research Innovation Centre, University of Calgary, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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Bouma SE, van Beek JFE, Diercks RL, van der Woude LHV, Stevens M, van den Akker-Scheek I. Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review. BMJ Open 2022; 12:e056831. [PMID: 35105598 PMCID: PMC8808449 DOI: 10.1136/bmjopen-2021-056831] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA). DESIGN Scoping review. DATA SOURCES The databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021. ELIGIBILITY CRITERIA Primary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded. DATA EXTRACTION AND SYNTHESIS Barriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist. RESULTS Thirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients' negative attitude towards LIs, patients' low health literacy and HCPs' lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs' own role in implementing LIs, the content or structure of LIs and HCPs' positive attitude towards LIs. CONCLUSIONS Multiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs. PROSPERO REGISTRATION NUMBER CRD42019129348.
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Affiliation(s)
- Sjoukje E Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juliette F E van Beek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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