1
|
Logan SJ, Hider S, Green J, Ryan SJ. The information required by people with inflammatory arthritis when taking Methotrexate: a mixed-methods systematic review. Rheumatology (Oxford) 2024; 63:2615-2623. [PMID: 38323666 PMCID: PMC11443017 DOI: 10.1093/rheumatology/keae055] [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: 09/14/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES This mixed-methods systematic review aimed to identify and synthesize knowledge of the characteristics, content, and preferred format of information to support people with inflammatory arthritis (IA) to take MTX. METHODS A literature search using MEDLINE, The Cochrane Library, EMBASE, CINAHL, PsychInfo, GreyEU, Web of Science and Open Dissertation was conducted to identify all studies published from 2000 to December 2022. Included studies detailed factors related to MTX information needs of people aged ≥18 years with IA published in English. The Joanna Briggs Institute Guidelines (JBI) for convergent integrated mixed-methods systematic reviews were followed using validated tools for data extraction and quality. The data was analysed using reflexive thematic analysis. RESULTS Thirteen studies (seven quantitative, two mixed-methods and four qualitative) were included, involving 3425 adults, mainly female n = 2434 (71%), age 20-84 years. An overarching theme of a requirement for person-centred care was developed, with three interlinking themes: (1) accepting the need for treatment with MTX, (2) concerns about taking MTX, and (3) a need for tailored information and support. Limitations of the evidence included the use of heterogeneous outcome measures and instruments for measuring information needs. CONCLUSION People with IA have individual, multifaceted information and support needs about MTX that are often unresolved when a one-size-fits-all approach is used. The findings of this review can inform rheumatology training to support a person-centred approach to identifying and addressing the specific needs and concerns and development of consistent easy-to-understand accessible MTX information.
Collapse
Affiliation(s)
- Sarah J Logan
- School of Medicine, Keele University, Staffordshire, UK
| | - Samantha Hider
- School of Medicine, Keele University, Staffordshire, UK
- Department of Rheumatology, Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Julie Green
- School of Nursing and Midwifery, Keele University, Staffordshire, UK
| | - Sarah J Ryan
- Department of Rheumatology, Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| |
Collapse
|
2
|
Fusama M, Nakahara H, Gregg M, Kuroe Y, Urata Y, Kawahata K, Kawahito Y, Kojima M, Sugihara T, Hashimoto M, Miyamae T, Murashima A, Mori M, Yajima N, Matsui T. Challenges faced by nurses engaged in rheumatology care in Japan. Mod Rheumatol 2024; 34:711-719. [PMID: 37540545 DOI: 10.1093/mr/road079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aimed to identify the challenges faced by nurses engaged in rheumatology care in Japan. METHODS We conducted a questionnaire survey of nurses in Japan in 2020 on challenges experienced in rheumatology care. The participants were nurses certified by the Japan Rheumatism Foundation. Participants' answers were coded and categorized based on relevant phrases and words. Content analysis was performed on the findings. RESULTS Responses were collected from 162 participants, and a total of 228 issues were identified. Eighteen categories with 56 subcategories emerged from the data analysis, which were grouped into five types of challenges: (1) communication, (2) understanding, (3) expertise, (4) system, and (5) collaboration. In particular, the results highlighted deficiencies in needs-based multidisciplinary team care. CONCLUSION This study elucidated issues experienced by rheumatology nurses in clinical settings in Japan. Furthermore, this investigation revealed the necessity of patient-centred multidisciplinary team care, including health professionals, patients, and other relevant individuals. This study provided practical directions to facilitate the implementation of effective care focused on improving patients' quality of life.
Collapse
Affiliation(s)
- Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Misuzu Gregg
- Graduate School of Nursing, Meio University, Nago, Japan
| | - Yuriko Kuroe
- Kansai University of Nursing and Health Sciences, Hyogo, Japan
| | - Yukitomo Urata
- Department of Rheumatology, Tsugaru General Hospital, Aomori, Japan
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayo Kojima
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiko Sugihara
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| |
Collapse
|
3
|
Landgren E, Mogard E, Bremander A, Lindqvist E, Nylander M, Larsson I. Belonging, happiness, freedom and empowerment-a qualitative study of patients' understanding of health in early rheumatoid arthritis. BMC Rheumatol 2024; 8:29. [PMID: 38937849 PMCID: PMC11212251 DOI: 10.1186/s41927-024-00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients' health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA. METHODS The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients' understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38-80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3-7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology's (EULAR) recommendations, a patient research partner participated in all phases of the study. RESULTS The analysis revealed four main descriptive categories: 'Health as belonging' was described as experiencing a sense of coherence. 'Health as happiness' was understood as feeling joy in everyday life. 'Health as freedom' was understood as feeling independent. 'Health as empowerment' was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life. CONCLUSIONS This study revealed that patients' perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients' participation in treatment goals, which may lead to better treatment adherence and health outcomes.
Collapse
Affiliation(s)
- Ellen Landgren
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden.
- Spenshult Research and Development Centre, Halmstad, Sweden.
| | - Elisabeth Mogard
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Ann Bremander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Maria Nylander
- Spenshult Research and Development Centre, Halmstad, Sweden
- Swedish Rheumatism Association, Stockholm, Sweden
| | - Ingrid Larsson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| |
Collapse
|
4
|
Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024; 83:730-740. [PMID: 38212040 PMCID: PMC11103326 DOI: 10.1136/ard-2023-225041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
Collapse
Affiliation(s)
- Tuva Moseng
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Simone Battista
- University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Vladimira Boyadzhieva
- UMHAT "St. Iv. Rilski" Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Andrew G Finney
- Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ingvild Kjeken
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Hans Lund
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Karel Pavelka
- Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Dieter Wiek
- EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy
| | - Nina Østerås
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
5
|
Teuwen MMH, van Weely SFE, Vliet Vlieland TPM, van Wissen MAT, Peter WF, den Broeder AA, van Schaardenburg D, van den Hout WB, Van den Ende CHM, Gademan MGJ. Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial. Ann Rheum Dis 2024; 83:437-445. [PMID: 38171602 DOI: 10.1136/ard-2023-224912] [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: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare the effectiveness of longstanding (>52 weeks), supervised exercise therapy with usual care in adults with rheumatoid arthritis (RA) and severe functional limitations. METHODS Participants were randomised 1:1 to the intervention (individualised goal-setting, active exercises, education and self-management regarding physical activity) or usual care. Primary endpoint was the change in the Patient-Specific Complaints activity ranked 1 (PSC1, 0-10) at 52 weeks. Secondary endpoints included the PSC activities ranked 2 and 3 (PSC2, PSC3), Health Assessment Questionnaire-Disability Index (HAQ-DI), Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL), 6-minute walk test (6MWT), Patient Reported Outcome Measurement Information System Physical Function-10 (PROMIS PF-10) and the Short Form-36 Physical and Mental Component Summary Scales (SF-36 PCS and MCS). (Serious) Adverse events (AEs) were recorded. Measurements were done by blinded assessors. Analyses at 52 weeks were based on the intention-to-treat principle. RESULTS In total, 217 people (90% female, age 58.8 (SD 12.9) years) were randomised (n=104 intervention, n=98 usual care available for analyses). At 52 weeks, the improvement of the PSC1 was significantly larger in the intervention group (mean difference (95% CI) -1.7 (-2.4, -1.0)). Except for the SF-36 MCS, all secondary outcomes showed significantly greater improvements favouring the intervention (PSC2 -1.8 (-2.4, -1.1), PSC3 -1.7 (-2.4, -1.0), PROMIS PF-10 +3.09 (1.80, 4.38), HAQ-DI -0.17 (-0.29, -0.06), RAQoL -2.03 (-3.39, -0.69), SF-36 PCS +3.83 (1.49, 6.17) and 6MWT +56 (38, 75) m). One mild, transient AE occurred in the intervention group. CONCLUSION Longstanding, supervised exercise therapy was more effective than usual care in people with RA and severe functional limitations. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL8235), included in the International Clinical Trial Registry Platform (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8235).
Collapse
Affiliation(s)
- Max M H Teuwen
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Salima F E van Weely
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria A T van Wissen
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfred F Peter
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Cornelia H M Van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Maaike G J Gademan
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
6
|
Magnussen HJ, Kjeken I, Pinxsterhuis I, Sjøvold TA, Feiring M. Negotiating Professional Tasks in a Hospital: A Qualitative Study of Rheumatologists and Occupational Therapists in the Management of Hand Osteoarthritis. J Multidiscip Healthc 2023; 16:3057-3074. [PMID: 37873535 PMCID: PMC10590564 DOI: 10.2147/jmdh.s425640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose Societal change and rise in demand for healthcare call for new health professional practices and task redistribution. Through negotiated order theory, this study explores how hospital rheumatologists (RT) and occupational therapists (OT) negotiate professional tasks in the clinical management of hand osteoarthritis. Methodology Fourteen qualitative interviews and 16 observations in clinical consultations were conducted in two hospitals specialized in rheumatology in Norway. Participants included eight OTs, six RTs, and patients in consultations. Data were analyzed using reflexive thematic analysis. Results Three themes were developed from codes: hierarchical ordering of hospital work impacts interprofessional negotiations; diagnostic organization of tasks preserves RT authority; and evidence-based recommendations in rheumatology enhance OT responsibilities. Overall, RTs and OTs enact tasks in succession where higher-ranking RTs establish a diagnosis and decide the subsequent in-hospital trajectory entrenched in a medical knowledge system. When medicine does not hold evidence-based treatment alternatives for patients, OTs respond by providing therapeutic interventions that are legitimized through international recommendations in rheumatology when they equip patients with tools to cope with chronic illness. Conclusion Negotiations over tasks do not take place from equal power positions when status and knowledge hierarchies frame professional practices. The enactment of tasks is concurrently highly influenced by the arena of the workplace, where the two professional groups both cross boundaries and work together in concert despite professional differences in order to meet patient interests and provide relevant healthcare.
Collapse
Affiliation(s)
- Hege Johanne Magnussen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Irma Pinxsterhuis
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Marte Feiring
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
7
|
van der Kraan YM, Paap D, Lennips N, Veenstra ECA, Wink FR, Kieskamp SC, Spoorenberg A. Patients' Needs Concerning Patient Education in Axial Spondyloarthritis: A Qualitative Study. Rheumatol Ther 2023; 10:1349-1368. [PMID: 37523038 PMCID: PMC10469151 DOI: 10.1007/s40744-023-00585-7] [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: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Within the EULAR recommendations, patient education (PE) is stated as the basis of the management of axial spondyloarthritis (axSpA). However, educational needs are scarcely qualitatively studied in axSpA. Therefore, we aimed to explore experiences and needs of PE in patients with axSpA. METHODS A phenomenological approach was used, with semi-structured in-depth interviews with patients with axSpA including broad variation in characteristics. Thematic analysis was applied. To enhance credibility, data saturation, research triangulation, peer debriefing, member checking, theoretical notes, and bracketing were performed. RESULTS Three interrelated themes regarding PE were identified from 20 interviews: illness perception, content, and 'availability'. Illness perception affects how patients experience and process PE, which consequently influences coping strategies. Prognosis, treatment, and coaching to self-management were identified as the most important content of PE. Regarding 'availability', face-to-face PE is preferred for exploring needs, supplemented by self-education, which can be freely applied. Additionally, sufficient time and a comprehensible amount of information were important and participants emphasized the need for axSpA-tailored information for relatives and friends. Participants reported a trusting patient-healthcare provider (HCP) relationship, and multidisciplinary and interdisciplinary attunement between HCPs as prerequisites for effective PE. CONCLUSIONS This first qualitative study exploring patients' experiences and needs of PE in axSpA revealed that prognosis, treatment, and coaching to self-management are important regarding content, and the combination of face-to-face contact and self-education the preferred modalities. It seems essential that patients' illness perceptions are taken into account for effective PE. These results add relevant insights for future PE guidelines in axSpA.
Collapse
Affiliation(s)
- Yvonne M van der Kraan
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
- Department of Physiotherapy, School of Health, Saxion University of Applied Sciences, 7513 AB, Enschede, The Netherlands
| | - Niels Lennips
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Else C A Veenstra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Freke R Wink
- Department of Rheumatology, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands
| | - Stan C Kieskamp
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
8
|
Beckers E, Hermans K, Van Tubergen A, Boonen A. Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions. RMD Open 2023; 9:e003056. [PMID: 37541741 PMCID: PMC10407379 DOI: 10.1136/rmdopen-2023-003056] [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: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4) consequences and (5) effectiveness of interventions. METHODS A systematic literature search of reviews was performed in five bibliographical databases. A hierarchical data extraction was applied based on review type (Cochrane reviews (CRs), followed by non-Cochrane systematic reviews (SRs) and narrative reviews (NRs)) and year of publication. Extracted data were summarised in elaborated narrative syntheses. Results were discussed with a patient panel. RESULTS One hundred and thirty-four reviews were included (19 CRs, 44 SRs, 71 NRs). No agreed on definition was reported for general fatigue, nor for types of fatigue. Twenty-five measurement instruments were found, all self-reported. Five instruments proposed a threshold for excessive fatigue. Pain, physical function and depressive symptoms were the most frequently studied disease-related determinants of fatigue; female sex and stress the most frequent contextual determinants. Work performance, followed by impact on pain, physical activity and social roles were the most frequently studied consequences. Whenever quantified, associations between fatigue with determinants and consequences were on average small. For non-pharmacological interventions, if effect sizes were reported, these were negligible to small and for pharmacological interventions negligible to moderate. Patients recommended actions for research and practice. CONCLUSION Syntheses of reviews point to the complexity of fatigue. The extensive amount of evidence could be used to offer tailored management plans to patients in clinical practice and inform future research agendas.
Collapse
Affiliation(s)
- Esther Beckers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Kasper Hermans
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Astrid Van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| |
Collapse
|
9
|
Ritschl V, Sperl L, Andrews MR, Björk M, Boström C, Cappon J, Davergne T, de la Torre-Aboki J, de Thurah A, Domján A, Dragoi RG, Estévez-López F, Ferreira RJO, Fragoulis GE, Grygielska J, Kõrve K, Kukkurainen ML, Madelaine-Bonjour C, Marques A, Meesters J, Moe RH, Moholt E, Mosor E, Naimer-Stach C, Ndosi M, Pchelnikova P, Primdahl J, Putrik P, Rausch Osthoff AK, Smucrova H, Testa M, van Bodegom-Vos L, Peter WF, Zangi HA, Zimba O, Vliet Vlieland TPM, Stamm TA. Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers-results of a EULAR-funded European survey. RMD Open 2023; 9:e003120. [PMID: 37230762 PMCID: PMC10230966 DOI: 10.1136/rmdopen-2023-003120] [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: 03/02/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. METHODS AND PARTICIPANTS We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. RESULTS The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. CONCLUSIONS To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.
Collapse
Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Margaret Renn Andrews
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Carina Boström
- Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Jeannette Cappon
- Department of Pediatric Rehabillitation, Reade Centre for Rehabillitation and Rheumatology, Amsterdam, The Netherlands
| | - Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Domján
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Razvan Gabriel Dragoi
- Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Fernando Estévez-López
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Coimbra, Portugal
| | - George E Fragoulis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katti Kõrve
- Center of Rheumatology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | | | - Andréa Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Jorit Meesters
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Rikke Helene Moe
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ellen Moholt
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erika Mosor
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Polina Putrik
- Department of Rheumatology, Internal Medicine, MUMC and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, Zurich University of Applied Sciences; School of Health Professions, Winterthur, Switzerland
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Hana Smucrova
- Center of Medical Rehabilitation, Institute of Rheumatology, Prague, Czech Republic
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Heidi A Zangi
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology and Research, VID Specialized University, Oslo, Norway
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| |
Collapse
|
10
|
Minopoulou I, Pyrgidis N, Tishukov M, Sokolakis I, Baniotopoulos P, Kefas A, Doumas M, Hatzichristodoulou G, Dimitroulas T. Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:1021-1030. [PMID: 35951753 DOI: 10.1093/rheumatology/keac457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In women with systemic autoimmune rheumatic diseases (SARDs), female sexual dysfunction (SD) remains underestimated. We aimed to explore the prevalence and correlates of SD in females with SARDs. METHODS We performed a systematic review and meta-analysis of studies assessing the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in this setting (PROSPERO: CRD42021287346). We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases and grey literature until February 2022. We evaluated the quality of the selected records using the Hoy Risk of Bias tool. A random-effects meta-analysis of proportions with the double arcsine transformation was conducted. Subgroup and sensitivity analyses, as well as meta-regression of important correlates, were conducted. RESULTS We included 68 studies with 5457 females diagnosed with a SARD (mean age: 43.7 [12.9] years). The overall SD prevalence was 63% (95% CI: 56, 69%, I2 = 94%) and the overall FSFI total score was 19.7 points (95% CI: 18.4, 21, I2 = 97%). Including only sexually active females, the SD prevalence was estimated as 60% (95% CI: 53, 67%, I2 = 88%), whereas the FSFI total score was 22 points (95% CI: 20.8, 23.1, I2 = 93%). Across the different SARDs, women with Sjögren's syndrome and systemic sclerosis reported the highest levels of SD (74%, 95% CI: 58, 87%, I2 = 84% and 69%, 95% CI: 54, 83%, I2 = 94%, respectively). CONCLUSION Sexual function in females with SARDs seems to be severely impaired, irrespective of the type of SARD. Screening and treatment of SD in females with SARDs should become an integral part of healthcare clinical practice.
Collapse
Affiliation(s)
- Ioanna Minopoulou
- Fourth Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Pyrgidis
- Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany
| | - Maksim Tishukov
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sokolakis
- Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany
| | | | - Aristeidis Kefas
- Second Propedeutic Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
11
|
Hilberdink B, van der Giesen F, Vliet Vlieland T, van Bodegom-Vos L, Van Weely S. Implementing enhancements in supervised group exercise for people with axial spondyloarthritis: a hybrid effectiveness-implementation study. Scand J Rheumatol 2023; 52:60-68. [PMID: 34788187 DOI: 10.1080/03009742.2021.1992845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The content of supervised group exercise (SGE) for axial spondyloarthritis (axSpA) has hardly changed in recent decades, despite new evidence-based insights to improve SGE quality. This pilot implementation study evaluated the effects and feasibility of enhancements in axSpA-specific SGE in four regions in the Netherlands. METHOD The implemented enhancements included: more high-intensity aerobic exercise; exercise personalization with periodic assessments; and patient education on home exercise. The implementation strategy included a one-day supervisor training course and telephone support. To evaluate effects, aerobic capacity [Six-Minute Walk Test (6MWT)], physical functioning [Ankylosing Spondylitis Performance-based Improvement (ASPI); improved/not improved], health status [Assessment of SpondyloArthritis international Society Health Index (ASAS HI) questionnaire], and home exercise engagement [Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH)] were assessed at baseline and after one year in 60 participants. Changes were analysed with the Wilcoxon signed-rank test. To evaluate feasibility, a survey of participants and semi-structured interviews with four SGE supervisors assessed uptake and satisfaction with the enhancements. RESULTS Aerobic capacity increased significantly and 35% of participants improved functioning, whereas health status and home exercise engagement did not change. The participants' survey and supervisors' interviews showed that high-intensity aerobic exercise was implemented successfully, exercise personalization and periodic assessments were implemented partially, and patient education was not implemented at all. Most participants were satisfied with the changes. CONCLUSIONS After this pilot implementation, SGE enhancements were only partially implemented. Nevertheless, aerobic capacity improved significantly and satisfaction with accomplished changes was high. Nationwide implementation would require adaptations to improve feasibility.
Collapse
Affiliation(s)
- B Hilberdink
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - F van der Giesen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - S Van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
Gall S, Kiltz U, Kobylinski T, Andreica I, Vaupel K, Waldecker C, Baraliakos X, Braun J. Patient knowledge about biosimilars and satisfaction with the education provided by rheumatologists or nurse specialists in a biosimilar multiswitch scenario – The perception study. Semin Arthritis Rheum 2022; 57:152119. [DOI: 10.1016/j.semarthrit.2022.152119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
|
13
|
Murray N, Palermo C, Batt A, Bell K. Does patient and public involvement influence the development of competency frameworks for the health professions? A systematic review. Front Med (Lausanne) 2022; 9:918915. [PMID: 35957861 PMCID: PMC9360578 DOI: 10.3389/fmed.2022.918915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Competency frameworks typically describe the perceived knowledge, skills, attitudes and other characteristics required for a health professional to practice safely and effectively. Patient and public involvement in the development of competency frameworks is uncommon despite delivery of person-centered care being a defining feature of a competent health professional. This systematic review aimed to determine how patients and the public are involved in the development of competency frameworks for health professions, and whether their involvement influenced the outcome of the competency frameworks. Studies were identified from six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Web of Science and ERIC). The database search yielded a total of 8,222 citations, and 43 articles were included for data extraction. Most studies were from the United Kingdom (27%) and developed through multidisciplinary collaborations involving two or more professions (40%). There was a large variation in the number of patients and members of the public recruited (range 1–1,398); recruitment sources included patients and carers with the clinical condition of interest (30%) or established consumer representative groups (22%). Common stages for involving patients and the public were in generation of competency statements (57%) or reviewing the draft competency framework (57%). Only ten studies (27%) took a collaborative approach to the engagement of patients and public in competency framework development. The main ways in which involvement influenced the competency framework were validation of health professional-derived competency statements, provision of desirable behaviors and attitudes and generation of additional competency statements. Overall, there was a lack of reporting regarding the details and outcome of patient and public involvement. Further research is required to optimize approaches to patient and public involvement in competency framework development including guidance regarding who, how, when and for what purposes they should be engaged and the requirements for reporting.
Collapse
Affiliation(s)
- Nicole Murray
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- *Correspondence: Nicole Murray
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alan Batt
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Paramedic Programs, Faculty of Health Sciences and Human Services, Fanshawe College, London, ON, Canada
| | - Kristie Bell
- Department of Dietetics and Foodservices, Queensland Children's Hospital, Brisbane, QLD, Australia
| |
Collapse
|
14
|
Jones B, Ndosi M. Adoption of a biopsychosocial approach to musculoskeletal pain faces barriers at the micro, meso and macro levels. Evid Based Nurs 2022; 25:81. [PMID: 34815305 DOI: 10.1136/ebnurs-2021-103434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Bethan Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- School of Health and Social Wellbeing, University of the West of England Bristol, Bristol, UK
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England Bristol, Bristol, UK
- Academic Rheumatology Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
15
|
Bennett SE, Zangi HA, Larsson I, Beauvais C, Boström C, Domján A, van Eijk-Hustings Y, Van der Elst K, Fayet F, Ferreira RJO, Fusama M, Geneva-Popova M, Herrero Manso MDC, Hoeper K, Jones B, Kukkurainen ML, Gladys Kwok SK, Minnock P, Nava T, Primdahl J, Rawat R, Sierakowska M, Stoffer-Marx M, van Tubergen A, Ndosi M. Assessing acceptability and identifying barriers and facilitators to implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with rheumatology professionals in 23 European and Asian countries. Ann Rheum Dis 2022; 81:1348-1357. [PMID: 35676076 DOI: 10.1136/annrheumdis-2022-222253] [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: 01/27/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To disseminate and assess the level of acceptability and applicability of the European Alliance of Associations for Rheumatology (EULAR) recommendations for patient education among professionals in rheumatology across Europe and three Asian countries and identify potential barriers and facilitators to their application. METHODS A parallel convergent mixed-methods design with an inductive approach was used. A web-based survey, available in 20 different languages, was distributed to health professionals by non-probability sampling. The level of agreement and applicability of each recommendation was assessed by (0-10) rating scales. Barriers and facilitators to implementation were assessed using free-text responses. Quantitative data were analysed descriptively and qualitative data by content analysis and presented in 16 categories supported by quotes. RESULTS A total of 1159 completed the survey; 852 (73.5%) were women. Most of the professionals were nurses (n=487), rheumatologists (n=320), physiotherapists (n=158). For all recommendations, the level of agreement was high but applicability was lower. The four most common barriers to application were lack of time, lack of training in how to provide patient education, not having enough staff to perform this task and lack of evaluation tools. The most common facilitators were tailoring patient education to individual patients, using group education, linking patient education with diagnosis and treatment and inviting patients to provide feedback on patient education delivery. CONCLUSIONS This project has disseminated the EULAR recommendations for patient education to health professionals across 23 countries. Potential barriers to their application were identified and some are amenable to change, namely training patient education providers and developing evaluation tools.
Collapse
Affiliation(s)
- Sarah E Bennett
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Heidi A Zangi
- National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Health, VID Specialized University, Oslo, Norway
| | - Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden
| | - Catherine Beauvais
- Rheumatology Department, Hôpital Saint-Antoine Sorbonne Université Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Domján
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Yvonne van Eijk-Hustings
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Kristien Van der Elst
- Department of Rheumatology, University Hospitals Leuven, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Françoise Fayet
- Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal.,Rheumatology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | | | | | - Kirsten Hoeper
- Rheumatology and Immunology, Medizinische Hochschule Hannover Klinikum, Hannover, Germany
| | - Bethan Jones
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Suet Kei Gladys Kwok
- Rheumatology and Clinical Immunology Unit, Grantham Hospital, Hong Kong, Hong Kong
| | - Patricia Minnock
- Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Tiziana Nava
- Department of Translational Medicine and Surgery, University of Milan-Bicocca, Milano, Lombardia, Italy
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Roopa Rawat
- Indian Spinal Injuries Centre, New Delhi, India
| | - Matylda Sierakowska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Michaela Stoffer-Marx
- Institute for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria.,Department of Health Sciences, FH Campus Wien, University of Applied Sciences, , Vienna, Austria
| | - Astrid van Tubergen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Department of Rheumatology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK .,Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
16
|
Mogard E, Bremander A, Haglund E. A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study. BMC Rheumatol 2022; 6:29. [PMID: 35610662 PMCID: PMC9131533 DOI: 10.1186/s41927-022-00260-4] [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: 01/02/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA). METHODS A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as "healthy" or "unhealthy", summarized for each patient and stratified into four groups (0-3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis. RESULTS Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors-more frequently patients with PsA (48%) than AS (39%) or USpA (38%)-and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes. CONCLUSION Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.
Collapse
Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Ann Bremander
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Emma Haglund
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Rydberg Laboratory of Applied Sciences, Halmstad University, Halmstad, Sweden
| |
Collapse
|
17
|
de Thurah A, Bosch P, Marques A, Meissner Y, Mukhtyar CB, Knitza J, Najm A, Østerås N, Pelle T, Knudsen LR, Šmucrová H, Berenbaum F, Jani M, Geenen R, Krusche M, Pchelnikova P, de Souza S, Badreh S, Wiek D, Piantoni S, Gwinnutt JM, Duftner C, Canhão HM, Quartuccio L, Stoilov N, Prior Y, Bijlsma JW, Zabotti A, Stamm TA, Dejaco C. 2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Ann Rheum Dis 2022; 81:1065-1071. [PMID: 35470160 DOI: 10.1136/annrheumdis-2022-222341] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD). OBJECTIVE To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD. METHODS A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting. RESULTS Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible.The level of agreement to each statement ranged from 8.5 to 9.8/10. CONCLUSION The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice.
Collapse
Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philipp Bosch
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria
| | - Andrea Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal.,Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet University College and Hospital, Oslo, Norway
| | - Tim Pelle
- Department of Rheumatic Diseases, Radboud University, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hana Šmucrová
- Institute of Rheumatology, Centre of Medical Rehabilitation, Praha, Czech Republic
| | | | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK.,Patient Research Partner, EULAR, London, UK
| | - Sara Badreh
- Patient Research Partner, EULAR, Stockholm, Sweden
| | - Dieter Wiek
- Patient Research Partner, EULAR, Bonn, Germany
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck/Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helena M Canhão
- Comprehensive Research Center, CHRC, EpicDoC Unit, CEDOC-NOVA Medical School-NOVA University of Lisbon, Portugal, Lisboa, Portugal
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Nikolay Stoilov
- Faculty of Medicine, University Hospital St. Ivan Rilski, Medical University of Sofia, Sofia, Bulgaria
| | - Yeliz Prior
- Centre for Health Sciences Research, School of Health and Society, University of Salford, Salford, UK
| | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.,Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Bruneck, Italy
| |
Collapse
|
18
|
Stöcker JK, Schouffoer AA, Spierings J, Schriemer MR, Potjewijd J, de Pundert L, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Staal JB, Satink T, Vonk MC, van den Ende CHM. Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud's phenomenon and digital ulcers in patients with systemic sclerosis. Rheumatology (Oxford) 2022; 61:1476-1486. [PMID: 34260723 PMCID: PMC8996778 DOI: 10.1093/rheumatology/keab537] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE SSc is a complex CTD affecting mental and physical health. Fatigue, hand function loss, and RP are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. METHODS A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding RP and digital ulcers. For each recommendation, the level of evidence and the level of agreement was determined. RESULTS Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue, hand function loss, and RP/digital ulcers-related problems, were approved by the task force. CONCLUSIONS These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings.
Collapse
Affiliation(s)
- Juliane K Stöcker
- Department of Research, Sint Maartenskliniek
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen
| | - Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden
- Department of Rheumatology, Haga Teaching Hospital, The Hague
| | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College London, London, UK
| | - Marisca R Schriemer
- Department of Research, Sint Maartenskliniek
- National Association for People with Lupus, Systemic Sclerosis, Antiphospholipid Syndrome, and Mixed Connective Tissue Disease, Utrecht
| | - Judith Potjewijd
- Department of Clinical Immunology, Maastricht University Medical Center, Maastricht
| | - Lian de Pundert
- Department of Physical Therapy, Haga Teaching Hospital, The Hague
- Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Frank H J van den Hoogen
- Department of Research, Sint Maartenskliniek
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen
| | | | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center
| | - Ton Satink
- Research Group Neuro Rehabilitation, HAN University of Applied Sciences, Nijmegen
- European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Madelon C Vonk
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen
| | - Cornelia H M van den Ende
- Department of Research, Sint Maartenskliniek
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen
| | | |
Collapse
|
19
|
Romand X, Dalecky M, Baillet A, Dougados M. Answer to Avril et al.: “In response to the recent recommendations on the assessment of patients with spondyloarthritis, a translation is needed for health professionals”. Joint Bone Spine 2022;89:105355. Joint Bone Spine 2022; 89:105363. [DOI: 10.1016/j.jbspin.2022.105363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
|
20
|
Zickuhr L, Mandell BF. Rheumatology Education Needs a Splash of Color. J Rheumatol 2022; 49:343-345. [PMID: 35034005 DOI: 10.3899/jrheum.211233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health disparities in the delivery and outcomes of clinical care exist across the spectrum of patients with rheumatic diseases. In a retrospective analysis of the Corrona registry, patients with rheumatoid arthritis identifying as racial or ethnic minorities achieved lower rates of remission or low disease activity scores and reported poorer functional status compared to White patients.1.
Collapse
Affiliation(s)
- Lisa Zickuhr
- L. Zickuhr, MD, MHPE, Assistant Professor of Medicine, Washington University School of Medicine, Division of Rheumatology, St. Louis, Missouri; B.F. Mandell, MD, PhD, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Rheumatologic and Immunologic Diseases, Cleveland, Ohio, USA. LZ declares consulting for Lilly and funding from the Rheumatology Research Foundation (CSE2122), both unrelated to this work. BFM declares no disclosures relevant to this article. Address correspondence to Dr. B.F. Mandell, Cleveland Clinic Foundation, Rheumatic and Immunologic Disease, 9500 Euclid Ave A50, Cleveland, OH 44022, USA.
| | - Brian F Mandell
- L. Zickuhr, MD, MHPE, Assistant Professor of Medicine, Washington University School of Medicine, Division of Rheumatology, St. Louis, Missouri; B.F. Mandell, MD, PhD, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Rheumatologic and Immunologic Diseases, Cleveland, Ohio, USA. LZ declares consulting for Lilly and funding from the Rheumatology Research Foundation (CSE2122), both unrelated to this work. BFM declares no disclosures relevant to this article. Address correspondence to Dr. B.F. Mandell, Cleveland Clinic Foundation, Rheumatic and Immunologic Disease, 9500 Euclid Ave A50, Cleveland, OH 44022, USA.
| |
Collapse
|
21
|
Søvik ML, Eide REM, Rene B, Strand MM, Devik I, Liland DE, Kjeken I, Taule T. Rheumatic disease and fatigue: Participants' experiences of an activity-pacing group. Scand J Occup Ther 2021:1-12. [PMID: 34749574 DOI: 10.1080/11038128.2021.1998609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fatigue is a common symptom of inflammatory rheumatic disease and has a great impact on everyday life. Activity-pacing is proposed as an intervention to increase participation in meaningful activities. AIMS To explore participants' experiences with an activity-pacing group, how participants perceived self-managing everyday life after group attendance, and their reflections on unmet needs that could enhance self-management of everyday life with fatigue. MATERIALS AND METHODS Semi-structured interviews were conducted with 10 participants who had attended an activity-pacing group. Thematic analyses were conducted. FINDINGS Prior to group attendance, the participants expressed an awareness of their lack of knowledge of fatigue. Through group attendance, they increased their understanding of fatigue and their ability to apply strategies to better manage everyday life. Participants found it difficult to balance their energy use and realised that implementing activity-pacing strategies takes time. Therefore, they requested follow-up sessions with the activity-pacing group. They also desire that rheumatologists pay more attention to and acknowledge fatigue. CONCLUSIONS AND SIGNIFICANCE Enhancing the understanding of fatigue and how to manage everyday life with fatigue, appears to be important. Group interventions led by occupational therapists and with a focus on activity-pacing may be a suitable approach. Follow-up sessions are recommended.
Collapse
Affiliation(s)
- Margaret L Søvik
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ruth Else M Eide
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Rene
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Ingvill Devik
- Department of Rheumatology, Nordland Hospital, Bodø, Norway
| | - Dag Einar Liland
- Patient Participation Group, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
22
|
Studenic P, Radner H. Back to Basics: Prioritizing Communication as a Key Instrument in Managing Rheumatoid Arthritis. J Rheumatol 2021; 49:123-125. [PMID: 34599049 DOI: 10.3899/jrheum.210984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with rheumatoid arthritis (RA) have come to experience a tremendous increase in therapeutic options with disease-modifying antirheumatic drugs (DMARDs).1 After decades of dissatisfying drug therapy results with conventional synthetic DMARDs (csDMARDs) only, the introduction of the first tumor necrosis factor inhibitors in the late 1990s has revolutionized RA treatment.2.
Collapse
Affiliation(s)
- Paul Studenic
- This work was supported through the FOREUM research fellowship grant. P. Studenic, MD, PhD, Karolinska Institutet, Department of Medicine (Solna), Division of Rheumatology, Stockholm, Sweden, and Medical University of Vienna, Department of Medicine 3, Division of Rheumatology, Vienna, Austria; H. Radner, Associate Professor, MD, Medical University of Vienna, Department of Medicine , Division of Rheumatology, Vienna, Austria. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P. Studenic, Karolinska Institutet, Department of Medicine (Solna), Division of Rheumatology, D2:01, Karolinska Universitetssjukhuset, 171 76 Stockholm, Sweden.
| | - Helga Radner
- This work was supported through the FOREUM research fellowship grant. P. Studenic, MD, PhD, Karolinska Institutet, Department of Medicine (Solna), Division of Rheumatology, Stockholm, Sweden, and Medical University of Vienna, Department of Medicine 3, Division of Rheumatology, Vienna, Austria; H. Radner, Associate Professor, MD, Medical University of Vienna, Department of Medicine , Division of Rheumatology, Vienna, Austria. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P. Studenic, Karolinska Institutet, Department of Medicine (Solna), Division of Rheumatology, D2:01, Karolinska Universitetssjukhuset, 171 76 Stockholm, Sweden.
| |
Collapse
|
23
|
Liem S, van Leeuwen NM, Vliet Vlieland T, Boerrigter G, van den Ende C, de Pundert L, Schriemer MR, Spierings J, Vonk MC, de Vries-Bouwstra JK. Physical therapy in patients with systemic sclerosis: physical therapists' perspectives on current delivery and educational needs. Scand J Rheumatol 2021; 51:394-401. [PMID: 34263718 DOI: 10.1080/03009742.2021.1937306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To assess the perspectives of physical therapists treating patients with systemic sclerosis (SSc) on their current practice and educational needs.Method: In July 2019, 405 SSc patients attending a multidisciplinary SSc programme received a survey on physical therapy. Patients who indicated having received physical therapy in the past 2 years were asked to invite their treating physical therapist to complete a questionnaire including sociodemographic characteristics, referral process, content of treatment, perceived knowledge and skills, and educational needs (mostly yes/no answers).Results: Forty-eight of 80 possibly eligible physical therapists treating SSc patients returned the questionnaire [median age 44 years (interquartile range 35-58); 52% female; median number of SSc patients currently treated: 1 (range 1-4)]. Eighty-one per cent (n = 39) of physical therapists had received a referral, with 69% (n = 27/39) judging its content as insufficient. The most often provided types of exercises were range of motion (96%), muscle-strengthening (85%), and aerobic (71%) exercises, followed by hand (42%) and mouth (10%) exercises. Concerning manual treatment, 65% performed either massage or passive mobilization. Regarding competences, 65% indicated feeling capable of treating SSc patients. Nevertheless, 85% expressed the need for an information website on physical therapy in SSc, and 77% for postgraduate education on SSc.Conclusion: Primary care physical therapists treating patients with SSc used a wide range of treatment modalities. Although most stated that they treated very few patients, the majority felt capable of treating SSc patients. Nevertheless, the large majority expressed a need for additional information and educational activities concerning SSc.
Collapse
Affiliation(s)
- Sie Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - N M van Leeuwen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tpm Vliet Vlieland
- Department of Orthopedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Gmw Boerrigter
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Chm van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laj de Pundert
- Department of Physical Therapy, HagaZiekenhuis, The Hague, The Netherlands
| | - M R Schriemer
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - J Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J K de Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
24
|
Zaini R, Alrehaily A, Alhazmi A, Halabi H, Mohamed H, Almoallim H. Future Directions of Rheumatology Training According to Saudi Vision 2030: Recommendations From a Saudi Experts Meeting. Open Access Rheumatol 2021; 12:347-355. [PMID: 33380845 PMCID: PMC7769142 DOI: 10.2147/oarrr.s286285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Worldwide research anticipates that a current shortage of rheumatologists will exacerbate over the next decade, whereas the need for arthritis specialists will continue to escalate. Saudi Arabia (SA) also encounters a limited geographical distribution of rheumatologists and rheumatology fellowship training centres. Objective Reporting the Saudi rheumatologists’ advisory meeting conducted in Makkah, SA in January 2020 with the aim to discuss the “Saudi Vision 2030” for rheumatology training programs. Materials and Methods A meeting of Saudi rheumatology experts and consultants was conducted to address the future directions, challenges, and recommendations of rheumatology training. The 10th Rheumatology Practice Symposium was organised by Alzaidi Chair of Research in Rheumatic Diseases (ZCRD), and conducted in Makkah Commerce Chamber, Makkah, SA on January 28, 2020. More than 30 consultants and rheumatology fellows with five Saudi experts in the field of rheumatology assembled to form 10 recommendations that tackle rheumatology training challenges in SA. Results The meeting recommendations shed light on the clinical practice of rheumatology training in SA; challenges and opportunities in rheumatology fellowship programs; efforts of the Saudi Commission for Health Specialties (SCFHS) to design and implement a competent postgraduate rheumatology training; and challenges with trainers, trainee, and within training centres. Conclusion To address rheumatology challenges in SA, rheumatology consultants and fellows assembled to form 10 recommendations. The recommendations tackled the challenges of rheumatology fellowship programs and the efforts to implement a competent postgraduate rheumatology training. These recommendations are expected to lead us successfully to fulfil our ambition in the “Saudi Vision of 2030”.
Collapse
Affiliation(s)
- Rania Zaini
- Department of Medical Education, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Ali Alrehaily
- Department of Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia.,Chairman of the Scientific Committee of Adult Rheumatology Fellowship Program, Saudi Commission for Health Specialties (SCFHS), Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia.,Chairman, Supervisory Committee for Saudi Board Adult Rheumatology Fellowship Program in Western Region, Saudi Commission For Health Specialties (SCFHS), Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital And Research Center, Jeddah, Saudi Arabia
| | - Heba Mohamed
- Pfizer Biopharmaceutical Group, Emerging Markets, Riyadh, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
| |
Collapse
|
25
|
Organisation and content of supervised group exercise for people with axial spondyloarthritis in The Netherlands. Rheumatol Int 2020; 41:391-401. [PMID: 33244645 PMCID: PMC7835145 DOI: 10.1007/s00296-020-04742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023]
Abstract
Supervised group exercise (SGE) is recommended for people with axial spondyloarthritis (axSpA). Recent literature suggests that its contents and dosage must probably be revised. As a first step towards renewal, this study examined the current SGE organisation and content for people with axSpA in The Netherlands. A pen-and-paper survey was sent to the boards of the 82 local patient associations affiliated with the Dutch Arthritis Society in 2016. One member of each board was asked to complete questions on the nature and organisation of SGE and one of the supervising therapists to complete questions on the SGE supervision and contents. The questionnaire was returned by representatives of 67/82 (82%) local patient associations, of which 17 (25%) provided axSpA-specific SGE (16/17 SGE programmes with both land-based exercise and hydrotherapy and 1/17 with only hydrotherapy). These involved in total 56 groups with 684 participants and 59 supervisors, of whom 54 were physical therapists and 21 had had postgraduate education on rheumatic and musculoskeletal diseases (RMDs). Besides mobility and strengthening exercises and sports (17/17), most programmes included aerobic exercise (10/17), but rarely with heart rate monitoring (1/17), patient education (8/17), periodic assessments (2/17), or exercise personalisation (1/17). In the Netherlands, a quarter of local patient associations organised axSpA-specific SGE, mostly containing land-based exercises combined with sports and hydrotherapy. Most supervisors lacked postgraduate education on RMDs and most programmes lacked intensity monitoring, patient education, periodic assessments, and personalisation, which are needed for optimising exercise programmes according to current scientific insights.
Collapse
|
26
|
Gregory WJ, Burchett S, McCrum C. National survey of the current clinical practices of the UK rheumatology physiotherapists: A short report. Musculoskeletal Care 2020; 19:136-141. [PMID: 32975369 DOI: 10.1002/msc.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022]
Affiliation(s)
- William J Gregory
- Rheumatology Directorate, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.,Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, All Saints Building, Manchester, UK
| | | | - Carol McCrum
- East Sussex Healthcare NHS Trust, Eastbourne, UK.,Research Centre for Health Care Professions, University of Brighton, Brighton, UK
| |
Collapse
|
27
|
|
28
|
Fragoulis GE, Edelaar L, Vliet Vlieland TPM, Iagnocco A, Schäfer VS, Haines C, Schoones J, Nikiphorou E. Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2018 EULAR recommendations. RMD Open 2019; 5:e001028. [PMID: 31749985 PMCID: PMC6827818 DOI: 10.1136/rmdopen-2019-001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 10/11/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To identify generic competences on the desired knowledge, skills and of health professionals in rheumatology (HPRs) to inform the respective EULAR recommendations. Methods A systematic literature review was performed on the generic core competences (defined as knowledge, skills or attitudes) of HPRs (nurses, physical therapists (PTs) or occupational therapists (OTs)). Literature was obtained from electronic databases, published EULAR recommendations and via personal communication with representatives of national rheumatology societies and experts in the field. Qualitative, quantitative and mixed methods studies were included, and their methodological quality was scored using appropriate instruments. Results From 766 references reviewed, 79 fulfilled the inclusion criteria. Twenty studies addressed competences of multiple HPRs: 15 were of qualitative design, 1 quantitative, 1 mixed-methods, 2 systematic reviews and 1 opinion paper. The methodological quality of most studies was medium to high. Five studies concerned the development of a comprehensive set of competences. Key competences included: basic knowledge of rheumatic diseases, holistic approach to patient management, effective communication with colleagues and patients and provision of education to patients. The proposed competences were confirmed in studies focusing on one or more specific competences, on a rheumatic disease or on a specific profession (nurses, PTs or OTs). Conclusion Generic competences were identified for HPRs. Data were mostly derived from qualitative studies. All identified studies varied and were at national level, highlighting the need for the harmonisation of HPR competences across Europe. These findings underpin the development of EULAR recommendations for the core competences of HPRs.
Collapse
Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow School of Medicine, Glasgow, UK
| | - Lisa Edelaar
- Department of Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, The Netherlands
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Rome, Italy
| | - Valentin Sebastian Schäfer
- Medical Clinic III, Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Catherine Haines
- EULAR, Zurich, Switzerland
- Department of Clinical Education, King's College London, London, UK
| | - Jan Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Elena Nikiphorou
- Rheumatology Research, Academic Department of Rheumatology, King's College London, London, UK
- Applied Health Research, University College London, London, UK
| |
Collapse
|