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Peolsson A, Nilsing Strid E, Peterson G. Novel Internet Support for Neck-Specific Rehabilitation Improves Work-Related Outcomes to the Same Extent as Extensive Visits to a Physiotherapy Clinic in Individuals with Chronic Whiplash-Associated Disorders: A Prospective Randomised Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10176-0. [PMID: 38526764 DOI: 10.1007/s10926-024-10176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To address the current lack of information about work-related factors for individuals with whiplash-associated disorders (WAD) we investigated the effectiveness of 3 months of neck-specific rehabilitation with internet support in combination with four physiotherapy visits (NSEIT) compared to the same exercises performed twice a week (24 times) at a physiotherapy clinic (NSE). METHODS This is a prospective, multicentre, randomised controlled trial regarding secondary outcomes of work-related factors in 140 individuals with chronic moderate/severe WAD with 3- and 15-month follow-up. RESULTS There were no group differences between NSE and NSEIT in the Work Ability Scale or work subscales of the Neck Disability Index, Whiplash Disability Questionnaire or Fear Avoidance Beliefs Questionnaire (FABQ-work). Both groups improved in all work-related outcome measures, except for FABQ-work after the 3-month intervention and results were maintained at the 15-month follow-up. CONCLUSIONS Despite fewer physiotherapy visits for the NSEIT group, there were no group differences between NSEIT and NSE, with improvements in most work-related measures maintained at the 15-month follow-up. The results of the present study are promising for those with remaining work ability problems after a whiplash injury. Protocol registered before data collection started: clinicaltrials.gov NCT03022812.
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Affiliation(s)
- Anneli Peolsson
- Occupational and Environmental Medicine Centre, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, 58185, Linköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
| | - Emma Nilsing Strid
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
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2
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Nordin A, Kjellstrom S, Robert G, Masterson D, Areskoug Josefsson K. Measurement and outcomes of co-production in health and social care: a systematic review of empirical studies. BMJ Open 2023; 13:e073808. [PMID: 37739472 PMCID: PMC10533672 DOI: 10.1136/bmjopen-2023-073808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret. OBJECTIVE The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured. DESIGN AND METHODS A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc* OR coproduc* OR co-design* OR codesign*) and contexts (health OR 'public service* OR "public sector") were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers. RESULTS 43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning. CONCLUSIONS The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.
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Affiliation(s)
- Annika Nordin
- Department of Quality improvement and Leadership, Jönköping Academy of Improvement of Health and Welfare, Jönköping University School of Health and Welfare, Jonkoping, Sweden
| | - Sofia Kjellstrom
- Department of Quality improvement and Leadership, Jönköping Academy of Improvement of Health and Welfare, Jönköping University School of Health and Welfare, Jonkoping, Sweden
| | - Glenn Robert
- Department of Quality improvement and Leadership, Jönköping Academy of Improvement of Health and Welfare, Jönköping University School of Health and Welfare, Jonkoping, Sweden
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Daniel Masterson
- Department of Quality improvement and Leadership, Jönköping Academy of Improvement of Health and Welfare, Jönköping University School of Health and Welfare, Jonkoping, Sweden
| | - Kristina Areskoug Josefsson
- Department of Quality improvement and Leadership, Jönköping Academy of Improvement of Health and Welfare, Jönköping University School of Health and Welfare, Jonkoping, Sweden
- Department of Health Sciences, University West, Trollhattan, Sweden
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3
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Beauvais C, Pham T, Montagu G, Gleizes S, Madrisotti F, Lafourcade A, Vidal C, Dervin G, Baudard P, Desouches S, Tubach F, Le Calvez J, de Quatrebarbes M, Lafarge D, Grange L, Alliot-Launois F, Jeantet H, Antignac M, Tropé S, Besset L, Sellam J. Development and real-life use assessment of a self-management smartphone application for patients with inflammatory arthritis. A user-centred step-by-step approach. PLoS One 2022; 17:e0272235. [PMID: 36107954 PMCID: PMC9477307 DOI: 10.1371/journal.pone.0272235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mobile health applications (apps) are increasing in interest to enhance patient self-management. Few apps are actually used by patients and have been developed for patients with inflammatory arthritis (IA) treated with disease-modifying anti-rheumatic drugs which use entails risk of adverse effects such as infections. Objective To develop Hiboot, a self-management mobile app for patients with IA, by using a user-centred step-by-step approach and assess its real-life use. Methods The app development included first a qualitative study with semi-guided audiotaped interviews of 21 patients to identify the impact of IA on daily life and patient treatments practices and an online cross-sectional survey of 344 patients to assess their health apps use in general and potential user needs. A multidisciplinary team developed the first version of the app via five face-to-face meetings. After app launch, a second qualitative study of 21 patients and a users’ test of 13 patients and 3 rheumatologists led to the app’s current version. The number of app installations, current users and comments were collected from the Google Play store and the Apple store. Results The qualitative study revealed needs for counselling, patient–health professional partnership, and skills to cope with risk situations; 86.8% participants would be ready to use an app primarily on their rheumatologist’s recommendation. Six functionalities were implemented: a safety checklist before treatment administration, aids in daily life situations based on the French academic recommendations, treatment reminders, global well-being self-assessment, periodic counselling messages, and a diary. The Hiboot app was installed 20,500 times from September 2017 to October 2020, with 4300 regular current users. Scores were 4.4/5 stars at Android and iOS stores. Conclusion Hiboot is a free self-management app for patients with IA developed by a step-by-step process including patients and health professionals. Further evaluation of the Hiboot benefit is needed.
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Affiliation(s)
- Catherine Beauvais
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- * E-mail:
| | - Thao Pham
- Service de Rhumatologie, Hôpital Sainte Marguerite, Aix Marseille Univ, Assistance Publique Hôpitaux de Paris (APHM), Marseille, France
| | - Guillaume Montagu
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Sophie Gleizes
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
- Laboratoire d’Anthropologie Sociale (LAS), Collège de France/EHESS/EPHE, Paris, France
| | - Francesco Madrisotti
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
- Centre de National de la Recherche Scientifique (CNRS), Laboratoire CERMES3 (CNRS-EHESS-INSERM), Université de Paris, Paris, France
| | - Alexandre Lafourcade
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, Hôpital Pitié Salpêtrière, Sorbonne Université, APHP, Paris, France
| | | | - Guillaume Dervin
- Clinique Juge, Institut Médical Sport Santé Marseille, Marseille, France
| | - Pauline Baudard
- Service de Rhumatologie, Centre Hospitalo-Universitaire Caen, Caen, France
| | - Sandra Desouches
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Florence Tubach
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, Hôpital Pitié Salpêtrière, Sorbonne Université, APHP, Paris, France
| | | | | | | | - Laurent Grange
- AFLAR Association Française de Lutte Anti rhumatismale (AFLAR), Paris, France
| | | | - Henri Jeantet
- Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Marie Antignac
- Service de Pharmacie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- Equipe d’Épidémiologie Intégrative, INSERM U 970, PARCC, Paris, France
| | - Sonia Tropé
- Association Nationale de Défense Contre l’Arthrite Rhumatoïde (ANDAR), Paris, France
| | - Ludovic Besset
- Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMRS_938, FHU PaCeMM, Paris, France
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Chen SH, Yu KH, Lee YH, Shao JH. Expectations of an Online-Self-Management Program for Rheumatoid Arthritis. Clin Nurs Res 2021; 31:1023-1032. [PMID: 34423684 DOI: 10.1177/10547738211041692] [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: 11/15/2022]
Abstract
This qualitative descriptive study aimed to explore expectations of patients and healthcare experts for an online self-management program for rheumatoid arthritis. Participants were recruited from rheumatology clinics, medical centers, and universities in Taiwan. Individual face-to-face, semi-structured interviews were conducted with patients (n = 16) and healthcare experts (n = 7). Content analysis of the interview data resulted in five subthemes for expectations of an online self-management program: information about how the disease trajectory would impact future health status, availability of opportunities for self-monitoring, opportunities to interact with fellow patients and healthcare providers, simplicity and ease-of-use of the program, and methods to facilitate patient-motivation. These subthemes formulated two overarching themes: content and format. An online self-management program for patients with rheumatoid arthritis should provide evidence-based information about disease variables and behaviors aligned with the specific needs of the individual and adopt strategies that encourage and increase motivation and confidence.
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Affiliation(s)
- Su-Hui Chen
- Chang Gung University of Science and Technology, Taoyuan City.,Chang Gung Memorial Hospital, Taoyuan City
| | | | | | - Jung-Hua Shao
- Chang Gung Memorial Hospital, Taoyuan City.,Chang Gung University, Taoyuan City
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5
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Richter JG, Chehab G, Schwartz C, Ricken E, Tomczak M, Acar H, Gappa H, Velasco CA, Rosengren P, Povilionis A, Schneider M, Thestrup J. The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment-experiences of patients and clinicians. Arthritis Res Ther 2021; 23:151. [PMID: 34044850 PMCID: PMC8157758 DOI: 10.1186/s13075-021-02526-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes. Methods The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data. Results Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications). Conclusion Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible. Trial registration DRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.
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Affiliation(s)
- Jutta G Richter
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Catarina Schwartz
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Elisabeth Ricken
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Monika Tomczak
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Hasan Acar
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Henrike Gappa
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Carlos A Velasco
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | | | | | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
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6
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Sekhon M, White C, Godfrey E, Amirova A, Revenäs Å, King S, Pedro J, Quailey J, Bearne L. Effectiveness of web-based and mobile health interventions designed to enhance adherence to physical activity for people with inflammatory arthritis: a systematic review. Rheumatol Adv Pract 2021; 5:rkab016. [PMID: 33928212 PMCID: PMC8058395 DOI: 10.1093/rap/rkab016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/15/2021] [Indexed: 12/28/2022] Open
Abstract
Objective The aim of this systematic review was to assess the evidence from randomized controlled trials (RCTs) and cohort studies for the effectiveness of digital interventions designed to enhance adherence to physical activity (PA) for people with inflammatory arthritis and describe the intervention content using established coding criteria. Methods Six electronic databases were searched for published and unpublished studies. Independent data extraction and quality assessment (Cochrane risk of bias II or ROBINS-I) were conducted by two reviewers. The primary outcome was self-reported adherence to PA post-intervention. Secondary outcomes included self-reported adherence to PA at other time points, level of PA or engagement with intervention at any follow-up time point. Intervention content was assessed using the Consensus on Exercise Reporting Template and the Behaviour Change Techniques Taxonomy version 1. Results From 11 136 citations, four moderate risk of bias studies (three RCTs and one cohort study) including 1160 participants with RA or JIA were identified. Owing to heterogeneity of outcomes, a narrative synthesis was conducted. Only one RCT reported a small between-group difference in adherence to PA [mean difference (95% CI) −0.46 (−0.82, −0.09)] in favour of the intervention. There were no between-group differences in any secondary outcomes. Interventions included between 3 and 11 behaviour change techniques but provided minimal information on exercise prescription. Conclusion There is currently limited moderate-quality evidence available to provide confident evaluation of the effect of web-based and mobile health interventions on adherence to PA or level of PA post-intervention in people with inflammatory arthritis.
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Affiliation(s)
- Mandeep Sekhon
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Claire White
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Emma Godfrey
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aliya Amirova
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Åsa Revenäs
- Centre for Clinical Research, Region Västmanland-Uppsala University.,School of Health, Care and Social Welfare, Mälardalen University.,Orthopedic Clinic, Västmanland Hospital Västerås, Västerås, Sweden
| | - Sinead King
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joshua Pedro
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jamaal Quailey
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lindsay Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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7
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Feasibility and Acceptability of a Self-Management Program for Patients With Rheumatoid Arthritis. Orthop Nurs 2020; 39:238-245. [DOI: 10.1097/nor.0000000000000676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Grainger R, Townsley HR, Ferguson CA, Riley FE, Langlotz T, Taylor WJ. Patient and clinician views on an app for rheumatoid arthritis disease monitoring: Function, implementation and implications. Int J Rheum Dis 2020; 23:813-827. [PMID: 32424997 DOI: 10.1111/1756-185x.13850] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
AIM Best practice management for rheumatoid arthritis (RA) involves regular clinical assessment of RA disease activity. This is not achievable with current rheumatology systems of care. We aimed to use opinions from people with RA and their specialist rheumatology healthcare professionals to inform development of a mobile app for people with RA for recording their disease activity data for potential integration into clinical service, and assess usability of the app. METHOD In phase 1 we interviewed nine people with RA and seven healthcare professionals. In phase 2 we developed an app with professional software developers. In phase 3 we evaluated app usability for people with RA using the System Usability Scale (SUS). RESULTS Interview data showed four themes regarding functionality and implementation of a patient-held app in RA care: (a) variable app acceptance and readiness; (b) app use to reduce barriers; (c) pros and cons of patient-reported outcomes; and (d) allocation of clinics by need. The app developed has high usability in people with RA using the app on their own device for a month (SUS 79.5, n = 16) or using the app on a study device for 10 minutes (SUS 83, n = 100). CONCLUSION People with RA and healthcare professionals have clearly identified features, benefits and risks of an app for self-assessment of RA and incorporation into clinical care. An app developed informed by these opinions has high usability. Next steps are development and validation of a method of patient-performed joint counts, and implementation, with evaluation, in the clinical setting.
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Affiliation(s)
- Rebecca Grainger
- University of Otago Wellington, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | | | | | | | - Tobias Langlotz
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | - William John Taylor
- University of Otago Wellington, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
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Kalb R, Brown TR, Coote S, Costello K, Dalgas U, Garmon E, Giesser B, Halper J, Karpatkin H, Keller J, Ng AV, Pilutti LA, Rohrig A, Van Asch P, Zackowski K, Motl RW. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler 2020; 26:1459-1469. [PMID: 32323606 PMCID: PMC7575303 DOI: 10.1177/1352458520915629] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - Susan Coote
- School of Allied Health and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Ulrik Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Eric Garmon
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - June Halper
- Consortium of Multiple Sclerosis Centers and International Organization of MS Nurses, Hackensack, NJ, USA
| | - Herb Karpatkin
- Program in Physical Therapy, Hunter College, New York, NY, USA
| | - Jennifer Keller
- Motion Analysis Lab, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alexander V Ng
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Paul Van Asch
- Fit Up Neurological and Sport Physiotherapy, Antwerp, Belgium
| | | | - Robert W Motl
- UAB/Lakeshore Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
Care is central to many health professions, including physiotherapy. Different forms of care are enacted as part of being a caring professional. For example, a practitioner who provides good service to others and upholds standards while doing so is in-grained in education for professional formation. However, there are other topics and aspects of care that are not as well attended to, and that is care for the future of the profession. This too is an aspect of care, and it is an urgent objective in an era where societies and healthcare are changing at rapid rates. In this paper, I argue that Golde and Walker's (2006) idea of stewardship can help health professionals think about this often overlooked aspect of care. Stewardship adds a perspective that is centered on a deep authentic care for and responsibility towards the ongoing relevance of the profession. Stewardship keeps the question of what the profession is, and what a professional does, alive as part of its present and future practice.
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Affiliation(s)
- Sarah Barradell
- Physiotherapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.,Sydney School of Education & Social Work, University of Sydney, Sydney, New South Wales, Australia.,Physiotherapy, Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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11
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DiRenzo D, Finan P. Self-Efficacy and the Role of Non-Pharmacologic Treatment Strategies to Improve Pain and Affect in Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:168-178. [PMID: 31832330 PMCID: PMC6907160 DOI: 10.1007/s40674-019-00123-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is increasing evidence that adjunctive, non-pharmacologic treatment programs are beneficial in the management of arthritis when added to traditional disease-modifying medications. This review focuses on non-pharmacologic management strategies that impact pain and affect, with a focus on self-efficacy, for those with osteoarthritis (OA) and rheumatoid arthritis (RA). RECENT FINDINGS We reviewed both office-based and internet-based self-management strategies, mindfulness based interventions (MBIs), and cognitive behavioral therapies (CBTs) for patients with arthritis. These behavioral strategies have shown to improve pain, mood disturbance, and physical function in those with both osteoarthritis and rheumatoid arthritis. Improvements in self-efficacy and coping capacity are associated with improvements in patient-reported outcomes (PROs) related to pain and functioning. SUMMARY Self-management programs, MBIs, and CBTs are more effective at improving pain and mood disturbance compared to usual care for patients with arthritis although high quality randomized controlled trials are lacking. Non-pharmacologic management programs are increasingly available via the internet and mobile applications.
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Affiliation(s)
- Dana DiRenzo
- The Johns Hopkins University, Baltimore, MD, USA
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Peolsson A, Peterson G, Hermansen A, Ludvigsson ML, Dedering Å, Löfgren H. Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity. BMJ Open 2019; 9:e027387. [PMID: 30782952 PMCID: PMC6377535 DOI: 10.1136/bmjopen-2018-027387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. METHODS AND ANALYSIS This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (≥30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. ETHICAL CONSIDERATIONS This study was approved by the Regional Ethical Review Board in Linköping Ref. 2016/283-31 and 2017/91- 32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme.Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. DISSEMINATION If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media. TRIAL REGISTRATION NCT03036007.
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Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Anna Hermansen
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
- Department of Rehabilitation and Department of Medical and Health Sciences, Rehab Väst, Region Council of Östergötland, Linkoping, Sweden
| | - Åsa Dedering
- Allied Health Professionals Function, Occupational Therapy and Physiotherapy, University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden
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Griffiths AJ, White CM, Thain PK, Bearne LM. The effect of interactive digital interventions on physical activity in people with inflammatory arthritis: a systematic review. Rheumatol Int 2018; 38:1623-1634. [PMID: 29556750 PMCID: PMC6105152 DOI: 10.1007/s00296-018-4010-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/12/2018] [Indexed: 12/05/2022]
Abstract
The aim of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of interactive digital interventions (IDIs) for physical activity (PA) and health related quality of life (HRQoL) in people with Inflammatory Arthritis [rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) axial Spondyloarthritis (AS) and psoriatic arthritis (PsA)]. Seven electronic databases identified published and unpublished studies. Two reviewers conducted independent data extraction and quality assessment using the Cochrane risk of bias tool (RoB). The primary outcome was change in objective PA after the intervention; secondary outcomes included self-reported PA and HRQoL after the intervention and objective or self-reported PA at least 1 year later. Five manuscripts, reporting four RCTs (three high and one low RoB) representing 492 (459 RA, 33 JIA) participants were included. No trials studying PsA or AS met the inclusion criteria. Interventions ranged from 6 to 52 weeks and included 3-18 Behaviour Change Techniques. Due to heterogeneity of outcomes, a narrative synthesis was conducted. No trials reported any significant between group differences in objective PA at end of intervention. Only one low RoB trial found a significant between group difference in self-reported vigorous [MD Δ 0.9 days (95% CI 0.3, 1.5); p = 0.004], but not moderate, PA in people with RA but not JIA. There were no between group differences in any other secondary outcomes. There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS.
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Affiliation(s)
- Alison J. Griffiths
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Claire M. White
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Peter K. Thain
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
| | - Lindsay M. Bearne
- Faculty of Life Sciences and Medicine, School of Population Health and Environmental Sciences, King’s College London, Addison House, Guys Campus, London, SE1 1UL UK
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Rizzello F, Olivieri I, Armuzzi A, Ayala F, Bettoli V, Bianchi L, Cimino L, Costanzo A, Cristaudo A, D'Angelo S, Daperno M, Fostini AC, Galeazzi M, Gilio M, Gionchetti P, Gisondi P, Lubrano E, Marchesoni A, Offidani A, Orlando A, Pugliese D, Salvarani C, Scarpa R, Vecchi M, Girolomoni G. Multidisciplinary Management of Spondyloarthritis-Related Immune-Mediated Inflammatory Disease. Adv Ther 2018. [PMID: 29516409 PMCID: PMC5910456 DOI: 10.1007/s12325-018-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis and uveitis. Methods A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. Results Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. Conclusion The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. Funding Aristea and Hippocrates.
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Affiliation(s)
- Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Ignazio Olivieri
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy
| | - Alessandro Armuzzi
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Fabio Ayala
- UOC di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Vincenzo Bettoli
- Department of Clinical and Experimental Dermatology, O.U. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Bianchi
- U.O.C. Dermatologia, Fondazione Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
| | - Luca Cimino
- SSD di Immunologia Oculare, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Costanzo
- Unità Dermatologia Dipartimento di Scienze Biomediche Humanitas University, Rozzano, Milan, Italy
- UOC Dermatologia IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Antonio Cristaudo
- UO Dermatologia, MST, Ambientale e Tropicale San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Salvatore D'Angelo
- Istituto Reumatologico Lucano (IReL), Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy.
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy.
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Anna Chiara Fostini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Galeazzi
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Michele Gilio
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Department of Health Science, University "Magna Grecia", Catanzaro, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- U.O.C. Day Hospital di Reumatologia, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Ambrogio Orlando
- UOSD MICI-A.O. Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Daniela Pugliese
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS e Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | | | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Peolsson A, Landén Ludvigsson M, Peterson G. Neck-specific exercises with internet-based support compared to neck-specific exercises at a physiotherapy clinic for chronic whiplash-associated disorders: study protocol of a randomized controlled multicentre trial. BMC Musculoskelet Disord 2017; 18:524. [PMID: 29233141 PMCID: PMC5727971 DOI: 10.1186/s12891-017-1853-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/15/2017] [Indexed: 01/18/2023] Open
Abstract
Background Globally, neck pain is the fourth most common condition associated with longer periods of living with disability. Annually, approximately 0.3% of the population of Western countries undergo whiplash trauma, and half of those individuals will develop chronic problems with high costs for the individual and society. Evidence for chronic whiplash-associated disorders (WAD) treatment is scarce, though neck-specific training at a physiotherapy clinic twice a week for 12 weeks has demonstrated good results. More efficient, flexible rehabilitation with reduced waiting times and lower costs is needed, ideally replacing lengthy on-site treatment series by healthcare providers. Internet-based care has been shown to be a viable alternative for a variety of diseases and interventions, but studies are lacking on Internet-based interventions for individuals with chronic neck problems. The aim of the trial described here is to compare the effects of an Internet-based neck-specific exercise programme to the same exercises performed at a physiotherapy clinic in regards to self-reported and clinical measures, as well as cost-effectiveness. Methods This prospective, randomized controlled trial will involve 140 participants. Measurements will be made at baseline, 3 months (end of treatment), and 15 months (12 months after end of intervention) and will include ratings of pain, disability, satisfaction with care, work ability, quality of life, and cost-effectiveness. Discussion The study results may contribute to the development of a more effective rehabilitation, flexible and equal care, shorter waiting times, increased availability, and lower costs for healthcare and society. Trial registration ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016.
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Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.
| | - Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.,Department of Rehabilitation and Department of Medical and Health Sciences, Rehab Väst, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Sandbäcksg. 7, 58183, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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