1
|
Adouni M, Aydelik H, Faisal TR, Hajji R. The effect of body weight on the knee joint biomechanics based on subject-specific finite element-musculoskeletal approach. Sci Rep 2024; 14:13777. [PMID: 38877075 PMCID: PMC11178890 DOI: 10.1038/s41598-024-63745-x] [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: 03/08/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024] Open
Abstract
Knee osteoarthritis (OA) and obesity are major public health concerns that are closely intertwined. This intimate relationship was documented by considering obesity as the most significant preventable risk factor associated with knee OA. To date, however, the effects of obesity on the knee joint's passive-active structure and cartilage loading have been inconclusive. Hence, this study investigates the intricate relationship between obesity and knee OA, centering on the biomechanical changes in knee joint active and passive reactions during the stance phase of gait. Using a subject-specific musculoskeletal and finite element approach, muscle forces, ligament stresses, and articular cartilage contact stresses were analyzed among 60 individuals with different body mass indices (BMI) classified under healthy weight, overweight, and obese categories. Our predicted results showed that obesity significantly influenced knee joint mechanical reaction, increasing muscle activations, ligament loading, and articular cartilage contact stresses, particularly during key instances of the gait cycle-first and second peak loading instances. The study underscores the critical role of excessive body weight in exacerbating knee joint stress distribution and cartilage damage. Hence, the insights gained provide a valuable biomechanical perspective on the interaction between body weight and knee joint health, offering a clinical utility in assessing the risks associated with obesity and knee OA.
Collapse
Affiliation(s)
- Malek Adouni
- Biomedical and Instrumentation Engineering, Abdullah Al Salem University, Khalidiya, Kuwait.
- Physical Medicine and Rehabilitation Department, Northwestern University, 345 East Superior Street, Chicago, IL, 60611, USA.
| | - Harun Aydelik
- Mathematics, College of Integrative Studies, Abdullah Al Salem University, Khalidiya, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, 70508, USA
| | - Raouf Hajji
- Internal Medicine Department, Medicine Faculty of Sousse, University of Sousse, Sousse, Tunisia
| |
Collapse
|
2
|
Vennik J, Hughes S, Smith KA, Misurya P, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Dambha-Miller H, Morrison L, Leydon G, Everitt H, Bishop FL. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography. PATIENT EDUCATION AND COUNSELING 2022; 105:1865-1877. [PMID: 35125208 DOI: 10.1016/j.pec.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.
Collapse
Affiliation(s)
- Jane Vennik
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Pranati Misurya
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mohana Ratnapalan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hajira Dambha-Miller
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Swaithes L, Paskins Z, Dziedzic K, Finney A. Factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis. Musculoskeletal Care 2020; 18:101-110. [PMID: 31997576 DOI: 10.1002/msc.1452] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Implementation of evidence-based health guidelines in primary care is challenging. This systematic review aimed to synthesize qualitative evidence that investigates the factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care. METHODS A systematic review of qualitative studies. MEDLINE, EMBASE, CINAHL, HMIC, PsychINFO, Web of Science and Assia were searched (from 2000 to March 2019). The methodological quality of the included studies was assessed by two independent reviewers. Data were analyzed and synthesized using thematic synthesis. RESULTS 1612 articles were screened and four articles with a total of 87 participants (46 patients, 28 GPs, 13 practice nurses) were included. Three of the studies were conducted in England within the context of an implementation trial and one was conducted in the Netherlands. The thematic synthesis revealed three overarching themes. Best practice was not enough to achieve 'buy-in' to implementation but a range of tacit motivators to implementation were identified. Healthcare professionals used patient reasons to justify engaging or not engaging with implementation. Engaging with the whole practice was important in achieving implementation. A disconnect between research and 'real-world' primary care practice influenced long-term implementation. CONCLUSIONS Despite the relative paucity of current evidence, this systematic review has identified a series of possible disconnects may impact uptake of interventions to improve osteoarthritis care, existing between clinicians and patients, researchers and clinicians, clinicians and guidelines and within general practice itself. There remains a need to further explore the experiences of key stakeholders, including patients involved in implementation for osteoarthritis in primary care.
Collapse
Affiliation(s)
- Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| |
Collapse
|
4
|
Tahir A, Al-Zubaidy M, Naqvi D, Tarfiee A, Naqvi F, Malik A, Vara S, Meyer E. Medical school teaching on interprofessional relationships between primary and social care to enhance communication and integration of care - a pilot study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:311-332. [PMID: 31239798 PMCID: PMC6554710 DOI: 10.2147/amep.s179833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 04/06/2019] [Indexed: 06/09/2023]
Abstract
Background: A pilot study to identify if the delivery of teaching session to medical students would have the potential to enhance communication and a culture of integration between primary and social care, ultimately improving interprofessional relationships between primary and social care. Health and social care integration is a topic of great debate in the developed world and the focus of the upcoming Green Paper by the Secretary of State for Health and Social Care in the NHS. There is much uncertainty to how this should be done and is hindered by the various current barriers. The literature identifies that collaborative cultures encourage effective interprofessional relationships and that communication is vital to integration of primary and social care and should be established early in medical training. Materials and Method: The General Medical Council's Outcomes for Graduates and Imperial College School of Medicine curriculum were reviewed out to identify outcomes relating to inter-professional relationships between primary and social care. The relevant year group was surveyed to identify if the learning objective was delivered. In order to determine if delivery of a teaching session on nurturing interprofessional relationships between primary and social care would be effective, it was delivered to early clinical years to measure benefits as a pilot study. This was devised of case-based scenarios derived from learning objectives developed with experienced health care professionals. A survey was administered before and after the teaching session to determine if the students felt they had improved with respect to the learning objectives. Results: The initial survey identified the majority of students found the learning objectives were not delivered. The teaching session found a statistically significant improvement in confidence to nurture interprofessional relationships between primary and social care. Conclusion: Effective interprofessional relationships between primary and social care, improving communication and collaborative cultures, can be effectively taught in medical school, to improve integration of primary and social care.
Collapse
Affiliation(s)
- Anas Tahir
- Imperial College School of Medicine, Imperial College, London, UK
| | | | - Danial Naqvi
- Imperial College School of Medicine, Imperial College, London, UK
| | - Ali Tarfiee
- Imperial College School of Medicine, Imperial College, London, UK
| | - Falak Naqvi
- Imperial College School of Medicine, Imperial College, London, UK
| | - Anam Malik
- Imperial College School of Medicine, Imperial College, London, UK
| | - Sarina Vara
- Faculty of Medicine, University of Manchester, Manchester, UK
| | - Edgar Meyer
- Imperial College Business School, Imperial College Business School, London, UK
| |
Collapse
|
5
|
McCormick AJ, Becker MJ, Grabowski TJ. Involving People with Memory Loss in the Development of a Patient Handbook: A Strengths-Based Approach. SOCIAL WORK 2018; 63:357-366. [PMID: 30137585 DOI: 10.1093/sw/swy043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
A memory clinic used two key approaches in developing a patient and family handbook: partnership with people with memory loss and strengths-based social work practice. Social worker coeditors of the handbook intentionally sought guidance from people with mild to moderate memory loss regarding handbook content, design, and overall tone. A focus group, three sessions of a review group, e-mails, and personal interviews were used to solicit and review input from participants. The editors also incorporated content contributions in the form of essays, quotations, and an original poem from people with memory loss, alongside contributions from clinic staff, university faculty, and community service providers. People with memory loss provided input in five areas: response to a new diagnosis, coping with memory loss, messages to other newly diagnosed people and health care professionals, available community resources, and recommendations for handbook design. The development process reinforced a key message of the handbook: People with memory loss exhibit ongoing strengths, which help them participate in life. The process also ensured that the handbook content and design would be relevant and applicable to its users. The handbook is now regularly distributed as a primary patient education tool in the memory clinic and community programs.
Collapse
Affiliation(s)
- Andrew J McCormick
- Andrew J. McCormick, PhD, MSW, is a retired social worker, 10208 NE 23rd Street, Bellevue, WA 98004; e-mail: . Marigrace J. Becker, MSW, is a social worker and Thomas J. Grabowski, MD, is director, UW Medicine, Memory, and Brain Wellness Center, Harborview Medical Center, University of Washington, Seattle
| | - Marigrace J Becker
- Andrew J. McCormick, PhD, MSW, is a retired social worker, 10208 NE 23rd Street, Bellevue, WA 98004; e-mail: . Marigrace J. Becker, MSW, is a social worker and Thomas J. Grabowski, MD, is director, UW Medicine, Memory, and Brain Wellness Center, Harborview Medical Center, University of Washington, Seattle
| | - Thomas J Grabowski
- Andrew J. McCormick, PhD, MSW, is a retired social worker, 10208 NE 23rd Street, Bellevue, WA 98004; e-mail: . Marigrace J. Becker, MSW, is a social worker and Thomas J. Grabowski, MD, is director, UW Medicine, Memory, and Brain Wellness Center, Harborview Medical Center, University of Washington, Seattle
| |
Collapse
|
6
|
Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| |
Collapse
|
7
|
Dziedzic KS, Allen KD. Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care. Rheumatology (Oxford) 2018; 57:iv88-iv98. [PMID: 29684219 PMCID: PMC5905599 DOI: 10.1093/rheumatology/key062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Indexed: 12/20/2022] Open
Abstract
A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health management, complex interventions and outcomes. It sets this in the context of competing health priorities and multimorbidity, access to high quality conservative care, non-pharmacological therapies, resource limitations and models of care. The overuse of some therapies and neglect of others are discussed, as well as the potential for self-management. The roles of patient and public involvement and the healthcare team are highlighted in enhancing best care for OA and providing solutions for closing the evidence-to-practice gap. Implementation of models of care offer one solution to the challenges and progress of such implementation is described. Areas for further research are highlighted.
Collapse
Affiliation(s)
- Krysia S Dziedzic
- Institute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Veterans Affairs Health Care System, Center for Health Services Research in Primary Care, Durham, NC, USA
| |
Collapse
|
8
|
Claassen AAOM, van den Ende CHM, Meesters JJL, Pellegrom S, Kaarls-Ohms BM, Vooijs J, Willemsen-de Mey GEMP, Vliet Vlieland TPM. How to best distribute written patient education materials among patients with rheumatoid arthritis: a randomized comparison of two strategies. BMC Health Serv Res 2018; 18:211. [PMID: 29580277 PMCID: PMC5870684 DOI: 10.1186/s12913-018-3039-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this randomized controlled trial was to evaluate the effect of a 'supply on demand'-distribution strategy, compared to an 'unsolicited supply'-distribution strategy, on the use of a care booklet and clinical outcomes among patients with rheumatoid arthritis (RA). In addition, differences in socio-demographic and clinical characteristics between users and non-users were explored. METHODS As part of regular care the care booklet was distributed among RA-patients of two hospitals in the Netherlands. 1000 patients received the care booklet by mail, whereas another 1000 received an information letter with the option to order the care booklet. Four months after distribution, a random sample of 810 patients (stratified by hospital and distribution method) received a questionnaire on the use of the booklet, social-demographic and clinical characteristics. To compare effects between the two distribution strategies and differences between users and non-users univariate and multilevel regression analyses were performed. Secondary analysis included a per-protocol analysis (excluding participants who did not order the care booklet). RESULTS One hundred ninety four patients in the 'unsolicited supply' and 176 patients in the 'supply on demand' group (46%) returned the questionnaire. In the 'supply on demand' group 106 (60.2%) participants ordered the care booklet. In total, no difference was found in use between the 'unsolicited supply'-group (23.2%) and the 'supply on demand'-group (21.6%) (OR 0.9 CI:0.6-1.5). However, the proportion of users among patients in the 'supply on demand'-group who ordered the booklet (35%) was significantly higher than in the 'unsolicited supply'-group (OR 1.9 CI:1.1-3.2). Regardless of distribution method, use of the care booklet was associated with being married (OR 2.4 CI:1.2-4.6), higher disease activity (mean difference 0.5 CI: 0.0-1.1), more activity limitations (mean difference 0.2 CI: 0.1-0.4), use of corticosteroids (OR 1.9 CI:1.0-3.5), perception of disease course as fluctuating (mean difference 1.4 CI:0.5-2.3) and higher educational needs (mean difference 9.7 CI: 2.9-16.6). CONCLUSIONS From an economic and environmental perspective a 'supply on demand'-distribution strategy could be recommended. Results of this study provide starting points to optimize further implementation strategies of a care-booklet in routine care. TRIAL REGISTRATION ISRCTN registry ( ISRCTN22703067 ). Retrospectively registered 27 March 2017.
Collapse
Affiliation(s)
- Aniek A O M Claassen
- Department of Rheumatology, Sint Maartenskliniek, 6500 GM, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, 6500 GM, Nijmegen, The Netherlands. .,Department of Rheumatology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
| | - Jorit J L Meesters
- Department of Rheumatology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Sanne Pellegrom
- Department of Rheumatology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | | | | | | | - Thea P M Vliet Vlieland
- Department of Orthopedics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
9
|
Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. Osteoarthritis Cartilage 2018; 26:43-53. [PMID: 29037845 PMCID: PMC5759997 DOI: 10.1016/j.joca.2017.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. METHOD Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. PARTICIPANTS 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. RESULTS 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). CONCLUSION Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. TRIAL REGISTRATION ISRCTN06984617.
Collapse
|
10
|
Dunphy E, Hamilton FL, Spasić I, Button K. Acceptability of a digital health intervention alongside physiotherapy to support patients following anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2017; 18:471. [PMID: 29162071 PMCID: PMC5697059 DOI: 10.1186/s12891-017-1846-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/14/2017] [Indexed: 01/29/2023] Open
Abstract
Background Physiotherapy rehabilitation following surgical reconstruction to the Anterior Cruciate Ligament (ACL) can take up to 12 months to complete. Given the lengthy rehabilitation process, a blended intervention can be used to compliment face-to-face physiotherapy with a digital exercise intervention. In this study, we used TRAK, a web–based tool that has been developed to support knee rehabilitation, which provides individually tailored exercise programs with videos, instructions and progress logs for each exercise, relevant health information and a contact option that allows a patient to email a physiotherapist for additional support. The aim of this study was to evaluate the acceptability of TRAK–based blended intervention in post ACL reconstruction rehabilitation. Methods A qualitative research design using semi-structured interviews was used on a convenience sample of participants following an ACL reconstruction, and their treating physiotherapists, in a London NHS hospital. Participants were asked to use TRAK alongside face-to-face physiotherapy for 16 weeks. Interviews were carried out, audio recorded, transcribed verbatim and coded by two researchers independently. Data were analyzed using thematic analysis. Results Of the 25 individuals that were approached to be part of the study, 24 consented, comprising 8 females and 16 males, mean age 30 years. 17 individuals used TRAK for 16 weeks and were available for interview. Four physiotherapists were also interviewed. The six main themes identified from patients were: the experience of TRAK rehabilitation, personal characteristics for engagement, strengths and weaknesses of the intervention, TRAK in the future and attitudes to digital healthcare. The main themes from the physiotherapist interviews were: potential benefits, availability of resources and service organization to support use of TRAK. Conclusions TRAK was found to be an acceptable method of delivering ACL rehabilitation alongside face-to-face physiotherapy. Patients reported that TRAK, specifically the videos, increased their confidence and motivation with their rehabilitation. They identified ways in which TRAK could be developed in the future to meet technological expectations and further support rehabilitation. For Physiotherapists time and availability of computers affected acceptability. Organization of care to support integration of digital exercise interventions such as TRAK into a blended approach to rehabilitation is required.
Collapse
Affiliation(s)
- Emma Dunphy
- E-Health Unit, Research Department of Primary Care and Population Health, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, London, UK. .,Homerton University Hospital NHS Trust, Homerton Row E96SR, London, UK.
| | - Fiona L Hamilton
- E-Health Unit, Research Department of Primary Care and Population Health, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, London, UK
| | - Irena Spasić
- School of Computer Science & Informatics, Cardiff University, Queens Building, 5 The Parade, Cardiff, CF24 3AA, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK.,Cardiff & Vale University Health Board, Health Park, Cardiff, CF14 4XW, UK
| |
Collapse
|
11
|
Cottrell E, Foster NE, Porcheret M, Rathod T, Roddy E. GPs' attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey. BMJ Open 2017; 7:e014999. [PMID: 28624759 PMCID: PMC5541518 DOI: 10.1136/bmjopen-2016-014999] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/22/2017] [Accepted: 04/25/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate general practitioners' (GPs) attitudes, beliefs and behaviours regarding the use of exercise for patients with chronic knee pain (CKP) attributable to osteoarthritis. SETTING Primary care GPs in the UK. PARTICIPANTS 5000 GPs, randomly selected from Binley's database, were mailed a cross-sectional questionnaire survey. OUTCOME MEASURES GPs' attitudes and beliefs were investigated using attitude statements, and reported behaviours were identified using vignette-based questions. GPs were invited to report barriers experienced when initiating exercise with patients with CKP RESULTS: 835 (17%) GPs responded. Overall, GPs were positive about general exercise for CKP. 729 (87%) reported using exercise, of which, 538 (74%) reported that they would use both general and local (lower limb) exercises. However, only 92 (11% of all responding) GPs reported initiating exercise in ways aligning with best-evidence recommendations. 815 (98%) GPs reported barriers in using exercise for patients with CKP, most commonly, insufficient time in consultations (n=419; 51%) and insufficient expertise (n=337; 41%). CONCLUSIONS While GPs' attitudes and beliefs regarding exercise for CKP were generally positive, initiation of exercise was often poorly aligned with current recommendations, and barriers and uncertainties were reported. GPs' use of exercise may be improved by addressing the key barriers of time and expertise, by developing a pragmatic approach that supports GPs to initiate individualised exercise, and/or by other professionals taking on this role.
Collapse
Affiliation(s)
- Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nadine E Foster
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Trishna Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| |
Collapse
|
12
|
Prothero L, Georgopoulou S, de Souza S, Bosworth A, Bearne L, Lempp H. Patient involvement in the development of a handbook for moderate rheumatoid arthritis. Health Expect 2016; 20:288-297. [PMID: 27086728 PMCID: PMC5354020 DOI: 10.1111/hex.12457] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Self-management is a key recommendation for people with rheumatoid arthritis (RA). Educational materials may support self-management, and increasingly patients are becoming involved with the development of these materials. The TITRATE trial compares the effectiveness of intensive management to standard care in patients with moderate RA across England. As part of the intensive management intervention, participants are given a handbook. AIM AND OBJECTIVES The aim of this study was to develop a handbook to support the intensive management. The objectives were to: (i) involve patients in the identification of relevant information for inclusion in the TITRATE handbook; (ii) ensure the content of the handbook is acceptable and accessible. DESIGN We held an audio-taped workshop with RA patients. The transcript of the workshop was analysed using thematic content analysis. RESULTS Five main themes were identified as follows: 'rheumatoid arthritis treatment, perceptions of rheumatoid arthritis, the importance of individualized goals, benefits of self-management and the patient handbook'. Feedback from the workshop was incorporated into the handbook, and patients' anonymous testimonies were added. CONCLUSION This study demonstrates that patient contribution to the development of educational material to support intensive management of RA is both feasible and valuable. A qualitative evaluation of the use and impact of the handbook with patients and practitioners is planned on completion of the TITRATE trial.
Collapse
Affiliation(s)
- Louise Prothero
- Academic Department of Rheumatology, Clinical Trials Group, King's College London, Faculty of Life Sciences and Medicine, Weston Education Centre, London, UK
| | - Sofia Georgopoulou
- Academic Department of Rheumatology, Clinical Trials Group, King's College London, Faculty of Life Sciences and Medicine, Weston Education Centre, London, UK
| | - Savia de Souza
- Academic Department of Rheumatology, Clinical Trials Group, King's College London, Faculty of Life Sciences and Medicine, Weston Education Centre, London, UK
| | - Ailsa Bosworth
- National Rheumatoid Arthritis Society, Maidenhead, Berkshire, UK
| | - Lindsay Bearne
- Academic Department of Physiotherapy, Division of Health and Social Care Research, King's College London, London, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, Clinical Trials Group, King's College London, Faculty of Life Sciences and Medicine, Weston Education Centre, London, UK
| |
Collapse
|