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Jasim S, Aspinal F, Mehta R, Ledger J, Raine R, Fulop NJ, Barratt H. 'Maze' not pathway: focus group exploration of patients' and public experiences of the UK NHS elective total joint arthroplasty pathway. BMJ Open 2023; 13:e066762. [PMID: 37558439 PMCID: PMC10414077 DOI: 10.1136/bmjopen-2022-066762] [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: 09/16/2022] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To explore patient and public perceptions of planned improvements to the National Health Service (NHS) total joint arthroplasty (TJA) pathway. DESIGN Three qualitative focus groups undertaken March-May 2018, as part of a mixed-methods evaluation of Getting It Right First Time. Transcripts were subject to framework analysis to identify thematic content between October 2018 and October 2021. SETTING Elective TJA surgery in the English NHS. PARTICIPANTS Two focus groups including patients who had undergone TJA in the previous 2 years (group 1: n=5; group 2: n=4) and the other individuals who had not but were aged 60+ (group 3: n=5). Participants were recruited via community groups and patient panels. RESULTS Fourteen individuals took part in the focus groups; all were aged over 60; seven (50%) were female and nine (64%) had undergone TJA surgery. Participants' perspectives were categorised into themes and mapped onto stages of the TJA pathway. Although perioperative care is often the focus of improvement efforts, participants argued that the patient journey begins before individuals present to primary care. Participants had concerns about other aspects of the pathway, such as obtaining a surgical referral, with prereferral interventions aimed at potentially avoiding the need for surgery (ie, physiotherapy) being perceived as a mechanism to restrict access to secondary care. Patient experience was also conceptualised as a 'maze', rather than the logical, sequential process set out in clinical guidelines; exacerbated by a lack of information, knowledge and power imbalances. CONCLUSION The linear conceptualisation of the TJA pathway is at odds with patient experience. Improvement programmes focused on perioperative care fail to consider patient concerns and priorities. Patients should be directly involved in improvement programmes, to ensure that patient experience is optimised, as well as informing related processes and important outcomes of care.
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Affiliation(s)
- Sarah Jasim
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Fiona Aspinal
- Department of Applied Health Research, University College London, London, UK
| | - Raj Mehta
- Department of Applied Health Research, University College London, London, UK
| | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Helen Barratt
- Department of Applied Health Research, University College London, London, UK
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Conrad M, Steffensmeier KS, Van Tiem J, Obrecht A, Mares J, Mosher HJ, Weg MWV, Sibenaller Z, Stout L, Patel P, Hadlandsmyth K. Military Veterans' Perspectives on Postoperative Opioid Use: A Secondary Analysis of Qualitative Data. J Perianesth Nurs 2023; 38:483-487. [PMID: 36635123 DOI: 10.1016/j.jopan.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE This qualitative analysis of interviews with surgical patients who received a brief perioperative psychological intervention, in conjunction with standard medical perioperative care, elucidates patient perspectives on the use of pain self-management skills in relation to postoperative analgesics. DESIGN This study is a secondary analysis of qualitative data from a randomized controlled trial. METHODS Participants (N = 21) were rural-dwelling United States Military Veterans from a mixed surgical sample who were randomized to receive a manual-based, telephone-based Perioperative Pain Self-management intervention consisting of a total of four pre- and postoperative contacts. Semi-structured qualitative interviews elicited participant feedback on the cognitive-behavioral intervention. Data was analyzed by two qualitative experts using MAXQDA software. Key word analyses focused on mention of analgesics in interviews. FINDINGS Interviews revealed a dominant theme of ambivalence towards postoperative use of opioids. An additional theme concerned the varied ways acquiring pain self-management skills impacted postoperative opioid (and non-opioid analgesic) consumption. Participants reported that employment of pain self-management strategies reduced reliance on pharmacology for pain relief, prolonged the time between doses, took the "edge off" pain, and increased pain management self-efficacy. CONCLUSIONS Perioperative patient education may benefit from inclusion of teaching non-pharmacologic pain self-management skills and collaborative planning with patients regarding how to use these skills in conjunction with opioid and non-opioid analgesics. Perianesthesia nurses may be in a critical position to provide interdisciplinary postoperative patient education that may optimize postoperative pain management while minimizing risks associated with prolonged opioid use.
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Affiliation(s)
- Mandy Conrad
- Center for Integrated Healthcare, Buffalo, NY; Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA.
| | - Kenda Stewart Steffensmeier
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA
| | - Jennifer Van Tiem
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA
| | - Ashlie Obrecht
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA
| | - Jasmine Mares
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | - Hilary J Mosher
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Internal Medicine, Iowa City, IA
| | - Mark W Vander Weg
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, College of Public Health, Department of Community and Behavioral Health, Iowa City, IA
| | - Zita Sibenaller
- University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | - Lori Stout
- University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | | | - Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
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Pacheco-Brousseau L, Poitras S, Ben Amor S, Desmeules F, Kiss A, Stacey D. Hip and Knee Total Joint Arthroplasty Online Resources for Patients and Health Care Professionals: A Canadian Environmental Scan. Physiother Can 2023. [DOI: 10.3138/ptc-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Purpose: To appraise the quality of publicly available online Canadian resources for patients with hip or knee osteoarthritis considering total joint arthroplasty (TJA) and health care professionals participating in TJA decision-making processes. Method: An environmental scan. Two independent authors appraised: a) patient resources against the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Material Evaluation Tool (PEMAT); and b) health care professional resources against six appropriateness criteria for TJA and eight elements of shared decision-making. Analysis was descriptive. Results: Of 84 included resources, 71 were for patients, 11 for health care professionals, and 2 for both. For patient resources, the median number of IPDAS defining criteria met was 2 of 7, median PEMAT understandability score was 83%, and median PEMAT actionability score was 60%. For health care professional resources, the median number of appropriateness criteria was 3 of 6, and the median number of shared decision-making elements was 3 of 8. Conclusions: Only four of 73 patient resources were structured to help patients consider their options and reach a decision based on their preferences. Health care professional resources were limited to traditional criteria for determining TJA appropriateness (evidence of osteoarthritis, use of conservative treatments) and poorly met key elements of shared decision-making.
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A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100355. [PMID: 37020788 PMCID: PMC10068262 DOI: 10.1016/j.ocarto.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.
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Anderson AM, Drew BT, Antcliff D, Redmond AC, Comer C, Smith TO, McHugh GA. Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review. Syst Rev 2022; 11:184. [PMID: 36050795 PMCID: PMC9436722 DOI: 10.1186/s13643-022-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).
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Affiliation(s)
- Anna M. Anderson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Benjamin T. Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK
- School of Medicine, Keele University, Keele, UK
| | - Anthony C. Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O. Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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Stauber A, Schüßler N, Palmdorf S, Schürholz N, Bruns D, Osterbrink J, Nestler N. RECOVER-E - a mobile app for patients undergoing total knee or hip replacement: study protocol. BMC Musculoskelet Disord 2020; 21:71. [PMID: 32019529 PMCID: PMC7001367 DOI: 10.1186/s12891-020-3090-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) or total hip replacement (THR) are common and effective procedures in patients with osteoarthritis (OA) to restore physical function and reduce joint related pain. Patient education plays an important role in the treatment process aiming to develop necessary self-management skills to facilitate recovery and ensure long-term success. We have developed a mobile app (RECOVER-E) for iOS and Android smartphones which provides important information on the preoperative phase, surgery and recovery. The concomitant study will determine the efficacy of RECOVER-E on patients' surgical outcomes. METHODS/DESIGN This study is a non-randomized, multi-centre (4 sites), double-arm, controlled trial with 1:1 assignment. 160 patients undergoing primary TKR or THR will be recruited from January until October 2019 in 4 German hospitals. Both groups will receive standard care. Additionally, the intervention group will use the app RECOVER-E. Measurements will be taken 4-6 weeks before surgery, on the day of admission to the hospital, on the first and 7th postoperative day and 3 months post-surgery. Primary outcome will be self-reported physical function measured on the activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) for patients with knee and hip osteoarthritis, respectively. Secondary outcomes include the subscales for pain, symptoms, function in sport and recreation and knee/hip-related quality of life of the HOOS and KOOS, preoperative anxiety, measured by the Hospital Anxiety and Depression Scale (HADS), as well as, pain at rest and pain during activity measured by a numerical rating scale (NRS). Primary endpoint is 3 months post-surgery. DISCUSSION Mobile Health (mHealth) has become increasingly important in patient-centred health care aiming to enhance patient involvement and self-management capabilities. To our knowledge this is the first study to investigate the effect of an evidence-based mobile app on patient reported outcomes after joint replacement. This study should provide evidence supporting the use of mHealth to facilitate recovery and open up new possibilities for patient care in joint replacement. TRIAL REGISTRATION DRKS Data Management retrospectively registered. DRKS-ID DRKS00012744.
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Affiliation(s)
- Anja Stauber
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Nadine Schüßler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sarah Palmdorf
- Faculty of Health Sciences, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Nina Schürholz
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - David Bruns
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Nadja Nestler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
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Mahendira L, Jones C, Papachristos A, Waddell J, Rubin L. Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2020; 44:77-83. [PMID: 31520177 PMCID: PMC6938792 DOI: 10.1007/s00264-019-04405-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact. METHODS We prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined. RESULTS Five patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered "de facto" surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management. CONCLUSION These findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens.
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Affiliation(s)
- Luxme Mahendira
- Division of Rheumatology, Unity Health-Saint Michael's Hospital, 30 Bond Street, Bond Wing 3-061, Toronto, Ontario, M5B 1W8, Canada
| | - Caroline Jones
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
| | - Angelo Papachristos
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
| | - James Waddell
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
- Division of Orthopedics, Unity Health-Saint Michael's Hospital, 55 Queen St E. Suite 207, Toronto, Ontario, M5C 1R6, Canada
| | - Laurence Rubin
- Division of Rheumatology, Unity Health-Saint Michael's Hospital, 30 Bond Street, Bond Wing 3-061, Toronto, Ontario, M5B 1W8, Canada.
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada.
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Nicola M, Correia H, Ditchburn G, Drummond P. Invalidation of chronic pain: a thematic analysis of pain narratives. Disabil Rehabil 2019; 43:861-869. [PMID: 31290347 DOI: 10.1080/09638288.2019.1636888] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain. METHOD A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain. FINDINGS Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation. CONCLUSION Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.
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Affiliation(s)
- Melinda Nicola
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Helen Correia
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Graeme Ditchburn
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Peter Drummond
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
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Engel J, Prentice D, Hicks R. Where Does the Patient Fit? An Analysis of Word Use Within the Context of Interprofessional Collaborative Care. Glob Qual Nurs Res 2019; 6:2333393619889353. [PMID: 31840037 PMCID: PMC6900618 DOI: 10.1177/2333393619889353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022] Open
Abstract
Patient-centeredness is considered central to interprofessional collaborative patient care as a participatory, partnered approach between health care professionals and patients. Content analysis of 501 articles from the 1986, 1987, 1988, 1996, 2006, 2013, 2014, and 2018 volumes of a selected journal was undertaken. The purposes were to identify contexts in which the term patient was used in articles with a primary focus on interprofessional care and to identify trends in its usage. With Dilthey's ideas on language as a framework, patient and its variations in the articles were coded under five categories. Findings suggest that the term patient appears predominantly as a modifier for activities enacted by experts and a platform for the discussion of relationships among professionals. There is limited evidence that use of the term patient fits within the context of partnership, suggesting that the language in published interprofessional collaborative research and discussion is currently largely expert, not patient-centered.
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Affiliation(s)
- Joyce Engel
- Brock University, St. Catharines, Ontario, Canada
| | | | - Rachel Hicks
- Brock University, St. Catharines, Ontario, Canada
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Dainty KN, Seaton MB, Drennan IR, Morrison LJ. Home Visit-Based Community Paramedicine and Its Potential Role in Improving Patient-Centered Primary Care: A Grounded Theory Study and Framework. Health Serv Res 2018. [PMID: 29542111 DOI: 10.1111/1475-6773.12855] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Community paramedicine (CP) is a model of community-based health care being used around the world. Our objective was to study the patient perspective and valuation of this type of program to understand its potential value for primary care innovation in the future. STUDY SETTING The EPIC community paramedicine program is a partnership between primary care physicians and specially trained community paramedics, designed to provide in-home support for complex chronic disease patients in Ontario, Canada. STUDY DESIGN As part of an ongoing clinical trial we designed an embedded qualitative evaluation using constructionist grounded theory methodology. DATA COLLECTION METHODS Data collection included in-depth interviews with 30 patients and/or family members and 60 hours of observation. PRINCIPAL FINDINGS The health care needs of this complex population are largely attributes that impact a patient's quality of life-including recognition of their vulnerability, providing a safety-net in times of exacerbation and health education and accountability. This seems to be facilitated by a relationship with a dedicated provider that increases continuity of care. CONCLUSIONS Home-based community paramedicine programs like EPIC appear to be able to create a patient-centered, safe, responsive therapeutic relationship that is often not possible within the standard primary health care system.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, North York, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, North York, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, North York, Toronto, ON, Canada.,Office of Research and Innovation, North York General Hospital, North York, Toronto, Ontario, Canada
| | - M Bianca Seaton
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ian R Drennan
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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Goldsmith LJ, Suryaprakash N, Randall E, Shum J, MacDonald V, Sawatzky R, Hejazi S, Davis JC, McAllister P, Bryan S. The importance of informational, clinical and personal support in patient experience with total knee replacement: a qualitative investigation. BMC Musculoskelet Disord 2017; 18:127. [PMID: 28340610 PMCID: PMC5366158 DOI: 10.1186/s12891-017-1474-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature. Methods We report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders. Results Participants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves. Conclusions Patient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.
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Affiliation(s)
- Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Nitya Suryaprakash
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Ellen Randall
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jessica Shum
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, 10th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Valerie MacDonald
- Burnaby Hospital & Surgical Network, Fraser Health, 3935 Kincaid Street, Burnaby, BC, V5K 2X6, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Service, Fraser Health, Suite 400, Central City Tower, 13450 102 Avenue, Surrey, BC, V3T 0H1, Canada
| | - Jennifer C Davis
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Aging, Mobility, and Cognitive Neurosciences Lab, University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Ashcroft R, Menear M, Silveira J, Dahrouge S, McKenzie K. Incentives and disincentives for treating of depression and anxiety in Ontario Family Health Teams: protocol for a grounded theory study. BMJ Open 2016; 6:e014623. [PMID: 28186951 PMCID: PMC5128770 DOI: 10.1136/bmjopen-2016-014623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION There is strong consensus that prevention and management of common mental disorders (CMDs) should occur in primary care and evidence suggests that treatment of CMDs in these settings can be effective. New interprofessional team-based models of primary care have emerged that are intended to address problems of quality and access to mental health services, yet many people continue to struggle to access care for CMDs in these settings. Insufficient attention directed towards the incentives and disincentives that influence care for CMDs in primary care, and especially in interprofessional team-based settings, may have resulted in missed opportunities to improve care quality and control healthcare costs. Our research is driven by the hypothesis that a stronger understanding of the full range of incentives and disincentives at play and their relationships with performance and other contextual factors will help stakeholders identify the critical levers of change needed to enhance prevention and management of CMDs in interprofessional primary care contexts. Participant recruitment began in May 2016. METHODS AND ANALYSIS An explanatory qualitative design, based on a constructivist grounded theory methodology, will be used. Our study will be conducted in the Canadian province of Ontario, a province that features a widely implemented interprofessional team-based model of primary care. Semistructured interviews will be conducted with a diverse range of healthcare professionals and stakeholders that can help us understand how various incentives and disincentives influence the provision of evidence-based collaborative care for CMDs. A final sample size of 100 is anticipated. The protocol was peer reviewed by experts who were nominated by the funding organisation. ETHICS AND DISSEMINATION The model we generate will shed light on the incentives and disincentives that are and should be in place to support high-quality CMD care and help stimulate more targeted, coordinated stakeholder responses to improving primary mental healthcare quality.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Menear
- CHU de Quebec Research Centre, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| | - Jose Silveira
- Mental Health and Addiction Program, St. Joseph's Health Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Wellesley Institute, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Lofters A, Guilcher S, Maulkhan N, Milligan J, Lee J. Patients living with disabilities: The need for high-quality primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e457-e464. [PMID: 27521411 PMCID: PMC4982744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. DESIGN A waiting room survey using a convenience sample. SETTING A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. PARTICIPANTS A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. MAIN OUTCOME MEASURES Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. RESULTS Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). CONCLUSION In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care.
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Affiliation(s)
- Aisha Lofters
- Scientist with the Centre for Urban Health Solutions of the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont.
| | - Sara Guilcher
- Assistant Professor with the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Niraj Maulkhan
- Research assistant with the Centre for Family Medicine Family Health Team at the time of this research
| | - James Milligan
- Family physician with the Centre for Family Medicine Family Health Team
| | - Joseph Lee
- Family physician with the Centre for Family Medicine Family Health Team
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Brembo EA, Kapstad H, Eide T, Månsson L, Van Dulmen S, Eide H. Patient information and emotional needs across the hip osteoarthritis continuum: a qualitative study. BMC Health Serv Res 2016; 16:88. [PMID: 26969622 PMCID: PMC4788906 DOI: 10.1186/s12913-016-1342-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 03/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time. Methods As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients’ need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach. Results The thematic analysis revealed a pattern of patients’ information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option. Conclusion Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies.
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Affiliation(s)
- Espen Andreas Brembo
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden - Drammen kunnskapspark. Grønland 58, 3045, Drammen, Norway. .,Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Heidi Kapstad
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden - Drammen kunnskapspark. Grønland 58, 3045, Drammen, Norway
| | - Tom Eide
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden - Drammen kunnskapspark. Grønland 58, 3045, Drammen, Norway
| | - Lukas Månsson
- Department of Emergency and Orthopaedics, Vestre Viken HF, Drammen Hospital, Dronninggata 28, 3004, Drammen, Norway
| | - Sandra Van Dulmen
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden - Drammen kunnskapspark. Grønland 58, 3045, Drammen, Norway.,NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden - Drammen kunnskapspark. Grønland 58, 3045, Drammen, Norway
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Webster F, Perruccio AV, Jenkinson R, Jaglal S, Schemitsch E, Waddell JP, Venkataramanan V, Bytautas J, Davis AM. Understanding why people do or do not engage in activities following total joint replacement: a longitudinal qualitative study. Osteoarthritis Cartilage 2015; 23:860-7. [PMID: 25707933 DOI: 10.1016/j.joca.2015.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Numerous studies report large and significant improvements in basic mobility and activities of daily living following total hip or knee replacement (TJR). Nevertheless, quantitative research has shown minimal increase in participation in activities that benefit overall health. This study explored why people do or do not engage in activities following hip or knee TJR. METHOD This was a longitudinal qualitative study. Sampling was guided by constructivist grounded theory and data collected using open-ended, semi-structured interviews. Participants were recruited using maximum variation sampling based on age, sex and joint replaced (hip or knee). Data were analysed using a constant comparative approach and coded for thematic patterns and relationships from which overarching themes were constructed. RESULTS Twenty-nine patients participated in interviews prior to, and 8 and 18 months post following TJR. A high degree of variability with regard to participants' return to activities was found and five emergent themes were identified that accounted for this variability. These themes highlight the importance of issues beyond medical factors alone, such as socio-cultural factors that partially determine participants' participation in activity following TJR. CONCLUSION Findings suggest that multi-faceted experiences impact participation in activity following TJR. These experiences include changes in identity and lifestyle that preclude a 'return to normal'. There is an urgent need for supports to increase people's activity post-TJR in order to facilitate enhancement of post-surgery levels of engagement. Approaches that take into consideration more personalized interventions may be critical to promoting healthy aging in people with TJR.
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Affiliation(s)
- F Webster
- Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
| | - A V Perruccio
- Arthritis Program, Division of Orthopaedic Surgery, University Health Network, Institute of Health Policy, Management & Evaluation, University of Toronto, 399 Bathurst Street, EW1-449, Toronto, Ontario M5T 2S8, Canada.
| | - R Jenkinson
- Division of Orthopaedics, Sunnybrook Health Sciences Centre and Division of Orthopaedics, Department of Surgery, University of Toronto, 2075 Bayview Avenue, MG 361, Toronto, Ontario M4N 3M5, Canada.
| | - S Jaglal
- Departments of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G 1V7, Canada.
| | - E Schemitsch
- Division of Orthopaedics, St. Michael's Hospital and Division of Orthopaedics, Department of Surgery, University of Toronto, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada.
| | - J P Waddell
- Division of Orthopaedics, St. Michael's Hospital and Division of Orthopaedics, Department of Surgery, University of Toronto, 38 Shuter Street, 3rd Floor, Room 3005, Toronto, Ontario M5B 1A6, Canada.
| | - V Venkataramanan
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 399 Bathurst Street, MP11-324, Toronto, Ontario M5T 2S8, Canada.
| | - J Bytautas
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 399 Bathurst Street, MP11-326, Toronto, Ontario M5T 2S8, Canada.
| | - A M Davis
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Institute of Health Policy, Management and Evaluation, Departments of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, 399 Bathurst Street, MP11-322, Toronto, Ontario M5T 2S8, Canada.
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Barker KL. How can qualitative research be utilised in the NHS when re-designing and commissioning services? Br J Pain 2015; 9:70-2. [PMID: 26516559 PMCID: PMC4616992 DOI: 10.1177/2049463714544553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient experience is acknowledged as a key quality metric of healthcare quality and can be used to identify problems with healthcare delivery, to drive quality improvements and to inform commissioning of services that promote patient choice. In this article, the contribution of qualitative research studies to inform the redesign and patient-focussed commissioning of services is considered, illustrated with particular reference to elective orthopaedic surgical services. To fully embrace the concept of patient and public involvement (PPI) and to embed it in service delivery, health service design and informing commissioners to purchase healthcare that truly meets patient need and expectations, qualitative research has an increasingly important role to play. Through well-conducted qualitative research exploring patients' experiences, their knowledge and experiences of conditions can be utilised for the benefit of others and the impact of the patient voice truly heard when designing and commissioning healthcare services.
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Affiliation(s)
- Karen L Barker
- Orthopaedic Directorate, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Crespin DJ, Griffin KH, Johnson JR, Miller C, Finch MD, Rivard RL, Anseth S, Dusek JA. Acupuncture provides short-term pain relief for patients in a total joint replacement program. PAIN MEDICINE 2015; 16:1195-203. [PMID: 25586769 DOI: 10.1111/pme.12685] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Given the risks of opioid medications, nonpharmacological strategies should be considered for total joint replacement patients. We investigated acupuncture as an adjunct therapy for postsurgical pain management in a total joint replacement program by examining which total hip and knee replacement patients elected to receive acupuncture and the effect of acupuncture on short-term pain. DESIGN A total joint replacement program using fast-track physiotherapy offered elective postsurgical acupuncture to all patients, at no additional cost, as an adjunct therapy to opioids for pain management. SETTING The Joint Replacement Center at Abbott Northwestern Hospital, a 630-bed teaching and specialty hospital in Minneapolis, Minnesota from 2010 to 2012. SUBJECTS Our sample included 2,500 admissions of total hip (THR) and total knee replacement (TKR) patients. METHODS Self-reported pain was assessed before and after acupuncture using a 0-10 scale and categorized as none/mild (0-4) and moderate/severe pain (5-10). RESULTS Seventy-five percent of admissions included acupuncture. Women (Odds Ratio: 1.48, 95% Confidence Interval (CI): 1.22, 1.81) had higher odds of receiving acupuncture compared to men, and nonwhite patients (Odds Ratio: 0.55, 95% CI: 0.39, 0.78) had lower odds of receiving acupuncture compared to white patients. Average short-term pain reduction was 1.91 points (95% CI: 1.83, 1.99), a 45% reduction from the mean prepain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture. CONCLUSIONS Acupuncture may be a viable adjunct to pharmacological approaches for pain management after THR or TKR.
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Affiliation(s)
- Daniel J Crespin
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Kristen H Griffin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota
| | - Jill R Johnson
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota
| | - Cynthia Miller
- Penny George Institute for Health and Healing, Allina Health, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael D Finch
- Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota
| | - Rachael L Rivard
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota
| | | | - Jeffery A Dusek
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota
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Comments on Factors Influencing Medical Service Quality. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1314-5. [PMID: 26175993 PMCID: PMC4500441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/12/2014] [Indexed: 12/03/2022]
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