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van den Bekerom L, van Gestel LC, Schoones JW, Bussemaker J, Adriaanse MA. Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness. Health Psychol Behav Med 2024; 12:2365931. [PMID: 38903803 PMCID: PMC11188964 DOI: 10.1080/21642850.2024.2365931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. Methods A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Results Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Conclusion Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
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Affiliation(s)
- Loes van den Bekerom
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
| | - Laurens C. van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jan W. Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jet Bussemaker
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- The Institute of Public Administration, Leiden University, Leiden, the Netherlands
| | - Marieke A. Adriaanse
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
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Damgaard AJ, Primdahl J, Esbensen BA, Latocha KM, Bremander A. Self-management support needs of patients with inflammatory arthritis and the content of self-management interventions: a scoping review. Semin Arthritis Rheum 2023; 60:152203. [PMID: 37068398 DOI: 10.1016/j.semarthrit.2023.152203] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Self-management skills can empower a person to manage the physical, psychological, and social impact of a health condition. However, the components of self-management interventions differ widely between studies and interventions. By performing a scoping review, we aimed to describe patients' self-management needs and how health professionals (HPs) can provide effective self-management support to patients with inflammatory arthritis (IA). OBJECTIVES 1) to identify the evidence for self-management support needs of patients with IA, and 2) to identify the content (theory/theoretical approach, mode of delivery, duration and frequency) of self-management interventions that target patients with IA. METHODS In May 2021, we performed a systematic literature search (from 2000 onward) in five databases (CINAHL (Ebsco), Cochrane Library, Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) regarding self-management in patients with IA. RESULTS Out of 11,748 records identified, we included 31 articles describing patients' support needs and 33 articles describing the content of self-management interventions. Patients' support needs were sorted into six topics: 1) disease impact and the pharmacological treatment, 2) care continuity and relations with HPs, 3) the importance of non-pharmacological treatment, 4) the need for support from family and friends, 5) support needs related to work issues, and 6) contextual preferences for self-management support. The theory/theoretical approach, mode of delivery, duration and frequency varied widely and were often unclearly or insufficiently described. In addition, the self-management concept was scarcely - or not - defined in the included articles. The identified topics for support needs were compared with the described content in the included articles. Only a few self-management interventions focused on patients' need for support in relation to work, and to family and friends. CONCLUSION HPs provided self-management support to patients with IA in various ways, but there were gaps between the patients' support needs and the identified interventions. In developing self-management interventions, the self-management concept needs to be defined and a clear theory is required to support the development of the intervention. Future studies should seek to investigate various modes of delivery, frequency and duration, to develop effective interventions that meet patients' support needs.
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Thomas M, Harrison M, De Vera MA. Reporting of Determinants of Health Inequities in Rheumatoid Arthritis Randomized Controlled Trials in Canada: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:101-114. [PMID: 35792665 DOI: 10.1002/acr.24978] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE More than ever, it is important to consider inclusion and diversity in rheumatology research. We reviewed and synthesized randomized controlled trials (RCTs) for rheumatoid arthritis (RA) in Canada with the aim of characterizing participants and identifying how determinants of health inequities are reported. METHODS We conducted a scoping review following the Arksey and O'Malley framework. We searched Medline (1990 to December 2021), Embase (1990 to December 2021), and CENTRAL (inception to December 2021) for articles meeting inclusion criteria of: 1) used an RCT design; 2) evaluated pharmacologic or nonpharmacologic interventions; 3) included participants with RA; and 4) conducted in Canada. Data extraction was guided by the Campbell and Cochrane Equity Methods Group's PROGRESS-Plus framework on determinants that lead to health inequities (e.g., place of residence; race; occupation; gender/sex; religion; education; socioeconomic status; and social capital). RESULTS Of 6,290 unique records, 42 were eligible for inclusion. We grouped studies according to 3 time periods: before 2000; 2000-2010; and 2011 to present. Participants of included studies were mostly middle-aged, female, and White. Sex and age were the most widely reported determinants in 41 studies. Other determinants reported were race (15 studies), education (11 studies), socioeconomic status (7 studies), and occupation (6 studies). Religion, features of relationships, and time-dependent relationships were not reported in any study. CONCLUSION This scoping review suggests limited reporting on determinants of health inequities in RCTs for RA in Canada. Establishing reporting standards for equity factors in RCTs is important for addressing health inequities and informing accessible research and care for patients with RA.
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Affiliation(s)
- Megan Thomas
- University of British Columbia, Arthritis Research Canada, and Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mark Harrison
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- University of British Columbia, Arthritis Research Canada, and Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Michou L, Julien AS, Witteman HO, Légaré J, Ratelle L, Godbout A, Tardif J, Côté S, Boily G, Lui R, Ikic A, Trudeau J, Tremblay JL, Fortin I, Bessette L, Chetaille AL, Fortin PR. Measuring the impact of an educational intervention in rheumatoid arthritis: An open-label, randomized trial. Arch Rheumatol 2021; 37:169-179. [PMID: 36017212 PMCID: PMC9377171 DOI: 10.46497/archrheumatol.2022.8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to determine whether patients with active rheumatoid arthritis (RA), either starting on or changing biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs), demonstrate better self-management safety skills three months after receiving a multidisciplinary educational intervention compared to patients receiving usual care. Patients and methods
Between October 2015 and October 2018 , this open-label, randomized-controlled trial included a total of 107 RA patients (27 males, 80 females; mean age: 60.2±10.4 years; range, 54 to 71 years) who were on treatment or in whom treatment was changed with a biological or targeted synthetic DMARD. The patients were randomized into two groups: Group 1 (n=57) received additional intervention with educational DVD and one teleconference session and Group 2 (n=55) received usual care and were offered the intervention at three months. All patients underwent a final visit at six months. At each visit, the patients completed the BioSecure questionnaire measuring the self-care safety skills, a behavioral intention questionnaire, and the Beliefs about Medicines Questionnaire (BMQ). Results
No significant difference was observed in the Biosecure score at three months between the two groups (p=0.08). After pooling the first three-month data in Group 1 and the last three-month data in Group 2, the mean score of the BioSecure questionnaire increased to 7.10±0.92 in the group receiving educational intervention (p<0.0001). This increase was maintained at six months in Group 2 (p=0.88). The rate of appropriate behavioral intention increased over time (76% at baseline and 85% at six months for both groups). There was no significant change in the BMQ (p=0.44 to 0.84). Conclusion
The development of an educational DVD followed by a teleconference seem to improve self-care safety skills of the patients in practical situations.
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Affiliation(s)
- Laëtitia Michou
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Sophie Julien
- Department of Mathematics and statistics, Université Laval, Québec (Québec) Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec (Québec) Canada
| | - Jean Légaré
- Arthritis Alliance of Canada, Québec (Québec) Canada
| | - Lucie Ratelle
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | - Alexandra Godbout
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | | | - Suzanne Côté
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | | | - Rebecca Lui
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Alena Ikic
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Judith Trudeau
- Department of Rheumatology, Hôtel-Dieu de Lévis, Lévis, (Québec) Canada
| | - Jean-Luc Tremblay
- Clinique de Rhumatologie du Centre du Québec, Trois-Rivières, (Québec) Canada
| | - Isabelle Fortin
- Centre de Rhumatologie de l’Est du Québec, Rimouski, (Québec) Canada
| | - Louis Bessette
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Laure Chetaille
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Paul R Fortin
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
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Hoski SO, Chauvin S, Vrkljan B, Beauchamp MK. The Effect of Lifestyle Interventions on the ICF Participation Domain in Older Adults: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2021; 62:e304-e316. [PMID: 33433560 DOI: 10.1093/geront/gnab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization's International Classification of Functioning, Disability and Health (ICF) recognizes participation in life situations as a major component of health. Identifying interventions that target this component is critical, particularly in older adulthood where declines in physical functioning can impact participation. The purpose of this study was to evaluate the effectiveness of lifestyle or behavior change interventions on the ICF participation domain in older adults. RESEARCH DESIGN AND METHODS MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), AgeLine (EBSCO), PsycINFO (Ovid), and AMED (Ovid) were searched from inception to April 2020 for randomized controlled trials comparing the effects of any behavior change or lifestyle intervention to usual care among community-dwelling adults ≥60 years with respect to participation-related domains of the ICF. The protocol was registered with Prospero (CRD42019125334). RESULTS Eight studies with a total of 1548 participants were included. No significant effect on participation outcomes was found (standardized mean difference 0.04; 95% CI -0.19 to 0.26; p = 0.76) and the quality of evidence was judged to be very low. DISCUSSION AND IMPLICATIONS Lifestyle or behavior change interventions showed limited effect on participation in later life. However, there remains much uncertainty in the estimate of this effect due, in part, to the low quality of the included studies. Measurement tools that are responsive to changes in participation in older adulthood should be used to determine the effect of such interventions. Improving study design will lead to more efficacious interventions that promote the participation for our aging population.
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Affiliation(s)
- Sachi O' Hoski
- Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephane Chauvin
- Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Vrkljan
- Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marla K Beauchamp
- Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Hafkamp FJ, de Vries J, Gosens T, den Oudsten BL. The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty 2021; 36:78-87. [PMID: 32893058 DOI: 10.1016/j.arth.2020.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms. METHODS Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics. RESULTS The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms. CONCLUSION The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.
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Affiliation(s)
- Frederique J Hafkamp
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
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Ramraj B, Logaraj M. Is home bound a major burden towards health access among the elderly population? A community based cross sectional study in the selected northern districts in Tamilnadu. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kimmel B, Anderson JA, Walder A, Martin L, Shegog R. Veteran stroke survivors' lived experiences after being discharged home: a phenomenological study. Disabil Rehabil 2020; 44:2372-2384. [PMID: 33126821 DOI: 10.1080/09638288.2020.1836041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability in adults and second cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. AIMS To examine Veterans' lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. METHODS Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45-80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. RESULTS Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. CONCLUSIONS SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment.IMPLICATIONS FOR REHABILITATIONSeveral implications for clinical practice were identified:Providers should acknowledge Veterans' challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood.More emphasis should be given to the Veterans' caregivers' availability and willingness to help with their loved one's recovery, work reinstatement status and financial struggles.Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked.Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits.Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system.Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.
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Affiliation(s)
- Barbara Kimmel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jane A Anderson
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Annette Walder
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lindsey Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ross Shegog
- Department of Health Prevention and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
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Safari R, Jackson J, Sheffield D. Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e15365. [PMID: 32706657 PMCID: PMC7428148 DOI: 10.2196/15365] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Jessica Jackson
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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Hardman R, Begg S, Spelten E. What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review. BMC Health Serv Res 2020; 20:150. [PMID: 32106889 PMCID: PMC7045733 DOI: 10.1186/s12913-020-5010-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes. Methods Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results. Results Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura’s concept of self-efficacy. Conclusions The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity. Trial registration PROSPERO registration CRD42019124760. Registration date 17/4/19.
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Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, Victoria, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia
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Associations between psychological symptoms and treatment outcomes of a massage therapy intervention: Secondary analyses of a randomized controlled trial. Complement Ther Med 2019; 46:116-122. [PMID: 31519267 PMCID: PMC9934915 DOI: 10.1016/j.ctim.2019.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 01/30/2023] Open
Abstract
Massage therapy (MT) may be more effective for certain subgroups of advanced cancer patients, but this is not well-studied. Psychological symptoms are one potential moderator of MT outcomes, as they occur frequently in MT patients. Therefore, we conducted a secondary analysis of data from a multi-site study which compared MT to simple touch in 380 adults with advanced cancer. We examined whether the presence of depression or baseline psychological symptom frequency moderated outcomes of change in pain, interference of pain, quality of life, 60-second heart and respiratory rates, and physical distress. We found significant main effects of depression and baseline psychological symptom frequency on changes in pain, 60-second heart and respiratory rates, quality of life, and physical distress for both MT and simple touch, but did not find differential responses between groups in moderator analyses. Results imply that psychological interventions could be targeted to patients with cancer who are receiving any type of touch therapy to improve outcomes.
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Deidda M, Coll-Planas L, Giné-Garriga M, Guerra-Balic M, Roqué i Figuls M, Tully MA, Caserotti P, Rothenbacher D, Salvà Casanovas A, Kee F, Blackburn NE, Wilson JJ, Skjødt M, Denkinger M, Wirth K, McIntosh E. Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ Open 2018; 8:e022266. [PMID: 30327403 PMCID: PMC6194476 DOI: 10.1136/bmjopen-2018-022266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Promoting physical activity (PA) and reducing sedentary behaviour (SB) may exert beneficial effects on the older adult population, improving behavioural, functional, health and psychosocial outcomes in addition to reducing health, social care and personal costs. This paper describes the planned economic evaluation of SITLESS, a multicountry three-armed pragmatic randomised controlled trial (RCT) which aims to assess the short-term and long-term effectiveness and cost-effectiveness of a complex intervention on SB and PA in community-dwelling older adults, based on exercise referral schemes enhanced by a group intervention providing self-management strategies to encourage lifestyle change. METHODS AND ANALYSIS A within-trial economic evaluation and long-term model from both a National Health Service/personal social services perspective and a broader societal perspective will be undertaken alongside the SITLESS multinational RCT. Healthcare costs (hospitalisations, accident and emergency visits, appointment with health professionals) and social care costs (eg, community care) will be included in the economic evaluation. For the cost-utility analysis, quality-adjusted life-years will be measured using the EQ-5D-5L and capability well-being measured using the ICEpop CAPability measure for Older people (ICECAP-O) questionnaire. Other effectiveness outcomes (health related, behavioural, functional) will be incorporated into a cost-effectiveness analysis and cost-consequence analysis.The multinational nature of this RCT implies a hierarchical structure of the data and unobserved heterogeneity between clusters that needs to be adequately modelled with appropriate statistical and econometric techniques. In addition, a long-term population health economic model will be developed and will synthesise and extrapolate within-trial data with additional data extracted from the literature linking PA and SB outcomes with longer term health states.Methods guidance for population health economic evaluation will be adopted including the use of a long-time horizon, 1.5% discount rate for costs and benefits, cost consequence analysis framework and a multisector perspective. ETHICS AND DISSEMINATION The study design was approved by the ethics and research committee of each intervention site: the Ethics and Research Committee of Ramon Llull University (reference number: 1314001P) (Fundació Blanquerna, Spain), the Regional Committees on Health Research Ethics for Southern Denmark (reference number: S-20150186) (University of Southern Denmark, Denmark), Office for Research Ethics Committees in Northern Ireland (ORECNI reference number: 16/NI/0185) (Queen's University of Belfast) and the Ethical Review Board of Ulm University (reference number: 354/15) (Ulm, Germany). Participation is voluntary and all participants will be asked to sign informed consent before the start of the study.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634 270. This article reflects only the authors' view and the Commission is not responsible for any use that may be made of the information it contains.The findings of the study will be disseminated to different target groups (academia, policymakers, end users) through different means following the national ethical guidelines and the dissemination regulation of the Horizon 2020 funding agency.Use of the EuroQol was registered with the EuroQol Group in 2016.Use of the ICECAP-O was registered with the University of Birmingham in March 2017. TRIAL REGISTRATION NUMBER NCT02629666; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
| | - Laura Coll-Planas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Míriam Guerra-Balic
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Marta Roqué i Figuls
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Mark A Tully
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | | | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Frank Kee
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nicole E Blackburn
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Jason J Wilson
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mathias Skjødt
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Katharina Wirth
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
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Wang J, Yang L, Li Q, Wu Z, Sun Y, Zou Q, Li X, Xu Z, Ye C. Construction of an adherence rating scale for exercise therapy for patients with knee osteoarthritis. BMC Musculoskelet Disord 2018; 19:263. [PMID: 30053843 PMCID: PMC6064120 DOI: 10.1186/s12891-018-2200-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is one of the most common chronic diseases in the elderly and is the primary cause of the loss of motor function and disability in this population. Exercise therapy is a core, basic and matureand treatment method of treating patients with KOA. Exercise therapy is “strongly recommended” or “recommended” in the diagnosis and treatment guidelines of osteoarthritis in many countries, and most scholars advocate exercise therapy as the preferred rehabilitation method for KOA patients. However, poor long-term adherence is a serious problem affecting the therapeutic effect of this mature treatment. The objective of this study was to construct a concise and practical adherence rating scale (ARS) based on the exercise therapy adherence prediction model in patients with knee osteoarthritis. Methods A binary logistic regression model was established, with the adherence of 218 cases of KOA patients as the dependent variable. The patients’ general information, exercise habits, knowledge, attitude, and exercise therapy were independent variables. The regression coefficients were assigned to various variables in the model, and the ARS was constructed accordingly. Receiver operating characteristic curves and curve fitting were used to analyse the effect of the ARS in predicting the adherence and to determine the goodness of fit for the adherence. The external validity of the ARS was examined in a randomized controlled trial. Results The construction of the adherence model and the ARS included the following variables: age (1 point), education level (1 point), degree of social support (2 points), exercise habits (3 points), knowledge of KOA prevention and treatment (2 points), degree of care needed to treat the disease (1 point), familiarity with exercise therapy (4 points) and treatment confidence (3 points). The critical value of the total score of the ARS was 6.50, with a sensitivity of 87.20% and a specificity of 76.34%. Conclusions A KOA exercise therapy adherence model and a simple and practical ARS were constructed. The ARS has good internal validity and external validity and can be used to evaluate the adherence to exercise therapy in patients with KOA.
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Affiliation(s)
- Jianji Wang
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Long Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Qingjun Li
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Zhanyu Wu
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Yu Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Qiang Zou
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Xuanze Li
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Zhe Xu
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China.,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China
| | - Chuan Ye
- Department of Orthopedic Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China. .,Center for Bioprinting and Biomanufacturing, Guizhou Medical University, Guiyang, China. .,Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang, China. .,China Orthopedic Regenerative Medicine Group (CORMed), Guiyang, China.
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New-graduate Physical Therapists' Self-efficacy to Perform Patient Education Is Influenced by Entry-level Training Experiences. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/jte.0000000000000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Forbes R, Mandrusiak A, Smith M, Russell T. Training physiotherapy students to educate patients: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:295-303. [PMID: 28847438 DOI: 10.1016/j.pec.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine the effect of a training intervention on physiotherapy students' self-efficacy and skills in the area of patient education. METHODS Final year physiotherapy students were randomised to an intervention group or a wait-list control group. The intervention group participated in a 3.5h training intervention about patient education that included video observation, simulated patient practice and structured feedback. The control group did not receive any training. Self-efficacy was assessed at baseline (T1) and after the intervention (or no intervention for the control group) (T2). Patient education performance was assessed by a blinded rater from a video-recorded standardised clinical examination. RESULTS 83 students were randomised to the intervention group and 81 students to the control group. There were no differences in demographic variables or self-efficacy between groups at baseline. There was significant improvement in self-efficacy for the intervention group, but no change for the control group. The intervention group performed significantly better than the control group for nine of the eleven performance items, with significantly higher scores overall. CONCLUSION A training intervention enhances physiotherapy student self-efficacy and performance in patient education. PRACTICE IMPLICATION Use of patient education training is recommended to enhance student self-efficacy and performance.
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Affiliation(s)
- R Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
| | - A Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - M Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - T Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Jing LW, Wang FL, Zhang XL, Yao T, Xing FM. Occurrence of and factors influencing elderly homebound in Chinese urban community: A cross-sectional study. Medicine (Baltimore) 2017; 96:e7207. [PMID: 28658111 PMCID: PMC5500033 DOI: 10.1097/md.0000000000007207] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies on the occurrence of homebound and the factors influencing it are available. However, the study of community homebound in China is still in its preliminary stage. No previous studies about this issue are available. This study aims to assess the occurrence of and factors influencing homebound elderly in Chinese communities and to provide a basis for effective intervention and prevention of homebound elderly people.One sample community from three provinces was randomly selected. Investigations were performed on the selected communities and 2180 elderly people were chosen as the research subjects. Unified survey scales were used. Home visit and face-to-face interviews were performed to ensure that no single qualified survey respondent was missed.The rate of morbidity in homebound elderly Chinese community was found to be 15.49% and it gradually increased with age, and also with a lower education or poorer Activities of Daily Living (ADL). Single factor analysis showed that general situation, living habits, physical condition, mental condition, society, social support, and other factors affected the occurrence of community homebound elderly. Women were more likely to be homebound than men (P < .05). Having a spouse or high income reduced the rate of morbidity in the homebound elderly (P < .05). Multifactor regression analysis revealed that poor ADL, depression, hearing impairment, being old, no exercise, and low social support are the main influencing factors.Appropriate measures should be taken based on the specific influencing factor to prevent the occurrence of homebound.
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17
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Giné-Garriga M, Coll-Planas L, Guerra M, Domingo À, Roqué M, Caserotti P, Denkinger M, Rothenbacher D, Tully MA, Kee F, McIntosh E, Martín-Borràs C, Oviedo GR, Jerez-Roig J, Santiago M, Sansano O, Varela G, Skjødt M, Wirth K, Dallmeier D, Klenk J, Wilson JJ, Blackburn NE, Deidda M, Lefebvre G, González D, Salvà A. The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial. Trials 2017; 18:221. [PMID: 28521831 PMCID: PMC5437412 DOI: 10.1186/s13063-017-1956-x] [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] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background Older adults are the fastest growing segment of the world‘s population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. Methods A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45–60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics’ related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. Discussion The findings of this study may help inform the design and implementation of more effective interventions to reduce SB and increase PA levels, and hence improve long-term health outcomes in the older adult population. SITLESS aims to support policy-makers in deciding how or whether ERS should be further implemented or restructured in order to increase its adherence, impact and cost-effectiveness. Trial registration ClinicalTrials.gov, NCT02629666. Registered 19 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1956-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain.
| | - Laura Coll-Planas
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | - Míriam Guerra
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Àlex Domingo
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | | | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany
| | | | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Lilibank Gardens, Glasgow, G12 8RZ, UK
| | - Carme Martín-Borràs
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Guillermo R Oviedo
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Javier Jerez-Roig
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Marta Santiago
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Oriol Sansano
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Guillermo Varela
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Mathias Skjødt
- Syddansk Universitet, Campusvej 55, 5230, Odense M, Denmark
| | - Katharina Wirth
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany
| | - Jason J Wilson
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nicole E Blackburn
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Lilibank Gardens, Glasgow, G12 8RZ, UK
| | - Guillaume Lefebvre
- Sport Initiative et Loisir Bleu Association, BP 18104, 67038, Strasbourg, Cedex, France
| | - Denise González
- Sport Initiative et Loisir Bleu Association, C/ Bailén 5 bajos, 08010, Barcelona, Spain
| | - Antoni Salvà
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
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Forbes R, Mandrusiak A, Smith M, Russell T. A comparison of patient education practices and perceptions of novice and experienced physiotherapists in Australian physiotherapy settings. Musculoskelet Sci Pract 2017; 28:46-53. [PMID: 28171778 DOI: 10.1016/j.msksp.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/13/2016] [Accepted: 01/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient education is an integral component of physiotherapy practice. Little is known about the differences in reported use and perception of patient education between experienced and novice physiotherapists. Understanding these differences has important implications for training approaches and physiotherapy practice. OBJECTIVES To compare how experienced and novice physiotherapists report frequency of patient education practices and their perceptions of the importance of these practices. DESIGN AND METHODS A web-based purpose-designed survey was developed, piloted and administered to practicing physiotherapists through direct email. Of 305 complete responses, two subgroups were explored for comparative analysis: 'novice' (≤5years' experience, n = 52); and 'experienced' (≥11 years' experience, n = 204). RESULTS The experienced group rated 14 of 15 educational items higher than the novice group in relation to frequency of use and perceived importance. Experienced physiotherapists reported a significantly higher frequency of using one-to-one discussion, personalised handouts and explicitly seeking patient understanding (p < 0.05). Novice physiotherapists perceived more barriers to patient education, particularly those related to characteristics of the patient (p < 0.05). CONCLUSION Experienced physiotherapists report higher use of self-management education and education content that is patient-centred. Experienced therapists report a higher frequency of seeking explicit patient understanding to evaluate their teaching than novice physiotherapists and perceive fewer patient-related barriers to their practice. These findings are important when considering teaching and learning of patient education skills. Students or novice physiotherapists may benefit from strategies to facilitate patient-centred education, self-management education, evaluation approaches and strategies to manage barriers.
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Affiliation(s)
- Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Michelle Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Forbes R, Mandrusiak A, Russell T, Smith M. Evaluating physiotherapists' practice and perceptions of patient education: A national survey in Australia. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.3.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roma Forbes
- Clinical educator, associate lecturer in physiotherapy. School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Allison Mandrusiak
- Senior lecturer in physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Russell
- Professor in physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Michelle Smith
- Senior lecturer in physiotherapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol 2016; 8:103-113. [PMID: 27843376 PMCID: PMC5098683 DOI: 10.2147/oarrr.s93516] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Anxiety and depression are common psychological comorbidities that impact the quality of life (QoL) of patients. In this systematic review, we 1) determined the impact of anxiety and depression on outcomes in patients with osteoarthritis (OA) and 2) summarized unique challenges these comorbidities present to current OA management. Patients and methods A systematic literature search was performed using the OVID Medline and EMBASE databases until April 2016. Full-text research articles published in English from the year 2000 onward with a sample size of >100 were included in this review. Eligible research articles were reviewed and the following data were extracted: study author(s), year of publication, study design, and key findings. Results A total of 38 studies were included in the present review. The present study found that both anxiety and/or depression were highly prevalent among patients with OA. Patients with OA diagnosed with these comorbidities experienced more pain, had frequent hospital visits, took more medication, and reported less optimal outcomes. Management strategies in the form of self-care, telephone support, audio/video education programs, and new pharmacotherapies were reported with favorable results. Conclusion Anxiety and depression adversely impact the QoL of patients with OA. Physicians/caregivers are highly recommended to consider these comorbidities in patients with OA. Ultimately, a holistic individualized management approach is necessary to improve patient outcomes.
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Affiliation(s)
- Anirudh Sharma
- Division of Genetics and Development, Krembil Research Institute
| | - Prtha Kudesia
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Qian Shi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Ackerman IN, Ngian GS, Van Doornum S, Briggs AM. A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis. Clin Rheumatol 2015; 35:33-41. [DOI: 10.1007/s10067-015-3131-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 12/16/2022]
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Iredale C, Fornells-Ambrojo M, Jolley S. Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London. J Ment Health 2015; 25:204-11. [PMID: 26472054 DOI: 10.3109/09638237.2015.1078882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People with psychosis often have difficulty leaving their homes to perform tasks of daily living, which also limits their access to clinic-based interventions to support recovery. Home-based psychological therapy may offer a solution. AIM To examine service user and therapist perspectives on (i) houseboundness in psychosis and (ii) the value of home-based psychological interventions, as a first step towards a systematic evaluation. METHOD Semistructured interviews with 10 service users and 12 therapists from a large inner city mental health NHS Foundation Trust were thematically analysed. RESULTS Houseboundness most commonly resulted from anxiety, paranoia and amotivation, indicating the potential usefulness of targeted psychological therapies. Home-based therapy was offered unsystematically, with variable goals. Although beneficial for engagement and assessment, little gain was reported from undertaking a full course of therapy at home. CONCLUSION Home visits could be offered by psychological therapists to engage and assess housebound service users, but home-based therapy may be best offered on a short-term basis, targeting paranoia, anxiety and amotivation to increase access to other resources. Given the increased cost associated with home-based psychological interventions, a systematic evaluation of their impact is warranted.
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Affiliation(s)
- Catherine Iredale
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and
| | - Miriam Fornells-Ambrojo
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and.,c Department of Clinical , Educational and Health Psychology, University College London , London , UK
| | - Suzanne Jolley
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
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Boger EJ, Hankins M, Demain SH, Latter SM. Development and psychometric evaluation of a new patient -reported outcome measure for stroke self -management: The Southampton Stroke Self - Management Questionnaire (SSSMQ). Health Qual Life Outcomes 2015; 13:165. [PMID: 26432093 PMCID: PMC4592550 DOI: 10.1186/s12955-015-0349-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management is important to the recovery and quality of life of people following stroke. Many interventions to support self-management following stroke have been developed, however to date no reliable and valid outcome measure exists to support their evaluation. This study outlines the development and preliminary investigation of the psychometric performance of a newly developed patient-reported outcome measure (PROM) of self-management competency following stroke; the Southampton Stroke Self-Management Questionnaire (SSSMQ). METHODS A convenience sample of 87 people who had had a stroke completed responses to the SSSMQ, the Stroke Self-Efficacy Questionnaire and the Stroke Impact Scale. Scaling properties were assessed using Mokken Scale Analysis. Reliability and construct validity were assessed using intra-class correlation coefficient (ICC), Mokken and Cronbach's reliability coefficients and Spearman rank order correlations with relevant measures. RESULTS Mokken scaling refined the SSSMQ to 28 scalable items. Internal consistency reliability (Mokken r = 0.89) and test-retest reliability (ICC = 0.928) were excellent. Hypotheses of expected correlations with additional measures held, demonstrating good evidence for construct validity. CONCLUSIONS Early findings suggest the Southampton Stroke Self-Management Questionnaire is a reliable and valid scale of self-management competency. The SSSMQ represents a potentially valid PROM for the evaluation of self-management following stroke.
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Affiliation(s)
- Emma J Boger
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Matthew Hankins
- Real-World Evidence Solutions, IMS Health, London, N1 9JY, UK.
| | - Sara H Demain
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Susan M Latter
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
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Smartphone application for rheumatoid arthritis self-management: cross-sectional study revealed the usefulness, willingness to use and patients' needs. Rheumatol Int 2015; 35:1675-85. [PMID: 25903352 DOI: 10.1007/s00296-015-3270-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Patient-centered smartphone applications have potential to support rheumatoid arthritis (RA) self-management but remain almost unexplored in literature. Therefore, this study evaluated the usefulness of a smartphone application to support RA self-management, the willingness of RA patients to use and pay for it and the features the application should have. In this cross-sectional study, a questionnaire was developed to collect information on population, device ownership, usefulness and willingness to use and pay for a RA self-management application and application features. Descriptive statistics, Chi-square, Fisher's exact test, t test or Mann-Whitney's test and multivariate analysis were used. One hundred RA patients answered the questionnaire. Patients' mean age was 57 ± 11.9 years, most were females (91 %), with multiple drug regimens and a 40 % treatment non-compliance rate. Most patients believed that could have a more active role in self-management (94 %) and reported it would be useful to develop a RA self-management application (86 %). Patients willing to use an application (83 %) were younger, with a possible more active role in self-management, with access to a smartphone, and using short message service, electronic mail and Internet. Multivariate analysis confirmed these results, except the associations regarding access to a smartphone and use of electronic mail and Internet. Fifty-eight patients (82 %) were willing to pay for a RA self-management application and the most requested feature for it was information in a simple format. This study suggested the usefulness and patients' willingness to use and pay for a RA self-management application and provided insight on patients' needs.
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Bishop FL, Fenge-Davies AL, Kirby S, Geraghty AWA. Context effects and behaviour change techniques in randomised trials: a systematic review using the example of trials to increase adherence to physical activity in musculoskeletal pain. Psychol Health 2015; 30:104-21. [PMID: 25109300 DOI: 10.1080/08870446.2014.953529] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe and explore the effects of contextual and behaviour change technique (BCT) content of control and target interventions in clinical trials. DESIGN Review and meta-analysis of 42 trials from a Cochrane review of physical activity in chronic musculoskeletal pain. MAIN OUTCOME MEASURES Two researchers coded descriptions of target and control interventions for (a) 93 BCTs and (b) whether target and control interventions shared each of five contextual features (practitioners' characteristics, patient-practitioner relationship, intervention credibility, superficial treatment characteristics e.g. delivery modality, and environment). Quality of study reporting was assessed. Effect sizes for adherence to physical activity and class attendance were computed (Cohen's d) and analysed separately. RESULTS For physical activity outcomes, after controlling for reporting quality, larger effect sizes were associated with target and control interventions using different modalities (β = -.34, p = .030), target and control interventions involving equivalent patient-practitioner relationship (β = .40, p = .002), and target interventions having more unique BCTs (i.e. more BCTs not also in the control) (β = .008, p = .030). There were no significant effect moderators for class attendance outcomes. CONCLUSION Contents of control conditions can influence effect sizes and should be considered carefully in trial design and systematic reviews.
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Affiliation(s)
- Felicity L Bishop
- a Faculty of Social and Human Sciences, Centre for Applications of Health Psychology , University of Southampton , Southampton , UK
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Berdal G, Smedslund G, Dagfinrud H, Hagen KB, Kjeken I. Design and Effects of Supportive Followup Interventions in Clinical Care of Patients With Rheumatic Diseases: A Systematic Review With Meta-Analysis. Arthritis Care Res (Hoboken) 2015; 67:240-54. [DOI: 10.1002/acr.22407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 07/15/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Geir Smedslund
- Diakonhjemmet Hospital and the Norwegian Knowledge Centre for the Health Services; Oslo Norway
| | | | | | - Ingvild Kjeken
- Diakonhjemmet Hospital and University of Oslo; Oslo Norway
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Azevedo ARP, de Sousa HML, Monteiro JAF, Lima ARNP. Future perspectives of Smartphone applications for rheumatic diseases self-management. Rheumatol Int 2014; 35:419-31. [PMID: 25168866 DOI: 10.1007/s00296-014-3117-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/13/2014] [Indexed: 01/17/2023]
Abstract
Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived self-efficacy. Despite these demonstrated good results, there are several issues that hinder or render less appealing these interventions. One economically and socially viable solution is exploiting the potential of Smartphone technology. This potential comes from Smartphones pervasive presence in actual society, combined with the advantages of being personal, intuitive, and computationally powerful, with capability to support applications and assist its user throughout different activities of daily living and environments persistently. With their global acceptance increasing quickly, there is a great opportunity for mobile health in using Smartphone applications for RD self-management. Besides the potential of such applications, research on the development and evaluation of such applications is in the early stages. Therefore, it is important to foresee its future applicability in order to meet the needs of the twenty-first century.
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Affiliation(s)
- Ana Rita Pereira Azevedo
- Faculty of Medicine of University of Porto (FMUP), Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal,
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Richardson J, Loyola-Sanchez A, Sinclair S, Harris J, Letts L, MacIntyre NJ, Wilkins S, Burgos-Martinez G, Wishart L, McBay C, Martin Ginis K. Self-management interventions for chronic disease: a systematic scoping review. Clin Rehabil 2014; 28:1067-77. [DOI: 10.1177/0269215514532478] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the contributions of physiotherapy and occupational therapy to self-management interventions and the theoretical models used to support these interventions in chronic disease. Data sources: We conducted two literature searches to identify studies that evaluated self-management interventions involving physiotherapists and occupational therapists in MEDLINE, the Cochrane Library, CINAHL, EMBASE, AMED (Allied and Complementary Medicine), SPORTdiscus, and REHABDATA databases. Study selection: Four investigator pairs screened article title and abstract, then full text with inclusion criteria. Selected articles ( n = 57) included adults who received a chronic disease self-management intervention, developed or delivered by a physiotherapist and/or an occupational therapist compared with a control group. Data extraction: Four pairs of investigators performed independent reviews of each article and data extraction included: (a) participant characteristics, (b) the self-management intervention, (c) the comparison intervention, (d) outcome measures, construct measured and results. Data synthesis: A total of 47 articles reported the involvement of physiotherapy in self-management compared with 10 occupational therapy articles. The type of chronic condition produced different yields: arthritis n = 21 articles; chronic obstructive pulmonary disease and chronic pain n = 9 articles each. The theoretical frameworks most frequently cited were social cognitive theory and self-efficacy theory. Physical activity was the predominant focus of the self-management interventions. Physiotherapy programmes included disease-specific education, fatigue, posture, and pain management, while occupational therapists concentrated on joint protection, fatigue, and stress management. Conclusions: Physiotherapists and occupational therapists make moderate contributions to self-management interventions. Most of these interventions are disease-specific and are most frequently based on the principles of behaviour change theories.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Adalberto Loyola-Sanchez
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Susanne Sinclair
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Norma J MacIntyre
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Seanne Wilkins
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Gabriela Burgos-Martinez
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Laurie Wishart
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Cathy McBay
- Outpatient Stroke Rehabilitation Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kathleen Martin Ginis
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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Kroon FPB, van der Burg LRA, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self-management education programmes for osteoarthritis. Cochrane Database Syst Rev 2014; 2014:CD008963. [PMID: 24425500 PMCID: PMC11104559 DOI: 10.1002/14651858.cd008963.pub2] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Self-management education programmes are complex interventions specifically targeted at patient education and behaviour modification. They are designed to encourage people with chronic disease to take an active self-management role to supplement medical care and improve outcomes. OBJECTIVES To assess the effectiveness of self-management education programmes for people with osteoarthritis. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PyscINFO, SCOPUS and the World Health Organization (WHO) International Clinical Trial Registry Platform were searched, without language restriction, on 17 January 2013. We checked references of reviews and included trials to identify additional studies. SELECTION CRITERIA Randomised controlled trials of self-management education programmes in people with osteoarthritis were included. Studies with participants receiving passive recipients of care and studies comparing one type of programme versus another were excluded. DATA COLLECTION AND ANALYSIS In addition to standard methods we extracted components of the self-management interventions using the eight domains of the Health Education Impact Questionnaire (heiQ), and contextual and participant characteristics using PROGRESS-Plus and the Health Literacy Questionnaire (HLQ). Outcomes included self-management of osteoarthritis, participant's positive and active engagement in life, pain, global symptom score, self-reported function, quality of life and withdrawals (including dropouts and those lost to follow-up). We assessed the quality of the body of evidence for these outcomes using the GRADE approach. MAIN RESULTS We included twenty-nine studies (6,753 participants) that compared self-management education programmes to attention control (five studies), usual care (17 studies), information alone (four studies) or another intervention (seven studies). Although heterogeneous, most interventions included elements of skill and technique acquisition (94%), health-directed activity (85%) and self-monitoring and insight (79%); social integration and support were addressed in only 12%. Most studies did not provide enough information to assess all PROGRESS-Plus items. Eight studies included predominantly Caucasian, educated female participants, and only four provided any information on participants' health literacy. All studies were at high risk of performance and detection bias for self-reported outcomes; 20 studies were at high risk of selection bias, 16 were at high risk of attrition bias, two were at high risk of reporting bias and 12 were at risk of other biases. We deemed attention control as the most appropriate and thus the main comparator.Compared with attention control, self-management programmes may not result in significant benefits at 12 months. Low-quality evidence from one study (344 people) indicates that self-management skills were similar in active and control groups: 5.8 points on a 10-point self-efficacy scale in the control group, and the mean difference (MD) between groups was 0.4 points (95% confidence interval (CI) -0.39 to 1.19). Low-quality evidence from four studies (575 people) indicates that self-management programmes may lead to a small but clinically unimportant reduction in pain: the standardised mean difference (SMD) between groups was -0.26 (95% CI -0.44 to -0.09); pain was 6 points on a 0 to 10 visual analogue scale (VAS) in the control group, treatment resulted in a mean reduction of 0.8 points (95% CI -0.14 to -0.3) on a 10-point scale, with number needed to treat for an additional beneficial outcome (NNTB) of 8 (95% CI 5 to 23). Low-quality evidence from one study (251 people) indicates that the mean global osteoarthritis score was 4.2 on a 0 to 10-point symptom scale (lower better) in the control group, and treatment reduced symptoms by a mean of 0.14 points (95% CI -0.54 to 0.26). This result does not exclude the possibility of a clinically important benefit in some people (0.5 point reduction included in 95% CI). Low-quality evidence from three studies (574 people) showed no signficant difference in function between groups (SMD -0.19, 95% CI -0.5 to 0.11); mean function was 1.29 points on a 0 to 3-point scale in the control group, and treatment resulted in a mean improvement of 0.04 points with self-management (95% CI -0.10 to 0.02). Low-quality evidence from one study (165 people) showed no between-group difference in quality of life (MD -0.01, 95% CI -0.03 to 0.01) from a control group mean of 0.57 units on 0 to 1 well-being scale. Moderate-quality evidence from five studies (937 people) shows similar withdrawal rates between self-management (13%) and control groups (12%): RR 1.11 (95% CI 0.78 to 1.57). Positive and active engagement in life was not measured.Compared with usual care, moderate-quality evidence from 11 studies (up to 1,706 participants) indicates that self-management programmes probably provide small benefits up to 21 months, in terms of self-management skills, pain, osteoarthritis symptoms and function, although these are of doubtful clinical importance, and no improvement in positive and active engagement in life or quality of life. Withdrawal rates were similar. Low to moderate quality evidence indicates no important differences in self-management , pain, symptoms, function, quality of life or withdrawal rates between self-management programmes and information alone or other interventions (exercise, physiotherapy, social support or acupuncture). AUTHORS' CONCLUSIONS Low to moderate quality evidence indicates that self-management education programmes result in no or small benefits in people with osteoarthritis but are unlikely to cause harm.Compared with attention control, these programmes probably do not improve self-management skills, pain, osteoarthritis symptoms, function or quality of life, and have unknown effects on positive and active engagement in life. Compared with usual care, they may slightly improve self-management skills, pain, function and symptoms, although these benefits are of unlikely clinical importance.Further studies investigating the effects of self-management education programmes, as delivered in the trials in this review, are unlikely to change our conclusions substantially, as confounding from biases across studies would have likely favoured self-management. However, trials assessing other models of self-management education programme delivery may be warranted. These should adequately describe the intervention they deliver and consider the expanded PROGRESS-Plus framework and health literacy, to explore issues of health equity for recipients.
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Affiliation(s)
- Féline PB Kroon
- Leiden University Medical CenterDepartment of RheumatologyLeidenNetherlands
| | | | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Richard H Osborne
- Deakin UniversityDirector, Public Health Innovation, Deakin221 Burwood HighwayBurwoodVictoriaAustralia3125
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Veronica Pitt
- National Trauma Research Institute, The Alfred Hospital, Monash UniversityLevel 4, 89 Commercial RoadMelbourneVictoriaAustralia3004
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Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing, outcomes from a randomized-controlled trial. Clin J Pain 2013; 29:296-304. [PMID: 23042474 DOI: 10.1097/ajp.0b013e318254ac76] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. METHODS A total of 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire (FIQ)-Physical Impairment score, assessed at pretreatment, posttreatment, and 3-month and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. RESULTS There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, P=0.06). Compared with EC participants, MI participants also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 m, P=0.03). In addition, MI was superior to EC in increasing the number of hours of physical activity immediately postintervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. CONCLUSIONS Despite a lack of benefits on long-term outcome, MI seems to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim.
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Rat AC. Efficacité de l’éducation thérapeutique du patient dans les rhumatismes inflammatoires : quelles preuves ? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.monrhu.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wertli MM, Schöb M, Brunner F, Steurer J. Incomplete reporting of baseline characteristics in clinical trials: an analysis of randomized controlled trials and systematic reviews involving patients with chronic low back pain. PLoS One 2013; 8:e58512. [PMID: 23505524 PMCID: PMC3591326 DOI: 10.1371/journal.pone.0058512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/05/2013] [Indexed: 12/19/2022] Open
Abstract
Objective The aim of this study was to evaluate the reporting of relevant prognostic information in a sample of randomized controlled trials (RCTs) that investigated treatments for patients with chronic low back pain (LBP). We also analysed how researchers conducting the meta-analyses and systematic reviews addressed the reporting of relevant prognostic information in RCTs. Methods We searched the Cochrane Database to identify systematic reviews that investigated non-surgical treatments for patients with chronic LBP. The reported prognostic information was then extracted from the RCTs included in the reviews. We used a purpose-defined score to assess the quantity of information reported in the RCTs. We also determined how the authors of systematic reviews addressed the question of comparability of patient populations between RCTs. Results Six systematic reviews met our inclusion criteria, and we analysed 84 RCTs. Based on the scores, the reporting of important prognostic variables was incomplete in almost half of the 84 RCTs. Information regarding patients’ general health, social support, and work-related conditions was rarely reported. Almost half of the studies included in one of the meta-analyses provided insufficient information that did not allow us to determine whether patients in the primary trials were comparable. Conclusions Missing prognostic information potentially threatens the external validity (i.e. the generalizability or applicability) not only of primary studies but also of systematic reviews that investigate treatments for LBP. A detailed description of baseline patient characteristics that includes prognostic information is needed in all RCTs to ensure that clinicians can determine the applicability of the study or review results to their patients.
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Affiliation(s)
- Maria M Wertli
- Horten Center for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Zurich, Switzerland.
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The role of social reinforcement in the maintenance of short-term effects after a self-management intervention for frail housebound seniors with arthritis. Can J Aging 2012; 31:195-207. [PMID: 22571836 DOI: 10.1017/s0714980812000025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Following the program I'm Taking Charge of My Arthritis!, study participants reported fewer functional limitations, less helplessness, and better coping effectiveness than did controls. This study examined the maintenance of these effects and the role of social reinforcement in maintaining benefits eight months post-intervention. The study collected information (1) at baseline (n=125); (2) two months later, before randomization (pre-intervention); (3) two months post-randomization (post-intervention 1); and (4) ten months post-randomization (post-intervention 2) (n=80). We conducted a randomized controlled trial comparing three groups: a control group, intervention group without social reinforcement, and intervention group with social reinforcement after the program. A multilevel analysis revealed that intervention participants with social reinforcement following the program continued to report significantly fewer functional limitations and greater coping effectiveness compared to intervention group participants without social reinforcement. This research provides preliminary evidence for the value of additional contact with frail housebound seniors post-intervention for maintaining the intervention benefits.
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Milesl CL, Pincusl T, Carnesl D, Homerl KE, Taylorl SJ, Bremnerl SA, Rahmanl A, Underwoodl M. Review: Can we identify how programmes aimed at promoting self‐management in musculoskeletal pain work and who benefits? A systematic review of sub‐group analysis within RCTs. Eur J Pain 2012; 15:775.e1-11. [DOI: 10.1016/j.ejpain.2011.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/04/2011] [Accepted: 01/31/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Clare L. Milesl
- Royal Holloway University of London, Department of Psychology, Egham, Surrey TW20 0EX, UK
| | - Tamar Pincusl
- Royal Holloway University of London, Department of Psychology, Egham, Surrey TW20 0EX, UK
| | - Dawn Carnesl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Kate E. Homerl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Stephanie J.C. Taylorl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Stephen A. Bremnerl
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Health Sciences, London, UK
| | - Anisur Rahmanl
- University College London, Centre for Rheumatology Research, UK
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Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol 2010; 29:1277-83. [PMID: 20721594 DOI: 10.1007/s10067-010-1547-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 06/04/2010] [Accepted: 07/25/2010] [Indexed: 11/26/2022]
Abstract
The aims of this study are to ascertain the prevalence of anxiety and depressive disorders in an outpatient population with osteoarthritis (OA), examine the interrelationships between severity of OA, pain, disability, and depression, and evaluate the Hospital Anxiety and Depression Scale (HADS) as a screening tool for this population. Patients with lower limb OA were evaluated with the Short Form McGill Pain and Present Pain Index Questionnaires, and a visual analogue scale, WOMAC Osteoarthritis Index-section C, and the HADS. Participants underwent a structured clinical interview by a liaison psychiatrist (AB). X-rays of affected joints were rated for disease severity. Fifty-four patients (42 females; mean age 63.3) were investigated. The prevalence of clinically significant anxiety and/or depression was 40.7% (95% confidence interval (CI), 27.6-55.0%). HADS was a good predictor of anxiety and depression with a sensitivity and specificity of 88% (95%CI, 64% to 99%) and 81% (95%CI, 65% to 92%), respectively. Pain correlated with HADS anxiety and depression scores (e.g. Rank correlation coefficients (Kendall's tau-b) between total HADS scores and Pain VAS scores 0.29; p=0.003). Disability was greater in patients with depression and/or anxiety (e.g. total HADS score; Kendall's rank correlation coefficient tau-b=0.26, p=0.007) OA severity as determined by radiological score was not a good predictor for anxiety nor depression and only weakly associated with disability. Anxiety and depression are very common in OA patients. HADS anxiety was a better predictor of diagnosed anxiety than HADS depression was of diagnosed depression. HADS is a valid and reliable screening instrument for detecting mood disorder, but not a diagnostic tool or a substitute for asking about symptoms of depression. The interrelationship between mental health, pain and disability is strong. We should therefore adopt a multidisciplinary approach to the management of OA.
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Affiliation(s)
- John Axford
- The Sir Joseph Hotung Centre for Musculoskeletal Disorders, Department of Cellular Molecular Medicine, St George's University of London, and Department of Adult Psychiatry, Springfield University Hospital, London, SW17 OQT, UK.
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Characteristics and development of therapeutic patient education in rheumatoid arthritis: analysis of the 2003-2008 literature. Joint Bone Spine 2010; 77:405-10. [PMID: 20381401 DOI: 10.1016/j.jbspin.2010.01.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/25/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study is to point out the recent characteristics and developments of therapeutic patient education (TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. METHOD Studies were selected from major databases, using the following keywords: rheumatoid arthritis, patient education, self-management, programs. Three authors independently reviewed each study and selected the data using the patient education research categories (PERC). Articles consistently related to patient education in rheumatoid arthritis (37 among 109) were included. RESULTS The selected articles have been published in 23 scientific journals. The majority of them concern TPE for adult patients with rheumatoid arthritis. TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team. There are two types of programs: educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers to TPE are linked to cultural and socio-economic factors. CONCLUSION A large number of studies still assess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barriers to this practice have become a major issue for research.
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Jordan JL, Holden MA, Mason EEJ, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 2010; 2010:CD005956. [PMID: 20091582 PMCID: PMC6769154 DOI: 10.1002/14651858.cd005956.pub2] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. OBJECTIVES To assess the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain. SEARCH STRATEGY We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials. SELECTION CRITERIA Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints. DATA COLLECTION AND ANALYSIS Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information. MAIN RESULTS We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials studying self-management programmes, six improved adherence measures. One trial found graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioural therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other CMP. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting. AUTHORS' CONCLUSIONS Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.
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Affiliation(s)
- Joanne L Jordan
- Keele UniversityArthritis Research Campaign National Primary Care Centre Primary Care SciencesKeeleStaffordshireUKST5 5BG
| | - Melanie A Holden
- Keele UniversityPrimary Care Sciences Research CentreKeeleStaffordshireUKST5 5BG
| | - Elizabeth EJ Mason
- Keele UniversityPrimary Care Sciences Research CentreKeeleStaffordshireUKST5 5BG
| | - Nadine E Foster
- Keele UniversityPrimary Care Sciences Research CentreKeeleStaffordshireUKST5 5BG
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Laforest S, Nour K, Parisien M, Poirier MC, Gignac M, Lankoande H. “I'm Taking Charge of My Arthritis”: Designing a Targeted Self-Management Program for Frail Seniors. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/02703180801963816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nour K, Laforest S, Gauvin L, Gignac M. Long-term maintenance of increased exercise involvement following a self-management intervention for housebound older adults with arthritis. Int J Behav Nutr Phys Act 2007; 4:22. [PMID: 17547757 PMCID: PMC1910606 DOI: 10.1186/1479-5868-4-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 06/04/2007] [Indexed: 11/10/2022] Open
Abstract
Background Sustained maintenance of health behaviors is a determinant of successful symptom reduction strategies for older adults with arthritis. This study examined whether or not short-term improvements in exercise involvement were maintained 8 months following a home-based arthritis self-management intervention as well as the moderating role of individual characteristics in the maintenance of behavior change. Methods Of the 113 housebound older adult participants at pre-intervention, 97 completed the post-intervention interview, and 80 completed the 8-month post-intervention interview. Results Some post-intervention improvements in exercise involvement were maintained 8 months later. More specifically, weekly exercise frequency, particularly regarding walking frequency, and variety of exercise activities were still significantly greater in the experimental group than in the control group 8 months following the completion of the intervention. No moderating influences were observed for any of the individual characteristics. Conclusion We conclude that gains in exercise involvement achieved through a self-management intervention can be maintained 8 months following the intervention.
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Affiliation(s)
- Kareen Nour
- Centre de recherche et d'expertise en gérontologie sociale (CREGES), CSSS Cavendish-Centre Affilié Universitaire, Montreal, Quebec, Canada
| | - Sophie Laforest
- Department of Kinesiology, University of Montreal; Associate Researcher, Groupe de recherche interdisciplinaire en santé (GRIS), University of Montreal, and Centre de recherche et d'expertise en gérontologie sociale(CREGES), CSSS Cavendish-Centre Affilié Universitaire, Montreal, Quebec, Canada
| | - Lise Gauvin
- Department of Social and Preventive Medicine, University of Montreal; Associate Researcher, Groupe de recherche interdisciplinaire en santé (GRIS), University of Montreal; Researcher, The Léa-Roback Centre on Social Inequalities of Health in Montreal, Montreal, Quebec, Canada
| | - Monique Gignac
- Health Care & Outcomes Research, University Health Network & Associate Professor, Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
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