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Ampiah PK, Hendrick P, Moffatt F, Ampiah JA. Barriers and facilitators to the delivery of a biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana. A qualitative study. Disabil Rehabil 2024:1-11. [PMID: 38963089 DOI: 10.1080/09638288.2024.2374497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study. MATERIAL AND METHODS This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study. RESULTS Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients' expectations; patients' health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists. CONCLUSION The themes that emerged from this study demonstrated many positive facilitators based on participants' improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.
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Affiliation(s)
- Paapa Kwesi Ampiah
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Paul Hendrick
- Department of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, UK
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Söderlund A, von Heideken Wågert P. Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models. J Clin Med 2021; 10:jcm10020303. [PMID: 33467552 PMCID: PMC7830780 DOI: 10.3390/jcm10020303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.
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Ampiah PK, Hendrick P, Moffatt F. Implementation of a biopsychosocial physiotherapy management approach for patients with non-specific chronic low back pain in Ghana: a study protocol for a mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
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Smith BE, Moffatt F, Hendrick P, Bateman M, Selfe J, Rathleff MS, Smith TO, Logan P. Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study. BMJ Open 2019; 9:e023805. [PMID: 31164360 PMCID: PMC6561411 DOI: 10.1136/bmjopen-2018-023805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control. DESIGN Qualitative study, embedded within a mixed-methods design, using semi-structured interviews. SETTING A UK National Health Service physiotherapy clinic in a large teaching hospital. PARTICIPANTS Purposively sampled 20 participants within a feasibility RCT study; 10 patients with a diagnosis of patellofemoral pain, aged between 18 and 40 years, and 10 physiotherapists delivering the interventions. RESULTS In respect to barriers and facilitators, the five overlapping themes that emerged from the data were: (1) locus of control; (2) belief and attitude to pain; (3) treatment expectations and preference; (4) participants' engagement with the loaded self-managed exercises and (5) physiotherapists' clinical development. Locus of control was one overarching theme that was evident throughout. Contrary to popular concerns relating to painful exercises, all participants in the intervention group reported positive engagement. Both physiotherapists and patients, in the intervention group, viewed the single exercise approach in a positive manner. Participants within the intervention group described narratives demonstrating self-efficacy, with greater internal locus of control compared with those who received usual physiotherapy, particularly in relation to physical activity. CONCLUSIONS Implementation, delivery and evaluation of the intervention in clinical settings may be challenging, but feasible with the appropriate training for physiotherapists. Participants' improvements in pain and function may have been mediated, in some part, by greater self-efficacy and locus of control. TRIAL REGISTRATION NUMBER ISRCTN35272486; Pre-results.
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Affiliation(s)
- Benjamin E Smith
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marcus Bateman
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Phillipa Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study. BMC Musculoskelet Disord 2019; 20:129. [PMID: 30917806 PMCID: PMC6438027 DOI: 10.1186/s12891-019-2516-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/17/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with PFP compared with usual physiotherapy. METHODS In a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n = 30) or usual physiotherapy (n = 30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists. RESULTS Recruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%. Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%. At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as 'recovered'. Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5 L from baseline to six months. CONCLUSION The results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT. TRIAL REGISTRATION ISRCTN 35272486 . Registered 19th December 2016.
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Affiliation(s)
- Benjamin E. Smith
- Physiotherapy Department (Level 3) London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Physiotherapy Department (Level 3) London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O. Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Munce SEP, Jaglal S, Kastner M, Nelson MLA, Salbach NM, Shepherd J, Sweet SN, Wilcock R, Thoms C, Bayley MT. Ontario Brain Injury Association Peer Support Program: a mixed methods protocol for a pilot randomised controlled trial. BMJ Open 2019; 9:e023367. [PMID: 30904839 PMCID: PMC6475259 DOI: 10.1136/bmjopen-2018-023367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The objective of this study is to conduct a pilot randomised controlled trial (RCT) of the Ontario Brain Injury Association (OBIA) Peer Support Program. The RCT is designed to evaluate the effectiveness and dose-response of the Peer Support Program in improving participation and mood for people with moderate-to-severe traumatic brain injury compared with a wait-list control group. METHODS AND ANALYSIS The proposed research is a three-phase, mixed methods pilot RCT. Consistent with an integrated knowledge translation approach, the study design has been informed in consultation with the knowledge user (ie, OBIA). It will include an initial qualitative examination of barriers and enablers to the trial implementation (phase 1), a pilot RCT (phase 2) and conclude with a qualitative component (phase 3). A qualitative descriptive approach will be adopted for both qualitative phases of the study (n=20-25) and thematic analysis will be used. The 6 months phase-2 trial will be conducted with 60 participants. These participants will be randomised to one of three groups: a twice a week programme (n=20), a once a week programme (n=20) or the wait-list control group (n=20). The feasibility of participant recruitment and retention, data collection, as well as participant adherence to the OBIA Peer Support Program will be evaluated. The primary outcome measure will be participation, as measured by the Participation Assessment with Recombined Tools-Objective. Other proposed outcomes of interest will include mood, health-related quality of life and self-efficacy. ETHICS AND DISSEMINATION Ethics approval will be obtained from the principal author's institution (University Health Network Research Ethics Board). The results of this study will inform the development of a larger scale RCT and will inform future iterations of the OBIA Peer Support Program including a revised programme curriculum. TRIAL REGISTRATION NUMBER NCT03450460; Pre-results.
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Affiliation(s)
- Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle L A Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Toronto, Ontario, Canada
| | - Ruth Wilcock
- Ontario Brain Injury Association, St. Catherines, Ontario, Canada
| | - Carla Thoms
- Ontario Brain Injury Association, St. Catherines, Ontario, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sinclair J, Janssen J, Richards JD, Butters B, Taylor PJ, Hobbs SJ. Effects of a 4-week intervention using semi-custom insoles on perceived pain and patellofemoral loading in targeted subgroups of recreational runners with patellofemoral pain. Phys Ther Sport 2018; 34:21-27. [DOI: 10.1016/j.ptsp.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023]
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Kay MC, Kucera KL. Mixed Methods Designs for Sports Medicine Research. Clin Sports Med 2018; 37:401-412. [PMID: 29903382 DOI: 10.1016/j.csm.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Mixed methods research is a relatively new approach in the field of sports medicine, where the benefits of qualitative and quantitative research are combined while offsetting the other's flaws. Despite its known and successful use in other populations, it has been used minimally in sports medicine, including studies of the clinician perspective, concussion, and patient outcomes. Therefore, there is a need for this approach to be applied in other topic areas not easily addressed by one type of research approach in isolation, such as the retirement from sport, effects of and return from injury, and catastrophic injury.
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Affiliation(s)
- Melissa C Kay
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB #8700, Chapel Hill, NC 27599, USA.
| | - Kristen L Kucera
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB #8700, Chapel Hill, NC 27599, USA
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Smith BE, Moffatt F, Hendrick P, Bateman M, Rathleff MS, Selfe J, Smith TO, Logan P. The experience of living with patellofemoral pain-loss, confusion and fear-avoidance: a UK qualitative study. BMJ Open 2018; 8:e018624. [PMID: 29362256 PMCID: PMC5786111 DOI: 10.1136/bmjopen-2017-018624] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the experience of living with patellofemoral pain (PFP). DESIGN Qualitative study design using semistructured interviews and analysed thematically using the guidelines set out by Braun and Clarke. SETTING A National Health Service physiotherapy clinic within a large UK teaching hospital. PARTICIPANTS A convenience sample of 10 participants, aged between 18 and 40 years, with a diagnosis of PFP and on a physiotherapy waiting list, prior to starting physiotherapy. RESULTS Participants offered rich and detailed accounts of the impact and lived experience of PFP, including loss of physical and functional ability; loss of self-identity; pain-related confusion and difficulty making sense of their pain; pain-related fear, including fear-avoidance and 'damage' beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. CONCLUSIONS These findings offer an insight into the lived experience of individuals with PFP. Previous literature has focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest that future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain-related fear for people with PFP. The current consensus that best-evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, 'weakness' and 'patellar mal-tracking' and its impact and interpretation by patients. TRIAL REGISTRATION NUMBER ISRCTN35272486; Pre-results.
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Affiliation(s)
- Benjamin E Smith
- Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals, Nottingham, UK
| | - Marcus Bateman
- Physiotherapy Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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