Living with osteoarthritis: a systematic review and meta-ethnography

People with painful knee osteoarthritis hold negative implicit attitudes towards activity

ABSTRACT

Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat-activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between "danger" and "activity" was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI -0.03 to 0.24) but was significantly greater in the KOA group than in the pain free ( P < 0.001) and non-KOA lower limb pain ( P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = -0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat-activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat-activity associations and real-world behaviour, including physical activity levels, is warranted.

Perioperative experiences of patients with high pain catastrophizing and knee arthroplasty after receiving or not preoperative physiotherapy: Qualitative study

BACKGROUND

Among the risk factors studied for persistent pain after total knee arthroplasty (TKA), pain catastrophizing stands out above the others. In this regard, preoperative interventions based on pain neuroscience education or multimodal physiotherapy have been shown to be effective in reducing pain catastrophizing.

OBJECTIVES

The present qualitative study aims to explore the perioperative experiences of high pain catastrophizing participants undergoing total knee arthroplasty surgery. Comparisons will be made between those who received, and those who did not receive a preoperative physiotherapy intervention.

METHODS

Based on the purposive sampling approach, participants from a randomized controlled trial were selected. In total, 14 persons participated in face-to-face semi-structured interviews.

RESULTS

Following a thematic analysis, the results were divided into two themes: 1) The preoperative experiences of patients with symptomatic knee arthroplasty, covering aspects related to health, functioning, cognition, and behaviour; and 2) The perioperative TKA rehabilitation process, illustrating differing experiences between individuals who received the preoperative physiotherapy interventions and those who did not.

CONCLUSIONS

While participants who received no preoperative physiotherapy intervention showed limited coping strategies during post-surgery rehabilitation and the same cognitions as before (hypervigilance, rumination, or avoidance of activities), those participants who received the preoperative physiotherapy showed abilities to cope with their pain, felt empowered and were involved in their rehabilitation.

Patients' experiences following total knee arthroplasty: a qualitative evidence synthesis

PURPOSE

Total knee arthroplasty (TKA) is a common surgical intervention for patients with advanced arthritis. The aim of this qualitative evidence synthesis was to systematically review the qualitative literature on patients' experiences following primary TKA.

MATERIALS AND METHODS

Four electronic databases (PubMed, CINAHL, Cochrane and Embase) were searched from inception until October 2021. Pairs of reviewers independently screened search results for eligibility, analysed the quality of included studies and extracted data. We undertook a thematic synthesis and used an interpretive approach to identify recurring themes and draw a conclusion. Data were synthesised using thematic analysis and an interpretive approach was used to identify themes.

RESULTS

Twenty-three studies exploring patients' experiences following TKA were included. Five main themes emerged: (i) Experience of healthcare staff, (ii) Pain/Medications, (iii) Was it worth it? (iv) Social Support (v) Follow up.

CONCLUSIONS

This review highlights the variability in patients' experiences following TKA. Whether this experience detailed their pain, function, or encounter with healthcare staff or systems, patients reported a variety of both positive and negative sentiments. Each theme invites attention to an area in which healthcare can improve to enhance patients' experiences. The importance of patient support, individualised rehabilitation and appropriate follow-up are highlighted.

Experiences of living with hip osteoarthritis and of receiving advice, education and ultrasound-guided intra-articular hip injection in the hip injection trial. A qualitative study

OBJECTIVES

The Hip Injection Trial (HIT) compared the effectiveness of adding a single ultrasound-guided intra-articular injection of either corticosteroid and local anaesthetic or local anaesthetic alone to advice and education among people with hip osteoarthritis (OA). This nested qualitative study explored participants' experiences of living with hip OA and of the trial treatment they received.

METHOD

Semi-structured telephone interviews were undertaken with a purposeful sample of trial participants after a 2-month trial follow-up. Interviewers were blinded to which injection participants had received. Thematic analysis using constant comparison was undertaken prior to knowing the trial results.

RESULTS

34 trial participants were interviewed across all arms. OA causes pain, physical limitations, difficulties at work, lowered mood, and disrupted sleep. Those who received advice and education alone felt that they had not received 'treatment' and described little/no benefit. Participants in both injection groups described marked improvements in pain, physical function, and other aspects of life (e.g., sleep, confidence). The perceived magnitude of benefit appeared greater among those who received the corticosteroid injection; however, the length of benefit varied in both injection groups. There was uncertainty about the longer-term benefits of injection and repeated injections.

CONCLUSION

Hip OA is highly burdensome. Participants perceived little/no benefit from advice and education alone but reported marked improvements when combined with either injection. However, the magnitude of benefit was greater among those who received corticosteroid. The varying duration of response to injection and uncertainty regarding longer-term benefits of injection and repeated injections suggests that these areas are important for future research.

TRIAL REGISTRATION

EudraCT 2014-003412-37; ISRCTN50550256.

Feasibility of pain informed movement program for people with knee osteoarthritis

Objective

To establish the feasibility of an intervention consisting of neuromuscular exercise, mind-body techniques, and pain neuroscience education (PNE), referred to as Pain Informed Movement in people with knee Osteoarthritis (KOA). This program has the potential to improve our understanding of intrinsic pain modulation and its role in the management of chronic pain.

Methods

This was a single-arm feasibility trial with a nested qualitative component. Primary outcome: complete follow-up. Inclusion criteria: age ≥40 years, KOA clinical diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10. The program consisted of 8-week in-person and at-home exercise sessions. PNE and mind-body techniques were provided as videos and integrated into the exercise sessions. Participants completed questionnaires and physical assessments including blood draws at baseline and program completion. Secondary feasibility outcomes: acceptability of the intervention, burden, rates of recruitment, compliance and adherence, and adverse events. A priori success criteria were identified. Participants were invited to an online focus group.

Results

19 participants were enrolled, with a complete follow-up rate of 74% (mean age 63.3 years (SD 10.5), 73% female), indicating modifications were necessary to proceed. All other success criteria were met. The focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations.

Conclusion

The Pain Informed Movement program is deemed feasible, with minor modifications needed to proceed. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of Pain Informed Movement compared to conventional neuromuscular exercise and standard OA education.

Bringing the Walk with Ease Programme to the UK: a mixed-methods study to assess the relevance, acceptability, and feasibility of implementation for people with arthritis and musculoskeletal conditions

Developed in the United States (US), Walk With Ease (WWE) is a popular evidence-based, 6-week community walking programme for adults with arthritis, delivered in either an instructor-led or self-directed format. While WWE has expanded into communities across the USA, it is relatively unknown in other countries across the globe. This study, in collaboration with community and patient partners, aimed to examine the relevance, acceptability and feasibility of introducing WWE into a UK context. After initial cultural adaptation, participants were recruited into the study. Eligible (≥18 years, doctor diagnosed arthritis (confirmed or self-report), self-reported joint symptoms in last 30 days, BMI ≥25 kg/m2, and <150 min/week of moderate/vigorous PA) and consented participants were randomized into two groups: WWE programme or usual care. A mixed-methods analysis approach integrated quantitative data (physical performance assessment; baseline and post-six week programme questionnaire) and qualitative data (narrative interviews exploring participants' pre- and post-WWE experiences and stakeholders' perceptions). Of 149 participants, the majority were women (70%) aged ≥60 years (76%). Among the 97 receiving the programme, 52 chose instructor-led; 45 chose self-directed. Participants found WWE relevant and acceptable-99% indicating they would recommend WWE to family/friends. Within both WWE formats, mixed differences representing improvement were observed at 6 weeks from baseline for physical performance and arthritis symptoms. Emergent themes included improved motivation, health, and social well-being. WWE is a relevant and acceptable walking programme with scope for wider implementation to support UK health and well-being policy strategies.

Adaptation and validation of the chronic illness-related shame scale among patients with knee osteoarthritis in Singapore

BACKGROUND

Osteoarthritis (OA) of the knee is one of the most common and disabling conditions worldwide. A neglected aspect of knee OA is its psychosocial impact, such as shame. However, assessment tools to measure shame among patients diagnosed with knee OA are lacking. In this study, the psychometric properties of the Chronic Illness-related Shame Scale (CISS) were evaluated among knee OA patients in Singapore.

METHODS

Adaptations were made to CISS for use among the knee OA population. An exploratory factor analysis (EFA) was performed to analyze the factor structure. Cronbach's Alpha and corrected item-total correlations were used to evaluate the internal consistency. Spearman correlation coefficient was used to test the correlation between CISS and Patient Health Questionnaire-4 (PHQ-4) to determine the validity of the instrument.

RESULTS

The EFA yielded a one-factor structure, with an eigenvalue of 4.78 explaining 68.25% of variance. Cronbach Alpha was 0.92, which indicated good internal consistency. The Spearman correlation revealed a significant correlation between CISS and PHQ-4.

CONCLUSIONS

The adapted CISS is a valid and reliable instrument to measure shame for knee OA patients. Both research and clinical settings can benefit from the use of the adapted CISS for assessing shame among knee OA patients.

Health-Seeking Behaviors and Misconceptions about Osteoarthritis in Patients and the General Population in Saudi Arabia

Osteoarthritis (OA) is a public health disease that causes decreased mobility and leads to poor quality of life. A person's health-seeking behavior can influence their understanding of a disease, which in turn can alter its course. The objectives of this study were to measure the misconceptions about osteoarthritis and to identify the associated health-seeking behaviors. An online, self-administered, questionnaire-based study was conducted with 872 Arabic-speaking participants divided into three strata, group 1 comprising of patients with OA, group 2 participants with joint pain (without OA) and group 3 comprised of general population. Multivariate logistic regression analysis found that seeking care from general practitioners [3.29 (1.19, 9.16)], taking advice from friends [2.83 (1.08, 7.42)], seeking care from chiropractors [3.67 (1.02, 13.60)] and podiatrist [4.64 (1.31, 16.51)] were significantly associated with misconceptions, whereas, the odds were lower for those using social media [0.16 (0.06, 0.46)] and expert websites [0.63 (0.40, 0.99)]. The findings of this study imply that the level of misconceptions is high amongst all three strata.. Expert websites and social media have a positive effect on the management of osteoarthritis. However, general practitioners and allied health workers should regularly update their knowledge using refresher courses.

A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis

Objective

Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement.

Methods

We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 ​123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world.

Results

We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making.

Conclusions

Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.

Demonstrating the effectiveness of Platelet Rich Plasma and Prolotherapy treatments in knee osteoarthritis

BACKGROUND

Platelet-rich plasma(PRP) and prolotherapy(PRL) are regenerative treatment approaches in the knee osteoarthritis (KOA).

AIM

To see how efficient PRP and PRL are in treating KOA.

METHODS

A total of 108 patients with a diagnosis of KOA who received either PRL, PRP, or exercise therapy and whose 3-month follow-up data were available were included in this retrospective study (PRL n = 35 or PRP n = 35, exercise n = 38). Visual Analogue Scale(VAS) and The Western Ontario McMaster University Osteoarthritis Index(WOMAC) were used as outcome measures at baseline, 1 month, and 3 months.

RESULTS

There were no statistically significant differences between the three groups in terms of demographic parameters, baseline assessments of pain intensity, or WOMAC scores. At the first and third months, all groups showed a substantial improvement in the VAS activity, resting and WOMAC values as compared to before treatment(p < 0.05). When the groups were compared, the VAS activity, resting, and WOMAC values in PRP and PRL improved significantly in the first and third months compared to the exercise group. At one month, there was a statistically significant improvement in VAS activity and WOMAC pain and total scores compared to PRP and PRL, but this improvement was not significant at 3 months.

CONCLUSION

Pain and disability were significantly improved with PRL and PRP compared with exercise therapy. Although PRP is more effective than PRL in the first month after treatment, PRL may be preferred due to its low cost, long-term efficacy, and low complication rates due to the periarticular application.

Patients' perspectives on the benefits of feedback on patient-reported outcome measures in a web-based personalized decision report for hip and knee osteoarthritis

BACKGROUND

Applications of patient-reported outcome measures (PROMs) for individual patient management are expanding with the support of digital tools. Providing PROM-based information to patients can potentially improve care experiences and outcomes through informing and activating patients. This study explored patients' perspectives on the benefits of receiving feedback on PROMs in the context of a web-based personalized decision report to guide care for their hip or knee osteoarthritis.

METHODS

This qualitative descriptive interview study was nested in a pragmatic clinical trial of a personalized report, which includes descriptive PROM scores and predicted postoperative PROM scores. Patients completed a semi-structured interview within 6 weeks of an office visit with an orthopaedic surgeon. Only patients who reported receiving the report and reviewing it with the surgeon and/or a health educator were included. Data were iteratively analyzed using a combination of deductive and inductive coding strategies.

RESULTS

Twenty-five patients aged 49-82 years (60% female, 72% surgical treatment decision) participated and described three primary benefits of the PROM feedback within the report: 1. Gaining Information About My Health Status, including data teaching new information, confirming what was known, or providing a frame of reference; 2. Fostering Communication Between Patient and Surgeon, encompassing use of the data to set expectations, ask and answer questions, and facilitate shared understanding; and 3. Increasing My Confidence and Trust, relating to the treatment outcomes, treatment decision, and surgeon.

CONCLUSIONS

Patients identified actual and hypothetical benefits of receiving feedback on PROM scores in the context of a web-based decision report, including advantages for those who had already made a treatment decision before seeing the surgeon. Findings provide insight into patients' perspectives on how digital PROM data can promote patient-centered care. Results should be considered in the context of the homogeneous sample and complex trial. While participants perceived value in this personalized report, questions remain regarding best practices in patient-facing data presentation and engagement.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03102580. Registered on 5 April 2017.

Perceptions and Experiences of Individuals With Neck Pain: A Systematic Critical Review of Qualitative Studies With Meta-Summary and Meta-Synthesis

OBJECTIVE

This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies.

METHODS

A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool.

RESULTS

Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical ("My neck has gone wrong"); psychological ("I am worried about my recovery"); and social ("Pain limits my life"). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively).

CONCLUSION

An individual's experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual's experiences to offer a truly patient-centered care pathway.

IMPACT

This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.

A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain

ABSTRACT

Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial

BACKGROUND

Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA.

OBJECTIVE

To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE).

STUDY DESIGN

A prospective, assessor-blinded, and block-randomized controlled trial.

METHODS

Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health.

RESULTS

At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included.

CONCLUSIONS

BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.

How do middle-aged and older adults with chronic hip pain view their health problem and its care? A protocol for a systematic review and qualitative evidence synthesis

INTRODUCTION

Chronic hip pain in middle-aged and older adults is common and disabling. Patient-centred care of chronic hip pain requires a comprehensive understanding of how people with chronic hip pain view their health problem and its care. This paper outlines a protocol to synthesise qualitative evidence of middle-aged and older adults' views, beliefs, expectations and preferences about their chronic hip pain and its care.

METHODS AND ANALYSIS

We will perform a qualitative evidence synthesis using a framework approach. We will conduct this study in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. We will search MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE and PsycINFO using a comprehensive search strategy. A priori selection criteria include qualitative studies involving samples with a mean age over 45 and where 80% or more have chronic hip pain. Two or more reviewers will independently screen studies for eligibility, assess methodological strengths and limitations using the Critical Appraisal Skills Programme qualitative studies checklist, perform data extraction and synthesis and determine ratings of confidence in each review finding using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Data extraction and synthesis will be guided by the Common-Sense Model of Self-Regulation. All authors will contribute to interpreting, refining and finalising review findings. This protocol is registered on PROSPERO and reported according to the PRISMA Statement for Protocols (PRISMA-P) checklist.

ETHICS AND DISSEMINATION

Ethics approval is not required for this systematic review as primary data will not be collected. The findings of the review will be disseminated through publication in an academic journal and scientific conferences.

PROSPERO REGISTRATION NUMBER

PROSPERO registration number: CRD42021246305.

Peer mentorship to improve self-management of hip and knee osteoarthritis: a randomised feasibility trial

OBJECTIVE

To determine the feasibility of conducting a randomised controlled trial (RCT) of a peer mentorship intervention to improve self-management of osteoarthritis (OA).

DESIGN

Six-month parallel group non-blinded randomised feasibility trial.

SETTING

One secondary care and one primary care UK National Health Service Trust.

PARTICIPANTS

Fifty adults aged ≥55 years old with hip and/or knee OA.

INTERVENTIONS

Participants were allocated 1:1 to the intervention or control group using an online randomisation service. Intervention group participants received usual care (information resources) and up to eight community-based self-management support sessions delivered by a peer mentor (trained volunteer with hip and/or knee OA). Control group participants received usual care only.

OUTCOME MEASURES

Key feasibility outcomes were participant and peer mentor recruitment and attrition, intervention completion and the sample size required for a definitive RCT. Based on these feasibility outcomes, four success criteria for proceeding to a definitive RCT were prespecified. Patient-reported outcomes were collected via questionnaires at baseline, 8 weeks and 6 months.

RESULTS

Ninety-six individuals were screened, 65 were eligible and 50 were randomised (25 per group). Of the 24 participants who commenced the intervention, 20 completed it. Four participants did not complete the 6-month questionnaire. Twenty-one individuals were eligible for the peer mentor role, 15 were trained and 5 withdrew prior to being matched with a participant. No intervention-related harms occurred. Allowing for 20% attrition, the sample size required for a definitive RCT was calculated as 170 participants. The intervention group showed improvements in self-management compared with the control group.

CONCLUSIONS

The feasibility outcomes achieved the prespecified criteria for proceeding to an RCT. The exploratory analyses suggest peer mentorship may improve OA self-management. An RCT of the OA peer mentorship intervention is therefore warranted with minor modifications to the intervention and trial procedures.

TRIAL REGISTRATION NUMBER

ISRCTN:50675542.

Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience

OBJECTIVE

The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments.

METHODS

A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme appraisal tool.

RESULTS

Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact ("It has been a big upheaval"); (2) developing an understanding ("Why is it hurting so much?"); and (3) exercise ("Am I going to go through a lot of pain in moving it…?"). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a "permanent" solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations.

CONCLUSION

These findings deepen our understanding of the impact of shoulder pain on peoples' lives and provide novel insight into the experience of treatment. Enhanced awareness of people's experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation.

IMPACT

To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms.

LAY SUMMARY

Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People's understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.

Approaches to osteoarthritis - A qualitative study among patients in a rural setting in Central Western India

BACKGROUND

Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world.

OBJECTIVE

The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India.

DESIGN AND METHOD

Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India.

RESULTS

Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients' approaches to OA. The categories were further elaborated on in seven subcategories.

CONCLUSION

Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists' implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients.

Experiences of sexual health in persons with hip and knee osteoarthritis: a qualitative study

Background

Osteoarthritis (OA) is the world’s most common form of arthritis and a common cause of musculoskeletal pain and disability. Persons living with chronic diseases often have affected sexual health because of pain and limited function. Osteoarthritis is a chronic disease but there is scarce knowledge about how sexual health is experienced. The aim of this study was to explore the experience of sexual health in persons who have seen a physiotherapist for their hip and/or knee OA.

Methods

This study has a qualitative design. Participants were recruited from the Swedish Quality Register Better Management of Patients with Osteoarthritis (BOA). To reach a variety of experiences and strengthen credibility, a purposeful sampling strategy based on age, sex and hip and knee OA was used. Semi-structured telephone interviews were held with 20 persons with hip and/or knee OA. Data were analysed with qualitative content analysis and inductive category development was applied.

Results

The analysis resulted in two main categories. The first category, Individual differences in how sexual health is affected by hip and knee OA, comprises of two sub categories: Pain limits sexual health; and Strategies for sexual health in the relationship. The second main category, Varying needs for communication about sexual health, is supported by the sub categories: Physiotherapists do not ask about sexual health; and Relevance of communicating about sexual health.

Conclusions

Painful hip and knee OA limit sexual health to varying degrees, and individuals make adjustments or develop strategies to maintain sexual life. Sexual health is not talked about during consultations with physiotherapists or other health care professionals, indicating that patients with OA may have unmet needs regarding their sexual health. Further research is needed on how to provide support and information about sexual health in OA.

Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography

Background

People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain.

Methods

A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results

From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad.

Conclusion

The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.

Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis

OBJECTIVE

Hip osteoarthritis may cause compensational movement strategies that require extra physical and mental effort. Such aberrant functioning can be captured in movement quality evaluation. The objective of this study was to explore whether movement quality, evaluated as a multiperspective phenomenon, is reflected in commonly used and recommended functional measures in this group of patients.

METHODS

A cross-sectional study design was used. Baseline included 80 female and 21 male participants with hip osteoarthritis. Movement quality was evaluated by the Body Awareness Rating Scale-Movement Quality and Experience (BARS-MQE), part one, including 12 movement items. Correlation analyses (Pearson and Spearman) were performed to explore associations between BARS-MQE (sum score and single item scores), and scores on measures of physical capacity (Chair test, Stairs test, 6 minutes walking test; 6MWT), self-reported activity level (UCLA), function (HOOS subscales), pain during walking (NRS), self-efficacy (ASES) and health (EQ-5D-5L). Based on previous evidence, we hypothesized moderate associations between BARS-MQE and these measures.

RESULTS

BARS-MQE's sum score showed moderate associations with Stairs test, 6MWT and UCLA (r = -0.425 to 0.304) and weak associations (r = 0.29 to 0.12) with ASES Pain and Symptoms, HOOS ADL, Chair test, NRS, HOOS Pain and Sports, and EQ-5D-5L. No association was found between BARS-MQE and HOOS Symptoms and Quality of life. Movement quality in item 12, walking, demonstrated moderate or weak association with all included measures.

CONCLUSION

In this study of participants diagnosed with hip osteoarthritis, movement quality evaluated by BARS-MQE was moderately reflected in measures of physical capacity and activity, but weakly reflected in self-reported measures of health problems. With its particular dynamic procedure and inclusion of the whole moving person, movement quality evaluation by the BARS-MQE was shown to provide supplementary information on functioning, scarcely captured by the commonly used and recommended measures.

Knowledge of Knee Osteoarthritis and Its Impact on Health in the Middle East: Are They Different to Countries in the Developed World? A Qualitative Study

Knowledge of knee osteoarthritis (OA) and its management options affects adherence to treatment, symptoms, and function. Many sociocultural differences exist between Jordan, as a representative of the Middle East, and the developed world which might influence the knowledge of the pathology and its impact on health. Objectives. To explore the knowledge of the pathology and the experience of people diagnosed with knee OA living in Jordan. Methods. Qualitative study design using a triangulation method of both focus groups and in-depth semistructured interviews. Fourteen participants were included (13 females and one male). One focus group and seven in-depth semistructured interviews were conducted. Discussions were audiotaped and transcribed. Framework analysis was used, and data were mapped to the International Classification of Functioning, Disability and Health framework. Results. The themes are as follows: (1) body functions and structures included two subthemes: physical changes and psychological impact; (2) activity limitation and participation restriction included three subthemes: factors influencing the activities, cultural and social perspectives to activity limitation, and participation restriction; (3) personal factors included three subthemes: knowledge and personal interpretation of disease process, knowledge of management options to relief symptoms, and influence of personal factors on activity and participation; and (4) environmental factors included three subthemes: service delivery process, ineffective communication across the care pathway, and facilitators and barriers. Conclusions. Knowledge of the disease was lacking as a consequence of inappropriate service delivery and culture. Activity limitations and participation restrictions are similar in Jordan to other cultures in addition to limitations in religious, employment, and transportation activities. The results demonstrate that the effect of knee OA varies among different cultures and highlight the role of healthcare professionals worldwide in understanding the impact of culture on health. They also increase the awareness of healthcare professionals, specifically in Jordan, on the limitations in delivered services and the importance of education.

Influence of knee osteoarthritis on functional performance, quality of life and pain in older women

Abstract Introduction: Knee osteoarthritis (KOA) is a common degenerative disease in older people, causing pain, stiffness and dysfunction. Objective: To determine the influence of KOA on functional performance (FP), quality of life (QoL) and pain in older women. Method: This is a cross-sectional study, in which 50 older women diagnosed with KOA and 51 without KOA participated. Participants were assessed using FP tests: Sit-to-stand (STS); Gait speed test (GST); Timed Up and Go (TUG); 6-minute walk test (6 MWT) and the Berg Balance Scale (BBS). Pain was assessed by the visual analog scale (VAS); quality of life by applying the SF-36; and self-perception of the disease by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: No intergroup statistical differences were found in the BBS (p: 0.42), STS (p: 0.59) and 6MWT (p: 0.97). However, the KOA group showed slower GS (p < 0.00) and longer time in TUG (p < 0.00). They also presented higher pain levels (p < 0.01), worse perceived health status regarding pain, stiffness and physical function (WOMAC) (p < 0.01), as well as worse QoL indices in functional capacity, physical limitations, pain and overall health status (p < 0.010). Conclusion: The results of the study demonstrate that older women with KOA showed a decline in FP, QoL and higher pain levels.

Partial or total knee replacement? Identifying patients' information needs on knee replacement surgery: a qualitative study to inform a decision aid

Purpose

For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid.

Methods

Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis.

Results

Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery.

Conclusions

Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended.

Electronic supplementary material

The online version of this article (10.1007/s11136-019-02381-9) contains supplementary material, which is available to authorized users.

Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study

BACKGROUND

The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients.

METHODS

A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL.

RESULTS

The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (β = .10, p = .01) and patient factors (β = .29, p = .00 for self-management and β = -.49, p = .00 for disease factors). Access to health services was determined by self-management (β = .10, p = .01), but it was not significantly associated with QoL (β = .00, p = 1.0).

CONCLUSIONS

This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.

Experience of living with knee osteoarthritis: a systematic review of qualitative studies

OBJECTIVES

Systematically review the qualitative literature on living with knee osteoarthritis from patient and carer perspectives.

DESIGN

Systematic review of qualitative studies. Five electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, SPORTDiscus) were searched from inception until October 2018. Data were synthesised using thematic and content analysis.

PARTICIPANTS

Studies exploring the experiences of people living with knee osteoarthritis, and their carers were included. Studies exploring experiences of patients having participated in specific interventions, including surgery, or their attitudes about the decision to proceed to knee replacement were excluded.

RESULTS

Twenty-six articles reporting data from 21 studies about the patient (n=665) and carer (n=28) experience of living with knee osteoarthritis were included. Seven themes emerged: (i) Perceived causes of knee osteoarthritis are multifactorial and lead to structural damage to the knee and deterioration over time (n=13 studies), (ii) Pain and how to manage it predominates the lived experience (n=19 studies), (iii) Knee osteoarthritis impacts activity and participation (n=16 studies), (iv) Knee osteoarthritis has a social impact (n=10 studies), (v) Knee osteoarthritis has an emotional impact (n=13 studies), (vi) Interactions with health professionals can be positive or negative (n=11 studies), (vii) Knee osteoarthritis leads to life adjustments (n=14 studies). A single study reporting the perspectives of carers reported similar themes. Psychosocial impact of knee osteoarthritis emerged as a key factor in the lived experience of people with knee osteoarthritis.

CONCLUSIONS

This review highlights the value of considering patient attitudes and experiences including psychosocial factors when planning and implementing management options for people with knee osteoarthritis. Trial registrationnumber CRD42018108962.

Care-seeking pathways, care challenges, and coping experiences of rural women living with rheumatoid arthritis in Odisha, India

AIM

The aim of the study was to explore the care-seeking pathway of rural women living with rheumatoid arthritis (RA) and attending a tertiary health-care facility in Odisha, India.

BACKGROUND

RA is the third leading chronic health condition and causes severe pain and immense psychosocial stress. The prevalence of RA is three to four times higher in women than in men. Furthermore, in India, women delay care seeking due to the prevailing sociocultural norms. Women report more severe symptoms and greater disability; however, there is a lack of information on their care-seeking pathways.

METHOD

We conducted 113 in-depth interviews among RA patients those who visited specialists at the outpatients' Department of Rheumatology, SCB Medical College Hospital, a tertiary care hospital in Cuttack, Odisha, India. The grounded theory approaches were used for data analysis.

FINDINGS

The key findings included physical pain and psychosocial stress in relation to RA, cultural issues in relation to RA, mapping of the health-care providers for RA, the first point of cares and changes in care-seeking pathways, the perceived challenge for seeking health-care, and coping strategies of patients and social supports. This study explored that the RA patients seek care from multiple providers - untrained, trained and specialist without any gatekeeping. However, the primary health centers were the first point of care for maximum patients due to accessibility and affordability. Furthermore, follow-up care is significant to prevent complication among RA patients; the primary health centers are the gateway for keeping RA patients. Hence, the availability of RA trained providers at primary health center including interprofessional care, such as physiotherapy providers, and proper referral system is essential to convalesce care-seeking pathways.

Descriptions of movement experiences in the Body Awareness Rating Scale - Movement Quality and Experience evaluation. A qualitative study of patients diagnosed with hip osteoarthritis

Background: Patients' access to movement experiences is implemented in the evaluation tool Body Awareness Rating Scale - Movement Quality and Experience, with its two intertwined parts: 1) the physiotherapist's observations of movement quality; and 2) the patient's descriptions of immediate movement experiences.Objective: To study movement experiences and reflections described by patients diagnosed with hip osteoarthritis when guided to explore simple daily-life movements in this particular evaluation context.Design: An explorative qualitative study with open-ended questions following each of the 12 movements integrated into the evaluation.Methods: 35 participants diagnosed with hip osteoarthritis were included; 28 women and 7 men, aged 23-78 years. Their descriptions were audiotaped, transcribed verbatim and analyzed in accordance with qualitative content analysis.Results: The patients described experiences of a dynamic adaptation of movement strategies based on sensations from the moving body. Two interrelated categories of movement awareness were identified: 1) Experienced movement challenges, including three sub-categories; a) Lack of contact, b) Movement changed by symptoms, and c) Compensational movement habits, and 2) Movement components promoting well-being, including three sub-categories; a) Integrating balance, breathing and awareness into movement, b) Small, simple, soft and safe movements, and c) A taste of own movement resources for daily life.Conclusions: The Body Awareness Rating Scale - Movement Quality and Experience provides a platform for patients to become aware of and describe their movement habits and resources in own words, intertwined with the physiotherapist movement observations. Derived descriptions reflect a patient perspective to be implemented in therapy.

A fragile normality - illness experiences of working-age individuals with osteoarthritis in knees or hips

Objective: Examine how individuals manage to live a life with osteoarthritis in the knee or hip.Methods: Focus group interviews were held with ten female and two male patients aged 45-65 years, who had participated in a vocational rehabilitation programme one to five years' earlier. The interviews were analysed using thematic analysis.Results: Participants' experiences are described in three themes: (1) Having "a changed and unreliable body" refers to a persistent presence of symptoms and an occasional, unpredictable flare up of symptoms involving sudden loss of movement control; (2) patients living with "(un) manageable life situations" downscale their daily activities to maintain a normal life; however, their flare-ups are unmanageable and cause significant life disruption; and (3) patients "strive to maintain an independent self" by doing their best to continue living as before without receiving any help. For the patients, continuing to participate in working life signifies an independent life that is on equal terms with others.Conclusions: The participants of this study adjusted and managed their daily activities to continue to live a normal life in accord with cultural norms. However, unpredictable flare ups and loss of control made their otherwise normal life somewhat fragile.Implications for rehabilitation•Osteoarthritis is a common disease which is often considered relatively stable, controllable and manageable.•This sample study highlights the participants uncertainty related to unpredictable variability in symptoms.•Appropriate management strategies for bad days need to be developed especially for those struggling at work.

Living life precariously with rheumatoid arthritis - a mega-ethnography of nine qualitative evidence syntheses

Background

Rheumatoid arthritis is an autoimmune disease that causes joint inflammation. It affects around 400,000 people in the UK and 1 million adults in the USA. Given the appropriate treatment, many can have relatively few symptoms. It is therefore important to understand what it is like to live with rheumatoid arthritis and gain insight into peoples’ decisions about utilising healthcare. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients’ experience of living with rheumatoid arthritis and (2) develop a conceptual understanding of what it is like to live with rheumatoid arthritis.

Methods

We used the methods of mega-ethnography. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched four bibliographic databases from inception until September 2018 to identify qualitative evidence syntheses that explored patients’ experience of rheumatoid arthritis.

Results

We identified 373 qualitative evidence syntheses, removed 179 duplicates and screened 194 full text studies. We identified 42 qualitative evidence syntheses that explored the experience of pain or arthritis and 9 of these explored the experience of rheumatoid arthritis. We abstracted ideas into 10 conceptual categories: (1) rheumatoid arthritis is in control of my body (2) rheumatoid arthritis alters reciprocity; (3) rheumatoid arthritis is an emotional challenge; (4) rheumatoid arthritis disrupts my present and future self; (5) the challenge of balancing personal and work life; (6) I am trying to make sense of what is happening; (7) rheumatoid arthritis is variable and unpredictable; (8) rheumatoid arthritis is invisible; (9) I need a positive experience of healthcare, and (10) I need to reframe the situation. We developed a conceptual model underpinned by living life precariously with rheumatoid arthritis.

Conclusions

This is the second mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Future research should consider the proliferation of qualitative evidence synthesis in order to avoid duplication of research effort. Our model for rheumatoid arthritis has some important clinical implications that might be transferable to other musculoskeletal conditions.

Electronic supplementary material

The online version of this article (10.1186/s41927-018-0049-0) contains supplementary material, which is available to authorized users.

Who seeks physiotherapy or exercise treatment for hip and knee osteoarthritis? A cross-sectional analysis of the English Longitudinal Study of Ageing

OBJECTIVES

To determine the characteristics of individuals with hip and/or knee osteoarthritis who are recommended to seek physiotherapy or exercise treatment, and to explore which people are more or less likely to follow such recommendations.

METHODS

All data were obtained from Wave 4 of the English Longitudinal Study of Ageing (ELSA) cohort (2008-2009), a prospectively collected community-based dataset. Eligibility was justified by a patient-reported diagnosis of hip and/or knee osteoarthritis with a visual analog scale (VAS) pain score of 1 or above. Data were collected from a self-completed questionnaire and nurse assessment visit. Prevalence of being recommended to physiotherapy or exercise (or not) and then the actioning of this recommendation (or not) were calculated and presented as 95% confidence intervals (CI). Data on characteristics of those recommended (or not) were explored using univariate analyses and then a forward selection logistic regression model.

RESULTS

In total, 1262 and 1877 individuals with hip and/or knee osteoarthritis pain were analyzed. This included 41% (95% CI: 0.38-0.44) who had been recommended to seek physiotherapy or exercise treatment. Subsequently, 83% of those recommended sought these treatments. Individuals who presented with isolated knee pain, those who reported "fair" self-reported general health and were younger had a greater chance of being recommended for physiotherapy or exercise treatment, respectively (P ≤ 0.02).

CONCLUSION

Encouragement should be given to formal and informal care providers of older people to highlight this inequality. This may then improve current and future access to evidence-based treatments for this population.

The effect of low-level laser therapy and physical exercise on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis: a blind randomized clinical trial

Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis (OA).Methods: Subjects with knee OA (Grades 1-3) were evaluated and randomized into four groups: Control Group (CG), untreated; Laser Group (LG), treated with laser at 808 nm, 5.6 J; Exercise Group (EG), treated with exercise; and Laser + Exercise Group (LEG), treated with laser and exercises. The treatment was carried out twice a week for 2 months. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was applied for evaluation and reevaluation; evaluation of spatiotemporal gait variables was performed using GAITRite equipment.Results: The EG showed significant improvement in pain (p = 0.006) and function (p = 0.01) according to WOMAC. Regarding gait variables, in intergroup analysis after 8 weeks all groups receiving intervention showed a significant increase in gait speed: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005). Only the group treated with laser + exercise showed a significant increase (p = 0.009) in the cadence and duration of single right limb support (p = 0.04), and only the groups treated with exercise and laser + exercise showed significant decreases in the duration of right limb support (p = 0.035 and p = 0.003, respectively), compared to the CG.Conclusions: The group treated only with exercise showed improvement in WOMAC questionnaire scores. Regarding the gait variables, all groups undergoing the interventions showed increases in the gait speed compared to the CG. The laser and exercise combination therapy provided the best results for the other gait variables (cadence and duration of right limb support and duration of single right limb support).Implications for rehabilitationThere are differences in gait patterns in patients with knee OA, including decreased gait speed, cadence, and step length.The results shown in the present study provide additional information about the physical therapy approaches that should be chosen during clinical practical to improve gait performance in individuals with knee osteoarthritis.The improvement in gait performance is a relevant issue due to the fact that is associated to physical independence and better quality of life.

Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing

Introduction

Musculoskeletal pain is a prevalent health challenge for all age groups worldwide, but most notably in older adults. Social isolation is the consequence of a decrease in social network size with a reduction in the number of social contacts. Loneliness is the psychological embodiment of social isolation and represents an individual's perception of dissatisfaction in the quality or quantity of their social contacts. This study aims to determine whether a relationship exists between musculoskeletal pain and social isolation and loneliness.

Methods

A cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA) cohort was undertaken. ELSA is a nationally representative sample of the non-institutionalised population of individuals aged 50 years and over based in England. Data were gathered on social isolation through the ELSA Social Isolation Index, loneliness through the University of California, Los Angeles (UCLA) Loneliness Scale and musculoskeletal pain. Data for covariates included physical activity, depression score, socioeconomic status, access to transport and demographic characteristics. Logistic regression analyses were undertaken to determine the relationship between social isolation and loneliness with pain and the additional covariates.

Results

A total of 9299 participants were included in the analysis. This included 4125 (44.4%) males, with a mean age of 65.8 years. There was a significant association where social isolation was lower for those in pain (odd ratio (OR): 0.87; 95% confidence intervals (CI): 0.75 to 0.99), whereas the converse occurred for loneliness where this was higher for those in pain (OR: 1.15; 95% CI: 1.01 to 1.31). Age, occupation, physical activity and depression were all associated with increased social isolation and loneliness.

Conclusion

People who experience chronic musculoskeletal pain are at greater risk of being lonely, but at less risk of being socially isolated. Health professionals should consider the wider implications of musculoskeletal pain on individuals, to reduce the risk of negative health implications associated with loneliness from impacting on individual's health and well-being.

Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review

BACKGROUND

Chronic peripheral joint pain due to osteoarthritis (OA) is extremely prevalent and a major cause of physical dysfunction and psychosocial distress. Exercise is recommended to reduce joint pain and improve physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) in this population is unknown.

OBJECTIVES

To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise.

SEARCH METHODS

Review authors searched 23 clinical, public health, psychology and social care databases and 25 other relevant resources including trials registers up to March 2016. We checked reference lists of included studies for relevant studies. We contacted key experts about unpublished studies.

SELECTION CRITERIA

To be included in the quantitative synthesis, studies had to be randomised controlled trials of land- or water-based exercise programmes compared with a control group consisting of no treatment or non-exercise intervention (such as medication, patient education) that measured either pain or function and at least one psychosocial outcome (self-efficacy, depression, anxiety, quality of life). Participants had to be aged 45 years or older, with a clinical diagnosis of OA (as defined by the study) or self-reported chronic hip or knee (or both) pain (defined as more than six months' duration).To be included in the qualitative synthesis, studies had to have reported people's opinions and experiences of exercise-based programmes (e.g. their views, understanding, experiences and beliefs about the utility of exercise in the management of chronic pain/OA).

DATA COLLECTION AND ANALYSIS

We used standard methodology recommended by Cochrane for the quantitative analysis. For the qualitative analysis, we extracted verbatim quotes from study participants and synthesised studies of patients' views using framework synthesis. We then conducted an integrative review, synthesising the quantitative and qualitative data together.

MAIN RESULTS

Twenty-one trials (2372 participants) met the inclusion criteria for quantitative synthesis. There were large variations in the exercise programme's content, mode of delivery, frequency and duration, participant's symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Comparator groups were varied and included normal care; education; and attention controls such as home visits, sham gel and wait list controls. Risk of bias was high in one and unclear risk in five studies regarding the randomisation process, high for 11 studies regarding allocation concealment, high for all 21 studies regarding blinding, and high for three studies and unclear for five studies regarding attrition. Studies did not provide information on adverse effects.There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6% (95% confidence interval (CI) -9% to -4%, (9 studies, 1058 participants), equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6% (95% CI -7.6% to 2.0%; standardised mean difference (SMD) -0.27, 95% CI -0.37 to -0.17, equivalent to reducing (improving) WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function on a 0 to 100 scale from 49.9 to 44.3) (13 studies, 1599 participants)). Self-efficacy was increased by an absolute percent of 1.66% (95% CI 1.08% to 2.20%), although evidence was low quality (SMD 0.46, 95% CI 0.34 to 0.58, equivalent to improving the ExBeliefs score on a 17 to 85 scale from 64.3 to 65.4), with small benefits for depression from moderate quality evidence indicating an absolute percent reduction of 2.4% (95% CI -0.47% to 0.5%) (SMD -0.16, 95% CI -0.29 to -0.02, equivalent to improving depression measured using HADS (Hospital Anxiety and Depression Scale) on a 0 to 21 scale from 3.5 to 3.0) but no clinically or statistically significant effect on anxiety (SMD -0.11, 95% CI -0.26 to 0.05, 2% absolute improvement, 95% CI -5% to 1% equivalent to improving HADS anxiety on a 0 to 21 scale from 5.8 to 5.4; moderate quality evidence). Five studies measured the effect of exercise on health-related quality of life using the 36-item Short Form (SF-36) with statistically significant benefits for social function, increasing it by an absolute percent of 7.9% (95% CI 4.1% to 11.6%), equivalent to increasing SF-36 social function on a 0 to 100 scale from 73.6 to 81.5, although the evidence was low quality. Evidence was downgraded due to heterogeneity of measures, limitations with blinding and lack of detail regarding interventions. For 20/21 studies, there was a high risk of bias with blinding as participants self-reported and were not blinded to their participation in an exercise intervention.Twelve studies (with 6 to 29 participants) met inclusion criteria for qualitative synthesis. Their methodological rigour and quality was generally good. From the patients' perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual's preferences, abilities and needs; challenge inappropriate health beliefs and provide better support.An integrative review, which compared the findings from quantitative trials with low risk of bias and the implications derived from the high-quality studies in the qualitative synthesis, confirmed the importance of these implications.

AUTHORS' CONCLUSIONS

Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people.

Does the person's context influence engagement in life activities following primary knee replacement? Results from a Canadian prospective cohort study

OBJECTIVE

The impact of the context of a person's life on recovery from surgical interventions is not well understood. This study evaluated if people's social, environmental and biomedical context was associated with change in frequency in engagement in life activities after total knee replacement (TKR).

METHODS

418 people aged 30+ years who had TKR were followed presurgery to 1 year postsurgery. The outcome was change in frequency in engagement in life activities measured by the Late Life Disability Index (LLDI). Predictor variables of interest evaluated in multivariable linear regression analysis were positive and negative life events (Life Experiences Survey), development of a new comorbidity, another joint replacement and complications after TKR surgery.

RESULTS

Mean age was 65 years, 36% were male; 22% and 21% had no comorbidity presurgery and postsurgery. Presurgery LLDI frequency was 69.6 (±11.4) and the mean change was 6.1 (±10.2). Thirty-four per cent and 65% reported at least one positive or negative life event. Seven per cent developed hypertension, 6% cardiovascular disease, 2% lung disease and 2% diabetes. Eleven per cent had a complication and 9% another hip or knee replaced. Smaller changes in LLDI frequency were associated with more negative life events (beta=-0.56; 95% CI -0.92 to-0.18) and complications (beta=-4.01; 95% CI -6.63 to -1.38) after adjusting for age, sex, education, body mass index, comorbidities presurgery, number of symptomatic joints and knee-specific pain and function, LLDI limitations and depression. A new comorbidity or another joint replacement was not associated with outcome in unadjusted or adjusted analysis.

CONCLUSIONS

Multifaceted life experiences shape the context of peoples' lives impacting their engagement in activities important for healthy living post-TKR.

Qualitative meta-synthesis: the experience of chronic pain across conditions

AIM

To synthesize qualitative descriptions of the experience of chronic pain across conditions.

BACKGROUND

Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches.

DESIGN

Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research (CERQual) developed by Grading of Recommendations Assessment Development and Evaluation (GRADE) working group to evaluate the strength of the evidence.

DATA SOURCES

PubMed and Ovid Medline from 2000-2015.

REVIEW METHODS

Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings.

RESULTS

Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'.

CONCLUSIONS

The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions.

Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review

OBJECTIVE

To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis.

METHODS

A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components.

RESULTS

Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively.

CONCLUSIONS

Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.

Patient information and emotional needs across the hip osteoarthritis continuum: a qualitative study

Background

Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time.

Methods

As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients’ need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach.

Results

The thematic analysis revealed a pattern of patients’ information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option.

Conclusion

Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies.

The prevalence, impact and management of musculoskeletal disorders in older people living in care homes: a systematic review

The aim was to systematically review the literature describing the prevalence, impact and current management of musculoskeletal pain in older people living in care homes. Published literature (AMED, CINAHL, EMBASE, psycINFO, MEDLINE, Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, UK National Research Register Archive) were searched on 1 March 2015. All studies assessing the prevalence, impact and management of musculoskeletal disorders in older people living in care homes were included. Literature was appraised using the CASP cohort and qualitative critical appraisal tools. Data were analysed using descriptive statistical approaches, meta-analysis and meta-ethnography techniques. Twenty-four papers reporting the results of 263,775 care home residents in 12 countries were identified. The evidence base was moderate in quality. Prevalence of musculoskeletal pain for people in care homes was 30.2 % (95 % confidence intervals 29.9-30.5 %; n = 105,463). Care home residents reported that musculoskeletal pain had a significant impact on their perceived independence and overall ability to participate in everyday activities of daily living. Three papers which presented data on interventions demonstrated that whilst multi-component assessment and management packages did not significantly change clinical outcomes, these empowered care home staff to feel more confident in managing these patients. Musculoskeletal pain is a common problem in care homes worldwide, and residents report significant impact on their lives. However, there is uncertainty regarding how to assess and manage such pain. PROSPERO Registration Number: CRD42014009824.