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van der Veer SN, Ali SM, Yu Z, McBeth J, Chiarotto A, James B, Dixon WG. Reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting. Pain Rep 2024; 9:e1131. [PMID: 38375091 PMCID: PMC10876220 DOI: 10.1097/pr9.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Many people worldwide suffer from chronic pain. Improving our knowledge on chronic pain prevalence and management requires methods to collect pain self-reports in large populations. Smartphone-based tools could aid data collection by allowing people to use their own device, but the measurement properties of such tools are largely unknown. Objectives To assess the reliability, validity, and responsiveness of a smartphone-based manikin to support pain self-reporting. Methods We recruited people with fibromyalgia, rheumatoid arthritis, and/or osteoarthritis and access to a smartphone and the internet. Data collection included the Global Pain Scale at baseline and follow-up, and 30 daily pain drawings completed on a 2-dimensional, gender-neutral manikin. After deriving participants' pain extent from their manikin drawings, we evaluated convergent and discriminative validity, test-retest reliability, and responsiveness and assessed findings against internationally agreed criteria for good measurement properties. Results We recruited 131 people; 104 were included in the full sample, submitting 2185 unique pain drawings. Manikin-derived pain extent had excellent test-retest reliability (intraclass correlation coefficient, 0.94), moderate convergent validity (ρ, 0.46), and an ability to distinguish fibromyalgia and osteoarthritis from rheumatoid arthritis (F statistics, 30.41 and 14.36, respectively; P < 0.001). Responsiveness was poor (ρ, 0.2; P, 0.06) and did not meet the respective criterion for good measurement properties. Conclusion Our findings suggest that smartphone-based manikins can be a reliable and valid method for pain self-reporting, but that further research is warranted to explore, enhance, and confirm the ability of such manikins to detect a change in pain over time.
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Affiliation(s)
- Sabine N. van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - S. Mustafa Ali
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Ziqiao Yu
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Kenning C, Bower P, Small N, Ali SM, Brown B, Dempsey K, Mackey E, McMillan B, Sanders C, Serafimova I, Van der Veer SN, Dixon WG, McBeth J. Users' views on the use of a smartwatch app to collect daily symptom data in individuals with multiple long-term conditions (Multimorbidity): A qualitative study. J Multimorb Comorb 2024; 14:26335565231220202. [PMID: 38223165 PMCID: PMC10785716 DOI: 10.1177/26335565231220202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
Introduction Long-term conditions are a major burden on health systems. One way to facilitate more research and better clinical care among patients with long-term conditions is to collect accurate data on their daily symptoms (patient-generated health data) using wearable technologies. Whilst evidence is growing for the use of wearable technologies in single conditions, there is less evidence of the utility of frequent symptom tracking in those who have more than one condition. Aims To explore patient views of the acceptability of collecting daily patient-generated health data for three months using a smartwatch app. Methods Watch Your Steps was a longitudinal study which recruited 53 patients to track over 20 symptoms per day for a 90-day period using a study app on smartwatches. Semi-structured interviews were conducted with a sub-sample of 20 participants to explore their experience of engaging with the app. Results In a population of older people with multimorbidity, patients were willing and able to engage with a patient-generated health data app on a smartwatch. It was suggested that to maintain engagement over a longer period, more 'real-time' feedback from the app should be available. Participants did not seem to consider the management of more than one condition to be a factor in either engagement or use of the app, but the presence of severe or chronic pain was at times a barrier. Conclusion This study has provided preliminary evidence that multimorbidity was not a major barrier to engagement with patient-generated health data via a smartwatch symptom tracking app.
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Affiliation(s)
- Cassandra Kenning
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nicola Small
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Benjamin Brown
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Dempsey
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Elaine Mackey
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ilina Serafimova
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sabine N Van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Healey EL, McBeth J, Nicholls E, Chew‐Graham CA, Dent S, Foster NE, Herron D, Pincus T, Hartshorne L, Hay EM, Jinks C. The acceptability and feasibility of conducting a randomised controlled trial to test the effectiveness of a walking intervention for older people with persistent musculoskeletal pain in primary care: A mixed methods evaluation of the iPOPP pilot trial. Musculoskeletal Care 2023; 21:1372-1386. [PMID: 37688496 PMCID: PMC10946998 DOI: 10.1002/msc.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established. OBJECTIVES To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant-led walking intervention for older people with persistent MSK pain (iPOPP) in primary care. METHODS A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods. RESULTS All pre-specified success criteria were achieved in terms of feasibility (recruitment, follow-up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient-centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data. CONCLUSIONS This pilot trial suggests that the iPOPP intervention and a future full-scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn.
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Affiliation(s)
| | - John McBeth
- Arthritis Research UK Centre for EpidemiologyThe University of ManchesterManchesterUK
| | - Elaine Nicholls
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Keele Clinical Trials UnitKeele UniversityKeeleStaffordshireUK
| | - Carolyn A. Chew‐Graham
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Midlands Partnership Foundation TrustStaffordStaffordshireUK
| | - Stephen Dent
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Nadine E. Foster
- School of MedicineKeele UniversityKeeleStaffordshireUK
- STARS Education and Research AllianceSurgical Treatment and Rehabilitation ServiceThe University of Queensland and Metro North HealthBrisbaneQueenslandAustralia
| | - Daniel Herron
- School of Health, Science and WellbeingStaffordshire UniversityScience Centre BuildingStoke‐on‐TrentUK
| | - Tamar Pincus
- The Faculty for Environment and Life Sciences (FELS)University of SouthamptonUniversity RoadSouthamptonUK
| | - Liz Hartshorne
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Elaine M. Hay
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Clare Jinks
- School of MedicineKeele UniversityKeeleStaffordshireUK
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Druce KL, Yimer BB, Humphreys J, Njuki LN, Bourke D, Li M, Ellis B, Zhang Y, Bravo R, Hyrich KL, Verstappen SMM, Dixon WG, McBeth J. The epidemiology of psoriatic arthritis in the UK: a health intelligence analysis of UK Primary Care Electronic Health Records 1991-2020. Rheumatology (Oxford) 2023:kead586. [PMID: 37934150 DOI: 10.1093/rheumatology/kead586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES Epidemiological estimates of psoriatic arthritis (PsA) underpin the provision of healthcare, research, and the work of government, charities and patient organizations. Methodological problems impacting prior estimates include small sample sizes, incomplete case ascertainment, and representativeness. We developed a statistical modelling strategy to provide contemporary prevalence and incidence estimates of PsA from 1991 to 2020 in the UK. METHODS Data from Clinical Practice Research Datalink (CPRD) were used to identify cases of PsA between 1st January 1991 and 31st December 2020. To optimize ascertainment, we identified cases of Definite PsA (≥1 Read code for PsA) and Probable PsA (satisfied a bespoke algorithm). Standardized annual rates were calculated using Bayesian multilevel regression with post-stratification to account for systematic differences between CPRD data and the UK population, based on age, sex, socioeconomic status and region of residence. RESULTS A total of 26293 recorded PsA cases (all definitions) were identified within the study window (77.9% Definite PsA). Between 1991 and 2020 the standardized prevalence of PsA increased twelve-fold from 0.03 to 0.37. The standardized incidence of PsA per 100,000 person years increased from 8.97 in 1991 to 15.08 in 2020, an almost 2-fold increase. Over time, rates were similar between the sexes, and across socioeconomic status. Rates were strongly associated with age, and consistently highest in Northern Ireland. CONCLUSION The prevalence and incidence of PsA recorded in primary care has increased over the last three decades. The modelling strategy presented can be used to provide contemporary prevalence estimates for musculoskeletal disease using routinely collected primary care data.
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Affiliation(s)
- Katie L Druce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Belay Birlie Yimer
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lucy N Njuki
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Darryl Bourke
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Benjamin Ellis
- Versus Arthritis, London, UK
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yuanyuan Zhang
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ramiro Bravo
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Little CL, Druce KL, Dixon WG, Schultz DM, House T, McBeth J. What do people living with chronic pain want from a pain forecast? A research prioritization study. PLoS One 2023; 18:e0292968. [PMID: 37824568 PMCID: PMC10569639 DOI: 10.1371/journal.pone.0292968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
Because people with chronic pain feel uncertain about their future pain, a pain-forecasting model could support individuals to manage their daily pain and improve their quality of life. We conducted two patient and public involvement activities to design the content of a pain-forecasting model by learning participants' priorities in the features provided by a pain forecast and understanding the perceived benefits that such forecasts would provide. The first was a focus group of 12 people living with chronic pain to inform the second activity, a survey of 148 people living with chronic pain. Respondents prioritized forecasting of pain flares (100, or 68%) and fluctuations in pain severity (94, or 64%), particularly the timing of the onset and the severity. Of those surveyed, 75% (or 111) would use a future pain forecast and 80% (or 118) perceived making plans (e.g., shopping, social) as a benefit. For people with chronic pain, the timing of the onset of pain flares, the severity of pain flares and fluctuations in pain severity were prioritized as being key features of a pain forecast, and making plans was prioritized as being a key benefit.
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Affiliation(s)
- Claire L. Little
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Katie L. Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - David M. Schultz
- Centre for Atmospheric Science, Department of Earth and Environmental Sciences, University of Manchester, Manchester, United Kingdom
- Centre for Crisis Studies and Mitigation, University of Manchester, Manchester, United Kingdom
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Eccleston C, Begley E, Birkinshaw H, Choy E, Crombez G, Fisher E, Gibby A, Gooberman-Hill R, Grieve S, Guest A, Jordan A, Lilywhite A, Macfarlane GJ, McCabe C, McBeth J, Pickering AE, Pincus T, Sallis HM, Stone S, Van der Windt D, Vitali D, Wainwright E, Wilkinson C, de C Williams AC, Zeyen A, Keogh E. The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research. Pain 2023; 164:2143-2147. [PMID: 37310436 PMCID: PMC10502876 DOI: 10.1097/j.pain.0000000000002951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Psychology, The University of Helsinki, Helsinki, Finland
| | - Emma Begley
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Hollie Birkinshaw
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ernest Choy
- Section of Rheumatology, Cardiff University, Cardiff, United Kingdom
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Anna Gibby
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Rachael Gooberman-Hill
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sharon Grieve
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Amber Guest
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amanda Lilywhite
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Gary J. Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Candida McCabe
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - John McBeth
- Division of Musculoskeletal and Dermatological Science, Faculty of Biology, Medicine, and Health, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anthony E. Pickering
- Anaesthesia, Pain, and Critical Care Research, School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Tamar Pincus
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Hannah M. Sallis
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Samantha Stone
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Danielle Van der Windt
- Centre for Primary Care Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Diego Vitali
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Colin Wilkinson
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amanda C. de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Anica Zeyen
- Department of Strategy, International Business, and Entrepreneurship, School of Business and Management, Royal Holloway University of London, London, United Kingdom
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Edmund Keogh
- Centre for Pain Research, University of Bath, Bath, United Kingdom
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Yimer BB, Lunt M, Beasley M, Macfarlane GJ, McBeth J. BayesGmed: An R-package for Bayesian causal mediation analysis. PLoS One 2023; 18:e0287037. [PMID: 37314996 DOI: 10.1371/journal.pone.0287037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The past decade has seen an explosion of research in causal mediation analysis. However, most analytic tools developed so far rely on frequentist methods which may not be robust in the case of small sample sizes. In this paper, we propose a Bayesian approach for causal mediation analysis based on Bayesian g-formula, which will overcome the limitations of the frequentist methods. METHODS We created BayesGmed, an R-package for fitting Bayesian mediation models in R. The application of the methodology (and software tool) is demonstrated by a secondary analysis of data collected as part of the MUSICIAN study, a randomised controlled trial of remotely delivered cognitive behavioural therapy (tCBT) for people with chronic pain. We tested the hypothesis that the effect of tCBT would be mediated by improvements in active coping, passive coping, fear of movement and sleep problems. We then demonstrate the use of informative priors to conduct probabilistic sensitivity analysis around violations of causal identification assumptions. RESULT The analysis of MUSICIAN data shows that tCBT has better-improved patients' self-perceived change in health status compared to treatment as usual (TAU). The adjusted log-odds of tCBT compared to TAU range from 1.491 (95% CI: 0.452-2.612) when adjusted for sleep problems to 2.264 (95% CI: 1.063-3.610) when adjusted for fear of movement. Higher scores of fear of movement (log-odds, -0.141 [95% CI: -0.245, -0.048]), passive coping (log-odds, -0.217 [95% CI: -0.351, -0.104]), and sleep problem (log-odds, -0.179 [95% CI: -0.291, -0.078]) leads to lower odds of a positive self-perceived change in health status. The result of BayesGmed, however, shows that none of the mediated effects are statistically significant. We compared BayesGmed with the mediation R- package, and the results were comparable. Finally, our sensitivity analysis using the BayesGmed tool shows that the direct and total effect of tCBT persists even for a large departure in the assumption of no unmeasured confounding. CONCLUSION This paper comprehensively overviews causal mediation analysis and provides an open-source software package to fit Bayesian causal mediation models.
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Affiliation(s)
- Belay B Yimer
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
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8
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Das R, Muldoon M, Lunt M, McBeth J, Yimer BB, House T. Modelling and classifying joint trajectories of self-reported mood and pain in a large cohort study. PLOS Digit Health 2023; 2:e0000204. [PMID: 36996020 DOI: 10.1371/journal.pdig.0000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/27/2023] [Indexed: 03/31/2023]
Abstract
It is well-known that mood and pain interact with each other, however individual-level variability in this relationship has been less well quantified than overall associations between low mood and pain. Here, we leverage the possibilities presented by mobile health data, in particular the "Cloudy with a Chance of Pain" study, which collected longitudinal data from the residents of the UK with chronic pain conditions. Participants used an App to record self-reported measures of factors including mood, pain and sleep quality. The richness of these data allows us to perform model-based clustering of the data as a mixture of Markov processes. Through this analysis we discover four endotypes with distinct patterns of co-evolution of mood and pain over time. The differences between endotypes are sufficiently large to play a role in clinical hypothesis generation for personalised treatments of comorbid pain and low mood.
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Affiliation(s)
- Rajenki Das
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Mark Muldoon
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Belay Birlie Yimer
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
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9
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Ali SM, Lee RR, McBeth J, James B, McAlister S, Chiarotto A, Dixon WG, van der Veer SN. Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study. JMIR Hum Factors 2023; 10:e42177. [PMID: 36753324 PMCID: PMC9947768 DOI: 10.2196/42177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. OBJECTIVE We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. METHODS Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. RESULTS Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. CONCLUSIONS To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | | | | | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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10
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Kazi K, Ali SM, Selby DA, McBeth J, van der Veer S, Dixon WG. Examining the variability of multiple daily symptoms over time among individuals with multiple long-term conditions (MLTC-M/multimorbidity): An exploratory analysis of a longitudinal smartwatch feasibility study. J Multimorb Comorb 2023; 13:26335565221150129. [PMID: 36698685 PMCID: PMC9869202 DOI: 10.1177/26335565221150129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/13/2023] [Indexed: 01/20/2023]
Abstract
Introduction People living with multiple long-term conditions (MLTC-M) (multimorbidity) experience a range of inter-related symptoms. These symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices, and then summarised to provide useful clinical insight. Aim We aimed to perform an exploratory analysis to summarise the extent and trajectory of multiple symptom ratings tracked via a smartwatch, and to investigate the relationship between these symptom ratings and demographic factors in people living with MLTC-M in a feasibility study. Methods 'Watch Your Steps' was a prospective observational feasibility study, administering multiple questions per day over a 90 day period. Adults with more than one clinician-diagnosed long-term condition rated seven core symptoms each day, plus up to eight additional symptoms personalised to their LTCs per day. Symptom ratings were summarised over the study period at the individual and group level. Symptom ratings were also plotted to describe day-to-day symptom trajectories for individuals. Results Fifty two participants submitted symptom ratings. Half were male and the majority had LTCs affecting three or more disease areas (N = 33, 64%). The symptom rated as most problematic was fatigue. Patients with increased comorbidity or female sex seemed to be associated with worse experiences of fatigue. Fatigue ratings were strongly correlated with pain and level of dysfunction. Conclusion In this study we have shown that it is possible to collect and descriptively analyse self reported symptom data in people living with MLTC-M, collected multiple times per day on a smartwatch, to gain insights that might support future clinical care and research.
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Affiliation(s)
- Khalid Kazi
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - David A Selby
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK
| | - Sabine van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - William G Dixon
- Northern Care Alliance NHS Foundation Trust, Salford, UK
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK
- William G Dixon, Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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11
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Druce KL, Gibson DS, McEleney K, Yimer BB, Meleck S, James B, Hellman B, Dixon WG, McBeth J. Remote sampling of biomarkers of inflammation with linked patient generated health data in patients with rheumatic and musculoskeletal diseases: an Ecological Momentary Assessment feasibility study. BMC Musculoskelet Disord 2022; 23:770. [PMID: 35964066 PMCID: PMC9375303 DOI: 10.1186/s12891-022-05723-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background People with rheumatic diseases experience troublesome fluctuations in fatigue. Debated causes include pain, mood and inflammation. To determine the relationships between these potential causes, serial assessments are required but are methodologically challenging. This mobile health (mHealth) study explored the viability of using a smartphone app to collect patient-reported symptoms with contemporaneous Dried Blood Spot Sampling (DBSS) for inflammation. Methods Over 30 days, thirty-eight participants (12 RA, 13 OA, and 13 FM) used uMotif, a smartphone app, to report fatigue, pain and mood, on 5-point ordinal scales, twice daily. Daily DBSS, from which C-reactive Protein (CRP) values were extracted, were completed on days 1–7, 14 and 30. Participant engagement was determined based on frequency of data entry and ability to calculate within- and between-day symptom changes. DBSS feasibility and engagement was determined based on the proportion of samples returned and usable for extraction, and the number of days between which between-day changes in CRP which could be calculated (days 1–7). Results Fatigue was reported at least once on 1085/1140 days (95.2%). Approximately 65% of within- and between-day fatigue changes could be calculated. Rates were similar for pain and mood. A total of 287/342 (83.9%) DBSS, were returned, and all samples were viable for CRP extraction. Fatigue, pain and mood varied considerably, but clinically meaningful (≥ 5 mg/L) CRP changes were uncommon. Conclusions Embedding DBSS in mHealth studies will enable researchers to obtain serial symptom assessments with matched biological samples. This provides exciting opportunities to address hitherto unanswerable questions, such as elucidating the mechanisms of fatigue fluctuations. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05723-w.
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Affiliation(s)
- Katie L Druce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - David S Gibson
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Biomedical Sciences Research Institute, Ulster University, Londonderry, UK
| | - Kevin McEleney
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Biomedical Sciences Research Institute, Ulster University, Londonderry, UK
| | - Belay B Yimer
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | | | | | | | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.,The NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK. .,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK. .,The NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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12
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Ali SM, Lee RR, Chiarotto A, Dixon WG, McBeth J, van der Veer SN. Adoption of Digital Pain Manikins for Research Data Collection: A Systematic Review. Stud Health Technol Inform 2022; 290:748-751. [PMID: 35673117 DOI: 10.3233/shti220178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chronic pain is common and disabling. Researchers need robust methods to collect pain data in large populations to enhance knowledge on pain prevalence, causes and treatment. Digital pain manikins address this by enabling self-reporting of location-specific pain. However, it is unknown to what extent pain studies adopted digital manikins for data collection. Therefore, we systematically searched the literature. We included 17 studies. Most were published after 2017, collected pain data cross-sectionally in ≥50 participants, and reported pain distribution and pain extent as manikin-derived summary metrics. Across the studies, 13 unique manikins were used, of which four had been evaluated. Our review shows that adoption of digital pain manikins in research settings has been slow. Harnessing the digital nature of manikins, enabling use of personal devices, and assessing and improving the reliability, validity and responsiveness of digital manikins will expedite their adoption as digital data collection tools for pain research.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | | | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
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13
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McBeth J, Dixon WG, Moore SM, Hellman B, James B, Kyle SD, Lunt M, Cordingley L, Yimer BB, Druce KL. Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study. J Med Internet Res 2022; 24:e32825. [PMID: 35451978 PMCID: PMC9077504 DOI: 10.2196/32825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/11/2021] [Accepted: 12/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies. OBJECTIVE This mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL. METHODS The quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social). RESULTS Of the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants' scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β=1.11, 95% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF. CONCLUSIONS Optimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA.
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Affiliation(s)
- John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Susan Mary Moore
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | | | | | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Manchester University, Manchester, United Kingdom
| | - Belay Birlie Yimer
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Katie L Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
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14
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Gandrup J, Selby D, van der Veer SN, McBeth J, Dixon WG. Using patient-reported data from a smartphone app to capture and characterise real-time patient-reported flares in rheumatoid arthritis. Rheumatol Adv Pract 2022; 6:rkac021. [PMID: 35392426 PMCID: PMC8982773 DOI: 10.1093/rap/rkac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to explore the frequency of self-reported flares and their association with preceding symptoms collected through a smartphone app by people with RA. Methods We used data from the Remote Monitoring of RA study, in which patients tracked their daily symptoms and weekly flares on an app. We summarized the number of self-reported flare weeks. For each week preceding a flare question, we calculated three summary features for daily symptoms: mean, variability and slope. Mixed effects logistic regression models quantified associations between flare weeks and symptom summary features. Pain was used as an example symptom for multivariate modelling. Results Twenty patients tracked their symptoms for a median of 81 days (interquartile range 80, 82). Fifteen of 20 participants reported at least one flare week, adding up to 54 flare weeks out of 198 participant weeks in total. Univariate mixed effects models showed that higher mean and steeper upward slopes in symptom scores in the week preceding the flare increased the likelihood of flare occurrence, but the association with variability was less strong. Multivariate modelling showed that for pain, mean scores and variability were associated with higher odds of flare, with odds ratios 1.83 (95% CI, 1.15, 2.97) and 3.12 (95% CI, 1.07, 9.13), respectively. Conclusion Our study suggests that patient-reported flares are common and are associated with higher daily RA symptom scores in the preceding week. Enabling patients to collect daily symptom data on their smartphones might, ultimately, facilitate prediction and more timely management of imminent flares.
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Affiliation(s)
- Julie Gandrup
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - David Selby
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | | | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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15
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Yimer BB, Schultz DM, Beukenhorst AL, Lunt M, Pisaniello HL, House T, Sergeant JC, McBeth J, Dixon WG. Heterogeneity in the association between weather and pain severity among patients with chronic pain: a Bayesian multilevel regression analysis. Pain Rep 2022; 7:e963. [PMID: 35047712 PMCID: PMC8759613 DOI: 10.1097/pr9.0000000000000963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Previous studies on the association between weather and pain severity among patients with chronic pain have produced mixed results. In part, this inconsistency may be due to differences in individual pain responses to the weather. METHODS To test the hypothesis that there might be subgroups of participants with different pain responses to different weather conditions, we examined data from a longitudinal smartphone-based study, Cloudy with a Chance of Pain, conducted between January 2016 and April 2017. The study recruited more than 13,000 participants and recorded daily pain severity on a 5-point scale (range: no pain to very severe pain) along with hourly local weather data for up to 15 months. We used a Bayesian multilevel model to examine the weather-pain association. RESULTS We found 1 in 10 patients with chronic pain were sensitive to the temperature, 1 in 25 to relative humidity, 1 in 50 to pressure, and 3 in 100 to wind speed, after adjusting for age, sex, belief in the weather-pain association, mood, and activity level. The direction of the weather-pain association differed between people. Although participants seem to be differentially sensitive to weather conditions, there is no definite indication that participants' underlying pain conditions play a role in weather sensitivity. CONCLUSION This study demonstrated that weather sensitivity among patients with chronic pain is more apparent in some subgroups of participants. In addition, among those sensitive to the weather, the direction of the weather-pain association can differ.
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Affiliation(s)
- Belay B. Yimer
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - David M. Schultz
- Department of Earth and Environmental Sciences, Centre for Atmospheric Science, University of Manchester, Manchester, United Kingdom
- Centre for Crisis Studies and Mitigation, University of Manchester, Manchester, United Kingdom
| | - Anna L. Beukenhorst
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Huai L. Pisaniello
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
| | - Thomas House
- School of Mathematics, The University of Manchester, Manchester, United Kingdom
| | - Jamie C. Sergeant
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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16
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Ali SM, Selby DA, Khalid K, Dempsey K, Mackey E, Small N, van der Veer SN, Mcmillan B, Bower P, Brown B, McBeth J, Dixon WG. Engagement with consumer smartwatches for tracking symptoms of individuals living with multiple long-term conditions (multimorbidity): A longitudinal observational study. J Comorb 2021; 11:26335565211062791. [PMID: 34869047 PMCID: PMC8637784 DOI: 10.1177/26335565211062791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Introduction People living with multiple long-term conditions (multimorbidity) (MLTC-M)
experience an accumulating combination of different symptoms. It has been
suggested that these symptoms can be tracked longitudinally using consumer
technology, such as smartphones and wearable devices. Aim The aim of this study was to investigate longitudinal user engagement with a
smartwatch application, collecting survey questions and active tasks over
90 days, in people living with MLTC-M. Methods ‘Watch Your Steps’ was a prospective observational study,
administering multiple questions and active tasks over 90 days. Adults with
more than one clinician-diagnosed long-term conditions were loaned Fossil®
Sport smartwatches, pre-loaded with the study app. Around 20 questions were
prompted per day. Daily completion rates were calculated to describe engagement patterns over
time, and to explore how these varied by patient characteristics and
question type. Results Fifty three people with MLTC-M took part in the study. Around half were male
( = 26; 49%) and the majority had a white ethnic background
(n = 45; 85%). About a third of participants engaged
with the smartwatch app nearly every day. The overall completion rate of
symptom questions was 45% inter-quartile range (IQR 23–67%) across all study
participants. Older patients and those with greater MLTC-M were more
engaged, although engagement was not significantly different between
genders. Conclusion It was feasible for people living with MLTC-M to report multiple symptoms per
day over 3 months. User engagement appeared as good as other mobile health
studies that recruited people with single health conditions, despite the
higher daily data entry burden.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - David A Selby
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Kazi Khalid
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Katherine Dempsey
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Elaine Mackey
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Nicola Small
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian Mcmillan
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and health, Manchester Academic Health Science Centre Manchester, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR Policy Research Unit for Older People and Frailty, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and health, Manchester Academic Health Science Centre Manchester, University of Manchester, Manchester, UK
| | - Benjamin Brown
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and health, Manchester Academic Health Science Centre Manchester, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
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Beukenhorst AL, Sergeant JC, Schultz DM, McBeth J, Yimer BB, Dixon WG. Understanding the Predictors of Missing Location Data to Inform Smartphone Study Design: Observational Study. JMIR Mhealth Uhealth 2021; 9:e28857. [PMID: 34783661 PMCID: PMC8663442 DOI: 10.2196/28857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones compared to when using research-grade location trackers. Missing location data can affect study validity and intervention safety. OBJECTIVE The objective of this study was to investigate the distribution of missing location data and its predictors to inform design, analysis, and interpretation of future smartphone (observational and interventional) studies. METHODS We analyzed hourly smartphone location data collected from 9665 research participants on 488,400 participant days in a national smartphone study investigating the association between weather conditions and chronic pain in the United Kingdom. We used a generalized mixed-effects linear model with logistic regression to identify whether a successfully recorded geolocation was associated with the time of day, participants' time in study, operating system, time since previous survey completion, participant age, sex, and weather sensitivity. RESULTS For most participants, the app collected a median of 2 out of a maximum of 24 locations (1760/9665, 18.2% of participants), no location data (1664/9665, 17.2%), or complete location data (1575/9665, 16.3%). The median locations per day differed by the operating system: participants with an Android phone most often had complete data (a median of 24/24 locations) whereas iPhone users most often had a median of 2 out of 24 locations. The odds of a successfully recorded location for Android phones were 22.91 times higher than those for iPhones (95% CI 19.53-26.87). The odds of a successfully recorded location were lower during weekends (odds ratio [OR] 0.94, 95% CI 0.94-0.95) and nights (OR 0.37, 95% CI 0.37-0.38), if time in study was longer (OR 0.99 per additional day in study, 95% CI 0.99-1.00), and if a participant had not used the app recently (OR 0.96 per additional day since last survey entry, 95% CI 0.96-0.96). Participant age and sex did not predict missing location data. CONCLUSIONS The predictors of missing location data reported in our study could inform app settings and user instructions for future smartphone (observational and interventional) studies. These predictors have implications for analysis methods to deal with missing location data, such as imputation of missing values or case-only analysis. Health studies using smartphones for data collection should assess context-specific consequences of high missing data, especially among iPhone users, during the night and for disengaged participants.
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Affiliation(s)
- Anna L Beukenhorst
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jamie C Sergeant
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - David M Schultz
- Centre for Atmospheric Science, Department of Earth and Environmental Sciences, University of Manchester, Manchester, United Kingdom.,Centre for Crisis Studies and Mitigation, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Belay B Yimer
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Will G Dixon
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Holden MA, Callaghan M, Felson D, Birrell F, Nicholls E, Jowett S, Kigozi J, McBeth J, Borrelli B, Jinks C, Foster NE, Dziedzic K, Mallen C, Ingram C, Sutton A, Lawton S, Halliday N, Hartshorne L, Williams H, Browell R, Hudson H, Marshall M, Sowden G, Herron D, Asamane E, Peat G. Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial. BMJ Open 2021; 11:e048196. [PMID: 33771832 PMCID: PMC8006841 DOI: 10.1136/bmjopen-2020-048196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Brace effectiveness for knee osteoarthritis (OA) remains unclear and international guidelines offer conflicting recommendations. Our trial will determine the clinical and cost-effectiveness of adding knee bracing (matched to patients' clinical and radiographic presentation and with adherence support) to a package of advice, written information and exercise instruction delivered by physiotherapists. METHODS AND ANALYSIS A multicentre, pragmatic, two-parallel group, single-blind, superiority, randomised controlled trial with internal pilot and nested qualitative study. 434 eligible participants with symptomatic knee OA identified from general practice, physiotherapy referrals and self-referral will be randomised 1:1 to advice, written information and exercise instruction and knee brace versus advice, written information and exercise instruction alone. The primary analysis will be intention-to-treat comparing treatment arms on the primary outcome (Knee Osteoarthritis Outcomes Score (KOOS)-5) (composite knee score) at the primary endpoint (6 months) adjusted for prespecified covariates. Secondary analysis of KOOS subscales (pain, other symptoms, activities of daily living, function in sport and recreation, knee-related quality of life), self-reported pain, instability (buckling), treatment response, physical activity, social participation, self-efficacy and treatment acceptability will occur at 3, 6, and 12 months postrandomisation. Analysis of covariance and logistic regression will model continuous and dichotomous outcomes, respectively. Treatment effect estimates will be presented as mean differences or ORs with 95% CIs. Economic evaluation will estimate cost-effectiveness. Semistructured interviews to explore acceptability and experiences of trial interventions will be conducted with participants and physiotherapists delivering interventions. ETHICS AND DISSEMINATION North West Preston Research Ethics Committee, the Health Research Authority and Health and Care Research in Wales approved the study (REC Reference: 19/NW/0183; IRAS Reference: 247370). This protocol has been coproduced with stakeholders including patients and public. Findings will be disseminated to patients and a range of stakeholders. TRIAL REGISTRATION NUMBER ISRCTN28555470.
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Affiliation(s)
- Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Michael Callaghan
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - David Felson
- Boston University School of Medicine, Boston, Massachusetts, USA
- Research in OsteoArthritis Manchester (ROAM), Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, Manchester, UK
| | - Fraser Birrell
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | - Elaine Nicholls
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - J Kigozi
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - John McBeth
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Manchester, UK
| | - Belinda Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology and Manchester Academic Health Science Centre, The University of Manchester, Manchester, Manchester, UK
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Krysia Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Carol Ingram
- Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Alan Sutton
- Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Sarah Lawton
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Nicola Halliday
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Liz Hartshorne
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Helen Williams
- Research in OsteoArthritis Manchester (ROAM), Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, Manchester, UK
| | - Rachel Browell
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | - Hannah Hudson
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Gail Sowden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Dan Herron
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Evans Asamane
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Ali SM, Lau WJ, McBeth J, Dixon WG, van der Veer SN. Digital manikins to self-report pain on a smartphone: A systematic review of mobile apps. Eur J Pain 2021; 25:327-338. [PMID: 33113241 PMCID: PMC7839759 DOI: 10.1002/ejp.1688] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic pain is the leading cause of disability. Improving our understanding of pain occurrence and treatment effectiveness requires robust methods to measure pain at scale. Smartphone-based pain manikins are human-shaped figures to self-report location-specific aspects of pain on people's personal mobile devices. METHODS We searched the main app stores to explore the current state of smartphone-based pain manikins and to formulate recommendations to guide their development in the future. RESULTS The search yielded 3,938 apps. Twenty-eight incorporated a pain manikin and were included in the analysis. For all apps, it was unclear whether they had been tested and had end-user involvement in the development. Pain intensity and quality could be recorded in 28 and 13 apps, respectively, but this was location specific in only 11 and 4. Most manikins had two or more views (n = 21) and enabled users to shade or select body areas to record pain location (n = 17). Seven apps allowed personalising the manikin appearance. Twelve apps calculated at least one metric to summarise manikin reports quantitatively. Twenty-two apps had an archive of historical manikin reports; only eight offered feedback summarising manikin reports over time. CONCLUSIONS Several publically available apps incorporated a manikin for pain reporting, but only few enabled recording of location-specific pain aspects, calculating manikin-derived quantitative scores, or generating summary feedback. For smartphone-based manikins to become adopted more widely, future developments should harness manikins' digital nature and include robust validation studies. Involving end users in the development may increase manikins' acceptability as a tool to self-report pain. SIGNIFICANCE This review identified and characterised 28 smartphone apps that included a pain manikin (i.e. pain drawings) as a novel approach to measure pain in large populations. Only few enabled recording of location-specific pain aspects, calculating quantitative scores based on manikin reports, or generating manikin feedback. For smartphone-based manikins to become adopted more widely, future studies should harness the digital nature of manikins, and establish the measurement properties of manikins. Furthermore, we believe that involving end users in the development process will increase acceptability of manikins as a tool for self-reporting pain.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Wei J. Lau
- Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUK
| | - John McBeth
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - William G. Dixon
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Sabine N. van der Veer
- Centre for Epidemiology Versus ArthritisUniversity of ManchesterManchesterUK
- Centre for Health InformaticsDivision of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- NIHR Manchester Musculoskeletal Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUK
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20
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Macfarlane GJ, Beasley M, Scott N, Chong H, McNamee P, McBeth J, Basu N, Hannaford PC, Jones GT, Keeley P, Prescott GJ, Lovell K. Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study). Ann Rheum Dis 2021; 80:903-911. [PMID: 33526434 PMCID: PMC8237175 DOI: 10.1136/annrheumdis-2020-219091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Objective Cognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk. Methods A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment. Results 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention. Conclusions A short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP. Trial registration number ClinicalTrials.gov Registry (NCT02668003).
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Huey Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Phil Keeley
- School of Nursing and Midwifery, University of Keele, Stoke-on-Trent, Staffordshire, UK
| | - Gordon J Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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21
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Gandrup J, Ali SM, McBeth J, van der Veer SN, Dixon WG. Remote symptom monitoring integrated into electronic health records: A systematic review. J Am Med Inform Assoc 2020; 27:1752-1763. [PMID: 32968785 PMCID: PMC7671621 DOI: 10.1093/jamia/ocaa177] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE People with long-term conditions require serial clinical assessments. Digital patient-reported symptoms collected between visits can inform these, especially if integrated into electronic health records (EHRs) and clinical workflows. This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions. MATERIALS AND METHODS We searched Medline, Web of Science, and Embase. Inclusion criteria were symptom reporting systems in adults with long-term conditions; data integrated into the EHR; data collection outside of clinic; data used in clinical care. We synthesized data thematically. Benefits were assessed against a list of outcome indicators. We critically appraised studies using the Mixed Methods Appraisal Tool. RESULTS We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based on the study results, and were only supported by evidence from early-stage qualitative studies. Studies were primarily feasibility and pilot studies of acceptable quality. DISCUSSION AND CONCLUSIONS EHR-integrated remote symptom monitoring is possible, but there are few published efforts to inform development of these systems. Currently there is limited evidence that this improves care and outcomes, warranting future robust, quantitative studies of efficacy and effectiveness.
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Affiliation(s)
- Julie Gandrup
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
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22
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Khanom S, McDonagh JE, Briggs M, Bakir E, McBeth J. Adolescents' experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis. BMC Musculoskelet Disord 2020; 21:645. [PMID: 33008357 PMCID: PMC7532580 DOI: 10.1186/s12891-020-03627-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents' experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. METHODS Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents' experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. RESULTS Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent's perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents' characteristics such as their developmental status, pain condition, and the duration of the pain experience. CONCLUSIONS Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of 'typical' fluctuations in pain, or whether they reflect symptom exacerbations classified as 'flares'. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ebru Bakir
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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23
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Khanom S, McDonagh JE, Briggs M, McBeth J. Characterizing pain flares in adolescent inflammatory and non-inflammatory musculoskeletal disorders: A qualitative study using an interpretative phenomenological approach. Eur J Pain 2020; 24:1785-1796. [PMID: 32608154 DOI: 10.1002/ejp.1626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/11/2020] [Accepted: 06/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescents with musculoskeletal disorders experience acute exacerbations in pain, colloquially called "pain flares" in adult literature. This study aimed to explore adolescents' lived experience of pain flares, including what pain flares are, why they occur, how they are managed and what lasting effects they have on adolescents. METHODS A sample of 10 adolescents diagnosed with juvenile idiopathic arthritis or chronic idiopathic pain syndrome were recruited from a tertiary hospital in the UK. Data were collected using semi-structured interviews and visual aids, and analysed using interpretative phenomenological analysis. RESULTS Four broad themes were identified which describe as a journey of change from participants: (a) daily life with pain, where adolescents report a level of pain that is "normal" for them which they can tolerate and continue their daily routines around; (b) pre-flare period, where adolescents begin to notice pain increasing beyond normal levels and employ preventative strategies to reduce the risk of symptoms developing into a flare; (c) flare period, where adolescents describe the symptoms, frequency, duration, impact and their attempts to manage flares; to their (d) post-flare period, where symptoms begin to return to baseline levels and adolescents take actions to regain the level of normality experienced in daily life. CONCLUSION This study has identified a number of components of the pain flare experience. Findings show that pain flares are more than an increase in pain intensity; they are multi-layered and require other features to change. These findings help to differentiate pain flares from typical fluctuations in pain.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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24
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Van Der Veer SN, Beukenhorst AL, Ali SM, James B, Silva P, McBeth J, Dixon WG. Development of a Mobile Digital Manikin to Measure Pain Location and Intensity. Stud Health Technol Inform 2020; 270:946-950. [PMID: 32570521 DOI: 10.3233/shti200301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Painful conditions are prevalent and substantially contribute to disability worldwide. Digital manikins are body-shaped drawings to facilitate self-reporting of pain. Some of them have been validated, but without allowing for recording of location-specific pain intensity and for use on a smartphone. This paper describes the initial development of a digital pain manikin to support self-reporting of pain location and location-specific intensity using people's own mobile device. Subsequently, we conducted reliability and usability tests with eight researchers and seven patient representatives. Test-retest reliability depended on the manikin's level of detail, but was generally high with most intraclass correlation coefficients âĽě0.70 and all similarity coefficients âĽě0.50. Participants found the manikin easy to use, but suggested clearer orientation (front/back, certain body locations) and would value additional feedback and diary functions. We will address these issues in the next version of the manikin before conducting a validation study.
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Affiliation(s)
| | - Anna L Beukenhorst
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - S Mustafa Ali
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | | | | | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
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25
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Druce KL, McBeth J. Central sensitization predicts greater fatigue independently of musculoskeletal pain. Rheumatology (Oxford) 2020; 58:1923-1927. [PMID: 30815696 PMCID: PMC6812719 DOI: 10.1093/rheumatology/kez028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/17/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To test whether central sensitization was associated with greater fatigue, independently of musculoskeletal pain. Methods 2477 prospective cohort study participants completed a baseline questionnaire comprising the Chalder Fatigue Scale (CFQ), pain, demographics, physical activity, anxiety, depression and medication use. In a clinical assessment of 290 (11.7%) participants, central sensitization was measured by the wind-up ratio test at the hand (WUR-H) and foot (WUR-F). Bioelectric impedance determined proportion body fat. All participants were followed up 12 months later, at which time they completed the CFQ. Linear regression, with inverse probability sampling weights, tested the relationship between WUR at baseline and CFQ at 12 months, adjusted for baseline CFQ, demographics, lifestyle factors, mental health and baseline pain. Results At baseline, the median interquartile range WUR-H and WUR-F were similar (2.3 (1.5, 4.0) and 2.4 (1.6, 3.9) respectively) and did not differ by sex (difference WUR-H: −0.29, 95% confidence interval −1.28–0.71; WUR-F: −0.57 (−1.50–0.36) or age(WUR-H: −0.53, −1.49–0.43; WUR-F:−0.08, −0.98–0.82). WUR-H scores (β = 0.11, 95% confidence interval: 0.07–0.16) and WUR-F scores (0.13, 0.08–0.17) were positively associated with CFQ scores at follow-up, independently of baseline CFQ and other covariates. These associations were not explained by baseline pain. Conclusion Fatigue was predicted by central sensitization, independently of the presence of pain. For those seeking to treat fatigue, the benefit of interventions that reduce central sensitization should be investigated.
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Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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26
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Macfarlane GJ, Beasley M, Scott N, McNamee P, McBeth J, Prescott G, Jones GT, Hannaford P, Basu N, Keeley P, Lovell K. O15 Maintaining musculoskeletal health: a randomised controlled trial of cognitive behaviour therapy among people at high risk of developing chronic widespread pain. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive behaviour therapy (CBT) is effective in the management of fibromyalgia (and its characteristic feature chronic widespread pain (CWP). CBT is recommended in all recent major fibromyalgia management guidelines. From large-scale epidemiological studies, prediction models are available which identify groups at high-risk of developing CWP. We now test whether it is possible to prevent onset of CWP and/or change factors associated with its onset.
Methods
A randomised controlled trial of CBT delivered by telephone plus usual care (tCBT) was tested against usual care alone (UC). Eligible adults aged at least 25 years were identified by a survey of persons registered with sixteen general practices across Scotland. Respondents reporting regional pain (not CWP) for which they had recently consulted their GP and at least 2 items from a previously validated ‘high risk’ profile (Somatic Symptom Scale, Sleep Problem Scale, Illness Behaviour Scale) were invited to participate. tCBT was delivered across 6 sessions over 8 weeks with booster sessions 3 and 6 months after treatment start. Primary outcome was CWP at 12 months. Secondary outcomes were risk profile measures: fatigue (Chalder Fatigue Scale), Patient Global Impression of Change (PGIC: 7 categories), psychological distress (General Health Questionnaire) and quality of life (EQ-5D-5L) also at 12 months. Analysis used logistic, ordinal logistic or linear regression depending on outcome variable type; expressed as an effect size with 95% confidence interval.
Results
1,002 people were randomised, with equal numbers assigned to each arm of the trial: 59% of participants were female, with a median age of 59 (range 25-91) years. 66% of tCBT participants completed treatment and 83% of all participants provided follow-up data at 12 months. There was no difference in the proportion with CWP at 12 months (tCBT 18.0% v. UC 17.5%). There were improvements (all favouring tCBT) in Illness Behaviour Score (mean difference (md) -0.83; -1.55,-0.11), Sleep Problem Scale (md -0.90; -1.45,-0.36), psychological distress (Odds Ratio (OR) per category 0.65; 0.50, 0.85), EQ-5D-5L (md 0.024; 0.009, 0.039), Chalder Fatigue Scale (md -1.05; -1.66,-0.44) and PGIC (OR per category 0.51;0.39,0.67). Specifically 30.2% of those receiving tCBT reported their health as much or very much better, compared to 17.3% of those receiving UC.
Conclusion
This first-ever large-scale trial of prevention, aimed at persons at high risk, has shown tCBT does not change the likelihood of CWP onset but does improve the underlying risk profile for developing the condition as well as improving distress , fatigue and quality of life. Those receiving tCBT were, 12 months later, significantly more like to consider their health was better. This trial provides evidence for extending the group of people considered to benefit from CBT.
Disclosures
G.J. Macfarlane None. M. Beasley None. N. Scott None. P. McNamee None. J. McBeth None. G. Prescott None. G.T. Jones None. P. Hannaford None. N. Basu None. P. Keeley None. K. Lovell None.
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
| | - Gordon Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UNITED KINGDOM
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Phil Hannaford
- Primary Care, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Basu
- Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Phil Keeley
- Human and Health Sciences, University of Huddersfield, Huddersfield, UNITED KINGDOM
| | - Karina Lovell
- Nursery, Midwifery and Social Work, University of Manchester, Manchester, UNITED KINGDOM
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Beukenhorst AL, Howells K, Cook L, McBeth J, O'Neill TW, Parkes MJ, Sanders C, Sergeant JC, Weihrich KS, Dixon WG. Engagement and Participant Experiences With Consumer Smartwatches for Health Research: Longitudinal, Observational Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e14368. [PMID: 32012078 PMCID: PMC7016619 DOI: 10.2196/14368] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/18/2019] [Accepted: 10/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Wearables provide opportunities for frequent health data collection and symptom monitoring. The feasibility of using consumer cellular smartwatches to provide information both on symptoms and contemporary sensor data has not yet been investigated. OBJECTIVE This study aimed to investigate the feasibility and acceptability of using cellular smartwatches to capture multiple patient-reported outcomes per day alongside continuous physical activity data over a 3-month period in people living with knee osteoarthritis (OA). METHODS For the KOALAP (Knee OsteoArthritis: Linking Activity and Pain) study, a novel cellular smartwatch app for health data collection was developed. Participants (age ≥50 years; self-diagnosed knee OA) received a smartwatch (Huawei Watch 2) with the KOALAP app. When worn, the watch collected sensor data and prompted participants to self-report outcomes multiple times per day. Participants were invited for a baseline and follow-up interview to discuss their motivations and experiences. Engagement with the watch was measured using daily watch wear time and the percentage completion of watch questions. Interview transcripts were analyzed using grounded thematic analysis. RESULTS A total of 26 people participated in the study. Good use and engagement were observed over 3 months: most participants wore the watch on 75% (68/90) of days or more, for a median of 11 hours. The number of active participants declined over the study duration, especially in the final week. Among participants who remained active, neither watch time nor question completion percentage declined over time. Participants were mainly motivated to learn about their symptoms and enjoyed the self-tracking aspects of the watch. Barriers to full engagement were battery life limitations, technical problems, and unfulfilled expectations of the watch. Participants reported that they would have liked to report symptoms more than 4 or 5 times per day. CONCLUSIONS This study shows that capture of patient-reported outcomes multiple times per day with linked sensor data from a smartwatch is feasible over at least a 3-month period. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10238.
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Affiliation(s)
- Anna L Beukenhorst
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kelly Howells
- The National Institute for Health Research, School for Primary Care Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Louise Cook
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Matthew J Parkes
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Caroline Sanders
- The National Institute for Health Research, School for Primary Care Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Katy S Weihrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
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Welsh VK, Mallen CD, Ogollah R, Wilkie R, McBeth J. Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study. PLoS One 2019; 14:e0226268. [PMID: 31826023 PMCID: PMC6905547 DOI: 10.1371/journal.pone.0226268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/24/2019] [Indexed: 11/21/2022] Open
Abstract
Older people are continuing to fall despite fall prevention guidelines targeting known falls’ risk factors. Multisite pain is a potential novel falls’ risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls’ risk factors and putative confounders. This prospective cohort study linked data from self-completed questionnaires, primary care electronic health records, secondary care admission statistics and national mortality data. Between 2002–2005, self-completion questionnaires were mailed to community-dwelling individuals aged 50 years and older registered with one of eight general practices in North Staffordshire, UK(n = 26,129) yielding 18,497 respondents. 11,375 respondents entered the study; 4386 completed six year follow-up. Self-reported falls were extracted from three and six year follow-up questionnaires. Falls requiring healthcare were extracted from routinely collected primary and secondary healthcare data. Increasing number of pain sites increased odds of future 3 year (odds ratio 1.12 (95% confidence interval: 1.01–1.24)) and 6 year self-reported fall (odds ratio 1.02 (1.00–1.03)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.01 (1.00–1.03)). The presence of widespread pain increased odds of future 3 year (odds ratio 1.27 (0.92–1.75)) and 6 year fall (odds ratio 1.43(1.06–1.95)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.27(0.98–1.65)). Multisite pain was not associated with future fall requiring secondary care admission. Multisite pain must be included as a falls’ risk factor in guidelines to ensure clinicians identify their older patients at risk of falls and employ timely implementation of current falls prevention strategies.
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Affiliation(s)
- Victoria K. Welsh
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
- * E-mail:
| | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Reuben Ogollah
- Faculty of Medicine & Health Sciences, South Block, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Ross Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Khanom S, McBeth J, Briggs M, McDonagh J. P37 Exploring the experience of pain flares in adolescent inflammatory and non-inflammatory musculoskeletal disorders: a phenomenological study. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez416.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adolescents with inflammatory and non-inflammatory rheumatic musculoskeletal disorders (RMD) experience acute exacerbations in pain, referred to as pain flares in the adult literature. But little remains known about what pain flares are, why they occur, how they are managed and what lasting effects they have during adolescence. This study explored the lived experience of pain flares in adolescents with RMD.
Methods
Adolescents with juvenile idiopathic arthritis (JIA) or chronic idiopathic pain syndromes (CIPS) were recruited from a UK tertiary paediatric and adolescent rheumatology centre. Data were collected using semi-structured interviews and visual aids, and analysed using interpretative phenomenological analysis.
Results
Participants were eight females and two males aged between 13 and 17 years (M = 14.7, SD = 1.25). Four participants had JIA and six had CIPS. All participants experienced periods when pain deviates from their usual variation in pain, but none reported using the term pain flare to describe these experiences. These experiences were conceptualised as a journey of change from their 1) daily life with pain, 2) pre-flare period, 3) flare period, to their 4) post-flare period. 1) In daily life, adolescents report a level of pain that is usual for them which they manage and continue their daily routines around. 2) Pain, at times, increased beyond usual levels and adolescents reported noticing when a pain flare was coming on (e.g. due to physical exertion). They employed strategies for managing the pre-flare period, however, if they did not succeed in preventing a flare, or when flares occurred without a trigger or controllable cause, pain began to intrude on their lives. 3) All pain flares were described as an increase in the intensity of their usual pain, and were also associated with an increase in the location, duration and/or quality of pain; an increase in other unpleasant symptoms such as fatigue, psychological symptoms, headaches and/or sickness; and a reduction in physical, emotional, cognitive and/or social functioning. The frequency of flares was variable, ranging from weekly flare events to less than two a year. Flares were generally short lived, lasting a few hours to a few days. The majority of flares were managed with parental input, with adolescents seeking medical support when a flare was perceived to be associated with infection in JIA. 4) As flares were brought under control, the pain returned to usual levels but the psychological symptoms outstayed the pain. Participants took actions to regain the level of normality experienced in daily life.
Conclusion
Participants had varying interpretations of what constitutes a flare, but the key finding was that flares are not only an increase in pain intensity, but other features are also required to change. These findings help to differentiate flares from normal variation in pain.
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Janet McDonagh
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Khanom S, McBeth J, Briggs M, Bakir E, McDonagh J. P36 Adolescents’ experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez416.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adolescents with chronic musculoskeletal pain experience pain that fluctuates within and across days. The aim of this review was to (i) synthesise the qualitative literature on adolescents’ experiences of fluctuating pain in musculoskeletal disorders, (ii) identify the concept of pain flare and how this may differ from daily fluctuation of pain, and (ii) identify knowledge gaps to inform the design of future research.
Methods
Six electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, OpenGrey and Scopus) and reference lists of relevant articles were searched from inception to June 2018. Articles were eligible for inclusion if they were qualitative studies exploring the experiences of pain in adolescents, aged between 10–19 years, diagnosed with juvenile idiopathic arthritis (JIA) and chronic idiopathic pain syndromes (CIPS). Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research (COREQ) framework, and studies were analysed using thematic synthesis.
Results
Of the 3,787 records identified, 32 studies were included from 11 countries. 536 young people with JIA or CIPS participated in the studies, of which 509 had a diagnosis of JIA, and 27 with CIPS. Interviews were conducted in 29 studies, with 9 studies also combining interviews with focus groups, observations, questionnaires, researcher journaling, visual depictions and diaries. Although all included studies reported adolescent’s experience of pain, only 19 studies provide insight into the impact of fluctuating pain on an individual’s life and lived experience. 21 studies included data from parents, siblings, health professionals and/or individuals with other chronic illnesses, but efforts were made to only extract data referring to or expressed by adolescents with JIA or CIPS. Ages of patients ranged from 3 to 23 years, but all studies averaged within the adolescent range. Principal findings were synthesised under three themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. These themes can be seen to describe a journey through which the adolescent experiences fluctuating pain and associated symptoms, encounters the challenges to lifestyle that fluctuating pain presents, followed by employing coping strategies to regain a sense of control of their lives and pain. Each stage is experienced differently depending on individual factors such as adolescents’ developmental status, pain condition, and duration of the pain experience.
Conclusion
Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It is not clear whether these symptoms and challenges are experienced as part of normal fluctuations in pain, or whether they reflect symptom exacerbations classified as flares. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their normal fluctuations in pain.
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ebru Bakir
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Janet McDonagh
- Centre for Epidemiology, Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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31
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Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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32
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Welsh VK, Clarson LE, Mallen CD, McBeth J. Multisite pain and self-reported falls in older people: systematic review and meta-analysis. Arthritis Res Ther 2019; 21:67. [PMID: 30795790 PMCID: PMC6387492 DOI: 10.1186/s13075-019-1847-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Multisite pain and falls are common in older people, and isolated studies have identified multisite pain as a potential falls risk factor. This study aims to synthesise published literature to further explore the relationship between multisite pain and falls and to quantify associated risks. Methods Bibliographic databases were searched from inception to December 2017. Studies of community-dwelling adults aged 50 years and older with a multisite pain measurement and a falls outcome were included. Two reviewers screened articles, undertook quality assessment and extracted data. Random-effects meta-analysis was used to pool the effect estimate (odds ratio (OR) and 95% confidence interval (95%CI)). Heterogeneity was assessed by I2; sensitivity analyses used adjusted risk estimates and exclusively longitudinal studies. Results The search identified 49,577 articles, 3145 underwent abstract review, 22 articles were included in the systematic review and 18 were included in the meta-analysis. The unadjusted pooled OR of 1.82 (95%CI 1.55–2.13), demonstrating that those reporting multisite pain are at increased risk of falls, is supported by the adjusted pooled OR of 1.56 (95%CI 1.39–1.74). Multisite pain predicts future falls risk (OR = 1.74 (95%CI 1.57–1.93)). For high-quality studies, those reporting multisite pain have double the odds of a future fall compared to their pain-free counterparts. Conclusion Multisite pain is associated with an increased future falls risk in community-dwelling older people. Increasing public awareness of multisite pain as a falls risk factor and advising health and social care professionals to identify older people with multisite pain to signpost accordingly will enable timely falls prevention strategies to be implemented. Electronic supplementary material The online version of this article (10.1186/s13075-019-1847-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria K Welsh
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Lorna E Clarson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
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Beukenhorst AL, Parkes MJ, Cook L, Barnard R, van der Veer SN, Little MA, Howells K, Sanders C, Sergeant JC, O'Neill TW, McBeth J, Dixon WG. Collecting Symptoms and Sensor Data With Consumer Smartwatches (the Knee OsteoArthritis, Linking Activity and Pain Study): Protocol for a Longitudinal, Observational Feasibility Study. JMIR Res Protoc 2019; 8:e10238. [PMID: 30672745 PMCID: PMC6366393 DOI: 10.2196/10238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/19/2018] [Accepted: 06/11/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Knee OsteoArthritis, Linking Activity and Pain (KOALAP) study is the first to test the feasibility of using consumer-grade cellular smartwatches for health care research. OBJECTIVE The overall aim was to investigate the feasibility of using consumer-grade cellular smartwatches as a novel tool to capture data on pain (multiple times a day) and physical activity (continuously) in patients with knee osteoarthritis. Additionally, KOALAP aimed to investigate smartwatch sensor data quality and assess whether engagement, acceptability, and user experience are sufficient for future large-scale observational and interventional studies. METHODS A total of 26 participants with self-diagnosed knee osteoarthritis were recruited in September 2017. All participants were aged 50 years or over and either lived in or were willing to travel to the Greater Manchester area. Participants received a smartwatch (Huawei Watch 2) with a bespoke app that collected patient-reported outcomes via questionnaires and continuous watch sensor data. All data were collected daily for 90 days. Additional data were collected through interviews (at baseline and follow-up) and baseline and end-of-study questionnaires. This study underwent full review by the University of Manchester Research Ethics Committee (#0165) and University Information Governance (#IGRR000060). For qualitative data analysis, a system-level security policy was developed in collaboration with the University Information Governance Office. Additionally, the project underwent an internal review process at Google, including separate reviews of accessibility, product engineering, privacy, security, legal, and protection regulation compliance. RESULTS Participants were recruited in September 2017. Data collection via the watches was completed in January 2018. Collection of qualitative data through patient interviews is still ongoing. Data analysis will commence when all data are collected; results are expected in 2019. CONCLUSIONS KOALAP is the first health study to use consumer cellular smartwatches to collect self-reported symptoms alongside sensor data for musculoskeletal disorders. The results of this study will be used to inform the design of future mobile health studies. Results for feasibility and participant motivations will inform future researchers whether or under which conditions cellular smartwatches are a useful tool to collect patient-reported outcomes alongside passively measured patient behavior. The exploration of associations between self-reported symptoms at different moments will contribute to our understanding of whether it may be valuable to collect symptom data more frequently. Sensor data-quality measurements will indicate whether cellular smartwatch usage is feasible for obtaining sensor data. Methods for data-quality assessment and data-processing methods may be reusable, although generalizability to other clinical areas should be further investigated. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10238.
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Affiliation(s)
- Anna L Beukenhorst
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthew J Parkes
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Louise Cook
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rebecca Barnard
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sabine N van der Veer
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
- Health eResearch Centre, The United Kingdom Farr Institute of Health Informatics Research, Manchester, United Kingdom
| | - Max A Little
- Mathematics Group, Aston University, Birmingham, United Kingdom
- Human Dynamics Group, Massachusetts Institute of Technology Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kelly Howells
- The National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Primary Care, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- The National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Terence W O'Neill
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - John McBeth
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - William G Dixon
- Arthritis Research United Kingdom Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Health eResearch Centre, The United Kingdom Farr Institute of Health Informatics Research, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
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O'Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol 2018; 32:312-326. [PMID: 30527434 DOI: 10.1016/j.berh.2018.10.007] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.
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Affiliation(s)
- Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul S McCabe
- Royal Oldham Hospital, Pennine Acute NHS Trust, Rochdale Rd, Oldham OL1 2JH, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Creed F, Tomenson B, Chew-Graham C, Macfarlane G, McBeth J. The associated features of multiple somatic symptom complexes. J Psychosom Res 2018; 112:1-8. [PMID: 30097128 DOI: 10.1016/j.jpsychores.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess whether two or more functional somatic symptom complexes (SSCs) showed stronger association with psychosocial correlates than single or no SSC after adjustment for depression/anxiety and general medical disorders. METHODS In a population-based sample we identified, by standardised questionnaire, participants with chronic widespread pain, chronic fatigue and irritable bowel syndrome, excluding those with a medical cause for pain/fatigue. We compared psychosocial variables in three groups: multiple (>1), single or no FSS, adjusting for depression/anxiety and general medical disorders using ordinal logistic regression. We evaluated whether multiple SSCs predicted health status 1 year later using multiple regression to adjust for confounders. RESULTS Of 1443 participants (58.0% response) medical records were examined in 990: 4.4% (n = 44) had 2 or 3 symptom complexes, 16.2% a single symptom complex. Many psychosocial adversities were significantly associated with number of SSCs in the expected direction but, for many, statistical significance was lost after adjustment for depression/anxiety and medical illness. Somatic symptoms, health anxiety, impairment and number of prior doctor visits remained significantly associated. Impaired health status 1 year later was predicted by multiple somatic symptom complexes even after adjustment for depression, anxiety, medical disorders and number of symptoms. CONCLUSIONS Depression, anxiety, medical illness and health anxiety, demonstrated an exposure-response relationship with number of somatic symptom complexes. These may be core features of all Functional Somatic Syndromes and may explain why number of somatic symptom complexes predicted subsequent health status. These features merit inclusion in prospective studies to ascertain causal relationships.
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Affiliation(s)
- Francis Creed
- Neuroscience and Mental Health, University of Manchester, UK.
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, West Midlands CLAHRC, Keele University, Newcastle ST5 5BG, UK
| | - Gary Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - John McBeth
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
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Costello R, Jacklin C, Jameson Evans M, McBeth J, Dixon WG. Representativeness of a digitally engaged population and a patient organisation population with rheumatoid arthritis and their willingness to participate in research: a cross-sectional study. RMD Open 2018; 4:e000664. [PMID: 29955383 PMCID: PMC6018858 DOI: 10.1136/rmdopen-2018-000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives To describe (1) the representativeness of (a) users of an online health community (HealthUnlocked.com (HU)) with rheumatoid arthritis (RA) and (b) paid members of an RA patient organisation, the National Rheumatoid Arthritis Society (NRAS), compared with the general RA population; and (2) the willingness of HU users with RA to participate in types of research (surveys, use of an app or activity tracker, and trials). Methods A pop-up survey was embedded on HU to determine the characteristics of users and their willingness to participate in research. An anonymous data set of NRAS member characteristics was provided by the NRAS (N=2044). To represent the general RA population, characteristics of people with RA were identified from the Clinical Practice Research Datalink (CPRD) (N=20 594). Cross-sectional comparisons were made across the three groups. Results Compared with CPRD, HU respondents (n=615) were significantly younger (49% aged below 55 years compared with 23% of CPRD patients), significantly more deprived (21% in the most deprived Townsend quintile compared with 12% of CPRD patients) and had more recent disease, with 62% diagnosed between 2010 and 2016 compared with 37% of CPRD patients. NRAS members were more similar to the CPRD, but significantly under-represented those aged 75 years or over and over-represented those aged 55–75 years compared with the CPRD. High proportions of HU users were willing to participate in future research of all types. Conclusions NRAS members were broadly representative of the general RA population. HU users were younger, more deprived and more recently diagnosed. HU users were willing to participate in most types of research.
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Affiliation(s)
- Ruth Costello
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Clare Jacklin
- National Rheumatoid Arthritis Society, Berkshire, UK
| | | | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Health eResearch Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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McBeth J. i010 Pain: not simply a question of disease control. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John McBeth
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UNITED KINGDOM
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Smith D, Wilkie R, Croft P, McBeth J. Pain and Mortality in Older Adults: The Influence of Pain Phenotype. Arthritis Care Res (Hoboken) 2018; 70:236-243. [DOI: 10.1002/acr.23268] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Diane Smith
- Arthritis Research UK Primary Care Centre Research Institute for Primary Care and Health Sciences Keele University Staffordshire UK
| | - Ross Wilkie
- Arthritis Research UK Primary Care Centre Research Institute for Primary Care and Health Sciences Keele University Staffordshire UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre Research Institute for Primary Care and Health Sciences Keele University Staffordshire UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, and Manchester Academic Health Sciences Centre University of Manchester Manchester UK
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Mason KJ, O’Neill TW, Lunt M, Jones AK, McBeth J. Psychosocial factors partially mediate the relationship between mechanical hyperalgesia and self-reported pain. Scand J Pain 2018; 18:59-69. [DOI: 10.1515/sjpain-2017-0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
Abstract
Background and aims:
Amplification of sensory signalling within the nervous system along with psychosocial factors contributes to the variation and severity of knee pain. Quantitative sensory testing (QST) is a non-invasive test battery that assesses sensory perception of thermal, pressure, mechanical and vibration stimuli used in the assessment of pain. Psychosocial factors also have an important role in explaining the occurrence of pain. The aim was to determine whether QST measures were associated with self-reported pain, and whether those associations were mediated by psychosocial factors.
Methods:
Participants with knee pain identified from a population-based cohort completed a tender point count and a reduced QST battery of thermal, mechanical and pressure pain thresholds, temporal summation, mechanical pain sensitivity (MPS), dynamic mechanical allodynia (DMA) and vibration detection threshold performed following the protocol by the German Research Network on Neuropathic Pain. QST assessments were performed at the most painful knee and opposite forearm (if pain-free). Participants were asked to score for their global and knee pain intensities within the past month (range 0–10), and complete questionnaire items investigating anxiety, depression, illness perceptions, pain catastrophising, and physical functioning. QST measures (independent variable) significantly correlated (Spearman’s rho) with self-reported pain intensity (dependent variable) were included in structural equation models with psychosocial factors (latent mediators).
Results:
Seventy-two participants were recruited with 61 participants (36 women; median age 64 years) with complete data included in subsequent analyses. Tender point count was significantly correlated with global pain intensity. DMA at the knee and MPS at the most painful knee and opposite pain-free forearm were significantly correlated with both global pain and knee pain intensities. Psychosocial factors including pain catastrophising sub-scales (rumination and helplessness) and illness perceptions (consequences and concern) were significant partial mediators of the association with global pain intensity when loaded on to a latent mediator for: tender point count [75% total effect; 95% confidence interval (CI) 22%, 100%]; MPS at the knee (49%; 12%, 86%); and DMA at the knee (63%; 5%, 100%). Latent psychosocial factors were also significant partial mediators of the association between pain intensity at the tested knee with MPS at the knee (30%; 2%, 58%), but not for DMA at the knee.
Conclusions:
Measures of mechanical hyperalgesia at the most painful knee and pain-free opposite forearm were associated with increased knee and global pain indicative of altered central processing. Psychosocial factors were significant partial mediators, highlighting the importance of the central integration of emotional processing in pain perception.
Implications:
Associations between mechanical hyperalgesia at the forearm and knee, psychosocial factors and increased levels of clinical global and knee pain intensity provide evidence of altered central processing as a key mechanism in knee pain, with psychological factors playing a key role in the expression of clinical pain.
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Affiliation(s)
- Kayleigh J. Mason
- BADBIR, Rutherford House (Unit 1) , Manchester Science Park, 40 Pencroft Way , Manchester, M15 6SZ , UK , Tel.: +44 (0) 161 306 1908, Fax: +44 (0) 161 306 1912
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
| | - Terence W. O’Neill
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
- Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - Mark Lunt
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
| | - Anthony K.P. Jones
- Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
- Human Pain Research Group , Division of Neuroscience and Experimental Psychology , The University of Manchester , Manchester , UK
| | - John McBeth
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
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Druce KL, Cordingley L, Short V, Moore S, Hellman B, James B, Lunt M, Kyle SD, Dixon WG, McBeth J. Quality of life, sleep and rheumatoid arthritis (QUASAR): a protocol for a prospective UK mHealth study to investigate the relationship between sleep and quality of life in adults with rheumatoid arthritis. BMJ Open 2018; 8:e018752. [PMID: 29374666 PMCID: PMC5829597 DOI: 10.1136/bmjopen-2017-018752] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People with rheumatoid arthritis (RA) frequently report reduced health-related quality of life (HRQoL), the impact one's health has on physical, emotional and social well-being. There are likely numerous causes for poor HRQoL, but people with RA have identified sleep disturbances as a key contributor to their well-being. This study will identify sleep/wake rhythm-associated parameters that predict HRQoL in patients with RA. METHODS AND ANALYSIS This prospective cohort study will recruit 350 people with RA, aged 18 years or older. Following completion of a paper-based baseline questionnaire, participants will record data on 10 symptoms including pain, fatigue and mood two times a day for 30 days using a study-specific mobile application (app). A triaxial accelerometer will continuously record daytime activity and estimate evening sleep parameters over the 30 days. Every 10 days following study initiation, participants will complete a questionnaire that measures disease specific (Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF)) and generic (WHOQOL-BREF) quality of life. A final questionnaire will be completed at 60 days after entering the study. The primary outcomes are the AIMS2-SF and WHOQOL-BREF. Structural equation modelling and latent trajectory models will be used to examine the relationship between sleep/wake rhythm-associated parameters and HRQoL, over time. ETHICS AND DISSEMINATION Results from this study will be disseminated at regional and international conferences, in peer-reviewed journals and Patient and Public Engagement events, as appropriate.
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Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Manchester University, Manchester, UK
| | - Vicky Short
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Susan Moore
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | | | | | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Will G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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41
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Beukenhorst AL, Sergeant JC, Little MA, McBeth J, Dixon WG. Consumer Smartwatches for Collecting Self-Report and Sensor Data: App Design and Engagement. Stud Health Technol Inform 2018; 247:291-295. [PMID: 29677969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Longitudinal data from patients' natural environments would benefit chronic disease care, yet most devices cannot collect sensor data alongside patient-reported outcomes. Here we describe Koalap, a consumer cellular smartwatch application that collects patient-reported outcomes alongside physical activity data from various sensors. Additionally, we show preliminary results indicating high engagement of our 26 participants with knee osteoarthritis. Our future work will show whether data collection with consumer smartwatches is feasible in terms of user engagement, acceptability, data quality and consistency.
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Affiliation(s)
| | - Jamie C Sergeant
- ARUK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Max A Little
- Department of Mathematics, Aston University, Birmingham, UK
| | - John McBeth
- ARUK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - William G Dixon
- ARUK Centre for Epidemiology, University of Manchester, Manchester, UK
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Healey EL, Jinks C, Foster NE, Chew-Graham CA, Pincus T, Hartshorne L, Cooke K, Nicholls E, Proctor J, Lewis M, Dent S, Wathall S, Hay EM, McBeth J. The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care 2017; 16:118-132. [PMID: 29218808 DOI: 10.1002/msc.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.
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Affiliation(s)
- E L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - T Pincus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - L Hartshorne
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Cooke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Proctor
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - M Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Dent
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Lacey RJ, Wilkie R, Wynne-Jones G, Jordan JL, Wersocki E, McBeth J. Evidence for strategies that improve recruitment and retention of adults aged 65 years and over in randomised trials and observational studies: a systematic review. Age Ageing 2017; 46:895-903. [PMID: 28481964 DOI: 10.1093/ageing/afx057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Background adults aged ≥65 years are often excluded from health research studies. Lack of representation reduces generalisability of treatments for this age group. Objective to evaluate the effectiveness of strategies that improve recruitment and retention of adults aged ≥65 in observational studies and randomised controlled trials (RCTs). Methods searches conducted in 10 databases for RCTs of recruitment and retention strategies in RCTs or observational studies. Two reviewers screened abstracts and full-text articles for eligibility and extracted data. Studies without separate data for adults aged ≥65 were discarded. Risk of bias assessed using the Cochrane Risk of Bias tool. Results were synthesised narratively. Results thirty-two studies were included in the review (n = 75,444). Twelve studies had low risk of bias, of which 10 had successful strategies including: Opt-out versus opt-in increased recruitment (13.6% (n = 261)-18.7% (n = 36) difference; two studies); Advance notification increased retention (1.6% difference, OR 1.45; 95% CI 1.01, 2.10, one study (n = 2,686); 9.1% difference at 4 months, 1.44; 1.08, 1.92, one study (n = 753)); Hand-delivered versus postal surveys increased response (25.1% difference; X2 = 11.40, P < 0.01; one study (n = 139)); Open randomised design versus blinded RCT increased recruitment (1.56; 1.05, 2.33) and retention (13.9% difference; 3.1%, 24.6%) in one study (n = 538). Risk of bias was high/unclear for studies in which incentives or shorter length questionnaires increased response. Discussion in low risk of bias studies, few of the strategies that improved participation in older adults had been tested in ≥1 study. Opt-out and advance notification strategies improved recruitment and retention, respectively, although an opt-out approach may have ethical limitations. Evidence from single studies limits the generalisability of other strategies.
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Affiliation(s)
- Rosie J Lacey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Ross Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Gwenllian Wynne-Jones
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Joanne L Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Emily Wersocki
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - John McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Druce KL, McBeth J, van der Veer SN, Selby DA, Vidgen B, Georgatzis K, Hellman B, Lakshminarayana R, Chowdhury A, Schultz DM, Sanders C, Sergeant JC, Dixon WG. Recruitment and Ongoing Engagement in a UK Smartphone Study Examining the Association Between Weather and Pain: Cohort Study. JMIR Mhealth Uhealth 2017; 5:e168. [PMID: 29092810 PMCID: PMC5688244 DOI: 10.2196/mhealth.8162] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The huge increase in smartphone use heralds an enormous opportunity for epidemiology research, but there is limited evidence regarding long-term engagement and attrition in mobile health (mHealth) studies. OBJECTIVE The objective of this study was to examine how representative the Cloudy with a Chance of Pain study population is of wider chronic-pain populations and to explore patterns of engagement among participants during the first 6 months of the study. METHODS Participants in the United Kingdom who had chronic pain (≥3 months) and enrolled between January 20, 2016 and January 29, 2016 were eligible if they were aged ≥17 years and used the study app to report any of 10 pain-related symptoms during the study period. Participant characteristics were compared with data from the Health Survey for England (HSE) 2011. Distinct clusters of engagement over time were determined using first-order hidden Markov models, and participant characteristics were compared between the clusters. RESULTS Compared with the data from the HSE, our sample comprised a higher proportion of women (80.51%, 5129/6370 vs 55.61%, 4782/8599) and fewer persons at the extremes of age (16-34 and 75+). Four clusters of engagement were identified: high (13.60%, 865/6370), moderate (21.76%, 1384/6370), low (39.35%, 2503/6370), and tourists (25.44%, 1618/6370), between which median days of data entry ranged from 1 (interquartile range; IQR: 1-1; tourist) to 149 (124-163; high). Those in the high-engagement cluster were typically older, whereas those in the tourist cluster were mostly male. Few other differences distinguished the clusters. CONCLUSIONS Cloudy with a Chance of Pain demonstrates a rapid and successful recruitment of a large, representative, and engaged sample of people with chronic pain and provides strong evidence to suggest that smartphones could provide a viable alternative to traditional data collection methods.
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Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Sabine N van der Veer
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - David A Selby
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Bertie Vidgen
- Oxford Internet Institute, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Afiqul Chowdhury
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - David M Schultz
- Centre for Atmospheric Science, School of Earth and Environmental Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- Medical Sociology, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Abstract
OBJECTIVES To identify the side effects most important to glucocorticoid (GC) users through a survey of a UK online health community (Healthunlocked.com). DESIGN Online cross-sectional survey. SETTING Participants were recruited through Healthunlocked.com, an online social network for health. PARTICIPANTS Adults who were currently taking GCs, or had taken GCs in the past month. METHOD Responders scored the importance of listed side effects from 1 to 10, with 10 being of high importance to them. For each side effect, histograms were plotted, and the median rating and IQR were determined. Side effects were ranked by median ranking (largest to smallest) and then IQR (smallest to largest). The scores were categorised as low (scores 1-3), medium (scores 4-7) and high (scores 8-10) importance. RESULTS 604 responders completed the survey. Histograms of side effect scores showed a skew towards high importance for weight gain, a U-shaped distribution for cardiovascular disease (CVD), diabetes, eye disease and infections, and a skew towards low importance for acne. When ranked, the side effect of most importance to responders was weight gain (median score=9, IQR 6-10) followed by insomnia and moon face with equal median score (8) and IQR (5-10). Three serious side effects, CVD, diabetes and infections, were ranked of lower importance overall but had wide ranging scores (median score=8, IQR 1-10). CONCLUSIONS The three most highly rated side effects were not clinically serious but remained important to patients, perhaps reflecting their impact on quality of life and high prevalence. This should be taken into consideration when discussing treatment options and planning future GC safety studies.
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Affiliation(s)
- Ruth Costello
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rikesh Patel
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jennifer Humphreys
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Health eResearch Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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46
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Druce KL, van der Veer SN, Beukenhorst AL, Selby DA, Vidgen B, Georgatzis K, Laksshminarayana R, Schultz DM, McBeth J, Sergeant JC, Dixon WG. PAIN299. ENGAGEMENT IN A UNITED KINGDOM SMARTPHONE STUDY EXAMINING THE ASSOCATION BETWEEN WEATHER AND PAIN: PRELIMINARY RESULTS FROM CLOUDY WITH A CHANCE OF PAIN. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Costello R, Patel R, Humphreys J, McBeth J, Dixon W. 209. PATIENT PERCEPTIONS OF GLUCOCORTICOID SIDE EFFECTS: A SURVEY OF USERS IN AN ONLINE HEALTH COMMUNITY. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48
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Reade S, Spencer K, Sergeant JC, Sperrin M, Schultz DM, Ainsworth J, Lakshminarayana R, Hellman B, James B, McBeth J, Sanders C, Dixon WG. Cloudy with a Chance of Pain: Engagement and Subsequent Attrition of Daily Data Entry in a Smartphone Pilot Study Tracking Weather, Disease Severity, and Physical Activity in Patients With Rheumatoid Arthritis. JMIR Mhealth Uhealth 2017; 5:e37. [PMID: 28341616 PMCID: PMC5384994 DOI: 10.2196/mhealth.6496] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing ownership of smartphones provides major opportunities for epidemiological research through self-reported and passively collected data. OBJECTIVE This pilot study aimed to codesign a smartphone app to assess associations between weather and joint pain in patients with rheumatoid arthritis (RA) and to study the success of daily self-reported data entry over a 60-day period and the enablers of and barriers to data collection. METHODS A patient and public involvement group (n=5) and 2 focus groups of patients with RA (n=9) supported the codesign of the app collecting self-reported symptoms. A separate "capture app" was designed to collect global positioning system (GPS) and continuous raw accelerometer data, with the GPS-linking providing local weather data. A total of 20 patients with RA were then recruited to collect daily data for 60 days, with entry and exit interviews. Of these, 17 were loaned an Android smartphone, whereas 3 used their own Android smartphones. RESULTS Of the 20 patients, 6 (30%) withdrew from the study: 4 because of technical challenges and 2 for health reasons. The mean completion of daily entries was 68% over 2 months. Patients entered data at least five times per week 65% of the time. Reasons for successful engagement included a simple graphical user interface, automated reminders, visualization of data, and eagerness to contribute to this easily understood research question. The main barrier to continuing engagement was impaired battery life due to the accelerometer data capture app. For some, successful engagement required ongoing support in using the smartphones. CONCLUSIONS This successful pilot study has demonstrated that daily data collection using smartphones for health research is feasible and achievable with high levels of ongoing engagement over 2 months. This result opens important opportunities for large-scale longitudinal epidemiological research.
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Affiliation(s)
- Samuel Reade
- Manchester Medical School, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Karen Spencer
- Manchester Academic Health Science Centre, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Manchester Academic Health Science Centre, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom.,National Institute of Health Research, Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Sperrin
- The Farr Institute @ Health eResearch Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - David M Schultz
- School of Earth, Atmospheric & Environmental Sciences, The University of Manchester, United Kingdom
| | - John Ainsworth
- National Institute of Health Research, Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Ben James
- uMotif Limited, London, United Kingdom
| | - John McBeth
- Manchester Academic Health Science Centre, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- Manchester Academic Health Science Centre, Centre for Primary Care, The University of Manchester, Manchester, United Kingdom
| | - William G Dixon
- Manchester Academic Health Science Centre, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom.,The Farr Institute @ Health eResearch Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Salford Royal NHS Foundation Trust, Rheumatology Department, Salford, United Kingdom
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49
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Costello R, Patel R, Humphreys J, McBeth J, Dixon WG. Timing of glucocorticoid administration: a cross-sectional survey of glucocorticoid users in an online social network for health. Rheumatology (Oxford) 2017; 56:494-495. [PMID: 27994092 PMCID: PMC5410988 DOI: 10.1093/rheumatology/kew421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ruth Costello
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences
| | - Rikesh Patel
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences
| | - Jennifer Humphreys
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences.,Health eResearch Centre, Manchester Academic Health Science Centre, University of Manchester.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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50
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Baker S, McBeth J, Chew-Graham CA, Wilkie R. Musculoskeletal pain and co-morbid insomnia in adults; a population study of the prevalence and impact on restricted social participation. BMC Fam Pract 2017; 18:17. [PMID: 28173767 PMCID: PMC5297165 DOI: 10.1186/s12875-017-0593-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022]
Abstract
Background Comorbidity is common in patients consulting in primary care. Musculoskeletal pain and insomnia each increase the risk of the other. Co-occurrence may pose an increased burden on well-being. However, the prevalence and impact of co-existing pain and insomnia in adults living in the community who may present to primary care is unclear. The aim of this study was to report the prevalence of pain and insomnia in adults registered with primary care, and to examine the impact of co-occurrence on social activities. Methods This population-based prospective cohort study of adults aged ≥18 years (n = 1181) used health survey data collected via baseline and 12 month follow-up questionnaires. Baseline data on pain, insomnia (4 symptoms: delayed sleep onset, difficulty maintaining sleep, early waking and non-restorative sleep) and putative confounders and social activity restriction at follow up was collected. Associations between baseline pain, insomnia and restricted social activities (RSA) at 12 months were examined using logistic regression, with adjustment for confounders. Interaction terms between pain and each insomnia symptom were examined in final models. Results Mean respondent age was 49.6 (SD ± 15.2) years, 55.7% were female. At baseline, 880 (74.5%) reported pain, 122 (10.3%) delayed sleep onset, 298 (25.2%) difficulty maintaining sleep, 188 (15.9%) early wakening, and 215 (18.2%) reported non-restorative sleep. At follow-up 200 (16.9%) reported RSA. Pain and each insomnia symptom were associated with RSA at 12 month follow-up; pain [unadjusted odds ratio (OR:2.3;95%CI:1.5,3.5), delayed sleep onset (OR:6.1;95%CI:4.0,9.1), difficulty maintaining sleep (OR:3.2;95%CI:2.3,4.4), early wakening (OR:4.1;95%CI:2.9,5.9), and non-restorative sleep (OR:4.0; 95%CI:2.8,5.8). Only delayed sleep onset (OR:2.6;95%C:1.5,4.5) remained significantly associated with restricted social activities in the fully adjusted model. There was a significant interaction between pain and delayed sleep onset (OR:0.3;95%CI:0.1,0.99; p = .049) and restricted social activity at 12 months in the final multivariable model. Conclusions Pain and insomnia commonly co-occur, resulting in greater impact upon subsequent functional ability. Delayed sleep onset is the insomnia symptom most strongly associated with reduced functional ability. Clinicians should be aware of the common co-occurrence of insomnia symptoms, inquire about sleep in patients consulting with pain, and offer interventions that target both sleep and pain.
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Affiliation(s)
- Shula Baker
- Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK.
| | - John McBeth
- Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, M13 9PT, UK
| | - Carolyn A Chew-Graham
- Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK.,Collaboration for Leadership in Applied Health Research and Care, West Midlands, Birmingham, UK
| | - Ross Wilkie
- Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK
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