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Lynch M, Bucknall M, Jagger C, Kingston A, Wilkie R. Demographic, health, physical activity, and workplace factors are associated with lower healthy working life expectancy and life expectancy at age 50. Sci Rep 2024; 14:5936. [PMID: 38467680 PMCID: PMC10928117 DOI: 10.1038/s41598-024-53095-z] [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: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 03/13/2024] Open
Abstract
Although retirement ages are rising in the United Kingdom and other countries, the average number of years people in England can expect to spend both healthy and work from age 50 (Healthy Working Life Expectancy; HWLE) is less than the number of years to the State Pension age. This study aimed to estimate HWLE with the presence and absence of selected health, socio-demographic, physical activity, and workplace factors relevant to stakeholders focusing on improving work participation. Data from 11,540 adults in the English Longitudinal Study of Ageing were analysed using a continuous time 3-state multi-state model. Age-adjusted hazard rate ratios (aHRR) were estimated for transitions between health and work states associated with individual and combinations of health, socio-demographic, and workplace factors. HWLE from age 50 was 3.3 years fewer on average for people with pain interference (6.54 years with 95% confidence interval [6.07, 7.01]) compared to those without (9.79 [9.50, 10.08]). Osteoarthritis and mental health problems were associated with 2.2 and 2.9 fewer healthy working years respectively (HWLE for people without osteoarthritis: 9.50 years [9.22, 9.79]; HWLE with osteoarthritis: 7.29 years [6.20, 8.39]; HWLE without mental health problems: 9.76 years [9.48, 10.05]; HWLE with mental health problems: 6.87 years [1.58, 12.15]). Obesity and physical inactivity were associated with 0.9 and 2.0 fewer healthy working years respectively (HWLE without obesity: 9.31 years [9.01, 9.62]; HWLE with obesity: 8.44 years [8.02, 8.86]; HWLE without physical inactivity: 9.62 years [9.32, 9.91]; HWLE with physical inactivity: 7.67 years [7.23, 8.12]). Workers without autonomy at work or with inadequate support at work were expected to lose 1.8 and 1.7 years respectively in work with good health from age 50 (HWLE for workers with autonomy: 9.50 years [9.20, 9.79]; HWLE for workers lacking autonomy: 7.67 years [7.22, 8.12]; HWLE for workers with support: 9.52 years [9.22, 9.82]; HWLE for workers with inadequate support: 7.86 years [7.22, 8.12]). This study identified demographic, health, physical activity, and workplace factors associated with lower HWLE and life expectancy at age 50. Identifying the extent of the impact on healthy working life highlights these factors as targets and the potential to mitigate against premature work exit is encouraging to policy-makers seeking to extend working life as well as people with musculoskeletal and mental health conditions and their employers. The HWLE gaps suggest that interventions are needed to promote the health, wellbeing and work outcomes of subpopulations with long-term health conditions.
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Affiliation(s)
- Marty Lynch
- School of Medicine, Keele University, David Weatherall Building, Newcastle under Lyme, ST5 5BG, UK.
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.
| | - Milica Bucknall
- School of Medicine, Keele University, David Weatherall Building, Newcastle under Lyme, ST5 5BG, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ross Wilkie
- School of Medicine, Keele University, David Weatherall Building, Newcastle under Lyme, ST5 5BG, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Archer L, Relton SD, Akbari A, Best K, Bucknall M, Conroy S, Hattle M, Hollinghurst J, Humphrey S, Lyons RA, Richards S, Walters K, West R, van der Windt D, Riley RD, Clegg A. Development and external validation of the eFalls tool: a multivariable prediction model for the risk of ED attendance or hospitalisation with a fall or fracture in older adults. Age Ageing 2024; 53:afae057. [PMID: 38520142 PMCID: PMC10960070 DOI: 10.1093/ageing/afae057] [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: 12/07/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Falls are common in older adults and can devastate personal independence through injury such as fracture and fear of future falls. Methods to identify people for falls prevention interventions are currently limited, with high risks of bias in published prediction models. We have developed and externally validated the eFalls prediction model using routinely collected primary care electronic health records (EHR) to predict risk of emergency department attendance/hospitalisation with fall or fracture within 1 year. METHODS Data comprised two independent, retrospective cohorts of adults aged ≥65 years: the population of Wales, from the Secure Anonymised Information Linkage Databank (model development); the population of Bradford and Airedale, England, from Connected Bradford (external validation). Predictors included electronic frailty index components, supplemented with variables informed by literature reviews and clinical expertise. Fall/fracture risk was modelled using multivariable logistic regression with a Least Absolute Shrinkage and Selection Operator penalty. Predictive performance was assessed through calibration, discrimination and clinical utility. Apparent, internal-external cross-validation and external validation performance were assessed across general practices and in clinically relevant subgroups. RESULTS The model's discrimination performance (c-statistic) was 0.72 (95% confidence interval, CI: 0.68 to 0.76) on internal-external cross-validation and 0.82 (95% CI: 0.80 to 0.83) on external validation. Calibration was variable across practices, with some over-prediction in the validation population (calibration-in-the-large, -0.87; 95% CI: -0.96 to -0.78). Clinical utility on external validation was improved after recalibration. CONCLUSION The eFalls prediction model shows good performance and could support proactive stratification for falls prevention services if appropriately embedded into primary care EHR systems.
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Affiliation(s)
- Lucinda Archer
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Samuel D Relton
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Kate Best
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Simon Conroy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Miriam Hattle
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Joe Hollinghurst
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Sara Humphrey
- Bradford District and Craven Health and Care Partnership, Bradford, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Suzanne Richards
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Walters
- Primary Care and Population Health, University College London, London, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Richard D Riley
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Abstract
OBJECTIVE Summarise longitudinal observational studies to determine whether diabetes (types 1 and 2) is a risk factor for frozen shoulder. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, AMED, PsycINFO, Web of Science Core Collection, CINAHL, Epistemonikos, Trip, PEDro, OpenGrey and The Grey Literature Report were searched on January 2019 and updated in June 2021. Reference screening and emailing professional contacts were also used. ELIGIBILITY CRITERIA Longitudinal observational studies that estimated the association between diabetes and developing frozen shoulder. DATA EXTRACTION AND SYNTHESIS Data extraction was completed by one reviewer and independently checked by another using a predefined extraction sheet. Risk of bias was judged using the Quality In Prognosis Studies tool. For studies providing sufficient data, random-effects meta-analysis was used to derive summary estimates of the association between diabetes and the onset of frozen shoulder. RESULTS A meta-analysis of six case-control studies including 5388 people estimated the odds of developing frozen shoulder for people with diabetes to be 3.69 (95% CI 2.99 to 4.56) times the odds for people without diabetes. Two cohort studies were identified, both suggesting diabetes was associated with frozen shoulder, with HRs of 1.32 (95% CI 1.22 to 1.42) and 1.67 (95% CI 1.46 to 1.91). Risk of bias was judged as high in seven studies and moderate in one study. CONCLUSION People with diabetes are more likely to develop frozen shoulder. Risk of unmeasured confounding was the main limitation of this systematic review. High-quality studies are needed to confirm the strength of, and understand reasons for, the association. PROSPERO REGISTRATION NUMBER CRD42019122963.
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Affiliation(s)
- Brett Paul Dyer
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Claire Burton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Danielle van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Milica Bucknall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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Lynch M, Bucknall M, Jagger C, Wilkie R. Projections of healthy working life expectancy in England to the year 2035. Nat Aging 2022; 2:13-18. [PMID: 37118357 DOI: 10.1038/s43587-021-00161-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/06/2021] [Indexed: 04/30/2023]
Abstract
UK state pension age is rising in response to life expectancy gains but population health and job opportunities may not be sufficient to achieve extended working lives1-3. This study aimed to estimate future trends in healthy working life expectancy (HWLE) from age 50 to 75 for men and women in England. Using the 'intercensal' health expectancy approach, annual period HWLE from 1996 to 2014 was estimated using cross-sectional Health Survey for England data and mortality statistics4-7. HWLE projections until the year 2035 were estimated from Lee-Carter forecasts of transition rates8. Projections of life expectancy from age 50 showed gains averaging 10.7 weeks (0.21 years) and 6.4 weeks (0.12 years) per calendar year between 2015 and 2035 for men and women respectively. HWLE has been extending in England but gains are projected to slow to an average of 1 week per year for men (0.02 years) and 2.8 weeks (0.05 years) per year for women between 2015 and 2035. Modest projected HWLE gains and the widening gap between HWLE and life expectancy from age 50 suggest that working lives are not extending in line with policy goals. Further research should identify factors that increase healthy working life.
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Affiliation(s)
- Marty Lynch
- School of Medicine, Keele University, Keele, UK.
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.
| | | | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ross Wilkie
- School of Medicine, Keele University, Keele, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Wynne-Jones G, Myers H, Hall A, Littlewood C, Hennings S, Saunders B, Bucknall M, Jowett S, Riley R, Wathall S, Heneghan C, Cook J, Pincus T, Mallen C, Roddy E, Foster N, Beard D, Lewis J, Rees JL, Higginbottom A, van der Windt D. Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol. BMJ Open 2021; 11:e052758. [PMID: 34535486 PMCID: PMC8451291 DOI: 10.1136/bmjopen-2021-052758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain. METHODS AND ANALYSIS The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options. ETHICS AND DISSEMINATION The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites. TRIAL REGISTRATION NUMBER ISRCTN46948079.
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Affiliation(s)
| | - Helen Myers
- Clinical Trials Unit, Keele University, Keele, UK
| | - Alison Hall
- School of Medicine, Keele University, Keele, UK
| | - Chris Littlewood
- School of Medicine, Keele University, Keele, UK
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - S Hennings
- Clinical Trials Unit, Keele University, Keele, UK
| | | | | | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | | | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Johanna Cook
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Tamar Pincus
- Psychology, Royal Hollaway University of London, London, UK
| | | | | | - Nadine Foster
- School of Medicine, Keele University, Keele, UK
- STARS Education and Research Alliance, The University of Queensland, Saint Lucia, Queensland, Australia
| | - David Beard
- Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Central London Community Healthcare NHS Trust, London, UK
| | - J L Rees
- Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Lynch M, Bucknall M, Jagger C, Wilkie R. OP0259-HPR THE EFFECT OF OSTEOARTHRITIS ON HEALTHY WORKING LIFE EXPECTANCY AT AGE 50 IN ENGLAND. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Retirement ages are rising in many countries due to population ageing and increasing life expectancy. However, poor health, comorbidity and workplace factors are major reasons for work absence and it is unclear if people in later working-age life (age ≥50) are able to work for longer. Osteoarthritis (OA), the most common joint condition in adults, is the fastest increasing major health condition globally and is a leading cause of disability (especially in adults age ≥50).Objectives:We aimed to estimate healthy working life expectancy (HWLE; defined as the average number of years that adults from age 50 can expect to be healthy and in paid work) for adults with and without osteoarthritis and investigate the role of mental health problems as a comorbidity and the role of workplace factors through examining whether there is a sense of having any control over what happens at work.Methods:Longitudinal survey data of adults aged ≥50 years were used from six waves (2002-2013) of the English Longitudinal Study of Ageing with linked mortality data from the National Health Service Central Register. HWLE was defined using two self-report variables; health was defined as no long-standing illness or no activity limitation if long-standing illness was present, and work was defined being in employment or self-employment. OA status was identified by self-report of ever receiving a diagnosis from a doctor. Mental health and control of work were measured by self-report. Continuous-time multistate models with three states (healthy and working [state 1], other alive [2], dead [3]) were fitted in R (version 3.6.1) to investigate factors driving transitions out of the healthy and working state. Models included age and combinations of sex, OA, control at work, and mental health problems. Age-adjusted hazards of transitions between states were estimated using the ‘msm’ R package. HWLE for adults with different factors (OA, control of work, mental health) was estimated with the ‘elect’ R package using models fitted with ‘msm’. Missing data was handled using multiple imputation by predictive mean matching.Results:There were 11,540 adults with at least two observations (including survey and mortality data) for the study period (5251 males, 6289 females). Life expectancy at age 50 was 29.7 years for men and 33.4 years for women with HWLE being 9.9 years (men) and 8.3 years (women). HWLE at age 50 for adults with osteoarthritis was 7.3 years (men: 8.2, women: 6.8), and for adults without osteoarthritis was higher at 9.9 years (men: 10.6, women: 9.1). After adjusting for age, the instantaneous risk of ceasing to be both healthy and in work (not due to death) for people with OA was 1.5 times that of people without OA (hazard rate ratio 1.5 with 95% CI [1.3, 1.6]). For adults without OA, HWLE at age 50 was 13.2 years if they felt they had control at work and 4.1 years without control at work, whilst for adults with OA, HWLE was 10.4 years if they felt they had control at work and 3.1 years without. The effect of mental health problems as a comorbidity on HWLE was smaller; for adults without OA, HWLE at age 50 was 11.0 years for those without mental health problems and 8.3 years for those with, whilst for adults with OA, HWLE was 8.6 years for those without mental health problems and 6.2 years with.Conclusion:While the average HWLE for men and women in England is lower than State Pension age, HWLE at age 50 is even lower (by approximately 25%) in adults with OA compared to adults without OA. Poor mental health further reduces HWLE. However, good quality work environments significantly lessen the impact of osteoarthritis (there is a 7.3 year difference in HWLE for those with OA who do and do not experience control at work). These results suggest that interventions and policies that create appropriate job opportunities and supportive workplaces for older workers with health conditions are key to the feasibility and success of extended working life policies.Disclosure of Interests:None declared
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Hider SL, Bucknall M, Jinks C, Cooke K, Cooke K, Desilva EE, Finney AG, Healey EL, Herron D, Machin AR, Mallen CD, Wathall S, Chew-Graham CA. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot Feasibility Stud 2021; 7:9. [PMID: 33407943 PMCID: PMC7786467 DOI: 10.1186/s40814-020-00750-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. METHODS A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist. RESULTS 453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified. CONCLUSIONS The findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training. TRIAL REGISTRATION ISRCTN, ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK. .,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK.
| | - Milica Bucknall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Erandie Ediriweera Desilva
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Andrew G Finney
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, UK
| | - Emma L Healey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Daniel Herron
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Annabelle R Machin
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
| | - Simon Wathall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
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Parker M, Bucknall M, Jagger C, Wilkie R. Population-based estimates of healthy working life expectancy in England at age 50 years: analysis of data from the English Longitudinal Study of Ageing. Lancet Public Health 2020; 5:e395-e403. [PMID: 32619541 DOI: 10.1016/s2468-2667(20)30114-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Retirement ages are rising in many countries to offset the challenges of population ageing, but people's capacity to work for more years in their later working life (>50 years) is unclear. We aimed to estimate healthy working life expectancy in England. METHODS This analysis included adults aged 50 years and older from six waves (2002-13) of the English Longitudinal Study of Ageing (ELSA), with linked mortality data. Healthy working life expectancy was defined as the average number of years expected to be spent healthy (no limiting long-standing illness) and in paid work (employment or self-employment) from age 50 years. Healthy working life expectancy was estimated for England overall and stratified by sex, educational attainment, deprivation level, occupation type, and region by use of interpolated Markov chain multi-state modelling. FINDINGS There were 15 284 respondents (7025 men and 8259 women) with survey and mortality data for the study period. Healthy working life expectancy at age 50 years was on average 9·42 years (10·94 years [95% CI 10·65-11·23] for men and 8·25 years [7·92-8·58] for women) and life expectancy was 31·76 years (30·05 years for men and 33·49 years for women). The number of years expected to be spent unhealthy and in work from age 50 years was 1·84 years (95% CI 1·74-1·94) in England overall. Population subgroups with the longest healthy working life expectancy were the self-employed (11·76 years [95% CI 10·76-12·76]) or those with non-manual occupations (10·32 years [9·95-10·69]), those with a tertiary education (11·27 years [10·74-11·80]), those living in southern England (10·73 years [10·16-11·30] in the South East and 10·51 years [9·80-11·22] in the South West), and those living in the least deprived areas (10·53 years [10·06-10·99]). INTERPRETATION Healthy working life expectancy at age 50 years in England is below the remaining years to State Pension age. Older workers of lower socioeconomic status and in particular regions in England might benefit from proactive approaches to improve health, workplace environments, and job opportunities to improve their healthy working life expectancy. Continued monitoring of healthy working life expectancy would provide further examination of the success of such approaches and that of policies to extend working lives. FUNDING Economic and Social Research Council.
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Affiliation(s)
- Marty Parker
- School of Primary, Community and Social Care, Keele University, Newcastle under Lyme, UK.
| | - Milica Bucknall
- School of Primary, Community and Social Care, Keele University, Newcastle under Lyme, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ross Wilkie
- School of Primary, Community and Social Care, Keele University, Newcastle under Lyme, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Hider S, Machin A, Bucknall M, Cooke K, Jinks C, Healey E, Finney A, Cooke K, Wathall S, Mallen C, Chew-Graham C. P146 Undertaking an integrated nurse led review (INCLUDE) for patients with inflammatory conditions: does it change management of morbidities? Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.141] [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
People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care.
Methods
A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient management plan, including signposting to additional services as appropriate. Medical record review was undertaken (in consenting participants) at 12 months. We compared primary care contacts (which include consultations, letters and test results) and prescribing rates (of antihypertensives, lipid-lowering, osteoporosis and antidepressant/anxiety medication) at baseline and 12 months.
Results
333 patients participated in the study. The mean (SD) age was 68.2 (13.4) years and 200 (60%) were female. Of these 172 (52%) had RA and 88 (26%) had PMR. 154 (46%) reported high blood pressure, 70 (21%) existing anxiety/depression and 37 (11%) osteoporosis. Medical record data was available for 299/333 participants. Participants in intervention practices had more primary care contacts (mean 29 vs 22). Over the 12-month follow-up, there was higher prescribing of all medication classes in participants in intervention practices (see Table), particularly so for osteoporosis medication (baseline 29% vs 12 month 46%).
Conclusion
Nurse-delivered integrated reviews for patients with IRCs identified a significant comorbidity burden. Practices undertaking these reviews had higher prescribing rates at 12 months following treatment of previously un-identified conditions, suggesting that patients with IRCs would benefit from an integrated care review to identify and manage common morbidities.
Disclosures
S. Hider None. A. Machin None. M. Bucknall None. K. Cooke None. C. Jinks None. E. Healey None. A. Finney None. K. Cooke None. S. Wathall None. C. Mallen None. C. Chew-Graham None.
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Affiliation(s)
- Samantha Hider
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Annabelle Machin
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Milica Bucknall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Kendra Cooke
- Clinical Trials Unit, Keele University, Staffordshire, UNITED KINGDOM
| | - Clare Jinks
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Emma Healey
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Andrew Finney
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- School of Nursing and Midwifery, Keele University, Staffordshire, UNITED KINGDOM
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Simon Wathall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Christian Mallen
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Carolyn Chew-Graham
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
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Sultan AA, Whittle R, Muller S, Roddy E, Mallen CD, Bucknall M, Helliwell T, Hider S, Paskins Z. Risk of fragility fracture among patients with gout and the effect of urate-lowering therapy. CMAJ 2019; 190:E581-E587. [PMID: 29759964 DOI: 10.1503/cmaj.170806] [Citation(s) in RCA: 11] [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] [Accepted: 12/18/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Previous studies that quantified the risk of fracture among patients with gout and assessed the potential effect of urate-lowering therapy have provided conflicting results. Our study aims to provide better estimates of risk by minimizing the effect of selection bias and confounding on the observed association. METHODS We used data from the Clinical Practice Research Datalink, which records primary care consultations of patients from across the United Kingdom. We identified patients with incident gout from 1990 to 2004 and followed them up until 2015. Each patient with gout was individually matched to 4 controls on age, sex and general practice. We calculated absolute rate of fracture and hazard ratios (HRs) using Cox regression models. Among patients with gout, we assessed the impact of urate-lowering therapy on fracture, and used landmark analysis and propensity score matching to account for immortal time bias and confounding by indication. RESULTS We identified 31 781 patients with incident gout matched to 122 961 controls. The absolute rate of fracture was similar in both cases and controls (absolute rate = 53 and 55 per 10 000 person-years, respectively) corresponding to an HR of 0.97 (95% confidence interval 0.92-1.02). Our finding remained unchanged when we stratified our analysis by age and sex. We did not observe statistically significant differences in the risk of fracture among those prescribed urate-lowering therapy within 1 and 3 years after gout diagnosis. INTERPRETATION Overall, gout was not associated with an increased risk of fracture. Urate-lowering drugs prescribed early during the course of disease had neither adverse nor beneficial effect on the long-term risk of fracture.
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Affiliation(s)
- Alyshah Abdul Sultan
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Rebecca Whittle
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Sara Muller
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Milica Bucknall
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Toby Helliwell
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Samantha Hider
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre (Abdul Sultan, Whittle, Muller, Roddy, Mallen, Bucknall, Helliwell, Hider, Paskins), Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK; Haywood Academic Rheumatology Centre (Roddy, Hider, Paskins), Staffordshire and Stoke-on-Trent Partnership Trust, Stokeon-Trent, UK
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Machin AR, Hider SL, Chew-Graham CA, Bucknall M. 040 The incidence of anxiety or depression in patients with and without inflammatory rheumatic conditions. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.039] [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: 11/13/2022] Open
Affiliation(s)
- Annabelle R Machin
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Samantha L Hider
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, West Midlands CLAHRC, Staffordshire, UNITED KINGDOM
| | - Milica Bucknall
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
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Machin AR, Haththotuwa R, Babatunde O, Scott I, Bucknall M, Corp N, Chew-Graham CA, Hider SL. 088 The impact of anxiety on quality of life and disease activity in rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.087] [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: 11/14/2022] Open
Affiliation(s)
- Annabelle R Machin
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Randula Haththotuwa
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Opeyemi Babatunde
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Ian Scott
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust,, Staffordshire, UNITED KINGDOM
| | - Milica Bucknall
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Nadia Corp
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, West Midlands CLAHRC, Staffordshire, UNITED KINGDOM
| | - Samantha L Hider
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust,, Staffordshire, UNITED KINGDOM
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Morton C, Muller S, Bucknall M, Gilbert K, Mallen CD, Hider SL. Examining management and research priorities in patients with polymyalgia rheumatica: a primary care questionnaire survey. Clin Rheumatol 2019; 38:1767-1772. [PMID: 30617599 PMCID: PMC6544756 DOI: 10.1007/s10067-018-04405-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
Abstract
Introduction/objectives Polymyalgia rheumatica (PMR) is a common inflammatory disorder that is usually managed with oral glucocorticoids, which although effective can cause significant adverse events. Support group survey data suggests length of glucocorticoid treatment and managing side effects are key priority areas of management for patients. Recognising that not all patients will access patient support organisations, our objective was to identify priorities for PMR management and research among primary care PMR patients. Method All adults aged ≥ 50 years registered with 150 English general practices who had a first read code for PMR in their medical records in the preceding 3 years were mailed a self-completion questionnaire (n = 704). Survey items included questions regarding patient priorities for PMR management (from a pre-defined list of 10 items) and suggestions for future research (8 items, plus a free-text option), which were developed in collaboration with PMRGCAuk. Results Five hundred fifty patients responded (78%). The mean (SD) age was 74.1 (8.5) years and 361 (66%) were female. Priority research areas were focused on how to better manage pain, stiffness and fatigue (431, 78%), improving the diagnosis of PMR (393, 71%) and steroid management (342, 62%). Conclusions This survey of PMR patients suggests that symptom management, early diagnosis and managing medication are key areas for patients for future research. Researchers and funding organisations should be aware of these priorities if we are to generate research findings that are relevant to the widest range of stakeholders.
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Affiliation(s)
- Chris Morton
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Sara Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milica Bucknall
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
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Hider SL, Bucknall M, Cooke K, Cooke K, Finney AG, Goddin D, Healey EL, Hennings S, Herron D, Jinks C, Lewis M, Machin A, Mallen C, Wathall S, Chew-Graham CA. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial. J Comorb 2018; 8:2235042X18792373. [PMID: 30191145 PMCID: PMC6088485 DOI: 10.1177/2235042x18792373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022]
Abstract
Background Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs). Discussion Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Milica Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Andrew G Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,School of Nursing and Midwifery, Keele University, Keele UK.,Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Stoke on Trent UK
| | - Dave Goddin
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Emma L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | | | - Daniel Herron
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Annabelle Machin
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Simon Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
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Paskins Z, Whittle R, Hider S, Sultan AA, Bucknall M, Helliwell T, Roddy E, Mallen CD. 092. RISK OF FRAGILITY FRACTURE OVER 10 YEARS IN POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS: A UK POPULATION STUDY. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.092] [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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Tobias J, Deere K, Palmer S, Clark E, Clinch J, Fikree A, Aktar R, Wellstead G, Knowles C, Grahame R, Aziz Q, Amaral B, Murphy G, Ioannou Y, Isenberg DA, Tansley SL, Betteridge ZE, Gunawardena H, Shaddick G, Varsani H, Wedderburn L, McHugh N, De Benedetti F, Ruperto N, Espada G, Gerloni V, Flato B, Horneff G, Myones BL, Onel K, Frane J, Kenwright A, Lipman TH, Bharucha KN, Martini A, Lovell DJ, Baildam E, Ruperto N, Brunner H, Zuber Z, Keane C, Harari O, Kenwright A, Cuttica RJ, Keltsev V, Xavier R, Penades IC, Nikishina I, Rubio-Perez N, Alekseeva E, Chasnyk V, Chavez J, Horneff G, Opoka-Winiarska V, Quartier P, Silva CA, Silverman ED, Spindler A, Lovell DJ, Martini A, De Benedetti F, Hendry GJ, Watt GF, Brandon M, Friel L, Turner D, Lorgelly PK, Gardner-Medwin J, Sturrock RD, Woodburn J, Firth J, Waxman R, Law G, Siddle H, Nelson AE, Helliwell P, Otter S, Butters V, Loughrey L, Alcacer-Pitarch B, Tranter J, Davies S, Hryniw R, Lewis S, Baker L, Dures E, Hewlett S, Ambler N, Clarke J, Gooberman-Hill R, Jenkins R, Wilkie R, Bucknall M, Jordan K, McBeth J, Norton S, Walsh D, Kiely P, Williams R, Young A, Harkess JE, McAlarey K, Chesterton L, van der Windt DA, Sim J, Lewis M, Mallen CD, Mason E, Hay E, Clarson LE, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD, Gibson J, Whiteford S, Williamson E, Beatty S, Hamilton-Dyer N, Healey EL, Ryan S, McHugh GA, Main CJ, Porcheret M, Nio Ong B, Pushpa-Rajah A, Dziedzic KS, MacRae CS, Shortland A, Lewis J, Morrissey M, Critchley D, Muller S, Mallen CD, Belcher J, Helliwell T, Hider SL, Cole Z, Parsons C, Crozier S, Robinson S, Taylor P, Inskip H, Godfrey K, Dennison E, Harvey NC, Cooper C, Prieto Alhambra D, Lalmohamed A, Abrahamsen B, Arden N, de Boer A, Vestergaard P, de Vries F, Kendal A, Carr A, Prieto-Alhambra D, Judge A, Cooper C, Chapurlat R, Bellamy N, Czerwinski E, Pierre Devogelaer J, March L, Pavelka K, Reginster JY, Kiran A, Judge A, Javaid MK, Arden N, Cooper C, Sundy JS, Baraf HS, Becker M, Treadwell EL, Yood R, Ottery FD. Oral Abstracts 3: Adolescent and Young Adult * O13. Hypermobility is a Risk Factor for Musculoskeletal Pain in Adolescence: Findings From a Prospective Cohort Study. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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