Development and feasibility of a function-based preventive intervention for lifestyle-related disorders

BACKGROUND

The enormous effect of lifestyle-related disorders on health of the global population warrants the development of preventive interventions. Focusing on musculoskeletal health and physical activity may be a way to encourage necessary lifestyle changes by making them more concrete and understandable. The aims of the current study were to develop a function-based preventive intervention aimed at lifestyle-related disorders in physically inactive 40-year-old people and to investigate the feasibility of the intervention. The feasibility study aimed to solve practical and logistical challenges and to develop the intervention based on the experiences of participants and involved clinical personnel according to defined criteria.

METHODS

Development of the standardised functional examination was based on literature-validated tests and clinical reasoning. Development of a risk profile was based on the functional examination and similar profiles which have already proved feasible. The feasibility of the functional examination and risk profile, together with function-based lifestyle counselling was tested on 27 participants in a pilot study with two physiotherapist examinations over a four-month period. Practical results and feedback from participants and collaborating personnel were examined.

RESULTS

The functional examination consists of 20 established tests not requiring specialised equipment or training which were deemed relevant for a middle-aged population and a sub-maximal ergometer test. The risk profile consists of seven functional dimensions: cardiovascular fitness, strength in upper extremity, lower extremity and trunk, mobility, balance and posture, and three non-functional dimensions: weight, self-assessed physical activity and pain. Each dimension contains at least two measures. The participants appreciated the intervention and found it motivating for making lifestyle changes. They found the tests and risk profile understandable and could see them as tools to help achieve concrete goals. The examination required 60-75 min for one physiotherapist. The recruitment rate was low and recruited participants were highly motivated to making lifestyle changes.

CONCLUSION

This project developed a functional test battery and risk profile aimed at inactive 40-year-olds which fulfilled our feasibility criteria. Functional screening and lifestyle counselling were found to be of value to a sub-group of inactive 40-year-olds who were already motivated to improve their health situations.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05535296 first posted on 10/09/2022.

The Predictive Ability of the Full and Short Versions of the Orebro Questionnaire for Absenteeism and Presenteeism Over the Subsequent 12 Months, in a Cohort of Young Community-Based Adult Workers

OBJECTIVE

The primary purpose of this study was to investigate the predictive ability of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in regard to work productivity (absenteeism and presenteeism) in early adulthood.

METHODS

A prospective study was performed using data from the Raine Study Generation 2 (Gen2) 22-year follow-up. The ÖMPSQ was completed at baseline, and absenteeism and presenteeism assessed at four intervals over the following 12 months.

RESULTS

In early adulthood, the full and short versions of the ÖMPSQ showed some predictive ability for work absenteeism but the Receiver Operator Characteristic demonstrated poor discrimination. There was no evidence of predictive ability for presenteeism.

CONCLUSION

Further work is required to increase the fidelity of screening for risk of reduced work productivity at the population level.

Shall we use cryotherapy in the treatment in surgical procedures, in acute pain or injury, or in long term pain or dysfunction? - A systematic review

PURPOSE

This review aimed to evaluate the certainty of evidence for the use of cryotherapy in patients with musculoskeletal disorders.

METHODS

PubMed, Embase, Cochrane Library and AMED were searched from January 2000 to January 2018 (update June 2019) for systematic reviews (SRs) and randomized controlled trials (RCTs) reporting outcomes on pain, swelling, range of motion (ROM), function, blood loss, analgesic use, patient satisfaction and adverse advents. The papers were categorised into: surgical procedures, acute pain or injury and long-term pain or dysfunction. Methodological quality and risk of bias were assessed using the AMSTAR and the Swedish Health Technology Assessment instruments. Level of certainty of evidence was synthesized using GRADE.

STUDY SELECTION

Eight SRs and 50 RCTs from a total of 6027 (+839) were included. In total 34 studies evaluated cryotherapy in surgical procedures, twelve evaluated cryotherapy use in acute pain or injury and twelve studies evaluated cryotherapy in long-term pain and dysfunction.

RESULTS

The certainty of evidence is moderate (GRADE III) after surgical procedures to reduce pain, improve ROM, for patient satisfaction and few adverse events are reported. Cryotherapy in acute pain and injury or long-term pain and dysfunction show positive effects but have a higher number of outcomes with low certainty of evidence (GRADE II).

CONCLUSION

Cryotherapy may safely be used in musculoskeletal injuries and dysfunctions. It is well tolerated by patients. More advanced forms of cryotherapy may accentuate the effect. Future research is needed where timing, temperature for cooling, dose (time) and frequency are evaluated.

Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial

Background:

Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients’ attitudes of responsibility for musculoskeletal disorders.

Methods:

This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements.

Results:

The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients’ attitudes of responsibility for musculoskeletal disorders.

Conclusions:

Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders.

ClinicalTrials.gov identifier:

NCT148611.

"Take me seriously and do something!" - a qualitative study exploring patients' perceptions and expectations of an upcoming orthopaedic consultation

Background

Patients’ perceptions of care is an important factor in evaluation of health care, in quality assessment, and in improvement efforts. Expectations of assessments or procedures such as surgery have been found to be related to perceptions of outcome as well as satisfaction, and are therefore of interest to both clinicians and researchers. Increased understanding of these patient views is important so that orthopaedic assessments, regardless of who performs them, can be further developed and patient-centred to better meet patients’ needs. The purpose of this study was therefore to explore patients’ perceptions and expectations of an upcoming orthopaedic consultation.

Methods

This was an explorative qualitative study with an inductive approach. Thirteen patients who were referred for orthopaedic consultation were included using a purposeful sampling strategy. Patients participated in individual, semi-structured interviews that were recorded, transcribed verbatim and analysed with qualitative content analysis.

Results

The participants’ expressed perceptions and expectations of the upcoming orthopaedic surgeon consultation were classified into 5 categories: Hoping for action, Meeting an expert, A respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! The participants emphasised a desire to be taken seriously and for something to happen, both during the consultation itself and as a result of the orthopaedic consultation. They described a trust in the expertise of the orthopaedic surgeon and stressed the importance of the surgeon’s attitude, but still expected to participate in the consultation as well as in the decision-making process.

Conclusions

The study findings illuminate aspects that are important for patients in an orthopaedic consultation. The descriptions of patients’ perceptions and expectations can serve to improve patient–clinician relationships as well as to inform the development of new models of care, and a greater understanding of these aspects may improve the patient experience.

Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study

RATIONALE, AIMS AND OBJECTIVES

It is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables.

METHODS

A prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi-component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3-hour implementation seminar. The control group received no intervention. Self-reported attitudes towards, access to and use of outcome measures were assessed with a web-based questionnaire before and after the implementation.

RESULTS

After the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow-up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow-up, no differences related to demographic variables were found in the subgroup analyses.

CONCLUSIONS

The findings suggest that a tailored, multi-component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.

Selecting the correct incontinence pad in nursing home patients by pad weighing

The aim of this study was to identify which types of absorbent pads were being used by the inhabitants of two nursing home wards and to determine to what extent the pads were adapted to the patient's leakage volume. An objective assessment of urinary leakage was performed in all the men (age 80.2 +/- 8.0 years) and women (age 84.8 +/- 6.5 years), from the two wards, who used incontinent aids (n=41). Subjects were assessed by weighing all incontinence aids on a precision weight scale before and after use during a period of 7 days. The number of patients experiencing wetting of external clothing or bedding was recorded. During the assessment period 1146 pads were used and the mean urinary leakage per patient during the day was 260 +/- 212 ml and during the night 413 +/- 230 ml. Wetting of external clothing or bedding occurred during the day time in 16% and in 40% at night time despite the use of pads. Only 22% of the pads were adapted to the patients degree of urinary incontinence. Many of the nursing home inhabitants were using larger pads than necessary. If the pads had been adapted to the patient's urinary leakage volume, costs for incontinence aids would have been reduced by 31%.