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Haber T, Hall M, Dobson F, Lawford BJ, McManus F, Lamb KE, Hinman RS. Effects of Hip Pain Diagnostic Labels and Their Explanations on Beliefs About Hip Pain and How to Manage It: An Online Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:673-684. [PMID: 37795555 DOI: 10.2519/jospt.2023.11984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVES: To compare the effects of diagnostic labels and their explanations on people's beliefs about managing hip pain. DESIGN: Online randomized controlled trial involving 626 participants. METHODS: Participants aged ≥45 years with and without hip pain considered a hypothetical scenario (initial doctor consultation for hip pain). They were randomized to receive a diagnostic label and explanation of (1) hip osteoarthritis, (2) persistent hip pain, or (3) hip degeneration. Primary outcomes were the beliefs (1) exercise would damage the hip and (2) surgery is necessary at some stage (scales, 0 = definitely would not/unnecessary, 10 = definitely would/necessary). Secondary outcomes included beliefs about other treatments and care providers. RESULTS: Compared to hip degeneration, participants who were allocated to hip osteoarthritis and persistent hip pain believed exercise was less damaging (mean difference -1.3 [95% CI: -1.9, -0.7] and -1.8 [-2.3, -1.2], respectively) and surgery less necessary (-1.5 [-2.1, -1.0] and -2.2 [-2.7, -1.6], respectively). Compared to hip osteoarthritis, participants who were allocated to persistent hip pain believed surgery was less necessary (-0.7 [-1.2, -0.1]), but not that exercise was less damaging (-0.5 [-1.1, 0.1]). Compared to hip degeneration, participants who were allocated to hip osteoarthritis and persistent hip pain were less concerned about their hip and believed exercise and care from an exercise and sports physician, rheumatologist, or physiotherapist would be more helpful, and care from an orthopaedic surgeon less helpful. CONCLUSIONS: People who were allocated a diagnostic label and explanation of hip osteoarthritis or persistent hip pain believed exercise was less damaging and surgery less necessary for a hip problem than hip degeneration. J Orthop Sports Phys Ther 2023;53(11):673-684. Epub 5 October 2023. doi:10.2519/jospt.2023.11984.
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Pacheco-Brousseau L, Poitras S, Charette M, Amor SB, Desmeules F, Stacey D. Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive descriptive study. J Eval Clin Pract 2023; 29:942-954. [PMID: 37410789 DOI: 10.1111/jep.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
RATIONAL The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. AIMS AND OBJECTIVES Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. METHODS Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi-structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. RESULTS Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy-in fosters programme changes. CONCLUSION Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision-making.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Quebec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken) 2023; 75:1897-1907. [PMID: 36762545 PMCID: PMC10952362 DOI: 10.1002/acr.25101] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG recommendations. METHODS Five databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions. RESULTS Of 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA. CONCLUSION This synthesis of high-quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.
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Affiliation(s)
- Brooke Conley
- The University of MelbourneMelbourneVictoriaAustralia
| | - Samantha Bunzli
- The University of Melbourne, Melbourne, Victoria, Australia, Griffith University, Nathan, Queensland, Australia, and Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | | | - Penny O'Brien
- The University of MelbourneMelbourneVictoriaAustralia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia and Sir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | | | | | - Ivan Lin
- University of Western Australia and Geraldton Regional Aboriginal Medical ServiceGeraldtonWestern AustraliaAustralia
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Grenier JP, Rothmund M, Missmann M. Variation in the utilisation of physiotherapy in patients with advanced knee osteoarthritis prior to total knee arthroplasty a systematic review. Musculoskeletal Care 2023; 21:338-354. [PMID: 36539952 DOI: 10.1002/msc.1726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Due to demographic changes and increasing knee osteoarthritis (KOA) prevalence, the incidence of total knee arthroplasties (TKA) is constantly rising. Clinical practice guidelines for the treatment of KOA unanimously recommend non-surgical interventions such as exercise, education, and weight reduction in overweight patients. The aim of this systematic review is to determine the proportion of patients with end-stage KOA who attended physiotherapy (PT) prior to TKA. METHODS A systematic literature search was carried out in the medical databases MEDLINE (via Pubmed), PEDro, and EBSCO in August of 2022. Studies were included regardless of their design, if they reported the proportion of patients with a diagnosis of primary KOA, who participated in PT prior to undergoing TKA. Study quality assessment was performed by two independent authors using the Joanna Briggs Institutes Checklist for studies reporting prevalence data. Results were presented by using a narrative synthesis. RESULTS Eighteen studies, comprising 579,718 patients, were identified in this systematic review. PT utilisation prior to TKA ranged from 10% to 73% for patients with advanced KOA. Only two studies showed PT utilisation rates of 60% or higher. Female gender, higher income, better socioeconomic status, higher education levels, older age were associated with PT utilisation. Data for other predicting factors was conflicting. DISCUSSION This review shows substantial variation in the utilisation of PT in patients with end-stage KOA. This is concerning, considering the uniform recommendation from clinical practice guidelines for non-surgical treatments like exercise and education in patients with KOA, which are mostly provided by physiotherapists.
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Affiliation(s)
- Jean-Pascal Grenier
- Department for Health Sciences, University for Continuing Education Krems, Krems, Austria
- Department of Physiotherapy, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Maria Rothmund
- University Clinic for Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Martin Missmann
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Austrian Workers' Compensation Board AUVA, Innsbruck, Austria
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Pacheco-Brousseau L, Stacey D, Desmeules F, Ben Amor S, Lambert D, Tanguay E, Hillaby A, Bechiau C, Charette M, Poitras S. Instruments to assess appropriateness of hip and knee arthroplasty: a systematic review. Osteoarthritis Cartilage 2023:S1063-4584(23)00701-X. [PMID: 36898655 DOI: 10.1016/j.joca.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To assess criteria and psychometric properties of instruments for assessing appropriateness of elective joint arthroplasty (JA) for adults with primary hip and knee osteoarthritis (OA). METHODS A systematic review guided by Cochrane methods and PRISMA guidelines. Studies were searched in five databases. Eligible articles include all study designs developing, testing, and/or using an instrument to assess JA appropriateness. Two independent reviewers screened and extracted data. Instruments were compared with Hawker et al. JA consensus criteria. Psychometric properties of instruments were described and appraised guided by Fitzpatrick's and COSMIN approaches. RESULTS Of 55 instruments included, none met all Hawker et al. JA consensus criteria. Criteria the most met were pain (n = 50), function (n = 49), quality of life (n = 33), and radiography (n = 24). Criteria the least met were clinical evidence of OA (n = 18), expectations (n = 15), readiness for surgery (n = 11), conservative treatments (n = 8), and patient/surgeon agree benefits outweigh risks (n = 0). Instrument by Arden et al. met the most criteria (6 of 9). The most tested psychometric properties were appropriateness (n = 55), face/content validity (n = 55), predictive validity (n = 29), construct validity and feasibility (n = 24). The least tested psychometric properties were intra-rater reliability (n = 3), internal consistency (n = 5), and inter-rater reliability (n = 13). Instruments by Gutacker et al. and Osborne et al. met the most psychometric properties (4 of 10). CONCLUSION Most instruments included traditional criteria for assessing JA appropriateness but did not include a trial of conservative treatments or shared decision-making elements. There was limited evidence on psychometric properties.
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Affiliation(s)
- L Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - F Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Canada.
| | - S Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
| | - D Lambert
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - E Tanguay
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - A Hillaby
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - C Bechiau
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
| | - M Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - S Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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Wallis JA, Barton CJ, Ackerman IN, Sherwood J, Kemp JL, Young K, Jennings S, Trivett A, Brusco NK. A survey of patient and medical professional perspectives on implementing osteoarthritis management programs for hip and knee osteoarthritis. Musculoskeletal Care 2023; 21:272-282. [PMID: 36101975 DOI: 10.1002/msc.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Strategies are needed to improve referral into, and uptake of, osteoarthritis (OA) management programs. This survey investigated and compared patients' and medical professionals' views around hip and knee OA management and factors impacting implementation of an osteoarthritis management program. METHODS As part of a mixed-methods program of research, patients with hip or knee OA and medical professionals routinely involved in the management of OA, were invited to complete a comprehensive online survey. All data were analysed descriptively or using chi squared tests. Survey findings for factors perceived to impact implementation of an OA management programme were triangulated with previously reported qualitative data. RESULTS Fifty-three patients (38 females, 15 males) and 32 medical professionals (orthopaedic surgeons, sports physicians, rehabilitation physicians, rheumatologists and general practitioners) completed the survey. Twenty-eight patients (53%) had prior participation in the OA management programme (GLA:D® ) and 19 medical professionals (59%) had previously referred patients to the programme. Of the participants with prior exposure, 21 patients (75%) and 15 medical professionals (79%) agreed the programme was beneficial. A higher proportion of medical professionals, compared to patients, believed weight loss (100% vs. 67%), injection therapy (50% vs. 21%), hip replacement (100% vs. 62%) and knee replacement (97% vs. 62%) were effective treatments, with no differences for all other treatments. The barriers and enablers identified for referral into, and participation in, an OA management programme mostly aligned to factors identified in previous related qualitative research. Divergent factors in the survey included patients concerns about doing exercise-therapy with 81% (higher than expected) not reporting any concerns about exercising, and 19% (lower than expected) concerned about their OA joint, such as making their pain worse. CONCLUSIONS This study has extended our understanding of barriers and enablers for referral into, and participation in, an OA management programme with a lower than expected number of patients being concerned about exercising due to their OA joint. Patients and medical professionals had positive views relating to the quality of the programme delivery, patient satisfaction and programme effectiveness. Medical professionals were more likely than patients to consider weight loss, injections and joint replacement as effective treatment options.
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Affiliation(s)
- Jason A Wallis
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Ilana N Ackerman
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Joanne L Kemp
- Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Kirby Young
- Cabrini Health, Malvern, Victoria, Australia
| | | | | | - Natasha K Brusco
- Cabrini Health, Malvern, Victoria, Australia.,Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Goff AJ, De Oliveira Silva D, Ezzat AM, Crossley KM, Pazzinatto MF, Barton CJ. Co-design of the web-based ‘My Knee’ education and self-management toolkit for people with knee osteoarthritis. Digit Health 2023; 9:20552076231163810. [PMID: 37009308 PMCID: PMC10052584 DOI: 10.1177/20552076231163810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023] Open
Abstract
Objective Describe the co-design process and learnings related to developing the web-based Translating Research Evidence and Knowledge (TREK) ‘My Knee’ education and self-management toolkit for people with knee osteoarthritis. Co-design process Stage (i): Understand and define; systematically reviewed education interventions in published trials; appraised web-based information about knee osteoarthritis; and used concept mapping to identify education priorities of people with knee osteoarthritis and physiotherapists. Stage (ii): Prototype; created a theory-, guideline- and evidence-informed toolkit. Stage (iii): Test and iterate; completed three co-design workshops with end-users (i.e., people with knee osteoarthritis and health professionals); plus an expert review. Results The toolkit is available at myknee.trekeducation.org. Stage (i) identified the need for more accurate and co-designed resources to address broad education needs generated during concept mapping, including guidance on surgery, dispelling common misconceptions and facilitating engagement with exercise therapy and weight management. A theory- and research-informed prototype was created in Stage (ii) to address broad learning and education needs. Stage (iii) co-design workshops ( n = 15 people with osteoarthritis and n = 9 health professionals) informed further content creation and refinement, alongside improvements to optimise usability. Expert opinion review ( n = 8) further refined accuracy and usability. Conclusions The novel co-design methodology employed to create the TREK ‘My Knee’ toolkit facilitated the alignment of the content and usability to meet the broad education needs of people with knee osteoarthritis and health professionals. This toolkit aims to improve and facilitate engagement with guideline-recommended first-line care for people with knee osteoarthritis. Future work will determine its effectiveness in improving clinical outcomes in this population.
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Affiliation(s)
- Anthony J Goff
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Anthony Goff, SIT@Dover, 10 Dover Drive, Singapore, 138683, Singapore.
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Marcella F Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Department of Physiotherapy Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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8
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Gibbs AJ, Wallis JA, Taylor NF, Kemp JL, Barton CJ. Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services. Musculoskeletal Care 2022; 20:860-872. [PMID: 35403316 PMCID: PMC10084427 DOI: 10.1002/msc.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Hip and knee osteoarthritis guidelines internationally provide consistent first-line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline-based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care. METHODS Nineteen semi-structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n = 10; OsteoArthritis Chronic Care Programme n = 4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n = 5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis. RESULTS The overarching theme to emerge was that accessing first-line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co-morbidities is challenging. CONCLUSION Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first-line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.
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Affiliation(s)
- Alison J Gibbs
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Physiotherapy Department, Eastern Health, Box Hill, Victoria, Australia
| | - Jason A Wallis
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, School of Public Health & Preventative Medicine, Monash University, Melbourne, Australia.,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Joanne L Kemp
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia
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Jönsson T, Dell’Isola A, Lohmander LS, Wagner P, Cronström A. Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis. JAMA Netw Open 2022; 5:e2240126. [PMID: 36326763 PMCID: PMC9634502 DOI: 10.1001/jamanetworkopen.2022.40126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities. OBJECTIVE To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention. DESIGN, SETTING, AND PARTICIPANTS This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021. EXPOSURES Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application. MAIN OUTCOMES AND MEASURES Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior. RESULTS A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome. CONCLUSIONS AND RELEVANCE This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.
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Affiliation(s)
- Therese Jönsson
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - L. Stefan Lohmander
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anna Cronström
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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10
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Coetzee M, Clifford AM, Jordaan JD, Louw QA. Global profile of individuals undergoing total knee replacement through the PROGRESS-PLUS equity lens: Protocol for a systematic review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1649. [PMID: 35547962 PMCID: PMC9082286 DOI: 10.4102/sajp.v78i1.1649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background Osteoarthritis (OA) is a heterogenous degenerative disorder often causing destructive joint changes with severe pain and functional disability. Modifiable and non-modifiable risk factors, social context and psychological factors influence the development and progression of the disease. Total knee replacement (TKR) aims at reducing pain and improving function and is more successful with pre-operative and post-operative rehabilitation. However, most international research on rehabilitation interventions is conducted in high income contexts. Objective The aim of our systematic review is to gain an overview of the demographic and social profiles of adults undergoing TKR for primary knee OA in lower, middle- and high-income countries through a health equity lens to inform the translation of intervention research in local contexts. Methods A systematic review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Eligibility criteria include observational studies and grey literature (theses) since the beginning of the databases reporting on demographic data of adults awaiting or undergoing TKR surgery. The PROGRESS-Plus framework will be used to describe equity elements. Results A narrative summary and description of the global profile of individuals undergoing total knee replacement for osteoarthritis. Conclusion A snapshot of the global demographic and social profile of individuals receiving TKR for primary knee OA through an equity lens will shed light on the similarities and differences between individuals from different contexts. Global demographic profile information may inform or assist in the development of translational strategies for evidence-based rehabilitation. Clinical implications Translation of existing rehabilitation interventions to local contexts could improve pre-operative and post-operative outcomes for individuals on our surgical waiting lists.
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Affiliation(s)
- Marisa Coetzee
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda M. Clifford
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Health Research Institute, Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Jacobus D. Jordaan
- Department of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette A. Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Hawker GA, Lohmander LS. What an earlier recognition of osteoarthritis can do for OA prevention. Osteoarthritis Cartilage 2021; 29:1632-1634. [PMID: 34461227 DOI: 10.1016/j.joca.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/02/2023]
Affiliation(s)
- G A Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - L S Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
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