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Debie V, Boymans T, Ottenheijm R, van Schayck O, Gidding-Slok A. Expanding the ABCC-tool for osteoarthritis: Development and content validation. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100488. [PMID: 38807711 PMCID: PMC11130725 DOI: 10.1016/j.ocarto.2024.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Objective Osteoarthritis (OA) care should be more person-centered based on physical, emotional and social aspects, instead of the current stepped-care approach solely based on physical symptoms, according to OA patients. By developing a novel module for OA in the Assessment of Burden of Chronic Condition (ABCC)-tool, a tool based on these three aspects, experienced quality of OA care and shared-decision making are expected to improve. Design The development of the novel OA module involved a triangular iterative process, interviewing OA patients and healthcare professionals in the field of OA, an expert panel and a literature search to identify the needs to improve OA care. Patients provided feedback on the first version of the OA module, leading to a second version. This second version was used to evaluate content validity. OA patients and healthcare professionals in the field of OA were asked to evaluate relevance, comprehensiveness and comprehensibility, based on the COSMIN methodology. For healthcare professionals, the item-content validity index (I-CVI) was calculated. Results The module includes questions about pain, kinesiophobia and joint stiffness. For all three questions, 94% of the patients found these questions important for patients with OA. The I-CVI scores of the healthcare professionals ranged from 1.0 (pain, kinesiophobia) to 0.75 (joint stiffness). Conclusion A novel, condition-specific OA module is developed for the ABCC-tool, as a supplement to the generic questions. The module includes three questions, to measure OA specific complaints. This novel module is intended to make the ABCC-tool more elaborate and useable for a larger population.
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Affiliation(s)
- V.H.J. Debie
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - T.A.E.J. Boymans
- Department of Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R.P.G. Ottenheijm
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - O.C.P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - A.H.M. Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Sutton L, Jose K, Hansen E, Laslett L, Makin J, Winzenberg T, Balogun S, Aitken D. Navigating the maze of osteoarthritis treatment: A qualitative study exploring the experience of individuals with osteoarthritis in Tasmania, Australia. Musculoskeletal Care 2023; 21:264-271. [PMID: 36097647 DOI: 10.1002/msc.1700] [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: 08/19/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Using a qualitative design this study aimed to (1) explore the experience of people living with osteoarthritis (OA), (2) gain an understanding of their navigation of the health system and, (3) explore their opinions on the role of exercise and joint replacement surgery for the management of OA. METHODS Purposive sampling was used to recruit 26 participants with knee OA, aged 45 years and over, from Tasmania, Australia. Semi-structured interviews were audio-recorded, transcribed, coded, and thematically analysed to document participant understanding and experience of OA and their opinions on the role of exercise and surgery in managing OA. RESULTS Of the 26 participants, 80% (n = 21) were female with a mean age of 66 years. The main theme identified was that individuals with knee OA were navigating a maze of OA treatments. Three related subthemes were that participants: (i) perceived their general practitioner did not have an ongoing role in their OA care, (ii) self-directed their management and, (iii) sampled from a 'smorgasbord' of treatment options, including low-value care options. Two other major themes were: the role of exercise for OA management, and surgery as a last resort. CONCLUSION Our findings suggest that OA patients may not be choosing consistent, high-value care for their OA. This highlights the importance of an evidence-based multi-disciplinary approach to guide patients to self-manage their OA and support their navigation of the health system. Reducing emphasis on the pathway to surgery and streamlining access to conservative management strategies may assist people to receive high-value care.
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Affiliation(s)
- Laura Sutton
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Emily Hansen
- School of Social Sciences, University of Tasmania, Tasmania, Australia
| | - Laura Laslett
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Jennifer Makin
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
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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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Dean BJF, Srikesavan C, Horton R, Toye F. A qualitative study exploring clinicians’ views on clinical trials in thumb carpometacarpal joint osteoarthritis. Bone Jt Open 2022; 3:321-331. [PMID: 35394369 PMCID: PMC9044087 DOI: 10.1302/2633-1462.34.bjo-2022-0017.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials. Methods We interviewed a purposive sample of 24 clinicians, consisting of 12 surgeons and 12 therapists (four occupational therapists and eight physiotherapists) who managed patients with CMCJ OA. This is a qualitative study using semi-structured, online interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 14 themes were developed, six of which were developed relating to the clinical management of CMCJ OA: 1) A flexible ‘ladder’ approach starting with conservative treatment first; 2) The malleable role of steroid injection; 3) Surgery as an invasive and risky last resort; 4) A shared and collaborative approach; 5) Treating the whole person; and 6) Severity of life impact influences treatment. The remaining eight themes were developed relating to clinical trial barriers and facilitators: 1) We need to embrace uncertainty; 2) You are not losing out by taking part; 3) It is difficult to be neutral about certain treatments; 4) Difficult to recruit to ‘no treatment’ ; 5) Difficult to recruit to a trial comparing no surgery to surgery; 6) Patients are keen to participate in research; 7) Burden on staff and participants; and 8) A enthusiasm for a variety of potential trial arms. Conclusion Our findings contribute to a better understanding of how clinicians manage thumb CMCJ OA in their practice settings. Our study also provides useful insights informing the design of randomized clinical trials involving steroid injections and surgery in people with thumb CMCJ OA. Cite this article: Bone Jt Open 2022;3(4):321–331.
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Affiliation(s)
- Benjamin J. F. Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | | | - Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
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