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McLaughlin P, Hurley M, Chowdary P, Khair K, Smith C, Stephensen D. Using theory of change to co-create a programme theory for a telerehabilitation intervention for pain management in people with haemophilia. Orphanet J Rare Dis 2023; 18:376. [PMID: 38041200 PMCID: PMC10693140 DOI: 10.1186/s13023-023-02988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Improved approaches for chronic pain management are a clinical and research priority for people with haemophilia (PWH). Involving people with lived experience in the design of a complex rehabilitation intervention strengthens the credibility and plausibility of the intervention, particularly in relation to rare disorders. Here we describe using a 'Theory of Change' (ToC) dialogue-based stakeholder process to create a programme theory for a telerehabilitation intervention. METHODS An online workshop was convened and stakeholders received a briefing document in advance. Five stakeholders took part (3 PWH and 2 physiotherapists). At the workshop the group first agreed the overall aim of the intervention. Discussions then identified the resources, activities, barriers and enablers needed to achieve this outcome. All discussions were recorded and annotated by the workshop moderator. Behaviour change techniques were mapped for inclusion in the theory. RESULTS A programme theory and narrative report were produced. All stakeholders reviewed these for clarity and to ensure a true reflection of the workshop discussions. Agreement was based on how meaningful, well-defined, do-able, plausible, credible, and testable each component was. Stakeholders highlighted the importance of issues unique to PWH. Key components included the need for physiotherapists to be knowledgeable of the condition, a range of exercises that were inclusive of all abilities, and the need for people to feel safe and supported whilst taking part. CONCLUSIONS Co-developed theory based approaches to intervention design offer an inclusive and transparent way to develop novel and meaningful interventions for people with complex health conditions. The ToC is wholly transparent in its design and content. Together with the identified behaviour change techniques, the theory informs the protocol for a feasibility study evaluating a telerehabilitation intervention. Importantly, it allows the opportunity to revise, adapt and improve the programme theory for further implementation and evaluation.
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Affiliation(s)
- Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK.
- Department of Academic Haematology, University College, London, UK.
| | | | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
- Department of Academic Haematology, University College, London, UK
| | | | | | - David Stephensen
- School of Medicine, Health and Social Care, Canterbury Christchurch University, Canterbury, Kent, UK
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Ferreira RL, do Nascimento IJB, de Almeida VIA, de Oliveira VRL, Marangne LG, dos Santos Gameleira F, Dutra TRC, de Oliveira Santos D, Dias Afonso MP, dos Santos PEA, de Oliveira HN, Vilhena Dias FM. The utilisation of primary health care system concepts positively impacts the assistance of patients with rare diseases despite limited knowledge and experience by health care professionals: A qualitative synopsis of the evidence including approximately 78 000 individuals. J Glob Health 2023; 13:04030. [PMID: 37539555 PMCID: PMC10401310 DOI: 10.7189/jogh.13.04030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background Individuals with rare diseases (RD) have been historically understudied. Previous publications reported that existing primary health care (PHC) workforces and associated infrastructure had been shown to improve their access and health-related outcomes in low- and middle-income countries (LMICs). As current evidence about the impact of PHC on patients diagnosed with RD is yet highly dispersed, this scoping review aimed to collate available evidence of the impact of PHC on patients with RD and summarize published information from multiple stakeholders about the perceived usefulness and barriers to effective use of the PHC system. Methods We searched Embase, Health System Evidence, PubMed, LILACS / BVS, and The Cochrane Library, from inception to September 1, 2022, for publications providing clear expert- or experience-based insights or data from patients living with RD at the PHC level of care. We included publications highlighting barriers to integrated care of patients with RD, reported by multiple social actors involved in caring for patients with RD. Two investigators screened publications, extracted data, and clustered information among records deemed eligible for inclusion. Data synthesis was performed using narrative and thematic-based analysis. Major findings identified and coded through a semantic-driven analysis were processed in vosViewer software and reported using descriptive statistics. Findings Eighty publications were included in this review. Quali-quantitative analyses evidenced that the PHC level is essential for approaching patients with RD, mainly due to its longitudinal, multidisciplinary, and coordinated care delivery. In addition, several publications highlighted that the medical curriculum is inappropriate for preparing health care providers to deal with patients presenting unusual signs and symptoms and being diagnosed with RD. PHC teams are essential in orienting patients and families on emergency events. Technology-related concepts were reported in 19 publications, emphasizing their effectiveness on early diagnosis, optimal treatment definition, improvement of quality of life, and long-lasting follow-up. Conclusions We provided valuable information on the effectiveness of the PHC in fostering a creative, integrative, and supportive environment for patients living with RD. Our results can be helpful to several stakeholders in deciding what actions are still pending to achieve a solid and positive experience for patients with RD in the PHC. Registration PROSPERO (CRD42022332347).
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Affiliation(s)
- Raquel Lemos Ferreira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Israel Júnior Borges do Nascimento
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Victor Izidro Alves de Almeida
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanuza Regina Lommez de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Gomes Marangne
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flávia dos Santos Gameleira
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tárcia Regina Coura Dutra
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela de Oliveira Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Pellizzaro Dias Afonso
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Programa de Pós Graduação em Saúde Pública, da Faculdade de Medicina, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Paula Eduarda Alves dos Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helian Nunes de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, UFMG, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
| | - Fernando Machado Vilhena Dias
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
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Chen CM, Lin CH, Kung KY. Effects of Physical Therapy on Joint Pain, Joint Range of Motion, Joint Health, Strength, and Mobility in Patients With Hemophilia: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:577-587. [PMID: 36811546 DOI: 10.1097/phm.0000000000002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study investigated the effects of physical therapy, including exercise, manual therapy, and physical agent modality, on joints, muscle strength, and mobility of patients with hemophilia. METHODS PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched from inception to September 10, 2022. Randomized controlled trials comparing pain, range of motion, and health of joints, as well as muscle strength and mobility (timed up and go test) between physical therapy and control groups were included. RESULTS Fifteen randomized controlled trials with 595 male patients with hemophilia were included. In comparisons between physical therapy and control groups, physical therapy significantly reduced joint pain (standardized mean difference = -0.87; 95% confidence interval, -1.14 to -0.60), increased joint range of motion (standardized mean difference = 0.24; 95% confidence interval, 0.14-0.35), enhanced joint health (standardized mean difference = -1.08; 95% confidence interval, -1.38 to -0.78), improved muscle strength (standardized mean difference = 1.42; 95% confidence interval, 1.16-1.69), and timed up and go test performance (standardized mean difference = -1.25; 95% confidence interval, -1.89 to -0.60). The comparisons demonstrate moderate to high evidentiary quality grades. CONCLUSIONS Physical therapy is effective in reducing pain, increasing joint range of motion, enhancing joint health, as well as improving muscle strength and mobility in patients with hemophilia. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Recognize the overall effectiveness of physical therapy for patients with hemophilia; (2) Determine how therapeutic exercise can help improve various outcomes of major joints in these patients; and (3) Appraise that physical therapy is safe and can be implemented in clinical practice for these patients. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Chien-Min Chen
- From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan (C-MC, K-YK); School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-MC); and Department of Physical Medicine and Rehabilitation, Lin Shin Hospital, Taichung, Taiwan (C-HL)
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de Kleijn P, Duport G, Jansone K, Marinić M, McLaughlin P, Noone D, Ramishvili L, Tollwé A, Stephensen D. European principles of care for physiotherapy provision for persons with inherited bleeding disorders: Perspectives of physiotherapists and patients. Haemophilia 2022; 28:649-655. [PMID: 35506491 DOI: 10.1111/hae.14566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In their Chronic Care Model, the World Health Organisation states that people with chronic disorders and their families should be informed about the expected course, potential complications, and effective strategies to prevent complications and manage symptoms. Physiotherapists are a key professional group involved in the triage, assessment and management of musculoskeletal conditions of persons with a bleeding disorder (PWBD). Nevertheless, recent reports describe access to physiotherapy for those with these conditions is only sometimes available. AIM Access to high quality individualised physiotherapy should be ensured for all PWBD, including those with mild and moderate severities, male and female, people with von Willebrand Disease (vWD) and other rare bleeding disorders. Physiotherapy should be viewed as a basic requisite in their multidisciplinary care. METHODS/ RESULTS Following a series of meetings with physiotherapists representing the European Association for Haemophilia and Allied Disorders (EAHAD) and PWBD representing the European Haemophilia Consortium (EHC) and a review of publications in the field, eight core principles of physiotherapy care for persons with a bleeding disorder have been co-produced by EAHAD and EHC. CONCLUSION These eight principles outline optimum standards of practice in order to advocate personalised patient-centred care for physical health in which both prevention and interventions include shared decision making, and supported self-management.
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Affiliation(s)
- Piet de Kleijn
- European Haemophilia Consortium (EHC), Brussels, Belgium
| | - G Duport
- European Haemophilia Consortium (EHC), Brussels, Belgium.,Association Française des Hémophiles (French Haemophilia Association), Paris, France
| | - K Jansone
- European Haemophilia Consortium (EHC), Brussels, Belgium
| | - M Marinić
- European Haemophilia Consortium (EHC), Brussels, Belgium.,Institute of Social Sciences Ivo Pilar, Zagreb, Croatia.,Društvo hemofiličara Hrvatske (Croatian Haemophilia Society), Croatia
| | - P McLaughlin
- European Association for Haemophilia and Allied Disorders Physiotherapy Committee (EAHAD), Brussels, Belgium.,Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - D Noone
- European Haemophilia Consortium (EHC), Brussels, Belgium
| | - L Ramishvili
- European Association for Haemophilia and Allied Disorders Physiotherapy Committee (EAHAD), Brussels, Belgium.,Haemophilia and Thrombosis Treatment Centre, K. Eristavi National Centre of Experimental and Clinical Surgery, Tbilisi, Georgia
| | - A Tollwé
- European Haemophilia Consortium (EHC), Brussels, Belgium.,Förbundet Blödarsjuka i Sverige (Swedish Bleeding Disorder Society), Sweden.,Kent Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - D Stephensen
- European Association for Haemophilia and Allied Disorders Physiotherapy Committee (EAHAD), Brussels, Belgium.,Haemophilia Centre, Royal London Hospital, Barts Health NHS Trust, London, UK.,European Haemophilia Consortium (EHC), Committee of Women and Bleeding Disorders, Brussels, Belgium
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