Giving an account of patients' experience: A qualitative study on the care process of hip and knee osteoarthritis

Barriers and facilitators to exercise-based rehabilitation in people with musculoskeletal conditions: A systematic review

BACKGROUND

Exercise-based rehabilitation is the first line of treatment for people with musculoskeletal conditions. However, uptake and adherence are suboptimal, compromising the success of rehabilitation.

OBJECTIVES

To identify the barriers and facilitators that influence adherence to exercise-based rehabilitation in people with musculoskeletal conditions. Additionally, to identify the methods and instruments used to determine these barriers and facilitators.

DESIGN

Systematic review METHODS: Five databases from inception to May 2024 using terms related to exercise, musculoskeletal conditions, methods, barriers and facilitators. Risk of bias was assessed using either the Newcastle-Ottawa Scale or Cochrane risk of bias tool. Using an inductive thematic approach, barriers and facilitators were grouped into intrapersonal, interpersonal and community factors. Methods/instruments were categorized into three groups, being questionnaires, interviews and focus-groups.

RESULTS

Eighty-one of 8380 studies were included. The majority of studies were of good or fair quality (95%). The most frequently identified barriers were lack of time (53%), pain (45%) and health (40%). The most frequent facilitators were self-efficacy (42%), perceived health benefits (32%) and previous experiences (30%). The methods used were interviews (n = 53), questionnaires (n = 44) and focus groups (n = 10).

CONCLUSION

Most barriers and facilitators to exercise were related to intrapersonal factors. Although there is a lack of consistency in instruments used, the reported barriers and facilitators were similar across studies. Clinicians and researchers should consider intrapersonal factors when promoting exercise-based rehabilitation programs. Applying a theoretical framework to investigate barriers and facilitators to exercise-based rehabilitation in people with musculoskeletal conditions might assist practitioners to prioritize their practice.

Effects of X-ray-based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial

BACKGROUND

Although X-rays are not recommended for routine diagnosis of osteoarthritis (OA), clinicians and patients often use or expect X-rays. We evaluated whether: (i) a radiographic diagnosis and explanation of knee OA influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve X-rays; and (ii) showing the patient their X-ray images when explaining radiographic report findings influences beliefs, compared to not showing X-ray images.

METHODS AND FINDINGS

This was a 3-arm randomised controlled trial conducted between May 23, 2024 and May 28, 2024 as a single exposure (no follow-up) online survey. A total of 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for 6 months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of 3 groups where they watched a 2-min video of the general practitioner providing them with either: (i) clinical explanation of knee OA (no X-rays); (ii) radiographic explanation (not showing X-ray images); or (iii) radiographic explanation (showing X-ray images). Primary comparisons were: (i) clinical explanation (no X-rays) versus radiographic explanation (showing X-ray images); and (ii) radiographic explanation (not showing X-ray images) versus radiographic explanation (showing X-ray images). Primary outcomes were perceived (i) necessity of joint replacement surgery; and (ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0 to 10. Compared to clinical explanation (no X-rays), those who received radiographic explanation (showing X-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing X-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours.

CONCLUSIONS

An X-ray-based diagnosis and explanation of knee OA may have potentially undesirable effects on people's beliefs about management.

TRIAL REGISTRATION

ACTRN12624000622505.

Perceived bioethical issues in cancer rehabilitation: a qualitative study among Italian physiotherapists

Introduction

Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists.

Participants

Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected.

Data Collection

Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics.

Data Analysis

Sessions were recorded, transcribed, and analyzed using Braun and Clarke's 'Reflexive Thematic Analysis'.

Results

Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis - ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations - navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation - balancing -treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment - ethical considerations in discontinuing treatment.

Discussion

These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context.

Conclusions

The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.

Making sense of osteoarthritis: A narrative review

People make sense of osteoarthritis (OA) by drawing on information, beliefs, and knowledge. This narrative review summarises diverse qualitative and quantitative research investigating beliefs and knowledge about OA and the impact these have on behaviour and outcomes. It synthesises evidence and highlights key actions clinicians can take to support people to make sense of OA in helpful ways. Beliefs about OA inform the behaviour of those living with OA and the behaviour of clinicians caring for people with OA. Beliefs about OA often focus on joint degradation and inevitable progression. These impairment-focused fatalistic beliefs can result in reduced offer of, or engagement in, active management strategies. Alternative views focus on health as part of a dynamic ecosystem where people are healthy when they can participate in activities they value. These beliefs are associated with increased engagement in self-management and lifestyle-based interventions. Clinician actions that support people to make sense of OA ways that align with helpful behaviours and support participation in valued activities represent key opportunities to improve health and well-being.

A Phenomenological Qualitative Study Protocol and Semi-Structured Interview Guide Development to Identify Perceptions, Experiences, Facilitators and Inhibitors in Patients With Knee Osteoarthritis Undergoing Rehabilitation in a Low- and Middle-Income Country

BACKGROUND

Perceptions, experiences, facilitators, and inhibitors of disease among patients may be shaped by their lifestyle and cultural background. Despite the significance of understanding their perspectives and experiences about disease for the prevention and management of osteoarthritis (OA) through physiotherapy, this subject has not been explored among patients with knee OA (PKOA) from lower and middle-income countries (LMICs).

PURPOSE

This study aims to explore the perception, and experiences of knee OA and physiotherapy treatment and identify the facilitators and inhibitors of physiotherapy treatment in PKOA from a lower- and middle-income country, India.

METHOD

40 PKOA (n = 10 in each Kellgren and Lawrence grade) will be recruited using a purposive sampling technique. Data will be collected through semi-structured interviews which are composed of pre-determined open-ended questions. Based on patients' flexibility and feasibility, the interview will be conducted face-to-face or by telephone or videoconference. The interview will be recorded using a digital audio recorder. Recorded data will be transcribed verbatim. Data will be analysed using thematic analysis based on the Braun and Clark approach.

RESULTS

The verbatim transcript will be evaluated to identify sub-themes and themes through thematic analysis. Generated data will be investigated through inductive qualitative analysis to examine the viewpoints of PKOA.

CONCLUSION

This study will explore the patients' perspectives, experiences, and the factors which will facilitate and inhibit the physiotherapy treatment for knee osteoarthritis. The result might reveal a new way to promote insightful decision-making towards physiotherapy care for PKOA and help to improve their access to physiotherapy care.

"How can we help you?": results of a scoping review on the perceived needs of people living with chronic pain regarding physiotherapy

BACKGROUND

Physiotherapy is effective to reduce pain and improve the quality of life of people living with chronic pain. To offer high-quality physiotherapy services, these services must be patient-centred and respond to patients' needs. However, few studies seem to target patients' perceived needs, whereas more studies tend to focus on needs assessed by healthcare experts, which are not always in line with patients' perceived needs. In addition, people living with chronic pain are often faced with several health inequities and may have varied perceived needs depending on their personal conditions. To offer services that truly meet patients' needs, it is therefore crucial to understand these needs. This scoping review aims to identify and map the perceived needs of people living with chronic pain towards physiotherapy services.

METHODS

To conduct this review, we followed the six stages framework proposed by Arksey and O'Malley. We searched four databases (Medline, Embase, CINHAL and APA PsycINFO) as well as the grey literature. We included all studies describing the needs, demands, preferences or expectations of adults living with chronic pain towards physiotherapy. We then performed an inductive thematic analysis of the results and discussion sections of these studies to identify the perceived needs. Once those needs were identified, we mapped them into the seven dimensions of the patient-centred healthcare delivery framework.

RESULTS

Our review included 96 studies. Various perceived needs were identified through the thematic analysis, such as the needs for an empathetic relationship; for a clear, adapted and supervised exercise program; and for personalized treatment. Our mapping into the patient-centred healthcare delivery framework showed that most studies reported needs associated with the dimensions of interpersonal care, individualized healthcare and professional care. Needs associated with the other dimensions of the framework (access; coordination and continuity; services and facilities; data and information) were less frequently mentioned.

CONCLUSIONS

The results of this review have enabled us to identify and better understand multiple needs perceived by people living with chronic pain regarding physiotherapy services. The perceived needs identified through this scoping review were mapped within the seven dimensions of the Patient-centred healthcare delivery framework.

Geographical Differences in the Perspective of Osteoarthritis Care Management: A Cross-Sectional Study in Italy, Sweden and Russia

BACKGROUND

This study aimed to explore the awareness, experiences, and beliefs of individuals with osteoarthritis (OA) regarding their healthcare management, along with assessing their overall satisfaction levels.

METHODS

A cross-sectional online survey was conducted in Italy, Sweden, and Russia, rigorously developed based on OA international guidelines in collaboration with healthcare professionals and individuals with OA. Participants over 40 years of age with self-reported hip and/or knee OA were eligible. The analytical framework included descriptive analysis (assessment of awareness levels for 'recommended', 'optional', and 'not recommended' treatments), analysis of suggested treatments and taken treatments, exploration of beliefs, barriers and satisfaction analysis (0-100 scale).

RESULTS

A total of 401 participants (mean age: 59.7, 78.3% female, 28% Italian, 49% Swedish, 23% Russian) contributed to the study. In Sweden, 57%-72% accurately identified recommended treatments, while in Russia, the range was 34%-91%, and in Italy, it was 35%-73%. The predominant suggested and taken treatments were oral anti-inflammatory drugs in Italy (87/81%) and Russia (97/97%) and specific exercise in Sweden (84/79%). Notably, only Sweden reached a consensus on the effectiveness of exercise for everyone, while Russia and Italy insisted on radiographic findings as a prerequisite for exercise. Mean satisfaction levels were 59.7 (Italy), 47.4 (Sweden), and 35.2 (Russia).

CONCLUSIONS

This study uncovered variations in awareness, treatment preferences, and beliefs among the three countries, underscoring the necessity for tailored education on OA management that accounts for regional differences across Europe.

Physical activity and depression symptoms in people with osteoarthritis-related pain: A cross-sectional study

Osteoarthritis is a leading cause of chronic pain and is associated with high rates of depression. Physical activity reduces depression symptoms and pain levels. It remains unknown if physical activity is associated with lower symptoms of depression irrespective of pain levels in individuals with osteoarthritis. We explored whether pain mediated or moderated the relationship between levels of physical activity engagement and depression symptoms. Individuals with osteoarthritis who were waiting for an orthopaedic consultation at a public hospital in Melbourne, Australia, were recruited. Data collected on pain levels, physical activity engagement and depression symptoms. Descriptive statistics were used to summarise participant characteristics. Moderation and mediation analyses were used to establish the impact of pain on the relationship between physical activity and depression, after adjusting for demographic and joint specific characteristics. The results indicated that the inverse association between physical activity and depression depended on the level of pain, such that the association was stronger in people with greater pain. The mediation results confirm that participating in physical activity is indirectly, inversely associated with symptoms of depression through lower levels of pain. The highest levels of pain were associated with the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity. Physical activity may be particularly important to manage depression symptoms in people with greater osteoarthritis-related pain as patients with the highest pain may have the greatest benefits.

I Am Afraid I Will Not Be Able to Walk, That Is What Worries Me-The Experience of Patients with Knee Osteoarthritis before Total Knee Arthroplasty: A Qualitative Study

Background: Knee osteoarthritis is the most prevalent type of osteoarthritis. Patients frequently encounter pain triggered by movement that evolves into impaired joint function. Needing persistent rest or having night-time pain signifies advanced disease. Qualitative research is considered the most effective method for comprehending patients' needs and contexts. Methods: This study employed a qualitative research design, allowing the researchers to acquire insights into the patients' beliefs and values, and the contextual factors influencing the formation and expression of these beliefs and values. Results: A cohort of nine patients awaiting total knee replacement (TKR) surgery was included and they were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: "The existence of pain impedes the capacity to participate in daily life activities"; "TKR induced fears and uncertainties regarding the progression of the disease"; "Severe nighttime pain compromising sleep quality". Conclusions: This study analyzes the experiences of people awaiting TKR surgery, emphasizing the importance of addressing their unique needs to improve preoperative education and rehabilitation. In this way, patients' recovery during the postoperative phase can be improved.

Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

OBJECTIVES

Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan.

DESIGN

In-depth interviews and thematic analysis.

SETTING

Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.

PARTICIPANTS

21 outpatients with at least three visits for DJD and who were aware of SDM.

RESULTS

Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations.

CONCLUSIONS

In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.

Physiotherapists' training in oncology rehabilitation from entry-level to advanced education: A qualitative study

BACKGROUND AND PURPOSE

Physiotherapy is gaining a central role in oncology. However, the training and competencies needed by physiotherapists in oncology rehabilitation are still unclear. This study aims to articulate the training trajectory of physiotherapists in oncology rehabilitation from entry-level education to advanced education degrees.

METHODS

Qualitative focus group study following a 'Reflexive Thematic Analysis' for data analysis. Participants were Italian physiotherapists with expertise in Oncology Rehabilitation (either clinically or academically) and Physiotherapy Bachelor of Science (BSc) course leaders, selected through purposive sampling.

RESULTS

Two focus groups were conducted with 14 participants. Six themes were developed: 1. 'Entry-Level Education in Oncology Rehabilitation: Let's Have a Taste', as the BSc introduces oncology rehabilitation. 2. 'Basic Knowledge: Building up the Library' as students acquire basic knowledge on oncology rehabilitation during their BSc; 3. 'Learning by Experience: The Relevance of the Placement' to answer the question "Is this the right road for me?"; 4. 'Clinical Reasoning and Competencies in Oncology Rehabilitation Embedded in Uncertainty' because oncology physiotherapists need to deal with the uncertainty of their patients' status; 5. 'Advanced Education Degree Skills: from Appetiser to the Main Course', as advanced education degree courses allow for becoming an expert in the field; 6. 'A Call to Action for Physiotherapists: Prevention-Diagnosis-Survivorship & End of Life', to realise their critical role in all the phases of the oncology path.

CONCLUSIONS

The BSc in Physiotherapy provides a foundation for future physiotherapists to understand oncology rehabilitation, but advanced education is necessary for expertise. The findings of this study have important implications for creating a shared physiotherapy curriculum in oncology rehabilitation.

IMPLICATION FOR PHYSIOTHERAPY PRACTICE

This study has significant implications for improving physiotherapy curricula in oncology rehabilitation, positively impacting the skills and competencies of practitioners in this paramount field.

Factors Associated With Adherence to a Supervised Exercise Intervention for Osteoarthritis: Data From the Swedish Osteoarthritis Registry

OBJECTIVE

To explore how lifestyle and demographic, socioeconomic, and disease-related factors are associated with supervised exercise adherence in an osteoarthritis (OA) management program and the ability of these factors to explain exercise adherence.

METHODS

A cohort register-based study on participants from the Swedish Osteoarthritis Registry who attended the exercise part of a nationwide Swedish OA management program. We ran a multinomial logistic regression to determine the association of exercise adherence with the abovementioned factors. We calculated their ability to explain exercise adherence with the McFadden R2 .

RESULTS

Our sample comprises 19,750 participants (73% female, mean ± SD age 67 ± 8.9 years). Among them, 5,862 (30%) reached a low level of adherence, 3,947 (20%) a medium level, and 9,941 (50%) a high level. After a listwise deletion, the analysis was run on 16,685 participants (85%), with low levels of adherence as the reference category. Some factors were positively associated with high levels of adherence, such as older age (relative risk ratio [RRR] 1.01 [95% confidence interval (95% CI) 1.01-1.02] per year), and the arthritis-specific self-efficacy (RRR 1.04 [95% CI 1.02-1.07] per 10-point increase). Others were negatively associated with high levels of adherence, such as female sex (RRR 0.82 [95% CI 0.75-0.89]), having a medium (RRR 0.89 [95% CI 0.81-0.98] or a high level of education (RRR 0.84 [95% CI 0.76-0.94]). Nevertheless, the investigating factors could explain 1% of the variability in exercise adherence (R2 = 0.012).

CONCLUSION

Despite the associations reported above, the poorly explained variability suggests that strategies based on lifestyle and demographic, socioeconomic, and disease-related factors are unlikely to improve exercise adherence significantly.

Within-person change in patient-reported outcomes and their association with the wish to undergo joint surgery during a digital first-line intervention for osteoarthritis

AIM

To study the association between within-person changes in patient-reported outcomes (PROMs) and wish for joint surgery during participation in a digital first-line intervention comprising exercise and education for knee/hip osteoarthritis (OA).

METHODS

Retrospective observational registry study. Participants enrolled between June 1, 2018 and October 30, 2021, with follow-up data at three months (n = 13,961). We used asymmetric fixed effect (conditional) logistic regressions to study the association between change in wish to undergo surgery at last available time point (3, 6, 9, or 12 months) and improvement or worsening of PROMs pain (0-10), quality of life (QoL) (EQ5D-5L, 0.243-0.976), overall health (0-10), activity impairment (0-10), walking difficulties (yes/no), fear of movement (yes/no), and Knee/Hip injury and Osteoarthritis Outcome Score 12 Items (KOOS-12/HOOS-12, 0-100) function and QoL subscales.

RESULTS

The proportion of participants wishing to undergo surgery declined by 2% (95% CI: 1.9, 3.0), from 15.7% at the baseline to 13.3% at 3 months. Generally, improvements in PROMs were associated with reduced likelihood of wishing for surgery, while worsening was associated with increased likelihood. For pain, activity impairment EQ-5D and KOOS/HOOS QoL, a worsening led to a change in the probability of wish for surgery of larger absolute magnitude than an improvement in the same PROM.

CONCLUSIONS

Within-person improvements in PROMs are associated with reduced wish for surgery while worsenings with an increased wish for surgery. Larger improvements in PROMs may be needed to match the magnitude of the change in wish for surgery associated with a worsening in the same PROM.

Use of non-surgical treatments on the journey to knee replacement in patients with knee osteoarthritis: a 10-year population-based case-control study

AIM

To investigate temporal trends in primary care visits, physiotherapy visits, dispensed non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in knee osteoarthritis (OA) patients who have and have not undergone knee replacement.

METHODS

We analysed 5665 OA patients from the Skåne Healthcare Register, Sweden, who underwent knee replacement between 2015 and 2019. Controls were OA patients without knee replacement, matched 1:1 by sex, age, time and healthcare level of initial OA diagnosis, and assigned a pseudo-index date corresponding to their case's knee replacement date. Annual prevalence and prevalence ratio of primary care and physiotherapy visits, dispensed NSAIDs and opioids (all for any cause) in the 10 years before knee replacement were estimated using Poisson regression.

RESULTS

The annual prevalence of all-cause primary care visits, physiotherapy visits and opioid use was similar between cases and controls until 3 years before the index date when it started to increase among the cases. The year before the index date, the prevalence ratio (cases vs controls) for physiotherapy use was 1.8 (95% CI 1.7, 1.8), while for opioid use 1.6 (1.5, 1.7). NSAID use was consistently higher among cases, even 10 years before the index date when the prevalence ratio versus controls was 1.3 (1.2, 1.3), increasing to 1.8 (1.7, 1.9) in the year preceding the index date.

CONCLUSIONS

Management of OA patients who have and have not undergone knee replacement appears largely similar except for higher use of NSAIDs in knee replacement cases. Symptomatic treatments start to increase a few years before the surgery in knee replacement cases.

Which lecturers' characteristics facilitate the learning process? A qualitative study on students' perceptions in the rehabilitation sciences

BACKGROUND

In education, lecturers play a crucial role in facilitating students' learning process. However, only a few studies explored which lecturers' characteristics can facilitate this process in higher education for rehabilitation healthcare professionals. Starting from students' perspectives, our qualitative study investigated the lecturers' characteristics that facilitate students' learning process in the rehabilitation sciences.

METHODS

A qualitative interview study. We enrolled students attending the 2nd year of the Master of Science (MSc) degree in 'Rehabilitation Sciences of Healthcare Professions'. Different themes were generated following a 'Reflexive Thematic Analysis'.

RESULTS

Thirteen students completed the interviews. From their analysis, we generated five themes. Specifically, a lecturer that facilitates students' learning process should be: 1) 'A Performer who Interacts with the Classroom', 2) A Flexible Planner who Adopts Innovative Teaching Skills', 3) 'A Motivator who Embraces Transformational Leadership', 4) 'A Facilitator Who Encourages a Constructive Learning Context' and 5) 'A Coach who Devises Strategies to Reach Shared Learning Goals'.

CONCLUSIONS

The results of this study underscore the importance for lecturers in rehabilitation to cultivate a diverse set of skills drawn from the arts and performance, education, team building and leadership to facilitate students' learning process. By developing these skills, lecturers can design lessons that are worth attending not only for their relevant content but also for their value in human experience.

Patients' Perceptions and Experiences during the Pre-Admission Phase for Total Hip Replacement Surgery: A Qualitative Phenomenological Study

Osteoarthritis negatively impacts the patient's quality of life. Qualitative research is an effective tool in detecting the various emotions experienced by patients with osteoarthritis. Such studies play a crucial role in promoting comprehension of the patient's experiences of health and illness among healthcare professionals, including nurses. The purpose of this study is to examine patients' perceptions during the pre-admission process for total hip replacement (THR). The study utilized a qualitative descriptive methodology with a phenomenological approach. A sample of patients awaiting THR consented to participate in the study and were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: 1-Surgery generates mixed feelings; 2-Pain negatively impacts daily life activities; 3-Pain requires personal strategies to be alleviated. Patients awaiting THR demonstrate frustration and anxiety. They experience intense pain during daily activities, which persists even during night rest.

Where are we in shared decision-making in Italy? A brief updated review

The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice.