Co-design of the web-based ‘My Knee’ education and self-management toolkit for people with knee osteoarthritis

Co-design and prototype development of MedManageSCI: a medication self-management toolkit for adults with spinal cord injury/dysfunction

BACKGROUND

Medications are among the most common health interventions, with certain populations, such as individuals with spinal cord injury/dysfunction (SCI/D), commonly prescribed multiple medications. Consequently, adults with SCI/D often engage in activities related to medication self-management, but there are few comprehensive resources for this population. The objective of this study was to co-design the prototype of a toolkit to support medication self-management among adults with SCI/D.

METHODS

We conducted a participatory multi-methods study, using the Good Things Foundation Pathfinder Model as a guide for the co-design process. Participants included adults with SCI/D, caregivers, and healthcare providers. Following the model's three stages, we: (1) understood and defined the problem by conducting a scoping review, concept mapping study, and working group sessions; (2) created a prototype of the toolkit through working group sessions and website development meetings; and (3) tested the prototype through working group sessions.

RESULTS

The working group consisted of 19 individuals, including 9 adults with SCI/D, 1 caregiver, and 9 healthcare providers. In Stage 1, we identified the need for a comprehensive medication self-management resource through a scoping review, brainstormed content and delivery methods, and thematized and prioritized the content into eight categories through a concept mapping study. The concept mapping study included 44 participants, including 21 adults with SCI/D, 11 caregivers, and 12 healthcare providers. In Stage 2, feedback on the content mapped onto five categories: first impressions, message and purpose, visual elements, layout and flow, and graphics. The name, MedManageSCI, was selected by the working group. Through an iterative process with the website development company, an online version of the toolkit prototype was created ( www.medmanagesci.ca ). In Stage 3, participants provided recommendations to improve the website's functionality and navigation.

CONCLUSIONS

The co-design of the MedManageSCI prototype is a significant step toward addressing the medication self-management needs of adults with SCI/D. The implications of this work extend beyond SCI/D, highlighting the importance of tailored digital health resources for populations with complex healthcare needs. Future work is needed to refine the content, assess the feasibility, acceptability, and appropriateness of the toolkit, and examine outcomes related to medication self-management.

Building the OAChangeMap to Improve the Service Delivery of the New South Wales Osteoarthritis Chronic Care Program: A Worked Example of Using a Codesign Framework

OBJECTIVE

The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best evidence osteoarthritis (OA) care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritize the barriers, and generate strategies to address them.

METHODS

This study provides a worked example of a seven-step theory-informed codesign framework. We invited OACCP coordinators to participate in semistructured interviews (analyzed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, and researchers) to prioritize the barriers via a short survey (survey 2). We held five codesign workshops in which we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them.

RESULTS

Sixteen coordinators were interviewed, and the main barriers identified were as follows: (1) patients often have beliefs that are inconsistent with best evidence care, (2) there are aspects of clinical care that are not delivered optimally, and (3) system-level factors are a barrier to optimal patient care and sustainability of the OACCP. We codesigned a plan for action with patient educational materials, shared decision-making tools, and health professional education and training.

CONCLUSION

Our worked example of codesign used a theory-based, data-driven approach with key stakeholders, identified and prioritized barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.

Navigating HOPE (Hypermobile Online Pain managemEnt): Perspectives and Experiences From People With Hypermobile Ehlers-Danlos Syndrome or Hypermobility Spectrum Disorder on a Condition-Specific Online Pain Management Programme

INTRODUCTION

The Hypermobile Online Pain managemEnt (HOPE) programme is a stakeholder informed intervention adopting the biopsychosocial pain approach, specifically for people with hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD) experiencing pain. The programme topics included were based on a modified Delphi of a large sample of stakeholders: people with hEDS/HSD and healthcare practitioners who are experienced with managing these conditions. Programme feasibility, acceptability and appropriateness were previously evaluated quantitatively in a pilot randomised controlled trial, but the in-depth experiences and perceptions of participants who engaged with the programme is unknown.

METHODS

Qualitative study. 1:1, semi-structured online interviews of participants who took part in the HOPE programme. Data was analysed using an inductive thematic analysis approach as described by Braun and Clark.

RESULTS

Twelve participants were interviewed; 91% were female, mean age 38.1 (SD 9.1). Four themes emerged: (1) The biopsychosocial approach to understanding pain used in the HOPE programme was acceptable and appropriate, (2) benefits of the programme were stronger for those who were newer on their hEDS/HSD journey, (3) self-guided reflections included in the programme required headspace and personal meaning and (4) participants desired more adaptable content and programme functionality. Additionally, participants gave suggestions on how to improve the content, adherence and engagement to the programme.

CONCLUSION

The HOPE programme was considered feasible, acceptable and appropriate for people with hEDS/HSD. The four themes and suggestions from our study findings will be used to refine subsequent versions and large-scale trials of the HOPE programme, as well as provide translatable insights for other online interventions for hEDS/HSD or similar complex, chronic multisystemic conditions.

PATIENT OR PUBLIC CONTRIBUTION

A large community of hEDS/HSD patients' and healthcare providers' input were obtained from a two-staged online Delphi from a prior study. This approach was preferred to capture the greatest amount of feedback from a diverse international voice. Via the Delphi study, they provided suggestions for content topics and consensus on what they felt were important to include in a hEDS/HSD specific online pain management programme, as well as programme parameters (e.g., duration and frequency of programme; healthcare provider telehealth component; types of learning activities).

Voices from the clinic: a qualitative analysis of physiotherapy strategies in musculoskeletal care for knee osteoarthritis patients

BACKGROUND

Physiotherapy has emerged as an important health strategy to deliver lifestyle, exercise and physical activity for people with knee osteoarthritis. However, little is known about the extent to which physiotherapists adhere to clinical practice guidelines. This study aimed to explore the perspectives and care patterns of physiotherapists in Sydney, Australia on their delivery of knee osteoarthritis care and how this aligns with the 2019 Osteoarthritis Research Society International (OARSI) guidelines.

METHODS

We invited thirty-three physiotherapists from nine private practices in metropolitan Sydney to partake in a semi-structured interview. The interviews were digitally recorded and transcribed verbatim. The data collected were analysed deductively using content analysis, comparing guidelines to current care patterns, while their perspectives were inductively analysed through thematic analysis.

RESULTS

Thirty physiotherapists participated (age range 22-63 years, 17 male and 13 female). Interview responses indicated that most physiotherapists were satisfied with their care of knee osteoarthritis patients. Most physiotherapists delivered "core" guideline-based care of education and land-based exercise. Recommendations of modalities of exercise, including hydrotherapy and manual therapy, were discussed and were perceived to be beneficial despite not being "core" clinical guideline recommendations. Current treatment strategies focussed on disease severity, symptom presentation and/or patient exercise history with little emphasis on education about osteoarthritis pathophysiology and drug-based pain relief. The thematic analysis identified two over-arching themes; (1) capacity to deliver and awareness of evidence-based care and (2) perceived recommendations for future physiotherapy management. Participants identified notable areas of potential service improvement including developing stronger and more effective reimbursement models, increased consult times and improved patient access.

CONCLUSION

The study provided unique insights towards physiotherapists' current usual knee osteoarthritis care and their perceived barriers to delivering guideline-based care. Thus, informing a need for future studies to focus on developing specific and detailed guidelines if physiotherapists are to align more closely to the core guideline-based recommendations.

TRIAL REGISTRATION

This study was part of a larger study, with the full protocol published and registered at ClinicalTrials (ACTRN12620000188932, ACTRN12620000218998) 19/02/2020).

Exploring and prioritizing content to include in a medication self-management toolkit for persons with spinal cord injury/dysfunction: A concept mapping approach

BACKGROUND

Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior research emphasized the desire for more support with medication self-management among this population.

OBJECTIVE

To explore what content should be included in a medication self-management resource (i.e., toolkit) for adults with SCI/D, as well as considerations for delivery from the perspectives of adults with SCI/D, caregivers, healthcare providers, and representatives from community organizations.

METHODS

A concept mapping study was conducted. Participants took part in one or more of three activities: brainstorming; sorting and rating; and mapping. Participants generated ideas about the content to include in a medication self-management toolkit. Participants sorted the statements into conceptual piles and assigned a name to each. All statements were rated on a five-point Likert-type scale on importance and realistic to include in the toolkit. Participants decided on the final cluster map, rearranged statements, and assigned a name to each cluster to create visual representations of the data.

RESULTS

Forty-four participants took part in this study. The final map contained eight clusters: 1) information-sharing and communication; 2) healthcare provider interactions and involvement; 3) peer and community connections; 4) supports and services for accessing prescription medications and medication information; 5) information on non-prescription medication and medication supplies; 6) safety and lifestyle considerations; 7) general medication information; and 8) practical information and strategies related to medication-taking. Safety and lifestyle considerations was rated as the most important and realistic to include in the toolkit.

CONCLUSIONS

Given the limited tools to help adults with SCI/D with managing their medications, there is great potential to better support this population across all areas of medication self-management.

Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists

INTRODUCTION

In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions.

METHODS

A mixed-methods exploratory sequential design applied modified experience-based co-design methods (physiotherapists [n = 13], clinic administrators [n = 2], and people with musculoskeletal conditions [n = 7]) to develop an evidence-informed toolkit. Semi-structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre-post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30 min) and non-users (0 min) using chi-squared tests for independence. Website analytics were summarised.

RESULTS

Twenty-two participants engaged in co-design workshops. Feedback led to the inclusion of more patient-facing resources, increased assessment-related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty-nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3-month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non-users in 42% of statements. Seventy-two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views.

DISCUSSION

The co-designed web-based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth.