Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study

A mixed studies systematic review on the health and wellbeing effects, and underlying mechanisms, of online support groups for chronic conditions

This pre-registered systematic review aimed to examine whether online support groups affect the health and wellbeing of individuals with a chronic condition, and what mechanisms may influence such effects. In September 2024, literature searches were conducted across electronic databases (Medline, Embase, PsycInfo, Web of Science and Google Scholar), pre-publication websites (MedRxiv and PsyArXiv) and grey literature websites. Qualitative and quantitative studies were included if they explored the impact of online support groups on the health and wellbeing outcomes of individuals with a chronic condition. The Mixed Methods Appraisal Tool was used to appraise the quality of the included studies. In total 100 papers met the inclusion criteria with their findings presented in a thematic synthesis. Health and wellbeing outcomes were categorised as: physical health, mental health, quality of life, social wellbeing, behaviour and decision-making, and adjustment. Mechanisms reported in these studies related to exchanging support, sharing experiences, content expression, and social comparison. User and group characteristics were also explored. The included studies suggest that online support groups can have a positive impact on social wellbeing, behaviour, and adjustment, with inconclusive findings for physical health and quality of life. However, there is also the possibility of a negative effect on anxiety and distress, particularly when exposed to other group members' difficult experiences. Research comparing different online group features, such as platforms, size, and duration is needed. In particular, future research should be experimental to overcome the limitations of some of the cross-sectional designs of the included studies. The review was funded by the National Institute for Health and Care Research Health Protection Research in Emergency Preparedness and Response. Pre-registration ID: CRD42023399258.

Insufficient structure and reporting of process evaluations of complex interventions for musculoskeletal conditions in randomized controlled trials: a systematic review

OBJECTIVES

To explore how process evaluation of complex interventions alongside randomized clinical trials (RCTs) in musculoskeletal conditions are conducted.

STUDY DESIGN AND SETTING

Systematic review.

METHODS

We searched the MEDLINE, SCOPUS, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Studies were included if they reported process evaluation conducted alongside RCTs, within the main report or as separate reports, that assessed process evaluation of RCTs of complex nonsurgical and nonpharmacological interventions for musculoskeletal conditions. We performed a descriptive analysis of the included studies based on process evaluation parameters.

RESULTS

Data were extracted from 61 studies from 17 countries. Our findings showed studies used qualitative, quantitative, and mixed methods for process evaluations, typically reporting within the main RCT. Most studies were conducted in primary care settings. Only a few studies (16%) included a theoretical model to guide their process evaluation. Studies reported reach (8%), patients' and clinicians' perceptions of the interventions (44% and 8%, respectively), treatment fidelity and adherence (52% and 43%, respectively), training of patients and clinicians (eg, workshops, manuals and additional training) (54%), how the integration of process evaluation and outcome evaluation findings was performed (68%), barriers to perform the process evaluation (2%), and the strengths and weaknesses of the process evaluation (65%).

CONCLUSION

Reporting of process evaluations within RCTs is insufficiently reported. Researchers rarely adopted a theoretical model or framework to guide their process evaluation. Studies used a variety of methods to conduct process evaluations. We identified barriers, strengths, and weaknesses of methods used for assessing process evaluation as reported by authors from studies included in this review.

The Knee-SCHOOL: a brief patient-centered multidisciplinary educational program for knee osteoarthritis

Background

Knee osteoarthritis (KOA) is the most common form of arthritis in adults and a leading cause of years lived with disability, representing a significant burden on healthcare worldwide.

Objective

Describe the structure and educational elements of the Knee-SCHOOL, a brief patient-centered multidisciplinary educational program for patients with KOA.

Design

Observational prospective study.

Setting

Academically affiliated rehabilitation outpatient center in Brazil.

Methods

The program consisted of three in-person educational sessions (4.5 hr each) for 55 community dwelling adults, aged ≥50 years, with primary KOA-related pain. Study measures included demographic data (age, sex, and educational level), pain duration (years), pain intensity (visual analogue scale), affected knee (right, left, or both knees), comorbidities (presence of hypertension, diabetes, and hypercholesterolemia), Body Mass Index (BMI), Bristol Stool Scale, Adapted Healthy Eating Index (AHEI), bioelectrical impedance, daytime sleepiness, and the impact of the KOA on pain, symptoms, activities of daily living, recreation, and quality of life. Participants attended educational sessions delivered by a multidisciplinary team (two physicians, two nurses, two physical therapists, one occupational therapist, one dietitian, one psychologist, one social worker, and one physical educator) addressing several aspects of KOA. They also participated in supervised exercise practice and a home exercise program.

Results

Fifty-five subjects completed the study. The mean age was 67.73 (± 7.73) years; most were females (70.9%), 92.7% had bilateral KOA, with mean pain duration of 12.41 (± 10.17) years. The mean BMI was 32.52 (± 5.99), 65.5% were obese, and 96.4% reported an inadequate diet. KOA had a more negative impact on sports, recreation and quality of life. Daytime sleepiness was uncommon. The mean pain intensity, measured with visual analogue scale, score reduced from 5.52 (± 2.11) at baseline to 4.04 (± 2.38) after the program (week 2). The effect size was 0.7 (95% CI 0.32 to 1.07). All participants received the program well, with no drop-out rates or reported adverse events.

Conclusion

The Knee-SCHOOL utilized a multidisciplinary educational approach and an exercise practice addressing multiple aspects of KOA pain. While more studies are needed to assess the longitudinal impact of the program, it was promising in managing pain.

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.

The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials

ABSTRACT

This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception-January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD -3.48, 95% CI -6.61, -0.35; long-term: MD -1.97, 95% CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD -0.10, 95% CI -0.19, -0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD -0.41, 95% CI -0.77, -0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review

AIM

To explore what Internet-based breastfeeding peer support offers to breastfeeding parents.

DESIGN

Integrative review.

DATA SOURCES AND REVIEW METHODS

A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted.

RESULTS

The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices.

CONCLUSION

Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging.

IMPACT

These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

This was an integrative review therefore no patient or public contribution was necessary.

How Does Osteoarthritis Education Influence Knowledge, Beliefs, and Behavior in People With Knee and Hip Osteoarthritis? A Systematic Review

OBJECTIVE

Our goal was to inform the design and implementation of osteoarthritis (OA) education for people with knee and hip OA. This review investigated the impact of OA education on knowledge, beliefs, and behavior and how and why these changes occur.

METHODS

Five databases-MEDLINE, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Physiotherapy Evidence Database (PEDro)-were searched in August 2023. Eligible studies were quantitative, qualitative, and mixed-methods, involving OA education interventions and assessing knowledge, beliefs, and/or behavioral outcomes. An interpretivist analytic process guided data evaluation, synthesis, and description of meta-themes.

RESULTS

Ninety-eight studies were included (80 quantitative, 12 qualitative, 6 mixed-methods). OA education was heterogeneous in content and delivery. Outcome measures varied, with poor distinction among knowledge, beliefs, and behavior constructs. Trends toward short-term knowledge improvement were observed, but there were no clear trends in beliefs or behavior change. Intrinsic factors (eg, pre-existing beliefs) and extrinsic factors (eg, socioeconomic factors) appeared to influence change. Three meta-themes described how and why changes may occur: (i) engagement: how individuals relate with education content and delivery; (ii) embodiment: the role of experiential factors in learning, and (iii) empowerment: the level of agency education generates.

CONCLUSION

Beyond the provision of information and instruction, OA education is a complex, relational process influenced by multidimensional factors. This review identifies potentially important strategies at individual, interpersonal, and community levels to support the design and delivery of engaging education that promotes holistic, embodied learning and facilitates meaningful, empowering change.

Lessons learnt from a nationally funded training and mentoring programme for early-mid career musculoskeletal researchers in Australia

INTRODUCTION

Quality training and mentoring are crucial components of successful career development for early mid career researchers (EMCRs). This paper describes the overarching framework of novel ongoing national Training and Mentoring Programme Melbourne University Sydney Queensland:Impact (MUSQ:Impact) for musculoskeletal researchers, including a description of how it was set up and established, and lessons learned from its implementation.

RESULTS

The MUSQ:Impact programme spans four multidisciplinary musculoskeletal research teams across three universities in Australia, comprising 40-60 EMCR members. It was established to provide EMCRs with a unique learning environment and opportunities to gain exposure to, and network with, other national musculoskeletal research teams. Specific goals are to focus on core research competencies (e.g. writing skills, managing grant budgets, public speaking and media engagement, research translation), provide career mentoring, fund development activities (e.g. conference attendance, laboratory visits, skill development courses), and share training resources (e.g. data dictionaries, project summaries). A Steering Committee of 10-12 EMCR members, co-chaired by a senior researcher and one EMCR, is responsible for overseeing MUSQ:Impact and organising regular activities, including a monthly webinar series, a mentor/mentee scheme, annual group research retreats, annual infographic competition, and funding awards. An evaluation survey found that most participants perceived each activity to be beneficial and of value to their research career and development.

CONCLUSION

This paper presents the structure of national training and mentoring programme that serves as a potential template for other research teams to adapt within their own contexts.

Influence of Participation in a Medical-Themed Science Café on Patient Activation

Purpose

This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants' patient activation (PA), a concept that refers to patients' involvement in managing their own health, working with their healthcare providers, and maintaining their health.

Material and Methods

Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed.

Results

The interviews revealed three factors: "Experience & acceptance of chronic conditions", "Features of medical SC" and "Changes as a result of participation." The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret.

Conclusions

Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.

Comparative effect of two educational videos on self-efficacy and kinesiophobia in people with knee osteoarthritis: an online randomised controlled trial

OBJECTIVE

To compare change in self-efficacy for managing knee osteoarthritis (OA) pain and kinesiophobia after watching an educational video based on an empowerment and participatory discourse with a video based on a disease and impairment discourse.

DESIGN

Two-arm randomised controlled trial with participants aged ≥45 years with knee pain (n = 589). Participants completed both baseline and follow-up outcomes and watched one randomly-allocated video (12-minute duration) during one 30-45-minute session within a single online survey. The experimental video presented evidence-based knee OA information using design and language that aimed to empower people and focus on activity participation to manage OA, while the control video presented similar information but with a disease and impairment focus. Primary outcome measures were Arthritis Self-Efficacy Scale pain subscale (range 0-10) and Brief Fear of Movement Scale for OA (range 6-24). Secondary outcomes were expectations about prognosis and physical activity benefits, perceived importance and motivation to be physically active, knee OA knowledge, hopefulness for the future, level of concern and perceived need for surgery.

RESULTS

Compared to control (n = 293), the experimental group (n = 296) showed improved self-efficacy for managing OA pain (mean difference 0.4 [95%CI 0.2, 0.6] units) and reduced kinesiophobia (1.6 [1.1, 2.0] units). The experimental group also demonstrated greater improvements in all secondary outcomes apart from hopefulness, which was high in both groups.

CONCLUSION

An educational video based on an empowerment and participatory discourse improved pain self-efficacy and reduced kinesiophobia in people with knee OA more than a video based on a disease and impairment discourse.

CLINICALTRIALS

gov registration NCT05156216, Universal trial number U1111-1269-6143.