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Woodcock C, Cornwall N, Dikomitis L, Harrisson SA, White S, Helliwell T, Knaggs R, Hodgson E, Pincus T, Santer M, Mallen C, Ashworth J, Jinks C. Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study. BJGP Open 2024:BJGPO.2023.0221. [PMID: 38631722 DOI: 10.3399/bjgpo.2023.0221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. AIM To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. DESIGN & SETTING Primary care multi-method qualitative study. METHOD Adults with experience of persistent pain and taking opioids participated in semi-structured interviews (n=15, 73% female) and an online discussion forum (n=31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within-domains to generate subthemes, and subtheme comparison to form across-domain overarching themes. The behaviour change technique taxonomy v.1 and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. RESULTS 32 facilitator and barrier subthemes for patients reducing opioids were identified across 13 TDF domains. These combined into six overarching themes: learning to live with pain, opioid reduction expectations, assuming a medical model, pharmacist-delivered reviews, pharmacist-patient relationship and patient engagement. Subthemes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. CONCLUSION This study generated theoretically-informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training.
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Affiliation(s)
- Charlotte Woodcock
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
| | - Nicola Cornwall
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
| | - Lisa Dikomitis
- Centre for Health Services Studies and Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom
| | - Sarah A Harrisson
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, High Lane, Burslem, Stoke on Trent, United Kingdom
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Toby Helliwell
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, High Lane, Burslem, Stoke on Trent, United Kingdom
| | - Roger Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
- Primary Integrated Community Services Ltd, Nottingham, United Kingdom
| | | | - Tamar Pincus
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Christian Mallen
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, High Lane, Burslem, Stoke on Trent, United Kingdom
| | - Julie Ashworth
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership University NHS Foundation Trust, Haywood Hospital, High Lane, Burslem, Stoke on Trent, United Kingdom
| | - Clare Jinks
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, United Kingdom
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Lawton S, Mallen C, Hussain Z, Bajpai R, Muller S, Holmstrom C, Jinks C, Helliwell T. Identifying carers in general practice (STATUS QUO): a multicentre, cross-sectional study in England. BMJ Open 2024; 14:e083816. [PMID: 38626957 PMCID: PMC11029175 DOI: 10.1136/bmjopen-2023-083816] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES To determine General Practice (GP) recording of carer status and the number of patients self-identifying as carers, while self-completing an automated check-in screen prior to a GP consultation. DESIGN A descriptive cross-sectional study. SETTING 11 GPs in the West Midlands, England. Recruitment commenced in September 2019 and concluded in January 2020. PARTICIPANTS All patients aged 10 years and over, self-completing an automated check-in screen, were invited to participate during a 3-week recruitment period. PRIMARY AND SECONDARY OUTCOME MEASURES The current coding of carers at participating GPs and the number of patients identifying themselves as a carer were primary outcome measures. Secondary outcome measures included the number of responses attained from automated check-in screens as a research data collection tool and whether carers felt supported in their carer role. RESULTS 80.3% (n=9301) of patients self-completing an automated check-in screen participated in QUantifying the identification Of carers in general practice (STATUS QUO Study) (62.6% (n=5822) female, mean age 52.9 years (10-98 years, SD=20.3)). Prior to recruitment, the clinical code used to denote a carer was identified in 2.7% (n=2739) of medical records across the participating GPs.10.1% (n=936) of participants identified themselves as a carer. They reported feeling supported with their own health and social care needs: always 19.3% (n=150), a lot of the time 13.2% (n=102), some of the time 40.8% (n=317) and never 26.7% (n=207). CONCLUSIONS Many more participants self-identified as a carer than were recorded on participating GP lists. Improvements in the recording of the population's caring status need to be actioned, to ensure that supportive implementation strategies for carers are effectively received. Using automated check-in facilities for research continues to provide high participation rates.
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Affiliation(s)
- Sarah Lawton
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Christian Mallen
- School of Medicine, Keele University, Keele, Staffordshire, UK
- Midlands Partnership NHS Foundation Trust, Stafford, Staffordshire, UK
| | | | - Ram Bajpai
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Sara Muller
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Cath Holmstrom
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Toby Helliwell
- School of Medicine, Keele University, Keele, Staffordshire, UK
- Midlands Partnership NHS Foundation Trust, Stafford, Staffordshire, UK
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Gray L, Bullock L, Chew-Graham CA, Jinks C, Paskins Z, Hider S. Reviews for multimorbidity risk in people with inflammatory conditions: a qualitative study. BJGP Open 2024:BJGPO.2024.0011. [PMID: 38580391 DOI: 10.3399/bjgpo.2024.0011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at high risk of developing other conditions including cardiovascular disease and mood disorders. AIM To explore perspectives of people with IRCs and healthcare practitioners (HCPs) on the content and delivery of a review consultation aimed at identification and management of multiple long-term conditions. DESIGN & SETTING Semi-structured interviews and focus groups with people with IRCs and HCPs. METHOD People with IRCs participated in individual semi-structured interviews by telephone or online platform. HCPs (including primary and secondary care clinicians) participated in online focus groups. Data were transcribed verbatim and analysed using inductive thematic analysis. RESULTS 15 people with IRCs were interviewed; three focus groups with HCPs were conducted. Two main themes were identified: reflecting on the value of review consultations and what would a new review look like. Overall, people with IRCs and HCPs reflected that access to reviews is inequitable, leading to duplication of reviews and fragmentation in care. People with IRCs, at times, had difficulty conceptualising reviews, especially when discussing their future risk of conditions. People suggested that preparation before the healthcare review could align patient and HCP agendas as part of a flexible and person-centred discussion. CONCLUSION Any review introduced for people with IRCs must move beyond a "tick-box" exercise. To gain maximum value from a review, preparation from both patient and HCP may be required alongside a person-centred approach whilst ensuring they are targeted at people most likely to benefit.
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Affiliation(s)
- Lauren Gray
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Laurna Bullock
- School of Medicine, Keele University, Keele, United Kingdom
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, United Kingdom
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Samantha Hider
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
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Jinks C, Botto-van Bemden A, Bunzli S, Bowden J, Egerton T, Eyles J, Foster N, Healey EL, Maddison J, O'Brien D, Quicke JG, Schiphof D, Parry E, Thomas MJ, Holden MA. Changing the narrative on osteoarthritis: A call for global action. Osteoarthritis Cartilage 2024; 32:414-420. [PMID: 38354847 DOI: 10.1016/j.joca.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
| | | | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Jocelyn Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Thorlene Egerton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK; Physiotherapy Department, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK; School of Clinical Science, Auckland University of Technology, Auckland, New Zealand.
| | - Emma L Healey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
| | - John Maddison
- Research Users' Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
| | - Daniel O'Brien
- School of Clinical Science, Auckland University of Technology, Auckland, New Zealand.
| | - Jonathan G Quicke
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK; Research Users' Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
| | - Dieuwke Schiphof
- Department of General Practice, University Medical Center Rotterdam Erasmus MC, Rotterdam, The Netherlands.
| | - Emma Parry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Staffordshire ST6 7AG, UK.
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
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Bullock L, Abdelmagid S, Fleming J, Leyland S, Clark EM, Gidlow C, Iglesias-Urrutia CP, O'Neill TW, Mallen C, Jinks C, Paskins Z. Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey. Arch Osteoporos 2023; 19:5. [PMID: 38123745 PMCID: PMC10733195 DOI: 10.1007/s11657-023-01361-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
We conducted a survey of FLSs' consultation conduct and content which identified marked variation in whether FLS HCPs discussed osteoporosis medicine with patients. A review of service pro formas showed more content related to 'investigating' and 'intervening' than to 'informing'. We propose an expanded FLS typology and model FLS pro forma. PURPOSE To investigate the nature of direct patient contact in fracture liaison service (FLS) delivery, examine the use and content of pro formas to guide information eliciting and sharing in FLS consultations, and determine service changes which were implemented as a result of the COVID-19 pandemic. METHODS An electronic survey of UK FLS healthcare practitioners (HCPs) was distributed through clinical networks, social media, and other professional networks. Participants were asked to upload service pro formas used to guide consultation content. Documentary analysis findings were mapped to UK FLS clinical standards. RESULTS Forty-seven HCPs responded, providing data on 39 UK FLSs, over half of all 74 FLSs reporting to FLS-database. Results showed variation in which HCP made clinical decisions, whether medicines were discussed with patients or not, and in prescribing practice. Services were variably affected by COVID, with most reporting a move to more remote consulting. The documentary analysis of eight service pro formas showed that these contained more content related to 'investigating' and 'intervening', with fewer pro formas prompting the clinician to offer information and support (e.g., about coping with pain). Based on our findings we propose an expanded FLS typology and have developed a model FLS pro forma. CONCLUSION There is marked variation in the delivery of services and content of consultations in UK FLSs including discussion about osteoporosis medications. Clinical standards for FLSs should clarify the roles of primary and secondary HCPs and the importance of holistic approaches to patient care.
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Affiliation(s)
- Laurna Bullock
- School of Medicine, Keele University, Staffordshire, UK.
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital Fracture Liaison Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Emma M Clark
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-On-Trent, Staffordshire, UK
| | - Cynthia P Iglesias-Urrutia
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements (CHI), Aalborg University, Aalborg, Denmark
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Staffordshire, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-On-Trent Partnership Trust, Stoke-On-Trent, Staffordshire, UK
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Holden MA, Hawarden A, Paskins Z, Roddy E, Mallen CD, Liddle J, Bourton A, Jinks C. Experiences of living with hip osteoarthritis and of receiving advice, education and ultrasound-guided intra-articular hip injection in the hip injection trial. A qualitative study. Musculoskeletal Care 2023; 21:1601-1611. [PMID: 37905905 DOI: 10.1002/msc.1830] [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: 08/11/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The Hip Injection Trial (HIT) compared the effectiveness of adding a single ultrasound-guided intra-articular injection of either corticosteroid and local anaesthetic or local anaesthetic alone to advice and education among people with hip osteoarthritis (OA). This nested qualitative study explored participants' experiences of living with hip OA and of the trial treatment they received. METHOD Semi-structured telephone interviews were undertaken with a purposeful sample of trial participants after a 2-month trial follow-up. Interviewers were blinded to which injection participants had received. Thematic analysis using constant comparison was undertaken prior to knowing the trial results. RESULTS 34 trial participants were interviewed across all arms. OA causes pain, physical limitations, difficulties at work, lowered mood, and disrupted sleep. Those who received advice and education alone felt that they had not received 'treatment' and described little/no benefit. Participants in both injection groups described marked improvements in pain, physical function, and other aspects of life (e.g., sleep, confidence). The perceived magnitude of benefit appeared greater among those who received the corticosteroid injection; however, the length of benefit varied in both injection groups. There was uncertainty about the longer-term benefits of injection and repeated injections. CONCLUSION Hip OA is highly burdensome. Participants perceived little/no benefit from advice and education alone but reported marked improvements when combined with either injection. However, the magnitude of benefit was greater among those who received corticosteroid. The varying duration of response to injection and uncertainty regarding longer-term benefits of injection and repeated injections suggests that these areas are important for future research. TRIAL REGISTRATION EudraCT 2014-003412-37; ISRCTN50550256.
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Affiliation(s)
- Melanie Ann Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Ashley Hawarden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Jennifer Liddle
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Amy Bourton
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Healey EL, McBeth J, Nicholls E, Chew‐Graham CA, Dent S, Foster NE, Herron D, Pincus T, Hartshorne L, Hay EM, Jinks C. The acceptability and feasibility of conducting a randomised controlled trial to test the effectiveness of a walking intervention for older people with persistent musculoskeletal pain in primary care: A mixed methods evaluation of the iPOPP pilot trial. Musculoskeletal Care 2023; 21:1372-1386. [PMID: 37688496 PMCID: PMC10946998 DOI: 10.1002/msc.1815] [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: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established. OBJECTIVES To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant-led walking intervention for older people with persistent MSK pain (iPOPP) in primary care. METHODS A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods. RESULTS All pre-specified success criteria were achieved in terms of feasibility (recruitment, follow-up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient-centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data. CONCLUSIONS This pilot trial suggests that the iPOPP intervention and a future full-scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn.
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Affiliation(s)
| | - John McBeth
- Arthritis Research UK Centre for EpidemiologyThe University of ManchesterManchesterUK
| | - Elaine Nicholls
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Keele Clinical Trials UnitKeele UniversityKeeleStaffordshireUK
| | - Carolyn A. Chew‐Graham
- School of MedicineKeele UniversityKeeleStaffordshireUK
- Midlands Partnership Foundation TrustStaffordStaffordshireUK
| | - Stephen Dent
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Nadine E. Foster
- School of MedicineKeele UniversityKeeleStaffordshireUK
- STARS Education and Research AllianceSurgical Treatment and Rehabilitation ServiceThe University of Queensland and Metro North HealthBrisbaneQueenslandAustralia
| | - Daniel Herron
- School of Health, Science and WellbeingStaffordshire UniversityScience Centre BuildingStoke‐on‐TrentUK
| | - Tamar Pincus
- The Faculty for Environment and Life Sciences (FELS)University of SouthamptonUniversity RoadSouthamptonUK
| | - Liz Hartshorne
- Faculty of Medicine & Health SciencesUniversity of NottinghamNottinghamUK
| | - Elaine M. Hay
- School of MedicineKeele UniversityKeeleStaffordshireUK
| | - Clare Jinks
- School of MedicineKeele UniversityKeeleStaffordshireUK
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Prior JA, Roddy E, Solis-Trapala I, Cornwall N, Jinks C, Abhishek A, Bukhari M, Galloway J, Goodson N, Jowett S, Hider S. How do clinicians prescribe bridging glucocorticoids in people starting or escalating disease-modifying anti-rheumatic drugs for rheumatoid arthritis: a service evaluation survey. Rheumatol Adv Pract 2023; 7:rkad102. [PMID: 38025093 PMCID: PMC10665131 DOI: 10.1093/rap/rkad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- James A Prior
- School of Medicine, Keele University, Keele, UK
- Rheumatology Department, Midlands Partnership University NHS Foundation Trust, Newcastle-Under-Lyme, UK
| | - Edward Roddy
- School of Medicine, Keele University, Keele, UK
- Rheumatology Department, Midlands Partnership University NHS Foundation Trust, Newcastle-Under-Lyme, UK
| | | | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marwan Bukhari
- Rheumatology Department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - James Galloway
- Centre for Rheumatic Diseases, Kings College London, London, UK
| | - Nicola Goodson
- Rheumatology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Rheumatology Department, Midlands Partnership University NHS Foundation Trust, Newcastle-Under-Lyme, UK
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Hawarden A, Bullock L, Chew-Graham CA, Herron D, Hider S, Jinks C, Erandie Ediriweera De Silva R, Machin A, Paskins Z. Incorporating FRAX into a nurse-delivered integrated care review: a multi-method qualitative study. BJGP Open 2023; 7:BJGPO.2022.0146. [PMID: 36746471 PMCID: PMC10354387 DOI: 10.3399/bjgpo.2022.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at increased risk of common comorbidities including osteoporosis. AIM To explore the barriers to and facilitators of implementing nurse-delivered fracture risk assessments in primary care, in the context of multimorbidity reviews for people with IRCs. DESIGN & SETTING A multi-method qualitative study in primary care. METHOD As part of a process evaluation in a pilot trial, semi-structured interviews were conducted with 20 patients, two nurses, and three GPs. Twenty-four patient-nurse INCLUDE review consultations were audiorecorded and transcribed. A framework analysis was conducted using the Theoretical Domains Framework (TDF). RESULTS Nurses reported positive views about the value of the Fracture Risk Assessment Tool (FRAX) and they felt confident to deliver the assessments following training. Barriers to implementation, as identified by TDF, particularly related to the domains of knowledge, skills, professional roles, and environmental context. GPs reported difficulty keeping up to date with osteoporosis guidelines and voiced differing opinions about whether fracture risk assessment was the role of primary or secondary care. Lack of integration of FRAX into IT systems was a barrier to use. GPs and nurses had differing views about the nurse role in communicating risk and acting on FRAX findings; for example, explanations of the FRAX result and action needed were limited. Patients reported limited understanding of FRAX outcomes. CONCLUSION The findings suggest that, with appropriate training including risk communication, practice nurses are likely to be confident to play a key role in conducting fracture risk assessments, but further work is needed to address the barriers identified.
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Affiliation(s)
| | | | | | - Daniel Herron
- Department of Psychology, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Risni Erandie Ediriweera De Silva
- School of Medicine, Keele University, Keele, UK
- Department of Family Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
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Healey EL, Mallen CD, Chew-Graham CA, Nicholls E, Lewis M, Lawton SA, Finney AG, Tan V, Cooper V, Dziedzic KS, Liddle J, Wathall S, Jinks C. Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial. Fam Pract 2022; 39:592-602. [PMID: 34546341 DOI: 10.1093/fampra/cmab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multimorbidity is increasingly the norm; however, primary care remains focused on single diseases. Osteoarthritis, anxiety, and depression are frequently comorbid with other long-term conditions (LTCs), but rarely prioritized by clinicians. OBJECTIVES To test the feasibility of a randomized controlled trial (RCT) of an intervention integrating case-finding and management for osteoarthritis, anxiety, and depression within LTC reviews. METHODS A pilot stepped-wedge RCT across 4 general practices recruited patients aged ≥45 years attending routine LTC reviews. General practice nurses provided usual LTC reviews (control period), then, following training, delivered the ENHANCE LTC review (intervention period). Questionnaires, an ENHANCE EMIS-embedded template and consultation audio-recordings, were used in the evaluation. RESULTS General practice recruitment and training attendance reached prespecified success criteria. Three hundred and eighteen of 466 (68%) of patients invited responded; however, more patients were recruited during the control period (206 control, 112 intervention). Eighty-two percent and 78% returned their 6-week and 6-month questionnaires, respectively. Integration of the ENHANCE LTC review into routine LTC reviews varied. Case-finding questions were generally used as intended for joint pain, but to a lesser extent for anxiety and depression. Initial management through referrals and signposting were lacking, and advice was more frequently provided for joint pain. The stepped-wedge design meant timing of the training was challenging and yielded differential recruitment. CONCLUSION This pilot trial suggests that it is feasible to deliver a fully powered trial in primary care. Areas to optimize include improving the training and reconsidering the stepped-wedge design and the approach to recruitment by targeting those with greatest need. TRIAL REGISTRATION ISRCTN registry (ISRCTN: 12154418). Date registered: 6 August 15. Date first participant was enrolled: 13 July 2015. https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType=basic-search.
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Affiliation(s)
- Emma L Healey
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Elaine Nicholls
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Martyn Lewis
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Sarah A Lawton
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Andrew G Finney
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Valerie Tan
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Vince Cooper
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Krysia S Dziedzic
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Jennifer Liddle
- Population Health Sciences Institute, Newcastle University, Newcastle NE4 5TG,UK
| | - Simon Wathall
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
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Paskins Z, Nicholls E, Grossmann H, McRobert C, Peat G, Shivji N, Bartlam B, Croft P, Jinks C, Maddison J, Main C, Quicke J, Porcheret M, Protheroe J, Cottrell E. P077 Developing a better explanation of osteoarthritis: results from a conjoint analysis of patient preferences. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Despite the negative impact of osteoarthritis (OA) and existence of evidence-based guidelines, many patients and professionals lack clarity about the nature of OA and effective treatment strategies. This project aims to improve OA explanations in consultations and investigate the extent to which different explanation statements impact on intention to self-manage OA.
Methods
Participants registered at four general practices, aged ≥45 years, with a recorded consultation for OA in the previous two years were mailed a survey. The survey included eight pairs of potential OA explanation statements for participants to select the explanation that would most help them to self-manage their OA, alongside questions on socio-demographics, OA symptoms, comorbidity and health literacy. The OA explanations were designed using a partial-profile choice-based conjoint analysis (profile strength 4, comparison depth 3) from a set of 11 theoretically informed key attributes (Table 1). Each attribute contained two statements: one representing current information sources, and one a newly designed statement from our previous co-design work with patients and stakeholders.
Results
The survey response rate was 22% (428/1980) (average age = 65 years [SD = 10]; 66% female). The newer statement was preferred to the existing statement for 10 of the 11 statements (indicated by a positive regression coefficient) and 8 of these differences were statistically significant (p < 0.05) (Table 1). Sensitivity analyses (e.g. to adjust the model to allow for within person correlation of response, and to test for 2-way interactions between model attributes) did not change the findings from the primary model.
Conclusion
Patients with OA preferred the newer statements, with one exception (causes). The preferred statements have been discussed with the project’s Patient Advisory Group and the statements combined into a written leaflet and animation, and further assessed using Flesch reading ease and Flesch Grade level. Our conjoint analysis has provided evidence about what explanation statements patients with OA prefer and improve likelihood of self-management. The next step is to evaluate the leaflet and written animation in think-aloud qualitative interviews before refining the OA explanation and widespread dissemination.
Disclosure
Z. Paskins: None. E. Nicholls: None. H. Grossmann: None. C. McRobert: None. G. Peat: None. N. Shivji: None. B. Bartlam: None. P. Croft: None. C. Jinks: None. J. Maddison: None. C. Main: None. J. Quicke: None. M. Porcheret: None. J. Protheroe: None. E. Cottrell: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Elaine Nicholls
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Heiko Grossmann
- Faculty of Mathematics, OVGU University of Mageburg, Magdeburg, GERMANY
| | - Cliona McRobert
- School of Health Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
| | - George Peat
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Noureen Shivji
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Bernadette Bartlam
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Peter Croft
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Maddison
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Chris Main
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Jonathan Quicke
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Mark Porcheret
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Joanne Protheroe
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Elizabeth Cottrell
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
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12
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Jinks C, Narayanasamy M, Scott I, Sahota O, Ryan S. P059 Acceptability of remote consulting during COVID-19 among patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
The COVID-19 pandemic led to the widespread adoption of remote consultations. Whilst remote consultations offer many potential advantages to patients and healthcare services, they are unlikely to be suitable for all. Guidance encourages clinicians to consider patient preferences when choosing face-to-face vs remote consultations. However, little is known about acceptability of, and preferences for remote consultations, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, remote consultations among patients with osteoporosis and rheumatoid arthritis.
Methods
Data for this study derived from three UK qualitative studies: iFraP (improving fracture prevention study), Blast Off (BO; Bisphosphonate aLternAtive regimenS for the prevenTion of Osteoporotic Fragility Fractures), and ERA (Exploring people with Rheumatoid Arthritis’ experience of the pandemic). Each study explored patient experiences of accessing and receiving healthcare during the pandemic year. Transcripts from each data set relating to remote consulting were extracted. A minimum of two study team members worked independently, following a consistent approach, to conduct a rapid deductive analysis using the Theoretical Framework of Acceptability (TFA). The TFA consists of 7 constructs to understand acceptability of, in this context, remote consultations, including: affective attitudes; intervention coherence; perceived effectiveness; burden; self-efficacy; opportunity-costs; and ethicality. Following coding, the findings of all three studies were pooled. Analysis was facilitated by group meetings to discuss interpretations.
Results
Findings from 1 focus group and 64 interviews with 35 people, who had mostly experienced telephone consultations, were included the analysis. Participants’ emotional attitudes to remote consultations, views on fairness (ethicality) and sense making (intervention coherence) varied according to their specific needs for the consultation and values, relative to the pandemic context; participants perceived remote consultations as making more sense and being ‘fairer’ earlier in the pandemic. Some participants valued the reduced burden associated with remote consultations, while others highly valued, and did not want to give up, non-verbal communication or physical examination associated with face-to-face consults (opportunity costs); although perceived need for physical examination in participants with RA was associated with strong preference for face-to-face consultations, asymptomatic participants with RA and osteoporosis also expressed similar strong preferences. Some participants described low confidence (self-efficacy) in being able to communicate in remote consultations and others perceived remote consultations as ineffective, in part due to suboptimal communication.
Conclusion
Acceptability of, and preferences for remote consultation appear to be influenced by a range of societal, healthcare provider and personal factors and in this study, were not fixed, or condition-dependent. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. The findings have supported the development of patient-centred recommendations for practice that should be considered alongside clinician-focused recommendations when deciding whether remote consultations are appropriate.
Disclosure
Z. Paskins: Grants/research support; NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy. L. Bullock: None. F. Manning: Grants/research support; part funded NIHR Clinical Research Network Scholar Programme. S. Bishop: None. P. Campbell: None. E. Cottrell: None. C. Jinks: Grants/research support; part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. M. Narayanasamy: None. I. Scott: Grants/research support; funded by an NIHR Advanced Research Fellowship Award (NIHR300826). O. Sahota: None. S. Ryan: None.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Laurna Bullock
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Fay Manning
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- University of Exeter Medical School, University of Exeter, Exeter, UNITED KINGDOM
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Paul Campbell
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Elizabeth Cottrell
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
| | - Melanie Narayanasamy
- Nottingham University Business School, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Ian Scott
- School of Medicine, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Opinder Sahota
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM
| | - Sarah Ryan
- School of Nursing, Keele University, Newcastle-under-Lyme, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
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13
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Paskins Z, Bromley K, Lewis M, Hughes G, Hughes E, Hennings S, Cherrington A, Hall A, Holden MA, Stevenson K, Menon A, Roberts P, Peat G, Jinks C, Kigozi J, Oppong R, Foster NE, Mallen CD, Roddy E. Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial. BMJ 2022; 377:e068446. [PMID: 35387783 PMCID: PMC8984871 DOI: 10.1136/bmj-2021-068446] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education in adults with hip osteoarthritis. DESIGN Pragmatic, three arm, parallel group, single blind, randomised controlled trial. SETTING Two community musculoskeletal services in England. PARTICIPANTS 199 adults aged ≥40 years with hip osteoarthritis and at least moderate pain: 67 were randomly assigned to receive advice and education (best current treatment (BCT)), 66 to BCT plus ultrasound guided injection of triamcinolone and lidocaine, and 66 to BCT plus ultrasound guided injection of lidocaine. INTERVENTIONS BCT alone, BCT plus ultrasound guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 mL 1% lidocaine hydrochloride, or BCT plus ultrasound guided intra-articular hip injection of 5 mL 1% lidocaine. Participants in the ultrasound guided arms were masked to the injection they received. MAIN OUTCOME MEASURES The primary outcome was self-reported current intensity of hip pain (0-10 Numerical Rating Scale) over six months. Outcomes were self-reported at two weeks and at two, four, and six months. RESULTS Mean age of the study sample was 62.8 years (standard deviation 10.0) and 113 (57%) were women. Average weighted follow-up rate across time points was 93%. Greater mean improvement in hip pain intensity over six months was reported with BCT plus ultrasound-triamcinolone-lidocaine compared with BCT: mean difference -1.43 (95% confidence interval -2.15 to -0.72), P<0.001; standardised mean difference -0.55 (-0.82 to -0.27). No difference in hip pain intensity over six months was reported between BCT plus ultrasound-triamcinolone-lidocaine compared with BCT plus ultrasound-lidocaine (-0.52 (-1.21 to 0.18)). The presence of ultrasound confirmed synovitis or effusion was associated with a significant interaction effect favouring BCT plus ultrasound-triamcinolone-lidocaine (-1.70 (-3.10 to -0.30)). One participant in the BCT plus ultrasound-triamcinolone-lidocaine group with a bioprosthetic aortic valve died from subacute bacterial endocarditis four months after the intervention, deemed possibly related to the trial treatment. CONCLUSIONS Ultrasound guided intra-articular hip injection of triamcinolone is a treatment option to add to BCT for people with hip osteoarthritis. TRIAL REGISTRATION EudraCT 2014-003412-37; ISRCTN50550256.
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Affiliation(s)
- Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | | | - Martyn Lewis
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Gemma Hughes
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Emily Hughes
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | | | | | - Alison Hall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Kay Stevenson
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Ajit Menon
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | | | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Jesse Kigozi
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Nadine E Foster
- Surgical Treatment And Rehabilitation Service (STARS), Research and Education Alliance, University of Queensland and Metro North Hospital and Health Service, Brisbane QLD, Australia
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Edward Roddy
- Surgical Treatment And Rehabilitation Service (STARS), Research and Education Alliance, University of Queensland and Metro North Hospital and Health Service, Brisbane QLD, Australia
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14
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Paskins Z, Bullock L, Manning F, Bishop S, Campbell P, Cottrell E, Partner GP, Jinks C, Narayanasamy M, Scott IC, Sahota O, Ryan S. Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice. BMC Musculoskelet Disord 2022; 23:312. [PMID: 35366845 PMCID: PMC8976169 DOI: 10.1186/s12891-022-05273-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. Methods Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. Results Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants’ attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. Conclusions Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05273-1.
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Bury J, Yeowell G, Jinks C, Selfe J, Littlewood C. Development of an intervention ‘The COMBINED approach’ to optimise current treatments for people with a rotator cuff disorder. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open 2021; 11:e048811. [PMID: 34408051 PMCID: PMC8375717 DOI: 10.1136/bmjopen-2021-048811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER researchregistry5041.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Emma Clark
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK
| | | | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
- School of Medicine & School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - J E Lefroy
- School of Medicine, Keele University, Keele, UK
| | | | - C Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements, Aalborg Universitet, Aalborg, Denmark
| | | | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
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Crawford-Manning F, Greenall C, Hawarden A, Bullock L, Leyland S, Jinks C, Protheroe J, Paskins Z. Evaluation of quality and readability of online patient information on osteoporosis and osteoporosis drug treatment and recommendations for improvement. Osteoporos Int 2021; 32:1567-1584. [PMID: 33501570 PMCID: PMC8376728 DOI: 10.1007/s00198-020-05800-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
UNLABELLED Patient information is important to help patients fully participate in their healthcare. Commonly accessed osteoporosis patient information resources were identified and assessed for readability, quality, accuracy and consistency. Resources contained inconsistencies and scored low when assessed for quality and readability. We recommend optimal language and identify information gaps to address. INTRODUCTION The purpose of this paper is to identify commonly accessed patient information resources about osteoporosis and osteoporosis drug treatment, appraise the quality and make recommendations for improvement. METHODS Patient information resources were purposively sampled and text extracted. Data extracts underwent assessment of readability (Flesch Reading Ease and Flesch-Kincaid Grade Level) and quality (modified International Patient Decision Aid Standards (m-IPDAS)). A thematic analysis was conducted, and keywords and phrases were used to describe osteoporosis and its treatment identified. Findings were presented to a stakeholder group who identified inaccuracies and contradictions and discussed optimal language. RESULTS Nine patient information resources were selected, including webpages, a video and booklets (available online), from government, charity and private healthcare providers. No resource met acceptable readability scores for both measures of osteoporosis information and drug information. Quality scores from the modified IPDAS ranged from 21 to 64% (7-21/33). Thematic analysis was informed by Leventhal's Common-Sense Model of Disease. Thirteen subthemes relating to the identity, causes, timeline, consequences and controllability of osteoporosis were identified. Phrases and words from 9 subthemes were presented to the stakeholder group who identified a predominance of medical technical language, misleading terms about osteoporotic bone and treatment benefits, and contradictions about symptoms. They recommended key descriptors for providers to use to describe osteoporosis and treatment benefits. CONCLUSIONS This study found that commonly accessed patient information resources about osteoporosis have highly variable quality, scored poorly on readability assessments and contained inconsistencies and inaccuracies. We produced practical recommendations for information providers to support improvements in understanding, relevance, balance and bias, and to address information gaps.
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Affiliation(s)
- F Crawford-Manning
- School of Medicine, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK.
| | - C Greenall
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - A Hawarden
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - L Bullock
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - S Leyland
- Royal Osteoporosis Society, Bath, UK
| | - C Jinks
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - J Protheroe
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | - Z Paskins
- School of Medicine, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
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McKevitt S, Jinks C, Healey EL, Quicke JG. The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation. Musculoskeletal Care 2021; 20:167-179. [PMID: 34245657 DOI: 10.1002/msc.1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation. METHODS Semi-structured interviews with adults aged ≥45, with self-reported OA and comorbidity (N = 17). Face-to-face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach. RESULTS Participants did not conceptualise multiple long-term conditions (LTCs) together and instead self-prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co-existing barriers to PA, and problematized this as a multi-level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self-efficacy for managing OA alongside other LTCs and self-efficacy for PA. CONCLUSION People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi-level PA barriers and target increased self-efficacy for LTC management and PA.
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Affiliation(s)
- Sarah McKevitt
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Clare Jinks
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan G Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.,Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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Bullock L, Jinks C, Hawarden A, Crawford-Manning F, Leyland S, Fleming J, Clark EM, Cottrell E, Edwards J, Paskins Z. P117 Exploring experiences of Fracture Liaison Services and perceptions of a new decision tool to support patient and clinician decisions: a focus group study. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
The iFraP study (Improving uptake of Fracture Prevention Treatments) is developing a computerised decision-support tool to support clinician decision-making, risk communication and informed patient decision-making in Fracture Liaison Service (FLS) consultations. To inform iFraP intervention development, this study explored 1) patient and clinician experiences of FLSs and 2) perspectives towards the new iFraP tool.
Methods
Four focus groups and supplementary interviews included 9 FLS clinicians, 7 General Practitioners (GPs), and 8 patients who recently attended an FLS consultation. Theoretically-informed thematic analysis was conducted to facilitate understanding of current FLS practice, potential intervention acceptability and possible barriers to, and facilitators of, implementation.
Results
FLS clinicians and GPs suggested that FLSs worked well to identify patients at high risk of future fracture and to recommend medication. FLS clinicians were confident in their role and felt their consultations were person-centred and addressed information needs. However, some FLS clinicians described communicating risk as difficult and gave examples of when they are uncertain whether medication should be recommended (e.g. patient with osteopenic bone mineral density). FLS clinicians had varying perceptions of their roles in discussing medications, with some not viewing this as their responsibility; whereas GPs reported that medication discussions were an important aspect of the FLS clinician role. When medication recommendations (and discussion) were delivered, the setting varied across services including face-to-face in clinic or at the patient’s home, by letter, or by telephone. On the whole, patients reflected positively on their FLS appointment. However, some patients described unmet information needs, such as risk of future fractures, potential benefits and risks of medications, and information about follow-up.Many FLS clinicians and GPs reflected upon the potential value of the tool, including the inclusion of visual images to facilitate understanding of fracture risk, and to promote consistent messages across FLSs and between primary and secondary care. Barriers to intervention implementation were also identified. Clinicians expressed concern that evidence-based Cates plots to support explanations of medication effectiveness may make patients believe medications are not ‘worthwhile’. This suggests that clinicians prioritised promotion of medication adherence over informed decision-making, highlighting that the goal of FLS clinicians and iFraP may not align. Furthermore, concern was expressed that use of a computerised tool may detract from the clinician-patient relationship.
Conclusion
These novel findings illustrate the experience of FLS consultations from three perspectives. They highlight FLS clinicians’ clinical decision-support needs and patients’ unmet need for clear information that addresses their medication concerns. Overall, the iFraP intervention was viewed as acceptable, with the potential to support clinicians’ decision-making and to facilitate informed decision-making. Differences in FLS configuration and a move to more remote consulting may mean the intervention needs to be adaptable to different settings to address barriers to implementation.
Disclosure
L. Bullock: None. C. Jinks: Grants/research support; CJ is part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. A. Hawarden: Grants/research support; AH is a NIHR funded Academic Clinical Fellow. F. Crawford-Manning: Grants/research support; FCM is part funded by the NIHR Clinical Research Network Scholar Programme. S. Leyland: None. J. Fleming: None. E.M. Clark: None. E. Cottrell: None. J. Edwards: Grants/research support; JE is an NIHR Academic Clinical Lecturer in Primary Care (CL-2016-10-003). Z. Paskins: Grants/research support; ZP is funded by the NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy.
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Affiliation(s)
- Laurna Bullock
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Ashley Hawarden
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | | | - Sarah Leyland
- Royal Osteoporosis Society, Royal Osteoporosis Society, Bath, UNITED KINGDOM
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Emma M Clark
- Bristol Medical School, University of Bristol, Bristol, UNITED KINGDOM
| | - Elizabeth Cottrell
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Edwards
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Zoe Paskins
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
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20
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Bullock L, Jinks C, Crawford-Manning F, Leyland S, Fleming J, Clark EM, Cottrell E, Edwards J, Paskins Z. P118 Co-design of a model Fracture Liaison Service consultation: a Delphi survey with patients and clinicians. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Fracture Liaison Services (FLSs) are recommended to deliver best practice in secondary fracture prevention. As part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) research programme this study aimed to 1) co-design content for a ‘model FLS consultation’ and 2) gain consensus on the appropriateness of osteoporosis clinical guidelines in the context of FLSs.
Methods
Three rounds of modified Delphi survey were sent to patients with osteoporosis and/or fragility fractures, carers, and clinicians. Participants were presented with potential consultation content derived from an evidence synthesis of current guidelines, frameworks and theories of shared decision-making, communication and medicine adherence, and stakeholder consultation. Participants were asked to rate their perception of the importance of each statement on a 5-point Likert scale and elaborate using free-text boxes. In Round 2, participants were shown mean scores of importance from Round 1. Statements identified as of ‘low importance’ at the end of Rounds 1 and 2 were discussed by the study team, including patient contributors, and were removed or amended. In Round 3, participants were asked whether the statement was ‘essential’ or ‘optional’ in a time-limited FLS consultation. Percentage agreement with each statement was ranked. The threshold for ‘essential’ versus ‘optional’ was determined by the study team.
Results
391 invitations to participate were sent, with 72, 49, and 52 responders to Rounds 1, 2 and 3 respectively. Throughout Rounds 1-3 participants considered 122 statements. By Round 3, 81 statements were deemed essential, with an additional 14 optional statements. Essential statements were distilled into 18 recommendations constituting the ‘model FLS consultation’. Statements related to stages of the consultation, including: introductions; gather information; consider therapeutic options; elicit patient perceptions; establish shared decision-making preferences; share information about condition and treatment; check understanding; and signpost next steps. There was consensus that FLS clinicians should discuss the benefits and risks of oral and intravenous bisphosphonates and denosumab. Optional consultation content included a statement suggesting clinicians should observe the patient to look for signs of fractures in their spine, with free-text responses suggesting that FLS clinicians may not ‘be best qualified’ to perform physical examinations. Removed statements included those relating to the discussion of Hormone Replacement Therapy, Raloxifene and Teriparatide, with free-text statements suggesting that ‘specialists’ (e.g. Rheumatologists) should discuss these medications. Additionally, statements that described the potential consequences of fracture (e.g. ‘the clinician should explain that one in ten patients with a hip fracture will die within 12 months of fracture.’) were removed. Free-text comments described these statements as potentially ‘scary’.
Conclusion
The Delphi survey has informed iFraP intervention development by highlighting essential and optional FLS consultation content. Findings also provide insight into aspects of current osteoporosis clinical guidelines deemed appropriate in nurse/allied health professional led FLSs.
Disclosure
L. Bullock: None. C. Jinks: Grants/research support; CJ is part funded by the NIHR Applied Research Collaboration (ARC) West Midlands. F. Crawford-Manning: Grants/research support; FCM is part funded by the NIHR Clinical Research Network Scholar Programme. S. Leyland: None. J. Fleming: None. E.M. Clark: None. E. Cottrell: None. J. Edwards: Grants/research support; JE is an NIHR Academic Clinical Lecturer in Primary Care (CL-2016-10-003). Z. Paskins: Grants/research support; ZP is funded by the NIHR, Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy.
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Affiliation(s)
- Laurna Bullock
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Clare Jinks
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | | | - Sarah Leyland
- Royal Osteoporosis Society, Royal Osteoporosis Society, Bath, UNITED KINGDOM
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Emma M Clark
- Bristol Medical School, University of Bristol, Bristol, UNITED KINGDOM
| | - Elizabeth Cottrell
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - John Edwards
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
| | - Zoe Paskins
- Keele University, School of Medicine, Newcastle-under-Lyme, UNITED KINGDOM
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21
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Herron D, Chew-Graham CA, Hider S, Machin A, Paskins Z, Cooke K, Desilva EE, Jinks C. Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study. J Comorb 2021; 11:26335565211002402. [PMID: 33912472 PMCID: PMC8047946 DOI: 10.1177/26335565211002402] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.
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Affiliation(s)
- Daniel Herron
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Carolyn A Chew-Graham
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Annabelle Machin
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Erandie Ediriweera Desilva
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
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22
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Holden MA, Callaghan M, Felson D, Birrell F, Nicholls E, Jowett S, Kigozi J, McBeth J, Borrelli B, Jinks C, Foster NE, Dziedzic K, Mallen C, Ingram C, Sutton A, Lawton S, Halliday N, Hartshorne L, Williams H, Browell R, Hudson H, Marshall M, Sowden G, Herron D, Asamane E, Peat G. Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial. BMJ Open 2021; 11:e048196. [PMID: 33771832 PMCID: PMC8006841 DOI: 10.1136/bmjopen-2020-048196] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Brace effectiveness for knee osteoarthritis (OA) remains unclear and international guidelines offer conflicting recommendations. Our trial will determine the clinical and cost-effectiveness of adding knee bracing (matched to patients' clinical and radiographic presentation and with adherence support) to a package of advice, written information and exercise instruction delivered by physiotherapists. METHODS AND ANALYSIS A multicentre, pragmatic, two-parallel group, single-blind, superiority, randomised controlled trial with internal pilot and nested qualitative study. 434 eligible participants with symptomatic knee OA identified from general practice, physiotherapy referrals and self-referral will be randomised 1:1 to advice, written information and exercise instruction and knee brace versus advice, written information and exercise instruction alone. The primary analysis will be intention-to-treat comparing treatment arms on the primary outcome (Knee Osteoarthritis Outcomes Score (KOOS)-5) (composite knee score) at the primary endpoint (6 months) adjusted for prespecified covariates. Secondary analysis of KOOS subscales (pain, other symptoms, activities of daily living, function in sport and recreation, knee-related quality of life), self-reported pain, instability (buckling), treatment response, physical activity, social participation, self-efficacy and treatment acceptability will occur at 3, 6, and 12 months postrandomisation. Analysis of covariance and logistic regression will model continuous and dichotomous outcomes, respectively. Treatment effect estimates will be presented as mean differences or ORs with 95% CIs. Economic evaluation will estimate cost-effectiveness. Semistructured interviews to explore acceptability and experiences of trial interventions will be conducted with participants and physiotherapists delivering interventions. ETHICS AND DISSEMINATION North West Preston Research Ethics Committee, the Health Research Authority and Health and Care Research in Wales approved the study (REC Reference: 19/NW/0183; IRAS Reference: 247370). This protocol has been coproduced with stakeholders including patients and public. Findings will be disseminated to patients and a range of stakeholders. TRIAL REGISTRATION NUMBER ISRCTN28555470.
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Affiliation(s)
- Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Michael Callaghan
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - David Felson
- Boston University School of Medicine, Boston, Massachusetts, USA
- Research in OsteoArthritis Manchester (ROAM), Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, Manchester, UK
| | - Fraser Birrell
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | - Elaine Nicholls
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - J Kigozi
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - John McBeth
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Manchester, UK
| | - Belinda Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology and Manchester Academic Health Science Centre, The University of Manchester, Manchester, Manchester, UK
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Krysia Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Carol Ingram
- Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Alan Sutton
- Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Sarah Lawton
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Nicola Halliday
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Liz Hartshorne
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Helen Williams
- Research in OsteoArthritis Manchester (ROAM), Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, Manchester, UK
| | - Rachel Browell
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | - Hannah Hudson
- Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Gail Sowden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Dan Herron
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Evans Asamane
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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23
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Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards J, Clark EM, Thomas S, Chapman S, Gidlow C, Iglesias CP, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C, Paskins Z. Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention. Arch Osteoporos 2021; 16:58. [PMID: 33761007 PMCID: PMC7989712 DOI: 10.1007/s11657-021-00913-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Abstract
Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. PURPOSE The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the 'model Fracture Liaison Service (FLS) consultation' within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. METHODS A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was 'essential' and percentage agreement calculated; the study team subsequently determined the threshold for essential content. RESULTS Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. CONCLUSIONS This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.
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Affiliation(s)
- Laurna Bullock
- School of Medicine, Keele University, Newcastle, Staffordshire, UK.
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge & Addenbrooke's Hospital Fracture Liaison Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - John Edwards
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Emma M Clark
- Bristol Medical School, Faculty of Health Sciences,, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Newcastle, Staffordshire, UK
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Cynthia P Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvement (CHI), Aalborg University, Aalborg, Denmark
| | - Joanne Protheroe
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christian Mallen
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Newcastle, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, UK
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24
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Hider SL, Bucknall M, Jinks C, Cooke K, Cooke K, Desilva EE, Finney AG, Healey EL, Herron D, Machin AR, Mallen CD, Wathall S, Chew-Graham CA. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot Feasibility Stud 2021; 7:9. [PMID: 33407943 PMCID: PMC7786467 DOI: 10.1186/s40814-020-00750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. METHODS A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist. RESULTS 453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified. CONCLUSIONS The findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training. TRIAL REGISTRATION ISRCTN, ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK. .,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK.
| | - Milica Bucknall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Erandie Ediriweera Desilva
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Andrew G Finney
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, UK
| | - Emma L Healey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Daniel Herron
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Annabelle R Machin
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
| | - Simon Wathall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
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Paskins Z, Crawford-Manning F, Cottrell E, Corp N, Wright J, Jinks C, Bishop S, Doyle A, Ong T, Gittoes N, Leonardi-Bee J, Langley T, Horne R, Sahota O. Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis. BMJ Open 2020; 10:e040634. [PMID: 33148763 PMCID: PMC7640526 DOI: 10.1136/bmjopen-2020-040634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING Any developed country healthcare setting. PARTICIPANTS Patients, healthcare professionals, managers, payers and academics. INTERVENTION Experiences and views of oral and intravenous bisphosphonates. RESULTS Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER CRD42019143526.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
| | - Alison Doyle
- Operations and Clinical Practice, Royal Osteoporosis Society, Bath, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Swaithes L, Dziedzic K, Finney A, Cottrell E, Jinks C, Mallen C, Currie G, Paskins Z. Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework. Implement Sci 2020; 15:95. [PMID: 33115490 PMCID: PMC7594414 DOI: 10.1186/s13012-020-01055-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023] Open
Abstract
Background Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation. Methods This study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5–8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results. Results In operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. ‘Instinctive facilitation’ may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation. Conclusion This theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01055-2.
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Affiliation(s)
- Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Clare Jinks
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Christian Mallen
- Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Graeme Currie
- Entrepreneurship & Innovation, Organising Healthcare Research Network, Warwick Business School, The University of Warwick, Coventry, CV4 7AL, UK
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
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Paskins Z, Torres Roldan VD, Hawarden AW, Bullock L, Meritxell Urtecho S, Torres GF, Morera L, Espinoza Suarez NR, Worrall A, Blackburn S, Chapman S, Jinks C, Brito JP. Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan. Osteoporos Int 2020; 31:1837-1851. [PMID: 32500301 DOI: 10.1007/s00198-020-05479-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.
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Affiliation(s)
- Z Paskins
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK.
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, ST6 7AG, UK.
| | - V D Torres Roldan
- Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA
| | - A W Hawarden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, ST6 7AG, UK
| | - L Bullock
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - S Meritxell Urtecho
- Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA
| | - G F Torres
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Morera
- Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA
| | - N R Espinoza Suarez
- Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA
| | - A Worrall
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - S Blackburn
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - S Chapman
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, ST5 5BG, UK
| | - C Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - J P Brito
- Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA
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Paskins Z, Crawford-Manning F, Bullock L, Jinks C. Identifying and managing osteoporosis before and after COVID-19: rise of the remote consultation? Osteoporos Int 2020; 31:1629-1632. [PMID: 32548787 PMCID: PMC7297512 DOI: 10.1007/s00198-020-05465-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/19/2023]
Abstract
UNLABELLED The COVID-19 pandemic is influencing methods of healthcare delivery. In this short review, we discuss the evidence for remote healthcare delivery in the context of osteoporosis. INTRODUCTION The COVID-19 pandemic has undoubtedly had, and will continue to have, a significant impact on the lives of people living with, and at risk of, osteoporosis and those caring for them. With osteoporosis outpatient and Fracture Liaison Services on pause, healthcare organisations have already moved to delivering new and follow-up consultations remotely, where staffing permits, by telephone or video. METHODS In this review, we consider different models of remote care delivery, the evidence for their use, and the possible implications of COVID-19 on osteoporosis services. RESULTS Telemedicine is a global term used to describe any use of telecommunication systems to deliver healthcare from a distance and encompasses a range of different scenarios from remote clinical data transfer to remote clinician-patient interactions. Across a range of conditions and contexts, there remains unclear evidence on the acceptability of telemedicine and the effect on healthcare costs. Within the context of osteoporosis management, there is some limited evidence to suggest telemedicine approaches are acceptable to patients but unclear evidence on whether telemedicine approaches support informed drug adherence. Gaps in the evidence pertain to the acceptability and benefits of using telemedicine in populations with hearing, cognitive, or visual impairments and in those with limited health literacy. CONCLUSION There is an urgent need for further health service evaluation and research to address the impact of remote healthcare delivery during COVID-19 outbreak on patient care, and in the longer term, to identify acceptability and cost- and clinical-effectiveness of remote care delivery on outcomes of relevance to people living with osteoporosis.
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Affiliation(s)
- Z Paskins
- School of Primary, Community and Social Care, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK.
| | - F Crawford-Manning
- School of Primary, Community and Social Care, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - L Bullock
- School of Primary, Community and Social Care, Keele University, Newcastle-under-Lyme, UK
| | - C Jinks
- School of Primary, Community and Social Care, Keele University, Newcastle-under-Lyme, UK
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Morden A, Ong BN, Jinks C, Healey E, Finney A, Dziedzic KS. Resistance or appropriation? : Uptake of exercise after a nurse-led intervention to promote self-management for osteoarthritis. Health (London) 2020; 26:221-243. [PMID: 32486866 PMCID: PMC8928233 DOI: 10.1177/1363459320925879] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The philosophical underpinning of trials of complex interventions is critiqued for not taking into account causal mechanisms that influence potential outcomes. In this article, we draw from in-depth interviews (with practice nurses and patients) and observations of practice meetings and consultations to investigate the outcomes of a complex intervention to promote self-management (in particular exercise) for osteoarthritis in primary care settings. We argue that nurses interpreted the intervention as underpinned by the need to educate rather than work with patients, and, drawing from Habermasian theory, we argue that expert medicalised knowledge (system) clashed with lay ‘lifeworld’ prerogatives in an uneven communicative arena (the consultation). In turn, the advice and instructions given to patients were not always commensurate with their ‘lifeworld’. Consequently, patients struggled to embed exercise routines into their daily lives for reasons of unsuitable locality, sense-making that ‘home’ was an inappropriate place to exercise and using embodied knowledge to test the efficacy of exercise on pain. We conclude by arguing that using Habermasian theory helped to understand reasons why the trial failed to increase exercise levels. Our findings suggest that communication styles influence the outcomes of self-management interventions, reinforce the utility of theoretically informed qualitative research embedded within trials to improve conduct and outcomes and indicate incorporating perspectives from human geography can enhance Habermas-informed research and theorising.
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McKevitt S, Healey E, Jinks C, Rathod-Mistry T, Quicke J. The association between comorbidity and physical activity levels in people with osteoarthritis: Secondary analysis from two randomised controlled trials. Osteoarthr Cartil Open 2020; 2:100057. [PMID: 32596692 PMCID: PMC7307638 DOI: 10.1016/j.ocarto.2020.100057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To determine whether comorbidity presence, frequency or type is associated with Physical Activity (PA) levels in people with Osteoarthritis (OA). Design Secondary data analysis of adults aged ≥45, with OA related pain recruited to the BEEP trial (knee pain, n = 514) (ISRCTN93634563) and the MOSAICS trial (peripheral joint pain, n = 525) (ISRCTN06984617). Comorbidities considered were respiratory, cardiovascular diseases (CVD), depression, type 2 diabetes and obesity. Self-report PA was measured using the Physical Activity Scale for the Elderly (PASE). Linear regression models were used to estimate the mean change (β) in PA with comorbidity presence, frequency and type adjusting for potential confounding covariates. Results In the BEEP trial comorbidity presence was associated with a decrease in PASE score (β = -32.25 [95% confidence interval (95% CI) −48.57, −15.93]). Each additional comorbidity was associated with an incrementally lower PASE score, one comorbidity (β = −24.42 [-42.45, −6.38]), two comorbidities β = −34.76 [-56.05, −13.48]), and three or more comorbidities β = −73.71 [-106.84, −40.58]) compared to those with no comorbidity. This pattern was similar in MOSAICS, but with a plateau in association from two comorbidities onward. In BEEP and MOSAICS, respiratory (β = −40.60 [-60.50, −20.35]; β = −11.82 [-34.95, 11.31]) and CVD (β = −27.15 [-53.25, −1.05]; β = −30.84 [-51.89, −9.80]) comorbidities were associated with the largest reduction in PASE scores respectively. Conclusion Comorbidity presence and frequency is associated with lower PA levels and respiratory and CVD comorbidities have the greatest impact. Future exploratory work needs to be done to understand how and why comorbidity is associated with PA levels in people with OA.
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Affiliation(s)
- Sarah McKevitt
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Emma Healey
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Trishna Rathod-Mistry
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
| | - Jonathan Quicke
- School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, ST5 5BG, UK
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Hawarden AW, Paskins Z, Desilva EE, Herron D, Machin A, Jinks C, Hider S, Chew-Graham C. P193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary care. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community) pilot trial aimed to evaluate the feasibility and acceptability of a nurse-delivered review in primary care for people with inflammatory rheumatological conditions (IRCs), to identify and manage common comorbidities including anxiety and depression, cardiovascular and fracture risk. We report analysis of data focusing on the fracture risk assessment component of the review.
Methods
Ethical approvals obtained. Semi-structured interviews were conducted to explore experiences of participating in INCLUDE, with 20 patients, the two nurses delivering the intervention and three General Practitioners (GPs) within participating practices. 24 consenting patients had their INCLUDE review recorded for fidelity checking. Selected extracts were played within some interviews to stimulate discussion (tape-assisted recall). Extracts from recorded consultations relating to fracture risk assessment were transcribed and coded. Interviews were digitally recorded, with consent, transcribed and anonymised. Thematic analysis of the interview data was followed by mapping to the Theoretical Domains Framework (TDF).
Results
Findings mapped to 10/14 TDF domains relating to knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, memory attention and decision processes and environmental context/resources. GPs and nurses identified a lack of knowledge and skills in relation to the identification and management of osteoporosis, due to lack of exposure and repeated changes in clinical guidance. GPs reported differing opinions about whether osteoporosis screening was the role of primary or secondary care. GPs and nurses had differing views about the limits of the nurse role in communicating risk. The INCLUDE nurses reported confidence (self-efficacy) in undertaking FRAX assessments. Nurses valued the opportunity to learn new skills and believed that they were improving patient care. They described practical barriers using FRAX including the difficulty navigating between different IT systems. Nurses described uncertainty over when to refer to the GP. Fidelity checks of recorded reviews, showed that FRAX was appropriately calculated for 22/24 patients; whilst INCLUDE nurses introduced the reason for calculating fracture risk, explanations of the meaning of risk were limited, and patients’ understanding was not always checked and queries not responded to; patient interview findings confirmed patients had limited understanding of the meaning of FRAX. Life-style advice related to bone health was given in few consultations.
Conclusion
Screening for fracture risk in people with IRCs in a review consultation is acceptable and feasible, although explanations of the meaning of risk assessment could be improved. Integration of a fracture risk assessment tool within GP software would facilitate risk calculation. More work is needed to understand barriers to risk assessment, including clarity over roles and professional boundaries, and develop management pathways to optimise management of fracture risk in people with IRCs.
Disclosures
A.W. Hawarden None. Z. Paskins None. E. Ediriweera Desilva None. D. Herron None. A. Machin None. C. Jinks None. S. Hider None. C. Chew-Graham None.
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Affiliation(s)
- Ashley W Hawarden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Erandie Ediriweera Desilva
- Family Medicine Unit, Faculty of Medicine, University of Colombo, SRI LANKA
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Daniel Herron
- University of Derby Online Learning, University of Derby, Derby, UNITED KINGDOM
| | - Anabelle Machin
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
| | - Carolyn Chew-Graham
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trent, UNITED KINGDOM
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Holden M, Hawarden A, Paskins Z, Roddy E, Mallen C, Jinks C. P130 Qualitative findings from the Hip Injection Trial (HIT): experiences of living with hip osteoarthritis and receiving trial treatments. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The HIT trial compared ultrasound-guided intra-articular hip injection (USGI) of triamcinolone acetonide and 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone and (ii) an USGI of 1% lidocaine only combined with BCT (EudraCT: 2014-003412-37). BCT included verbal and written advice on exercise, weight loss and pain management. This nested qualitative study explored participants’ experiences of living with hip osteoarthritis (OA) and of the treatment they received.
Methods
Semi-structured interviews were completed with purposefully sampled trial participants after 2-month follow-up. Interviewers knew whether participants had received an injection within the trial, but not which injection. Thematic analysis was undertaken blind to the clinical trial results to facilitate an interpretive and inductive approach. Sampling ceased on inductive thematic saturation.
Results
34 trial participants were interviewed across all arms (USGI of triamcinolone acetonide and lidocaine plus BCT = 13, BCT alone = 8, USGI of lidocaine plus BCT = 11). Interviewees were males (n = 13) and females, of varying ages (53 - 83 years), with varying self-reported improvement. Participants described how hip OA impacted on many aspects of their life. It caused pain and physical limitations, difficulties at work, lowered mood, and commonly disrupted sleep. Participants who received BCT alone reported receiving an examination, information/explanation and exercises. Despite this, most felt that they had not received ‘treatment’ and reported limited exercise adherence. They described little or no benefit from BCT, and thoughts about the future tended to focus on inevitable decline. In contrast, participants in both injection groups experienced marked improvements in pain and other aspects of life, including sleep. Participants described getting their “life back” and having “a new lease of life”. Perceived benefit appeared greater among those randomised to USGI of triamcinolone acetonide and lidocaine plus BCT, however length of benefit varied in both injection groups. Despite uncertainty about the longer-term benefits of injection and the possibility of having repeated injections, there was more hope and optimism about the future among participants who had received an injection in comparison to those who had received BCT alone.
Conclusion
Hip OA is burdensome, affecting many different aspects of life. Participants perceived little or no benefit from BCT alone but reported marked improvements when combined with an USGI of triamcinolone and lidocaine or lidocaine alone. This complements the clinical trial results which demonstrated superiority of USGI of triamcinolone and lidocaine plus BCT over 6 months compared with BCT alone, but no significant difference in hip pain intensity between the injection groups. Together these findings raise the possibility of a degree of placebo effect. Varying duration of response to injection between individuals and reported uncertainty regarding effectiveness and safety of future injections, suggest these areas as important for future research.
Disclosures
M. Holden None. A. Hawarden None. Z. Paskins None. E. Roddy None. C. Mallen None. C. Jinks None.
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Affiliation(s)
- Melanie Holden
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
| | - Ashley Hawarden
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
| | - Zoe Paskins
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
| | - Edward Roddy
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
| | - Christian Mallen
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
| | - Clare Jinks
- The HIT Trial Team, Keele University, School of Primary, Community and Social Care, Keele, UNITED KINGDOM
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Paskins Z, Bromley K, Lewis M, Hughes G, Hughes E, Cherrington A, Hall A, Holden M, Oppong R, Kigozi J, Stevenson K, Menon A, Roberts P, Peat G, Jinks C, Foster NE, Mallen CD, Roddy E. O04 Clinical and cost-effectiveness of ultrasound-guided intra-articular corticosteroid and local anaesthetic injection for hip OA: a randomised controlled trial (HIT). Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence of the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis (OA) is limited. The HIT trial compared the clinical and cost-effectiveness of an ultrasound-guided intra-articular hip injection (USGI) of 40mg triamcinolone acetonide and 4ml 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone (primary objective) and (ii) an USGI of 5ml 1% lidocaine only combined with BCT (EudraCT:2014-003412-37).
Methods
This was a pragmatic, three-parallel arm, single-blind, randomised controlled trial in adults with moderate-severe painful hip OA recruited from community musculoskeletal services and primary care. Participants were randomised equally to: (1) BCT alone, (2) BCT plus USGI triamcinolone/lidocaine, or (3) BCT plus USGI lidocaine only. Outcomes were collected postally at 2 weeks, 2, 4 and 6 months. The primary outcome was self-reported current hip pain intensity (0-10 numeric rating scale (NRS)) over 6 months (repeated measures analysis). Secondary outcomes included function (WOMAC), and, for cost-utility analysis, general health (EQ-5D-5L) and healthcare utilisation. 204 participants were required to detect a minimum difference of 1 point in mean pain NRS score between arms (1) and (2) with 80% power (5% two-tailed significance level, 15% loss to follow-up). Analysis was by intention-to-treat.
Results
199 participants were recruited (43% male, mean age 63 years), 67 to arm (1) and 66 each to arms (2) and (3). Primary outcome completion rates were 95% at 2 weeks, 94% at 2 months, 90% at 4 months, and 89% at 6 months. Greater mean improvement in hip pain intensity (0-10 NRS) over 6 months was seen with BCT plus USGI triamcinolone/lidocaine compared with BCT alone: -1.43 (95%CI -2.15,-0.72). Greater mean improvement in pain intensity was seen at 2 weeks (-3.17; -4.06,-2.28) and 2 months (-1.81;-2.71,-0.92), but not at 4 (-0.86;-1.78,0.05) or 6 months (0.12; -0.80,1.04). Participants treated with BCT plus USGI triamcinolone/lidocaine compared with BCT alone had greater mean improvement in function (WOMAC-F -5.47;(-9.41,-1.53)) over 6 months. There was no statistically significant difference in hip pain intensity over 6 months between BCT plus USGI triamcinolone/lidocaine compared with BCT plus USGI lidocaine (-0.52;-1.21,0.18). There was one possible treatment-related serious adverse event: a participant with no signs of infection at randomisation died from endocarditis four months after USGI triamcinolone/lidocaine. BCT plus USGI triamcinolone/lidocaine was less costly (mean cost difference per participant £-161.59) and associated with significantly higher quality-adjusted life-years (QALYs) than BCT only over 6 months (mean difference 0.0477 (0.0257,0.0699).
Conclusion
USGI triamcinolone/lidocaine plus BCT leads to greater improvements in pain and function over 6 months in adults with hip OA than BCT alone, and was highly cost-effective. There was no significant difference in hip pain intensity between the groups receiving USGI triamcinolone/lidocaine and USGI lidocaine only, raising the possibility of a degree of placebo effect.
Disclosures
Z. Paskins None. K. Bromley None. M. Lewis None. G. Hughes None. E. Hughes None. A. Cherrington None. A. Hall None. M. Holden None. R. Oppong None. J. Kigozi None. K. Stevenson None. A. Menon None. P. Roberts None. G. Peat None. C. Jinks None. N.E. Foster None. C.D. Mallen None. E. Roddy None.
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Affiliation(s)
- Zoe Paskins
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UNITED KINGDOM
| | - Kieran Bromley
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Gemma Hughes
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Emily Hughes
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | | | - Alison Hall
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
| | - Melanie Holden
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Raymond Oppong
- Health Economics Unit, University of Birmingham, Birmingham, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Jesse Kigozi
- Health Economics Unit, University of Birmingham, Birmingham, UNITED KINGDOM
| | - Kay Stevenson
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UNITED KINGDOM
| | - Ajit Menon
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UNITED KINGDOM
| | - Philip Roberts
- Department of Orthopaedics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UNITED KINGDOM
| | - George Peat
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, Keele University, Keele, UNITED KINGDOM
- Keele Clinical Trials Unit, Keele University, Keele, UNITED KINGDOM
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Hider S, Machin A, Bucknall M, Cooke K, Jinks C, Healey E, Finney A, Cooke K, Wathall S, Mallen C, Chew-Graham C. P146 Undertaking an integrated nurse led review (INCLUDE) for patients with inflammatory conditions: does it change management of morbidities? Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care.
Methods
A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient management plan, including signposting to additional services as appropriate. Medical record review was undertaken (in consenting participants) at 12 months. We compared primary care contacts (which include consultations, letters and test results) and prescribing rates (of antihypertensives, lipid-lowering, osteoporosis and antidepressant/anxiety medication) at baseline and 12 months.
Results
333 patients participated in the study. The mean (SD) age was 68.2 (13.4) years and 200 (60%) were female. Of these 172 (52%) had RA and 88 (26%) had PMR. 154 (46%) reported high blood pressure, 70 (21%) existing anxiety/depression and 37 (11%) osteoporosis. Medical record data was available for 299/333 participants. Participants in intervention practices had more primary care contacts (mean 29 vs 22). Over the 12-month follow-up, there was higher prescribing of all medication classes in participants in intervention practices (see Table), particularly so for osteoporosis medication (baseline 29% vs 12 month 46%).
Conclusion
Nurse-delivered integrated reviews for patients with IRCs identified a significant comorbidity burden. Practices undertaking these reviews had higher prescribing rates at 12 months following treatment of previously un-identified conditions, suggesting that patients with IRCs would benefit from an integrated care review to identify and manage common morbidities.
Disclosures
S. Hider None. A. Machin None. M. Bucknall None. K. Cooke None. C. Jinks None. E. Healey None. A. Finney None. K. Cooke None. S. Wathall None. C. Mallen None. C. Chew-Graham None.
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Affiliation(s)
- Samantha Hider
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Annabelle Machin
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Milica Bucknall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Kendra Cooke
- Clinical Trials Unit, Keele University, Staffordshire, UNITED KINGDOM
| | - Clare Jinks
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Emma Healey
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Andrew Finney
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- School of Nursing and Midwifery, Keele University, Staffordshire, UNITED KINGDOM
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Simon Wathall
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
| | - Christian Mallen
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
| | - Carolyn Chew-Graham
- School of Primary Community and Social Care, Keele University, Staffordshire, UNITED KINGDOM
- NIHR, Applied Research Collaboration, (West Midlands), UNITED KINGDOM
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Hawarden A, Jinks C, Mahmood W, Bullock L, Blackburn S, Gwilym S, Paskins Z. Public priorities for osteoporosis and fracture research: results from a focus group study. Arch Osteoporos 2020; 15:89. [PMID: 32548718 PMCID: PMC7297850 DOI: 10.1007/s11657-020-00766-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Four focus groups were conducted with members of the public to identify important areas for future osteoporosis research. Participants identified priorities to increase public awareness of osteoporosis, reduce delays in diagnosis, improve communication between healthcare providers and to improve follow-up and information provision about causes of osteoporosis, medication harms and prognosis. PURPOSE Patients and the public must be involved in setting research agendas to ensure relevant and impactful questions are prioritised. This study aimed to understand what people living with osteoporosis and fragility fractures felt was important to research, to inform the content of a national survey on research priorities in this area. METHODS Focus groups were conducted with members of the public with experience of osteoporosis or fragility fractures. The topic guide was co-developed with a patient and public involvement research user group, and explored participants' experiences of osteoporosis including diagnosis, management and effect upon their lives, what aspects of their ongoing care was most important to them and what about their care or condition could be improved. Focus groups were audio-recorded, transcribed and analysed thematically. RESULTS A total of twenty-three participants were recruited to four focus groups. Analysis identified two main themes: challenges in living with osteoporosis and healthcare services for osteoporosis. Information needs was a further cross-cutting theme. Participants called for increased public awareness of osteoporosis and wanted healthcare services to address conflicting messages about diet, exercise and medication. Participants described long delays in diagnosis, poor communication between primary and secondary care and the need for structured follow-up as important areas for future research to address. CONCLUSION The findings from this study provide an understanding of research priorities from the perspective of patients and the public, have informed the content of a national survey and have implications for patient education, health services research and policy.
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Affiliation(s)
- Ashley Hawarden
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK ,grid.500956.fHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG UK
| | - Clare Jinks
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Waheed Mahmood
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Laurna Bullock
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Steven Blackburn
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Stephen Gwilym
- grid.4991.50000 0004 1936 8948Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zoe Paskins
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK ,grid.500956.fHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG UK
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Moore AJ, Holden MA, Foster NE, Jinks C. Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study. J Physiother 2020; 66:45-53. [PMID: 31843425 DOI: 10.1016/j.jphys.2019.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/16/2019] [Accepted: 11/18/2019] [Indexed: 01/19/2023] Open
Abstract
QUESTIONS What are people's experiences and perceived impact of physiotherapist-led exercise interventions for knee pain attributable to osteoarthritis? What barriers and facilitators to change in exercise and physical activity behaviour exist over time? DESIGN A longitudinal qualitative study was undertaken; it involved face-to-face, semi-structured and longitudinal interviews. PARTICIPANTS Interviews were undertaken with older adults with knee pain and who had been randomised to one of three physiotherapist-led exercise intervention arms in the Benefits of Effective Exercise for knee Pain (BEEP) trial. Thirty participants were enrolled in this qualitative study, with interviews scheduled at the end of the trial intervention period and 12 months later. DATA ANALYSIS A 'layered approach' to thematic analysis was used, including open coding (using constant comparison), deductive coding and within-case and cross-case longitudinal analysis of change. RESULTS Different levels of exercise supervision, progression and individualisation emerged, matching the content of the intervention protocols. Barriers to exercise and general physical activity were similar across intervention arms (lack of motivation, time, physical environment, lack of supervision and/or monitoring). Despite individualising exercise programs and specifically targeting exercise, some barriers to adherence remained at 12 months. Factors facilitating longer-term exercise adherence included change in or retained knowledge about the role of exercise for knee pain and the presence and quality of a therapeutic alliance, which was also reflective of the participants' experience of the intervention, regardless of the trial arm. CONCLUSION Despite a focus on individualisation and exercise adherence, barriers remained in the longer term. Strong therapeutic alliance during treatment appeared to facilitate adherence to exercise and general physical activity. The findings highlight ongoing physiotherapy support and therapeutic alliance as targets for future adherence-enhancing interventions for exercise in older adults with knee pain.
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Affiliation(s)
- Andrew J Moore
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
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Richards DA, Bazeley P, Borglin G, Craig P, Emsley R, Frost J, Hill J, Horwood J, Hutchings HA, Jinks C, Montgomery A, Moore G, Plano Clark VL, Tonkin-Crine S, Wade J, Warren FC, Wyke S, Young B, O'Cathain A. Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials. BMJ Open 2019; 9:e032081. [PMID: 31772096 PMCID: PMC6886933 DOI: 10.1136/bmjopen-2019-032081] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them.
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Affiliation(s)
- David A Richards
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Patricia Bazeley
- Transitional Research and Social Innovation Group, Western Sydney University, Penrith South, New South Wales, Australia
| | - Gunilla Borglin
- Department of Care Science, Malmo University, Malmo, Skåne, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Akershus, Norway
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Julia Frost
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jacqueline Hill
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | | | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Vicki L Plano Clark
- School of Education, University of Cincinnati College of Education Criminal Justice and Human Services, Cincinnati, Ohio, USA
| | - Sarah Tonkin-Crine
- Department of Primary Care Health Sciences, and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, Oxfordshire, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Fiona C Warren
- Institute of Health Sciences, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Glasgow, UK
| | - Bridget Young
- Institute of Population Health Sciences, University of Liverpool, Liverpool, Merseyside, UK
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hawarden A, Jinks C, Mahmood W, Gwilym S, Paskins Z. 169 Patient priorities in osteoporosis research: generating meaningful research questions. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez108.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashley Hawarden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Stoke on Trent, UNITED KINGDOM
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Stoke on Trent, UNITED KINGDOM
| | - Waheed Mahmood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Stoke on Trent, UNITED KINGDOM
| | - Stephen Gwilym
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UNITED KINGDOM
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Stoke on Trent, UNITED KINGDOM
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UNITED KINGDOM
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Machin AR, Hider SL, Jinks C, Herron D, Paskins Z, Cooke K, Chew-Graham CA. E059 Development of a nurse-led integrated care review based in primary care to identify and improve the management of co-morbidities in patients with inflammatory rheumatological conditions: the INCLUDE study. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez110.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Annabelle R Machin
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Samantha L Hider
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Clare Jinks
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Daniel Herron
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UNITED KINGDOM
| | - Zoe Paskins
- Research Institute, Primary Care and Health Sciences, Keele University, Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Staffordshire, UNITED KINGDOM
| | - Kendra Cooke
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UNITED KINGDOM
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, West Midlands CLAHRC, UNITED KINGDOM
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Stack RJ, Nightingale P, Jinks C, Shaw K, Herron-Marx S, Horne R, Deighton C, Kiely P, Mallen C, Raza K. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open 2019; 9:e024361. [PMID: 30837252 PMCID: PMC6429945 DOI: 10.1136/bmjopen-2018-024361] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. METHODS Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured. RESULTS 822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1-66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4-26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3-20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9-7.5 weeks). CONCLUSION This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.
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Affiliation(s)
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rob Horne
- UCL School of Pharmacy, UCL, London, UK
| | - Chris Deighton
- Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospital NHS Foundation Trust, London, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Healey EL, Afolabi EK, Lewis M, Edwards JJ, Jordan KP, Finney A, Jinks C, Hay EM, Dziedzic KS. Uptake of the NICE osteoarthritis guidelines in primary care: a survey of older adults with joint pain. BMC Musculoskelet Disord 2018; 19:295. [PMID: 30115048 PMCID: PMC6097435 DOI: 10.1186/s12891-018-2196-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake. Methods A cross-sectional survey mailed to adults aged ≥45 years (n = 28,443) from eight general practices in the UK as part of the MOSAICS study. Respondents who reported the presence of joint pain, a consultation in the previous 12 months for joint pain, and gave consent to medical record review formed the sample for this study. Results Four thousand fifty-nine respondents were included in the analysis (mean age 65.6 years (SD 11.2), 2300 (56.7%) females). 502 (12.4%) received an OA diagnosis in the previous 12 months. More participants reported using pharmacological treatments (e.g. paracetamol (31.3%), opioids (40.4%)) than non-pharmacological treatments (e.g. exercise (3.8%)). Those with an OA diagnosis were more likely to use written information (OR 1.57; 95% CI 1.26,1.96), paracetamol (OR 1.30; 95% CI 1.05,1.62) and topical NSAIDs (OR 1.30; 95% CI 1.04,1.62) than those with a joint pain code. People aged ≥75 years were less likely to use written information (OR 0.56; 95% CI 0.40,0.79) and exercise (OR 0.37; 95% CI 0.25,0.55) and more likely to use paracetamol (OR 1.91; 95% CI 1.38,2.65) than those aged < 75 years. Conclusion The cross-sectional population survey was conducted to examine the uptake of the treatments that are recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and to determine whether patient characteristics or OA diagnosis impact uptake. Non-pharmacological treatment was suboptimal compared to pharmacological treatment. Implementation of NICE guidelines needs to examine why non-pharmacological treatments, such as exercise, remain under-used especially among older people.
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Affiliation(s)
- Emma Louise Healey
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Ebenezer K Afolabi
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Martyn Lewis
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - John J Edwards
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Andrew Finney
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Staffordshire, UK
| | - Clare Jinks
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Elaine M Hay
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Krysia S Dziedzic
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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42
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Hider SL, Bucknall M, Cooke K, Cooke K, Finney AG, Goddin D, Healey EL, Hennings S, Herron D, Jinks C, Lewis M, Machin A, Mallen C, Wathall S, Chew-Graham CA. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial. J Comorb 2018; 8:2235042X18792373. [PMID: 30191145 PMCID: PMC6088485 DOI: 10.1177/2235042x18792373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs). Discussion Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Milica Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Andrew G Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,School of Nursing and Midwifery, Keele University, Keele UK.,Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Stoke on Trent UK
| | - Dave Goddin
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Emma L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | | | - Daniel Herron
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Annabelle Machin
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Simon Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
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43
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Paskins Z, Hughes G, Myers H, Hughes E, Hennings S, Cherrington A, Evans A, Holden M, Stevenson K, Menon A, Bromley K, Roberts P, Hall A, Peat G, Jinks C, Oppong R, Lewis M, Foster NE, Mallen C, Roddy E. A randomised controlled trial of the clinical and cost-effectiveness of ultrasound-guided intra-articular corticosteroid and local anaesthetic injections: the hip injection trial (HIT) protocol. BMC Musculoskelet Disord 2018; 19:218. [PMID: 30021588 PMCID: PMC6052622 DOI: 10.1186/s12891-018-2153-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Evidence on the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis is limited and conflicting. The primary objective of the Hip Injection Trial (HIT) is to compare pain intensity over 6 months, in people with hip OA between those receiving an ultrasound-guided intra-articular hip injection of corticosteroid with 1% lidocaine hydrochloride plus best current treatment with those receiving best current treatment alone. Secondary objectives are to determine specified comparative clinical and cost-effectiveness outcomes, and to explore, in a linked qualitative study, the lived experiences of patients with hip OA and experiences and impact of, ultrasound-guided intra-articular hip injection. Methods The HIT trial is a pragmatic, three-parallel group, single-blind, superiority, randomised controlled trial in patients with painful hip OA with a linked qualitative study. The current protocol is described, in addition to details and rationale for amendments since trial registration. 204 patients with moderate-to-severe hip OA will be recruited. Participants are randomised on an equal basis (1:1:1 ratio) to one of three interventions: (1) best current treatment, (2) best current treatment plus ultrasound-guided intra-articular hip injection of corticosteroid (triamcinolone acetonide 40 mg) with 1% lidocaine hydrochloride, or (3) best current treatment plus an ultrasound-guided intra-articular hip injection of 1% lidocaine hydrochloride alone. The primary endpoint is patient-reported hip pain intensity across 2 weeks, 2 months, 4 months and 6 months post-randomisation. Recruitment is over 29 months with a 6-month follow-up period. To address the primary objective, the analysis will compare participants’ ‘average’ follow-up pain NRS scores, based on a random effects linear repeated-measures model. Data on adverse events are collected and reported in accordance with national guidance and reviewed by external monitoring committees. Individual semi-structured interviews are being conducted with up to 30 trial participants across all three arms of the trial. Discussion To ensure healthcare services improve outcomes for patients, we need to ensure there is a robust and appropriate evidence-base to support clinical decision making. The HIT trial will answer important questions regarding the clinical and cost-effectiveness of intra-articular corticosteroid injections. Trial registration ISRCTN: 50550256, 28th July 2015.
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Affiliation(s)
- Zoe Paskins
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK. .,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.
| | - Gemma Hughes
- Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Helen Myers
- Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Emily Hughes
- Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Susie Hennings
- Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | | | - Amy Evans
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Kay Stevenson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Ajit Menon
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Kieran Bromley
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | | | - Alison Hall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.,Keele Clinical Trials Unit, Keele University, Newcastle-under-Lyme, UK
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44
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. Programme Grants Appl Res 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant 2018. [PMID: 29937585 DOI: 10.1007/s11135-017-0574-8.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation-as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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Affiliation(s)
- Benjamin Saunders
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Julius Sim
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Tom Kingstone
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Shula Baker
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Jackie Waterfield
- 2School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Bernadette Bartlam
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Heather Burroughs
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Clare Jinks
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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46
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Babatunde OO, Tan V, Jordan JL, Dziedzic K, Chew-Graham CA, Jinks C, Protheroe J, van der Windt DA. Evidence flowers: An innovative, visual method of presenting "best evidence" summaries to health professional and lay audiences. Res Synth Methods 2018; 9:273-284. [PMID: 29439286 DOI: 10.1002/jrsm.1295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/26/2017] [Revised: 11/03/2017] [Accepted: 01/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Barriers to dissemination and engagement with evidence pose a threat to implementing evidence-based medicine. Understanding, retention, and recall can be enhanced by visual presentation of information. The aim of this exploratory research was to develop and evaluate the accessibility and acceptability of visual summaries for presenting evidence syntheses with multiple exposures or outcomes to professional and lay audiences. METHODS "Evidence flowers" were developed as a visual method of presenting data from 4 case scenarios: 2 complex evidence syntheses with multiple outcomes, Cochrane reviews, and clinical guidelines. Petals of evidence flowers were coloured according to the GRADE evidence rating system to display key findings and recommendations from the evidence summaries. Application of evidence flowers was observed during stakeholder workshops. Evaluation and feedback were conducted via questionnaires and informal interviews. RESULTS Feedback from stakeholders on the evidence flowers collected from workshops, questionnaires, and interviews was encouraging and helpful for refining the design of the flowers. Comments were made on the content and design of the flowers, as well as the usability and potential for displaying different types of evidence. CONCLUSIONS Evidence flowers are a novel and visually stimulating method for presenting research evidence from evidence syntheses with multiple exposures or outcomes, Cochrane reviews, and clinical guidelines. To promote access and engagement with research evidence, evidence flowers may be used in conjunction with other evidence synthesis products, such as (lay) summaries, evidence inventories, rapid reviews, and clinical guidelines. Additional research on potential adaptations and applications of the evidence flowers may further bridge the gap between research evidence and clinical practice.
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Affiliation(s)
- O O Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - V Tan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J L Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,West Midlands CLAHRC and South Staffs and Shropshire Foundation Trust, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - D A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
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Blackburn S, McLachlan S, Jowett S, Kinghorn P, Gill P, Higginbottom A, Rhodes C, Stevenson F, Jinks C. The extent, quality and impact of patient and public involvement in primary care research: a mixed methods study. Res Involv Engagem 2018; 4:16. [PMID: 29850029 PMCID: PMC5966874 DOI: 10.1186/s40900-018-0100-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/10/2018] [Indexed: 05/06/2023]
Abstract
PLAIN ENGLISH SUMMARY In the UK, more patients go to primary care than other parts of the health service. Therefore it is important for research into primary care to include the insights and views of people who receive these services. To explore the extent, quality and impact of patient and public involvement (PPI) in primary care research, we examined documents of 200 projects and surveyed 191 researchers.We found that about half of studies included PPI to develop research ideas and during the study itself. Common activities included designing study materials, advising on methods, and managing the research. Some studies did not undertake the PPI activities initially planned and funded for. PPI varied by study design, health condition and study population. We found pockets of good practice: having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However, good practice was lacking in other areas. Few projects offered PPI contributors training, used PPI to develop information for participants about study progress and included PPI to advise on publishing findings.Researchers reported beneficial impacts of PPI. Most impact was reported when the approach to PPI included more indicators of good practice. The main cost of PPI for researchers was their time. Many reported difficulties providing information about PPI.In partnership with PPI contributors, we have used these findings to develop:a new Cost and Consequences Framework for PPI highlighting financial and non-financial costs, benefits and harms of PPIFifteen co-produced recommendations to improve the practice and delivery of PPI. ABSTRACT Background: To improve the lives of patients in primary care requires the involvement of service users in primary care research. We aimed to explore the extent, quality and impact of patient and public involvement (PPI) in primary care research.Methods: We extracted information about PPI from grant applications, reports and an electronic survey of researchers of studies funded by the NIHR School for Primary Care Research (SPCR). We applied recognised quality indicators to assess the quality of PPI and assessed its impact on research.Results: We examined 200 grant applications and reports of 181 projects. PPI was evident in the development of 47 (24%) grant applications. 113 (57%) grant applications included plans for PPI during the study, mostly in study design, oversight, and dissemination. PPI during projects was reported for 83 (46%) projects, including designing study materials and managing the research. We identified inconsistencies between planned and reported PPI. PPI varied by study design, health condition and study population.Of 46 (24%) of 191 questionnaires completed, 15 reported PPI activity. Several projects showed best practice according to guidelines, in terms of having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However few projects offered PPI contributors training, used PPI to develop information for participants about study progress, and had PPI in advising on dissemination.Beneficial impacts of PPI in designing studies and writing participant information was frequently reported. Less impact was reported on developing funding applications, managing or carrying out the research. The main cost of PPI for researchers was their time. Many researchers found it difficult to provide information about PPI activities.Our findings informed:a new Cost and Consequences Framework for PPI in primary care research highlighting financial and non-financial costs, plus the benefits and harms of PPIFifteen co-produced recommendations to improve PPI in research and within the SPCR.Conclusions: The extent, quality and impact of PPI in primary care research is inconsistent across research design and topics. Pockets of good practice were identified making a positive impact on research. The new Cost and Consequences Framework may help others assess the impact of PPI.
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Affiliation(s)
- Steven Blackburn
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Sarah McLachlan
- Department of Physiotherapy, Division of Health and Social Care Research, King’s College London, London, UK
| | - Sue Jowett
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Social Science and Systems in Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Adele Higginbottom
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
- PPI Contributor, Keele, UK
| | - Carol Rhodes
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
- PPI Contributor, Keele, UK
| | - Fiona Stevenson
- The Research Department of Primary Care and Population Health, University College London, London, UK
| | - Clare Jinks
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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Healey EL, Jinks C, Foster NE, Chew-Graham CA, Pincus T, Hartshorne L, Cooke K, Nicholls E, Proctor J, Lewis M, Dent S, Wathall S, Hay EM, McBeth J. The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care 2017; 16:118-132. [PMID: 29218808 DOI: 10.1002/msc.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.
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Affiliation(s)
- E L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - T Pincus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - L Hartshorne
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Cooke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Proctor
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - M Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Dent
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Paskins Z, Jinks C, Mahmood W, Jayakumar P, Sangan CB, Belcher J, Gwilym S. Public priorities for osteoporosis and fracture research: results from a general population survey. Arch Osteoporos 2017; 12:45. [PMID: 28455735 PMCID: PMC5409917 DOI: 10.1007/s11657-017-0340-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/18/2017] [Indexed: 02/03/2023]
Abstract
This is the first national study of public and patient research priorities in osteoporosis and fracture. We have identified new research areas of importance to members of the public, particularly 'access to information from health professionals'. The findings are being incorporated into the research strategy of the National Osteoporosis Society. PURPOSE This study aimed to prioritise, with patients and public members, research topics for the osteoporosis research agenda. METHODS An e-survey to identify topics for research was co-designed with patient representatives. A link to the e-survey was disseminated to supporters of the UK National Osteoporosis Society (NOS) in a monthly e-newsletter. Responders were asked to indicate their top priority for research across four topics (understanding and preventing osteoporosis, living with osteoporosis, treating osteoporosis and treating fractures) and their top three items within each topic. Descriptive statistics were used to describe demographics and item ranking. A latent class analysis was applied to identify a substantive number of clusters with different combinations of binary responses. RESULTS One thousand one hundred eighty-eight (7.4%) respondents completed the e-survey. The top three items overall were 'Having easy access to advice and information from health professionals' (63.8%), 'Understanding further the safety and benefit of osteoporosis drug treatments' (49.9%) and 'Identifying the condition early by screening' (49.2%). Latent class analysis revealed distinct clusters of responses within each topic including primary care management and self-management. Those without a history of prior fracture or aged under 70 were more likely to rate items within the cluster of self-management as important (21.0 vs 12.9 and 19.8 vs 13.3%, respectively). CONCLUSION This is the first study of public research priorities in osteoporosis and has identified new research areas of importance to members of the public including access to information. The findings are being incorporated into the research strategy of the National Osteoporosis Society.
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Affiliation(s)
- Zoe Paskins
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, ST6 7AG, UK.
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Waheed Mahmood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Prakash Jayakumar
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - John Belcher
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Stephen Gwilym
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Jordan K, Edwards J, Porcheret M, Healey E, Jinks C, Bedson J, Clarkson K, Hay E, Dziedzic K. Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care. Osteoarthritis Cartilage 2017; 25:1588-1597. [PMID: 28591564 PMCID: PMC5613776 DOI: 10.1016/j.joca.2017.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of a model osteoarthritis (OA) consultation (MOAC) informed by National Institute for Health and Care Excellence (NICE) recommendations compared with usual care on recorded quality of care of clinical OA in general practice. DESIGN Two-arm cluster randomised controlled trial. SETTING Eight general practices in Cheshire, Shropshire, or Staffordshire UK. PARTICIPANTS General practitioners and nurses with patients consulting with clinical OA. INTERVENTION Following six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged ≥45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators. OUTCOMES Quality of OA care over six months recorded in the medical record. RESULTS 1851 patients consulted in baseline period (1015 intervention; 836 control); 1960 consulted following randomisation (1118 intervention; 842 control). At baseline wide variations in quality of care were noted. Post-randomisation increases were found for written advice on OA (4-28%), exercise (4-22%) and weight loss (1-15%) in intervention practices but not controls (1-3%). Intervention practices were more likely to refer to physiotherapy (10% vs 2%, odds ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38). CONCLUSIONS The intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care. TRIAL REGISTRATION NUMBER ISRCTN06984617.
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Affiliation(s)
- K.P. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK,Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK,Address correspondence and reprint requests to: K.P. Jordan, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.Arthritis Research UK Primary Care CentreResearch Institute for Primary Care & Health SciencesKeele UniversityDavid Weatherall BuildingStaffordshireST5 5BGUK
| | - J.J. Edwards
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - M. Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - E.L. Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - C. Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - J. Bedson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - K. Clarkson
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - E.M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - K.S. Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
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