1
|
Tacey A, Behne J, Patten RK, Ngo MT, Thomas R, Ancilleri J, Bone C, Paredes Castro A, McCarthy H, Harkin K, Gilmartin-Thomas JF, Takla A, Downie C, Mulcahy J, Ball M, Sharples J, Dash S, Lawton A, Wright B, Sleeth P, Kostecki T, Sonn C, McKenna MJ, Apostolopoulos V, Lane R, Said CM, De Gori M, McAinch A, Tran P, Levinger I, Parker A, Woessner MN, Pascoe M. Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study. JMIR Form Res 2023; 7:e41974. [PMID: 38064257 PMCID: PMC10746964 DOI: 10.2196/41974] [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: 08/24/2022] [Revised: 12/02/2022] [Accepted: 10/20/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. OBJECTIVE This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. METHODS The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. RESULTS Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. CONCLUSIONS Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.
Collapse
Affiliation(s)
- Alexander Tacey
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
| | - Jack Behne
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Rhiannon K Patten
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Minh Truc Ngo
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
| | - Rees Thomas
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jessica Ancilleri
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Chelsea Bone
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | | | - Helen McCarthy
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Katherine Harkin
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- First Year College, Victoria University, Melbourne, Australia
| | - Julia Fm Gilmartin-Thomas
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Amir Takla
- Australian Sports Physiotherapy, Melbourne, Australia
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
- School of Physiotherapy, Melbourne School of Health science, The University of Melbourne, Melbourne, Australia
| | - Calum Downie
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Jane Mulcahy
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Michelle Ball
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Jenny Sharples
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Sarah Dash
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Amy Lawton
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Breanna Wright
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Peter Sleeth
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Tina Kostecki
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- School of Social Sciences, University of Tasmania, Launceston, Australia
| | - Christopher Sonn
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Michael J McKenna
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Rebecca Lane
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Catherine M Said
- Department of Physiotherapy, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
- School of Physiotherapy, Melbourne School of Health science, The University of Melbourne, Melbourne, Australia
| | - Mary De Gori
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Andrew McAinch
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Phong Tran
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Alexandra Parker
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Mary N Woessner
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Michaela Pascoe
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| |
Collapse
|
2
|
Patten RK, Asilioglu A, Levinger I, Tacey A, Pascoe M, Tran P, McKenna MJ, Said CM, Coric N, De Gori M, Lane R, Apostolopoulos V, Woessner MN, Parker A. Prevalence of diagnosable depression in patients awaiting orthopaedic specialist consultation: a cross-sectional analysis. BMC Musculoskelet Disord 2023; 24:599. [PMID: 37481532 PMCID: PMC10362723 DOI: 10.1186/s12891-023-06688-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Musculoskeletal conditions, including osteoarthritis (OA), are a leading cause of disability and chronic pain, and are associated with high rates of comorbid depression. However, signs of depression are often masked by pain. The aim of this study was to determine the prevalence and severity of depression and pain in individuals awaiting specialist orthopaedic consultation. A secondary objective was to determine the relationship between pain and depression, irrespective of demographic factors and clinical diagnosis. METHODS Cross-sectional analysis of individuals awaiting orthopaedic consultation at a public hospital in Melbourne, Australia. Relevant data were extracted from medical records and questionnaires. Descriptive statistics were used to summarise participant characteristics. The patient health questionnaire (PHQ-9) was used to assess depression and a numerical rating scale (NRS) was used to assess pain severity. Multiple linear regression analyses were used to establish the relationship between pain and depression. RESULTS Nine hundred and eighty-six adults (mean ± standard deviation, age = 54.1 ± 15.7 years, 53.2% women) participated in the study. OA was present in 56% of the population and 34% of the entire population had moderate depression or greater, 19% of which met the criteria for major depressive disorder. Moderate-to-severe pain was present in 79% of individuals with OA and 55% of individuals with other musculoskeletal complaints. Pain was significantly associated with depression scores (β = 0.84, adjusted R2 = 0.13, P < 0.001), and this relationship remained significant after accounting for gender, age, education and employment status, OA status, number of joints affected and waiting time (β = 0.91, adjusted R2 = 0.19, P < 0.001). CONCLUSIONS Depression affects one-third of individuals on an orthopaedic waitlist. A strong link between pain and depression in patients awaiting specialist orthopaedic consultation exists, indicating a need for an integrated approach in addressing pain management and depression to manage this complex and comorbid presentation.
Collapse
Affiliation(s)
- Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
| | - Alev Asilioglu
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Alexander Tacey
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
| | - Michaela Pascoe
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Phong Tran
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Catherine M Said
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
- Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Physiotherapy, Western Health, Melbourne, Australia
| | - Natali Coric
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
| | - Mary De Gori
- Physiotherapy, Western Health, Melbourne, Australia
| | - Rebecca Lane
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Mary N Woessner
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Alexandra Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| |
Collapse
|
3
|
Patten RK, Tacey A, Pile R, Parker A, De Gori M, Tran P, McKenna MJ, Lane R, Apostolopoulos V, Said CM, Levinger I, Woessner MN. Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition. Arch Public Health 2022; 80:103. [PMID: 35361270 PMCID: PMC8968262 DOI: 10.1186/s13690-022-00854-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
Background Osteoarthritis (OA) is a chronic, progressive condition that can be effectively managed via conservative treatments including exercise, weight management and education. Offering these treatments contemporaneously and digitally may increase adherence and engagement due to the flexibility and cost-effectiveness of digital program delivery. The objective of this review was to summarise the characteristics of current digital self-management interventions for individuals with OA and synthesise adherence and attrition outcomes. Methods Electronic databases were searched for randomised controlled trials utilising digital self-management interventions in individuals with OA. Two reviewers independently screened the search results and extracted data relating to study characteristics, intervention characteristics, and adherence and dropout rates. Results Eleven studies were included in this review. Intervention length ranged from 6 weeks to 9 months. All interventions were designed for individuals with OA and mostwere multi-component and were constructed around physical activity. The reporting of intervention adherence varied greatly between studies and limited the ability to form conclusions regarding the impact of intervention characteristics. However, of the seven studies that quantified adherence, six reported adherence > 70%. Seven of the included studies reported attrition rates < 20%, with contact and support from researchers not appearing to influence adherence or attrition. Conclusions Holistic digital interventions designed for a targeted condition are a promising approach for promoting high adherence and reducing attrition. Future studies should explore how adherence of digital interventions compares to face-to-face interventions and determine potential influencers of adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00854-x.
Collapse
Affiliation(s)
- Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Alexander Tacey
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Rebecca Pile
- Physiotherapy, Western Health, Melbourne, Australia
| | - Alexandra Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Mary De Gori
- Physiotherapy, Western Health, Melbourne, Australia
| | - Phong Tran
- Institute for Health and Sport, Victoria University, Melbourne, Australia.,Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Rebecca Lane
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | - Catherine M Said
- Physiotherapy, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia.,Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia.
| | - Mary N Woessner
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| |
Collapse
|