Making Every Contact Count with people with MSK conditions: Exploring physiotherapist acceptability

 

There are known risk factors that are associated with the onset and exacerbation of musculoskeletal (MSK) conditions and pain. Physiotherapists are uniquely placed to deliver brief interventions with their patients. Healthy Conversation Skills is the main training component of the Wessex approach to Making Every Contact Count. Despite its potential for promoting MSK health and wellbeing, there is no evidence to support its acceptability within MSK services. This is the first known study to explore the use and perceptions of the Wessex model of MECC HCS within MSK services. A mixed method design was used. Phase one employed an online questionnaire, open to all professionals trained in MECC HCS, consisting of items relating to implementation outcomes. Barriers and facilitators to delivery were explored and mapped to the Theoretical Domains Framework. Phase two invited physiotherapists for a follow-up interview and qualitatively explored their acceptability of delivering MECC HCS to patients with MSK conditions. MECC HCS was found to be highly acceptable, appropriate, and feasible. Physiotherapists reported using their skills at least daily but missed opportunities for delivering MECC HCS were evident. Barriers mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework. Qualitative themes developed during phase two were: ‘Recognising the patient as the expert supports change', ‘MECC HCS improves physiotherapy practice', ‘MECC HCS shared problem solving reduces workload', ‘time as a perceived barrier to MECC HCS’ and ‘system-level support needed to sustain MECC HCS'. MECC HCS is a promising brief intervention for supporting people with MSK conditions. Further rollout of this intervention may be beneficial for meeting the goals of the NHS and Public Health England in prevention of MSK conditions and promotion of MSK health. Barriers associated with sustainability must, however, be addressed.

Key messages

• Making Every Contact Count Healthy Conversation Skills is considered a highly acceptable brief intervention for supporting behaviour change in people with musculoskeletal conditions.

• Organisational, system-level barriers to implementation must be addressed in order to increase sustainability and enhance future roll out of the brief intervention.

Relative validity of a brief dietary survey to assess food intake and adherence to national dietary guidelines among Sri Lankan adults

BACKGROUND

Suboptimal diet is the leading cause of global morbidity and mortality. Addressing this problem requires context-specific solutions informed by context-specific data collected by context-specific tools. This study aimed to assess the relative validity of a newly developed brief dietary survey to estimate food intake and adherence to the Food Based Dietary Guidelines for Sri Lankans.

METHODS

Between December 2018 and February 2019, we interviewed 94 Sri Lankan adults living in Colombo (Western Province), Kalutara (Western Province), and Trincomalee (Eastern Province). We assessed the relative validity of the Sri Lankan Brief Dietary Survey (SLBDS) with Wilcoxon rank-sum tests, Spearman's Rho correlation coefficients, Bland-Altman plots, and Cohen's kappa tests using a 24-h Dietary Recall (24DR) as reference.

RESULTS

Ninety-four adults (40.7 years ±12.6; 66% female) completed both surveys during the same interview. With the exception of 'Fish, pulses, meat and eggs' food group median intake, which was underestimated by the SLBDS compared to the 24DR, there was no strong evidence of difference between median intakes reported by the two methods. Correlation coefficients were highest for 'Milk and dairy products' (0.84) at the food group level and for 'dosa', 'hoppers', 'milk rice', and 'dried fish' (1.00) among individual food and beverages. Visual exploration of Bland-Altman plots showed acceptable agreement between the SLBDS and 24DR, with the SLBDS tending to overestimate consumption as the number of servings of 'Rice, bread, other cereals and yams' and 'Vegetables' consumed increased and slightly underestimate consumption as the number of servings of 'Fish, pulses, meat and eggs', 'Milk and dairy products', and 'Nuts' increased. Kappa values ranged from from 0.59 (95% CI: 0.32-0.86) for 'Vegetables' to 0.81 (95% CI: 0.66-0.96) for 'Fruit' indicating a moderate to strong level of agreement.

CONCLUSIONS

Having been developed for and relatively validated with the study population in question, our study shows that the SLBDS can be used as a fit for purpose research tool. Additional research is needed to assess SLBDS test-retest reliability and to validate further the reporting of salt, oil, and coconut intake.

Food labour, consumption hierarchies, and diet decision-making in Sri Lankan households: a qualitative study

Background

Sri Lanka faces the double burden of over- and undernutrition. To tackle this dual challenge, double duty interventions that improve the quality of the Sri Lankan diet in line with national dietary guidelines have been suggested. The success of these interventions depends upon an understanding of the context-specific factors that impact their uptake within the population. The purpose of this study was threefold: explore household responsibility for food-related labour; understand food decision-making influences; and investigate consumption hierarchies that might impact the distribution of intervention benefits.

Methods

We conducted face-to-face semi-structured interviews with 93 Sri Lankan adults residing in urban Colombo (n = 56), and urban and rural sectors in Kalutara (n = 29) and Trincomalee (n = 8). Interview data were analysed thematically.

Results

Findings from this study suggest that women in Sri Lanka continue to shoulder the burden of food-related labour disproportionately to men but that this responsibility is not always a proxy for dietary decision-making power. While men are often absent from the kitchen, their role in food purchasing and payment is prominent in many households. Despite these observed gender differences in food labour and provisioning, “traditional” age- and gender-based consumption hierarchies with negative nutrition consequences for women and children are not common, indicating that Sri Lankan ‘table culture’ may be changing.

Conclusion

Dietary interventions with the aim of influencing day-to-day practice should be developed with an awareness of who is responsible for, who is able to perform, and who influences targeted behaviours.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s40795-020-00389-w.

FRI0610-HPR Β-ADRENORECEPTOR BLOCKING DRUGS ASSOCIATE WITH LOWER RISK OF KNEE OSTEOARTHRITIS AND KNEE PAIN CONSULTATIONS IN PRIMARY CARE: A PROPENSITY SCORE MATCHED COHORT STUDY USING THE CLINICAL PRACTICE RESEARCH DATALINK

Background:

The pharmacologic management of OA is centred around optimising pain control but first-line analgesics only have modest efficacy1. Findings from several studies suggest thatβ-adrenoreceptor blocking drugs (β-blockers) have anti-nociceptive effects2 3. However, evidence for the benefits of β-blockers in the context of OA pain is scarce. We recently demonstrated, for the first time, an association between beta-blockers and lower pain severity, and less opioid analgesic use in a secondary analysis of data for community dwelling adults with large-joint lower OA4. This association, however, was not confirmed in a hospital-based study5.

Objectives:

We examined [1] the association betweenβ-blocker prescription and first primary care consultation for knee OA, hip OA, knee pain, and hip pain and [2] the classes ofβ-blocker drugs that reduce the risk of these outcomes.

Methods:

This was a cohort study using data from the UK Clinical Practice Research Datalink. Participants aged ≥40 years, in receipt of ≥2 β-blocker prescriptions within 60 days were matched by age, sex, and propensity score (PS) for β-blocker prescription to one control using greedy nearest neighbour matching. Participants with chronic painful conditions, contra-indications to β-blockers, maintenance analgesic prescriptions, and with <2-years registration before index or matched follow-up start date were excluded. Cox proportional hazard ratios (aHRs) and 95% confidence intervals (CI) were calculated to examine the associations adjusted for other covariates. Analyses were stratified according to β-blocker classes.

Results:

Data for 223,436 PS-matched exposed and un-exposed participants were included. β-blocker prescription associated with a significantly reduced risk of knee OA, knee pain, and hip pain consultations with aHR(95%CI) 0.90(0.83–0.98), 0.88(0.83–0.92), 0.85(0.79–0.90) respectively. The reduction in hip OA lacked statistical significance (aHR 95%CI 0.94; 0.83-1.07) (Table 1). On stratified analysis, propranolol and atenolol had a statistically significant protective effect on knee OA and knee pain consultations with aHRs between 0.78 and 0.91 (Figure 1).

Table 1.

The association between β-blocker prescription and incident osteoarthritis and joint pain

OutcomesExposedEvents (n)Person-timeEvent rate (95% CI)*HR (95% CI)1Knee OANo986262,0033.76 (3.54 – 4.01)1.00Yes1,101307,2313.58(3.38 – 3.80)0.90(0.83 – 0.98)Hip OANo451263,7531.71(1.56– 1.87)1.00Yes530310,0451.71(1.57 – 1.86)0.94(0.83 – 1.07)Knee painNo3,074255,00312.06(11.64 – 12.49)1.00Yes3,560297,02711.99(11.60 – 12.37)0.88(0.83 – 0.92)Hip painNo1,767259,5156.81 (6.50 – 7.13)1.00Yes1,981304,4546.51 (6.23 - 6.80)0.85(0.79 – 0.90)

OA; osteoarthritis, *1,000 person-years,1PS matched and, additionally adjusted for age, number of GP consultations, hospital out-patient referrals, hospital admissions in the 12 month period preceding cohort entry, total number of GP consultations for knee or hip injury prior to cohort entry and non-osteoporotic fractures.

Figure 1.

The association between individual β-adrenoreceptor blocking drugs and incident knee osteoarthritis and knee pain11Comparison group is unexposed to β-blockers; size of the square is proportional to number of events.

Conclusion:

β-blockers appear to reduce consultations for knee OA, and knee or hip pain. Our results imply that, atenolol might be used preferentially for the treatment of people with cardiovascular comorbidities, while, propranolol with its’ anti-anxiety effect may be a suitable analgesic in people with OA and comorbid anxiety.

References:

[1] McAlindon TE, et al. Osteoarthritis and Cartilage 2014;22(3):363-88.

[2] Harkanen L, et al. Journal of anesthesia 2015;29(6):934-43. doi: 10.1007/s00540-015-2041-9

[3] Light KC, et al. The journal of pain 2009;10(5):542-52. doi: 10.1016/j.jpain.2008.12.006

[4] Valdes AM, et al. Arthritis Care Res (Hoboken) 2017;69(7):1076-81. doi: 10.1002/acr.23091

[5] Zhou L,et al. Osteoarthritis and Cartilage 2019 doi:https://doi.org/10.1016/j.joca.2019.08.008

Acknowledgments:

This work was funded by the National Institute for Health Research (grant numbers: PB-PG-0816-20025 and NIHR-RP-2014-04-026).

Disclosure of Interests:

Georgina Nakafero: None declared, Matthew Grainge: None declared, Ana Valdes Grant/research support from: Pfizer Inc, Consultant of: Consultant for Heel GmBH, Nick Townsend: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Mamas Mamas: None declared, Abhishek Abhishek Consultant of: Consulting for Inflazome, and Royalties from Uptodate and Springer

Paranasal sinus cysts in the horse: Complications related to their presence and surgical treatment in 37 cases

BACKGROUND

Paranasal sinus cysts (PSC) are a common cause of equine secondary sinusitis. The outcome and associated complications have not been frequently reported.

OBJECTIVES

To review the associated clinical signs, associated morbidities and outcomes of horses treated for PSC.

STUDY DESIGN

Retrospective multicentre case series.

METHODS

Retrospective analysis of case records and telephone follow up survey.

RESULTS

Subjects were 37 horses 1-24 years old that were presented with nasal discharge (n = 31), facial swelling (n = 25) and epiphora (n = 19). Radiography and computed tomography allowed identification of the cyst-induced changes including concomitant tissue destruction (n = 31), leading among other things to local nerve damage causing headshaking (n = 6) and unilateral blindness (n = 1). Radiographic changes to adjacent dental apices were present in 10 horses. Horses over 10 years old showed more of the named associated problems. Post-operative complications included surgical site infection (SSI) (n = 11), nasofrontal suture periostitis (n = 6) and sequestration (n = 1) following removal of the PSC via osteotomy. The long-term response to treatment was available for 28 cases with 22 horses (78.6%) fully cured, 4 (14.3%) partially cured and 2 (7.1%) not responding to treatment. In 7 horses (18.9%) there was recurrence of the cyst post-operatively.

MAIN LIMITATIONS

Due to the study being a multicentre retrospective case series with collection of data over an extended period, there may be inconsistency in data recording and absence of reporting of some findings.

CONCLUSIONS

Overall, the diagnosis and treatment of sinus cysts is relatively straightforward and carries a good prognosis. In long-standing cases complications secondary to the expansive growth of cysts will dramatically affect the prognosis for full recovery due to pressure-induced changes to facial bones, cheek teeth and nerves. These secondary complications mainly occurring in older horses may be due to a combination of a relatively longer period of affection and the inflexibility of older horses' bones. Cyst recurrence following treatment can occur in up to 19% of cases.

Improvements in the data quality of a national BMI measuring programme

Variations in data collection between collecting regions can affect the outcome measures. This study examines the impact of improvements in data collection on outcome measures in a national monitoring programme between 2007/2008 and 2010/2011. Multilevel analysis of 2007/2008 and 2010/2011 National Child Measurement Programme (NCMP) data estimated the relationship between body mass index (BMI) z-score and data collection variations within coordinating regions, while adjusting for individual-level and school-level factors. The total sample was 2,013,285 students from 17,279 primary schools in 152 coordinating regions in England. Data collection differences accounted for 31.2% of the regional variation in BMI z-score for Reception (aged 4-5 years) students in 2007/2008; this reduced to 12.6% in 2010/2011. For Year 6 (aged 10-11 years) students, it reduced from 5.3% in 2007/2008 to 2.4% in 2010/2011. Digit preference in the rounding of weight measurements showed the largest decreases, from 27.3 to 4.5% for Reception year pupils and from 4.2 to 1.0% for Year 6 pupils. This demonstrates that improvements in data collection variation between regions in the NCMP have led to improvements in data quality.

Equine paranasal sinus disease: a long-term study of 200 cases (1997-2009): ancillary diagnostic findings and involvement of the various sinus compartments

REASONS FOR PERFORMING STUDY

There is a lack of objective information on the value of ancillary diagnostic techniques used to investigate equine sinus disease, and also on which sinus compartments are commonly affected in this disorder.

OBJECTIVES

To record the ancillary diagnostic findings used to investigate equine sinus disease and to document which compartments are affected.

MATERIALS AND METHODS

The clinical case records of 200 consecutive cases of sinus disease, including subacute (<2 months' duration) primary (n = 52); chronic (>2 months' duration) primary (n = 37); dental (n = 40); traumatic (n = 13); sinus cyst (n = 26); sinus neoplasia (n = 10); dental related oromaxillary fistula (n = 8); mycotic sinusitis (n = 7) and intra-sinus progressive ethmoid haematoma (n = 7) were retrospectively examined.

RESULTS

Nasal endoscopy showed exudate draining from the sino-nasal ostia in 88% of cases and a sino-nasal fistula was present in 15% of cases. Sinoscopy was performed in 79% of cases and was of great diagnostic value. More recently, 22% of cases had fenestration of the ventral conchal bulla performed to allow sinoscopy of the rostral sinus compartments. Radiography was performed in 97% of cases and showed intra-sinus fluid lines to be common (69% prevalence) in subacute primary sinusitis. Radiographic dental apical changes were not specific to dental sinusitis, e.g. 29% of chronic primary sinusitis cases had radiographic dental changes. Scintigraphy was performed in 20% of cases and was helpful in identifying dental apical changes when radiography was inconclusive. Overall, the caudal maxillary (78% involvement) and rostral maxillary (61%) sinuses were most commonly affected, with the ventral conchal sinus (VCS) (54% involvement) and conchofrontal sinuses (48%) less so. The VCS showed the greatest tendency to contain inspissated pus (present in 46% of all affected VCS).

CONCLUSIONS

Nasal endoscopy, sinoscopy and skull radiography are of great value in diagnosing the presence and causes of equine sinus disease.

Application of mobile phone technology for managing chemotherapy-associated side-effects

BACKGROUND

Novel mobile phone technology linked to a server that communicates patients' symptoms to healthcare professionals has been adapted to register the side- effects of chemotherapy and provide advice on management of toxicity. We report a feasibility study to examine the utility of home monitoring of patients' symptoms via a mobile phone.

METHODS

Six colon cancer patients receiving adjuvant chemotherapy, entered symptom data onto user friendly screens on a mobile phone twice daily. This 'real time' self assessment of nausea, vomiting, mucositis, diarrhoea and hand-foot syndrome and measurement of temperature was sent via a secured connection to a remote computer. In the event of moderate or severe symptoms (generating amber and red alerts respectively), the nurse was immediately alerted by the computer, via a pager. The nurse then contacted the patient to reinforce the automatic advice sent to the patient on their phone and to assess the patient using clinical algorithms.

RESULTS

The patient used the mobile phones during the first two cycles of chemotherapy. The data were successfully analysed by the server software and alerts were generated alerting the study nurses to patients' symptoms at the appropriate time. There were 91 alerts-54 red and 37 amber; 54% (29/54) of the red alerts were data delay and transmission problems which were swiftly rectified. The remaining red alerts were managed appropriately by the study nurses. Both patients and staff felt confident in this approach to symptom management.

CONCLUSIONS

This study demonstrates that the technology for monitoring patients' symptoms worked well. The patients felt secure in the knowledge that their symptoms were being closely monitored and that they were participating effectively in their own care management.

IgA myeloma of donor origin arising 7 years after allogeneic renal transplant

We report the case of a 38-year-old man who developed IgA myeloma of donor origin 7 years after allogeneic renal transplant. The diagnosis of multiple myeloma was unequivocal and based on positive results from serum electrophoresis, skeletal survey and bone marrow investigations. The donor origin of the myeloma cells was confirmed by DNA fingerprinting. We believe this is the first reported case of disseminated multiple myeloma of donor origin developing after allogeneic renal transplant and, as such, gives some insight into the natural history and biology of the disease.

Good outcome from surgery for ampullary tumour

BACKGROUND

Ampulla of Vater tumours are rare but usually resectable. There is debate as to the better surgical approach between the standard radical procedure, which provides adequate resection margins, and local resection, which may carry a lower mortality. This study reports the 16-year experience of a specialist unit with these tumours, and compares our results with that of recently published series.

METHOD

A retrospective review of patients admitted with an ampullary tumour to the Hepatobiliary and Pancreatic Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia, between January 1981 and April 1997.

RESULTS

Twenty-five patients (13 men, 12 women) of median age 65 years were admitted with an ampullary tumour to the unit during this period. The most common presentation was obstructive jaundice. Multiple endoscopic biopsy was found to be very reliable in distinguishing between benign and malignant tumours. Five patients, all male, had benign neoplasms: three adenomas, one carcinoid and one gangliocytic paraganglioma. Transduodenal local excision was performed in four patients. One patient had a Whipple procedure resulting in the only in-hospital death at 3 months. Twenty patients had adenocarcinoma, of which 13 patients had a pancreaticoduodenectomy, two local excisions, two palliative bypasses, two were unfit for surgery and one declined surgery. The resectability rate was 88%, with no operative mortalities. The 5-year actuarial survival of patients who underwent radical resection was 49%.

CONCLUSIONS

Proximal pancreaticoduodenectomy, preferably a pylorus-preserving procedure, is safe and effective in the treatment of ampullary carcinoma, with low operative mortality and good long-term survival. Local resection is only recommended for small benign tumours and for patients who may be unfit for radical surgery.

Age estimation from the number of teeth erupted in young children: an aid to demographic surveys

The reporting of children's ages by parents is surprisingly inaccurate in many innumerate societies, but accurate knowledge of age is important for estimating recent changes in demographic rates. The timing of the eruption of children's teeth is largely independent of environmental influences and can provide a relatively accurate and unbiased estimate of a child's age. We have collected published data from 42 studies of children's dentition and have transformed them into estimates of age for children with particular numbers of teeth. We present estimates for different populations, but the lack of significant differences between these estimates justifies the use of a standard set.