Search

BACKGROUND Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. OBJECTIVE The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. METHODS This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. RESULTS Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. CONCLUSIONS Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958

BACKGROUND The internet is used for information related to health conditions, including low back pain (LBP), but most LBP websites provide inaccurate information. Few studies have investigated the effectiveness of internet resources in changing health literacy or treatment choices. OBJECTIVE This study aims to evaluate the effectiveness of the MyBackPain website compared with unguided internet use on health literacy, choice of treatments, and clinical outcomes in people with LBP. METHODS This was a pragmatic, web-based, participant- and assessor-blinded randomized trial of individuals with LBP stratified by duration. Participants were randomly allocated to have access to the evidence-based MyBackPain website, which was designed with input from consumers and expert consensus or unguided internet use. The coprimary outcomes were two dimensions of the Health Literacy Questionnaire (dimension 2: “having sufficient information to manage my health;” dimension 3: “actively managing my health;” converted to scores 1-100) at 3 months. Secondary outcomes included additional Health Literacy Questionnaire dimensions, quality of treatment choices, and clinical outcomes. RESULTS A total of 453 participants were recruited, and 321 (70.9%) completed the primary outcomes. Access to MyBackPain was not superior to unguided internet use on primary outcomes (dimension 2: mean difference −0.87 units, 95% CI −3.56 to 1.82; dimension 3: mean difference −0.41 units, 95% CI −2.78 to 1.96). Between-group differences in other secondary outcomes had inconsistent directions and were unlikely to be clinically important, although a small improvement of unclear importance in the quality of stated treatment choices at 1 month was found (mean difference 0.93 units, 95% CI 0.03 to 1.84). CONCLUSIONS MyBackPain was not superior to unguided internet use for health literacy, but data suggest some short-term improvement in treatment choices. Future research should investigate if greater interactivity and engagement with the website may enhance its impact. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001292369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372926 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2018-027516

Objective To evaluate the effects of the updated version of an evidence-based osteoarthritis (OA) resource and consumer hub, ‘My Joint Pain’ website, on health education and quality of care over 12 months. Methods Using a classic quasi-experimental design, participants with symptomatic hip or knee OA were recruited across Australia to evaluate the ‘My Joint Pain’ website, compared to a control group of non-users from 12 to 24 months. Outcome measures included the Health Education Impact Questionnaire (HEIQ) and the OA Quality Indicator (OAQI) questionnaire. The changes from 12 to 24 months in the HEIQ were evaluated using a generalised linear model. The differences between users and non-users in the OAQI were evaluated using a chi-square test. Results A total of 277 eligible participants with symptomatic hip or knee OA were recruited at baseline, and 122 participants completed the 24-month surveys (users: n = 35, non-users: n = 87). There was no significant difference between users and non-users for the HEIQ scores at 24 months after adjustments for age, sex and body mass index (BMI). Users had higher emotional distress scores than non-users in univariable analysis. When compared with non-users in the OAQI, users showed favourable changes in receiving information about “self-management” and “acetaminophen” and “non-steroidal anti-inflammatory drugs (NSAIDs)” from 12 to 24 months. Conclusion The evaluation of the updated ‘My Joint Pain’ website didn’t find significant improvements in terms of health education, but it may help delivering useful information about self-management and appropriate use of pharmacological treatments. More strategies are needed to facilitate the uptake of evidence-based self-management and education online resources for OA consumers.

Objective To qualitatively examine the experiences with, and impact of, evidence-based online resources in self-management among Australians with osteoarthritis. Methods Telephone interviews were conducted with 36 users of a novel osteoarthritis resource, the Osteoarthritis Awareness Hub. Rogers' 5 attributes of innovation (relative advantage, compatibility, complexity, trialability, and observability) and outcomes guided the semistructured interview and analysis. Maximum variation sampling was used, and data saturation occurred after 33 interviews. A coding scheme was agreed upon and all interview data were entered into NVivo for qualitative content analysis. Results Study participants had high levels of literacy and health literacy. For adoption and implementation of an innovation, the participants' narratives confirmed and underscored the fact that it was important that it come from an authoritative and trusting voice and that its perceived benefits align with participants' values and existing practices (relative advantage and compatibility). The participants also valued seeing the practical benefits of the innovation, such as its capacity to impart quality and balanced new insights and information, and to maintain and monitor their personal progress. Notably, many participants spoke about the mental and physical health benefits that they derived from engagement with the online resources. Conclusion Our study findings confirm that web-based tools can be a useful adjunct to patients adopting self-management strategies. Rogers' theory provides a framework for a deeper appreciation of the how, why, and what questions concerning the adoption and implementation processes, especially among people with good technology and health literacy.

IntroductionDespite the prevalence of low back pain (LBP) worldwide, many people with the condition do not receive evidence-based care or achieve the best possible outcomes. There is a gap in the dissemination of evidence-based information across the globe. The advent of the internet has changed the way people obtain health information. As such, trustworthy, tailored and validated LBP resources may help bridge the gap. This study aims to measure the effectiveness of a new website (MyBackPain) in improving spinal health literacy, treatment preferences and clinical outcomes for people with LBP, in comparison with other online resources.Methods and analysisThis online, pragmatic, randomised controlled trial will comprise 440 people with non-specific LBP of any duration. In addition to access to publicly available online information (control group), the intervention group will be given access to the MyBackPain.org.au website. Participants and research staff, including the biostatistician, will be blinded to treatment allocation. Data will be collected at baseline, 1, 3 (primary end-point), 6 and 12 months via online surveys and questionnaires. The primary outcome is spinal health literacy. Secondary outcomes include quality of treatment preferences (stated and observed) and LBP clinical outcomes (pain, disability and quality of life). Analyses will be by intention-to-treat and include outcome data on all randomised participants. Descriptive statistics will be presented for demographic and clinical characteristics.Ethics and disseminationThis trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry and has ethical approval from the University of Queensland Human Research Ethics Committee (2017000995). Trial outcomes will be shared via national and international conference presentations and peer-reviewed journal publications.Trial registration numberACTRN12617001292369; Pre-results.

Background: There are an estimated 4.7 million with knee osteoarthritis (OA) and 2.1 million with hip osteoarthritis in the United Kingdom. Resources to manage OA within the National Health Service are limited. National Institute for Health and Care Excellence guidelines advocate education and self-management for all people with osteoarthritis. Most recently E-health programmes via the internet are being used to deliver health services and information. . Arthritis Australia & Osteoarthritis Research Society International developed Myjointpain.org to support Australians in self-managing hip and/or knee joint pain. There is currently no equivalent UK e-health resource.. This study explored the attitudes, facilitators and barriers towards using e-health by people self-managing hip/knee OA in the UK. Method: A qualitative design using semi-structured telephone interviews was used. Patient and public involvement (PPI) members were recruited via Nottingham City Hospital. PPI members were included if they had Hip and/or Knee joint pain and internet access. Each PPI member was provided with an information sheet and consent form. All consenting members received a link to the Myjointpain,org website and given XX days to practice using the programme. Participants were then contacted for a telephone interview. The interviews were transcribed and a six step thematic analysis used. This included (1) Reading/re-reading of transcript, (2) Coding interesting features of data, (3) Categorising codes into potential themes/subthemes, (4) Reviewing themes, (5) Defining themes, (6) Producing final report. Themes identified were independently verified. Results:. Twelve PPI members wre recruited and contributed to telephone interviews. Overall PPI members were open to using an e-health initiative to self-manage their joint pain; Facilitators that encouraged PPI members to use Myjointpain.org included: . the interactive nature of the e-health programme; the personalised action plan, and participatns’ preceived trustworthiness of the content of the website. ,However excess information was reported as a barrier of use, as well as finding time to use the website due to busy lifestyles. The use of email/telephone prompting was thought may help people better engage with on line self management programmes. .. Conclusion PPI members with hip and /or knee OA in the UK report that they are receptive and open to considering using the Myjointpain.org web based e learning self management programme. Such an approach that emphasises personalised and interactive aspects to facilitate self management helps promote engagement with self management. Prompting is helpful in maintaining engagement (e.g. via e-mail) and provision of too much information may prevent people from engaging with the programme. Myjointpain.org presents an exciting opportunity for e-health strategies for people with arthritis in the UK.

Correlations of considerable apparent significance have been reported between data taken by two bar-type gravitational wave detectors and particle events recorded in the Mt. Blanc, Kamiokande, and IMB particle detectors during a 2-h period near the explosion of Supernova 1987A. In particular, the correlations among the gravitational wave detectors and the Mt. Blanc neutrinos were claimed to have a chance probability of less than 10−6. If this low probability implies that the correlations are a real physical effect, then new physics will be required to explain them. However, one of the statistical tests used to establish these correlations is seriously flawed, and most others were devised a posteriori and contain considerable freedom to make choices that affect the probability of finding correlations. By a careful consideration of these free parameters, and by applying similar analysis methods to simulated pseudorandom data sets, we show that the actual frequency with which correlations similar to those in the Mt. Blanc data would occur in random data streams is between 0.1% and 10%. Moreover, if the Mt. Blanc correlations were real, then one would expect them in the other particle detectors. After inspecting the evidence, we also conclude that there are no physically significant correlations of the Mt. Blanc–type between the gravitational wave detectors and the Kamiokande and/or IMB particles. This makes it very likely that the Mt. Blanc correlations are due, not to any physical effect, but simply to chance.