Search

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.

The philosophical underpinning of trials of complex interventions are critiqued for not taking into account causal mechanisms that influence potential outcomes. In this paper 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 was 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 places 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.

ObjectiveThe Joint Effort Initiative was endorsed by Osteoarthritis Research Society International (OARSI) in 2018 as a collaboration between international researchers and clinicians with an interest in the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify and prioritise activities for future work of the Joint Effort Initiative.DesignA survey was emailed to delegates of the 2018 OARSI World Congress attending a pre-conference workshop or with a known interest in OAMPs (n = 115). Delegates were asked about the most important issues regarding OAMP implementation. The top 20 issues were synthesised into 17 action statements, and respondents were invited to participate in a priority ranking exercise to determine the order of importance of the statements.ResultsSurvey respondents (n = 51, 44%) were most commonly female (71%), with an allied health background (57%), affiliated with universities (73%) from Oceania (37%), and Europe/UK (45%). The five highest ranked action statements were:i)Establish guidelines for the implementation of different OAMP models to ensure consistency of delivery and adherence to international best practice.ii)Develop and assess training and education programs for health care professionals (HCPs) delivering OAMPs.iii)Develop and evaluate the implementation and outcomes of novel models of OAMPs.iv)Develop and assess core skill sets and resources for HCPs delivering OA care.v)Develop a framework for enhancing the quality of care provided by OAMPs.ConclusionPrioritising statements will bring focus to the future work of the Joint Effort Initiative in the future and provide a basis for longer-term actions.

© The Author(s) 2018. Objectives. Evidence regarding the cost-effectiveness of enhancing physical therapy exercise programmes in order to improve outcomes for patients with knee OA remains unclear. This study investigates the cost-effectiveness of two enhanced physical therapy interventions compared with usual physical therapy care (UC) for adults with knee OA. Methods. A trial-based cost-utility analysis of individually tailored exercise (ITE) or targeted exercise adherence (TEA) compared with UC was undertaken over a period of 18 months. Patient-level costs were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a base-case UK health-care perspective. Results. The UC group was associated with lower National Health Service (NHS) costs [ITE-UC: £273.30, 95% CI: £-62.10 to £562.60; TEA-UC: £141.80, 95% CI: £-135.60 to £408.10)] and slightly higher QALY gains (ITE-UC: -0.015, 95% CI: -0.057 to 0.026; TEA-UC: -0.003, 95% CI: -0.045 to 0.038). In the base case, UC was the most likely cost-effective option (probability < 40% of ITE or TEA cost-effective at £20 000/QALY). Differences in total costs were attributable to intervention costs, number of visits to NHS consultants and knee surgery, which were higher in both ITE and TEA groups. Conclusion. This is the first economic evaluation comparing usual physical therapy care vs enhanced exercise interventions for knee OA that involves greater exercise individualization, supervision and progression or that focuses on exercise and physical activity adherence over the longer term. Our findings show that UC is likely to be the most cost-effective option., This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (grant number: RP-PG-0407-10386) and the Arthritis Research UK Centre in Primary Care grant (grant number: 18139). Time from E.L.H. was supported, in part, by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands and time from M.A.H. was supported, in part, by the NIHR School for Primary Care Research. N.E.F. was supported through an NIHR Research Professorship (NIHR-RP-011-015). N.E.F. and E.M.H. are NIHR Senior Investigators. The NIHR Clinical Research Network West Midlands (previously PCRN West Midlands North) and North Staffordshire Primary Care Research Consortium provided additional funding for GP and physical therapy Research Facilitators to support engagement of NHS providers in the BEEP trial; NIHR PCRN West Midlands North funded NHS service support costs for the delivery of the trial.

No abstract

The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care.