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1.
BMC Musculoskelet Disord ; 23(1): 260, 2022 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-35300671

RESUMEN

BACKGROUND: Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described. To determine whether physiotherapists as primary assessors for patients with suspected knee osteoarthritis in primary care are a cost-effective alternative compared with traditional physician-led care, we conducted a cost-effectiveness analysis alongside a randomized controlled pragmatic trial. METHODS: Patients were randomized to be assessed and treated by either a physiotherapist or physician first in primary care. A cost-effectiveness analysis compared costs and effects in quality adjusted life years (QALY) for the different care models. Analyses were applied with intention to treat, using complete case dataset, and missing data approaches included last observation carried forward and multiple imputation. Non-parametric bootstrapping was conducted to assess sampling uncertainty, presented with a cost-effectiveness plane and cost-effectiveness acceptability curve. RESULTS: 69 patients were randomized to a physiotherapist (n = 35) or physician first (n = 34). There were significantly higher costs for physician visits and radiography in the physician group (p < 0.001 and p = 0.01). Both groups improved their health-related quality of life 1 year after assessment compared with baseline. There were no statistically significant differences in QALYs or total costs between groups. The incremental cost-effectiveness ratio for physiotherapist versus physician was savings of 24,266 €/lost QALY (societal perspective) and 15,533 €/lost QALY (health care perspective). There is a 72-80% probability that physiotherapist first for patients with suspected knee osteoarthritis is less costly and differs less than ±0.1 in QALY compared to traditional physician-led care. CONCLUSION: These findings suggest that physiotherapist-led care model might reduce health care costs and lead to marginally less QALYs, but confidence intervals were wide and overlapped no difference at all. Health consequences depending on the profession of the first assessor for knee osteoarthritis seem to be comparable for physiotherapists and physicians. Direct access to physiotherapist in primary care seems to lead to fewer physician consultations and radiography. However, larger clinical trials and qualitative studies to evaluate patients' perception of this model of care are needed. CLINICAL TRIAL REGISTRATION: The study was retrospectively registered in clinicaltrial.gov, ID: NCT03822533.


Asunto(s)
Osteoartritis de la Rodilla , Fisioterapeutas , Médicos , Análisis Costo-Beneficio , Humanos , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/terapia , Atención Primaria de Salud , Calidad de Vida
2.
BMC Musculoskelet Disord ; 21(1): 380, 2020 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-32534579

RESUMEN

BACKGROUND: Self-efficacy is considered a core component in self-management. However, there is a lack of knowledge about the association between self-efficacy and health-related outcomes in osteoarthritis. The aim of this study was to investigate whether self-efficacy at baseline was associated with change over time in pain and physical activity after a supported osteoarthritis self-management programme. METHODS: A total of 3266 patients with hip or knee osteoarthritis attended this observational, register-based study. Self-efficacy was assessed using the Arthritis Self-Efficacy Scale. Pain was estimated on a visual analogue scale and physical activity by self-reporting number of days per week the patients were physically active ≥30 min. Data were self-reported at baseline and at follow-ups after 3 and 12 months. Analyses were performed using a mixed linear model analysis and are presented with an unadjusted and an adjusted model. RESULTS: High vs low self-efficacy for pain management at baseline resulted in reduced pain and increased physical activity at the follow-ups; least squares means and standard error were 37.43 ± 0.40 vs 44.26 ± 0.40, for pain, and 5.05 ± 0.07 vs 4.90 ± 0.08 for physical activity. High self-efficacy for management of other symptoms resulted in lower pain and higher physical activity at follow-up: 35.78 ± 0.71 vs 41.76 ± 0.71 for pain, and 5.08 ± 0.05 vs 4.72 ± 0.05 for physical activity. Patients with obesity reported lower activity levels at the follow-ups. CONCLUSION: Self-efficacy at baseline was associated with change over time in pain and physical activity at 3 and 12 months after the supported osteoarthritis self-management programme. High self-efficacy had a positive effect on pain and physical activity, indicating the need for exploring and strengthening patients' self-efficacy. Patients with obesity may need further interventions and support during a self-management programme to achieve an increase in physical activity.


Asunto(s)
Ejercicio Físico/fisiología , Osteoartritis de la Cadera/rehabilitación , Osteoartritis de la Rodilla/rehabilitación , Autoeficacia , Automanejo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Rodilla/diagnóstico , Manejo del Dolor/métodos , Dimensión del Dolor , Medición de Resultados Informados por el Paciente , Estudios Prospectivos
3.
BMC Musculoskelet Disord ; 20(1): 329, 2019 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-31301739

RESUMEN

BACKGROUND: In Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care. METHODS: An assessor-blinded randomised controlled pragmatic trial. Using a computer-generated list of random numbers, patients seeking primary care during 2013-2017 with suspected KOA were randomised to either a physiotherapist or physician for primary assessment and treatment. Data was collected before randomisation and at 3, 6, and 12-month follow-ups. Primary outcome was HrQoL using EuroQol 5 dimensions 3 levels questionnaire, index (EQ-5D-3L index) and a visual analogue scale (VAS) (EQ-5D-3L VAS); pain intensity was measured with VAS (0-100) and physical function measured with the 30-s chair stand test. Mixed effect model analyses compared repeated measures of HrQoL between groups. The significance level was p < 0.05 and data was applied with intention-to-treat. RESULTS: Patients were randomised to either a physiotherapist (n = 35) or physician (n = 34) for primary assessment. All 69 patients were included in the analyses. There were no significant differences in HrQoL for patients assessed by a physiotherapist or a physician as primary assessor (EQ-5D-3L index, p = 0.18; EQ-5D-3L VAS, p = 0.49). We found that HrQoL changed significantly 12 months after baseline assessment for all patients regardless of assessor (EQ-5D-3L index, p < 0.001; EQ-5D-3 L VAS, p = 0.0049). No adverse events or side effects were reported. CONCLUSIONS: There were no differences in HrQoL, when adjusted for pain and physical function, for patients with KOA when the healthcare process was initiated with physiotherapist assessment compared to physician assessment in primary care. Both assessments resulted in significantly higher HrQoL at the 12-month follow-up. The results imply that physiotherapists and physicians in primary care are equally qualified as primary assessors. TRIAL REGISTRATION: Retrospectively registered at http://clinicaltrial.gov , ID: NCT03715764.


Asunto(s)
Osteoartritis de la Rodilla/diagnóstico , Fisioterapeutas , Atención Primaria de Salud/organización & administración , Rol Profesional , Calidad de Vida , Anciano , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dimensión del Dolor , Medición de Resultados Informados por el Paciente , Aptitud Física/fisiología , Médicos , Atención Primaria de Salud/métodos , Índice de Severidad de la Enfermedad , Suecia
4.
BMC Musculoskelet Disord ; 19(1): 198, 2018 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-30037339

RESUMEN

BACKGROUND: Individuals with knee and hip osteoarthritis (OA) are less physically active than people in general, and many of these individuals have adopted a sedentary lifestyle. In this study we evaluate the outcome of education and supervised exercise on the level of physical activity in individuals with knee or hip OA. We also evaluate the effect on pain, quality of life and self-efficacy. METHODS: Of the 264 included individuals with knee or hip OA, 195 were allocated to the intervention group. The intervention group received education and supervised exercise that comprised information delivered by a physiotherapist and individually adapted exercises. The reference group consisted of 69 individuals with knee or hip OA awaiting joint replacement and receiving standard care. The primary outcome was physical activity (as measured with an accelerometer). The secondary outcomes were pain (Visual Analog Scale), quality of life (EQ-5D), and self-efficacy (Arthritis Self-Efficacy Scale, pain and other symptoms subscales). Participants in both groups were evaluated at baseline and after 3 months. The intervention group was also evaluated after 12 months. RESULTS: No differences were found in the number of minutes spent in sedentary or in physical activity between the intervention and reference groups when comparing the baseline and 3 month follow-up. However, there was a significant difference in mean change (mean diff; 95% CI; significance) between the intervention group and reference group favoring the intervention group with regard to pain (13; 7 to 19; p < 0.001), quality of life (- 0.17; - 0.24 to - 0.10; p < 0.001), self-efficacy/other symptoms (- 5; - 10 to - 0.3; p < 0.04), and self-efficacy/pain (- 7; - 13 to - 2; p < 0.01). Improvements in pain and quality of life in the intervention group persisted at the 12-month follow-up. CONCLUSIONS: Participation in an education and exercise program following the Swedish BOA program neither decreased the average amount of sedentary time nor increased the level of physical activity. However, participation in such a program resulted in decreased pain, increased quality of life, and increased self-efficacy. TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov. Registration number: NCT02022566 . Retrospectively registered 12/18/2013.


Asunto(s)
Terapia por Ejercicio/métodos , Ejercicio Físico/fisiología , Manejo del Dolor/métodos , Educación del Paciente como Asunto/métodos , Calidad de Vida , Autoeficacia , Acelerometría/métodos , Acelerometría/psicología , Adulto , Anciano , Intervención Médica Temprana/métodos , Ejercicio Físico/psicología , Terapia por Ejercicio/psicología , Terapia por Ejercicio/tendencias , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dolor/psicología , Manejo del Dolor/psicología , Dimensión del Dolor/métodos , Dimensión del Dolor/psicología , Calidad de Vida/psicología , Resultado del Tratamiento
5.
BMC Musculoskelet Disord ; 18(1): 42, 2017 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-28122519

RESUMEN

BACKGROUND: Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity. METHODS: An observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran's Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model. RESULTS: The proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability. CONCLUSIONS: Following the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.


Asunto(s)
Ejercicio Físico/fisiología , Estado de Salud , Osteoartritis de la Cadera/rehabilitación , Osteoartritis de la Rodilla/rehabilitación , Automanejo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Rodilla/diagnóstico , Sistema de Registros , Automanejo/tendencias , Adulto Joven
6.
Acta Orthop ; 85(3): 229-33, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24786904

RESUMEN

BACKGROUND AND PURPOSE: In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. PATIENTS AND METHODS: 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0-100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). RESULTS: Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. INTERPRETATION: The patients who reported poor response after TKA continued to be unhappy after 8-13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/psicología , Osteoartritis de la Rodilla/psicología , Osteoartritis de la Rodilla/cirugía , Satisfacción del Paciente , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Depresión/epidemiología , Femenino , Humanos , Incidencia , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Estudios Longitudinales , Masculino , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular/fisiología , Sistema de Registros , Proyectos de Investigación , Estudios Retrospectivos , Resultado del Tratamiento
7.
Ann Rheum Dis ; 72(3): 401-5, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22679305

RESUMEN

OBJECTIVES: To investigate sick leave and disability pension in working-age subjects with knee osteoarthritis (OA) compared with the general population. METHODS: Population-based cohort study: individual-level inpatient and outpatient Skåne Health Care Register data were linked with data from the Swedish Social Insurance Agency. In 2009 all working-age (16-64 years) Skåne County residents who in 1998-2009 had been diagnosed with knee OA (International Classification of Diseases-10 code M17) were identified and their sick leave and disability pension in 2009 related to those of the general working-age population (n=789 366) standardised for age. RESULTS: 15 345 working-age residents (49.6% women) with knee OA were identified. Compared with the general population, the RR (95% CI) of having had one or more episodes of sick leave during the year was 1.82 (1.73 to 1.91) for women and 2.03 (1.92 to 2.14) for men with knee OA. The corresponding risk for disability pension was 1.54 (1.48 to 1.60) for women and 1.36 (1.28 to 1.43) for men with knee OA. The annual mean number of sick days was 87 for each patient with knee OA and 57 for the general population (age- and sex-standardised). Of all sick leave and disability pension in the entire population, 2.1% of days were attributable to knee OA or associated comorbidity in the patients with knee OA (3.1% for sick leave and 1.8% for disability pension). CONCLUSIONS: Subjects with doctor-diagnosed knee OA have an almost twofold increased risk of sick leave and about 40-50% increased risk of disability pension compared with the general population. About 2% of all sick days in society are attributable to knee OA.


Asunto(s)
Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/economía , Pensiones/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Adolescente , Adulto , Estudios de Cohortes , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
8.
Physiother Res Int ; 28(4): e2014, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37170720

RESUMEN

PURPOSE: Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT). Our study aimed to describe Indian PTs' knowledge, attitudes and confidence on evidence-based management of OA, and their perceptions of a course on this subject. METHODS: The 2-day course included didactic parts and practical skills training. Thirty-five PTs participated and answered a questionnaire. Fourteen of them participated in focus group interviews. Questionnaire data are presented as medians and full ranges. Manifest content analysis was used to analyze interview data that are presented as catagories illustrated by interview quotes. The formal ethics permission was granted. RESULTS: 74% of PTs agreed that radiography determines the type of treatment required, and 69% agreed that a prescription for exercise is enough to ensure adherence. PTs agreed (mean 5 on 6-point scale) that exercises increasing pain should be advised against. Confidence in guiding the physical activity was generally high (≥5 on 6-point scales). Five categories reflected participants' perceptions of the course content: Shift in management focus, Need for cultural adaptation, Importance of social support, Development of organization and collaboration, and Feelings of hesitation. DISCUSSION: Our results indicate that in order to facilitate the implementation of CPGs, PT curricula may consider the inclusion of knowledge on CPGs, focus more on students' own reflections on transforming theory into practice, and incorporate training of basic skills required for implementation of self-management, body awareness, and neuromuscular fitness. If given access and mandates, PTs may play a major role in the early diagnosis and treatment of OA and thus contribute to the prevention of an epidemic of OA in India.

9.
BMC Musculoskelet Disord ; 13: 153, 2012 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-22917179

RESUMEN

BACKGROUND: The aim of this study was to document the development of bilateral knee osteoarthritis over a 12 year period using a middle-aged population-based cohort with knee pain at inclusion. METHODS: One hundred and forty three patients aged 35 to 54 were recruited from a population based cohort of 279 subjects who had knee pain at baseline and assessed with clinical and radiographic data, with 5 and 12 year follow up. The data was analysed with regard to the development and progression of uni- and bilateral knee osteoarthritis over 12 years. A definition of KL = 1 was used to define radiographic disease. RESULTS: 24 of the 30 (80%) patients with unilateral disease at baseline developed bilateral disease after 12 years. At baseline 37 patients (26%) had bilateral disease, whereas that number increased to 65 (52%) at 5 years and 100 (70%) at the 12 year follow up. The most common pattern was medial compartment involvement in both knees. Six patients had lateral compartment disease in one knee and medial in the other whereas only two had lateral compartment disease bilaterally. CONCLUSIONS: Bilateral knee osteoarthritis is very common with time, as the majority of sufferers will eventually develop radiographic disease in both knees. Clinicians need to be aware of the 'joint at risk' and researchers need to remember to account for both knees when assessing the relationship between physical function, pain and structural disease. The other knee should not be used for comparison, even if it appears to be normal at baseline.


Asunto(s)
Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Adulto , Factores de Edad , Artralgia/diagnóstico , Artralgia/etiología , Índice de Masa Corporal , Dolor Crónico/diagnóstico , Dolor Crónico/etiología , Progresión de la Enfermedad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor , Pronóstico , Estudios Prospectivos , Radiografía , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores de Tiempo
10.
Physiother Theory Pract ; : 1-11, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-36047816

RESUMEN

BACKGROUND AND OBJECTIVE: Osteoarthritis (OA) is a major and growing problem in India. Better knowledge dissemination and implementation of evidence-based practice in Indian physical therapy require a better understanding of approaches to OA (i.e. perceptions of the condition and its management by Indian physical therapists (PTs)) which was the aim of our study. DESIGN AND METHOD: We used qualitative content analysis to analyze semi-structured interviews with 19 PTs from Maharashtra state, purposefully selected to represent both sexes, different ages and different educational and professional backgrounds. FINDINGS: We identified a main overarching theme of meaning, OA as a degenerative and irreversible condition with the four descriptive themes Assessment, Standardized treatment protocol, Leadership and Patient compliance as PTs' approaches to OA. The descriptive themes indicate that much focus seems to be on pain, physical impairments and biomechanics, with initial treatments being mainly passive. Communication appears to be mainly unidirectional with the PTs instructing the patients, who are expected to comply with PTs instructions. Clinical practice guidelines (CPGs) were not mentioned. CONCLUSIONS: Our findings can inform the design of awareness campaigns on evidence-based OA management and increase the understanding of the educational needs of students and PTs in non-Western countries. It is important to recognize that CPGs are mainly based on studies carried out in Western countries and that there are context-specific barriers to implementation in other parts of the world that have large populations.

11.
BMC Public Health ; 11: 107, 2011 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-21324175

RESUMEN

BACKGROUND: Sickness absence has represented a growing public health problem in many Western countries over the last decade. In Sweden disorders of the musculoskeletal system cause approximately one third of all sick leave. The Social Insurance Agency (SIA) and the health care system are important actors in handling the sickness absence process. The objective was to study how patients with personal experience of sickness absence due to musculoskeletal disorders perceived their contact with these actors and what they considered as obstructing or facilitating factors for recovery and return to work in this situation. METHODS: In-depth interviews using open-ended questions were conducted with fifteen informants (aged 33-63, 11 women), all with experience of sickness absence due to musculoskeletal disorders and purposefully recruited to represent various backgrounds as regards diagnosis, length of sick leave and return to work. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis. RESULTS: The informants' perceived the interaction with the SIA and health care as ranging from coherent to fragmented. Being on sick leave was described as going through a process of adjustment in both private and working life. This process of adjustment was interactive and included not only the possibilities to adjust work demands and living conditions but also personal and emotional adjustment. The informants' experiences of fragmented interaction reflected a sense that their entire situation was not being taken into account. Coherent interaction was described as facilitating recovery and return to work, while fragmented interaction was described as obstructing this. The complex division of responsibilities within the Swedish rehabilitation system may hamper sickness absentees' possibilities of taking responsibility for their own rehabilitation. CONCLUSIONS: This study shows that people on sick leave considered the interaction with the SIA and health care as an important part of the rehabilitation process. The contact with these actors was perceived as affecting recovery and return to work. Working for a more coherent process of rehabilitation and offering professional guidance to patients on sick leave might have an empowering effect.


Asunto(s)
Absentismo , Atención a la Salud , Enfermedades Musculoesqueléticas , Satisfacción del Paciente , Seguridad Social , Adulto , Empleo , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Suecia
12.
Disabil Rehabil ; 42(15): 2133-2140, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-30686131

RESUMEN

Purpose: Describe the change in self-efficacy after a supported osteoarthritis self-management program.Materials and methods: An observational register-based study comprising 11 906 patients. Participants with hip or knee osteoarthritis self-reported at baseline, 3 and 12 months. Self-efficacy for pain and other symptoms were assessed with the Arthritis Self-efficacy Scale. Change was analyzed using a mixed-effect model for repeated measurements.Results: In total, 9440 (pain subscale) and 9361 (symptom subscale) patients reported self-efficacy scores at baseline and at least one follow-up. The lowest self-efficacy at baseline was reported by patients with low education, walking difficulties, comorbidity and low physical activity level. Overall, the self-efficacy scores improved at the 3-month follow-up and returned to baseline at the 12-month follow-up. Younger age (pain and symptom subscales) and exercise (pain subscale) were associated with a greater increase in self-efficacy. Obesity (pain subscale) and hip problems (pain and symptom subscales) were associated with lower self-efficacy at baseline and a greater decrease at follow-up.Conclusion: Self-efficacy was related to the level of education, physical activity, mobility, and comorbidity. In addition, hip problems or obesity were associated with greater difficulties in enhancing or maintaining self-efficacy. An increased focus on patients with hip problems or obesity might help to improve outcomes after supported self-management programs for osteoarthritis.IMPLICATIONS FOR REHABILITATIONSelf-efficacy increased more in younger patients and in those who opted for exercise as part of the intervention, which indicates that offering supported self-management early in the course of the disease might be important.Lower self-efficacy at baseline and reduced beliefs about their ability to manage pain indicate that patients with hip OA or obesity may need to be given a special focus by healthcare.Self-efficacy in managing pain and other symptoms seemed to increase after a supported self-management osteoarthritis program, but was not maintained at the 12-month follow-up, indicating that more on-going support might be needed to maintain self-efficacy.


Asunto(s)
Osteoartritis de la Cadera , Osteoartritis de la Rodilla , Automanejo , Ejercicio Físico , Terapia por Ejercicio , Humanos , Autoeficacia
13.
BMC Musculoskelet Disord ; 10: 153, 2009 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-19968876

RESUMEN

BACKGROUND: A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample. METHODS: Health care utilization, defined as having seen a family doctor (GP) during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in a community based sample aged 35 or over and reporting pain in hip or knee. Adjusted odds ratios were determined for social deprivation, rurality, pain severity, mobility, anxiety/depression, co-morbidities, and body mass index. RESULTS: Of 1119 persons reporting hip or knee pain, 52% had pain in both sites. Twenty-five percent of them had seen a doctor only, 3% an AHP only, and 4% an alternative therapist only. Thirteen percent had seen more than one category of health care professionals, and 55% had not seen any health care professional. In the multivariate model, factors associated with consulting a GP were mobility problems (OR 2.62 (1.64-4.17)), urban living (OR 2.40 (1.14-5.04) and pain severity (1.28 (1.13-1.44)). There was also some evidence that obesity was associated with increased consultation (OR 1.72 (1.00-2.93)). Factors were similar for consultation with a combination of several health care professionals. In contrast, seeing an alternative therapist was negatively associated with pain severity, anxiety and mobility problems (adjusting for age and sex). CONCLUSION: Disability appears to be a more important determinant of help-seeking than pain severity or anxiety and depression, for adults with chronic pain in hip or knee. The determinants of seeking help from alternative practitioners are different from determinants of consulting GPs, AHPs or a combination of different health care providers.


Asunto(s)
Artralgia/terapia , Servicios de Salud Comunitaria/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Articulación de la Cadera/fisiopatología , Articulación de la Rodilla/fisiopatología , Aceptación de la Atención de Salud , Derivación y Consulta/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/etiología , Artralgia/fisiopatología , Artralgia/psicología , Enfermedad Crónica , Terapias Complementarias/estadística & datos numéricos , Depresión/etiología , Evaluación de la Discapacidad , Humanos , Modelos Logísticos , Persona de Mediana Edad , Limitación de la Movilidad , Obesidad/fisiopatología , Obesidad/terapia , Oportunidad Relativa , Dimensión del Dolor , Características de la Residencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
14.
BMC Musculoskelet Disord ; 10: 100, 2009 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-19664258

RESUMEN

BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee traumas; and many described their lack of trust in their knee. Patients believed that surgery would provide joint stability. Despite the ostensible satisfaction with surgery, more detailed exploration showed mixed views. CONCLUSION: Participants in a trial of treatments for acute ACL injury express a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach, incorporating patients' as well as surgeons' views before treatment decisions are made.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Artroscopía , Conducta de Elección , Terapia por Ejercicio , Traumatismos de la Rodilla/terapia , Satisfacción del Paciente , Adulto , Ligamento Cruzado Anterior/fisiopatología , Estudios Cruzados , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/terapia , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/cirugía , Masculino , Investigación Cualitativa , Recuperación de la Función , Rotura , Resultado del Tratamiento , Listas de Espera , Adulto Joven
15.
BMC Health Serv Res ; 8: 231, 2008 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-18992160

RESUMEN

BACKGROUND: Objective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave. METHODS: Fifteen social insurance officers (SIOs) working with administration of sickness benefits were interviewed. They were purposefully recruited to represent different parts of the social insurance office organization, different ages, gender, education, and work experience. The interviews were audio-recorded, transcribed verbatim and analyzed using phenomenographic approach. RESULTS: 11 women and 4 men, aged 25-65, with a work experience ranging from 1-40 years were interviewed. Three descriptive categories embracing eleven subcategories emerged: 1) Communication channels included three subcategories; to obtain medical opinions, to hold meetings with actors involved, to experience support functions; 2) Organizational conditions included five subcategories; to experience lack of time, to experience problems of availability, to experience lack of continuity, to experience unclear responsibility, to experience ongoing change; 3) Attitudes included three subcategories; to conceive the attitudes of the physicians, to conceive the attitudes of the patients, to conceive the attitudes of the SIOs. CONCLUSION: Personal communication was described as crucial to ensure a more efficient working process. The personal contact was obstructed mainly by issues related to work load, lack of continuity, and reorganisations. By enhancing and enabling personal contact between SIOs and health care professionals, the waiting times for the sick-listed might be shortened, resulting in shorter periods of sick-leave. Issues around collaboration and communication between gatekeepers need to be recognized in the ongoing work with new guidelines and education in insurance medicine.


Asunto(s)
Actitud , Certificación/métodos , Conducta Cooperativa , Evaluación de la Discapacidad , Control de Acceso/organización & administración , Seguro por Discapacidad/organización & administración , Comunicación Interdisciplinaria , Ausencia por Enfermedad , Adulto , Escolaridad , Femenino , Procesos de Grupo , Humanos , Entrevistas como Asunto , Aprendizaje , Masculino , Persona de Mediana Edad , Medicina del Trabajo/educación , Medicina del Trabajo/organización & administración , Evaluación de Procesos, Atención de Salud , Psicometría , Investigación Cualitativa , Suecia , Evaluación de Capacidad de Trabajo
16.
BMC Musculoskelet Disord ; 7: 98, 2006 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-17156423

RESUMEN

BACKGROUND: COMP (Cartilage oligomeric matrix protein) is a matrix protein, which is currently studied as a potential serum marker for cartilage processes in osteoarthritis (OA). The influence of physical exercise on serum COMP is not fully elucidated. The objective of the present study was to monitor serum levels of COMP during a randomised controlled trial of physical exercise vs. standardised rest in individuals with symptomatic and radiographic knee OA. METHODS: Blood samples were collected from 58 individuals at predefined time points before and after exercise or rest, one training group and one control group. The physical exercise consisted of a one-hour supervised session twice a week and daily home exercises. In a second supplementary study 7 individuals were subjected to the same exercise program and sampling of blood was performed at fixed intervals before, immediately after, 30 and 60 minutes after the exercise session and then with 60 minutes interval for another five hours after exercise to monitor the short-term changes of serum COMP. COMP was quantified with a sandwich-ELISA (AnaMar Medical, Lund, Sweden). RESULTS: Before exercise or rest no significant differences in COMP levels were seen between the groups. After 60 minutes exercise serum COMP levels increased (p < 0.001). After 60 minutes of rest the serum levels decreased (p = 0.003). Median serum COMP values in samples obtained prior to exercise or rest at baseline and after 24 weeks did not change between start and end of the study. In the second study serum COMP was increased immediately after exercise (p = 0.018) and had decreased to baseline levels after 30 minutes. CONCLUSION: Serum COMP levels increased during exercise in individuals with knee OA, whereas levels decreased during rest. The increased serum COMP levels were normalized 30 minutes after exercise session, therefore we suggest that samples of blood for analysis of serum COMP should be drawn after at least 30 minutes rest in a seated position. No increase was seen after a six-week exercise program indicating that any effect of individualized supervised exercise on cartilage turnover is transient.


Asunto(s)
Ejercicio Físico/fisiología , Proteínas de la Matriz Extracelular/sangre , Glicoproteínas/sangre , Osteoartritis de la Rodilla/sangre , Adulto , Anciano , Biomarcadores/sangre , Proteína de la Matriz Oligomérica del Cartílago , Proteínas de la Matriz Extracelular/biosíntesis , Femenino , Glicoproteínas/biosíntesis , Humanos , Masculino , Proteínas Matrilinas , Persona de Mediana Edad , Descanso/fisiología , Factores de Tiempo
17.
Disabil Rehabil ; 28(1): 51-9, 2006 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-16393833

RESUMEN

PURPOSE: To describe conceptions, as registered by a semi-structured interview, of exercise as treatment among sixteen middle-aged patients with moderate to severe knee osteoarthritis. METHOD: Sixteen patients (aged 39-64) with symptomatic, radiographic knee osteoarthritis and previous participants in an exercise intervention, were interviewed. The qualitative data obtained were analysed using phenomenographic approach. RESULTS: Four descriptive categories containing 13 conceptions emerged: Category 1) To gain health included five conceptions; to experience coherence, to experience well-being, to be in control, to experience improved physical functioning, to experience symptom relief; 2) To become motivated included three conceptions; to experience inspiration, to be prepared to persevere, to experience the need to exercise; 3) To experience the need for support included three conceptions; to have structure, to receive guidance, to devote time; 4) To experience resistance included two conceptions; to hesitate, to deprecate. CONCLUSION: Patients with knee osteoarthritis and knee pain, previously participating in exercise intervention, are aware of the health benefits of exercise, but have many doubts and concerns about exercise as treatment. These aspects should be considered when designing patient information and treatment programmes. Furthermore, a hesitative and resistive perception of exercise as a concept could have major influences on the implementation of health programmes.


Asunto(s)
Terapia por Ejercicio/métodos , Ejercicio Físico/psicología , Conocimientos, Actitudes y Práctica en Salud , Osteoartritis de la Rodilla/psicología , Osteoartritis de la Rodilla/rehabilitación , Adulto , Formación de Concepto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad
18.
JMIR Res Protoc ; 5(2): e115, 2016 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-27261271

RESUMEN

BACKGROUND: Chronic conditions are the leading cause of disability throughout the world and the most expensive problem facing the health care systems. One such chronic condition is osteoarthritis (OA), a frequent cause of major disability. OBJECTIVE: To describe the effect on joint pain for the first users of a newly developed Web-based osteoarthritis self-managing program, Joint Academy, and to examine whether these patients would recommend other OA patients to use the program. METHODS: Patients with clinically established knee or hip OA according to national and international guidelines were recruited from an online advertisement. A trained physiotherapist screened the eligible patients by scrutinizing their answers to a standardized questionnaire. The 6-week program consisted of eight 2- to 5-minute videos with lectures about OA, effects of physical activity, self-management, and coping strategies. In addition, exercises to improve lower extremity physical function were introduced in daily video activities. During the course of the program, communication between physiotherapist and patients was based on an asynchronous chat. After 6 weeks, patients were able to continue without support from the physiotherapist. Patients reported their current pain weekly by using a numeric rating scale (range 0-10; 0=no pain, 10=worst possible pain) as long as they were in the program. In addition, after 6 weeks patients answered the question "What is the probability that you would recommend Joint Academy to a friend?" RESULTS: The eligible cohort consisted of 53 individuals (39 women; body mass index: mean 27, SD 5; age: mean 57, SD 14 years). With the continued use of the program, patients reported a constant change in pain score from mean 5.1 (SD 2.1) at baseline to mean 3.6 (SD 2.0) at week 12. Six patients participated for 30 weeks (mean 3.2, SD 2.1). Overall, the patients would highly recommend Joint Academy to other OA patients, suggesting that the platform may be useful for at least some in the vast OA population. CONCLUSIONS: Joint Academy, a Web-based platform for OA therapy, has the potential to successfully deliver individualized online treatment to many patients with OA that presently lack access to treatment.

19.
Best Pract Res Clin Rheumatol ; 30(3): 503-535, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27886944

RESUMEN

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Despite the existence of evidence-based treatments and guidelines, substantial gaps remain in the quality of OA management. There is underutilization of behavioral and rehabilitative strategies to prevent and treat OA as well as a lack of processes to tailor treatment selection according to patient characteristics and preferences. There are emerging efforts in multiple countries to implement models of OA care, particularly focused on improving nonsurgical management. Although these programs vary in content and setting, key lessons learned include the importance of support from all stakeholders, consistent program delivery and tools, a coherent team to run the program, and a defined plan for outcome assessment. Efforts are still needed to develop, deliver, and evaluate models of care across the spectrum of OA, from prevention through end-stage disease, in order to improve care for this highly prevalent global condition.


Asunto(s)
Atención a la Salud/métodos , Osteoartritis/terapia , Humanos
20.
BMC Musculoskelet Disord ; 6: 27, 2005 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-15924620

RESUMEN

BACKGROUND: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life. METHODS: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at > or = 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months. RESULTS: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02). CONCLUSION: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group.


Asunto(s)
Osteoartritis de la Rodilla/terapia , Adulto , Prueba de Esfuerzo , Terapia por Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/psicología , Evaluación de Resultado en la Atención de Salud , Dolor/fisiopatología , Cooperación del Paciente , Calidad de Vida , Factores de Tiempo , Resultado del Tratamiento
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