How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). METHODS: Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference -0.35, 95% confidence interval -0.59 to -0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. DISCUSSION: The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups.

Do health service waiting areas contribute to the health literacy of consumers? A scoping review.

Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.

Health service waiting areas are commonly used to provide health resources (such as health information, resources and supports) for consumers. Health resources which are appropriate and accessible for consumers can improve health literacy by increasing health knowledge, supporting good decision-making or changing behaviours which may result in better health. Although it is common to offer health resources in health service waiting areas, the evidence supporting this practice is unclear. This scoping review of the literature focussed on the use of health service waiting areas as a place to contribute to the health literacy of adult consumers attending outpatient or primary care health appointments. A total of 116 unique articles were included which addressed this issue. Majority of articles were set in primary and community care waiting areas (49%). A range of health topics and resource types were available but these were not always used by consumers. Overall, interventions in waiting areas targeting health literacy-related outcomes resulted in positive outcomes, although the benefit declined after 3­6 months. Research on using waiting areas for health-literacy purposes is increasing worldwide. Future research is needed to identify how to optimize the effectiveness of interventions in waiting areas to benefit consumers.

Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service.

Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n=6) and staff (n=6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P<0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P<0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.

Prevalence and associated factors for thoracic spine pain in the adult working population: a literature review.

OBJECTIVES: Spinal pain is a significant occupational health issue. Whilst neck pain and low back pain have received considerable attention, thoracic spinal pain (TSP) has not. The objective of this study was to systematically identify and report the evidence describing the prevalence and correlates of TSP within occupational groups. METHODS: This literature review systematically searched for reports of TSP prevalence and associated factors for TSP in working adult cohorts using nine electronic databases. Studies were evaluated for level of evidence and epidemiologic data were narratively synthesised. RESULTS: 52 studies were identified describing 65 cohorts covering manual labourers, office workers, health professionals, manufacturing and industrial workers, drivers, military personnel and performing artists. Prevalence varied with occupational group and time period. One year prevalence of TSP ranged from 3.0-55.0%, with most occupational groups having medians around 30%. Significant odds ratios for individual (concurrent musculoskeletal disorders, exercising, pre-menstrual tension and female gender), general work-related (high work load, high work intensity, perceiving ergonomic problems in the workplace, working in some specialised areas, performing boring/tedious work tasks, certain year levels of study, employment duration, driving specialised vehicles, and a high number of flying hours), physical work-related (manual physiotherapy tasks, climbing stairs and high physical stress) and psychosocial work-related (perceived risk of injury and high mental pressure) factors were reported. CONCLUSIONS: The high median prevalence rates suggest TSP may be a significant occupational health problem. The multiple domains of associated factors point to the need for prospective research encompassing these domains to inform targeted occupational interventions.