Reducing the impact of physical inactivity: evidence to support the case for targeting people with chronic mental and physical conditions.

BACKGROUND: Recent evidence suggests that small increases in the physical activity of those considered least active can have a bigger health impact than raising levels of those already achieving or close to achieving recommendations. Profiling the characteristics of those who are least active allows for appropriate targeting of interventions. This study therefore examined the characteristics of people in the lowest physical activity bracket. METHODS: Data were taken from the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funded 'South Yorkshire Cohort', a longitudinal observational dataset of residents of South Yorkshire, England. Five separate outcomes based on a shortened version of the GPPAQ were used to represent the lowest levels of physical activity. Potential predictors examined were age, sex, body mass index, ethnicity, chronic conditions, current employment and deprivation. Descriptive statistics and logistic regression were conducted. RESULTS: Individuals with chronic mental and physical conditions (fatigue, insomnia, anxiety, depression, diabetes, breathing problems, high blood pressure, heart disease, stroke and cancer) were more likely to report the lowest levels of physical activity across all five outcomes. Demographic variations were also observed. CONCLUSIONS: Targeting people with chronic mental and physical conditions has the potential to reduce the impact of physical inactivity.

Using health trainers to promote self-management of chronic pain: can it work?

BACKGROUND: In 2011, the Sheffield Primary Care Trust piloted a Health Trainer (HT) programme targeted specifically to people with chronic pain. The programme aimed to determine whether patients presenting to primary care with chronic pain would benefit from self-management support, thereby reducing the burden on primary care and secondary care services. METHODS: We conducted a formative mixed-methods evaluation of the pilot programme, focusing on four aspects of implementation: general practitioner (GP) referral to the programme, HT's ability to use cognitive behavioural (CB) approaches, short-term outcomes for clients and adequacy of resources. Qualitative data were collected via interviews with GPs, HTs and the chronic pain team; supervision sessions with HTs; and client case studies. Quantitative data were collected on satisfaction with training, HT's self-reported confidence to implement CB and clients' self-rated well-being before and after participation. RESULTS: A total of 143 clients with pain for 1 year or more were referred, exceeding the projected 90 referrals by over 50%. A total of 70% of the clients came from the most deprived areas of Sheffield, 40% were listed as permanently sick/disabled and only 20% were working. Qualitative analysis indicated that the CB training was delivered as intended. Clients reported that 75% of their goals were either achieved or partly achieved, and at follow-up 43% of them reported maintaining strategies for self-management. Financial resources were supplemented by indirect resources, including GP 'champions' with a special interest in pain, and a multidisciplinary chronic pain team. The prior history of working with community organizations was critical in ensuring credibility in client communities and addressing client needs. CONCLUSION: A HT programme promoting self-management of chronic pain can be successfully implemented when supported by community organisations. Preliminary data indicate that the programme can be instrumental in helping clients to actively participate in identifying their own problems, set achievable goals for self-management and successfully manage the challenges of everyday life. SUMMARY POINTS: Community-based Health Trainer programmes can be successfully established to promote self-management of chronic pain among clients in the deprived areas using multidisciplinary pain management teams. Utilising a community organization infrastructure that has experience of delivering successful programmes was instrumental in ensuring credibility of the initiative and access for clients. Health trainers can integrate cognitive behavioral training with their existing skills to work with clients who have chronic pain.

Sheffield spinal pathway audit cycle - pathways, mountains and the view from the top.

There is good evidence to suggest that a proactive stratified approach to management of spinal pain, taking into account psychosocial as well as biological factors, can realise significant savings for health-care systems and perhaps more importantly, health benefits for society at large. This audit cycle report captures data on quality of care and patient flows before and after the mandating of changes to the referral pathways in primary care. These included the introduction of a simple one-sided referral proforma, bounce back of inappropriate referrals from secondary care to physiotherapy lead teams and implementation of the STarT tool, as a decision aid in primary care.