Allied health professionals' experiences and views towards improving musculoskeletal services in the UK for patients with musculoskeletal and co-existing mental health conditions: a qualitative study.

BACKGROUND: Interplay between physical and mental health (MH) is widely recognised amongst patients with Musculoskeletal and co-existing MH conditions. Evidence suggests that psychological interventions improve outcomes and satisfaction in patients with physical conditions, however current healthcare models continue to separate physical and mental health care, as health services are fragmented. If the delivery of MH support could be facilitated by Allied Health Professionals (AHPs), such as physiotherapists and occupational therapists (OTs), this could be an effective, low-cost way to achieve routine integration. This study aimed to explore the experiences of UK physiotherapists and OTs working with patients with MSK and co-existing MH conditions and to understand views on improving MSK services. METHODS: This was an exploratory-descriptive qualitative study using semi-structured interviews. Participants were recruited via social media and professional organisations using convenience sampling. Participants included registered UK physiotherapists or OTs within MSK settings who managed patients with MH conditions. Inductive thematic analysis was used, where single and double-level coding, single counting and inclusion of divergent cases were conducted to enhance methodological rigour. RESULTS: Three overarching themes were identified. Overarching theme one referred to openness to provide MH support, with scope of practice and lack of confidence as themes. Overarching theme two described challenges, incorporating mental health stigma, the clinical environment, and limited experience. The overarching theme referring to training, identified the need for further training and strategies to implement as themes. CONCLUSION: Many challenges to achieving optimal integration of physical and mental health care exist within MSK services. These challenges go beyond the need for additional training and knowledge acquisition and include departmental readiness such as funding, diary management, and supervision by senior colleagues/or psychologists. These need consideration in parallel to match the evolving needs of the MSK population.

Collaborative care model versus usual care for the management of musculoskeletal and co-existing mental health conditions: a randomised feasibility mixed-methods study.

OBJECTIVE: This study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression. DESIGN: A single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements. SETTING: An orthopaedic rehabilitation outpatient tertiary hospital. PARTICIPANTS: Adult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments. INTERVENTION: The collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager. MAIN OUTCOMES MEASURE: Feasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation. RESULTS: Of the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial. CONCLUSIONS: The trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates. TRIAL REGISTRATION NUMBER: NCT05018039.

Collaborative care model versus usual care for people with musculoskeletal conditions and co-existing anxiety and depression: protocol for a feasibility mixed-methods randomised controlled trial.

BACKGROUND: In the UK 17.8 million people have musculoskeletal pathophysiology, which becomes universal with age. Levels of discomfort and incapability correlate with symptoms of anxiety and depression. People with sufficient symptoms who seek care can benefit from collaborative diagnosis and treatment of mental and physical health organised by a case manager. This paper presents the protocol for a feasibility trial of collaborative care in an orthopaedic setting. AIMS: To determine the feasibility and acceptability of providing collaborative care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression identified on a screening tool in a physical and occupational therapy out-patient setting. METHOD: A two-arm parallel-group randomised controlled trial will recruit 40 adult out-patients with at least moderate anxiety and depression, who have been referred for physiotherapy and occupational therapy. Participants will be allocated on a 1:1 ratio to collaborative care or to usual care. Co-primary outcomes will be key feasibility indicators collected at baseline and at 6 months. A qualitative study will be conducted post-intervention to explore the acceptability and potential improvements to the collaborative care model. RESULTS: This study will investigate the use of the collaborative care model for patients with musculoskeletal and co-existing moderate or severe levels of anxiety or depression. CONCLUSIONS: The results will provide important evidence to determine a future trial.

Breathing pattern recordings using respiratory inductive plethysmography, before and after a physiotherapy breathing retraining program for asthma: A case report.

Breathing retraining (BR) improves symptoms, psychological well-being and quality of life in adults with asthma; but there remains uncertainty as to mechanism of effect. One of the intuitively logical theories is that BR works through altering breathing pattern. There is currently no evidence, however, that BR does result in measurable changes in breathing pattern. In this case report we describe the effects of physiotherapy BR on a 57-year-old female with a 10-year history of asthma. Data were collected before and after a physiotherapy BR program comprising three sessions over 18 weeks: breathing pattern (respiratory inductive plethysmography (RIP); physiology (end tidal carbon dioxide (ETCO2), heart rate, oxygen saturations, spirometric lung function); questionnaires (Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression Score, Nijmegen Questionnaire); and medication usage. After BR, the patient's symptoms improved. Her physiology was largely unchanged, although her FEV1 increased by 0.12L, peak flow by 21L/min. The patient reported using less Salbutamol, yet her asthma control improved (ACQ down 1.5). Her Nijmegen score dropped from positive to negative for hyperventilation (from 39 to 7). Her anxiety-depression levels both reduced into 'normal' ranges. The patient's expiratory time increased, with longer respiratory cycles and slower respiratory rate. No changes were seen in relative contributions of ribcage and abdomen. Controlled trials are now needed to determine the generalizability of these findings.