Person-centred care in osteoarthritis and inflammatory arthritis: a scoping review of people's needs outside of healthcare.

BACKGROUND: Arthritis, regardless of cause, has significant physical, social and psychological impacts on patients. We aimed to identify the non-healthcare needs perceived by patients with inflammatory arthritis (IA) and osteoarthritis (OA), and to determine if these differ. METHODS: We electronically searched MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2020) systematically to identify non-healthcare-related needs of people with IA or OA. All citations were screened and quality appraised by two reviewers. Data was extracted by a single reviewer. RESULTS: The search identified 7853 citations, with 31 studies included (12 for OA, 20 for IA). Six areas of need emerged and these were similar in both group These were: 1) Assistance with activities of daily living especially related to a lack of independence; 2) Social connectedness: need for social participation; 3) Financial security: worry about financial security and increased costs of health-seeking behaviours; 4) Occupational needs: desire to continue work for financial and social reasons, facilitated by flexibility of workplace conditions/environment; 5) Exercise and leisure: including limitation due to pain; 6) Transportation: limitations in ability to drive and take public transport due to mobility concerns. Many areas of need were linked; e.g. loss of employment and requiring support from family was associated with a sense of "failure" and loss of identity, as social isolation. CONCLUSIONS: This review highlights the pervasive impact of arthritis on peoples' lives, regardless of aetiology, albeit with a limited evidence base. Improved identification and targeting of non-healthcare needs of people with arthritis is likely to improve person-centred care.

People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review.

QUESTION: What health information needs are perceived by people with low back pain? DESIGN: Systematic review of publications examining perceived health information needs related to low back pain identified through Medline, EMBASE, CINAHL and PsycINFO (1990 to 2018). PARTICIPANTS: Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS: Two reviewers independently extracted descriptive data regarding study design and methodology, and assessed risk of bias. Aggregated findings of the perceived needs of people with low back pain regarding health information were meta-synthesised. RESULTS: Forty-one studies (34 qualitative, four quantitative and three mixed-methods) were identified. Two major areas of perceived health information needs for low back pain emerged. The first major area was needs related to information content: general information related to low back pain, its cause and underlying pathology; strong desire for diagnosis and imaging; prognosis, future disability and effect on work capacity; precipitants and management of flares; general management approaches; self-management strategies; prevention; and support services. The second major area of needs related to how the information was delivered. People with low back pain wanted clear, consistent information delivered in suitable tone and understandable language. CONCLUSION: Available data suggest that the information needs of people with low back pain are centred around their desire for a diagnosis, potentially contributing to expectations for and overuse of imaging. People with low back pain expressed a strong desire for clear, consistent and personalised information on prognosis, treatment options and self-management strategies, related to healthcare and occupational issues. To correct unhelpful beliefs and optimise delivery of evidence-based therapy, patient and healthcare professional education (potentially by an integrated public health approach) may be warranted.

Patients' perceived health information needs in inflammatory arthritis: A systematic review.

OBJECTIVES: To identify the breadth of the literature regarding patients' perceived health information needs related to inflammatory arthritis care. METHODS: A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO was performed to identify relevant articles (1990 -2016) examining patients' perceived needs relating to health information in inflammatory arthritis. Data and themes were identified and categorised and risk of bias assessed. RESULTS: Twenty nine studies (11 quantitative, 14 qualitative and 4 mixed methods) from 4121 identified articles were relevant for inclusion. Most focussed on rheumatoid arthritis. Key findings included: (1) Reasons for seeking health information often focussed on gaining ownership over their condition and facilitating self-management. (2) Demographic differences in information needs were inconsistent, but women and younger patients generally reported more needs. (3) Desired information content was broad, and included targeted and practical information covering disease treatment and psychosocial wellbeing. (4) Preferred information delivery method was consultation with a Rheumatologist; however group sessions had advantages for psychosocial issues while written information provided useful supplementation. (5) Barriers to meeting health information needs were around timely access. CONCLUSIONS: Patients with inflammatory arthritis have high information needs, desiring practical and individualised information. When developing strategies to meet patients' information needs, aligning patient expectations with delivery methods that are accessible, cost-effective and flexible may help to optimize patient outcomes.

Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review.

BACKGROUND: Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis. OBJECTIVES: To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis. METHODS: A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically. RESULTS: In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. CONCLUSIONS: This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes.

Patients' perceived needs for medical services for non-specific low back pain: A systematic scoping review.

BACKGROUND: An improved understanding of patients' perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients' perceived needs for medical services for LBP. METHODS: A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs for medical services for LBP were categorised. RESULTS: 50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients' preferences for medications. (3) Of the few studies which examined the patients' perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms. CONCLUSIONS: Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.

Patients' perceived needs of osteoarthritis health information: A systematic scoping review.

BACKGROUND: Optimal management of osteoarthritis requires active patient participation. Understanding patients' perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients' perceived health information needs for OA. METHODS: A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoarthritis health information were categorized. RESULTS: 30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention. CONCLUSIONS: Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes.

Patients' perceived needs of health care providers for low back pain management: a systematic scoping review.

BACKGROUND CONTEXT: Optimal management of low back pain (LBP) involves patients' active participation in care, facilitated by positive interactions with their health care provider(s) (HCP). An understanding of patients' perceived needs regarding their HCP is, therefore, necessary to achieve such outcomes. Therefore, the aim of the present study is to review the existing literature regarding patients' perceived needs of HCP managing LBP. METHODS: A systematic scoping review of publications in MEDLINE, EMBASE, CINAHL, and PsycINFO (1990-2016) was performed. Descriptive data regarding study design and methodology were extracted, and risk of bias was assessed. Aggregates of patients' perceived needs of HCP for LBP were categorized. RESULTS: Forty-three studies (30 qualitative, 12 quantitative, and 1 mixed methods) from 1,829 were relevant. Four areas of perceived need emerged: (1) there are several characteristics of HCP that patients desire, such as good communication and shared decision-making; (2) patients wanted HCP to provide information, including a cause of their LBP and legitimization of their symptoms; (3) patients' valued holistic, individualized care, and continuity of care; and (4) patients perceived long waiting times, difficulties with access to treatment, cost, and personal effort to be obstacles to care. CONCLUSIONS: Patients with LBP want patient-centered care, to be actively involved, and they have identified characteristics of HCP that foster a good provider-patient relationship. They noted areas of dissatisfaction with HCP and perceived obstacles to care. Given limited health care resources, HCP and policy makers need to implement novel methods of health care delivery that address these issues to facilitate improved patient satisfaction and achieve better patient and health system outcomes.

People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review.

QUESTION: What needs of non-biomedical services are perceived by people with low back pain? DESIGN: Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016). PARTICIPANTS: Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS: Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. RESULTS: Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. CONCLUSION: People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE (2018) People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review. Journal of Physiotherapy 64: 74-83].

Considerations of "Combined Probability of Injury" in the next-generation USA frontal NCAP.

OBJECTIVE: The numerical basis for assigning star ratings in the next-generation USA New Car Assessment Program (NCAP) for frontal impacts was assessed. That basis, the Combined Probability of Injury, or CPI, is the probability of an occupant sustaining an injury to any of the specified body regions. For an NCAP test, a CPI value is computed by (a) using risk curves to convert body-region responses from a test dummy into body-region risks and (b) using a theoretical, overarching CPI equation to convert those separate body-region risks into a single CPI value. Though the general concept of applying a CPI equation to assign star ratings has existed since 1994, there will be numerous changes to the 2011 frontal NCAP: there will be two additional body regions (n = 4 vs. 2), the injury probabilities will be evaluated for lower-severity (more likely) injury levels, and some of the occupant responses will change. These changes could yield more disperse CPIs that could yield more disperse ratings. However, the reasons for this increased dispersion should be consistent with real-world findings. Related assessments were the topic of this two-part study, focused on drivers. METHODS: In Part 1, the CPI equation was assessed without applying risk curves. Specifically, field injury probabilities for the four body regions were used as inputs to the CPI equation, and the resulting equation-produced CPIs were compared with the field CPIs. In Part 2, subject to analyses of test dummy responses from recent NCAP tests, the effect of risk curve choice on CPIs was assessed. Specifically, dispersion statistics were compared for CPIs based on various underlying risk curves applied to data from 2001-2005 model year vehicles (n = 183). RESULTS AND CONCLUSIONS: From Part 1, the theoretical CPI equation for four body regions demonstrated acceptable fidelity when provided field injury rates (R(2)= 0.92), with the equation-based CPIs being approximately 12 percent lower than those of ideal correlation. From Part 2, the 2011 NCAP protocol (i.e., application of a four-body-region CPI equation whose inputs were from risk curves) generally increased both the CPIs and their dispersion relative to the current NCAP protocol. However, the CPIs generally increased due to an emphasis on neck injury-an emphasis not observed in real-world crashes. Subject to alternative risk curves for the neck and chest, again there was increased dispersion of the CPIs, but the unrealistic emphasis on the neck was eliminated. However, risk estimates for the knee/thigh/hip (KTH) for NCAP-type events remained understated and did not fall within the confidence bands of the field data. Accordingly, KTH risk estimation is an area for future research.

Derivation and theoretical assessment of a set of biomechanics-based, AIS2+ risk equations for the knee-thigh-hip complex.

A set of risk equations was derived to estimate the probability of sustaining a moderate-to-serious injury to the knee-thigh-hip complex (KTH) in a frontal crash. The study consisted of four parts. First, data pertaining to knee-loaded, whole-body, post-mortem human subjects (PMHS) were collected from the literature, and the attendant response data (e.g., axial compressive load applied to the knee) were normalized to those of a mid-sized male. Second, numerous statistical analyses and mathematical constructs were used to derive the set of risk equations for adults of various ages and genders. Third, field data from the National Automotive Sampling System (NASS) were analyzed for subsequent comparison purposes. Fourth, the fidelity of the resulting set of risk equations was assessed by using the risk equations to transform the axial compressive femur loads from simulated, full-engagement, frontal crashes into event risks, and the resulting model-based injury rates were compared with the field-based injury rates. The results were promising: For unbelted drivers in towaway frontal crashes involving 1985-1997 model year passenger cars whose speed changes were less that 58 km/h, the model-based average injury rate was 1.10%; the field-based rate was 1.30%. Moreover, some of the trends in the field were confirmed with the model (e.g., there were more KTH-injured males than KTH-injured females). The risk equations demonstrated better fidelity for lower-speed crashes than high-speed crashes.

A Theoretical Math Model for Projecting AIS3+ Thoracic Injury for Belted Occupants in Frontal Impact.

A theoretical math model was created to assess the net effect of aging populations versus evolving system designs from the standpoint of thoracic injury potential. The model was used to project the next twenty-five years of thoracic injuries in Canada. The choice of Canada was topical because rulemaking for CMVSS 208 has been proposed recently. The study was limited to properly-belted, front-outboard, adult occupants in 11-1 o'clock frontal crashes. Moreover, only AIS3+ thoracic injury potential was considered. The research consisted of four steps. First, sub-models were developed and integrated. The sub-models were made for numerous real-world effects including population growth, crash involvement, fleet penetration of various systems (via system introduction, vehicle production, and vehicle attrition), and attendant injury risk estimation. Second, existing NASS data were used to estimate the number of AIS3+ chest-injured drivers in Canada in 2001. This served as data for model validation. Third, the projection model was correlated favorably with the 2001 field estimate. Finally, for the scenario that 2004-2030 model-year systems would perform like 2000-2003 model-year systems, a projection was made to estimate the long-term effect of eliminating designs that would not comply with the proposed CMVSS 208. The 2006-2030-projection result for this scenario: 764 occupants would benefit from the proposed regulation. This projection was considered to be conservative because future innovation was not considered, and, to date, the fleet's average chest deflections have been decreasing. The model also predicted that, through 2016, the effect of improving system performance would be more influential than the population-aging effect; thereafter, the population-aging effect would somewhat counteract the effect of improving system performance. This theoretical math model can provide insights for both designers and rule makers.