Physiotherapy - Research Publications
Permanent URI for this collection
Search Results
1 - 10 of 17
-
ItemNo Preview AvailableExploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study(JMIR PUBLICATIONS, INC, 2019-12-03)BACKGROUND: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. OBJECTIVE: The objective of this study was to investigate health care- and health information-seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. METHODS: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care- and health information-seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. RESULTS: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care- and health information-seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. CONCLUSIONS: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups.
-
ItemA Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel(JMIR PUBLICATIONS, INC, 2019-10-18)BACKGROUND: Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. OBJECTIVE: The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. METHODS: The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. RESULTS: The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. CONCLUSIONS: This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
-
ItemRole of Hip Injury and Giving Way in Pain Exacerbation in Hip Osteoarthritis: An Internet-Based Case-Crossover Study(WILEY, 2019-06)OBJECTIVE: To evaluate the association between hip injury/giving way and hip pain exacerbations in patients with symptomatic hip osteoarthritis (OA). METHODS: We conducted an internet-based case-crossover study to assess hip injury and giving way for hip pain exacerbation. Eligible participants with symptomatic hip OA were followed up for 90 days and asked to complete online questionnaires at baseline and 10-day intervals (control periods). They also logged on to the study web site to complete questionnaires for an episode of a hip pain exacerbation (case periods) defined as an increase of 2 points in pain intensity compared with the baseline rating on a numeric rating scale (range 0-10). The relationship of hip injury and giving way to the risk of pain exacerbation was examined using conditional logistic regression. RESULTS: Of 252 patients recruited into the study, we included 133 patients (53%) who provided data from both case and control periods. Hip injury during the last 7 days increased the risk of hip pain exacerbation (odds ratio [OR] 2.74 [95% confidence interval (95% CI) 1.62-4.62]). The hip giving way during the last 2 days was associated with an increased risk of hip pain exacerbation (OR 2.10 [95% CI 1.30-3.39]) and showed a significant relationship between the number of hip giving way events and the risk of hip pain exacerbations (P < 0.001). CONCLUSION: Hip injury and episodes of the hip giving way were significantly related to pain exacerbation in patients with symptomatic hip OA. Methods to prevent exposure to injury may help to reduce the burden of pain in patients with hip OA.
-
ItemImplementation of person-centred practice principles and behaviour change techniques after a 2-day training workshop: A nested case study involving physiotherapists(WILEY, 2019-06)OBJECTIVES: The aims of the present study were to determine how well physiotherapists implemented person-centred practice principles and behaviour change techniques after a workshop, and to evaluate whether self-audit of performance differed from audits of an experienced training facilitator. METHODS: Eight physiotherapists each completed a 2-day workshop followed by two telephone consultations with four patients with knee osteoarthritis. The training facilitator audited audio-recordings of all consultations, and therapists self-audited 50% of consultations using a tool comprising: (a) 10 person-centred practice principles rated on a numerical rating scale of 0 (need to work on this) to 10 (doing really well); and (b) seven behaviour change techniques rated with an ordinal scale (using this technique effectively; need to improve skill level; or need to learn how to apply this technique). RESULTS: Physiotherapists showed "moderate" fidelity to person-centred principles, with mean scores between 5 and 7 out of 10. For behaviour change techniques, the training facilitator believed that physiotherapists were using three of seven techniques "effectively" during most consultations and "needed to improve skill levels" with most other techniques. Physiotherapists scored themselves significantly lower than the training facilitator for two of 10 person-centred principles, and tended to rate their skills using behaviour change techniques less favourably. CONCLUSIONS: Physiotherapists performed moderately well when implementing person-centred practice principles and behaviour change techniques immediately after training, but had room for improvement, particularly for skills relating to providing management options and changing thinking habits. Physiotherapists' self-ratings of performance generally did not differ from expert ratings; however, they underestimated their ability to implement some principles and techniques.
-
ItemA qualitative study exploring the views of individuals with knee osteoarthritis on the role of physiotherapists in weight management: A complex issue requiring a sophisticated skill set(WILEY, 2019-06)OBJECTIVES: The aim of the present study was to explore the attitudes of individuals with knee osteoarthritis (OA) towards the role of physiotherapists in weight management in knee OA. METHODS: The study took the form of a qualitative semi-structured telephone interview study. Participants included 13 purposively sampled individuals with symptomatic knee OA who were overweight or obese by body mass index. Each participated in a semi-structured telephone interview exploring their perspectives regarding the potential role of physiotherapists in weight management in knee OA. Data were transcribed and analysed using a thematic approach. RESULTS: Three main themes were identified, which highlighted that individuals with knee OA: (a) recognize that weight management is complex; (b) consider that a special skill set is required by clinicians for weight management; and (c) expressed ambivalence towards physiotherapists' role in weight management, with a focus on the role of exercise prescription. CONCLUSIONS: Although participants were open to physiotherapists taking on a weight management role within a multidisciplinary team, they were uncertain about whether physiotherapists had the skills and scope of practice needed to address this complex issue. The findings highlight the importance of engagement by physiotherapists in meaningful dialogue with patients, to understand better their experiences, expectations and preferences, and establish if, when and how to integrate patients in weight management discussions in the treatment plan for their knee OA.
-
ItemHow do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed-methods study(WILEY, 2019-03)BACKGROUND: Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA. METHODS: We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semi-structured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically. RESULTS: There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness. CONCLUSIONS: UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss. However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.
-
Item"I Was Really Pleasantly Surprised": Firsthand Experience and Shifts in Physical Therapist Perceptions of Telephone-Delivered Exercise Therapy for Knee Osteoarthritis-A Qualitative Study(WILEY, 2019-04)OBJECTIVE: To explore physiotherapists' perceptions before and after delivering exercise advice via telephone to patients with knee osteoarthritis (OA). METHODS: We performed a descriptive qualitative study (based on interpretivist methodology) embedded within a randomized controlled trial. Before and after providing exercise therapy to patients with knee OA, all 8 physiotherapists who were involved in the trial participated in semi-structured interviews via telephone. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. RESULTS: Prior to delivering the intervention, physiotherapists thought that the telephone should be used only for follow-up rather than as the primary mode of providing care. They believed that telephone-delivered care would be convenient and cost-saving for patients, would provide increased opportunity for patient education, and also increase access to services, but that the lack of visual and physical contact with patients would be problematic. After delivering the intervention, physiotherapists reflected that telephone-delivered care exceeded their expectations, noting positive patient outcomes including improved pain, function, and confidence. The focus on communication allowed more personal conversations with patients and shifted patient expectations of care away from manual therapies and toward self-management. Numerous implementation considerations were identified, including the need for clinician training in communication skills, written resources for patients to supplement telephone calls, and careful deliberation of how to schedule telephone consultations during the usual in-person consultations in the clinic. CONCLUSION: Although physiotherapists were initially skeptical about the effectiveness of telephone-delivered service models to patients with knee OA, perceptions shifted once they experienced delivery of care via this nontraditional method. Our findings suggest that firsthand experience may be necessary for physiotherapists to embrace new models of service delivery.
-
ItemMyBackPain - evaluation of an innovative consumer-focused website for low back pain: study protocol for a randomised controlled trial(BMJ PUBLISHING GROUP, 2019-05)INTRODUCTION: Despite the prevalence of low back pain (LBP) worldwide, many people with the condition do not receive evidence-based care or achieve the best possible outcomes. There is a gap in the dissemination of evidence-based information across the globe. The advent of the internet has changed the way people obtain health information. As such, trustworthy, tailored and validated LBP resources may help bridge the gap. This study aims to measure the effectiveness of a new website (MyBackPain) in improving spinal health literacy, treatment preferences and clinical outcomes for people with LBP, in comparison with other online resources. METHODS AND ANALYSIS: This online, pragmatic, randomised controlled trial will comprise 440 people with non-specific LBP of any duration. In addition to access to publicly available online information (control group), the intervention group will be given access to the MyBackPain.org.au website. Participants and research staff, including the biostatistician, will be blinded to treatment allocation. Data will be collected at baseline, 1, 3 (primary end-point), 6 and 12 months via online surveys and questionnaires. The primary outcome is spinal health literacy. Secondary outcomes include quality of treatment preferences (stated and observed) and LBP clinical outcomes (pain, disability and quality of life). Analyses will be by intention-to-treat and include outcome data on all randomised participants. Descriptive statistics will be presented for demographic and clinical characteristics. ETHICS AND DISSEMINATION: This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry and has ethical approval from the University of Queensland Human Research Ethics Committee (2017000995). Trial outcomes will be shared via national and international conference presentations and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER: ACTRN12617001292369; Pre-results.
-
ItemTibiofemoral joint structural change from 2.5 to 4.5years following ACL reconstruction with and without combined meniscal pathology(BMC, 2019-07-04)BACKGROUND: People who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk. This study aimed to investigate OA-related morphological change over 2 years in the TFJ among individuals who have undergone ACLR with or without concomitant meniscal pathology and in healthy controls. A secondary aim was to examine associations of baseline TFJ cartilage defects and bone marrow lesions (BML) scores with tibial cartilage volume change in ACLR groups. METHODS: Fifty seven ACLR participants aged 18-40 years (32 isolated ACLR, 25 combined meniscal pathology) underwent knee magnetic resonance imaging (MRI) 2.5 and 4.5 years post-surgery. Nine healthy controls underwent knee MRI at the ~ 2-year intervals. Tibial cartilage volume, TFJ cartilage defects and BMLs were assessed from MRI. RESULTS: For both ACLR groups, medial and lateral tibial cartilage volume increased over 2 years (P < 0.05). Isolated ACLR group had greater annual percentage increase in lateral tibial cartilage volume compared with controls and with the combined group (P = 0.03). Cartilage defects remained unchanged across groups. Both ACLR groups showed more lateral tibia BML regression compared with controls (P = 0.04). Baseline cartilage defects score was positively associated with cartilage volume increase at lateral tibia (P = 0.002) while baseline BMLs score was inversely related to medial tibia cartilage volume increase (P = 0.001) in the pooled ACLR group. CONCLUSIONS: Tibial cartilage hypertrophy was apparent in ACLR knees from 2.5 to 4.5 years post-surgery and was partly dependent upon meniscal status together with the nature and location of the underlying pathology at baseline. Magnitude and direction of change in joint pathologies (i.e., cartilage defects, BMLs) were less predictable and either remained stable or improved over follow-up.
-
ItemDeveloping strategic priorities in osteoarthritis research: Proceedings and recommendations arising from the 2017 Australian Osteoarthritis Summit(BMC, 2019-02-13)BACKGROUND: There is a pressing need to enhance osteoarthritis (OA) research to find ways of alleviating its enormous individual and societal impact due to the high prevalence, associated disability, and extensive costs. METHODS: Potential research priorities and initial rankings were pre-identified via surveys and the 1000Minds process by OA consumers and the research community. The OA Summit was held to decide key research priorities that match the strengths and expertise of the Australian OA research community and align with the needs of consumers. Facilitated breakout sessions were conducted to identify initiatives and strategies to advance OA research into agreed priority areas, and foster collaboration in OA research by forming research networks. RESULTS: From the pre-Summit activities, the three research priority areas identified were: treatment adherence and behaviour change, disease modification, and prevention of OA. Eighty-five Australian and international leading OA experts participated in the Summit, including specialists, allied health practitioners, researchers from all states of Australia representing both universities and medical research institutes; representatives from Arthritis Australia, health insurers; and persons living with OA. Through the presentations and discussions during the Summit, there was a broad consensus on the OA research priorities across stakeholders and how these can be supported across government, industry, service providers and consumers. CONCLUSION: The Australian OA Summit brought consumers, experts and opinion leaders together to identify OA research priorities, to enhance current research efforts by fostering collaboration that offer the greatest potential for alleviating the disease burden.