Patient Self-management Education Research Articles

A mobile serious game about diabetes self-management: Design and evaluation

Type 2 Diabetes Mellitus (T2DM) is a chronic condition that requires ongoing self-management and education. In recent years, there has been a growing interest in utilizing mobile serious games as a tool for patient education and engagement. This article presents the development of DiaPo, a mobile serious game designed to improve self-management education for patients with T2DM. DiaPo integrates gamification techniques to increase patient engagement and motivation while providing essential information about disease management. The development of DiaPo followed a structured design process, utilizing the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) educational system. This systematic approach allowed for the integration of best practices in educational game design and diabetes care. The development team consisted of experts in medical informatics, game design, and diabetes care, ensuring a multidisciplinary approach to the game's creation. The game's narrative focuses on a T2DM patient who earns positive points for making healthy lifestyle choices and negative points for poor ones. This gamified approach aims to reinforce positive behaviors and provide immediate feedback on negative ones. Interactive animations confirm or deny options selected by the player, further enhancing the learning experience. DiaPo offers a flexible and adaptable platform suitable for diverse audiences, promoting inclusiveness and accessibility in T2DM education. DiaPo represents a novel approach to self-management education for patients with T2DM, utilizing gamification techniques and a multidisciplinary design process to create an engaging and informative mobile serious game. By promoting inclusiveness and accessibility, DiaPo has the potential to empower patients with T2DM to take an active role in their disease management. As the field of mobile serious games continues to evolve, DiaPo stands as a promising tool for improving T2DM education and patient outcomes.

Health literacy and diabetes information preferences among Chinese immigrants: An Australian cross-sectional study.

Explore Australian-Chinese immigrants' health literacy and preferences and engagement with translated diabetes self-management patient education materials. The cross-sectional survey was conducted with Australian-Chinese immigrants at risk or with type 2 diabetes recruited via health services, and diabetes and community organisations. The survey had three parts: (1) diabetes screening; (2) sociodemographic information, clinical characteristics and preferences for translated materials; and (3) Functional, Communicative and Critical Health Literacy (FCCHL) Scale. Of 381 participants, 54.3% reported diabetes (n = 207), the remainder pre-diabetes or at risk (45.7%, n = 174); 34.1% male; mean age 64.1 years. Average total health literacy (FCCHL) scores were 35.3/56 (SD = 8.7). Participants with greater English proficiency reported higher health literacy (p < 0.001). This pattern also existed for functional (p < 0.001), communicative (p = 0.007) and critical (p = 0.041) health literacy subdomains. Health literacy scores did not differ significantly based on years of residence in Australia (all p > 0.05). Although the majority of participants (75.6%, N = 288) were willing to receive translated diabetes information, only a small proportion (19.7%, N = 75) reporting receiving such materials. There is a clear need for co-designed diabetes patient education materials that meet the needs and adequately reach Australian-Chinese immigrants. In particular, these materials must support people with limited English-language proficiency. This study highlights important considerations for nurses seeking to improve diabetes care for Chinese immigrants when incorporating patient education materials as part of their nursing education.

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts.

Osteoarthritis (OA) stands as a prevalent and progressively debilitating clinical condition globally, impacting joint structures and leading to their gradual deterioration through inflammatory mechanisms. While both non-modifiable and modifiable factors contribute to its onset, numerous aspects of OA pathophysiology remain elusive despite considerable research strides. Presently, diagnosis heavily relies on clinician expertise and meticulous differential diagnosis to exclude other joint-affecting conditions. Therapeutic approaches for OA predominantly focus on patient education for self-management alongside tailored exercise regimens, often complemented by various pharmacological interventions primarily targeting pain alleviation. However, pharmacological treatments typically exhibit short-term efficacy and local and/or systemic side effects, with prosthetic surgery being the ultimate resolution in severe cases. Thus, exploring the potential integration or substitution of conventional drug therapies with natural compounds and extracts emerges as a promising frontier in enhancing OA management. These alternatives offer improved safety profiles and possess the potential to target specific dysregulated pathways implicated in OA pathogenesis, thereby presenting a holistic approach to address the condition's complexities.

Policies in Canada fail to address disparities in access to person-centred osteoarthritis care: a content analysis

BackgroundWomen are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women.MethodsWe used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack’s six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women.ResultsWe included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups.ConclusionsCanadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.

Age at onset of type 1 diabetes between puberty and 30 years old is associated with increased diabetic nephropathy risk

Diabetic nephropathy is a critical complication of patients with type 1 diabetes, while epidemiological studies were scarce among Asian countries. We conducted a cross-sectional study to identify factors associated with diabetic nephropathy by questionnaires, using student’s t-test, chi-square test, and multivariable logistic regression. Among 898 participants, 16.7% had diabetic nephropathy. Compared with non-diabetic nephropathy patients, the patients with diabetic nephropathy had significantly higher percentage with onset age of type 1 diabetes between puberty and under 30 years old (female ≥ 12 or male ≥ 13 years old to 29 years old), longer diabetes duration, having family history of diabetes and diabetic nephropathy, accompanied with hypertension, hyperlipidemia, or coronary artery disease (CAD). Compared with patients with onset age before puberty, the odds of diabetic nephropathy occurrence increased to 1.61 times in patients with onset age between puberty and under 30 years old (p = 0.012) after adjusting diabetes duration. Age of diabetes onset between puberty and under 30 years old, diabetes duration, HbA1c, hospital admission within 3 years, diabetic retinopathy, hypertension, systolic blood pressure (SBP), triglyceride levels, and use of angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin receptor blockers (ARB) were independent factors associated with diabetic nephropathy Screening for proteinuria is important in daily clinical practice and should be part of diabetes self-management education for patients with type 1 diabetes.

The effect of health coaching on blood pressure control and disease self-management among patients in rural area in China: a randomized controlled trial.

The self-management education for patients with hypertension has not been widely provided in rural areas of China. Our study aimed to examine the effect of health coaching intervention on controlling BP and improving self-management skills among rural resident of ≤6 month-history of hypertension. A total of 102 participants were enrolled in the RCT. The control group received usual health guidance and follow-up management; the experimental group received health coaching and follow up management. The primary outcomes were the difference in changes of BP and mean self-management scores. The secondary outcomes included waist circumference, body mass index (BMI), and medication literacy. Participants in the experimental group showed a significantly greater improvement with respect to systolic BP and diastolic BP respectively (133.85 ± 4.74 mmHg vs 127.96 ± 5.42 mmHg;80.94 ± 5.52 mmHg vs 77.37 ± 4.44 mmHg, P < 0.05) and BMI (24.66 ± 2.19 kg/m2 vs 23.44 ± 2.05 kg/m2, P < 0.05) compared with the control group. A significant difference was also observed between the experimental and control groups in terms of self-management and medication literacy at both 3 and 6 months (P < 0.05). However, there was no significant difference in changes of waist circumferences between the two groups (22.6% vs 38.8%). In conclusion, for patients with diagnosed with hypertension within the last 6 months, health coaching maybe is an effective approach to control blood pressure and improve medication literacy and self-management skills.

An Epidemiological Study on Diabetes and Pre-Diabetes in an Urban Area with Reference to Lifestyle Modification

Diabetes mellitus (DM) is one of the most common non-communicable diseases (NCDs) globally. It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is an epidemic in newly industrialized and many economically developing countries. Diabetes mellitus is a chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Genetic factors are responsible for at least some of this. However, as evidenced by the increased incidence of diabetes mellitus in urban populations, the fast epidemiological shift linked to food pattern alterations and decreased physical activity is the main cause of the diabetes mellitus epidemic. Due to population aging, growth, urbanization, a lack of physical exercise, and a high incidence of obesity, there are more persons with DM. Lifestyle factors include eating patterns, exercise routines, alcohol consumption, and smoking. An improvement in these parameters would lead to better adherence to hypoglycemic medications. An epidemiological study on diabetes and pre-diabetes in an urban area with reference to lifestyle modification. A community-based intervention study. It was conducted in an urban area. Personal interviews using a semi-structured, pretested questionnaire were the main technique of data gathering. Detailed information has been taken on the demographic and socio-economic characteristics at both the individual and household levels. All responders provided their willingly given consent. Every second household was visited by systematic random sampling procedure to select 400 respondents. Due to non-response, inaccuracy and/or unreliability of information 50 Cases were not included in the analysis. Four more instances of diabetes were also removed from the research. Finally, analysis was carried out on 346 respondents. All respondents were questioned using a pretested, semi-structured questionnaire after giving their informed consent. Significant difference was observed with positive family history of diabetes, obesity, physical activities in male, high calorie intake, stress, chewable tobacco and blood pressure level with pre-diabetes and diabetes. Compared to responders with normal blood glucose levels, pre-diabetics and diabetics showed more positive family histories. Compared to responders with normal blood glucose levels, pre-diabetics and diabetics were more likely to be overweight. With regard to personal habits of the respondents, smoking was associated with more than 1-fold increase risk of obtaining serum glucose level &gt;110 mg/dl as compared to nonsmokers. The current research was an attempt to examine the effect of intervention with reference to life style modification. From the study, it is evident that overall awareness about diabetes has been found low and no awareness has been found about pre-diabetes. The present study also demonstrated that education is the fundamental tool to make the population aware of their health issues. Awareness about pre-diabetes and diabetes, which can make them beneficial for community and nation and so, they can play an innovative role for prevention of diabetes.

Non-pharmacological interventions for patients with psoriasis: a scoping review

ObjectivesHealthcare ultimately aims to eradicate diseases and restore normality to people’s lives. However, until this is achieved for every person, there is a need to support and assist patients with...

Systematic Review of the Frequency of Registered Dietitian-Nutritionist Intervention in the Primary Care Setting for Diabetes Self-Management Education for Patients with Type II Diabetes.

The purpose of this systematic review is to discuss the ideal frequency of Registered Dietitian-Nutritionist (RDN) contact required to improve glycemic control in patients with type 2 diabetes in the primary care setting. Researchers completed a literature search between April 1 and June 30, 2020. Researchers identified 184 studies and included seven studies for full-text analysis. Eligible studies were required to occur in a primary care setting, use A1C as an outcome measure, and use some form of education or contact with an RDN. Study quality was assessed using the NIH Study Quality Assessment Tool. Compared to the usual care group of each study, increased contact with an RDN improved A1C lowering regardless of frequency (round-the-clock, monthly, biannually). The largest decreases occurred in the round-the-clockand quarterly touch groups. Studies varied in modality (inperson, telehealth, etc.) and type of intervention. The participants had A1Cs between 8.07% and 10.25% before intervention. With RDN contact of any frequency between provider visits and participants saw A1Cs decreased between 0.66% and 2.2%. Greater glycemic control in patients with type 2 diabetes in the primary care environment is linked to more frequent RDN contact than that advised by the American Diabetes Association Standards of Care.

Promoting Diabetes Self-Management in a Psychiatric Hospital.

Type 2 diabetes and psychiatric illnesses have a bidirectional association, influencing each other in direct but independent ways. People with psychiatric illnesses are more likely than the general population to develop type 2 diabetes, in part because antipsychotic medications affect the metabolic system, disrupting glucose metabolism, and also because they lack diabetes self-management education and self-care skills. This study assessed the effectiveness of diabetes self-management education and support (DSMES) in patients with mental illness and diabetes using the Diabetes Self-Management Questionnaire. Analysis of paired responses to the pre- and post-DSMES survey questions showed a statistically significant increase in diabetes self-management knowledge after participation in the education sessions. These results emphasized the importance of DSMES in strengthening patients' knowledge and skills, with additional support from their psychiatrist and medical team.

COPD - An Underestimated Disease

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice.

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review.

Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.

Ethical Analysis of Diabetes Self-management Education: Review on Indonesian Healthcare Services

Self-management is a crucial part of diabetes treatment to prevent short-term and longterm complications. Self-management education sometimes raises some ethical issues. This paper aims to discuss the ethical issues arising from diabetes self-management education practice. We discuss the ethical issues based on case study of patient self-management education in a public health centre (PHC) outpatient department in Malang City, Indonesia. We observed the patients’ education practices and conducted interviews randomly with diabetes patients who visited PHC for their treatment. Findings showed that the central theme of ethical issues arising from the movement toward patient self-management must be raised: preparation, empowerment, predominant assumption of self-management, and lack of standards for patient selection. Putting patient education in its rightful place and respecting patient preferences’ was one way to reduce the risk of ethical dilemmas arising from self-management.&#x0D; Keywords: diabetes self-management, patient education, ethical issues reviews

“You have to believe the patient”: What do people with fibromyalgia find helpful (and hindering) when accessing health care?

ABSTRACT Background Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care. Aims This study investigated the research question, “What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?” with the aim of identifying clear, implementable changes for clinical practice. Materials and methods This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM. Results Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician–patient alliance, including invalidation and prejudice; therapeutic bond; and clinician–patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem. Conclusions Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician–patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.

COPD : a still neglected condition

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disorder with a complex clinical picture. The diagnosis may be difficult at times, as COPD may develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in early detection of disease. Suspected COPD may be confirmed by further investigations in collaboration with a pulmonologist. The most recent GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. General practitioners are crucial for implementing non-pharmacological measures such as smoking cessation, regular exercise, vaccinations, and patient self-management education. However, this also underlines the challenges to implement the GOLD recommendations in daily practice.

Exploring Brachytherapy Discharge Educational Needs of Gynecological Cancer Patients.

Brachytherapy (BT) plays a fundamental role in the treatment of gynecological cancers. Patient education for vaginal self-management and dilator use post-BT involves an interdisciplinary team of healthcare professionals (HCPs) and there is a paucity of post-BT education guidelines. Our objective was to determine the educational needs of gynecological cancer patients surrounding vaginal self-management post-BT and to determine enablers and barriers to the provision of education by HCPs. This cross-sectional study recruited gynecological oncology patients receiving external beam radiotherapy and BT for curative intent. Patients completed a questionnaire to assess their vaginal self-management educational needs, preferred education modality, and desired timing of post-BT education. HCPs were invited to complete a questionnaire to identify enablers and barriers to providing BT education. Twenty patients and 53 HCPs participated. All patients rated each topic as very important/important with information about preventing vaginal stenosis as the most important overall (89%). When asked about topics they addressed during BT education, most HCPs reported that "explaining what vaginal stenosis is and the negative effects of stenosis" was always discussed with patients (N = 37/49, 77%). Barriers to providing post-BT education, including the patients' language and culture, as well as enablers, such as the use of written resources and tools for patients, were identified. Despite a high level of engagement, current education surrounding vaginal self-management post-BT may be inadequate.

Impact of diabetes self-management education in middleaged patients with type 2 diabetes mellitus: A systematic review

Introduction: Diabetes Mellitus (DM) disease, if not treated properly, will cause various complications. Entering the age of 40 years and above, patients with DM disease begin to show progress toward the occurrence of complications. Hence, DM patients need to know about the appropriate self-management of diabetes through diabetes self-management education (DSME). This systematic review aimed to identify the effectiveness of diabetes self-management education in middle-aged patients (40-64 years) with type 2 DM.

Relationship between Self-Care Behavior and Diabetes Self-Management Education in Patients with Diabetes Mellitus Type 2

Diabetes mellitus type 2 is a disease caused by disruption of insulin secretion and insulin resistance. One aspect that plays an important role in the management of this disease is diabetes self-management education. Good self-care behavior will make diabetes management controlled and prevent complications and make the quality of life better. The purpose of this study is to determine the effect of self-care behavior and the magnitude of the influence of knowledge, patient motivation, family support, and self-efficacy on diabetes self-management education for type 2 diabetes mellitus patients. The method used in this study was a quantitative approach using cross-sectional methods. The sample used was 115 patients with type 2 diabetes mellitus in Palopo Regency. The analytical method used is the Structural Equation Model (SEM) using Amos 2.0 and SPSS 20 (IBM Corp). The findings of the study showed that self-care behavior in patients with diabetes mellitus of type 2 was influenced by knowledge factors by 89%, motivation factors by 82.8%, family support by 84.9%, and self-efficacy factors by 78.4%. Meanwhile, diabetes management of type 2 diabetes mellitus patients was influenced by treatment factors by 75.5%, blood sugar control factors by 88.1%, dietary factors by 60.9%, physical activity factors by 87.3%, and foot care factors 53. , 8%. The structural model of this study explains the variable care cell behavior with self-care management of 47.5%. Therefore, the management of diabetes mellitus must be more active in providing education to sufferers so that their knowledge or family members can increase and understand how to carry out diabetic management properly.

Using Normalisation Process Theory (NPT) to develop an intervention to improve referral and uptake rates for self-management education for patients with type 2 diabetes in UK primary care

BackgroundReferral and uptake rates of structured self-management education (SSME) for Type 2 diabetes (T2DM) in the UK are variable and relatively low. Research has documented contributing factors at patient, practitioner and organisational levels. We report a project to develop an intervention to improve referral to and uptake of SSME, involving an integrative synthesis of existing datasets and stakeholder consultation and using Normalisation Process Theory (NPT) as a flexible framework to inform the development process.MethodsA three-phase mixed-methods development process involved: (1) synthesis of existing evidence; (2) stakeholder consultation; and (3) intervention design. The first phase included a secondary analysis of data from existing studies of T2DM SSME programmes and a systematic review of the literature on application of NPT in primary care. Influences on referral and uptake of diabetes SSME were identified, along with insights into implementation processes, using NPT constructs to inform analysis. This gave rise to desirable attributes for an intervention to improve uptake of SSME. The second phase involved engaging with stakeholders to prioritise and then rank these attributes, and develop a list of associated resources needed for delivery. The third phase addressed intervention design. It involved translating the ranked attributes into essential components of a complex intervention, and then further refinement of components and associated resources.ResultsIn phase 1, synthesised analysis of 64 transcripts and 23 articles generated a longlist of 46 attributes of an embedded SSME, mapped into four overarching domains: valued, integrated, permeable and effectively delivered. Stakeholder engagement in phase 2 progressed this to a priority ranked list of 11. In phase 3, four essential components attending to the prioritised attributes and forming the basis of the intervention were identified: 1) a clear marketing strategy for SSME; 2) a user friendly and effective referral pathway; 3) new/amended professional roles; and 4) a toolkit of resources.ConclusionsNPT provides a flexible framework for synthesising evidence for the purpose of developing a complex intervention designed to increase and reduce variation in uptake to SSME programmes in primary care settings.

Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial

Background/objectivesThe aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. MethodsA total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. ResultsCompared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. ConclusionsThis RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. Trial registration numberNCT04571528.