Self-management Advice Research Articles

A hip and knee orthopaedic specialist triage service evaluation: comparing physiotherapists and chiropractors in an NHS pathway

Background: The burden of musculoskeletal pain and disability is a global problem; reducing waiting times and improving access to care is part of the solution. The need to widen the workforce to improve access is well documented. A possible solution could be chiropractors and allied health professionals working together in a multidisciplinary environment where workforce demands are high. Aims: This service evaluation sought to assess the outcomes of two groups of healthcare professionals in managing a hip and knee orthopaedic interface caseload. The two groups were physiotherapists and chiropractors. Methods: The two groups of healthcare professionals completed an internal competency programme based on national standards. They were evaluated based on outcomes from an interface service as part of a commissioned NHS pathway in a university setting for hip and knee complaints. A total of 810 contacts were achieved over a 7-month period in 2023. Findings: The two groups were comparable in the rate of imaging ordered (MRI, ultrasound and X-ray); while chiropractors ordered less Magnetic resonance imaging (MRI) and offered more self-management advice, the overall results were similar. NHS friends and family tests were also comparable and positive. Conclusions: Physiotherapists working with chiropractors produce similar outcomes within a musculoskeletal lower limb triage service.

“YOU THINK YOU'VE GOT THEM ON BOARD AND THEN THEY'RE BACK”: PRIMARY CARE CLINICIANS’ EXPERIENCES OF OFFERING SELF-MANAGEMENT ADVICE TO PEOPLE WITH BACK PAIN

Purpose and background of the studySelf-management and behaviour change is at the core of back pain management. Despite the high-rate of recurrence and healthcare utilisation, clinical guidelines do not include guidance for clinicians on return consultations. This project aimed to identify primary care clinicians’ reported practices and experiences of delivering self-management advice for people returning with persistent low back pain (LBP), to inform future delivery of self-management care.Methods and ResultsIn this qualitative study involving 27 primary care clinicians, four focus groups and two semi-structure interviews were conducted online. GPs (n=5) and physiotherapists working in primary care roles (First contact practitioners n=7, community and interface roles n=7, and mixed roles n=8) in England and Scotland shared their experience of delivering self-management advice to people returning with persistent LBP. Video recordings were transcribed verbatim and analysed with reflexive thematic analysis.Clinicians unanimously shared their frustrations identifying the challenges involved in supporting people who return with LBP. Helpful strategies to support self-management in return consultations were identified by clinicians in addition to service and system-level changes vital to optimise care. Patient-factors affecting delivery of care, lack of defined responsibility and challenges in meeting patients’ expectations illustrated the tensions that exist in return consultations.ConclusionThis novel study provides insight into the experiences and practices of the frontline primary care workforce seeing patients return with persistent or recurrent LBP. It identifies the tensions that exist between services, professional roles and between clinicians and patients regarding self-management. Important practice implications have been identified to improve information-sharing, agenda-setting, and exploring expectations.No conflicts of interest Source of fundingLisa Osborn-Jenkins is funded by University Hospital Southampton NHS Foundation Trust (UHS) Research & Development PhD Fellowship [GRT0723]

A support framework to facilitate social learning and integration skills of first-year undergraduate medical students

Background. Limited research exists on medical students’ coping and adjustment skills, especially in the South African context. Stakeholders planning medical curricula need to be aware of emotional and communication skills that allow students to cope and adjust to stress associated with transitioning to medical studies. Objective. To design a support framework to facilitate first-year undergraduate medical students’ social learning and integration skills. Methods. This descriptive qualitative case study used multiple data collection methods, nominal group meetings and Delphi questionnaires to explore and understand undergraduate medical students’ challenges with social learning and integration factors. These insights were then used to develop the support framework. Results. The support framework articulates levels of engagement and actions required to address social learning and integrated factors, namely under- preparedness, peer support, confidence, self-management, alienation and academic advice. Conclusion. Implementing the proposed support framework on social learning and integration could facilitate the successful transition of first-year undergraduate medical students from high school to university. This framework aids students in dealing with social learning and integrated factors, such as under-preparedness, peer support, confidence, self-management and alienation as well as academic advice using contextualised and appropriate skills and tools.

Changes in fatigue symptoms following an exercise-based rehabilitation programme for patients with long COVID.

There is evidence to support COVID-19 rehabilitation programmes improving persistent COVID-19 symptoms; however, there is concern that therapies that include an exercise component may increase fatigue and post-exertional symptom exacerbation (PESE). The objectives of the present study were to determine the effect of a 6-week COVID-19 rehabilitation programme on fatigue and PESE in individuals with ongoing COVID-19 symptoms. After a routine medical assessment, individuals with persistent COVID-19 symptoms were enrolled on a 6-week COVID-19 specific rehabilitation programme. The programme included symptom-titrated exercise, education and self-management advice. Fatigue was assessed pre- and post-programme using the Functional Assessment Chronic Illness Therapy Fatigue questionnaire (FACIT). Exercise capacity (Incremental and Endurance Shuttle Walking Test (ISWT and ESWT)) and PESE (DePaul Symptom Questionnaire (DSQ)) were also assessed pre- and post-programme. Composite scores were calculated for the frequency and severity domains of the DSQ. 148 patients (median (IQR) age 59 (49-72) years, 82 (55%) female, 81 (54%) hospitalised) completed the COVID-19 rehabilitation programme. FACIT score was reduced pre- to post-programme by a mean (CI) change of -5 (-7- -4); p<0.01. Exercise capacity increased by 82 (65-99) m for the ISWT and 398 (333-462) s for the ESWT (n=148). PESE was assessed in 44 patients. The DSQ frequency and severity composite score improved by 20 (13-28) and 19 (13-26) points, respectively (p<0.01, n=44). These data demonstrate the potential benefits of a COVID-19 rehabilitation programme in improving fatigue, exercise capacity and symptom exacerbation in those with persistent COVID-19 symptoms.

P005 Early inflammatory arthritis combined nurse and therapist clinic

Abstract Background/Aims NICE guidelines recommend patients have ongoing access to a multidisciplinary team (MDT). However, ensuring all patients are seen by physiotherapy, podiatry, and occupational therapy (OT), when needed, can be challenging. The aim of the project was for patients to be seen by a therapist, in the first six months of their disease. The plan was to provide treatment and encourage long-term self-management, by providing knowledge of when self-referring to the different therapy services would be beneficial. Methods A Nurse and therapist pilot clinic was implemented at the first Disease Modifying Anti-Rheumatic Drugs review appointment. The clinic allowed 15-minutes with a specialist nurse to discuss medication issues and drug counselling. This was followed by 30-minutes with a therapist, to discuss any functional needs and objectively assess any joint issues and to provide treatment. Patients were educated about their condition and signposted to information. Patients were also provided with self-management advice and informed about the role of MDT members. Written or emailed advice was provided. Patients were invited to complete an anonymous questionnaire evaluating their experience. Results 60 patients were seen in the first three months. Personalised therapy input was given to each patient; however, hand exercises and joint protection advice was given to over 60% of patients. Other therapy input included exercises for other specific joints that were problematic, the provision of wrist splints and relaxation advice. Results of the patient questionnaire showed 98% of patients felt they ‘definitely’ had more information to help manage their arthritis and 100% felt they knew where to go to get more information, if needed. Patients also had a greater understanding of the role of physiotherapy and OT. 88% of patients were confident they would ‘definitely’ know when to ask to be referred to these specialities in the future. Less than 15% of patients required further therapy input following the appointment. Conclusion The pilot clinic received excellent patient feedback and fulfilled the aims of providing therapy input, early in patient’s journey. Patients liked the convenience of seeing both the professionals in one visit, felt they had gained more information on their condition and were able to help themselves. Patient’s comments included ‘feeling more supported’ and ‘being able to help myself’. One experienced therapist seeing the patients was more cost effective than separate physiotherapy and OT appointments. The next stage will be to invite all newly diagnosed patients into this clinic as part of an early inflammatory arthritis pathway. We will then audit the impact on therapy referral rates and assess if early intervention reduces the number of therapy referrals long-term, encourages patient self-management and improves patient outcomes. Disclosure H. Harrison: None. R. Allan: None.

Individual outcomes after tailored versus generic self-management strategies for persistent fatigue in youth with a fatigue syndrome or rheumatic condition: A multiple single-case study.

To examine individual outcomes after tailored lifestyle (PROfeel) or generic dietary advice as self-management intervention for persistent fatigue in adolescents and young adults with a chronic condition, to compare participants who did and did not benefit and to explore changes to factors in the biopsychosocial model of fatigue after PROfeel. A multiple single-case AB-phase design was embedded in a randomized crossover trial (N = 45). Intensive longitudinal data (ILD) on outcomes 'fatigue severity', 'self-efficacy' and 'quality of life' (QoL) were collected through weekly smartphone measurement for 20 weeks. ILD on biopsychosocial factors were collected through experience sampling methodology for 28 days pre-post first intervention. Baseline characteristics were compared with t-tests and chi-square tests. Permutation distancing tests were used to assess change over time in all ILD. Regarding weekly measurements, nineteen participants (42.22%) showed small to large positive outcomes (drange = .05 to 2.59), mostly after PROfeel. Eleven participants (24.44%) showed small to moderate negative outcomes (drange = -.02 to -2.46), mostly after dietary advice. Fatigue severity improved most, followed by self-efficacy. Participants who benefitted showed higher QoL levels and lower fatigue and pain levels compared with others at baseline (all p < .02). When positive outcomes were observed after PROfeel, typically ≥1 biopsychosocial factor had been targeted successfully. Self-management advice has more potential when tailored to individual characteristics, including the biopsychosocial model of fatigue. PROfeel appears particularly useful as fatigue intervention for individuals with relatively less severe symptoms.

Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms.

The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms. To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs. We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions. Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment. One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis.

To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study.

Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. A qualitative study using semi-structured interviews with community pharmacists in England. Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine.

NCCN survivorship assessment of cancer survivors at an academic cancer center in the midwest and Great Plains region.

497 Background: Previous research has shown the patient reported outcome measures (PROM) have been instrumental in screening patient for physical and psychological morbidities, maximizing cancer care services, improving overall survival in cancer care, and provide tailored self-management advice to individual patients. This project is designed to describe the characteristics of our cancer survivorship population at the Buffett Cancer Center and to identify areas where both further research is needed in cancer survivorship for this unique population and where patient reported outcome measures may be helpful in providing individual personalized care. Methods: This needs assessment study is a retrospective review of demographic and patient reported outcome data collected on cancer survivors as part of routine clinical care at the UNMC Buffett Cancer Center. The study population focused on adult cancer patients with a unique encounter at the Cancer Survivorship clinic from 1/1/20-6/22/21. The NCCN Survivorship Assessment Survey was collected from all survivorship patients who had at least one unique encounter in the survivorship clinic at the Buffett Cancer Center in Omaha Nebraska. Data was stored in REDCap for patient safety and analyzed descriptively using SAS software. Results: There were a total of 473 patients seen in the Cancer Survivorship Clinic between 1/1/20 through 6/22/21. Mean age of all patients was 56 y/o with the youngest patient being 19 and the oldest patient at 87 y/o. Sixty-five percent of patients were female. Twenty-nine percent of patients lived in rural locations. There was a statistically significant difference in flu shot maintenance and vaccine maintenance between the different insurance groups. Those with private insurance had the highest proportion of individuals who perceived themselves to be up-to-date with both flu shots and all other vaccines as compared to Medicare, Medicaid and self-pay. There was also a statistically significant difference in vitamin usage among race. The white group had the highest proportion of individuals taking vitamins in survivorship care. In addition, life interference from stress was the lowest in the non-white and rural populations. Conclusions: This project showed that a third of the patient population utilizing cancer survivorship resources at this midwest cancer center were from rural communities. This underlines the need for further survivorship research at UNMC focusing on streamlining efficient and effective delivery of cancer survivorship care to rural populations. In addition, further research is needed concerning the impact of race and insurance on survivorship care.

Social learning and integration factors that affect first-year medical students transitioning directly from high school

Medical student's transition from high school to a new educational environment poses academic and personal challenges that could lead to withdrawal, dismissal or failure. Students who do not feel connected to the social and academic life of the educational environment are at risk of drop-out. Hence, most medical education institutions use remediation programmes to address learning gaps and increase the chances of student success. This study aimed to identify factors that affected the social learning and integration of undergraduate medical students who had failed the first year of study. The nominal group technique (NGT) was used involving 15 participants who had completed a six-month remediation programme. Results revealed the top five ranked and themed social learning and integration factors were underpreparedness, self-management, alienation, confidence and academic advice. Self-awareness and self-management were identified as complementary skills to address these factors. The study found that students could make valuable contributions to address challenges in the educational environment and enhance successful transition. In addition to other studies recommending a focus on academic integration, these results also pointed to the importance of social integration of first-year students as they transition from high school to a new educational environment at university.

Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD)—protocol for an external pilot randomised controlled trial and qualitative study comparing supervised versus self-managed rehabilitation for people after acute patellar dislocation

BackgroundPatellar dislocations mainly affect adolescents and young adults. After this injury, patients are usually referred to physiotherapy for exercise-based rehabilitation. Currently, limited high-quality evidence exists to guide rehabilitation practice and treatment outcomes vary. A full-scale trial comparing different rehabilitation approaches would provide high-quality evidence to inform rehabilitation practice. Whether this full-scale trial is feasible is uncertain: the only previous trial that compared exercise-based programmes in this patient population had high loss to follow-up. This study aims to assess the feasibility of conducting a future full-scale trial comparing the clinical and cost-effectiveness of two different rehabilitation approaches for people with an acute patellar dislocation.MethodsTwo-arm parallel external pilot randomised controlled trial and qualitative study. We aim to recruit at least 50 participants aged ≥ 14 years with an acute first-time or recurrent patellar dislocation from at least three English National Health Service hospitals. Participants will be randomised 1:1 to supervised rehabilitation (four to six, one-to-one, physiotherapy sessions of advice and prescription of tailored progressive home exercise over a maximum of 6 months) or self-managed rehabilitation (one physiotherapy session of self-management advice, exercise, and provision of self-management materials). Pilot objectives are (1) willingness to be randomised, (2) recruitment rate, (3) retention, (4) intervention adherence, and (5) intervention and follow-up method acceptability to participants assessed through one-to-one semi-structured interviews (maximum 20 participants). Follow-up data will be collected 3, 6, and 9 months after randomisation. Quantitative pilot and clinical outcomes will be numerically summarised, with 95% confidence intervals generated for the pilot outcomes using Wilson’s and exact Poisson methods as appropriate.DiscussionThis study will assess the feasibility of conducting a full-scale trial comparing supervised versus self-managed rehabilitation for people after acute first-time or recurrent patellar dislocation. This full-scale trial’s results would provide high-quality evidence to guide rehabilitation provision for patients with this injury.Trial registrationISRCTN registry ISRCTN14235231. Registered on 09 August 2022.

Experience of patients and physiotherapists within the AFTER pilot randomised trial of two rehabilitation interventions for people aged 50 years and over post ankle fracture: a qualitative study

ObjectivesTo explore patient and staff experience of best-practice rehabilitation advice (one session of face-to-face self-management advice with up to two additional optional sessions) compared with progressive functional exercise (up to...

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

PURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.

Towards improvement of oncology care through digital technology: A snapshot of Resilience remote patient monitoring (RPM) system implementation across 19 hospitals in Europe.

1518 Background: In clinical trials, RPM based on patient reported outcomes (PROs) has been shown to reduce symptom burden, increase dose intensity, improve quality of life and overall survival, and is recommended by international guidelines in routine oncology practice during systemic treatment (Di Maio et al., Ann Oncol 2022). Resilience developed a digital RPM system for oncology (CE marked, class IIa medical device) which prompts patients weekly with a notification to complete a survey including common symptoms from the NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification to the patient’s cancer care team, as well as personalized self-management advice, empowerment and educational material to patients. In this study we report the real-world implementation of Resilience RPM system in France and Belgium. Methods: Aggregated system-level metrics were collected covering all participating hospitals between Nov 2021 - Dec 2022. Qualitative and quantitative assessments focused on patient and provider utilization of Resilience RPM system was done. The implementation included a continued interaction between Resilience and hospital personnel for training, coordination and technical support. Results: 19 hospitals deployed Resilience in France and Belgium, including two Organization of European Cancer Institutes (OECI)-designated cancer centers and community oncology hospitals. Three integrated RPM with their electronic medical record. Overall, 1262 pts were registered (age range, 20-94), 40% with breast, 20% gastrointestinal and 8% genitourinary cancers. In the last 6 months, the main RPM interface was the mobile app (70%). Patient adherence with weekly RPM surveys was 85%, with a median time from prompt receipt to survey completion of 5h20min. RPM retention for 3 months, regardless of disease status, was 80%. Irrespective of severity, the most commonly reported PROs were performance status decline (94%), pain (89%) and anorexia (82%). The most common severe alert notifications were for nausea (33%), pain (31%) and anorexia (23%). The median time to alert management by the care team was 12h (70% within 24h), with 70% of alerts managed by a nurse navigator follow-up call, 5% by a referral for internal/external appointments, 0.5% with an emergency room referral and 0.4% with a hospitalization referral. 87% (32/38) of providers were satisfied with integrating the solution into their organization and 80% (30/38) felt patients were better managed through use of Resilience RPM. Conclusions: Implementation of the Resilience RPM system was feasible across a diverse group of 19 cancer centers in France and Belgium, with high levels of patient and provider participation and engagement. Resilience RPM offers an evidence-based approach to improve the quality and patient-centeredness of cancer care.

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

BackgroundOsteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use.MethodsA cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen.ResultsIn total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline.ConclusionsIn accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice.Trial registrationGerman Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

Evaluating Efficiency of a Provincial Telerehabilitation Service in Improving Access to Care During the COVID-19 Pandemic.

Early in the COVID-19 pandemic, community rehabilitation stakeholders from a provincial health system designed a novel telerehabilitation service. The service provided wayfinding and self-management advice to individuals with musculoskeletal concerns, neurological conditions, or post-COVID-19 recovery needs. This study evaluated the efficiency of the service in improving access to care. We used multiple methods including secondary data analyses of call metrics, narrative analyses of clinical notes using artificial intelligence (AI) and machine learning (ML), and qualitative interviews. Interviews revealed that the telerehabilitation service had the potential to positively impact access to rehabilitation during the COVID-19 pandemic, for individuals living rurally, and for individuals on wait lists. Call metric analyses revealed that efficiency may be enhanced if call handling time was reduced. AI/ML analyses found that pain was the most frequently-mentioned keyword in clinical notes, suggesting an area for additional telerehabilitation resources to ensure efficiency.

P070 Results of a consensus process to determine the elements of a complex digital intervention for distal upper limb musculoskeletal disorders

Abstract Background/Aims Painful distal upper limb (DUL) musculoskeletal disorders (MSDs), including hand, wrist and elbow problems, are common but lack effective self-management tools. The Digital-My Arm Pain Programme (D-MAPP) aims to develop and test a digital self-management intervention for DUL-MSDs. This project aimed to determine the elements required for the D-MAPP intervention package. Methods A review of self-management interventions for DUL-MSDs identified 31 potential intervention elements. Subsequently, the elements were grouped into three overarching categories; Information and self-management advice, Information on treatment options, and Features of an exercise programme. Next, we employed Delphi methodology to develop consensus on the intervention elements from key stakeholders: Healthcare professionals who manage DUL-MSDs and people with a DUL-MSD (pwDUL-MSDs). A three-round modified online/postal Delphi questionnaire was used, with collation and presentation of results in subsequent rounds. Participants scored the importance of including each element in the D-MAPP intervention using a 9-point Likert scale; 1-3 limited importance, 4-6 important but not critical, 7-9 critical. Consensus was pre-defined as &amp;gt; 70% of both healthcare professionals and pwDUL MSDs scoring an element in the same category. During each round, participants could suggest additional intervention elements for inclusion in the subsequent round. Results 23 healthcare professionals from a range of disciplines (including occupational therapists, physiotherapists, rheumatologists and orthopaedic surgeons) and 19 pwDUL-MSD completed round one; 83% and 89%, respectively, completed all three rounds. Round 1, consensus was achieved for 24 of the 31 elements, which were all deemed as critical to include in the D-MAPP intervention (Table 1). Two elements were suggested by participants and added to round 2. Two additional elements reached consensus as being critical in Round 2, and one further element reached consensus for inclusion in the third round. Six potential intervention elements did not reach a consensus. Conclusion Healthcare professionals and patients reached consensus on 27 elements, all of which were deemed as critical to include in the D-MAPP intervention. However, agreement among stakeholders on the importance level was not achieved for six potential elements. Following this work, the critically important elements will be developed through a co-design process to build the D-MAPP digital intervention. L. Brading: None. K. Kane: None. G. McHugh: None. K. Dziedzic: None. J. Adams: None. S. Chopra: None. L. Swaithes: None. K. Walker-Bone: None. G. Macfarlane: None. P. Conaghan: None. S. Kingsbury: None.

Abstract P6-05-57: Developing and feasibility testing a web-based intervention (ePainQ) to support post-operative pain and symptom self-management following surgery for breast cancer

Abstract Background: Breast cancer is the most commonly diagnosed women’s cancer with 2.3 million new global cases diagnosed in 2020. The global rise in survivorship has resulted in a significant health and economic burden on society. Breast cancer survivors report being overwhelmed physically and emotionally with treatment adverse effects. Recommendations include self-management support and personalised follow-up to meet patient needs. Persistent post-surgical pain (PPSP) is the most common negative consequence of breast surgery, often relating to inadequate acute post-surgical pain management. An unintended consequence of day surgery is reduced post-operative pain monitoring. There is a need to ensure appropriate support and pain monitoring alongside preparation, behavioural change and expectation management. Web-based interventions (WBI) could be a potential solution. A mixed-methods approach was used to develop a WBI to capture patient self-reported post-operative symptoms and provide individualised self-management advice. Methods: An audit and service evaluation revealed a 46% PPSP rate and identified opportunities where advice could support improved self-management. Developing the WBI (ePainQ) comprised a scoping review, systematic review, and development study with all results informing the development of ePainQ. ePainQ comprised two parts; a website containing supportive information and a post-operative symptom questionnaire. Intervention questions included pain, swelling, infection, functionality and QoL. Advice was generated for each question with different levels, based on CTCAE grading agreed with clinicians. A feasibility study prospectively tested ePainQ for acceptability, usability and perceived usefulness. Feasibility study aims were assessing uptake, retention, follow up and completion rates and acceptability of ePainQ. Study arms: usual care (cohort) or intervention (ePainQ). Intervention: daily online symptom questionnaire for 2 weeks commencing the day after surgery. Participants received immediate advice based on the severity of the reported symptoms, either self-management advice or in cases of clinical concern, advice to contact the hospital team. Reports were immediately available to HCPs as ePainQ was linked to the electronic patient record. Data collection: baseline, 2 weeks, 3 and 9 months post-operatively. Outcome measures: EORTC C30, and BR23, EQ-5D, HADS and BPI. Patient Activation was measured at baseline and 9 months. Results: 69 patients recruited over 8 months; 60 intervention and 9 cohort. Mean age: 57.7yrs (SD 9.8; range 38-82). Recruitment rate was 63%. IT issues prevented 12/60 using ePainQ but engagement of the 48/60 active participants was 89.6%. 40/48 completed a usability scale in which • 97.5% highlighted ePainQ as easy to use • 95% reported not needing any technical support • 90% felt very confident using ePainQ Outcome measures: 69/69 (100%) completion at baseline and 2 weeks. No active withdrawals with 13/69 passive withdrawals by 9 months. 67 participants (97.1%) consented to an interview invite with 14/67 interviews conducted. Participants were a mix of compliance rates to be reflective of the study and capture both positive and negative feedback. Feasibility study results demonstrated that ePainQ was perceived to be simple, easy to use and not requiring much learning to use effectively. All pre-set criteria for progression to a phase III RCT were met. Conclusion: ePainQ was designed in response to patient identified needs. The feasibility study established that ePainQ was accepted, used, and liked by participants who interacted with it. Even participants with limited use felt they had benefited from the advice. Results demonstrated patient positivity towards ePainQ suggesting recruitment rates could be increased if research capacity was improved and higher retention rates if IT issues were resolved and daily reporting duration was slightly reduced. Citation Format: Sue M. Hartup, Laura Ashley, Michelle Briggs, Galina Velikova, Mark Johnson. Developing and feasibility testing a web-based intervention (ePainQ) to support post-operative pain and symptom self-management following surgery for breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-57.

App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy.

Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.