Osteoarthritis Self-management Research Articles

Factors associated with empowerment after participating in a supported osteoarthritis self-management program: An explorative study

ObjectiveTo explore factors associated with change in empowerment in patients that have participated in a 3-month Supported Osteoarthritis Self-Management Program (SOASP). Further, to evaluate empowerment in the longer term. DesignAn explorative analysis including patients from a cohort study conducted in primary healthcare in Sweden was performed. Univariable linear regression models were performed to assess associations between demographics and patient-reported outcome measures (explanatory factors), respectively, and change in empowerment from baseline to 3-month follow-up (outcome variable). Long-term follow-up of empowerment was at 9 months. ResultsSelf-reported increase in enablement at the 3-month follow-up was associated with a greater improvement in empowerment (B ​= ​0.041, 95% CI (0.011, 0.07), p ​= ​0.008). Living alone was associated with less improvement in empowerment (B ​= ​−0.278, 95% CI (−0.469, −0.086), p ​= ​0.005) compared to living together. Physical exercise >120 ​min per week at baseline was associated with less improvement in empowerment (B ​= ​−0.293, 95% CI (−0.583, −0.004), p ​= ​0.047) compared to reporting no exercise at baseline. No other associations were observed (p ​> ​0.05). Empowerment improved from baseline to the 3-month follow-up (mean 0.20 (SD 0.5), p ​< ​0.001) but there was no change from baseline to the 9-month follow-up (mean 0.02 (SD 0.6), p ​= ​0.641). ConclusionsSelf-reported increased enablement may lead to greater improvement in empowerment after SOASP. Greater efforts may be needed to support those that live alone, are physically active, and to sustain empowerment in the longer term after SOASP. More research is needed on empowerment to provide personalized support for patients with OA after SOASP.

Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach

BackgroundKnee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support.MethodsThe development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention ‘planning’ and ‘optimisation’ informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate ‘guiding principles’ for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative ‘think aloud’ sessions (n = 6) with potential beneficiaries to refine the development of the intervention.ResultsKey themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application.ConclusionsUsing a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.

PAIN INTENSITY AND INTERFERENCE PREDICT STAGE OF ENGAGEMENT IN SELF-MANAGEMENT IN OLDER AFRICAN AMERICAN ADULTS

Abstract Osteoarthritis in African American older adults often causes a disproportionate burden of severe chronic joint pain that interferes with physical and emotional/cognitive activities. One tool commonly used in clinical research studies to evaluate patterns in pain intensity and pain interference is the Brief Pain Inventory-SF (BPI-SF). Confirmatory factor analysis validated a three-factor structure of the BPI-SF comprising pain intensity, activity-related pain interference, and affective pain interference. However, what is unclear and novel, is whether these three factors predict stage of readiness to engage in osteoarthritis self-management. Stage of readiness to engage (pre-contemplation, preparation, action) were assessed for seven recommended osteoarthritis self-management strategies: land-based exercise, water exercise, strength training/stretching, assistive devices, warm/cool compresses, medications, and self-management education. Using secondary data from 110 African American men and women (Mean Age 68.4, SD= 12.4), we performed ANOVA and ordinal logistic regression in SPSS. Pain intensity, activity-related pain interference, and affective pain interference were not significantly different between stages of engagement in pain self-management strategies except for medication use and assistive devices (p&amp;lt;.05). After controlling for age and employment, higher pain intensity was significantly associated with 27% reduction in the odds of being in preparation phase for water exercise, and higher levels of activity interference was associated with a 42% increase in the odds of being in the action phase for assistive devices. These results help us understand the relationship between behaviors and pain, particularly the impact of pain intensity and interference with physical activities on which strategies African Americans select to manage pain.

Increasing the capacity of health cadres to prevent and self-management of Osteoarthritis

Osteoarthritis (OA) is a clinical syndrome characterized by joint pain with varying degrees of functional limitations that impact quality of life. Data in Indonesia shows that the national prevalence of osteoarthritis is 7.3%. Several factors in the high prevalence of OA that can be modified require lifestyle modification to prevent OA. Self-management in OA can help maintain the individual's functional capacity, improve self-image, and improve the quality of life of the patients. This community service is health education for health cadres and the general public over the age of 35 years in one of the areas in Godean, Sleman, Yogyakarta. The team measured the level of participants' knowledge about osteoarthritis and self-screening for osteoarthritis in community service. Results obtained the majority of respondents were in the mild osteoarthritis category (36.5%). The results of the respondents' knowledge scores were the difference in average knowledge before and after providing education, there was an increase in knowledge scores of 17.87. Providing health education can increase public knowledge about osteoarthritis before and after health education about prevention and self-management of osteoarthritis.

Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians

Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme – a prospective observational study

BackgroundOsteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.MethodsPatients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1–5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0–12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.ResultsOne hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).ConclusionsHealth-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.Trial registrationClinicalTrials.gov. Identification number: NCT 02974036. First registration 28/11/2016, retrospectively registered.

MHealth for the Self-management of Knee Osteoarthritis: Scoping Review.

Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app-based disease self-management for patients with knee OA. PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords "knee osteoarthritis," "mobile health," and "self-management." Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. RR2-10.17504/protocols.io.buuxnwxn.

Digital self-management of hip and knee osteoarthritis and trajectories of work and activity impairments

ObjectiveTo investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA).MethodsWe conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment–Osteoarthritis (WPAI–OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership.ResultsA total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline–declining, moderate baseline–declining, high baseline–declining, very high baseline–substantially declining, and very high baseline–persistent) and three (low baseline–declining, mild baseline–declining, high baseline–declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups.ConclusionWhile participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.

Acceptability and preliminary effectiveness of a single-arm 12-week digital behavioral health intervention in patients with knee osteoarthritis

BackgroundDigital health interventions may improve osteoarthritis (OA) management. This study evaluated the acceptability and preliminary effectiveness of a multimodal digital nutrition, exercise, and mindfulness intervention in adults with knee OA.MethodsAdults with advanced knee OA and an orthopaedic referral were invited to self-enroll in a pragmatic 12-week single-arm intervention. OA-focused nutrition and exercise resources were delivered weekly by email, and secondary components accessed on-demand (web-platform, webinars, and nutrition consultation). Acceptability was assessed by qualitative interview data and completion rates. Preliminary effectiveness on clinical outcomes was assessed by change in health-related quality of life, well-being, mindfulness, self-efficacy, and interest in total knee arthroplasty (TKA) between baseline and 12-weeks.ResultsN = 102 patients self-enrolled (73.5% female, age 64 ± 7 years, body mass index 32.9 ± 7.3 kg/m2); n = 53 completed the 12-week intervention (71.7% female, age 65 ± 7 years, body mass index 33.4 ± 6.3 kg/m2). Acceptability was demonstrated by positive perceptions of tailored intervention resources. In study completers, health-related quality of life components of pain and physical functioning domains improved at 12-weeks [change in SF36 4.4 (95%CI 0.2–8.6), p = 0.016, and 6.7 (95%CI 2.7–10.7), p < 0.001, respectively]. Self-efficacy for managing daily activities improved [change in PROMIS T-score 4.4 (95%CI 2.8–6.0), p < 0.001].ConclusionA 12-week digital multimodal intervention for knee OA was acceptable to patients and shows preliminary effectiveness in improving self-efficacy, aspects of quality of life, and decreasing interest in TKA. Digital behavioral interventions for knee OA may be an acceptable approach to improve patient outcomes and OA self-management while potentially reducing utilization of costly health system resources.

Experiences of activity monitoring and perceptions of digital support among working individuals with hip and knee osteoarthritis – a focus group study

BackgroundMobile health (mHealth), wearable activity trackers (WATs) and other digital solutions could support physical activity (PA) in individuals with hip and knee osteoarthritis (OA), but little is described regarding experiences and perceptions of digital support and the use of WAT to self-monitor PA. Thus, the aim of this study was to explore the experiences of using a WAT to monitor PA and the general perceptions of mHealth and digital support in OA care among individuals of working age with hip and knee OA.MethodsWe conducted a focus group study where individuals with hip and knee OA (n = 18) were recruited from the intervention group in a cluster-randomized controlled trial (C-RCT). The intervention in the C-RCT comprised of 12-weeks use of a WAT with a mobile application to monitor PA in addition to participating in a supported OA self-management program. In this study, three focus group discussions were conducted. The discussions were transcribed and qualitative content analysis with an inductive approach was applied.ResultsThe analysis resulted in two main categories: A WAT may aid in optimization of PA, but is not a panacea with subcategories WATs facilitate PA; Increased awareness of one’s limitations and WATs are not always encouraging, and the second main category was Digital support is an appreciated part of OA care with subcategories Individualized, early and continuous support; PT is essential but needs to be modernized and Easy, comprehensive, and reliable digital support.ConclusionWATs may facilitate PA but also aid individuals with OA to find the optimal level of activity to avoid increased pain. Digital support in OA care was appreciated, particularly as a part of traditional care with physical visits. The participants expressed that the digital support should be easy, comprehensive, early, and continuous.

Designing a Mobile Phone Application for Self-Management of Knee and Lumbar Osteoarthritis: A Usability and Feasibility Study

Aim: This study aims to outline the major phases involved in developing a mobile app for self-management of knee and lumbar osteoarthritis.&#x0D; Method: This developmental research had three phases, including, content selection, application design and development, and evaluation. First, a questionnaire was created based on the literature review, and its content validity index (CVI) and content validity ratio (CVR) were measured by 15 specialists. To approve the contents of the app, the 15 rheumatologists used the Delphi technique. The application was designed using Android programming tools after the content was selected. SQLite was also used to develop a database. Finally, 12 patients evaluated the application's usability through the questionnaire for user interaction satisfaction (QUIS).&#x0D; Results: Based on the rheumatologists' preferences for information content and format, 45 key data elements were specified in 8 sections. The application was then built, which included six primary modules: medical records, educational information, disease management, record activities, reminders, and reporting. Finally, the application's usability was praised (7.56 out of 9). The application was updated with the necessary improvements based on user feedback following the evaluation.&#x0D; Conclusions: app evaluating is currently underway to verify the application's usability and feasibility, and its effect on osteoarthritis outcomes linked to pain control and physical activity will be investigated in future studies.

Enablement and empowerment among patients participating in a supported osteoarthritis self-management programme - a prospective observational study.

BackgroundIn Sweden, core treatment for osteoarthritis is offered through a Supported Osteoarthritis Self-Management Programme (SOASP), combining education and exercise to provide patients with coping strategies in self-managing the disease. The aim was to study enablement and empowerment among patients with osteoarthritis in the hip and/or knee participating in a SOASP. An additional aim was to study the relation between the Swedish version of the Patient Enablement Instrument (PEI) and the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23).MethodsPatients with osteoarthritis participating in a SOASP in primary health care were recruited consecutively from 2016 to 2018. The PEI (score range 0–12) was used to measure enablement and the SWE-RES-23 (score range 1–5) to measure empowerment. The instruments were answered before (SWE-RES-23) and after the SOASP (PEI, SWE-RES-23). A patient partner was incorporated in the study. Descriptive statistics, the Wilcoxon’s signed rank test, effect size (r), and the Spearman’s rho (rs) were used in the analysis.ResultsIn total, 143 patients were included in the study, 111 (78%) were women (mean age 66, SD 9.3 years). At baseline the reported median value for the SWE-RES-23 (n = 142) was 3.6 (IQR 3.3–4.0). After the educational part of the SOASP, the reported median value was 6 (IQR 3–6.5) for the PEI (n = 109) and 3.8 (IQR 3.6–4.1) for the SWE-RES-23 (n = 108). At three months follow-up (n = 116), the reported median value was 6 (IQR 4–7) for the PEI and 3.9 (IQR 3.6–4.2) for the SWE-RES-23. The SWE-RES-23 score increased between baseline and three months (p ≤ 0.000). The analysis showed a positive correlation between PEI and SWE-RES-23 after the educational part of the SOASP (rs = 0.493, p < 0.00, n = 108) and at follow-up at three months (rs = 0.507, p < 0.00, n = 116).ConclusionsPatients reported moderate to high enablement and empowerment and an increase in empowerment after participating in a SOASP, which might indicate that the SOASP is useful to enable and empower patients at least in the short term. Since our results showed that the PEI and the SWE-RES-23 are only partly related both instruments can be of use in evaluating interventions such as the SOASP.Trial registrationClinicalTrials.gov. NCT02974036. First registration 28/11/2016, retrospectively registered.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-022-05457-9.

EFFECTS OF DIGITAL SELF-MANAGEMENT OF OSTEOARTHRITIS ON WORK AND ACTIVITY IMPAIRMENTS

Purpose: Despite the importance of self-management and education in osteoarthritis (OA) management, delivery and uptake of these strategies remains suboptimal in routine care settings. In response to this and in line with the explosion of smart technology, there has been a growing interest in application of digital therapeutics in OA management. While previous studies documented significant improvements in pain and physical function following participation in digital self-management interventions, little is known about their effects on work and activity impairments despite substantial effect of OA on these measures.

AMSOS: AMSTERDAM OSTEOARTHRITIS SELFMANAGEMENT STUDY - PROTOCOL FOR A DEVELOPMENT AND FEASIBILITY STUDY

Purpose: Osteoarthritis (OA) of the hip and knee can cause large limitations in daily functioning. Even though there is no cure yet, lifestyle changes can prevent aggravation, in which self-management plays an important role. In the treatment of patients, physiotherapists, exercise therapists and dieticians stimulate self-management. Online applications have shown to be promising in improving self-management of OA. However, for many professionals the needs of patients with OA regarding self-management remain unclear, but also how these applications can be applied and how effective feedback can be provided to support behavior change. In this study we aim to develop a methodology that supports physiotherapists, exercise therapists and dieticians in the promotion of self-management in OA patients by using an online application. The study will determine whether the developed methodology is feasible in clinical practice and in metropolitan context, namely in Amsterdam, with its associated urban problems and challenges. When feasible, a Randomized Controlled Trial will be performed to determine the effectiveness of the developed methodology. The outcomes of this study are: 1.To develop a user friendly methodology that guides physiotherapists and dieticians in implementing online applications in the treatment of patients with OA, in order to promote self-management; 2.To test whether the developed methodology is feasible in clinical practice and enables professionals in increasing the self-management to support behavior change of patients with OA.

Promoting work ability with a wearable activity tracker in working age individuals with hip and/or knee osteoarthritis: a randomized controlled trial

BackgroundPhysical activity (PA) may improve work ability and health in individuals with hip and/or knee osteoarthritis (OA). The use of wearable activity trackers (WATs) has been shown to increase PA and improve other health outcomes but little is known concerning their effect on work ability. The objectives of this study were to examine the effect of self-monitoring PA with a WAT on work ability, PA and work productivity among individuals of working age with hip and/or knee OA.MethodsIndividuals (n = 160) were included and cluster-randomized to a Supported Osteoarthritis Self-management Program (SOASP) with the addition of self-monitoring PA using a commercial WAT for 12 weeks (n = 86), or only the SOASP (n = 74). Primary outcome was self-reported work ability measured with the Work Ability Index (WAI) and secondary outcomes were self-reported PA measured with the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and work productivity, measured with the Work Productivity and Activity Impairment scale: Osteoarthritis (WPAI:OA) at baseline and after 3, 6 and 12 months. Data was primarily analysed with linear mixed models.ResultsParticipants with data from baseline and at least one follow-up were included in the analyses (n = 124). Linear mixed models showed no statistically significant difference between groups regarding pattern of change in work ability or PA, from baseline to follow-ups. Also, neither group had a statistically significant difference in work ability between baseline and each follow-up.ConclusionThe SOASP together with self-monitoring PA with a WAT did not have any effect on the primary outcome variable work ability. Participants already at baseline had good work ability and were physically active, which could have reduced the possibility for improvements. Future interventions should target a population with lower work ability and PA-level.Trial registrationClinicalTrials.gov, NCT03354091. Registered 15/11/2017.

Modification of cognitive behavior therapy to improve the skill of elderly with osteoarthritis

One of the characteristics of physical changes in the elderly involves a decrease in the musculoskeletal system, such as the depletion of the synovial joint fluid which has an impact on the pain felt in joints. This condition can cause a disruption of the quality of life for the elderly and results in increases in the family burden. The purpose of cognitive-behavioral therapy in nurse care planning is to provide an overview of the implementation of family care nursing, community care health nursing, and management of health services by community health nurses to the elderly with osteoarthritis. The innovation and development of this senior citizen community program, initially named Lansia SMART (SMART Elderly), consists of six sessions, including psychoeducation sessions, cognitive restructuring sessions, pain management sessions with progressive muscle relaxation, activity scheduling sessions, problem-solving sessions, and tutorial sessions for the Lansia SMART (SMART Elderly) group with the Android application. The final maintaining challenging stage of these services involved 59 elderly participants. Data analysis used paired T-tests. The results of this innovation showed significant differences in the behavior of the elderly participants after the implementation of the SMART Elderly program (p &lt; 0.05). The SMART Elderly program was effective to improve the elderly participants’ behavior. Nurses can use cognitive behavioral therapy to improve the process of self-management of osteoarthritis among their clients.

Physiotherapists\u2019 experiences of osteoarthritis guidelines in primary health care \u2013 an interview study

BackgroundOsteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists’ experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.MethodsEighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis.ResultsThe analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow.ConclusionThe physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study.

BackgroundIn a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA).ObjectiveThis study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs).MethodsUsing methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype.ResultsInterviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability.ConclusionsThis evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality.

A review of strategies currently used to self-manage knee osteoarthritis in the aging population

Purpose: To determine the current strategies used for the self-management of knee osteoarthritis in the over 65s. Current recommendations include the general population however dismiss the changes in pain mechanisms in the older adult.

Exploring the feasibility, acceptability and value of volunteer peer mentors in supporting self-management of osteoarthritis: a qualitative evaluation

Background Hip and knee osteoarthritis (OA) affect a large and growing proportion of the population. Treatment options are typically conservative making self-management a priority. Using trained peers to support individuals with OA has potential to improve self-management. Purpose To explore the process of engaging and training volunteers to become peer mentors; and to qualitatively evaluate the feasibility, acceptability and value of being a peer mentor to support others’ self-management of OA. Materials and methods A qualitative evaluation of a peer mentorship support intervention reporting the processes of recruitment and training; and semi-structured interviews conducted with nine active peer mentors. Transcribed interviews were coded and analysed using framework analysis. Results It was possible to recruit, train and retain volunteers with OA to become peer mentors. The peer mentors benefitted from their training and felt equipped to deliver the intervention. They enjoyed social elements of the mentorship intervention and gained satisfaction through delivering valued support to mentees. Peer mentors perceived the mentorship intervention to have a positive impact on self-management of OA for mentees. Conclusion Training volunteers with OA to become peer mentors was feasible and acceptable. Peer mentors perceived their support benefitted others with OA. They positively rated their experience of providing mentorship support. IMPLICATIONS FOR REHABILITATION This study demonstrates that it is possible to recruit, train and engage older volunteers to become peer mentors for people with osteoarthritis. Training should highlight the significance of employing key self-management techniques such as goal-setting. Peer mentors acknowledged that they benefitted from training and delivering the mentorship intervention, and this impacted positively on their own osteoarthritis self-management. Careful consideration of matching mentors and mentees appears to enhance the success of mentorship support. Recognising the impact of mentorship support on mentees’ self-management is central to peer mentors’ sustained engagement with the intervention.