Therapeutic Team Research Articles

Comorbity of eating disorders and depression in T1DM patients: challenges and tasks for dietetician - a pilot study

Aim of the studyThe aim was to assess the occurrence of eating disorders (ED) in type 1 diabetes (T1DM) patients being under regular diabetologist care, that qualify for a visit to a psychologist and to evaluate possible correlation of eating disorders with symptoms of depression and anxiety in this population.Subject or material and methodsThe study included a selected group of 27 adult patients (55.5%- women) with T1DM under the constant care at the diabetes clinic. The following tools were used: to assess depression and anxiety, used the Patient Health Questionnaire (PHQ-9) and Center for Epidemiological Studies Depression Questionnaire (CES-D); EAT-26 assessed ED screening and Mood Disorder Questionnaire (MDQ) – other problems.ResultsBased on the overall assessment of the EAT-26 test as many as 7% of group was problem, which manifested a high level of concern about dieting, body weight or problematic eating behaviors. Additional the 25.9% people reported high depressive. We showed a relationship between ED and depression.DiscussionThere was a similar frequency of eating disorders ED eating disorders have elevated glycated haemoglobin (HbA1c), however, in our study, the mean HbA1c was 6.85% (51 mmol/mol) - fairly good glycemic control. In addition, a correlation between ED and depression has been noted, and patients with type 1 diabetes are very sensitive to both disorders.ConclusionsPeople suffering from type 1 diabetes, due to the increased risk of eating disorders or depression, require comprehensive care of a therapeutic team, which should include a diabetologist, psychologist, psychiatrist, diabetes educator, nurse, nutritionist.

The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic?

As an increased body of COVID-19 related research is now available, it becomes apparent that the effects of COVID-19 extend beyond that of the respiratory system. Among others, the endocrine system is particularly vulnerable to perturbation from the COVID-19 infection. The present scoping review summarizes the bidirectional relationship between COVID-19 and endocrine system in children and adolescents, by describing both the possible susceptibility of children and adolescents without endocrinopathies to endocrine disorders following COVID-19 infection, but also the potential susceptibility to COVID-19 infection and severe infection, or the aggravation of endocrine dysfunction in patients with pre-existing endocrine diseases. Data suggest increased obesity and diabetes rates, as well as increased severity and frequency of diabetic ketoacidosis following COVID-19 infection. Conversely, patients with diabetes and obesity may experience a more severe course of COVID-19 infection. However, in the majority of cases, children and adolescents with well-managed and regulated endocrine disorders do not appear to be at increased risk of infection or severe infection from COVID-19. Thus, adhering to the appropriate "sick day management rules", maintaining adequate supply of medications and supplies, keeping close contact with the therapeutic team and seeking medical help without delay when needed, are the main recommendations for a safe outcome. Additional lessons learnt during the pandemic include the risk for mental health diseases caused by children's disrupted routine due to COVID-19 related protective measures and the importance of adopting alternative communication options, such as telehealth visits, in order to ensure uninterrupted endocrine care.

Quality Internship Development and Supervision

While therapeutic recreation internships have long been required for individuals to be credentialed in Therapeutic Recreation, there have been few requirements for individuals to supervise an intern. Addressing two specific requirements of the Higher Education Task Force report (Carter & Hawkins, 2018), the Quality Internship Subcommittee was formed under the American Therapeutic Recreation Association Quality Providers team. The initial goal of the subcommittee was to advance excellence in internships by providing structure and direction for Therapeutic Recreation internship supervision. Descriptions of three subcommittee outcomes of the Subcommittee are detailed: the Qualified Supervisors Statement, the Internship Manual template, and the Quality Internship Supervisor Training. Limitations and ongoing Subcommittee efforts are noted.

Psychomotor development of a child under six years of age with experience of relational trauma – KORP diagnosis report

This article is about assessing the psychomotor development of a child who has experienced relational trauma up to the age of 6. This allows you to determine what level of development the child is at, develop a therapeutic plan, measure and document the child’s progress in this area, and ensure clear communication within the therapeutic team. The presented study used a tool standardised and normalised in 2014-2016 on a population of 905 Polish children: the Psychomotor Development Assessment Cards – KORP, which assesses a child’s psychomotor development in several spheres. From October to December 2023, 12 children up to 6 years of age placed in foster care in the Pomeranian region were surveyed, and in-depth interviews were conducted with their actual guardians. The main problem formulated in the question: In what areas does the psychomotor development of a child under the age of 6 who has experienced relational trauma proceed according to age norms, below norms or above age norms? The answer is unequivocal: the development of a child under the age of six who has experienced relational trauma is not in line with age norms but below them (incredible emotional and social development, development of behavioural functions and development of communication and speech). It would be worthwhile in the future to use the KORP test to study the development of children up to the age of 6 from biological families at risk of experiencing potentially traumatic relationship experiences, i.e. from families with problems of domestic violence, addiction, mental disorders, and to compare the psychomotor development of children at risk of experiencing relationship trauma with the psychomotor development of children living in relational health.

Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies

The therapeutic alliance is a fundamental component of rehabilitation in order to achieve effective outcomes. However, what develops, maintains or hinders this relationship has not been sufficiently explored. The aim of this systematic review is to recognize the role of the therapeutic alliance in the neurological rehabilitation process. A search for articles was carried out in the databases PubMed, Web of Science, SCOPUS, CINAHL, APA PsycInfo, OTseeker and Dialnet. They were selected according to the eligibility criteria. Internal quality assessment of the articles was measured with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The systematic review was registered in PROSPERO (ID 346523). The search in the databases identified 1596 articles, from which 9 different studies were finally included in the systematic review, reflecting the limitations of studies in this field. All studies are qualitative, from the point of view of the patients themselves, their relatives and healthcare professionals. The total sample of the included studies is 182 participants (96 health professionals, 76 users and 10 relatives). Semi-structured interviews, focus group discussions and written reflections were mainly used to collect the data. In conclusion, the therapeutic alliance can be an active component in the post-stroke rehabilitation process. Being recognized as a person, collaboration with the therapeutic team, empathy, empowerment, confidence, professional skills, maintenance of hope and the role of the family have been identified as aspects that can have an influence on the therapeutic alliance.

How Novartis deploys a new model of creativity to understand patients better

PurposeTo better understand the reality of living with the diseases and conditions that its drugs and therapies are developed to treat, the Novartis leadership determined a need for more meaningful insights into patients’ lives. They sought to develop a systematic, creative methodology – informed by the psychology of insightful rather than analytical thinking – to properly integrate and deploy the research commissioned into its day-to-day business decision-making. For it is well established that better understanding of the patient reality drives both compliance and adherence “beyond the pill”. The purpose of this paper is to bring the novel methodology of creativity to a wider audience and ensure that many others – notably in patient advocacy organizations – can benefit from this approach.Design/methodology/approachA core team of Insight and Analytics and Patient Engagement leads from various therapeutic area teams worked in partnership with a psychologist and practitioner in the field of insightful thinking, to develop an effective methodology that could reliably surface and articulate genuine patient insights. This methodology – the i4i Insights Discovery™ process – was developed, piloted, refined and codified in 2020 and implemented across the company in 2021–2022. It uses a combination of convergent and divergent thinking techniques – human rather than artificial intelligence, combining diverse research outputs – to understand patients’ lives better. With enhanced understanding, the insights then shape educational and behavioral strategies to drive adherence and compliance.FindingsAt a time of tightening budgets and demands to deliver enhanced impact from research budgets, i4i Insights Discovery™ has enabled Novartis teams to turn existing research outputs into profound and useful understandings of what it means to live with specific diseases and develop evidence-based patient engagement strategies; insight-driven decision-making around the lifecycle of any compound. i4i Insights Discovery™ has been applied across Novartis’s diverse areas of expertise, from heart disease to cancer, from organ transplantation to dermatology, from food allergy to ophthalmology.Practical implicationsThe i4i Insights Discovery™ process enables Novartis teams to gain deeper understanding of patients’ lives without the need to commission additional research; to do more with less. These insights enable cross-functional Novartis teams to develop better-informed strategies that better address the needs of patients and their care partners, of health-care professionals and health-care systems. The team creating the process is looking to make the i4i Insights Discovery™ approach a gold standard of insight discovery, both for pharma and health care and in other categories, too.Originality/valueThe i4i Insights Discovery™ process is a practical, novel application of well-established principles in the psychology of insightful thinking to address a clear business imperative. By repurposing and reinterpreting existing research outputs using creative verbal and visual exercises, it delivers a more human and empathetic understanding of the patient reality. It moves teams from “So what?” – this is what the data mean – to “Now what?” – this is what we should do as a result.

ICD-11 – Implications for Psycho-Pedagogical Research and Practice

Introduction: In Poland, as in other countries belonging to the World Health Organization (WHO), work is underway to implement the latest classification of diseases and health problems ICD-11. It was formally introduced on January 1, 2022. It must replace the current ICD-10 classification within five years. Research Aim: The aim of this study was to indicate the consequences of introducing the ICD-11 in the area of research and psychological and pedagogical practice. Moreover, an important goal was also to trace the implementation of the new classification in Poland. In addition, the most important changes introduced by the ICD-11 were reviewed in a horizontal approach, and so comparative with the ICD-10 and vertical, consisting in the identification of new items in the classification that do not fit into the current systematics. Evidence-based Facts: Given the implications of the ICD-11 in psychology and pedagogy, Chapter 6 on mental, behavioral and neurodevelopmental disorders deserves special attention. A pedagogue and a psychologist who are part of various diagnostic and therapeutic teams, most often cooperate with a psychiatrist and a neurologist, and this implies the practical use of ICD-11. Knowledge of classification and the ability to efficiently retrieve information in the ICD appear to be a necessary skill for practitioners. Conclusion: The process of implementing ICD-11 in our country will last at least until 2025 or even until 2026. During this period, the ICD-10 classification will still be used in medical practice, which implies its further presence also in psychological and pedagogical practice, as well as in scientific research using current diagnoses.

Internet as a source of patient information – Patient Targeted Googling

Abstract Introduction. Access to Internet resources has resulted in changes in the perception of principles related to interpersonal communication, privacy and sharing of personal information. Medical personnel may use data obtained from the Internet to supplement information gathered during the patient interview or to reveal a different picture of the patient’s health status. In PTG, it is crucial to assess the motivation for such an action, respect the patient’s rights and obtain his consent, comply with the rules of medical ethics, as well as assess the usefulness of such an action for the therapeutic process. There are questions as to whether the information provided is true, and to what extent it is altered by cognitive or mood disorders. Aim. The aim is to present selected issues related to the search for information about patients on the Internet by the therapeutic team. Method. Analysis of research and scientific studies in the Medline and PubMed databases. Summary. Scientific studies confirming the occurrence of PTG phenomenon, refer to the issue of ethical principles, obtaining patient’s consent, reliability of recorded data and true identity of patients, inclusion of obtained information in their medical records and its importance in shaping the relationship between the patient and the therapeutic team.

Practice examples: Suffolk's therapeutic fostering team builds relationships

Practice examples: Suffolk's therapeutic fostering team builds relationships

The Significance of Cooperation in Interdisciplinary Health Care Teams as Perceived by Polish Medical Students.

The aim of the study was to explore the opinions of medical students with regard to cooperation in the interdisciplinary team, as well as the factors affecting the formation of opinions. The study was conducted using the Polish version of the questionnaire Attitudes Towards Interprofessional Health Care Teams. The study involved 1266 participants, including students of medicine (n = 308), midwifery (n = 348), nursing (n = 316) and physiotherapy (n = 294). According to the opinions of the students participating in the study, the therapeutic process based on the interdisciplinary model improves the quality of medical care provided, increases patient safety, and improves communication between members of the therapeutic team. The factors affecting the assessment of cooperation in interdisciplinary medical care teams included the faculty and the year of studies, gender, as well as participation in the multidisciplinary courses. Students recognize the need for interdisciplinary medical teams. The training of future medical professionals should incorporate the elements of interprofessional education. This form of education allows students to develop both a professional identity and identification with their own profession, as well as encourages teamwork skills and shapes the attitude of openness towards representatives of other medical professions. However, in order to provide the students with the relevant knowledge, skills and competencies, it is essential to respect their diversity in terms of the faculty, as well as to account for the impact of gender and the year of studies which may affect their readiness to engage in teamwork.

A crisis of exhaustion in the game of escalation: a qualitative exploration of the consequences of occupational burnout among addiction therapists.

Research shows that occupational burnout can affect health, the quality of personal relationships, and levels of job satisfaction and engagement. At the same time, the impact of individual burnout at the group and organisational levels has tended to be neglected. We aim to provide theoretical insights into the multidimensionality of burnout consequences at the individual, interpersonal and societal levels. A theory-driven, computer-assisted qualitative data analysis was conducted, comprising a thematic analysis of 40 semi- structured telephone interviews with therapists working in alcohol treatment facilities in Poland. Maximum variation sampling was used to ensure the representation of participants with different characteristics. To theorise the implications of the collected data, the different viewpoints of addiction therapists on burnout and its consequences were interpreted through the lens of Rosa's resonance theory. Four interrelated sets of consequences were identified in the data: they related to (a) the therapists themselves, (b) their patients and the therapeutic process, and - in a broader sense - (c) the therapeutic team and (d) the treatment facility. Occupational burnout in individual therapists has serious implications for their patients and colleagues. It can also lead to a reduction in the quality and ultimately the effectiveness of the treatment of alcohol use disorders leading to a negative social image of the treatment facility and thus creating a further barrier to treatment for people with alcohol-related problems. Furthermore, the complexity of the individual experience of occupational burnout and a cause-and-effect chain forms a loop, deepening the severity of its consequences.

Stability in Variability, about the Importance of the Setting in Group Therapy for Adolescents in a Psychiatry Ward

In this article, we look at the role of the setting in group therapy for adolescents, exploring how the therapeutic environment influences the process of recovery and development of adolescents hospitalized in the Child and Adolescent Psychiatry Ward at the University Hospital in Krakow. The aim of the study was to examine how adolescents, particularly groups predominantly composed of girls, respond to the setting in group therapy and its impact on the healing process during hospitalization on a ward for adolescent patients. Three several-month-long periods of the group’s work conducted in 2021, 2022 and 2023 are analyzed. The basic principles of group work are discussed, both those introduced by the therapeutic team and ones proposed by adolescents and adopted by the group in the last few years. The rules that are most frequently broken or manipulated by adolescents are indicated.

„Amicus” – oswajanie lęku pacjenta Świętokrzyskiego Centrum Onkologii w Kielcach poprzez informacje. Działalność redaktorek Joanny Chądzyńskiej i Izabeli Opalińskiej

The paper presents the free quarterly Amicus, published from 2015 until today in 3000 copies by the Świętokrzyskie Oncology Centre in Kielce, addressed to the patients of this facility. It is edited by two persons: Joanna Chądzyńska and Izabela Opalińska. The purpose of launching this form of communication is to familiarize patients with the profile of the clinic’s operation, its departments, clinical trial prophylaxis, diagnostics, treatment methods (surgery, radio and chemotherapy, hormone therapy, immunotherapy), specialist doctors, multidisciplinary therapeutic teams that develop treatment plans for patients, telepathology – i.e., information systems in medicine, healthy lifestyle and nutrition, psycho-oncology, scientific conferences and symposia, nursing care, rehabilitation, patients’ rights. It performs a role of the friend-guide to people who are often startled by the diagnosis. The magazine presents interviews with famous people from the cultural and scientific world who have been cured or who are undergoing treatment, including medical doctors, encouraging readers to conduct preventive examinations and to be optimistic about their treatment. The main goal is to familiarise patients with the fear of illness that often results from ignorance. Since March 2020, topics related to the Covid -19 pandemic concern preventive measures, such as vaccination against the virus, and possible complications after the disease.

Parents' experiences of their child's transition from tube to oral feeding during an intensive intervention programme.

Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent-child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently. Fourteen parents were interviewed using semi-structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision-making process to undertaking an intensive multi-disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes. Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat-if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents. Parenting a tube-fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support.

Weight gain in type 1 diabetes during the SARS-CoV-2 pandemic. Does lockdown affect the metabolic control of pediatric patients?

Background and aimsDue to the severe acute respiratory syndrome coronavirus 2 pandemic, governments of many countries decided to implement lockdowns, which included school closures. This major lifestyle change also applied to people with diabetes. The aim of this paper was to analyze how the COVID-19 pandemic and related restrictions influenced the metabolic compensation of diabetes in the pediatric population.MethodsPatients with type 1 diabetes (T1D), treated by one therapeutic team, who in 2020 and 2021 paid at least two in-person visits in the outpatient clinic, were included in the study. The time in range (TIR) and HbA1c, as well as the total daily dose (TDD) of insulin and BMI from the visit before the announcement of the pandemic restrictions (March 2020) and during the lockdown (second visit after 6 months) and within the period of loosened restrictions (two visits in 2021) were analyzed.ResultsA total of 185 patients with T1D were included in the study (96 boys), aged 2–18 years (11.5 ± 3.5); 135 of them (72.9%) use CSII and 142 (76.8%) use CGM or FGM. During the first months of the studied period, despite comparable (p>0.05) TIR (57.5 ± 21.4% vs. 59.9 ± 20.5%), improvement of HbA1c was noticed (7.9 ± 1.6% vs. 7.5 ± 1.4%, p=0.0336), whereas in the following months, both HbA1c and TIR were comparable. Also, the TDD increased significantly (from 37.3 ± 18.9 units/day on the first visit up to 46.8 ± 22.7 units/day on the last visit, p=0.0003); however, TDD/kg remained constant (p>0.05) (0.8 ± 0.2 units/kg/day vs. 0.8 ± 0.3 units/kg/day) possibly due to an increased BMI (19.1 ± 3.7 kg/m2 vs. 20.9 ± 4.1 kg/m2, p=0.0001). The percentage of basal insulin in the TDD remained stable (p>0.05) (39.7 ± 11.3% vs. 39.3 ± 13.6%). Furthermore, a significant (p=0.0001) change in the BMI percentile was noticed [from 58.9 ± 26.2 percentiles (%iles) before lockdown vs. 64.6 ± 26.0%iles on the second visit]. However, the BMI percentile returned to baseline (58.1 ± 28.4%iles) at the visit at the end of the observation period.ConclusionsThe parameters of metabolic control in pediatric patients with T1D during the pandemic period remained stable; however, weight gain and an increase in daily insulin dose have been observed, possibly due to reduced physical activity.

The Impact of the COVID-19 Pandemic on the Professional Autonomy of Anesthesiological Nurses and Trust in the Therapeutic Team of Intensive Therapy Units-Polish Multicentre Study.

Introduction: The COVID-19 pandemic as well as the rate of spread of this particular pathogen around the world have caused the number of patients requiring medical attention and intensive care to exceed the capacity of even the best organized health care systems. This resulted in the need to hire employees who had not previously worked in intensive care units. Experience and knowledge have become particularly important in the context of mutual trust in the ICU team. At the same time, it could affect the level of professional autonomy of nurses, understood as the freedom to perform work based on knowledge, skills and competence without the need to submit to other medical professions. The pandemic status has required that nurses are always involved in their work by participating in training. Faced with the dangers of COVID-19, there is no doubt that by the end of the pandemic, both nursing and healthcare will be better equipped to face future challenges. Methods: The study lasted from July to September 2021. The data collection procedure started with the consent of the heads of the institutions where the data was collected. The study was conducted using the Dempster Practice Behavior Scale (DPBS), which examines work autonomy. The survey using the proprietary questionnaire was conducted among 225 nurses working in eleven ICUs in five voivodeships in Poland. Results: The autonomy of nurses during the COVID-19 pandemic was assessed at a high level. Younger respondents rated autonomy as being higher. Almost half of the respondents assessed the level of professional independence as high, including 52% of nurses, and significantly less, including 34% of doctors. A group of 47% of respondents assessed that trust had decreased and 28% said that trust had improved slightly. Conclusions: Professional independence allows you to perform work independently on others, taking responsibility for decisions and actions. The COVID-19 pandemic, through the influx of new staff members into treatment teams, had an impact on both nursing autonomy and the level of trust in a team, as shown in this study.

Patient‑centered care and "people-first language" as tools to prevent stigmatization of patients with obesity.

Obesity is a global health problem with serious consequences, such as diabetes, dyslipidemia, cardiovascular disease, infertility, and certain cancers. Excess body weight, mainly due to its manifestation in an individual's appearance, also affects the psychological condition. Therefore, health care providers need to make an effort to diagnose and comprehensively treat obesity. The obesity treatment should be systemic and carried out by a multidisciplinary therapeutic team consisting of a doctor, nurse, dietitian, psychologist or physiotherapist, and surgeon. The first-line therapy of obesity includes lifestyle modification and increased physical activity. Pharmacological treatment is recommended in all adult patients with a body mass index (BMI) exceeding 30 kg/m2 or those with a BMI greater than or equal to 27 kg/m2 with at least 1 obesity‑related comorbidity. Bariatric surgery should be considered in adults with a BMI of 40 kg/m2 or greater, or those with a BMI greater than or equal to 35 kg/m2 with at least 1 obesity‑related disease. The holistic model of obesity treatment also includes psychological therapy. The European Association for the Study of Obesity recommends psychological assistance for all individuals with previous treatment failure. Adverse or harmful actions toward people with obesity, ascribing negative traits and behaviors to them, and their marginalization in the public space are referred to as stigmatization of obesity. This phenomenon is associated with reduced compassion and willingness to help, and a feeling of dislike or even anger toward this group of patients. The consequences of stigmatization are worse mental health, poorer physical health, avoidance of health care, and the maintenance or increase of excess body weight. Therefore, talking about obesity using the principles of "people-first language," as well as implementing a patient‑centered care model are important.

Implementation of an Advanced Nursing Practice to advance transcultural healthcare: A practical development project

Implementation of an Advanced Nursing Practice to advance transcultural healthcare: A practical development project Abstract. Background: Patients and staff with different cultural backgrounds encounter each other in different roles at the children's hospital. Cultural differences are at the heart of misinterpretations and misunderstandings that can result in errors and prolong hospitalisation. Aim: To meet the challenges of reaching a common understanding in trans-cultural care, improve empowerment and ensure adequate treatment of children and family alike we introduced an ANP trans-cultural care team (ANP-TKV). Methods: The role of the ANP-TKV team was conceived as a project, encompassing a stakeholder and risk analysis, defining of the organisation, the setting of milestones, resources and controlling, as well as establishing an information concept. Results: The project concept successfully integrated and consolidated the APN-TKV team into our hospital activity. The team is now regularly consulted to manage complex trans-cultural situations, sensitises diverse professional groups and initiates professional inputs. It also provides helpful material and is able to anticipate potential current trans-cultural issues. Discussion: The evidence-based work of the ANP-TVK team has exerted positive effects on therapeutic teams as well as patients and their families and initiates a cultural change within the hospital. It is now an operative addition to the hospital's strategic commission. Further development of the meaning of trans-cultural and the question of allocation of financial and time resources to the APN-TKV team are presently under review.

Methods of communication in medical care respecting the dignity of an intellectually disabled person

People with intellectual disabilities experience stigma and discrimination. In caring for people with intellectual disabilities, special attention should be paid to respecting their dignity and subjectivity. The aim of this study is to emphasize the importance of respecting the dignity and subjectivity of adults with intellectual disabilities and the importance of communicating with them. The paper is based on a literature analysis of intellectual disability issues. The literature analysis indicates that the subject of intellectual disability concerns the subjectivity and the dignity of the people as well as the barriers to communication with the environment and medical personnel. It is fundamental to conduct research into care of people with intellectual disabilities. In addition, there is a need to organize training for all members of the therapeutic team, especially in the area of communication issues with people with intellectual disabilities.

Evaluation of the patient-accompanying app “alley ortho companion” for patients with osteoarthritis of the knee and hip: study protocol for a randomized controlled multi-center trial

BackgroundOsteoarthritis (OA) is one of the most common disabilities in the elderly. When conservative management fails, total joint arthroplasty (TJA) is the treatment of choice for end-stage OA. Since quality and durability of implants has steadily improved, pre -and postsurgical processes moved into the focus of research. Hence, eHealth approaches offer an opportunity to provide a more available continuity of care. Regarding individualized pre-, peri-, and postsurgical stages, eHealth is expected to improve patient engagement, self-care, and outcomes across the surgical pathway. Aim of this study is to evaluate the effectiveness of the eHealth application “alley” as an adjuvant intervention to TJA. The app provides comprehensive information to empower patient with hip or knee OA to prepare and accompany them for their TJA surgery. Our primary hypothesis is that the pre- and postoperative adjuvant use of the eHealth application “alley” (intervention group, IG) leads to improved functional outcome.MethodsProspective, randomized, controlled, multi-center trial including n = 200 patients diagnosed with hip and n = 200 patients with knee OA (n = 200) scheduled for TJA. Patients of both groups will be randomly assigned to one of two study arms. Patients in the intervention group will receive access to the functions of the “alley” app. The app presents informative (e.g., information about osteoarthritis), organizational (e.g., information about medical rehabilitation), and emotional/empowerment (e.g., information about the relationship between mood and pain) content. Patients evaluate their condition and functional level by means of standardized digitally questionnaires. Patients in the control group will not receive any functions of the app. Assessments will be performed at baseline before, 10 days after, 1 months after, 3 months after, 6 months after, and 12 months after TJA. Primary outcome is change from baseline measured by the Hip Osteoarthritis Outcome Score or Knee injury and Osteoarthritis Outcome Score 3 months after TJA. The statistical analysis (t-test for independent variables with effect size Cohen’s d) is performed separately for patients with TKA and THA.DiscussionOverall, the study aims to improve the understanding of the benefits of eHealth applications in the treatment of elderly patients with knee or hip arthroplasty. The approach is novel since a health care companion is combined with a digital information platform enabling direct and continuous feedback from the patients to the therapeutic treatment team. As the study investigate the effectiveness under everyday conditions, it is not feasible to control whether the patients in the IG read the educational information of the app respectively the control group consume additional information from other sources. However, this increases the external validity of the study if significant effects for the app can be demonstrated.Trial registrationGerman Clinical Trials Register: DRKS00025608. Registered on 21 June 2021.