Musculoskeletal Care (Muscoskel Care)

Publications in this journal

• Article: Health Behaviour Change Interventions for the Promotion of Physical Activity in Rheumatoid Arthritis: A Systematic Review.

  Fiona Cramp, John Berry, Matthew Gardiner, Felicity Smith, Daniel Stephens
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  ABSTRACT: BACKGROUND: Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease with typical onset between the ages of 40 and 50 years. Increasing levels of physical activity (PA) have been shown to decrease inflammation, reduce pain, increase functional ability and improve self-esteem in people with RA. Health behaviour change (HBC) interventions have recently shown promise in facilitating the promotion of PA within a range of long-term conditions. There is currently no evidence synthesis relating to HBC interventions to increase PA in the RA population. OBJECTIVES: The aim of the present study was to determine whether HBC interventions can increase PA in people with RA and identify optimal interventions or promising constituent components of the HBC interventions. METHODS: A systematic literature search was conducted to identify randomized, controlled trials investigating the effect of HBC interventions on PA level in adults with RA. Four review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. RESULTS: Following the application of inclusion/exclusion criteria, three studies remained for inclusion. Two studies reported significant short-term (<9 months) beneficial effects of HBC upon PA (p < 0.05). Individualized interventions were significantly more effective (p < 0.05). CONCLUSIONS: Due to methodological flaws and a lack of comparison with usual care, it is not possible to conclude whether HBC interventions can increase PA in the RA population. Although it is possible to highlight promising elements of HBC interventions, such as goal setting and feedback on performance, further research on all specific components, including information provision, behaviour contracts and problem solving, is required to establish conclusive clinical guidelines. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 05/2013;
• Article: Skin and Mucosa Care in Systemic Sclerosis - Patients' and Family Caregivers' Experiences and Expectations of a Specific Education Programme: A Qualitative Study.

  Agnes Kocher, Sabine Adler, Elisabeth Spichiger
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  ABSTRACT: BACKGROUND: Skin and mucosal manifestations such as skin thickening, pruritus, reduced microvascular circulation, digital lesions, appearance-related changes, and dryness of the eyes and mucosa are common in systemic sclerosis (SSc). A specific skin and mucosa care education programme for patients and their family caregivers should increase their self-efficacy and improve coping strategies. AIMS: The aims of this qualitative study were to explore the participants' experiences of both everyday life with skin and mucosal manifestations and the programme itself, while identifying unmet needs for programme development. METHODS: Narrative interviews were conducted with eight SSc patients and two family caregivers of individuals with SSc. Using qualitative content analysis techniques, the transcribed interviews were systematically summarized and categories inductively developed. RESULTS: The findings illustrated participants' experiences of skin and mucosal symptoms and revealed them to be experts in finding the right therapy mix alone (before diagnosis) and also in collaboration with health professionals (after diagnosis). Participants emphasized that the programme gave them useful education on skin and mucosa care. They described how they had to cope alone with the lack of information on pathophysiology, people's reactions, and the impact on their family and working lives. Nevertheless, participants said that they maintained a positive attitude by not dwelling on future disabilities. CONCLUSIONS: Patients and family caregivers benefited from the individualized and SSc-specific education on skin and mucosa care. Future improvements to the programme should focus on imparting understandable information on SSc pathophysiology, dealing with disfigurement and seeking reliable disease information, as well as facilitating peer support. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 03/2013;
• Article: The Colour of Pain: Can Patients Use Colour to Describe Osteoarthritis Pain?

  Vikki Wylde, Victoria Wells, Samantha Dixon, Rachael Gooberman-Hill
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  ABSTRACT: OBJECTIVE: The aim of the present study was to explore patients' views on the acceptability and feasibility of using colour to describe osteoarthritis (OA) pain, and whether colour could be used to communicate pain to healthcare professionals. METHODS: Six group interviews were conducted with 17 patients with knee OA. Discussion topics included first impressions about using colour to describe pain, whether participants could associate their pain with colour, how colours related to changes to intensity and different pain qualities, and whether they could envisage using colour to describe pain to healthcare professionals. RESULTS: The group interviews indicated that, although the idea of using colour was generally acceptable, it did not suit all participants as a way of describing their pain. The majority of participants chose red to describe high-intensity pain; the reasons given were because red symbolized inflammation, fire, anger and the stop signal in a traffic light system. Colours used to describe the absence of pain were chosen because of their association with positive emotional feelings, such as purity, calmness and happiness. A range of colours was chosen to represent changes in pain intensity. Aching pain was consistently identified as being associated with colours such as grey or black, whereas sharp pain was described using a wider selection of colours. The majority of participants thought that they would be able to use colour to describe their pain to healthcare professionals, although issues around the interpretability and standardization of colour were raised. CONCLUSIONS: For some patients, using colour to describe their pain experience may be a useful tool to improve doctor-patient communication. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 03/2013;
• Article: Physiotherapy and Lumbar Facet Joint Injections as a Combination Treatment for Chronic Low Back Pain. A Narrative Review of Lumbar Facet Joint Injections, Lumbar Spinal Mobilizations, Soft Tissue Massage and Lower Back Mobility Exercises.

  Hannah Chambers
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  ABSTRACT: OBJECTIVES: The aim of this study was to summarize the available evidence on lumbar facet joint injections and the physiotherapy treatments, land-based lower back mobility exercise, soft tissue massage and lumbar spinal mobilizations for chronic low back pain (CLBP). The plausibility of physiotherapy and lumbar facet joint injections as a combination treatment is discussed. METHODS: Using a systematic process, an online electronic search was performed using key words utilizing all available databases and hand searching reference lists. Using a critical appraisal tool from the Critical Appraisal Skills Programme (CASP), the literature was screened to include primary research. The main aspects of the research were summarized. RESULTS: The evidence for lumbar facet joint injections suggests an overall short-term positive effect on CLBP. Land-based lower back mobility exercise and soft tissue massage appear to have a positive effect on CLBP in the short term and possibly in the longer term. There is insufficient evidence to draw conclusions for lumbar spinal mobilizations. CONCLUSION: The review indicates that lumbar facet joint injections create a short period when pain is reduced. Physiotherapy treatments including land-based lower back mobility exercise and soft tissue massage may be of benefit during this time to improve the longer-term outcomes of patients with CLBP. It is not possible to make generalizations or firm conclusions. The current review highlights the need for further research. A randomized controlled trial is recommended to assess the impact of physiotherapy in combination with lumbar facet joint injections on CLBP. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 03/2013;
• Article: Implementing the NICE Osteoarthritis Guidelines in Primary Care: A Role for Practice Nurses.

  K S Dziedzic, E L Healey, C J Main
  Musculoskeletal Care 03/2013; 11(1):1-2.
• Article: Different Wording of the Patient Global Visual Analogue Scale (PG-VAS) Affects Rheumatoid Arthritis Patients' Scoring and the Overall Disease Activity Score (DAS28): A Cross-Sectional Study.

  Tracy French, Sarah Hewlett, John Kirwan, Tessa Sanderson
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  ABSTRACT: OBJECTIVE: The Disease Activity Score in 28 joints (DAS28) is a key measure in clinical practice and clinical trials. There are at least five different versions of the 'Patient Global' Visual Analogue Scale (PG-VAS) being used in the DAS28. The developers suggested that the PG-VAS can be an assessment of global health or disease activity, but did not specify the wording of the question. There is no consensus on what the PG-VAS is intended to capture, and the different words and phrases have not been evaluated. The aim of this study was to test if phrasing affects PG-VAS scores and hence yields different results for the DAS28. METHODS: Fifty patients with rheumatoid arthritis taking biologic agents in a rheumatology outpatient department completed a self-administered questionnaire containing five versions of the 100 mm PG-VAS. RESULTS: All PG-VAS versions correlated strongly with each other (rho = 0.67-0.87, p < 0.0001). However, individual scores for each PG-VAS, when compared with the comparator on a Bland-Altman chart had wide limits of agreement-the largest being -42 mm to +45 mm. The five overall DAS28 scores were calculated for each patient using the five different PG-VAS. The largest difference in DAS28 scores was 0.63. CONCLUSION: Different phrasing of the PG-VAS gives different DAS28 results. As the DAS28 is a key outcome measure, such differences have the potential to influence clinical decisions relating to eligibility for biologic agents and evaluation of new therapies. We urgently need to decide on the concept to be measured and the phrasing required to capture this. The PG-VAS phrasing should then be standardized and validated. Copyright © 2013 John Wiley & Sons, Ltd. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 02/2013;
• Article: Similar Problem in the Activities of Daily Living but Different Experience: A Qualitative Analysis in Six Rheumatic Conditions and Eight European Countries.

  Tanja Stamm, Robin Hieblinger, Carina Boström, Carina Mihai, Fraser Birrell, Carina Thorstensson, Veronika Fialka-Moser, Silvia Meriaux-Kratochvila, Josef Smolen, Michaela Coenen
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  ABSTRACT: OBJECTIVE: The aim of the present study was to compare and contrast the concepts of functioning in daily life which were important to patients with different rheumatological conditions. METHOD: The study comprised a qualitative analysis of 44 focus groups in eight European countries, in 229 patients with fibromyalgia, hand osteoarthritis, psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis, using the World Health Organization, International Classification of Functioning, Disability and Health as a framework. Concepts and - where necessary - also sub-concepts and transcripts were combined and compared independently by two researchers who, in case of disagreement, achieved consensus through discussion. RESULTS: Twenty concepts out of 109 (e.g. body image, fatigue, emotional issues, mobility and hand function) were similarly described in all six diseases. However, even if the same concept was mentioned, patients' experiences were different, such as mental AND physical aspects limiting the ability to drive in patients with fibromyalgia compared with ONLY physical problems in all other diseases. Within body functions and structures, several concepts were relevant for certain conditions only. CONCLUSION: A large number of similar problems are mentioned as 'typical' by patients with different rheumatic conditions. These could probably be targeted, using a disease-specific approach, in interventions by non-physician health professionals. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 01/2013;
• Article: Factors Influencing the Patient with Rheumatoid Arthritis in their Decision to Seek Podiatry.

  A Blake, P J Mandy, G Stew
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  ABSTRACT: INTRODUCTION: Despite the level of foot involvement in rheumatoid arthritis (RA), and the literature to support early assessment of foot care needs, local referral of patients to podiatry has been occurring too late to instigate certain preventative interventions. Preliminary fieldwork has highlighted that the primary responsibility for the instigation of this lies with the patient. The present study describes the factors that influence the patient with RA in their decision to self-report foot problems. METHOD: A case study research strategy was employed. Nine patients attending the outpatient rheumatology department participated in the study and data were gathered through semi-structured interviews. This information was analysed using a framework approach. RESULTS: The key themes derived from the data suggested that there are a variety of factors influencing the patient's decision to self-report foot concerns. Some will act to encourage the action and others will act to oppose it. Other factors can influence the decision either way, depending on the individual patient (psychological state, previous experience, body image changes). In addition, age, gender, and cultural and social aspects are also significant. CONCLUSION: Due to the multitude of factors influencing the individual's decision to seek help, the patient cannot be given sole responsibility for their foot health if we wish to achieve timely and appropriate podiatry, as recommended in the literature. Responsibility should be three-way; the patient, the members of the rheumatology team and, once in the podiatry service, the podiatrist should maintain this. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 01/2013;
• Article: Yoga for Functional Ability, Pain and Psychosocial Outcomes in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

  Lesley Ward, Simon Stebbings, Daniel Cherkin, G David Baxter
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  ABSTRACT: OBJECTIVES: Musculoskeletal conditions (MSCs) are the leading cause of disability and chronic pain in the developed world, impacting both functional ability and psychosocial health. The current review investigates the effectiveness of yoga on primary outcomes of functional ability, pain and psychosocial outcomes across a range of MSCs. METHODS: A comprehensive search of 20 databases was conducted for full-text, randomized controlled trials of yoga in clinically diagnosed MSCs. RESULT: Seventeen studies met the inclusion criteria, involving 1,626 participants with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), kyphosis or fibromyalgia. Studies were quality rated, and analysed for the effect of yoga on primary outcomes, immediately post-intervention. Twelve studies were rated as good quality. Yoga interventions resulted in a clinically significant improvement in functional outcomes in mild-to-moderate LBP and fibromyalgia, and showed a trend to improvement in kyphosis. Yoga significantly improved pain in OA, RA and mild-to-severe LBP. Psychosocial outcomes were significantly improved in mild-to-moderate LBP and OA. Meta-analysis of good-quality studies showed a moderate treatment effect for yoga of -0.64 (95%CI -0.89 to -0.39) for functional outcomes and -0.61 (95%CI -0.97 to -0.26) for pain outcomes. CONCLUSIONS: Evidence suggests that yoga is an acceptable and safe intervention, which may result in clinically relevant improvements in pain and functional outcomes associated with a range of MSCs. Future analysis of outcomes which take into account the amount of yoga received by participants may provide insight into any putative duration or dosage effects of yoga interventions for MSCs. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 01/2013;
• Article: Measuring Care Transition Quality for Older Patients with Musculoskeletal Disorders.

  Jordache McLeod, Paul Stolee, Jennifer Walker, George Heckman
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  ABSTRACT: OBJECTIVE: The aim of the current study was to examine the ability of a performance measurement scale, the Care Transitions Measure (CTM) adequately to assess the quality of care transitions among a complex population of older musculoskeletal (MSK) rehabilitation patients. METHODS: Fifteen older (aged 60+) patients with MSK disorders were recruited from two inpatient rehabilitation units. A telephone interview was conducted three to four weeks post-discharge; this included the CTM and global questions used for construct validation. To assess inter-rater reliability, the CTM was re-administered to ten subjects in a second interview six to ten days later. Participant comments were recorded in an effort to gauge how respondents understood and interpreted items. RESULTS: The CTM demonstrated acceptable inter-rater reliability for the overall score (intraclass correlation coefficient = 0.77; p = 0.03), in spite of only fair agreement for specific items. The internal consistency was high (Cronbach's alpha = 0.94). The construct validity was supported; however, qualitative data suggest that additional items should be considered for inclusion, and the need for revisions to the wording of the response options and some items. CONCLUSIONS: Although the CTM proved to be reliable for an MSK population, there is a need for modifications to improve the construct validity and utility of the CTM. Recommendations for scale improvement are made. The results of the present study support efforts to improve the outcomes of care transitions, care planning and the overall quality of life for older rehabilitation patients. Copyright © 2013 John Wiley & Sons, Ltd.
  Musculoskeletal Care 01/2013;
• Article: Quality Indicators for Physiotherapy Care in Hip and Knee Osteoarthritis: Development and Clinimetric Properties.

  W F Peter, P J van der Wees, E J M Hendriks, R A de Bie, J Verhoef, Z de Jong, L van Bodegom-Vos, W K H A Hilberdink, T P M Vliet Vlieland
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  ABSTRACT: OBJECTIVE: The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). METHODS: Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups. RESULTS: Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89. CONCLUSION: The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 12/2012;
• Article: 'Rheumatology for the Advanced Age': A Report of the West Midlands Rheumatology Forum Autumn Meeting 2012.

  Rainer Klocke
  Musculoskeletal Care 11/2012;
• Article: Fibromyalgia Family and Relationship Impact Exploratory Survey.

  Dawn A Marcus, Karen Lee Richards, Janet F Chambers, Amrita Bhowmick
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  ABSTRACT: BACKGROUND: Fibromyalgia is frequently associated with impairments in activities of daily living and work disability. Limited data have investigated the impact of fibromyalgia on relationships with family and friends. OBJECTIVES: This exploratory study was designed to survey a large community sample of adults with fibromyalgia about the impact on the spouse/partner, children and close friends. METHODS: A 40-question, multiple-choice survey was made available online for a two-month period, with potential participants recruited through fibromyalgia and migraine community websites. Items included questions about demographics, fibromyalgia symptoms, comorbid mood disturbance and relationship impact, including the Relationship Assessment Scale. RESULTS: The survey was completed by 6,126 adults who had been diagnosed with fibromyalgia. Using updated diagnostic criteria from the American College of Rheumatology, 91% satisfied the criteria for fibromyalgia (Fibromyalgia Severity score ≥13 and pain ≥3 months). Half of participants endorsed that fibromyalgia had mildly to moderately damaged relationship(s) with their spouse(s)/partner(s) or contributed to a break-up with a spouse or partner. Half of participants scored as not being satisfied with their current spouse/partner relationship, with satisfaction negatively affected by the presence of mood disturbance symptoms and higher fibromyalgia severity. Relationships with children and close friends were also negatively impacted for a substantial minority of participants. CONCLUSIONS: In addition to physical impairments that are well documented among individuals with fibromyalgia, fibromyalgia can result in a substantial negative impact on important relationships with family and close friends. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 11/2012;
• Article: Perceptions of Issues Relating to Exercise and Joint Health in Rheumatoid Arthritis: A UK-Based Questionnaire Study.

  Rebecca-Jane Law, David A Markland, Jeremy G Jones, Peter J Maddison, Jeanette M Thom
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  ABSTRACT: OBJECTIVES: This questionnaire study investigated the perceptions of rheumatoid arthritis (RA) patients across the UK in relation to exercise and joint health. The validity of the measure was also assessed. METHODS: Members of the National Rheumatoid Arthritis Society (NRAS) with self-reported RA completed the questionnaire online. Items related to five factors that emerged from previous qualitative research. Participants responded using a five-point Likert-style scale (strongly disagree to strongly agree). The International Physical Activity Questionnaire (IPAQ) assessed physical activity. The model was tested using confirmatory factor analysis (LISREL 8.8); statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS). RESULTS: A total of 247 responses were collected over 47 days (88% females; age: 18-77 years; disease duration: <1-51 years). Acceptable factorial validity was revealed (Satorra-Bentler χ(2)  = 774.47, df = 454, p < 0.001, root mean squared error of approximation (RMSEA) = 0.05, 90% confidence interval RMSEA = 0.05-0.06, comparative fit index = 0.94, standardized root mean square residual = 0.09), with the following factor endorsements: 'Health professionals show exercise knowledge' (19%); 'Knowing what exercise should be done' (43%); 'Having to exercise because it is helpful' (72%); 'Worry about causing harm to joints' (44%); and 'Not wanting to exercise as joints hurt' (52%). Patient concerns about joint pain, joint harm and how to exercise were significantly associated with lower physical activity (p < 0.05). CONCLUSIONS: These results confirm that patients perceive exercise as beneficial. However, concerns about how to exercise, joint pain, causing harm to joints and a perceived lack of exercise knowledge among health professionals remain. Addressing these concerns may have implications for increasing physical activity within the RA population. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 11/2012;
• Article: The Educational Needs of Nurses and Allied Healthcare Professionals Caring for People with Arthritis: Results from a Cross-Sectional Survey.

  Kate Lillie, Sarah Ryan, Jo Adams
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  ABSTRACT: AIM: The purpose of the present study was to identify the educational needs of rheumatology nurses and allied healthcare professionals (AHPs) working with people with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: A cross-sectional national online survey was carried out. RESULTS: The survey was completed by 162 health care practitioners. Seventy-one per cent of respondents had the knowledge and skills to manage the care of a person with RA. The elements of care for which the respondents were either unsure or did not have the necessary knowledge and skills related to providing advice on exercise (37%) and pain medication (30%) to people with RA. There was a consistent tendency for respondents to be less confident in their knowledge and skills when caring for people with OA, with respondents reporting that they were either unsure or did not have the necessary knowledge and skills to advise on appropriate exercise (61%), or medication for the management of pain (45%) or the management of ongoing care (51%). CONCLUSIONS: Current and future educational programmes on RA and OA management should provide nurses and AHPs with the opportunity to develop knowledge and skills in providing advice on exercise and pain medication. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 10/2012;
• Article: Experiences of Healthcare Provision for Foot Ulceration Occurring in People with Rheumatoid Arthritis.

  Jill Firth, Andrea Nelson, Michelle Briggs, Claudia Gorecki
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  ABSTRACT: BACKGROUND: Participants with rheumatoid arthritis (RA) report that foot ulceration has an impact on their health-related quality of life (HRQL) across physical, social and psychological domains. What is not known is how experiences of healthcare provision influence HRQL. The present study set out to map the patent journey while integrating the impact on HRQL. METHODS: A purposive sample of RA patients with open foot ulceration was recruited from podiatry clinics in West Yorkshire (UK) between May 2008 and June 2009. Patients with diabetes were excluded (the impact of foot ulceration in this group is well established). In-depth interviews were taped and transcribed. A framework approach to data management was used to facilitate a case- and theme-based analysis. RESULTS: Twenty-three RA patients (18 female, five male; aged 45-88 years) participated. Two themes and five sub-themes were identified. The patient journey theme comprised the following sub-themes: access to care; knowledge acquisition; care pathways and continuity of care. Patient-professional relationships comprised the sub-themes: therapeutic patient-professional relationships and task-orientated care. The journey took a highly variable course that was influenced by patient-specific factors (past experience of ulceration; symptomology; knowledge and self-efficacy); service-specific factors (access to care and care pathways) and professional-specific factors (knowing and trusting someone; holism). CONCLUSIONS: The present study highlights the need for clearer care pathways for patients affected by foot ulceration improved patient education and better coordination of care. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 10/2012;
• Article: The Continuing Professional Development for Nurses and Allied Health Professionals Working Within Musculoskeletal Services: A National UK Survey.

  Hannah Haywood, Helen Pain, Sarah Ryan, Jo Adams
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  ABSTRACT: OBJECTIVES: To explore the current UK status of continuing professional development (CPD) for nurses and allied health professionals (AHPs) working in musculoskeletal (MSK) services in the UK. METHODS: A web-based survey was developed and used to collect data from service managers, nurses and AHPs who work with people who have MSK conditions, recruited through professional interest groups via email and website notices. The questionnaire was designed following focus groups and telephone conference calls with managers and AHPs from MSK services to ensure content validity. Results were collected online and analysed in SPSS PASW 17 using frequency data and χ(2) analyses. RESULTS: A total of 354 responses were analysed. The most frequently reported reason for undertaking CPD was to improve patient care. The level of staff experience made no significant difference to the CPD activities undertaken. The majority of respondents reported that their organization was supportive of CPD activities and in applying new knowledge to practice, but lack of funding and having too many other tasks to complete at work were the most frequently reported barriers to CPD. Many commented about the difficulty in accessing CPD in the face of increasing workload pressure and tightened budgets. CONCLUSIONS: The results indicate that despite the organizational support for CPD, respondents faced substantial challenges in accessing CPD when under pressure to achieve productivity targets, with little assistance in terms of funding. This discrepancy may indicate that greater support is required to meet MSK nurses' and AHPs' CPD needs. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 09/2012;
• Article: Continuing professional development in musculoskeletal domains.

  Louise Warburton
  Musculoskeletal Care 09/2012; 10(3):125-6.
• Article: Users' Experience of Physical Activity Monitoring Technology in Rheumatoid Arthritis.

  Marie Tierney, Alexander Fraser, Norelee Kennedy
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  ABSTRACT: OBJECTIVES: The aim of the present study was to qualitatively explore users' experiences of home monitoring of health with specific regard to physical activity monitors. METHODS: Fourteen participants were randomly selected from a larger sample of individuals with rheumatoid arthritis (RA) who had taken part in a physical activity monitoring study and had worn two physical activity monitors for seven days in their homes. These individuals were assigned to one of two focus groups. Each focus group lasted for between 40 minutes and an hour and was audio-recorded. A semi-structured questioning route was used, followed by subsequent theoretical thematic analysis. RESULTS: No statistically significant differences were noted in the demographic factors between those who took part in the focus groups and the entire RA sample. Three distinct themes were identified: i) Experiences of having health monitored in the home, which was found to be largely positive; ii) Experiences of use of specific technology to monitor physical activity, which was generally reported as unobtrusive and not to impact significantly negatively on their daily life; iii) Perceptions and experiences of physical activity and exercise, which monitoring was reported to facilitate focusing on physical activity choices. CONCLUSIONS: These focus groups were the first to highlight the perceptions held by individuals with RA regarding home monitoring and, in particular, physical activity monitoring. This has implications for those planning interventions for this group which involve home monitoring. Interesting findings were also highlighted regarding the perceptions and understanding of physical activity and exercise among people with RA. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 08/2012;
• Article: Fatigue in Ankylosing Spondylitis: Causes, Consequences and Self-Management.

  Wendy Farren, Lynne Goodacre, Mark Stigant
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  ABSTRACT: OBJECTIVES: To explore the perceived causes, consequences and management of fatigue in ankylosing spondylitis (AS). METHODS: In this single-cohort qualitative study, ten participants completed a seven-day diary and participated in a semi-structured interview exploring possible causes, consequences and self-management of fatigue. Interviews were recorded, transcribed and analysed using 'framework' analysis. Ethical approval was obtained. RESULTS: Three themes emerged: patterns and causes, consequences and management of fatigue. While patients' descriptions of fatigue were similar, the patterns and perceived causes of fatigue varied between individuals. Fatigue impacted on social life, relationships and work. Two approaches to fatigue management were observed: help and support from others and self-management, with four participants having sought medical help for fatigue. CONCLUSIONS: The study suggested that fatigue has a negative impact on quality of life in people with AS. Future practice should include a comprehensive fatigue assessment and the development of treatment programmes directed at enhancing self-management techniques. Copyright © 2012 John Wiley & Sons, Ltd.
  Musculoskeletal Care 07/2012;