Examining the Building Blocks of Health Behavior Change in Rheumatology Rehabilitation: A Theory-Driven Qualitative Study

Gunnhild Berdal,1 Ingvild Kjeken,1 Anita Dyb Linge,2 Ann Margret Aasvold,3 Kjetil Tennebø,4 Siv Grødal Eppeland,5 Anne Sirnes Hagland,6 Guro Ohldieck-Fredheim,7 Helene Lindtvedt Valaas,1,7 Ingvild Bø,8 Åse Klokkeide,9 Maryam Azimi,10 Turid N Dager,1 Anne-Lene Sand-Svartrud1 1Health Services Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; 2Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway; 3Meråker Rehabilitation Centre, Meråker, Norway; 4Valnesfjord Health Sports Centre, Valnesfjord, Norway; 5Department of Physiotherapy, Sørlandet Hospital, Arendal, Norway; 6Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway; 7Vikersund Rehabilitation Centre, Vikersund, Norway; 8Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway; 9Rehabilitering Vest Rehabilitation Centre, Haugesund, Norway; 10REMEDY Patient Advisory Board, Diakonhjemmet Hospital, Oslo, NorwayCorrespondence: Gunnhild Berdal, Health Services Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, P.O. Box 23 Vinderen, Oslo, N-0319, Norway, Tel +47 91 88 71 63, Email [email protected]: To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients’ descriptions of their capability, opportunity, motivation, and readiness for health behavior change.Patients and Methods: Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior.Results: Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden.Conclusion: The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients’ persistent engagement in healthy behaviors.Keywords: rheumatic diseases, musculoskeletal diseases, rehabilitation, behavior therapy, qualitative research, patient engagemen

Predictive Factors, Management, and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation Insights From a Large Multicenter Registry

Objectives This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). Background Very little data exist on CO following TAVI. Methods This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1: 1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). Results Baseline and procedural variables associated with CO were older age (p<0.001), female sex (p<0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower inpatients with obstruction than in control subjects (10.6 +/- 2.1 mm vs. 13.4 Conclusions Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication. (C