Is healing an option to aid sustainable healthcare futures?

It is becoming ever more apparent that the current model of healthcare delivery within developed countries is not sustainable. There are at least two major problems: the continuing development of expensive, high-technology approaches to diagnosis and treatment, which are putting an unsustainable economic burden on healthcare organisations (1); and the rapidly increasing carbon footprint of modern healthcare delivery systems, resulting in an unsustainable burden on the planet (2). Many possible answers to these problems are being considered by medical bodies including the British Medical Association (3). In addition, politicians are turning their attention to prevention, and are trying to move the responsibility for maintaining good health away from healthcare workers, and back to individuals and communities. For example, Public Health England is developing work on ‘salutogenesis’ (the generation of health) in addition to working on the prevention of disease (4,5). Over the last few years there has also been a burgeoning interest in what might be called ‘low-tech/high talk’ interventions such as the ‘walk and talk for mental health’ movement (6) and arts for healthcare (7). This has been accompanied by an increasing appetite amongst the public for complementary and alternative approaches to medicine (CAM)

Galen and Wellbeing: Whole Person Care

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MOBILE and the provision of total joint replacement

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research

All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study

Objective To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip

Randomized controlled trial of a primary care–based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for skeletal health in Bristol and Avon (COSHIBA)

Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures. Despite this, less than one-third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of this study was to investigate whether a novel primary care–based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomized controlled trial was undertaken in 15 general practices within the Bristol area of the UK. A total of 3200 women aged 65 to 80 years were enrolled, with no exclusion criteria. A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs. All identified high-risk women were offered a diagnostic thoracolumbar radiograph. Radiographs were reported using standard National Health Service (NHS) reporting, with results sent back to each participant's general practitioner (GP). Participants in the control arm did not receive the screening tool or radiographs. The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a random 5% subsample verified against electronic GP records. Secondary outcome was self-reported incidence of new fractures. Results showed that allocation to screening increased prescription of osteoporosis medications by 124% (odds ratio [OR] for prescription 2.24 at 6 months; 95% confidence interval [CI], 1.16 to 4.33). Allocation to screening also reduced fracture incidence at 12-month follow-up (OR for new fracture 0.60; 95% CI, 0.35–1.03; p = 0.063), although this did not reach statistical significance. This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK. © 2012 American Society for Bone and Mineral Researc

Review of 99 self-report measures for assessing well-being in adults:exploring dimensions of well-being and developments over time

OBJECTIVE: Investigators within many disciplines are using measures of well-being, but it is not always clear what they are measuring, or which instruments may best meet their objectives. The aims of this review were to: systematically identify well-being instruments, explore the variety of well-being dimensions within instruments and describe how the production of instruments has developed over time. DESIGN: Systematic searches, thematic analysis and narrative synthesis were undertaken. DATA SOURCES: MEDLINE, EMBASE, EconLit, PsycINFO, Cochrane Library and CINAHL from 1993 to 2014 complemented by web searches and expert consultations through 2015. ELIGIBILITY CRITERIA: Instruments were selected for review if they were designed for adults (≥18 years old), generic (ie, non-disease or context specific) and available in an English version. RESULTS: A total of 99 measures of well-being were included, and 196 dimensions of well-being were identified within them. Dimensions clustered around 6 key thematic domains: mental well-being, social well-being, physical well-being, spiritual well-being, activities and functioning, and personal circumstances. Authors were rarely explicit about how existing theories had influenced the design of their tools; however, the 2 most referenced theories were Diener's model of subjective well-being and the WHO definition of health. The period between 1990 and 1999 produced the greatest number of newly developed well-being instruments (n=27). An illustration of the dimensions identified and the instruments that measure them is provided within a thematic framework of well-being. CONCLUSIONS: This review provides researchers with an organised toolkit of instruments, dimensions and an accompanying glossary. The striking variability between instruments supports the need to pay close attention to what is being assessed under the umbrella of ‘well-being’ measurement

Transformational Changes in Health Status: A Qualitative Exploration of Healing Moments

Background and Aims: Dramatic self-change is a familiar concept within religious experience and is recognized within psychotherapy and some fields of nursing. However, it has been given limited consideration in wider health research, including healing research. We sought to explore the phenomenon of “healing moments”. Methods: Alternative medicine practitioners attending a continuing professional development course for healers within the UK’s Holistic Health Show were shown a 10 min video clip showing two of the authors discussing healing moments. Sixty-nine (69) of the practitioners then provided “short stories” outlining their own experiences of such moments. Both the video and the short stories were analysed qualitatively using a thematic approach. We sought to evaluate holistic practitioners’ perceptions of the concept of healing moments. Results: The concept of healing moments was widely accepted by the 69 participants. An overarching theme of transformational change described personal shifts that ranged from the sudden and quasimiraculous to transient but much-needed improvements in health and wellbeing. Three subordinate themes of connectivity, quiescence and control were identified. Connectivity described intense connections, experienced through touch, empathy and love, which could provide reciprocal benefits for healers as well as clients. Quiescence captured the quiet, calm atmosphere that pervaded many healing episodes. The contrasting aspects of control encompassed healers relinquishing control to channel healing, and clients seizing control to become empowered in their own healing process. Conclusion :Healing moments are a recognized and distinct concept within healing, although they remain under-explored in the literature. Our findings suggest that such experiences are common among alternative medicine practitioners. The concepts we uncovered can inform future research

Rest Pain and Movement-Evoked Pain as Unique Constructs in Hip and Knee Replacements

OBJECTIVE: There is limited information about the extent to which the association between preoperative and chronic postoperative pain is mediated via pain‐on‐movement or pain‐at‐rest. We explored these associations in patients undergoing total hip replacement (THR) and total knee replacement (TKR). METHODS: A total of 322 and 316 patients receiving THR and TKR, respectively, were recruited into a single‐center UK cohort (Arthroplasty Pain Experience) study. Preoperative, acute postoperative, and 12‐month pain severity was measured using self‐reported pain instruments. The association between preoperative/acute pain and chronic postoperative pain was investigated using structural equation modeling (SEM). RESULTS: Patients with high levels of preoperative pain were more likely to report chronic pain after THR (β = 0.195, P = 0.02) and TKR (β = 0.749, P < 0.0001). Acute postoperative pain‐on‐movement was not associated with chronic pain after TKR or THR after adjusting for preoperative pain; however, acute pain‐at‐rest was associated with chronic pain after THR (β = 0.20, P < 0.0002) but not TKR after adjusting for preoperative pain. Analysis of pain‐at‐rest and pain‐on‐movement highlighted differences between THR and TKR patients. Chronic pain‐at‐rest after THR was weakly associated with pain‐at‐rest during the preoperative (β = 0.11, P = 0.068) and acute postoperative period (β = 0.21, P < 0.0001). In contrast, chronic pain‐on‐movement after TKR was strongly associated with the severity of pain‐on‐movement during the preoperative period (β = 0.51, P = 0.001). CONCLUSION: SEM illustrated the different patterns of association between measures of pain over time in patients undergoing THR and TKR for osteoarthritis. These findings highlight the importance of future work that explores the mechanisms underlying pain‐on‐movement and pain‐at‐rest