Patient experiences of hydrodistension as a treatment for frozen shoulder: a longitudinal qualitative study

Background Frozen shoulder is a condition associated with severe shoulder pain and loss of function impacting on a persons' physical and mental health. Hydrodistension treatment that has been widely adopted within the UK National Health Service for the condition. However, evidence of clinical effectiveness and understanding of the patient experiences of this treatment are lacking. This study explored the experiences of people with a frozen shoulder who received hydrodistension treatment. Methods A qualitative design with repeat semi-structured interviews was used to explore participants' experiences of hydrodistension treatment. Participants were interviewed 2-4 weeks and again at 8-10 weeks after treatment. Interviews were audio-recorded and transcribed verbatim. Findings were analysed using an inductive thematic analysis framework. The study is reported in accordance with the consolidated criteria for reporting qualitative (COREQ) research. Results 15 participants were interviewed online or over the phone. Three themes were identified: 'Preparing for and having a hydrodistension', 'Physiotherapy after hydrodistension', and 'Outcome of hydrodistension '. Participants believed hydrodistension would benefit them, was well tolerated by many, and the effects were apparent to most within the first week. Physiotherapy still seemed to be valued to support recovery beyond this timepoint, despite these early effects. Some participant's experienced harms including severe procedural pain and blood sugar dysregulation. Conclusion This is the first study to investigate the experiences of people who undergo hydrodistension for frozen shoulder. Hydrodistension appears an acceptable treatment to participants with a frozen shoulder, acceptability is enhanced through adequate shared decision making. Further high-quality research is required to understand the comparative effectiveness of hydrodistension as a treatment for frozen shoulder, including adverse events, and the benefit of treatment by a physiotherapist after hydrodistension

Exploring the pre-morbid contexts in which central sensitisation developed in people with non-specific chronic low back pain. A qualitative study

Background Central sensitisation pain is a predominant mechanism in a proportion of individuals with non-specific chronic low back pain and is associated with poor outcomes. It is proposed that the pre-morbid experiences and contexts may be related to the development of central sensitisation. Objectives The objective of this study was to explore the pre-morbid experiences and personal characteristics of participants with central sensitisation pain from a non-specific chronic low back pain population. Methods This was a qualitative, exploratory study, using a concurrent nested design within a mixed methods protocol. n = 9 participants were recruited purposively based on sensory profiles and trait anxiety-related personality types. Data were collected through semi structured interviews, managed using QSR NVivo 10 software and analysed using theoretical thematic analysis. Results Four themes emerged: developmental learning experiences, personal characteristics, sensitivity and trauma. Reported was lack of confidence, low esteem and a need to please others, physical hyper-sensitivities (smell, light, sound) and emotional sensitivity (anxiety) as well as physical hypo-sensitivity. Participants had also suffered emotional and/or physical trauma. Learning difficulties, sensory sensitivities and trauma are associated with autonomic stress responses, which in turn have been linked to physiological changes seen in central sensitisation pain. Conclusion Central sensitisation pain developed in the context of sensory processing differences related to learning difficulties, sensitivities and trauma, and personal characteristics of low confidence and control, in a group of participants with non-specific chronic low back pain. The role of pre-existing sensory processing differences, as a component of altered central nervous system function, in relation to central sensitisation pain warrants further investigation

An exploration of the experiences of people living with painful ankle osteoarthritis and the non-surgical management of this condition

Objectives Osteoarthritis (OA) of the ankle joint is associated with life-long joint pain and disability if not appropriately managed. There is a dearth of research concerning ankle OA and the impact on those living with the condition. Aim: To explore the experiences of people living with painful OA ankle and their views about the non-surgical management of this condition. Design Qualitative design, using semi-structured interviews. Participants Nine participants, recruited from an orthopaedic clinic at a UK hospital and the general population. All had a clinical and radiographic diagnosis of OA ankle. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken to identify emerging themes. Ethical approval was obtained. Results: Nine semi-structured interviews were undertaken. Eight participants were male, median age = 55 years (IQR = 42.5 - 64.5). Mechanism of onset was due to trauma (falls, repeated inversion injuries or road traffic collisions) (n = 7), or the effects of haemophilia (n = 2). The median duration of symptoms was 2 years (IQR = 1.5 - 10). Data saturation was achieved. Four themes were identified: • Signs and symptoms • Impact on participation • Impact on self-identity & mental wellbeing • Views on non-surgical management Conclusions: This is the first study to explore the experiences of people with symptomatic OA ankle. Our findings suggest that those with OA ankle suffer with severe pain, which has a substantial negative impact on a person’s physical and mental wellbeing. The findings of this study may be used to inform future research

The Effectiveness of Digital Health Interventions in the Management of Musculoskeletal Conditions: Systematic Literature Review

Background: Musculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations that address time and resource constraints Objective; This review aimed to investigate if digital health interventions are effective in reducing pain and functional disability in patients with musculoskeletal conditions. Methods: A systematic review was undertaken to address the research objective. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews before commencement of the study. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature, and Scopus from January 1, 2000, to November 15, 2019, using search terms and database specific−medical subject headings terms in various combinations appropriate to the research objective Results: A total of 19 English language studies were eligible for inclusion. Of the 19 studies that assessed musculoskeletal pain, 9 reported statistically significant reductions following digital intervention. In all, 16 studies investigated functional disability; 10 studies showed a statistically significant improvement. Significant improvements were also found in a range of additional outcomes. Due to the heterogeneity of the results, a meta-analysis was not feasible Conclusions: This review has demonstrated that digital health interventions have some clinical benefits in the management of musculoskeletal conditions for pain and functional disability. Digital health interventions have the potential to contribute positively toward reducing the multifaceted burden of musculoskeletal conditions to the individual, economy, and society. Trial Registration: OSPERO CRD42018093343; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=9334

The impact of introducing hydrodistension as a treatment for frozen shoulder in a primary care musculoskeletal service: a retrospective audit

Introduction Hydrodistension, where a relatively high volume of local anaesthetic, corticosteroid, and sterile saline are injected into the shoulder joint, is a treatment of interest for frozen shoulder. In the UK National Health Service this is typically provided in the hospital setting. In 2017 we introduced hydrodistension into our physiotherapy led musculoskeletal service. This report describes the findings from our audit of onward referral for orthopaedic assessment following the introduction of hydrodistension to our frozen shoulder treatment pathway. Methods A retrospective audit of data from 102 patients who followed our hydrodistension treatment pathway for frozen shoulder since 2017 was conducted. All 102 patients received at least one hydrodistension procedure performed by a physiotherapist. This involved injecting the glenohumeral joint with a combination of local anaesthetic, corticosteroid, and saline under ultrasound guidance with a total volume of 25–35 mls. This data was compared to the outcomes of 102 patients who presented with frozen shoulder prior to 2017 who did not receive hydrodistension. Results Of 102 patients who received hydrodistension within the musculoskeletal service, six patients required onward referral to orthopaedics. Of the 102 patients who did not receive hydrodistension prior to 2017, 58 required onward referral to orthopaedics. Conclusion We report a reduction in onward referral to orthopaedics following the introduction of hydrodistension to our physiotherapist-led treatment pathway for patients with frozen shoulder. This preliminary data identifies the need to further evaluate the clinical and cost-effectiveness of hydrodistension performed by physiotherapists for patients with frozen shoulder

Nigerian physiotherapists’ knowledge, current practice and perceptions of their role for promoting physical activity: A cross-sectional survey

Background: Nigeria has the highest rates of physical inactivity in Africa. As physical inactivity is a leading global risk factor for non-communicable diseases (NCD), physical activity promotion is a strategy for their mitigation. Physiotherapists are already ideally situated to undertake this role and can assist in the reversal of NCD. Gaining insight into how physiotherapists in Nigeria perceive their role in relation to physical activity promotion is needed to ensure this undertaking will be effective. This national survey aimed to investigate Nigerian physiotherapists’ knowledge and current practice for promoting physical activity across Nigeria and perceptions of their role related to this. Methods: Following ethical approval, a cross-sectional, online questionnaire survey design was employed to investigate the aim. 330 qualified physiotherapists, working across Nigeria were recruited. Internal consistency of the survey was examined using Cronbach’s alpha. Descriptive statistics were used to analyse closed questions. Thematic content analysis was used to analyse open-ended questions. Chi-square inferential statistic was used to investigate the association between variables with alpha interpreted at a level of 0.05. Results: The internal consistency of the questionnaire survey was good overall (Cronbach Alpha α = 0.71). 330 physiotherapists participated. 99.4% agreed that discussing the benefits of a physically active lifestyle with patients is part of their role. However, over 60% did not feel confident in suggesting specific physical activity programs for their patients. 59.7% were aware of one or more physical activity guideline. However, only 49.1% were incorporating it into their practice. 85.5% felt that developing a physical activity guideline specifically for Nigeria would promote physical activity. 63.3% of respondents did not use any resource in promoting physical activity. An association was found between the physiotherapist’s awareness of physical activity guidelines and male sex (χ2 = 8.95, df = 2, p = 0.01). Conclusion: Whilst most physiotherapists had a positive perception of their role in promoting physical activity, translating this into practice would seem to be challenging. A systems approach to physical activity health promotion is recommended with the need for a commitment by the Nigerian Government to the development and implementation of national guidelines. Incorporating more training in physiotherapy education could foster more confidence in the delivery of these guidelines. Greater use of resources and working with community organisations could help to optimise physical activity uptake in Nigeria

"Promoting the mental and physical wellbeing of people with mental health difficulties through social enterprise”

Purpose Interventions that promote both mental and physical wellbeing have been advocated for people with mental health difficulties, as they have been found to engage less in healthy behaviours and have lower levels of physical fitness. However, no optimal approach to facilitate this undertaking has been identified. This exploratory research aims to explore the experiences of people with psychological distress who accessed a social enterprise that fosters the building of positive social networks in the community, as part of a personalised recovery programme. The intention was to gain an insight into its therapeutic effect in relation to mental and physical health. Methodology An exploratory survey design was undertaken with a purposive sample of 50 individuals who had attended the enterprise. Descriptive statistics and thematic analysis were employed to analyse the data from both closed and open-ended questions. Findings The wellbeing service appeared to provide a supportive environment that offered people access to social networks through their participation in local services and activities. Fostering participants’ active participation, connection building and the ability to make meaningful contributions helped to facilitate health behaviours that had a positive impact on their health and wellbeing Originality/value This study highlights the potential role of a social enterprise in optimising the social context for promoting the health and wellbeing of people with mental health difficulties

Recommendations on patient-facing websites regarding diagnostic imaging for low back, knee, and shoulder pain: A scoping review

Objective To describe and synthesise the content of public-facing websites regarding the use of diagnostic imaging for adults with lower back pain, knee, and shoulder pain. Methods Scoping review conducted in accordance with PRISMA guidance. A Google search was performed to identify public-facing websites that were either United Kingdom-based, or National Health Service affiliated. The DISCERN tool was used to appraise website quality before information regarding the use of imaging was synthesised using thematic analysis. Results Eighty-six websites were included, with 48 making reference to the use of imaging. The information within the majority (n = 43) of public-facing websites aligns with best available evidence. Where there is inconsistency, this may be explained by lower website quality. Three themes were apparent regarding the use of imaging – imaging to inform diagnosis and management; imaging in context; patient experience and expectations. Conclusion The recommendations and rationale for use of imaging contained within public-facing websites does not appear to justify the increase in imaging rates for musculoskeletal pain in the UK. Innovation Publicly available information following a novel search strategy, is largely aligned with best evidence, further understanding is required to determine reasons for requesting imaging from a patient and clinician perspective