Pre-operative preparation of patients for total knee replacement: An action research study

Aims and objectives: To examine the development and impact of a multidisciplinary preparation clinic for patients undergoing total knee replacement (TKR) surgery. Background: There is evidence to suggest that patients’ preoperative characteristics such as pain and mental state impact the long term results of TKR surgery. Preparation sessions may help in identifying and working with those patients whose preoperative status could reduce the benefits of surgery. Design: Action research. Method: Actions cycles were carried out to develop an information booklet and multidisciplinary Knee Clinic at an acute Trust in outer London, UK. A sample (n = 23) of patients was recruited to test changes as they were implemented. Results: The Knee Clinic involved nurse practitioners, occupational therapists, physiotherapists and service users (patients recovered from TKR surgery). Elements of physical and social assessment and interventions were carried out using a Social Cognitive Theory framework. Patients reported they benefitted from the information booklet and attendance at the Knee Clinic. Conclusion: A structured pre-operative information and assessment clinic can be developed using a Social Cognitive Theory framework for the benefit of patients. Further studies are required to examine and utilise psychological assessment of patients at such clinics

A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis

This systematic review aimed to determine the effectiveness of interventions for improving knowledge and/or self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis (RA). We searched four databases (MEDLINE, CINAHL, Cochrane Trials, PsycINFO) using a comprehensive search strategy. Studies were eligible if they were prospective, published in English from 2004 to 2015, included participants with RA and tested an intervention designed to improve knowledge and/or self-management skills relating to family planning, pregnancy or breastfeeding. As no studies met the latter criterion, the search strategy was expanded to include all prospective studies evaluating RA educational and/or self-management interventions. Data on study characteristics, participant characteristics and programme content were extracted to summarise the evidence base for interventions to support people with RA during their reproductive years. Expanded literature searches identified 2290 papers, of which 68 were eligible. Of these, nine papers (13 %) specifically excluded pregnant women/breastfeeding mothers or recruited only older people.Only one study (1 %) explicitly evaluated pregnancy-focused education via a motherhood decision aid, while eight studies (12 %) incorporated relevant (albeit minor) components within broader RA educational or self-management interventions. Of these, three studies provided methotrexate education in relation to conception/pregnancy/breastfeeding; three incorporated discussions on RA and relationships, impact of RA on the family or sexual advice; one provided information regarding contraception and fertility; and one issued a warning regarding use of biologic therapy in pregnancy/breastfeeding. In conclusion, information regarding family planning, pregnancy or breastfeeding represents a negligible part of published RA educational interventions, with scope to develop targeted resources

Occupational advice for Patients undergoing Arthroplasty of the Lower limb: An intervention development and feasibility study (The OPAL Study)

Background Hip and knee replacements are regularly performed for patients who work. There is little evidence about these patients’ needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. Objective(s) To develop an occupational advice intervention to support early recovery to usual activities including work which is tailored to the requirements of patients undergoing hip and knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks Design An intervention mapping (IM) approach was used to develop the intervention. The research methods employed were: rapid evidence synthesis; qualitative interviews with patients and stakeholders; prospective cohort study; survey of clinical practice; modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the IM process. Setting Orthopaedic departments within NHS secondary care. Participants Patients in work, and intending to return to work following primary elective hip and knee replacement surgery; healthcare professionals and employers. Interventions Occupational advice intervention. Main outcome measures Development of an occupational advice intervention. Fidelity of the developed intervention when delivered in a clinical setting. Patient and clinician perspectives of the intervention. Preliminary assessments of intervention effectiveness and cost. Results A cohort study (154 patients), 110 stakeholder interviews, survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, personalized return to work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives (POs). To support delivery, a range of tools (e.g. occupational checklists, patient workbooks, employer information), roles (e.g. return-to-work coordinator) and training resources were created. Feasibility was assessed in 21 of the 26 patients recruited from 3 NHS trusts. Adherence with the defined performance objectives was 75% for patient POs and 74% for staff POs. The intervention was generally well received although the short timeframe available for implementation and concurrent research evaluation led to some confusion amongst patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. Limitations Implementation and uptake of the intervention was not standardized and was limited by the study timeframe. Evaluation of the intervention involved a small number of patients which limited the ability to assess it. Conclusions The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention Future work The intervention warrants a randomised controlled trial to assess its clinical and cost effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure adoption is sustained. Funding This project was funded by the NIHR Health Technology Assessment programme (project number 15/28/02) Trial Registrations International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982 International prospective register of systematic reviews (PROSPERO) Registration: CRD4201604523

L’annonce diagnostique dans la maladie chronique

L’annonce diagnostique, « minute éternelle », laisse une « empreinte indélébile » : tout patient se rappelle avec précision le contexte dans lequel il a appris ou deviné sa maladie. Cette consultation d’annonce pose des problèmes liés au médecin : temps (accueil, écoute, disponibilité...), au patient : sidération émotionnelle (le nom de la maladie est donné, mais il n’est pas entendu!) et à l’annonce elle-même : il n’y a pas une seule annonce mais des annonces (processus continu). Pour la consultation d’annonce en rhumatologie : il n’y a pas de recette, pas de « bonnes pratiques », elle n’est pas stéréotypée (il ne faut ne pas jouer un rôle ou réciter une méthode : à chacun son style). Mais, il ne faut pas être pris au dépourvu et improviser. En effet, la qualité de l’annonce diagnostique conditionne l’« acceptation » et le vécu ultérieur de la maladie chronique. L’annonce demande donc une démarche réfléchie et élaborée. Il est nécessaire de la faire après avoir évalué l’attitude du patient face à la maladie, et de répondre ainsi à ses attentes et à ses besoins personnels, afin de s’ajuster au patient et de progresser dans la démarche avec lui. Au décours de l’annonce, il est bon de revoir lepatient pour renforcer la consultation d’annonce, l’informer sur la maladie-les traitements, répondre à toutes les nouvelles questions, l’aider à « annoncer » aux autres et l’accompagner tout au long du suivi de sa maladie chronique

Characteristics and development of therapeutic patient education in rheumatology : analysis of the 2003-2008 literature

Objective:The aim of this study is to point out the recent characteristics and developments of therapeutic patient education(TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. Method: Studies were selected from major databases,using the following keywords:rheumatoid arthritis, patient education, self-management, programs. Thre eauthors independently reviewed each studyand selected the data using the patient education research categories(PERC). Articles consistently related to patient education in rheumatoid arthritis(37among109) were included. Results: The selected articles have been published in 23 scientific journals.The majority of them concern TPE for adult patients with rheumatoid arthritis.TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team.There are two types of programs:educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers toTPE are linked to cultural and socio-economic factors. Conclusion: A large number of studies stilla ssess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barrierst ot his practice havebecome a major issu

Characteristics and development of therapeutic patient education in rheumatology : analysis of the 2003-2008 literature

Objective:The aim of this study is to point out the recent characteristics and developments of therapeutic patient education(TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. Method: Studies were selected from major databases,using the following keywords:rheumatoid arthritis, patient education, self-management, programs. Thre eauthors independently reviewed each studyand selected the data using the patient education research categories(PERC). Articles consistently related to patient education in rheumatoid arthritis(37among109) were included. Results: The selected articles have been published in 23 scientific journals.The majority of them concern TPE for adult patients with rheumatoid arthritis.TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team.There are two types of programs:educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers toTPE are linked to cultural and socio-economic factors. Conclusion: A large number of studies stilla ssess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barrierst ot his practice havebecome a major issu