First validation study of the living with long term conditions scale (LwLTCs) among English-speaking population living with Parkinson's disease

INTRODUCTION: Parkinson's disease is the second most prevalent neurodegenerative disease, affecting 10 million people worldwide. Health and social care professionals need to have personalised tools to evaluate the process of living with Parkinson's disease and consequently, plan individualised and targeted interventions. Recently, the English version of the Living with Long term conditions (LwLTCs) scale has been developed filling an important gap related to person-centred tools to evaluate the process of living with long term conditions among English-speaking population. However, no validation studies for testing its psychometric properties have been conducted. AIM: To analyse the psychometric properties of the LwLTCs scale in a wide English-speaking population living with Parkinson's disease. METHODS: Validation study, with an observational and cross-sectional design. The sample was composed of individuals living with Parkinson's disease from non-NHS services in the community. Psychometric properties including feasibility and acceptability, internal consistency, reproducibility, and construct, internal and known-groups validity were tested. RESULTS: A total sample of 241 people living with Parkinson's disease were included. 6 individuals did not complete 1 or 2 items on the scale. Ordinal alpha was 0.89 for the total scale. The intraclass correlation coefficient for the total scale was 0.88. The LwLTCs scale is strongly correlated with scales measuring satisfaction with life (rs=0.67), quality of life (rs=0.54), and moderately correlated with social support (rs=0.45). Statistically significant difference just for therapy and co-morbidity, yet no for gender, employment situation, or lifestyle changes. CONCLUSIONS: The LwLTCs scale is a valid scale to evaluate how the person is living with Parkinson's disease. Future validation studies to prove the repeatability of the total scale and particularly, domains 3-Self-management, and 4-Integration and internal consistency will be needed. Developing further studies on the English version of the LwLTC in people with other long term conditions is also proposed

SAT0583-HPR - Differences between service providers and users when defining feasible optimal NHS occupational therapy treatment for patients with thumb base OA : results from a Delphi study

Background: The OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year developmental study for a full randomised controlled trial (RCT) into the clinical and cost effectiveness of an occupational therapy and splint intervention for thumb base OA. To develop an optimal package of care for evaluation within a multi-centre RCT, the views of both clinicians and patients are crucial. Objectives: To conduct a Delphi study to obtain agreement between both patients with thumb base OA and AHPs concerning the most appropriate optimal NHS OT programme, splint and placebo splint intervention to use in the RCT. Methods: The Delphi panel consisted of 63 AHPs experienced in treating adults with thumb base OA, and 7 patients with thumb base OA. The panel were asked to rate how much they agreed or disagreed about what optimal NHS OT care for thumb base OA should include, and what method(s) of delivery (individual one-to-one, group, patient leaflets, or telephone advice) they deemed were more appropriate. The Delphi study comprised 3 rounds. A seven-point Likert-type scale was used. Pre-defined inclusion and exclusion criteria were applied in order to reach a final number of statements which, in turn, created the desired tool. Group differences were analysed using Mann-Whitney U tests. Results: Between-groups analyses showed significant differences in the ratings of overall importance of items to be included in an optimal NHS OT consultation (Table 1). Conclusions: AHPs and patients differed in their views about the importance of including ‘Education for Family/Significant Others/Carers’, ‘NHS Clinic Procedures’, ‘Prognosis Advice’, ‘Referral to other Health Care Professional’, ‘Sleep Assessment and Management’ and ‘Treatment Options’ in an optimal NHS OT consultation, and in the methods of delivery used in the consultation. AHPs placed significantly less importance than patients on ‘One-to-One Contact’, ‘Leaflets’ and ‘Telephone Advice’. These findings demonstrate the importance of consulting with patients at an early stage in developing an intervention

The Osteoarthritis Thumb Therapy (OTTER) II Trial: a study protocol for a three-arm multi-centre randomised placebo controlled trial of the clinical effectiveness and efficacy and cost-effectiveness of splints for symptomatic thumb base osteoarthritis

Copyright © Author(s) (or their employer(s)) 2019. Introduction: The economic cost of osteoarthritis (OA) is high. At least 4.4 million people have hand OA in the UK. Symptomatic thumb base OA affects 20% of people over 55 years, causing more pain, work and functional disability than OA elsewhere in the hand. Most evidence-based guidelines recommend splinting for hand OA. Splints that support or immobilise the thumb base are routinely used despite there being limited evidence on their effectiveness. The potential effects of placebo interventions in OA are acknowledged, but few studies investigate the clinical efficacy of rehabilitation interventions nor the impact of any placebo effects associated with splints. Methods and analysis: Participants aged 30 years and over with symptomatic thumb base OA will be recruited into the trial from secondary care occupational therapy and physiotherapy centres. Following informed consent, participants will complete a baseline questionnaire and then be randomised into one of three treatment arms: a self-management programme, a self-management programme plus a verum thumb splint or a self-management programme plus a placebo thumb splint. The primary outcome is the Australian Canadian Osteoarthritis Hand Index (AUSCAN) hand pain scale. The study endpoint is 8 weeks after baseline. Baseline assessments will be carried out prior to randomisation and outcomes collected at 4, 8 and 12 weeks. Cost-effectiveness analysis will be conducted and individual qualitative interviews conducted with up to 40 participants after 8 weeks to explore perceptions and outcome expectations of verum and placebo splints and exercise. Ethics and dissemination: South Central—Oxford C Research Ethics Committee approved this study (16/SC/0188). The findings will be disseminated to health professional conferences, journals and lay publications for patient organisations. The research will contribute to improving the management of thumb base OA and help clinicians and patients make informed decisions about the value of different interventions. Trial registration number: ISRCTN54744256Arthritis Research U

The transdermal absorption of tea tree oil and potential anti-inflammatory properties

Melaleuca alternifolia (Tea tree oil) is commonly used by the general public in the treatment of superficial dermatological conditions. There is a growing body of evidence to support its use as an anti-fungal and anti-bacterial agent. However, there is little evidence of the in vivo penetration of components of the oil through the skin, imperative to ensure its use is directed appropriately and safely. Furthermore the extent of TTO’s ability as an anti-inflammatory agent and its potential mode of action are not know.This thesis describes the adaption and validation of the method in vivo dermal microdialysis in order to identify and quantify components of tea tree oil present at the dermal epidermal junction following the topical application of 100% TTO. In vitro investigations identified that the addition of hydroxypoply –?-cyclodextrin to the perfusate, the adjustment of flow rate and the use of cuprophan membranes ensured optimal recovery of components. Furthermore tape stripping was utilized to identify components present within the stratum corneum (SC). These methods were coupled with gas chromatography-mass spectrometry and were successful in the identification and quantification of terpinen-4-ol, 115.64±28.1 (ng±SEM) and 1,8 cineole, 15.05±2.6 at the dermal epidermal junction (n=10). Also the presence of 9 hydrophilic and lipid components (overall subjects) were observed within this top layer of epidermis (n=7).In addition the potential anti-inflammatory action of TTO and its component T-4-ol is investigated in vitro using the HaCaT cell line (model keratinocytes) including exploration of a potential mode of action. An inflammatory action was induced using lipopolysaccharide (LPS) and the cell supernatant analysed using the MSD™ electronchemiluminesence assay. A statistically significant increase in the release of IL1? was observed when non-stimulated HaCaT cells were incubated with TTO (not T-4-ol alone), compared to control (medium alone). Furthermore a statistically significant increase in IL6 was observed when non-stimulated HaCaT cells were incubated with TTO and T-4-ol compared with the incubation of stimulated HaCaT cells with the oil and its component. Investigation into the effect of TTO and T-4-ol on the transcription factor NF?B demonstrated that the oil and its component did not exert its effect by initiation of this pathway.The findings of this research have implications for clinical practice, particularly in the use of TTO on areas of dermatological inflammation and its use on ‘healthy’ skin

Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy

Aims and objectives: to develop and evaluate an evidence‐based Continence Product Patient Decision Aid (CP‐ PDA) to reduce decisional conflict and support continence product choice for men post‐radical prostatectomy.Background: in 2018, 1.3 million men globally were diagnosed with prostate cancer. A common treatment is radical prostatectomy, usually leading to sudden‐onset of urinary incontinence. For people experiencing incontinence, products to contain leakage are fundamental to health‐related quality‐of‐life, but many product users and healthcare professionals are unaware of available options. No evidence‐based guidance on choosing products exists despite known physical and psychological burdens of poorly managed leakage (e.g. isolation, anxiety, depression, skin‐damage).Design and Methods: 4 phases, underpinned by international decision‐aid guidance.Evidence/expert opinion: literature review; consultation with specialist continence clinicians (n=7) to establish evidence‐base.Prototype: CP‐PDA developed with continence specialist (n=7) feedback. Alpha testing (stakeholders): CP‐PDA materials were provided to expert patients (n=10) and clinicians (n=11) to assess content/presentation. Beta testing (field) following CONSORT guidelines, registered NIHR CPMS 31077: men (n=50) post‐radical prostatectomy randomised to evaluate usability and decision‐making using the Decisional Conflict Scale compared with usual care.Results: an algorithm differentiating patients by mobility, dependency, cognitive impairment and type/level of leakage, leading to 12 user groups was developed. For each group, an option table and associated product information sheets guide product choice. Total Decisional Conflict Score for men using the CP‐PDA was significantly better than for men without. CP‐PDA users reported greater confidence in product knowledge and choice.Conclusion: his is the first evidence‐based CP‐PDA, developed using an internationally recognised method. Compared to usual care, it significantly reduced decisional conflict for men choosing continence products post‐prostatectomy.Relevance to clinical Practice: the CP‐PDA provides nurses with the first comprehensive, evidence‐based intervention to help post‐prostatectomy men in complex continence product choices. An online version is available: www.continenceproductadvisor.org.<br/