A UK survey evaluation of First Contact Practitioners' and musculoskeletal physiotherapists' confidence, recognition, and referral of suspected axial spondyloarthritis

© 2022 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐Non Commercial‐No Derivatives License. https://creativecommons.org/licenses/by-nc-nd/4.0/Background: Axial Spondyloarthritis is an inflammatory disease associated with significant diagnostic delays. Steen et al. (2021) found inadequate consideration of axial Spondyloarthritis (axSpA) in physiotherapists back pain assessments. Since the previous survey, increased professional education on axSpA has occurred and First Contact Practitioners (FCPs), now widely established in General Practice, are key in supporting earlier recognition. Objectives: (1) To re‐evaluate physiotherapists' and evaluate FCPs' awareness, knowledge, and confidence in screening for and recognising features of axSpA and criteria prompting referral to rheumatology. (2) To compare these results to previous research (Steen et al., 2021). Design: As per Steen et al. (2021), an online survey was undertaken combining back pain vignettes (reflecting axSpA, non‐specific low back pain [NSLBP] and radicular syndrome) and questioning on features of suspected axSpA. Results: 165 surveys were analysed. Only 73% (n = 120/165) of respondents recognised the axSpA vignette compared to NSLBP 91% (n = 80/88) and radicular syndrome 88% (n = 68/77). An improvement in axSpA recognition was demonstrated compared with previous data. FCPs performed slightly better with 77% (n = 67/87) of respondents recognising the axSpA vignette. Adequate awareness of national referral guidance was evident in only 55% of ‘clinical reasoning’ and 6% of ‘further subjective screening’ responses. There was still misplaced confidence in recognising clinical features of axSpA compared to knowledge levels shown, including high importance given to inflammatory markers. Conclusion(s): Musculoskeletal physiotherapists demonstrate some improved knowledge and awareness of axSpA compared with previous study findings. Consideration of axSpA is still not universal in musculoskeletal physiotherapists' or FCPs' approaches to persistent back pain assessments and awareness of national referral guidance remains limited. This study highlights the continued need for professional education. Enhanced knowledge of screening and referral criteria in musculoskeletal clinical practice would support earlier diagnosis and better outcomes.Peer reviewe

“It Sounds Like a Drama:” Hearing Stories of Chronic Low Back Pain Through Poetic (Re)presentation

A poetic voice develops in different ways and from different sources. In this paper, a poetic voice is brought to the experiences of patients and family members as recounted in the first phase of a UK National Health Service funded Q-methodological study, the key outcomes of which are summarized. Their stories are presented as a single poetic performance text crafted from the analysis of combined transcripts of three focus group discussions. The performance bears witness to the sadness, frustration, and resolve of those living with chronic low back pain, and offers an additional hearing to that provided by the main study

Physiotherapists’ experiences of managing upper limb movement impairments due to breast cancer treatment

Women are increasingly being referred to physiotherapy for upper-limb dysfunction (ULD), a commonly reported side-effect of breast cancer treatment. Physiotherapists face many challenges deriving from a lack of research into the management of ULD, its pathophysiology and natural history. Evidence supports the need to gain insight into the experiences of physiotherapists caring for patients with ULD to improve understanding of this area of practice. The aim in this study was to explore physiotherapists’ experiences of managing ULD due to breast cancer treatment based on a qualitative research design, underpinned by a hermeneutic phenomenological approach. Six physiotherapists based in the UK were interviewed face-to-face, using in-depth techniques. The data was analysed using the Interpretative Phenomenological Analysis (IPA) method. Three master themes were identified from the interviews: (1) Dealing with uncertainty of best practice (2) Gaining confidence in practice (3) Being able to make a difference. It was concluded that the participants experienced managing ULD due to breast cancer treatment meaningfully in individually varied ways. All participants acknowledged the significant psychological, social and physical implications of ULD and perceived physiotherapy to be beneficial for people with ULD. They also identified a need for better patient and healthcare professional awareness of ULD and the role of physiotherapy in ULD management

The Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM):An assessment of validity, reliability, and responsiveness

Background: In response for the need of a freely available, stand-alone, validated outcome measure for use within musculoskeletal physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed a musculoskeletal patient reported outcome measure. Objectives: This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings. Methods: Two hundred and twenty four patients attending physiotherapy outpatient departments in South East of England with a musculoskeletal condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, n=224), reliability (internal consistency and test-retest reliability, n=42), validity (internal and external construct validity, n=224) and responsiveness (internal, n=25). Results: Exploratory factor analysis indicated that a two-factor model provides a good fit to the data. Factors were representative of ‘Functionality’ and ‘Wellbeing’. Correlations observed between the BmPROM and SF-36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both ‘Functionality’ (α = .85, 95% CI = .81- .88) and ‘Wellbeing’ (α = .80, 95% CI = .75- .84). Test-retest analyses (n= 42) demonstrated a high degree of reliability between ‘Functionality’ (ICC= .84; 95% CI = .72-.91) and ‘Wellbeing’ scores (ICC= .84; 95% CI = .72- .91). Further examination of test-retest reliability through the Bland-Altman analysis demonstrated that the difference between ‘Functionality’ and ‘Wellbeing’ test scores did not vary as a function of absolute test score). Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03). Conclusion: The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of musculoskeletal conditions

Patients’ Expectations of Physiotherapy Treatment for Musculoskeletal Conditions

Relevance Research shows that the expectations a patient brings to treatment have important influences on the clinical relationship, experiences of treatment, the treatment process, outcomes and satisfaction with care. This influence means that patients’ expectations are important for physiotherapists, service providers and researchers to take into account in approaches to care and treatment evaluations. Research highlights the need for a better understanding of expectations of physiotherapy treatment for Msk problems to enable more effective, high quality and cost-beneficial care. Purpose The aim of this qualitative study was to explore prospective responses to an open comment item on patients’ expectations of their physiotherapy treatment that was nested within a larger research project developing and validating the Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM). Methods/Analysis The BmPROM is a generic patient self-report outcome measure developed to evaluate the effectiveness of physiotherapy treatment for musculoskeletal conditions. A validity and reliability study was undertaken with patients newly referred into five NHS physiotherapy outpatient departments in SE England. The outcome tool has open-comment items, which included a pre-treatment invitation to provide expectations of their physiotherapy treatment. A thematic analysis was undertaken of the expectations expressed to gain insights for physiotherapy practice and patient care. Results Analysis was undertaken of 563 expectations of physiotherapy treatment expressed from 224 participants (mean 50.7yrs [17-88yrs]; 60% female) experiencing a range of Msk conditions (Lower limb:30%, Upper limb:25%, Spine:28%, Other/multiple sites:17%). Five key themes were identified. Three themes were outcome-related and desired effects of treatment; Relieving symptoms, predominately pain relief; Regaining and maintaining physical abilities and function; and Improving psychological well-being by enabling coping, confidence and control. Theme four was process-related; Explanation, advice and education, where physiotherapy was seen as a resource to acquire better knowledge, skills and strategies to support resolution, management or prevention. The final theme involved recovery expectations conveyed within responses; Problem resolution and responsibility, where responses implied an expectation of a cure or one of problem management and control. Discussion and conclusions The findings provide an understanding of domains considered important or appropriate by patients when seeking care for Msk problems. The themes show overlap with studies using retrospective explorations and surveys of treatment expectations, and research on outcomes considered important to evaluate within Msk PROMs. The study has also shown that a written method of eliciting expectations can be a valuable clinical tool for use to support discussions concerning treatment aims, strategies, desired outcomes and responsibilities. These communication processes are also likely to be integral to achieving the qualities in the therapist and clinical encounters considered important to patients, of feeling listened to, consulted with and respected, and associated with satisfaction with physiotherapy and features of patient-centred care. Impact and implications Healthcare is changing as evidence-informed practice and cost-benefit drivers influence what and how care is provided. Shifts from traditional understandings about Msk problems and their management makes exploring and addressing patients’ expectations particularly important. Developing ways to support appropriate expectations of physiotherapy treatment remains an important endeavour that is integral to its effectiveness and demonstrating its value

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Personal accounts of acute non-specific low back pain experiences

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A UK survey evaluation of First Contact Practitioners and Physiotherapists’ confidence, recognition, and referral of suspected axial spondyloarthritis

© 2022 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-Non Commercial-No Derivs License. https://creativecommons.org/licenses/by-nc-nd/4.0/Background Axial Spondyloarthritis is an inflammatory disease associated with significant diagnostic delays. Steen et al. (2021) found inadequate consideration of axial Spondyloarthritis (axSpA) in physiotherapists back pain assessments. Since the previous survey, increased professional education on axSpA has occurred and First Contact Practitioners (FCPs), now widely established in General Practice, are key in supporting earlier recognition. Objectives (1) To re-evaluate physiotherapists' and evaluate FCPs' awareness, knowledge, and confidence in screening for and recognising features of axSpA and criteria prompting referral to rheumatology. (2) To compare these results to previous research (Steen et al., 2021). Design As per Steen et al. (2021), an online survey was undertaken combining back pain vignettes (reflecting axSpA, non-specific low back pain [NSLBP] and radicular syndrome) and questioning on features of suspected axSpA. Results 165 surveys were analysed. Only 73% (n = 120/165) of respondents recognised the axSpA vignette compared to NSLBP 91% (n = 80/88) and radicular syndrome 88% (n = 68/77). An improvement in axSpA recognition was demonstrated compared with previous data. FCPs performed slightly better with 77% (n = 67/87) of respondents recognising the axSpA vignette. Adequate awareness of national referral guidance was evident in only 55% of ‘clinical reasoning’ and 6% of ‘further subjective screening’ responses. There was still misplaced confidence in recognising clinical features of axSpA compared to knowledge levels shown, including high importance given to inflammatory markers. Conclusion(s) Musculoskeletal physiotherapists demonstrate some improved knowledge and awareness of axSpA compared with previous study findings. Consideration of axSpA is still not universal in musculoskeletal physiotherapists' or FCPs' approaches to persistent back pain assessments and awareness of national referral guidance remains limited. This study highlights the continued need for professional education. Enhanced knowledge of screening and referral criteria in musculoskeletal clinical practice would support earlier diagnosis and better outcomes.Peer reviewe