‘It’s just a finger isn’t it…’: patients’ perspectives of recovery following finger fractures and participation in surgical trials – a qualitative interview study

Objectives: To (1) generate detailed, person-centred data about the experience of finger injury and treatment and (2) understand the patients’ perspectives of research involvement with a view to informing better designed future studies in hand injury.Design: Qualitative study using semistructured interviews and framework analysis.Participants: 19 participants who were part of the Cohort study of Patients’ Outcomes for Finger Fractures and Joint Injuries study in a single secondary care centre in the UK.Results: The results of this study showed that although finger injuries are frequently seen as minor by patients and healthcare professionals, their effects on peoples’ lives are possibly greater than first anticipated. The relative importance of hand functioning means that the experience of treatment and recovery varies and is shaped by an individual’s age, job, lifestyle and hobbies. These factors will also inform an individual’s perspective on and willingness to participate in, hand research. Interviewees showed reluctance to accept randomisation in surgical trials. Interviewees would be more likely to participate in a study testing two variants of the same treatment modality (eg, surgery vs surgery), rather than two different modalities, (eg, surgery vs splint). The Patient-Reported Outcome Measure questionnaires that were used in this study were seen as less relevant by these patients. Pain, hand function and cosmetic appearance were considered important, meaningful outcomes.Conclusions: Patients with finger injuries need more support from healthcare professionals as they may experience more problems than first anticipated. Good communication by clinicians and empathy can help patients engage with the treatment pathway. Perceptions of an ‘insignificant’ injury and/or need for quick functional recovery will influence recruitment to future hand research (both positively and negatively). Accessible information about the functional and clinical consequences of a hand injury will be important in enabling participants to make fully informed decisions about participation

Computerized adaptive testing of symptom severity : a registry-based study of 924 patients with trapeziometacarpal arthritis

We aimed to develop a computerized adaptive testing (CAT) version of the 11 item Patient Evaluation Measure (PEM), using an item response theory model. This model transformed the ordinal scores into ratio-interval scores. We obtained PEM responses from 924 patients with trapeziometacarpal osteoarthritis to build a CAT model and tested its performance on a simulated cohort of 1000 PEM response sets. The CAT achieved high precision (median standard error or measurement 0.26) and reduced the number of questions needed for accurate scoring from 11 to median two. The CAT scores and item-response-theory-based 15-item PEM scores were similar, and a Bland–Altman analysis demonstrated a mean score difference of 0.2 between the CAT and the full-length PEM scores on a scale from 0 to 100. We conclude that the CAT substantially reduced the burden of the PEM while also harnessing the validity of item response theory scoring

The presentation, diagnosis and management of non-traumatic wrist pain: an evaluation of current practice in secondary care in the UK NHS

AbstractObjectivesThe study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care, and to characterise how patients present, are diagnosed and are managed in secondary care in the United Kingdom National Health Service.MethodsTen consecutive patients presenting with non-traumatic wrist pain were identified retrospectively at each of 16 participating hospitals and data was extracted for twelve months following the initial referral.ResultsThe 160 patients consisted of 100 females and 60 males with a median age of 49, accounting for approximately 13% of all new hand/wrist referrals. The dominant wrist was affected in 60% of cases and the mean symptom duration was 13.3 months. Diagnoses were grouped into: osteoarthritis (OA) (31%), tendinopathy (13%), ganglion (14%), ulnar sided pain (17%) and other (25%). The OA group was significantly older than other groups, while other groups contained a predominance of females.The non-surgical interventions in decreasing frequency of usage were: steroid injections (39%), physiotherapy (32%), splint (31%) and analgesics (12%). Of those who underwent surgery, all patients had previously received non-surgical treatment, however 42% had undergone only one non-surgical intervention.ConclusionNon-traumatic wrist pain represents a significant burden to secondary care both in terms of new patient referrals and in terms of investigation, follow up and treatment. Those presenting with osteoarthritis are more likely to be older and male, while those presenting with other diagnoses are more likely to be younger and female

Changing Behavior : A Theory- and Evidence-Based Approach

Social problems in many domains, including health, education, social relationships, and the workplace, have their origins in human behavior. The documented links between behavior and social problems have sparked interest in governments and organizations to develop effective interventions to promote behavior change. The Handbook of Behavior Change provides comprehensive coverage of contemporary theory, research, and practice on behavior change. The handbook incorporates theory- and evidence-based approaches to behavior change with chapters from leading theorists, researchers, and practitioners from multiple disciplines, including psychology, sociology, behavioral science, economics, and implementation science. Chapters are organized into three parts: (1) Theory and Behavior Change; (2) Methods and Processes of Behavior Change: Intervention Development, Application, and Translation; and (3) Behavior Change Interventions: Practical Guides to Behavior Change. This chapter provides an overview of the theory- and evidence-based approaches of the handbook, introduces the content of the handbook, and provides suggestions on how the handbook may be used by different readers. The handbook aims to provide all interested in behavior change, including researchers and students, practitioners, and policy makers, with up-to-date knowledge on behavior change and guidance on how to develop effective interventions to change behavior in different populations and contexts.Peer reviewe

Cognitive and educational outcomes of maltreated and non-maltreated youth: A birth cohort study.

OBJECTIVES: Previous research suggests that child maltreatment is associated with adverse outcomes, but the potential impact on cognitive and educational outcomes into adulthood has rarely been studied using a birth cohort design. The aim of this study is to investigate whether child maltreatment is associated with adverse outcomes in cognitive function, high school completion and employment by the age of 21. METHODS: Longitudinal birth cohort study commencing in the prenatal period, with mothers and infants followed up to age 21. Of the original birth cohort of 7223, 3778 (52.3%) young people participated at age 21. Child maltreatment was identified by linkage with prospectively collected data from the relevant government agency. Associations between child maltreatment (abuse and neglect) and the outcomes were adjusted for relevant sociodemographic and perinatal variables. RESULTS: After full adjustment, young people who had been notified as cases of child maltreatment had reduced performance on the Peabody Picture Vocabulary Test by over a quarter of a standard deviation (coefficient = -2.85, p = 0.004). Maltreated young people also had three times the odds of failing to complete high school (odds ratio = 3.12, p < 0.001) and more than twice the odds of not being engaged in either study or employment at age 21 (odds ratio = 2.38, p < 0.001). Both abuse and neglect were similarly associated with adverse outcomes. CONCLUSION: Child maltreatment, including both abuse and neglect, is associated with adverse cognitive, educational and employment outcomes in young adulthood. This adds further impetus to efforts to prevent child maltreatment and assist young people who have experienced it

The Ecology of Multilevel Interventions to Reduce Social Inequalities in Health

Health inequities persist and, in some cases, are increasing. Multilevel interventions involve efforts to change aspects of social contexts related to the creation and maintenance of health inequities among varied groups. Momentum for conducting multilevel interventions to achieve health equity is found across professional fields as well as scientific and funding organizations. This article discusses the rationale for multilevel interventions, briefly reviews their evolution over time with respect to health inequities, and provides an ecological “way of thinking” about some of the conceptual and pragmatic challenges they raise for social science. This perspective frames community interventions as multilevel, ecologically based, collaboratively conducted, culturally situated, and designed to increase community capacity. Implications of this perspective are drawn for the development, implementation, and evaluation of multilevel interventions