A Feasibility study of the escape-pain programme for patients with knee osteoarthritis in the Malaysian context: Preparation of a protocol

Background: In Malaysia, around one in ten older people are diagnosed with osteoarthritis (OA), with the knee being one of the most commonly affected areas. This can lead to functional limitations, impaired activities of daily living and reduced quality-of-life. Thus, a systematic review of the literature concludes that a programme integrating exercise, education and active coping strategies, known as Enabling Self-management and Coping with Arthritic Pain using Exercise (ESCAPE-pain) provides the best evidence for patients with knee OA. Objective: Through Thus, this study aims to evaluate the feasibility of a randomised controlled trial to explore the implementation of the ESCAPE-pain programme among patients with knee OA in the Malaysian healthcare context guided by the UK Medical Research Council Framework (2000). Methods: This is a pragmatic, feasibility randomised controlled trial (RCT) recruiting patients (n=72) with knee osteoarthritis from two hospitals in Malaysia. Participants were randomised to receive ESCAPE-pain intervention plus usual care (n=36) (intervention group) or usual care only (n=36) (control group). The ESCAPE-pain programme was delivered twice weekly for six weeks by a certified trainer. Outcomes were measured for physical function (TUG), knee injury and osteoarthritis outcome scores (KOOS), mental wellbeing (Short-WEMWBS), exercise health beliefs and self-efficacy and fear of falling (Short-FES-I) at baseline, six-week and after 12-week of intervention. Results: This is the first study to evaluate the implementation in the Malaysian healthcare context. Conclusion: The findings are hoped to facilitate the practicality of the design of a definitive randomised controlled trial, to support people living with knee osteoarthritis in Malaysia

A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in Community Dwelling Adults with Rheumatoid Arthritis

Det er en sammenheng mellom bachelorstudentenes karakterpoeng fra videregående skole og resultater til eksamen i anatomi, fysiologi, biokjemi (AFB). Enkelte studenter med lavere opptakskarakterer enn landsgjennomsnittet oppnådde bedre eksamensresultat enn det nasjonale gjennomsnittsresultatet i AFB for 2016. Hensikten med studien var å undersøke hvordan bachelorstudenter i sykepleie med lave opptakspoeng og gode eksamensresultater i AFB lærte og tilegnet seg emnet. Studien har et kvalitativ forskningsdesign og det ble gjennomført semistrukturerte intervju av 12 bachelorstudenter i sykepleie, som ble analysert ved hjelp av innholdsanalyse. Funnene er beskrevet ut fra tre hovedkategorier: A) Relevansen til sykepleieryrket styrker læring, B) tilhørighet har betydning for læring, og C) læring skjer i samarbeid med andre. Vi fant at studentene lærte AFB mer inngående i samhandling med andre studenter. Samlinger på campus er viktig for studenters læring, til tross for at det er stort fokus på fleksible utdanninger og digitale pedagogiske metoder. Selvstendig arbeid kombinert med læring i et sosialt studentfellesskap, oppgis som motivasjonsfaktorer til målrettet arbeid med studiene. Studentene erfarer mestringsforventning, i et miljø som preges av anerkjennelse og samtidig gir opplevelse av tilhørighet. Studentene vektlegger studienes relevans sett i lys av det profesjonsyrket som de utdanner seg til, som en betydningsfull motivasjonsfaktor for læring.publishedVersio

Fear-of-falling and associated risk factors in persons with rheumatoid arthritis: a 1 year prospective study

Abstract: Background: Falls, associated injuries and fear-of-falling are common in adults with RA. Fear-of-falling can be a major consequence of, and as debilitating as falling, resulting in a cycle of activity restriction, reduced quality of life, institutionalisation and potentially increase risk of falls. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period. Methods: Five hundred fifty-nine patients with RA were recruited from four outpatient clinics in this prospective cohort study. Baseline assessments included socio-demographic, medical and lifestyle related risk factors. Fall incidence was prospectively obtained monthly using postal cards over a 1 year period. Fear-of-falling was assessed at baseline and 1 year using the Short Falls Efficacy Scale-International (Short FES-I). Logistic regression was used to determine the association between high fear-of-falling (Short FES-I > 11) at baseline (outcome) and a range of putative predictor variables including previous falls, and also baseline factors associated with a high fear-of-falling at follow-up. Results: Five hundred thirty-five (ninety-six percent) participants (mean age 62.1 yrs.; 18–88 yrs) completed 1 year follow-up and of these, 254 (47%) completed the Short FES-I questionnaire at 1 year. In a multivariate model, a history of multiple falls (OR = 6.08) higher HAQ score (OR = 4.87) and increased time to complete the Chair Stand Test (OR = 1.11) were found to be independent predictors of high fear-of-falling and had an overall classification rate of 87.7%. There were no significant differences found in fear-of-falling at 1 year follow-up in those who reported falls during the study, participant’s baseline fear appeared to predict future fear, regardless of further falls. Conclusions: Fear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RA patients would benefit from fall prevention measures whether or not they have previously fallen

Exploring the delivery of remote physiotherapy during the COVID-19 pandemic: UK wide service evaluation

IntroductionDuring the Coronavirus (Covid-19) pandemic, physiotherapists changed rapidly to working remotely. Research demonstrates the benefits of remote physiotherapy, but little is known about its implementation in practice.PurposeExplore the take-up and delivery of remote physiotherapy during the pandemic in the United Kingdom.MethodsSequential mixed methods evaluation with physiotherapists leading remote physiotherapy delivery. Two-stage approach included online survey (2020) and semi-structured interviews with documentary/data analysis (2021).ResultsThere were 1620 physiotherapists who completed the survey. The most used devices were telephone (n = 942,71.0%) and the AttendAnywhere platform (n = 511, 38.5%). Remote consultations were frequently used for initial assessment (n = 1105, 83%), screening/triage (n = 882, 67%), or to review, monitor, and progress treatment (n = 982–1004, 74%–76%). Qualitative survey responses reflected respondents’ response to COVID-19 and delivery of remote physiotherapy. Twelve remote physiotherapy leads were then purposively sampled across clinical areas. Three main themes emerged from interviews: response to Covid-19, delivery of remote physiotherapy, and future of remote physiotherapy.ConclusionRemote physiotherapy was safe, feasible, and acceptable for those who accessed it. There were patients for which it was deemed unsuitable across clinical areas. In practice, it should be combined with in-person consultation based on patients’ needs/preferences. Further research should explore post-pandemic maintenance of remote delivery

Reducing falls risk with Kinect based falls prevention EXERGAMES: a 12 week twocentre, cluster RCT of community-dwelling older adults living in sheltered housing

Introduction: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. Despite overwhelming evidence for strength/balance training, adherence to both group and home-exercise programmes is often poor1. A novel approach is the use of home-based, strength and balance video-games (EXERGAMES) but data from randomized controlled trials are limited2. The aim of this study was to test whether a 12 week EXERGAMES home-based intervention, co-developed with older adults and therapists, can improve the risk of falling [by Berg Balance Scale (BBS)] in older adults living in sheltered housing. Methods: We conducted a two-site (Manchester/Glasgow) cluster RCT. Twelve sheltered housing facilities were randomised (1:1) to either a 12wk standard care plus 3 times/ week EXERGAMES physiotherapist one-to-one intervention (n=56) or standard care (control group n=50). Standard care involved the provision of a home exercise booklet (standard approach for those unable/unwilling to attend group exercise programmes in the community). Results: A total of 106 older adults (83F, 23M) with a mean age of 77.8y (SD 10.2; range 55-101y), were recruited for the study. A total of 91 (86%) participants completed all study visits. Over 12 weeks the EXERGAMES intervention had a significant positive impact on BBS [p=0.003; mean (SD), 44.6 (10.7) (EXERGAMES) vs. 37.6 (14.9) (Control)]. The mean change of BBS from baseline was 2.9 (8.5) for the EXERGAMES and -2.8 (6.5) for the control group. The estimated increase in BBS score due to EXERGAMES was 6.2 (95% CI 2.4 to 9.9) which is greater than the minimal detectable change for the scale of 4.93. Conclusions: Balance, and thus risk of falling, can be improved through a 12wk physiotherapy led EXERGAMES programme. This type of home based intervention could be considered as an effective alternative to traditional falls prevention exercise regimes to support outcomes for patients

Clinical and biomechanical factors associated with falls and rheumatoid arthritis: Baseline cohort with longitudinal nested case-control study

OBJECTIVE: To identify the clinical and biomechanical characteristics associated with falls in people with RA. METHODS: A total of 436 people ≥60 years of age with RA completed a 1 year prospective survey of falls in the UK. At baseline, questionnaires recorded data including personal and medical history, pain and fatigue scores, health-related quality of life (HRQoL), physical activity and medication history. The occurrence of falls wasmonitored prospectively over 12 months by monthly self-reporting. A nested sample of 30 fallers (defined as the report of one or more falls in 12 months) and 30 non-fallers was evaluated to assess joint range of motion (ROM), muscle strength and gait parameters. Multivariate regression analyses were undertaken to determine variables associated with falling. RESULTS: Compared with non-fallers (n = 236), fallers (n = 200) were older (P = 0.05), less likely to be married (P = 0.03), had higher pain scores (P < 0.01), experienced more frequent dizziness (P < 0.01), were frequently taking psychotropic medications (P = 0.02) and reported lower HRQoL (P = 0.02). Among those who underwent gait laboratory assessments, compared with non-fallers, fallers showed a greater anteroposterior (AP; P = 0.03) and medial-lateral (ML) sway range (P = 0.02) and reduced isokinetic peak torque and isometric strength at 60° knee flexion (P = 0.03). Fallers also showed shorter stride length (P = 0.04), shorter double support time (P = 0.04) and reduced percentage time in swing phase (P = 0.02) and in knee range of motion through the gait cycle (P < 0.01). CONCLUSION: People with RA have distinct clinical and biomechanical characteristics that place them at increased risk of falling. Assessment for these factors may be important to offer more targeted rehabilitation interventions

The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: A multi-centre, cluster randomised controlled trial

Background: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. Methods: A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted-living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete-case analysis (intention to treat) was used to compare Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included: fear of falling, mobility, falls risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life; self-reported physical activity and falls. Results: Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0), reduced fear of falling (p=0.007) and pain (p=0.02) in Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 minutes/week). 24% of control group and 20% of Exergame group fell over trial period. The change in falls rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p=0.001)). The point estimate of the incremental cost effectiveness ratio (ICER) was £15,209.80 per QALY. Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY. Conclusions: Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older

Developing, Testing, and Implementing a Falls Prevention and Healthy Ageing App (Keep-On-Keep-Up) for Older Adults.

Falls are a common and costly concern for older adults. Digital technologies can offer new, inexpensive approaches to increase access and engagement with falls prevention programmes. Keep-On-Keep-Up is a personalised, falls prevention App with strength and balance exercises plus health literacy games. This study reports on the user-centred design, usability testing and implementation of the KOKU App. Older adults aged 55 years and older in the UK were invited to take part in the study. Data collection included focus groups; baseline and 6 week questionnaires and assessments; semi-structured interviews and one focus group with falls prevention therapists to explore App usability. Thirty older adults were invited to use KOKU unsupervised, 3 times a week for 6 weeks. Data were analysed using thematic content analysis. Focus groups (n=11) with 66 older users and 11 therapists informed development. Thirty older adults (mean age = 75) were recruited for the in-depth testing. Mean SUS score was 71 indicating high usability. Qualitative themes included: ease of use (app usability; iPad properties; exercise presentation), usefulness (physical/psychological benefits; falls education), attitude towards the App and intention to use (technological barriers; flexibility of use; exercise class versus App). Therapists (n=6) viewed the KOKU platform positively and suggested extensions for further progression. No adverse events were reported during the study. This research demonstrates that KOKU is an acceptable and easy to use falls prevention intervention that facilitates older adults’ ability to access falls prevention training at a time, and in a location, that suits them