Hip disorders and osteoarthritis: focus on health-related quality of life, assesssment and intervention

The overall aims of this work were to investigate the consequences of hip disorders and hip osteoarthritis (OA) on health-related quality of life (HRQL) physical function and self-efficacy. The condition, hip OA, is often associated with significant pain and has a strong impact on physical function and quality of life. The prevalence of hip disorders were 32% and among the individuals reporting hip disorders 86% experienced pain, 32% stiffness and 20% weakness and 92% of those with hip disorders also reported disorders in other joints. In individuals with hip OA, better physical function and better self-efficacy were associated with higher perceived health-related quality of life. A new instrument for assessing movement quality, the Body Awareness Movement Quality (BAS MQ)was examined. The inter-rater reliabiliy and validity were acceptable in a group of individuals with hip OA. Eighty-nine individuals with hip OA were randomized either to Tai Chi for Arthritis, Hip School or a control group. Within group-differences showed a significant improvement between baseline and the 6- months follow-up in physical function in both intervention group and the Tai Chi group also improved significantly in self-efficacy. No significant differences, regarding physical function, self-efficacy or HRQL, were seen at 6-or 12 months follow-up whwn comparing the groups

Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS)

BACKGROUND: Self-reported knee complaints may vary with age and gender. Reference data from the adult population would help to better interpret the outcome of interventions due to knee complaints. The objectives of the present study were to describe the variation of self-reported knee pain, function and quality of life with age and gender in the adult population and to establish population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). METHODS: Population-based cohort retrieved from the national population register. The knee-specific Knee injury and Osteoarthritis Outcome Score (KOOS) was mailed to 840 subjects aged 18–84 yrs. RESULTS: 68% response rate. Women in the age group 55–74 reported more knee-related complaints in all the KOOS subscales than age-matched men. The differences were significant for the subscales Pain (p = 0.027), Symptoms (p = 0.003) and ADL function (p = 0.046). In men, worse ADL and Sport and Recreation function was seen in the oldest age group 75–84 years compared to the younger age groups (p < 0.030). In women, worse Pain (p < 0.007), ADL (p < 0.030), Sport and Recreation (p < 0.001) and QOL (p < 0.002) were seen already in the age group 55–74 compared to the younger age groups. CONCLUSION: We found pain and other symptoms, physical function, and knee-related quality of life to vary with age and gender implying the use of age- and gender matched reference values for improved understanding of the outcome after interventions due to knee injury and knee OA

Clinical reasoning as a conceptual framework for interprofessional learning : a literature review and a case study

Background: Clinical reasoning has been proposed to be a key attribute of health professionals. We hypothesized that clinical reasoning may be one explicit way to further the understanding of each other’s roles in interprofessional learning activities, for nurse students and physiotherapy students. Objectives: The first part of this paper was a literature review. In the second part of the paper, we described a case study with an action-based approach. Major Findings: The literature review showed that, although sparse, clinical reasoning has been used as a conceptual framework for students learning in interprofessional activities. Through a collaboration between clinicians and university staff, we developed a structure for interprofessional student collaboration based on narratives in combination with a clinical reasoning structure as proposed by Levett-Jones, adapted to identify the different roles. The interprofessional collaboration was found crucial for development of authentic and useful narratives to work from, where both professions had important roles. The use of a reasoning framework could scaffold student discussions to learn with, from and about each other. Conclusions: We concluded that interprofessional learning can take place in theory courses and the use of clinical reasoning as a conceptual framework may facilitate to clarify professional similarities and differences

Persons’ various experiences of learning processes in patient education for osteoarthritis, a qualitative phenomenographic approach

Background: Patient education (PE) is a core treatment of osteoarthritis (OA) with the aim to increase persons’ knowledge, self-efficacy, and empowerment. Objective: To describe person’s various experiences of learning processes in PE for OA. Design: Phenomenography. Method: Semi-structured interviews were performed with the same persons, pre- (11) and post- (9) education. Results: Various experiences on learning processes were found and were described in an outcome space. Achieving knowledge describes self-regulated learning and strongly relates to Control, which describes a high order cognitive learning skill, and minor to Confirm, which describes a cognitive learning skill based on recognition and application. Receiving knowledge describes the expectancy of learning regulated from the educator and strongly relates to Comply, which describes a low-order cognitive learning skill, and minor to Confirm. Conclusion: Different experiences of motivation and learning impact on persons’ learning processes which, in turn, influence the persons’ capability to accomplish self-efficacy and empowerment. The outcome space may serve as a basis for discussions between healthcare educators involved in PE to better understand what learning implies and to develop PE further

Prevalence of self reported hip symptoms, relations to age, gender, pain, stiffness, weakness and other joint disorders

The objective was to estimate the prevalence and characteristics of self-reported hip disorders in an adult population-based sample from the general population in two defined primary healthcare districts in the south of Sweden. We used a population-based survey using a mailed questionnaire on a random sample of 2600 individuals aged 38-77 years. After two written reminders, the response rate was 86%. The prevalence of reported hip disorders was 32% and increased with age from 18% among males 38-47 years to 42% among females 48-67 years. Among the individuals reporting hip disorders (n=692), 86% experienced pain, 32% stiffness and 20% weakness, and 58% had consulted medical care for their hip disorders; 92% of the individuals with reported hip disorders also reported disorders in other joints. Females reported disorders from finger joints, ankle/toe, low back and neck significantly more often compared with males. Disorders related to the hip region are common in a population-based sample. Individuals reporting hip symptoms frequently have symptoms in other joints. Pain was the most common symptom and females more frequently than males reported symptoms from other joints. Future studies of the cohort will investigate the relationships between self-reported hip disorders and clinical symptoms of early-stage hip disease

Analyzing Movements Development and Evaluation of the Body Awareness Scale Movement Quality (BAS MQ).

Limitations in everyday movements, physical activities are/or pain are the main reasons for seeking help from a physiotherapist. The purpose of this study was to investigate the psychometric properties of the Body Awareness Scale Movement Quality (BAS MQ) focusing on factor structure, validity and reliability and to explore whether BAS MQ could discriminate between healthy individuals and patients. BAS MQ assesses both limitations and resources concerning functional ability and quality of movements

Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study

BACKGROUND: Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. METHODS: Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. RESULTS: The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow. CONCLUSION: The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis

Surgical treatment of breast cancer liver metastases : A nationwide registry-based case control study

Introduction: The benefit of liver resection or ablation for breast cancer liver metastases (BCLM) remains unclear. The aim of the study was to determine survival after isolated BCLM in nationwide cohorts and compare surgical versus systemic treatment regimens. Materials and methods: The Swedish register for cancer in the liver and the bile ducts (SweLiv) and the National register for breast cancer (NBCR) was studied to identify patients with 1-5 BCLM without extrahepatic spread diagnosed 2009-2016. Data from the registers were validated and completed by review of medical records. A Kaplan-Meier plot and log rank test were used to analyse survival. Prognostic and predictive factors were evaluated by Cox regression analysis. Results: A surgical cohort (n = 29) was identified and compared to a control cohort (n = 33) receiving systemic treatment only. There was no 90-day mortality after surgery. Median survival from BCLM diagnosis was 77 months (95% CI 41-113) in the surgical cohort and 28 months (95% CI 13-43) in the control cohort, (p = 0.004). There was a longer disease-free interval and more oestrogen receptor positive tumours in the surgical cohort. Surgery was a significant positive predictive factor in univariate analysis while a multivariable analysis resulted in HR 0.478 (CI 0.193-1.181, p = 0.110) for surgical treatment. Conclusion: Surgery for BCLM is safe and might provide a survival benefit in selected patients but prospective trials are warranted to avoid selection bias