Role of rheumatology clinical nurse specialists in optimizing management of hand osteoarthritis during daily practice in secondary care: an observational study

Wing-Yee Kwok, Margreet Kloppenburg, Liesbeth JJ Beaart-van de Voorde, Tom WJ Huizinga, Thea PM Vliet VlielandDepartment of Rheumatology, Leiden University Medical Center, Leiden, The NetherlandsBackground: The purpose of this study was to describe the effectiveness of a single one-hour consultation by a clinical nurse specialist in patients with hand osteoarthritis during daily rheumatology practice in secondary care.Methods: Consecutive patients diagnosed by rheumatologists to have primary hand osteoarthritis and referred to the clinical nurse specialist were eligible for entry into this study. The standardized 1-hour consultation consisted of assessments and education on hand osteoarthritis by a clinical nurse specialist. Before and 3 months after the consultation, assessments were done to evaluate treatment (use of assistive devices, acetaminophen), health-related quality of life (physical component summary [PCS] score of Short-Form 36), and hand pain/function (Australian/Canadian Osteoarthritis Hand Index [AUSCAN]). Paired t-tests and McNemar tests were used to analyze differences between baseline and follow-up. Satisfaction was measured after consultation at follow-up using a multidimensional questionnaire comprising 13 items (rated on a four-point scale).Results: A total of 439 patients were referred, with follow-up data available for 195 patients, comprising 177 (87%) females, and of mean age 59 ± 9.0 years. After consultation, the proportions of patients using assistive devices and/or acetaminophen increased significantly from 30% to 39% and from 35% to 49%, respectively. PCS improved significantly (P = 0.03) whereas AUSCAN hand pain/function showed no significant differences compared with baseline (P values 0.52 and 0.92, respectively). The proportions of patients reporting to be satisfied or fully satisfied ranged from 78% to 99% per item.Conclusion: A single, comprehensive, standardized assessment and education by a clinical nurse specialist improved the physical dimension of health-related quality of life in hand osteoarthritis. Most patients were satisfied with the consultation. Further controlled trials are needed to determine the added value of the clinical nurse specialist in care for hand osteoarthritis.Keywords: hand osteoarthritis, nursing, quality of life, satisfactio

Are Aspects of a Motivational Interview Related to Subsequent Changes in Physical Activity and Regulatory Style? Examining Relationships among Patients with Rheumatoid Arthritis

Objectives: To determine whether the integrity of motivational interviewing (MI) delivery relates to short-term changes in physical activity (PA) and regulatory style within a sample of patients with rheumatoid arthritis, and to examine whether therapist proficiency in MI improves over time. Methods: During a randomized controlled trial to promote PA, 27 patients received a motivational interview from one of three trained physical therapists, which was coded with the Motivational Interviewing Treatment Integrity scales (MITI). Pearson correlations examined associations between MITI scores and changes in PA and regulatory style. Linear regression examined therapist proficiency over time. Results: Motivational interviews with greater reflection-to-question ratios and higher MI proficiency scores were related to increases in PA. Motivational interviews higher in global spirit and with a greater percentage of MI-adherent behaviors were associated with decreases in introjected regulation. Proficiency in MI delivery tended to improve over time. Conclusions: Characteristics of motivational interviews are related to favorable shifts in regulatory style and PA behavior. Although MI proficiency increases over time and with feedback, a 15-hour training course seems insufficient for physical therapists to obtain basic MI proficiency. Practice Implications: Providing feedback to therapists new to delivering MI seems to improve MI proficiency and should help therapists to avoid using MI-non-adherent techniques

STUDY PROTOCOL Open Access

De-implementation of expensive blood saving measures in hip and knee arthroplasties: study protocol for the LISBOA-II cluster randomized tria