A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study.

Osteoarthritis of the hip is associated with pain, stiffness and limitations to activities of daily living. The aims of this quality improvement project were to introduce a service developed to promote the self-management of hip osteoarthritis through exercise and education, and to assess the impact of the programme on pain, function and quality of life. The service was a six-week cycling and education programme. 119 participants took part. Statistically significant improvements were found for Oxford Hip Score (Mean (SD) change 4.14 (95% CI (3.02, 5.25 ), p<0.001); Sit-to-stand score (mean change 3.06s 95% CI (2.33, 3.79), p<0.001); EQ5D-5L Utility (mean change 0.06 (95% CI 0.03,0.09), p<0.001); EQ5D VAS (mean change 7.05 (95% CI 4.72,9.39) p<0.001); pain on weight-bearing (WB) (mean change 1.56 (95% CI 0.77,2.36), p<0.001), HOOS function (median change (IQR) 7.35 (1.84 to 19.12), p<0.001) and TUG test (median change 1.11s (0.31 to 2.43), p<0.001). Participants reported improvements in pain and function; increased confidence in managing hip pain; and an increase in motivation to exercise. These findings were supported by a Patient and Public Involvement Forum who suggested extending the programme to eight weeks. These results suggest that the service has potential in the management of hip osteoarthritis

Can Social Exclusion Against “Older Entrepreneurs” Be Managed?

This paper investigates how sources of social exclusion and support emerge within an “older” entrepreneur's immediate environment, and how this affects the development of their small business. Based on 22 in-depth interviews in London, United Kingdom, we suggest how older entrepreneurs with different backgrounds are able to manage social exclusion, and identify four coping strategies—passive negotiation, active negotiation, modification, and avoidance. We argue that, if “older entrepreneurship” (people starting a business aged 50 or older) is to flourish, both entrepreneurs and support initiatives need to become sensitive to the diversity of sources of discrimination and strategies to manage them

A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study

AbstractOsteoarthritis of the hip is associated with pain, stiffness and limitations to activities of daily living. The aims of this quality improvement project were to introduce a service developed to promote the self-management of hip osteoarthritis through exercise and education and to assess the impact of the programme on pain, function and quality of life. The service was a six-week cycling and education programme and 119 participants took part. Statistically significant improvements were found for Oxford Hip Scores (Mean (SD) change 4.14, 95%, CI 3.02, 5.25, p < 0.001); Sit-to-stand scores (mean change 3.06, 95%, CI 2.33, 3.79, p < 0.001); EQ5D-5L Utility (mean change 0.06, 95%, CI 0.03, 0.09, p < 0.001); EQ5D VAS (mean change 7.05, 95%, CI 4.72, 9.39, p < 0.001); pain on weight-bearing (WB) (mean change 1.56, 95%, CI 0.77, 2.36, p < 0.001), HOOS function (median change (IQR) 7.35, 1.84 to 19.12, p < 0.001) and TUG test (median change 1.11, 0.31 to 2.43, p < 0.001). Participants reported improvements in pain and function; increased confidence in managing hip pain and an increase in motivation to exercise. These findings were supported by a patient and public involvement forum who suggested extending the programme to eight weeks. These results suggest that the service has potential in the management of hip osteoarthritis

Self-Management of Hip Osteoarthritis Five Years After a Cycling and Education Treatment Pathway

The Cycling against Hip Pain (CHAIN) programme is a six-week cycling and education treatment pathway for people with hip osteoarthritis. Preliminary results demonstrated significant improvements in clinical and patient-reported outcome measures following the course. Whilst the benefits of exercise for osteoarthritis are often reported in the short term, less is known about the long-term effects for this patient group. This study explores whether participants continued to selfmanage their hip osteoarthritis five years after completing the course. A cross-sectional survey was conducted to collect data from participants who completed the CHAIN programme between October 2013 and February 2015 (n = 96). Questionnaires were sent by post in April 2019, and then non-responders were followed up again four weeks later. Eighty-three (87%) participants responded to the survey. Five years (range 4–6) after completion of a six-week cycling and education programme, 37 (45%) participants had not returned to their general practitioner for further treatment of their hip pain, and 47 (57%) had not pursued surgical intervention. All participants were still engaged in at least one physical activity per week and many reported that they had purchased a bike (29%), joined a gym (30%) or cycled regularly (indoor cycling 25%, outdoor cycling 24%). Eighty (96%) participants reported an increase in knowledge of self-managing their symptoms. The findings from this study suggest that many patients are motivated to self-manage their hip osteoarthritis, five years following a six-week cycling and education treatment pathway that encourages lifestyle change

Finding "small' matrices P,Q such that PDQ = S

Given an integer matrix A, there is a unique matrix S of a particular form, called the Smith Normal Form, and non-unique unimodular matrices P and Q such that PAQ = S. It is often the case that these matrices P and Q will be used for further calculation, and as such it is desirable to find P and Q with small entries. In this thesis we address the problem of finding such P and Q with small entries, in particular in the case where A is a diagonal matrix, which arises as a final step in many published algorithms. Heuristic algorithms are developed which appear to do well in practice and some theory is developed to explain this behaviour. We also give an account of the implementation of an alternative algorithm which bypasses this intermediary diagonal form. The basic theoretical development of this is work by Storjohan

For which patients is attending a pre-operative education session most important in a total hip and knee replacement ERAS pathway?

Objectives: Optimising the psychological status of patients’ pre-surgery through education is recommended by the Enhanced Recovery after Surgery (ERAS) Society. However, despite this; the majority of the current evidence base does not confirm that preoperative education reduces length of stay in total hip or knee replacement pathways. The aim of this study is to compare length of stay between patients who attended an education class prior to elective total hip or knee replacement surgery, compared to those who did no