Campbell, Mia

Deary, Vincent

Hackett, Katie

Kohlemainen, Niina

McCallum, Claire

Rapley, Tim

English

Teeside University's Research Repository

favouring the hip exercise group. Two RCTs compared weight bearingversus non-weight bearing exercises; there was no between groupdifference in knee extension strength (0.00(-0.41-0.42) p¼0.99) and anon-significant decrease in pain (mean (95% CI) 0.74(-0.42-1.90)p¼0.21) favouring weight bearing exercise. Four RCTs comparedmotor control exercises with knee þ/- hip strengthening exercises andfound increased hip abductor strength (0.50(-0.01-1.01) p¼0.05) andreduction in pain (mean (95% CI)-1.41(-2.08–0.74) p< 0.01) favouringmotor control exercise and non-significant increases in hip lateralrotator (-0.04(-0.53-0.45) p¼0.87) and knee extensor (-0.20(-0.51-0.11) p¼0.20) strength favouring the strengthening group. Two RCTsinvestigated kinematics and found increased hip flexion (0.89(0.37-1.41) p<0.01) and knee adduction (0.52(0.01-1.01) p¼0.04) jointangles favouring the motor control exercise. Three RCTs comparedexercise with non-exercise interventions and found between groupchanges in knee extensor strength (0.87(0.32-1.41)p<0.01) and pain (-1.01(-1.51- -0.51)p <0.01) favouring the exercise group.Conclusion: There is some evidence from RCTs of variable quality forthe effectiveness of hip, knee and motor control exercises on physicalfactors and pain in people with PFP. Exercise therapy targetingphysical factors should be considered when managing people withPFP.Disclosures: L. Kedroff: None. J. Skinner: None. C. Ratcliffe: None.047 MODELLING LOGICAL INTERVENTION PATHWAYSTHROUGH A STAKEHOLDER AUTHORED CONCEPT MAP TODESIGN COMPLEX INTERVENTIONS AIMED AT IMPROVINGPARTICIPATION FOR PEOPLE WITH SJO¨GREN’S SYNDROMEKatie Hackett1, Niina Kolehmainen2, Vincent Deary3, Katherine H.O. Deane4, Julia L. Newton5, Claire McCallum1, Miglena Campbell6,Wan-Fai Ng5 and Tim Rapley11Department of Social Work, Education and Community Wellbeing,Northumbria University, Newcastle upon Tyne, UNITED KINGDOM,2Institute of Health and Society, Newcastle University, Newcastleupon Tyne, UNITED KINGDOM, 3Department of Psychology,Northumbria University, Newcastle upon Tyne, UNITED KINGDOM,4Department of Health Sciences, University of East Anglia, Norwich,UNITED KINGDOM, 5Institute of Cellular Medicine, NewcastleUniversity, Newcastle upon Tyne, UNITED KINGDOM, and6Department of Psychology, Teesside University, Middlesborough,UNITED KINGDOMBackground: Participation in daily activities is problematic for manypeople with primary Sjo¨gren’s syndrome (pSS). A group concept map,co-developed with 232 patients, family and healthcare staff stake-holders (patients with pSS, family members and health professionals)contained 7 themed clusters of prioritized ideas. To utilize the map todevelop future interventions, our aims were: 1) model logical clearpathways through the map; 2) identify specific facilitators andoutcomes from the ideas within the map which relate to agreedintervention targets within the priority logical pathway.Methods: To utilize these maps to develop future interventions, weexplored their content further during three steering group interpretationsessions and through a validation process with clinicians. Steeringgroup members (n¼6) individually considered the map and agreementwas reached on the logical pathways following three interpretationmeetings. Specific priority intervention targets within one pathwaywere selected from within the concept map through discussion andreaching consensus. The priority intervention targets and all individualhighly rated ideas from within the concept map which explicitly relatedto these targets were presented to experienced psychologists,physiotherapists and occupational therapists (n¼10) for validation.The clinicians were asked to provide specific examples of how theserelated ideas could be applied and evaluated within a clinical setting.Results: The themed clusters in order of priority included; patientempowerment, symptoms, wellbeing, access & coordination ofhealthcare, knowledge & support, friends/family and public aware-ness. Four logical pathways were drawn through the themed clusterswithin map and are listed in order of priority: 1) To improve patientempowerment the priority symptoms of fatigue, dryness, pain andsleep need to be addressed in order to improve wellbeing. 2) Prioritysymptoms can be addressed through appropriate access & coordina-tion of healthcare which could positively impact on patient empower-ment. 3) Knowledge and support could be delivered through anappropriate healthcare system and may impact on public awarenessand support. 4) Friends and family are more likely to be supportive ifthere was better public awareness of pSS. Their support couldfacilitate patient empowerment. Pathway 1 included the highest ratedthemed clusters. The steering group agreed to focus on theintervention targets of fatigue, pain and sleep as these were oftennot being adequately addressed in current clinics. The clinicianvalidation process provided specific intervention examples for eachpriority idea relating to the targets of fatigue, pain and sleep andsuggested outcome measure tools.Conclusion: A priority logical intervention pathway to improveparticipation in Sjo¨gren’s syndrome has been developed through arigorous process of stakeholder engagement and a consensus activity.A clinician validation process has produced specific ingredients andoutcomes to form components of a future complex intervention toimprove participation in pSS patients.Disclosures: K. Hackett: None. N. Kolehmainen: None. V. Deary:None. K.H.O. Deane: None. J.L. Newton: None. C. McCallum:None. M. Campbell: None. W. Ng: None. T. Rapley: None.PAIN AND FIBROMYALGIA048 ‘NO ONEWANTS TO LOOK AFTER THE FIBRO PATIENT’:DESIGNING EFFECTIVE HEALTHCARE SERVICES FORPATIENTS WITH FIBROMYALGIA: TWO SYSTEMATICREVIEWSDoebl1, Gary Macfarlane1 and Rosemary Hollick1Group and Aberdeen Centre for Arthritis andHealth, University of Aberdeen, Aberdeen, UNITEDBackground: Patients with fibromyalgia describe feeling frustratedwith the healthcare system. Service provision is patchy at best butoften non-existent. It is unclear how to effectively organise and deliverhealthcare across care settings. In order to inform the development ofan optimal model of care for fibromyalgia, we undertook twosystematic reviews to examine existing evidence on a) models ofcare for fibromyalgia and b) patients’ experiences with the healthcaresystem.Methods: MEDLINE(R) Ovid, EMBASE, AMED, CINAHL, PsycINFO,Web of Science, and Cochrane CENTRAL were searched in January2018. Reference and citation lists of included studies were alsochecked. We defined a model of care as evidence-informed frame-work which guides how best to organise patients’ journeys through theentire healthcare system. The focus of the second review was onpatient experiences regarding these healthcare journeys. Articles werescreened by one reviewer and where there was uncertainty, twofurther reviewers adjudicated. Due to the heterogeneity of studydesigns, narrative syntheses were undertaken for quantitative data.Thematic analysis was applied for qualitative data.Results: Model of care: 1,535 titles were identified from which sixstudies were evaluated as eligible. They were conducted across fivecountries. There was one randomised controlled trial, three cross-sectional studies, one retrospective service evaluation and review ofmedical records. Patient care experiences: 8,268 titles were identifiedfrom which 19 studies were evaluated as eligible. This includedquantitative, qualitative and mixed methods studies from thirteencountries. Study populations were drawn from a range of care settings.No evidence-based model of care covering the whole patient journeythrough the healthcare system was identified. Studies either focusedon single healthcare services offered at specific stages of thehealthcare journey (mostly diagnosis) or compared outcomes betweendifferent care settings. Limited evidence suggests that the diagnosticaccuracy of specialist nurses was equivalent to rheumatologists.Rheumatology services can be helpful where there is diagnosticuncertainty but there was no clear advantage for ongoing care in asecondary care setting. Patients reported diagnostic delays, multiplevisits to a range of healthcare providers and a lack of purposefulcoordination of care. Difficult interactions with healthcare staff, inparticular not feeling believed or listened to, were of major concern topatients. They emphasised the importance of mutual trust in theirrelationships with healthcare professionals.Conclusion: Evidence on how best to organise care for patients withfibromyalgia is limited and overall patient experiences of care arepoor. These findings provide a strong rationale for conducting thefirst major programme of work to develop a new model of care forfibromyalgia.Disclosures: S. Doebl: None. G. Macfarlane: None. R. Hollick: None.INVITED SPEAKERS ABSTRACTS Tuesday 30 April 2019 iii59Downloaded from https://academic.oup.com/rheumatology/article-abstract/58/Supplement_3/kez106.046/5444480 by University of Teeside user on 15 May 2019

7 MODELLING LOGICAL INTERVENTION PATHWAYS THROUGH A STAKEHOLDER AUTHORED CONCEPT MAP TO DESIGN COMPLEX INTERVENTIONS AIMED AT IMPROVING PARTICIPATION FOR PEOPLE WITH SJO ¨ GREN’S SYNDROME

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7 MODELLING LOGICAL INTERVENTION PATHWAYS THROUGH A STAKEHOLDER AUTHORED CONCEPT MAP TO DESIGN COMPLEX INTERVENTIONS AIMED AT IMPROVING PARTICIPATION FOR PEOPLE WITH SJO ¨ GREN’S SYNDROME

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Teeside University's Research Repository

Teeside University's Research Repository