Objective: To provide more understanding of what rheumatoid arthritis (RA) patients want and need from an outpatient visit.Methods: 25 patients who experienced care in a nurse practitioner clinic (n = 10), junior doctor clinic (n = 9) or consultant clinic (n = 6) in a large teaching hospital in West Yorkshire were interviewed about their perceptions and experiences of care. Interviews were approximately 11/2 hours in duration and were carried out in a neutral environment by a research nurse. Interview data were subjected to atheoretical content analysis, which resulted in the identification of emergent themes.Results: Five main themes emerged from the analysis of interview data: 1) patients want to be communicated to clearly and effectively and value positive relationships with practitioners. These help to give patients confidence in the care they are receiving; 2) patients want to feel in control of their condition and tend to refuse interventions as a way of gaining control; 3) patients want to be given clear explanations during consultations, and want information in oral and written forms; 4) patients want to be able to access practitioners between scheduled appointments as a way of gaining reassurance; and 5) patients want to feel valued by society through having their difficulties appreciated and understood by others.Conclusion: This research adds to the body of evidence on what patients want from their rheumatology care, and each theme has clear implications for future practice. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....

Objectives: To evaluate the introduction of a new type of syringe for patients on a self-injection of methotrexate (MTX) programme and explore patients’ sense of empowerment relating to the self-injection of MTX.Methods: Data were collected using a postal questionnaire, which yielded quantitative and qualitative data. The questionnaire was sent to all eligible patients in the primary care setting who self-injected MTX (n = 24).Results: The response rate was 88% (n = 21). Patients’ responses illustrated numerous disadvantages of using the syringe, particularly difficulties with the syringe stopper, syringe handling and leakage potential of the mildly cytotoxic drug MTX. The advantages included the ease of syringe storage and longer use by date. Difficulties in using the syringe, and the amount of support and training from hospital staff were among the factors affecting patients’ sense of empowerment.Conclusions: Although a small study, this work indicates that there may be benefits in a collaboration between hospital staff and the syringe manufacturer, to modify the new syringe to address the problems noted. The potential of cytotoxic MTX spillage being minimized is recognized, making the new syringe more suitable for use by patients with inflammatory arthritis. Patient training may help to alleviate difficulties in using a new syringe, which, in turn, may also increase patients’ sense of empowerment. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....

Background and Purpose. To determine the construct and predictive validity and sensitivity of the sub-scale items for postural changes, sitting balance and standing balance of the Postural Control and Balance for Stroke (PCBS) test over a 90-day follow-up. Method. In the initial phase of stroke the PCBS test scores were compared with values obtained for the Barthel Index (BI) and the four neuropsychological domains most widely studied in the literature: memory; language; visuo-spatial functions; and visual inattention. The ability of the PCBS test at an early stage to predict functional status, as measured by the BI, and tendency to falls at 90 days after stroke was studied. The sensitivity of the PCBS test in evaluating postural control was studied by comparing the changes between the initial and 90 days’ measures, and by examining the ability of the test to discriminate between healthy people and stroke patients. Forty stroke patients (aged 51-89 years), measured 7 and 90 days post-stroke, and 35 healthy control subjects (aged 50-90 years) participated in the study. Results. Moderate correlations were found between the initial PCBS test and the BI (Spearman’s r = 0.56-0.79) and a negative correlation between the sum variables for visual inattention and postural changes (Spearman’s r = -0.39) and sitting balance (Spearman’s r = -0.55). The score for postural changes predicted functional capacity (p < 0.002) and standing balance predicted falls at the three-month follow-up (p < 0.007). The PCBS test proved to be sensitive to change: the median change in the PCBS test scores during the three-month follow-up was 6.06. The control subjects mostly obtained maximum scores, indicating that the PCBS test was able to discriminate between healthy individuals and those with stroke. Conclusions. The results confirm that the PCBS test has good construct validity, good ability to predict functional capacity and safe moving, and it is sensitive to changes in balance control after stroke. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

continue reading.....

In this paper, we conclude our two-part series discussing how readers of Musculoskeletal Care might employ qualitative methods. In the first paper of the series, we focused upon some issues surrounding the distinctions and similarities between qualitative and quantitative approaches, and outlined the origins, typology and limitations of qualitative methods. We introduced one particular qualitative research process which readers may find useful: interpretative phenomenological analysis (IPA). In this paper, we provide a guide to applying IPA via the design of an interview, a methodology with which it is particularly suited. We discuss some specific interview and interviewing processes and also some necessary ethical issues, including personal protection and participant well-being. We also discuss how to proceed through analysis while considering questions about the generalizability, reliability, validity and application of results. Finally, we question the overall direction of qualitative research, which we hope will fuel debate among readers. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....

Background: People with rheumatoid arthritis (RA) often have comorbidities with associated disability and complex medication regimens. Little published evidence exists about why people with RA require so many medications, although it is logical to hypothesize that this may relate to older age, longer duration of RA, more active RA, worse functional disability and a greater number of comorbidities.Objectives: We set out to quantify polypharmacy in RA and identify its predictors in an observational cohort.Methods: The case notes of 348 people receiving secondary care for RA were reviewed to record polypharmacy. The 28-joint Disease Activity Score (DAS28) was calculated and the Health Assessment Questionnaire (HAQ) and the Self-administered Comorbidity Questionnaire (SCQ) were completed.Results: The mean total number of medications was 5.39, with a maximum of 16; of these, a mean of 2.41 medications were directly for RA. A mediational relationship was identified: older age and longer RA duration were significant predictors of a greater total number of medications, but these relationships were explained by the greater number of comorbidities in older participants and those with longer RA duration. Polypharmacy was not related to RA activity or functional disability.Conclusions: Polypharmacy is common among people with RA and associates with older age and longer RA duration through a greater number of comorbidities. Regular review of the full treatment plan of individuals with RA by pharmacists and other health professionals specializing in rheumatology, to weigh the benefits and risks of each medication and their interactions in light of RA activity and comorbidities, is advocated. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....

Background and Purpose. Weakness in partially paralysed muscles is a disabling impairment for people with neurological conditions. Strength training programmes are widely administered to address this impairment. There is a common belief that the effectiveness of strength training programmes can be enhanced by the addition of electrical stimulation. The purpose of this systematic review was to assess the efficacy of electrical stimulation for increasing voluntary strength in people with neurological conditions. Method. Eligible randomized trials of electrical stimulation were identified by searches of computerized databases. The search yielded 11 267 abstracts, of which 60 were retrieved. Two assessors independently reviewed full text versions of these articles. Results. Eighteen studies satisfied the inclusion criteria. These studies involved participants with spina bifida (n = 1), cerebral palsy (n = 1), peripheral nerve lesion (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 3) and stroke (n = 11). The mean (SD) PEDro score for trial quality was 4.9 (1.0) out of 10. Meta-analyses of studies involving similar patients were not done because of insufficient data or lack of homogeneity. The results of all studies were analysed individually. Conclusion. Several studies suggest a modest beneficial effect of electrical stimulation in patients with stroke. It is not clear whether patients with other types of neurological disabilities benefit from electrical stimulation in the same way. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)

continue reading.....

This paper is intended to provide a practical overview for clinicians and researchers involved in assessing upper limb function. It considers 25 upper limb assessments used in musculoskeletal care and presents a simple, straightforward comparative review of each. The World Health Organization International Classification on Functioning, Disability and Health (WHO ICF) is used to provide a relative summary of purpose between each assessment. Measurement properties of each assessment are provided, considering the type of data generated, availability of reliability estimates and normative data for the assessment. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....

The purpose of this paper, the first of a series of two discussion pieces, is to introduce some of the issues in the debate surrounding qualitative research to the readers of Musculoskeletal Care. Recent issues of the Journal have seen an informative focus on quantitative methods and statistical analysis, and here we provide an equivalent introduction to semi-structured interviewing and qualitative analysis in this series. In the qualitative tradition, we have tried to keep our discussion reflexive, transparent and contextualized within the history of the approach and the theoretical considerations that underlie it, including the origins, nature, methods and limits of the approach. We provide information that we hope is useful for readers with all levels of familiarity with qualitative research, building from an introduction to some basic assumptions and ethical issues. We also introduce one specific qualitative approach, interpretative phenomenological analysis, which researchers might wish to apply. In the accompanying paper in a subsequent issue of Musculoskeletal Care, we will describe the potential application of this approach. Copyright © 2007 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)

continue reading.....