Jason Chua

HEALTH LITERACY AND BELIEFS AMONG A COMMUNITY COHORT WITH AND WITHOUT CHRONIC LOW BACK PAIN

&NA; Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One‐hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP‐related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short‐form Test of Functional Health Literacy in Adults (S‐TOFHLA). A sub‐sample of 36 participants with CLBP also participated in in‐depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP‐related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP‐high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S‐TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP‐high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP‐low disability. While all participants with CLBP had adequate health literacy scores (S‐TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.

Disease‐specific knowledge and clinical skills required by community‐based physiotherapists to co‐manage patients with rheumatoid arthritis

While strong evidence supports the role of physiotherapy in the co‐management of patients with rheumatoid arthritis (RA), it remains unclear what constitutes the essential disease‐specific knowledge and clinical skills required by community‐based physiotherapists to effectively and safely deliver recommended care. This study aimed to identify essential disease‐specific knowledge and skills, link these with evidence from clinical guidelines, and broadly determine the professional development (PD) needs and confidence related to the management of RA among physiotherapists.

Translating Evidence for Low Back Pain Management into a Consumer-Focussed Resource for Use in Community Pharmacies: A Cluster-Randomised Controlled Trial

Background This cluster-randomised controlled trial determined the effectiveness of an evidence-based, pamphlet intervention in improving low back pain (LBP)-related beliefs among pharmacy consumers. Methods Thirty five community pharmacies were randomised to three groups: pamphlet+education intervention [n = 11]; pamphlet only intervention [n = 11]; control: usual care [n = 13]. Eligibility requirements for clusters included: community-based pharmacies and proprietor participation consent. Pharmacy consumers (N = 317) aged 18–65 years currently experiencing LBP participated. Intervention group allocation depended on the pharmacy attended. Individual-level outcomes were measured at pre-intervention (T0), at two (T1) and eight (T2) weeks post-intervention and included beliefs about LBP [Back Pain Beliefs Questionnaire (BBQ); Fear Avoidance Beliefs Questionnaire (FABQ)]. Secondary outcomes included pain severity, activity impairment and pamphlet perceived usefulness. Blinding to group allocation included primary investigators, outcome assessors and the statistician. Pharmacy staff and consumers were un-blinded. Results Of 35 pharmacies recruited (317 consumers), no clusters were lost to follow-up. Follow-up was available for n = 24 at 2 weeks only; n = 38 at 8 weeks only; n = 148 at both time points, with n = 148+24+38 = 210 analysed (107 excluded: no follow up). Adjusting for baseline scores demonstrated no significant differences in beliefs (2 or at 8 weeks) between pamphlet (with or without education) versus control, or between ‘pamphlet with’ versus ‘without’ education. Work-related fear (FABQ) was significantly lower in consumers receiving pamphlet (with or without education) versus control (difference −2.3, 95%CI: −4.4 to −0.2). There was no significant difference between “pamphlet with” versus “pamphlet without” groups. Consumers receiving the “pamphlet with” reported greater perceived usefulness than consumers receiving the “pamphlet without” (difference 0.9 (95%CI: 0.0 to 1.8)). Conclusion Community pharmacies provided a feasible primary care portal for implementing evidence-based information. The associated improvement in work-related LBP-beliefs for consumers receiving the pamphlet suggests this simple intervention may be a useful component of care. Trial Registration ACTR.org.au ACTRN12611000053921

Translating Policy into Practice for Community-Based Management of Rheumatoid Arthritis: Targeting Professional Development Needs among Physiotherapists

Introduction. Contemporary health policy promotes delivery of community-based health services to people with musculoskeletal conditions, including rheumatoid arthritis (RA). This emphasis requires a skilled workforce to deliver safe, effective care. We aimed to explore physiotherapy workforce readiness to co-manage consumers with RA by determining the RA-specific professional development (PD) needs in relation to work and educational characteristics of physiotherapists in Western Australia (WA). Methods. An e-survey was sent to physiotherapists regarding their confidence in co-managing people with RA and their PD needs. Data including years of clinical experience, current RA clinical caseload, professional qualifications, and primary clinical area of practice were collected. Results. 273 physiotherapists completed the survey. Overall confidence in managing people with RA was low (22.7–58.2%) and need for PD was high (45.1–95.2%). Physiotherapists with greater years of clinical experience, a caseload of consumers with RA, postgraduate qualifications in musculoskeletal physiotherapy, or who worked in the musculoskeletal area were more confident in managing people with RA and less likely to need PD. Online and face-to-face formats were preferred modes of PD delivery. Discussion. To enable community-based RA service delivery to be effectively established, subgroups within the current physiotherapy workforce require upskilling in the evidence-based management of consumers with RA.

Policy-into-practice for rheumatoid arthritis: Randomized controlled trial and cohort study of E-learning targeting improved physiotherapy management

To examine the effectiveness of a physiotherapy‐specific, web‐based e‐learning platform, “RAP‐el,” in best‐practice management of rheumatoid arthritis (RA) using a single‐blind, randomized controlled trial (RCT) and prospective cohort study.

Young people's experiences of persistent musculoskeletal pain, needs, gaps and perceptions about the role of digital technologies to support their co-care: a qualitative study

Objective To investigate young peoples experiences of persistent musculoskeletal pain, including care needs and current service gaps as well as perceptions about the role of digital technologies to support their co-care. Methods A qualitative study employing two independent data collection modes: in-depth individual semistructured interviews and focus groups. Setting Community settings throughout Australia. Participants Participants were included if they had experienced persistent musculoskeletal pain of >3-month duration with an average of ≥3 on the visual analogue scale over the preceding 3 months, including non-specific conditions (eg, low back pain) and specific conditions (eg, juvenile idiopathic arthritis and other systemic arthritides), with/without pre-existing or current diagnosed mental health conditions. 23 young people (87.0% women; mean (SD) age: 20.8 (2.4) years) from across 6 Australian jurisdictions participated. Almost two-thirds of participants with persistent musculoskeletal pain reported comorbid mental health conditions. Main outcome measures Inductive and deductive approaches to analyse and derive key themes from verbatim transcripts. Results Participants described their daily experiences of living with persistent musculoskeletal pain, their fears and the challenges imposed by the invisibility of pain, and the two-way relationship between their pain and mental well-being. A lack of relevant and accessible information and resources tailored to young peoples unique needs, integrated and youth-relevant healthcare services and adequately skilled healthcare practitioners were identified as key care gaps. Participants strongly advocated for the use of digital technologies to improve access to age-appropriate resources and support for co-care. Conclusions Young people living with persistent musculoskeletal pain described the absence of age-appropriate pain services and clearly articulated their perceptions on the role of, and opportunities provided by, digital technologies to connect with and support improved pain healthcare. Innovative and digitally-enabled models of pain care are likely to be helpful for this group.

Innovative interdisciplinary e-learning to upskill medical students: insights.

that arise for students engaged in delivering clinical care to their patients. Viewing of these videos was not a course requirement, but in a class of 55 students who were tracked over their fourth and final years, 548 views were logged; 14% of these viewings took place in Year 4 and 86% in the final year. This was not surprising given that the bulk of clinical experience occurs in Year 5. Overall, 69% of viewings occurred within 1 week of competency testing, and 80% of students reported watching the speedlistener version. What lessons were learned? These learning resources allowed communal sharing among the larger student community of the rich dialogue and authentic case discussion that occurs between an individual student and a clinical teacher. In addition, it facilitated access to a broad range of clinical learning experiences to which students may not normally be exposed and thus increased the diversity of their learning. Feedback from an evaluation questionnaire showed students valued the communal consultation videos as supporting their learning, especially before competency testing. Although use of the videos was not compulsory, usage analytics showed encouraging rates of consumption. Future research will examine why some students were low consumers and whether this related to subject interest, approaches to learning or acceptance of technology for learning. However, although the videos were not designed to support preparation for competency testing, this proved to be a tipping point for consumption. The speed-listener videos facilitated efficient viewing. Students requested more of the student-based communal consultation videos.

Assessing Implementation Readiness and Success of an e-Resource to Improve Prelicensure Physical Therapy Workforce Capacity to Manage Rheumatoid Arthritis

&NA; • STUDY DESIGN: Prospective within‐subject, cross‐sectional, between‐group, nested qualitative designs within an implementation science framework. • BACKGROUND: Physical therapy is recommended for rheumatoid arthritis (RA) care, yet prelicensure RA curriculum time remains limited. • OBJECTIVES: To determine readiness for, and success of, implementing an e‐learning tool, Rheumatoid Arthritis for Physiotherapists e‐Learning (RAP‐eL), within the prelicensure physical therapy curriculum. • METHODS: All physical therapy students in a 1‐year cohort in 2014 had RAP‐eL embedded in their curriculum. Rheumatoid Arthritis for Physiotherapists e‐Learning is an online platform that delivers RA disease information with translation to clinical practice. Implementation readiness, determined by acceptability of RAP‐eL to students, was evaluated using focus groups (n = 23). Implementation success was measured using quantitative data from a previously validated questionnaire, including changes in students’ self‐reported confidence in knowledge (out of 45) and skills (out of 40) in managing RA after 4 weeks of access to RAP‐eL, retention of learning over 14 months, and differences in workforce readiness between students in the cohort who had access to RAP‐eL and a historical control cohort. • RESULTS: Acceptability of RAP‐eL was confirmed from qualitative data, demonstrating implementation readiness. Short‐term improvements were observed in RA knowledge (mean difference, 16.6; 95% confidence interval [CI]: 15.7, 17.6) and RA skills (mean difference, 14.9; 95% CI: 13.9, 15.9; n = 137). Retention was demonstrated after 14 months (P<.001; n = 62). Students in the 1‐year cohort who had RAP‐eL embedded in the curriculum scored significantly higher on knowledge (mean difference, 3.6; 95% CI: 1.3, 5.9) and skills (mean difference, 3.3; 95% CI: 0.9, 5.7; n = 62) compared to those without RAP‐eL (n = 36). Rheumatoid Arthritis for Physiotherapists e‐Learning remains embedded in the curriculum. • CONCLUSION: This study demonstrated both readiness and success of the sustainable implementation of RAP‐eL within a prelicensure physical therapy curriculum. • KEY WORDS: chronic disease, curriculum, e‐learning, musculoskeletal, qualitative