Paula Veinot

Perceptions of workplace health: building community partnerships

Purpose – Workplace health promotion initiatives are an effective way to reach adults, and provide safe and healthy working environments that support individual health. The purpose of this project was to: learn how organizations/businesses define workplace health; assess employer support and commitment for workplace health initiatives; assess facilitators and barriers to workplace wellness/health; and understand workplace needs around evaluation and outcome measures.Design/methodology/approach – A community partnership, Wellness Initiatives Network (WIN), was established to provide a forum for organizations in Atlantic Canada to share knowledge and experience on workplace health. Focus groups were conducted with businesses/organizations in the four Atlantic Provinces. Tape‐recorded transcriptions were analyzed using thematic analysis.Findings – Ingredients for successful workplace health initiatives include onsite programs, the provision of incentives and recognition for employees, and the need to build a...

Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot

Objectives To examine the feasibility and potential benefits of early peer support to improve the health and quality of life of individuals with early inflammatory arthritis (EIA). Design Feasibility study using the 2008 Medical Research Council framework as a theoretical basis. A literature review, environmental scan, and interviews with patients, families and healthcare providers guided the development of peer mentor training sessions and a peer-to-peer mentoring programme. Peer mentors were trained and paired with a mentee to receive (face-to-face or telephone) support over 12 weeks. Setting Two academic teaching hospitals in Toronto, Ontario, Canada. Participants Nine pairs consisting of one peer mentor and one mentee were matched based on factors such as age and work status. Primary outcome measure Mentee outcomes of disease modifying antirheumatic drugs (DMARDs)/biological treatment use, self-efficacy, self-management, health-related quality of life, anxiety, coping efficacy, social support and disease activity were measured using validated tools. Descriptive statistics and effect sizes were calculated to determine clinically important (>0.3) changes. Peer mentor self-efficacy was assessed using a self-efficacy scale. Interviews conducted with participants examined acceptability and feasibility of procedures and outcome measures, as well as perspectives on the value of peer support for individuals with EIA. Themes were identified through constant comparison. Results Mentees experienced improvements in the overall arthritis impact on life, coping efficacy and social support (effect size >0.3). Mentees also perceived emotional, informational, appraisal and instrumental support. Mentors also reported benefits and learnt from mentees’ fortitude and self-management skills. The training was well received by mentors. Their self-efficacy increased significantly after training completion. Participants’ experience of peer support was informed by the unique relationship with their peer. All participants were unequivocal about the need for peer support for individuals with EIA. Conclusions The intervention was well received. Training, peer support programme and outcome measures were demonstrated to be feasible with modifications. Early peer support may augment current rheumatological care. Trial registration number NCT01054963, NCT01054131.

Evaluation of a workplace health program to reduce coronary risk factors

Purpose – The purpose of this paper is to docoment a randomized controlled trial, with follow‐up at three and six months, to determine the impact of a coronary risk factor modification program for employees.Design/methodology/approach – Intervention participants received a 12‐week health promotion program involving exercise, education seminars, nutritional analysis and smoking cessation counselling. Outcome measures included differences in coronary risk factors of control and intervention participants between baseline and three and six‐month follow‐up visits.Findings – The participants included 566 individuals employed in the Halifax area, Nova Scotia, Canada. They were between 19 and 66 years old with at least two modifiable coronary risk factors. There were statistically significant differences at three months in coronary risk score improvement, smoking cessation, physical activity level increases, body mass index reductions and serum cholesterol. At six months, improvements remained significant except ...

SAT0478 Early inflammatory arthritis detection using a self-administered tool versus general practitioner diagnosis in primary care

Background Delays to rheumatologic care represent addressable barriers to improved outcomes for inflammatory arthritis (IA)1. A self-administered tool has been developed for early IA detection in pre-rheumatology care settings. Psychometric properties and discriminant validity of this tool in rheumatology triage have been previously studied2,3. A scoring algorithm enhanced discriminant validity of unweighted tool in rheumatology triage3. Objectives To determine if predictive performance of unweighted early IA detection tool differs from primary care physician (PCP)’s diagnosis in primary care. Secondary objective: To contrast relative performance of tool and PCP diagnosis between primary care and rheumatology triage settings. Methods Prospective study of 139 patients with 6-52 wks musculoskeletal complaints in Canadian primary care setting was conducted. Participants completed tool and received rheumatology consultation regardless of PCP’s recommendation. Predictive performance of participants’ positive responses to 6 of 11 tool items and IA diagnosis by PCP were compared using rheumatologist’s blinded diagnosis as reference standard. Relative performance of the tool and PCP diagnosis in primary care was compared to rheumatology triage setting where 143 referred patients were studied. Results 19 patients were diagnosed by rheumatologist to have IA. Compared to non-IA, cases had more swollen joints (p<0.0001), greater duration of morning stiffness (p<0.0001) and higher erythrocyte sedimentation rate (p=0.002). Similarly, cases were more frequently rheumatoid factor positive (p<0.0001), treated with NSAIDs by PCP (p<0.0001), had constitutional symptoms of IA diagnosis (p<0.01) and had positive metacarpophalangeal and metatarsophalangeal squeeze tests (p<0.0001 respectively). Predictive performance of tool included a significant odds ratio (OR) (95% CI) of 5.07 (1.59-16.20), sensitivity (Se) of 0.79 (0.61-0.97) and specificity (Sp) of 0.58 (0.49-0.66). In contrast, predictive performance of PCP diagnosis included non-significant OR of 2.94 (0.91-9.49), Se of 0.26 (0.07-0.46) and Sp of 0.89 (0.84-0.95). Among 56 participants missing PCP diagnosis (40.29%), OR for the tool was 6.91 (0.75-63.53). Median (IQR) number of positive rheumatology-derived cases was 7 (6-8), compared to 5 (4-6) for PCP-determined IA cases (p=0.02) and 5 (3-7) for rheumatologist-diagnosed non-IA (p=0.0014). In the triage setting (PCP referrals to rheumatology), the unweighted tool had OR of 7.03 (2.76-17.88) compared to 28.25 (8.93-89.32) for PCP diagnosis. Weighting the tool, OR was 25.28 (9.07-70.41). Among 34 referrals without PCP diagnosis (23.78%), OR was 49.5 (4.88-501.75) for unweighted tool and 69.67 (6.44-754.16) for weighted tool. Conclusions The unweighted, self-administered early IA detection tool has discriminant validity both in primary care and rheumatology triage settings. In primary care, the tool generally outperforms PCP diagnosis. In the rheumatology triage setting, the tool may be especially advantageous among referrals without a PCP diagnosis. In primary care, significant predictive performance of the tool may be further enhanced with a scoring algorithm. References Mottonen T, et al. Arthritis Rheum 2002;46(4):894-8. Bell MJ, et al. BMC Musculoskelet Disord 2010;11:50. Tavares R, et al. Arthritis Care Res 2012 (submitted). Disclosure of Interest None Declared

SAT0534 Early Inflammatory Arthritis Detection using a Self-Administered Tool in a Canadian Francophone Population

Background A self-administered Early Inflammatory Arthritis (EIA) tool has been developed.1-3 Objectives The purpose of this study is to cross-culturally adapt the developed EIA detection tool for the Canadian Francophone population and to determine its psychometric and discriminative properties. The external validity of a scoring algorithm previously developed in an English-speaking population was tested. Methods Three groups were recruited from outpatient clinics at two tertiary care hospitals: 92 EIA; 106 established IA; 94 non-IA. The current study was completed in four phases. Phase I: Translation and adaptation of the English tool into Canadian Francophone culture was conducted independently by two sets of translators. Phase II: A committee adjudicated the translated and adapted items to derive a single cross-culturally adapted tool. Phase III: A pilot validation study of the tool was conducted on a Canadian Francophone sample of 80 participants. Comprehensibility, internal consistency and test-retest reliability of the tool were determined. Phase IV: A full-scale validation study of 292 Canadian Francophone participants was conducted to determine the discriminative properties of the tool. Results A translated and cross-culturally adapted to Canadian French version of the EIA Detection Tool, with 100% committee agreement was produced. Comprehensibility approached unity for all tool items. The internal consistency Kuder-Richardson-20 was 0.96 (p<0.0001). The mean test-retest reliability kappa (standard error, SE) was 0.67 (0.03). The intraclass correlation coefficient (ICC) for summed ‘yes’ responses between test and retest phases was 0.77 (p<0.0001) and for algorithm scores was 0.86 (p<0.0001). The scoring algorithm receiver operating characteristic plot area under the curve (SE) was 0.818 (0.002). Conclusions The tool has favorable measurement and discriminative properties. A cross-culturally adapted and validated EIA Detection Tool for Canadian Francophones may improve appropriate care for this population. References Bell MJ, et al. BMC Musculoskelet Disord 2010;11:50. Tavares R, et al. J Rheumatol 2013 (in press). Tavares R, et al. Rheumatology 2013 (submitted). Acknowledgements This study was financial supported by a Canadian Arthritis Network Discovery Advancement Program peer-reviewed grant. We thank the following individuals for their contributions: bilingual translators, linguist (Rose Gorrie), methodologist (Dr. Lucie Brosseau), primary care practitioner (Dr. Diane Giroux), lay persons and moderator/coordinator (Isabelle Provost) who contributed to the translation of the tool; on-site staff who assisted with data collection (Diane Ferland, Isabelle Gagnon, Chantal Jaques, Evelyne Lejeune, Ann Ranking, Francine Raymond, Michelle Roy); and participating rheumatologists - Dr. Louis Bessette, Groupe de recherche en maladie osseueses (GRMO) Inc.; Dr. Gilles Boire, Centre de Recherche Clinique - Centre Hospitalier Universitaire de Sherbrooke; Dr. Isabelle Fortin, Centre de santé et de services sociaux de Rimouski-Neigette; Dr. Mark Hazeltine, Centre de rhumatologie de Laval; Dr Leo Picard, Centre Hospitalier Hopital Georges-L. Dumont Régie Vitalité; Dr. Jean-Luc Tremblay, Centre de Recherche Musculosquelettique. Disclosure of Interest None Declared