- Email: [email protected]
The role of the pharmacist within an advanced musculoskeletal physiotherapy screening clinic and multidisciplinary service
e6
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
Results: 5619 patient data sets were uploaded onto the online data collection system during the period of November 2014 to September 2015. There was a wide variety in the number of patient data sets input per practitioner from 1 to 410 data sets. The mean age of all patients was 52.3 years ± 17.8 years. Whilst the majority of patients were in paid employment, 28% of patients were retired. The largest source of referral was ‘selfreferral’ patients (77.2%), and the majority of patients (78.2%) paid for their own treatment. More than half the patients (62.8%) were treated within 2 days of referral and almost all (94.5%) were treated within one week of referral. The most frequently reported general body sites were “lower limb” (31.1%) and the “lumbar spine & pelvis” (28.7%). The number of treatments provided per episode ranged between 1 and 10. Goal achievement at discharge was significantly achieved for 72.6% of patients; goals were not achieved in 6.1% of patients. Improvements in physical/ functional outcome scores were observed with a reduction in the mean score. Only 1.7% of patients were unable to return to work following treatment. Conclusion: Standardised data collection provides useful information to all involved, in terms of patient profiling, marketing, evidence of outcomes, benchmarking and identifying areas for personal learning and professional development. Future work will include the introduction of a validated PROM which will provide additional information about efficiency, effectiveness and quality of care. Implications: Physio First and their clinicians have a growing database of patient data showing how efficient, timely and equitable their services are which will help support them in the ever changing healthcare market. Funding acknowledgements: This project was commissioned by Physio First and funded by the Private Practitioners Education Foundation. Ethics approval: Ethics approval was provided by University of Brighton. Disclosure of interest: None declared. Keywords: Private practice, Standardised data collection Teaching, Learning and Professional Development RA-AP-008 THE DEVELOPMENT OF AN ASSESSMENT TOOL TO MEASURE THE CLINICAL REASONING UTILIZED DURING A LIVE PATIENT EXAMINATION S. Cunningham*, R. Jackson, K. Herbel. Physical Therapy, Radford University, Roanoke, United States * Corresponding author.
Background: In all healthcare professions, the development and progression of clinical reasoning skills is perceived as a key factor in distinguishing expert from novice clinicians. However, the complex nature of clinical reasoning makes it difficult to objectively assess. The challenge is the ability to assess mental processes, which are not directly observable. An assessment tool has been developed to assess clinical reasoning development in post-graduate physical therapy education. The tool utilizes the skills and behaviors outlined in the American Board of Physical Therapy Specialties Dimensions of Specialty Practice (DSP) in Orthopaedics. The aptitudes assessed include the ability to perform an examination, evaluation, diagnosis, prognosis, and intervention. Purpose: The purpose of this study was determine the psychometric properties of an assessment tool designed to measure clinical reasoning development. Methods: The study sample included 12 graduating residents and 10 physiotherapists entering an 18- month manual therapy residency program in Kenya. The physiotherapists completed a live patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination, evaluation, and treatment of musculoskeletal conditions. Inclusion criteria included participation in or acceptance to the residency program, practice as a physiotherapist between 3 and 25 years, and 50% of work- day being involved in direct patient care. The examinations were performed over a 5-day period in Nairobi, Kenya at the Kenya Medical Training College. Results: Cronbach's alpha for internal consistency of the five aptitudes measured by the tool was determined as examination 0.871, evaluation 0.818, diagnosis 0.836, prognosis 0.603, and intervention 0.824. Inter and intra- rater reliability was determined for each of the 76 items assessed. Inter rater and intra- rater reliability was found to be significant at the 0.05
level for 42 of the items. Inter- rater reliability on overall pass or fail of the exam at a 75% was 0.730 with a 2- tail significance level of 0.001. Furthermore, the assessment was able to distinguish graduating from entering residents. Graduating residents achieved an average score of 83.4% on the live patient examination with an overall pass rate of 92.3%. Physiotherapists entering the residency program achieved an average score of 38.2% with an overall passing rate of 0.00%. The computed chisquare value was 19.30 with an associated p-value less than 0.001. A Fisher’s exact test demonstrated a two-tailed P value less than 0.0001. In those skills in which there was poor agreement between scores, the difficulty appeared to be in determining adequate performance in the physiotherapists waiting to enter the program. These items are being revised with more specific descriptions of the competence level required. Psychometric properties of the revised assessment should be completed in March 2016. Conclusion: This pilot study was an attempt to develop an effective assessment tool for the evaluation of clinical reasoning development in post- graduate physical therapy education. The assessment of integration of knowledge into the therapists' working hypothesis was difficult to consistently assess requiring revision of items to specifically describe expected components of the skill and what would determine adequate performance. Implications: The results of this study demonstrate the difficulty in assessing clinical reasoning, however, it is a significant first step in developing a tool to track progression of these skills in individuals seeking to become advanced clinicians. Funding acknowledgements: Funding was provided by the Institute for Global Enterprise Global Scholars Program. Ethics approval: This research was approved by the University of Evansville Institutional Review Board. Disclosure of interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program, K. Herbel: None declared. Keywords: Clinical Reasoning Assessment, Residency Program Changing roles and scope of practice RA-AP-009 THE ROLE OF THE PHARMACIST MUSCULOSKELETAL PHYSIOTHERAPY MULTIDISCIPLINARY SERVICE
WITHIN AN ADVANCED SCREENING CLINIC AND
P. Swete Kelly 1, *, L. Busuttin 2, N. Walton 2. 1 Physiotherapy, Performance Rehab, Annerley, Australia; 2 Pharmacy, Royal Brisbane and Women's Hospitals, Brisbane, Australia * Corresponding author.
Background: Advanced scope physiotherapists (ASP) undertake the assessment and case management of complex patients referred to Neuroand Orthopaedic Surgery Specialist Outpatient departments but in many situations have limited knowledge of appropriate medication use. The use of medicines is a common intervention in the holistic multidisciplinary management of patients with musculoskeletal conditions. Patients frequently present with poor understanding of their prescribed medicines, inadequate or inappropriate analgesia for their presenting condition/s and/or polypharmacy with high risk of actual or potential medicines related problems (MRP). Assessment and review of individual medicine regimens is a primary role of a clinical pharmacist despite this, this profession is not well represented in outpatient multidisciplinary teams. Purpose: The project purpose was to assess if, within a cohort of patients presenting to an ASP, there were patients with actual and/or potential MRP and the potential benefits from a pharmacist review. Secondary aims included identification of strategies to best utilise this profession’s expertise and scope of practice in this setting. Methods: Patients presenting to an ASP clinic underwent usual assessment and were also provided a questionnaire (completed by the patient and Physiotherapist) to stratify the patient risk for MRP. Appropriate patients were referred to a pharmacist who undertook a comprehensive medication assessment interview with the patient. Data recorded included opiate usage, identification of adverse effects, inappropriate medicines and
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
e7
Advanced assessment/practice and managing complex patients RA-BI-010 PATIENT EXPERIENCES OF A COMBINED EXERCISE AND ACCEPTANCE AND COMMITMENT THERAPY GROUP BASED PROGRAMME FOR CHRONIC PAIN. A QUALITATIVE STUDY
Results: Seven main themes emerged from the data. These themes included: (1) Group support: reassurance that participants were not alone with consequent validation of the pain experience, and new insights and perspectives in relation to pain, (2) Changed communication with other people; including improved family relationships and more defined boundary setting, (3) Acceptance of pain combined with an ability to move on in the midst of pain, (4) Practical strategies for managing pain: including pacing strategies, reduced fear and enhanced enjoyment in relation to exercise (5) Values, which centred around realisations as to the central importance of the family in addition to enhanced self-care, (6) Mindfulness in terms of it’s benefits and considerable challenges and (7) Frustration: lack of answers and lack of understanding from others. Conclusion: This is the first qualitative study to report on individual experiences of a multidisciplinary PMP combining ACT and exercise interventions for chronic pain. The findings demonstrate the fundamental insights gained by the participants on the programme, which impacted on their overall ability to engage as more active participants in relation to enhanced interpersonal relationships, self care and general function. They support the acceptability of this type of intervention by individuals with chronic pain and increase our understanding of treatment effects from the patient’s perspective. Implications: This qualitative study will have implications for both research and clinical practice in the field of chronic pain. The findings will help inform healthcare professionals regarding the design and implementation of future multidisciplinary PMPs which may positively impact the lives of people with chronic pain. Funding acknowledgements: Unfunded. Ethics approval: Mater Misericordiae University Hospital Ethics Committee. Disclosure of interest: None declared. Keywords: Acceptance and commitment therapy, Chronic pain, Exercise
M.-B. Casey*, D. Lowry 1, C. Hearty 2, R. Neary 3, C. Doody 3. 1 Psychology Department, Mater Misericordiae University Hospital, Ireland; 2 Department of Pain Medicine, Mater Misericordiae University Hosptial, Ireland; 3 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
Intergrating Research into practice RA-BI-011 PSYCHOLOGICAL CORRELATES OF PAIN INTENSITY AND PHYSICAL FUNCTION IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE IN NIGERIA
missing therapy. Any interventions made by the pharmacist including advice to the patient or to the patient’s prescriber were documented. Results: Eighty-eight percent of patients referred to the Pharmacist were identified to have actual and/or potential MRP including adverse effects, missing therapy and inappropriate medicines. In addition, 51% of patients were identified at high or highest risk for a potential MRP associated with their presenting complaint or other co-morbidities. Conclusion: Pharmacists provide an additional often overlooked profession in multidisciplinary teams managing patients with complex musculoskeletal conditions. They have proven valuable in identifying and providing advice to patients and prescribers regarding analgesia and the risk of actual and potential MRP. As medicines play a large role in healthcare interventions, the assessment and rationalisation of a patient’s medicine regimen is important to ensure all areas of a complex patients’ management are being addressed. Implications: Pharmacists have a broad knowledge of the risks and benefits of medicines. Inclusion of pharmacists within multidisciplinary teams should be considered. Funding acknowledgements: Funding for this project was provided through the Metro North Hospital and Health Service ‘Improving Outpatient Access program’. Ethics approval: No ethics was required as this was an implementation of a service redesign. Disclosure of interest: None declared. Keywords: Advanced practice, Pharmacy, Physiotherapy
* Corresponding author.
Background: Multidisciplinary pain management programmes (PMPs) are recommended for chronic pain. Exercise is well established as an effective treatment and there is emerging evidence to suggest that acceptance and commitment therapy (ACT) is an effective psychological approach for chronic pain. There is a notable lack of qualitative research in this area, particularly with regards to multidisciplinary PMPs which combine ACT with exercise interventions. Purpose: The aim of this qualitative study was to explore the experiences of participants of a multidisciplinary PMP which combined ACT with supervised exercise as a treatment for chronic pain. Methods: Thirty-six participants completed a group-based multidisciplinary PMP set in a hospital Pain Medicine clinic. Participants attended for one full day each week for a period of eight weeks. Each day began with a two-hour ACT psychology session delivered by a Senior Psychologist. This was followed by supervised aquatic or gym based exercise of one hour duration led by a Senior Physiotherapist. Educational talks were also provided each week covering topics such as medication management, pacing and sleep hygiene. All participants were invited to take part in focus groups between three and six months following completion of the PMP. Twenty-two participants attended one of four focus groups, with five or six participants attending per group. The focus groups were co-ordinated by a researcher who had no involvement in the delivery of the PMP. Semistructured interviews were conducted using an interview schedule as a guide. Participants were encouraged to speak freely and were asked to comment on the best and least helpful aspects of the programme, their opinions in relation to being part of a group, any changes positive or negative in their lives as a result of the programme, their opinions on the focus on values within the programme and any changes in physical activity levels and attitudes towards exercise. The interviews were recorded and transcribed verbatim. Transcripts were analysed using Thematic Framework analysis and themes were validated by a second assessor.
A. Odole*, E. Ekediegwu, N. Odunaiya. College of Medicine, University of Ibadan, Ibadan, Nigeria * Corresponding author.
Background: Osteoarthritis (OA) is a prevalent musculoskeletal condition of public health concern. It is mostly characterised by joint pain, joint limitation and decreased physical function. Clinical factors of OA such as pain intensity and physical function may be influenced by psychological factors such as kinesiophobia and pain catastrophizing. Published studies on the associations among these psychological and clinical factors are not readily available particularly in Nigeria. Purpose: The aim of this study was to investigate the associations among pain intensity, physical function, kinesiophobia and pain catastrophizing in patients with osteoarthritis of the knee in Enugu, South-East Nigeria. Methods: Ninety-nine consecutively sampled patients diagnosed of knee osteoarthritis from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey. Participants' psychosocial factors which included kinesiophobia and pain catastrophizing were assessed using Brief Fear of Movement Scale for Osteoarthritis (BFMSO), Pain Catastrophizing Scale (PCS). Visual Analogue Scale (VAS) and Ibadan Knee or Hip Osteoarthritis Measure (IKHOAM) were used to assess pain intensity and physical function respectively. Data were analysed using Pearson's correlation coefficient, independent t-test and multiple linear regression at p¼0.05. Results: Participants were aged 59.11 ± 12.46 years. Significant positive correlations were found between kinesiophobia and pain intensity (r ¼ 0.38), pain catastrophizing and pain intensity (r ¼ 0.39). Significant negative correlations existed between kinesiophobia and physical function (r ¼ 0.43), pain catastrophizing and physical function (r ¼ 0.28), physical function and age (r ¼ 0.35). However, no significant correlations existed between kinesiophobia and age (r ¼ 0.05), pain catastrophizing and age (r ¼ 0.05), pain intensity and age (r ¼ 0.15). There was no
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
Results: 5619 patient data sets were uploaded onto the online data collection system during the period of November 2014 to September 2015. There was a wide variety in the number of patient data sets input per practitioner from 1 to 410 data sets. The mean age of all patients was 52.3 years ± 17.8 years. Whilst the majority of patients were in paid employment, 28% of patients were retired. The largest source of referral was ‘selfreferral’ patients (77.2%), and the majority of patients (78.2%) paid for their own treatment. More than half the patients (62.8%) were treated within 2 days of referral and almost all (94.5%) were treated within one week of referral. The most frequently reported general body sites were “lower limb” (31.1%) and the “lumbar spine & pelvis” (28.7%). The number of treatments provided per episode ranged between 1 and 10. Goal achievement at discharge was significantly achieved for 72.6% of patients; goals were not achieved in 6.1% of patients. Improvements in physical/ functional outcome scores were observed with a reduction in the mean score. Only 1.7% of patients were unable to return to work following treatment. Conclusion: Standardised data collection provides useful information to all involved, in terms of patient profiling, marketing, evidence of outcomes, benchmarking and identifying areas for personal learning and professional development. Future work will include the introduction of a validated PROM which will provide additional information about efficiency, effectiveness and quality of care. Implications: Physio First and their clinicians have a growing database of patient data showing how efficient, timely and equitable their services are which will help support them in the ever changing healthcare market. Funding acknowledgements: This project was commissioned by Physio First and funded by the Private Practitioners Education Foundation. Ethics approval: Ethics approval was provided by University of Brighton. Disclosure of interest: None declared. Keywords: Private practice, Standardised data collection Teaching, Learning and Professional Development RA-AP-008 THE DEVELOPMENT OF AN ASSESSMENT TOOL TO MEASURE THE CLINICAL REASONING UTILIZED DURING A LIVE PATIENT EXAMINATION S. Cunningham*, R. Jackson, K. Herbel. Physical Therapy, Radford University, Roanoke, United States * Corresponding author.
Background: In all healthcare professions, the development and progression of clinical reasoning skills is perceived as a key factor in distinguishing expert from novice clinicians. However, the complex nature of clinical reasoning makes it difficult to objectively assess. The challenge is the ability to assess mental processes, which are not directly observable. An assessment tool has been developed to assess clinical reasoning development in post-graduate physical therapy education. The tool utilizes the skills and behaviors outlined in the American Board of Physical Therapy Specialties Dimensions of Specialty Practice (DSP) in Orthopaedics. The aptitudes assessed include the ability to perform an examination, evaluation, diagnosis, prognosis, and intervention. Purpose: The purpose of this study was determine the psychometric properties of an assessment tool designed to measure clinical reasoning development. Methods: The study sample included 12 graduating residents and 10 physiotherapists entering an 18- month manual therapy residency program in Kenya. The physiotherapists completed a live patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination, evaluation, and treatment of musculoskeletal conditions. Inclusion criteria included participation in or acceptance to the residency program, practice as a physiotherapist between 3 and 25 years, and 50% of work- day being involved in direct patient care. The examinations were performed over a 5-day period in Nairobi, Kenya at the Kenya Medical Training College. Results: Cronbach's alpha for internal consistency of the five aptitudes measured by the tool was determined as examination 0.871, evaluation 0.818, diagnosis 0.836, prognosis 0.603, and intervention 0.824. Inter and intra- rater reliability was determined for each of the 76 items assessed. Inter rater and intra- rater reliability was found to be significant at the 0.05
level for 42 of the items. Inter- rater reliability on overall pass or fail of the exam at a 75% was 0.730 with a 2- tail significance level of 0.001. Furthermore, the assessment was able to distinguish graduating from entering residents. Graduating residents achieved an average score of 83.4% on the live patient examination with an overall pass rate of 92.3%. Physiotherapists entering the residency program achieved an average score of 38.2% with an overall passing rate of 0.00%. The computed chisquare value was 19.30 with an associated p-value less than 0.001. A Fisher’s exact test demonstrated a two-tailed P value less than 0.0001. In those skills in which there was poor agreement between scores, the difficulty appeared to be in determining adequate performance in the physiotherapists waiting to enter the program. These items are being revised with more specific descriptions of the competence level required. Psychometric properties of the revised assessment should be completed in March 2016. Conclusion: This pilot study was an attempt to develop an effective assessment tool for the evaluation of clinical reasoning development in post- graduate physical therapy education. The assessment of integration of knowledge into the therapists' working hypothesis was difficult to consistently assess requiring revision of items to specifically describe expected components of the skill and what would determine adequate performance. Implications: The results of this study demonstrate the difficulty in assessing clinical reasoning, however, it is a significant first step in developing a tool to track progression of these skills in individuals seeking to become advanced clinicians. Funding acknowledgements: Funding was provided by the Institute for Global Enterprise Global Scholars Program. Ethics approval: This research was approved by the University of Evansville Institutional Review Board. Disclosure of interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program, K. Herbel: None declared. Keywords: Clinical Reasoning Assessment, Residency Program Changing roles and scope of practice RA-AP-009 THE ROLE OF THE PHARMACIST MUSCULOSKELETAL PHYSIOTHERAPY MULTIDISCIPLINARY SERVICE
WITHIN AN ADVANCED SCREENING CLINIC AND
P. Swete Kelly 1, *, L. Busuttin 2, N. Walton 2. 1 Physiotherapy, Performance Rehab, Annerley, Australia; 2 Pharmacy, Royal Brisbane and Women's Hospitals, Brisbane, Australia * Corresponding author.
Background: Advanced scope physiotherapists (ASP) undertake the assessment and case management of complex patients referred to Neuroand Orthopaedic Surgery Specialist Outpatient departments but in many situations have limited knowledge of appropriate medication use. The use of medicines is a common intervention in the holistic multidisciplinary management of patients with musculoskeletal conditions. Patients frequently present with poor understanding of their prescribed medicines, inadequate or inappropriate analgesia for their presenting condition/s and/or polypharmacy with high risk of actual or potential medicines related problems (MRP). Assessment and review of individual medicine regimens is a primary role of a clinical pharmacist despite this, this profession is not well represented in outpatient multidisciplinary teams. Purpose: The project purpose was to assess if, within a cohort of patients presenting to an ASP, there were patients with actual and/or potential MRP and the potential benefits from a pharmacist review. Secondary aims included identification of strategies to best utilise this profession’s expertise and scope of practice in this setting. Methods: Patients presenting to an ASP clinic underwent usual assessment and were also provided a questionnaire (completed by the patient and Physiotherapist) to stratify the patient risk for MRP. Appropriate patients were referred to a pharmacist who undertook a comprehensive medication assessment interview with the patient. Data recorded included opiate usage, identification of adverse effects, inappropriate medicines and
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
e7
Advanced assessment/practice and managing complex patients RA-BI-010 PATIENT EXPERIENCES OF A COMBINED EXERCISE AND ACCEPTANCE AND COMMITMENT THERAPY GROUP BASED PROGRAMME FOR CHRONIC PAIN. A QUALITATIVE STUDY
Results: Seven main themes emerged from the data. These themes included: (1) Group support: reassurance that participants were not alone with consequent validation of the pain experience, and new insights and perspectives in relation to pain, (2) Changed communication with other people; including improved family relationships and more defined boundary setting, (3) Acceptance of pain combined with an ability to move on in the midst of pain, (4) Practical strategies for managing pain: including pacing strategies, reduced fear and enhanced enjoyment in relation to exercise (5) Values, which centred around realisations as to the central importance of the family in addition to enhanced self-care, (6) Mindfulness in terms of it’s benefits and considerable challenges and (7) Frustration: lack of answers and lack of understanding from others. Conclusion: This is the first qualitative study to report on individual experiences of a multidisciplinary PMP combining ACT and exercise interventions for chronic pain. The findings demonstrate the fundamental insights gained by the participants on the programme, which impacted on their overall ability to engage as more active participants in relation to enhanced interpersonal relationships, self care and general function. They support the acceptability of this type of intervention by individuals with chronic pain and increase our understanding of treatment effects from the patient’s perspective. Implications: This qualitative study will have implications for both research and clinical practice in the field of chronic pain. The findings will help inform healthcare professionals regarding the design and implementation of future multidisciplinary PMPs which may positively impact the lives of people with chronic pain. Funding acknowledgements: Unfunded. Ethics approval: Mater Misericordiae University Hospital Ethics Committee. Disclosure of interest: None declared. Keywords: Acceptance and commitment therapy, Chronic pain, Exercise
M.-B. Casey*, D. Lowry 1, C. Hearty 2, R. Neary 3, C. Doody 3. 1 Psychology Department, Mater Misericordiae University Hospital, Ireland; 2 Department of Pain Medicine, Mater Misericordiae University Hosptial, Ireland; 3 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
Intergrating Research into practice RA-BI-011 PSYCHOLOGICAL CORRELATES OF PAIN INTENSITY AND PHYSICAL FUNCTION IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE IN NIGERIA
missing therapy. Any interventions made by the pharmacist including advice to the patient or to the patient’s prescriber were documented. Results: Eighty-eight percent of patients referred to the Pharmacist were identified to have actual and/or potential MRP including adverse effects, missing therapy and inappropriate medicines. In addition, 51% of patients were identified at high or highest risk for a potential MRP associated with their presenting complaint or other co-morbidities. Conclusion: Pharmacists provide an additional often overlooked profession in multidisciplinary teams managing patients with complex musculoskeletal conditions. They have proven valuable in identifying and providing advice to patients and prescribers regarding analgesia and the risk of actual and potential MRP. As medicines play a large role in healthcare interventions, the assessment and rationalisation of a patient’s medicine regimen is important to ensure all areas of a complex patients’ management are being addressed. Implications: Pharmacists have a broad knowledge of the risks and benefits of medicines. Inclusion of pharmacists within multidisciplinary teams should be considered. Funding acknowledgements: Funding for this project was provided through the Metro North Hospital and Health Service ‘Improving Outpatient Access program’. Ethics approval: No ethics was required as this was an implementation of a service redesign. Disclosure of interest: None declared. Keywords: Advanced practice, Pharmacy, Physiotherapy
* Corresponding author.
Background: Multidisciplinary pain management programmes (PMPs) are recommended for chronic pain. Exercise is well established as an effective treatment and there is emerging evidence to suggest that acceptance and commitment therapy (ACT) is an effective psychological approach for chronic pain. There is a notable lack of qualitative research in this area, particularly with regards to multidisciplinary PMPs which combine ACT with exercise interventions. Purpose: The aim of this qualitative study was to explore the experiences of participants of a multidisciplinary PMP which combined ACT with supervised exercise as a treatment for chronic pain. Methods: Thirty-six participants completed a group-based multidisciplinary PMP set in a hospital Pain Medicine clinic. Participants attended for one full day each week for a period of eight weeks. Each day began with a two-hour ACT psychology session delivered by a Senior Psychologist. This was followed by supervised aquatic or gym based exercise of one hour duration led by a Senior Physiotherapist. Educational talks were also provided each week covering topics such as medication management, pacing and sleep hygiene. All participants were invited to take part in focus groups between three and six months following completion of the PMP. Twenty-two participants attended one of four focus groups, with five or six participants attending per group. The focus groups were co-ordinated by a researcher who had no involvement in the delivery of the PMP. Semistructured interviews were conducted using an interview schedule as a guide. Participants were encouraged to speak freely and were asked to comment on the best and least helpful aspects of the programme, their opinions in relation to being part of a group, any changes positive or negative in their lives as a result of the programme, their opinions on the focus on values within the programme and any changes in physical activity levels and attitudes towards exercise. The interviews were recorded and transcribed verbatim. Transcripts were analysed using Thematic Framework analysis and themes were validated by a second assessor.
A. Odole*, E. Ekediegwu, N. Odunaiya. College of Medicine, University of Ibadan, Ibadan, Nigeria * Corresponding author.
Background: Osteoarthritis (OA) is a prevalent musculoskeletal condition of public health concern. It is mostly characterised by joint pain, joint limitation and decreased physical function. Clinical factors of OA such as pain intensity and physical function may be influenced by psychological factors such as kinesiophobia and pain catastrophizing. Published studies on the associations among these psychological and clinical factors are not readily available particularly in Nigeria. Purpose: The aim of this study was to investigate the associations among pain intensity, physical function, kinesiophobia and pain catastrophizing in patients with osteoarthritis of the knee in Enugu, South-East Nigeria. Methods: Ninety-nine consecutively sampled patients diagnosed of knee osteoarthritis from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey. Participants' psychosocial factors which included kinesiophobia and pain catastrophizing were assessed using Brief Fear of Movement Scale for Osteoarthritis (BFMSO), Pain Catastrophizing Scale (PCS). Visual Analogue Scale (VAS) and Ibadan Knee or Hip Osteoarthritis Measure (IKHOAM) were used to assess pain intensity and physical function respectively. Data were analysed using Pearson's correlation coefficient, independent t-test and multiple linear regression at p¼0.05. Results: Participants were aged 59.11 ± 12.46 years. Significant positive correlations were found between kinesiophobia and pain intensity (r ¼ 0.38), pain catastrophizing and pain intensity (r ¼ 0.39). Significant negative correlations existed between kinesiophobia and physical function (r ¼ 0.43), pain catastrophizing and physical function (r ¼ 0.28), physical function and age (r ¼ 0.35). However, no significant correlations existed between kinesiophobia and age (r ¼ 0.05), pain catastrophizing and age (r ¼ 0.05), pain intensity and age (r ¼ 0.15). There was no