scholarly journals P105 Therapists acceptability of delivering a psychologically informed gait rehabilitation intervention in early rheumatoid arthritis (GREAT): a qualitative interview study

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Mandeep Sekhon ◽  
Emma Godfrey ◽  
Gordon Hendry ◽  
Nadine E Foster ◽  
Samantha Hider ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Feasibility Study ◽  
Early Rheumatoid Arthritis ◽  
Self Efficacy ◽  
Gait Rehabilitation ◽  
Opportunity Costs ◽  
Perceived Effectiveness ◽  
Structured Interviews ◽  
Intervention Delivery ◽  
Affective Attitude

Abstract Background Great Strides is a brief psychologically informed gait rehabilitation intervention (two compulsory face-to-face sessions and up to four optional sessions delivered over 3 months) aimed at improving lower limb function for adults with early rheumatoid arthritis (RA). As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on i) the gait rehabilitation exercise programme (six walking exercises) ii) aspects of motivational interviewing (MI) and iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the Great Strides intervention. The training was supported by a bespoke therapist manual and session checklists. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training received and (2) delivering the intervention within the GREAT feasibility study. Methods All 10 therapists who received training were invited to complete semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Results Nine out of ten therapists (four physiotherapists, five podiatrists) participated in the semi-structured interviews. Five therapists (four physiotherapists, one podiatrist) delivered the Great Strides intervention. Key barriers and enablers with regards to the acceptability of the bespoke training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude), understood the purpose of the training sessions (intervention coherence), reported that the role play exercises aided their confidence in applying MI and BCTs (self-efficacy) and found that the training sessions were vital preparation for delivering the intervention (perceived effectiveness). Aspects of training which were considered unacceptable included the lack of time to attend the training sessions (opportunity costs). Delivery: All therapists enjoyed applying MI and BCTs to encourage participants to complete the gait exercises (affective attitude) and valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), interference of intervention delivery with routine clinical workload (opportunity costs) and the time delay between receiving training and initial intervention delivery (perceived effectiveness). Conclusion Both GREAT intervention training and delivery were considered acceptable to most therapists. The results have guided key refinements for training and intervention delivery for the GREAT internal pilot and full trial (e.g. remote access to training, timing of training in relation to intervention delivery). These refinements have the potential to improve the bespoke training and enhance the delivery of the Great Strides intervention maximising efficiency and potential for effectiveness. Disclosures M. Sekhon None. E. Godfrey None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

scholarly journals Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation (Preprint)

2021 ◽  
Author(s):  
Chris Keyworth ◽  
Rory O'Connor ◽  
Leah Quinlivan ◽  
Christopher J Armitage
Keyword(s):  
Self Efficacy ◽  
Health Conditions ◽  
Opportunity Costs ◽  
Perceived Effectiveness ◽  
Younger Adults ◽  
Web Based ◽  
Affective Attitude ◽  
Self Harm ◽  
White Ethnic

BACKGROUND The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. OBJECTIVE This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. METHODS We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, <i>affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs,</i> and <i>self-efficacy</i>. Data were analyzed using descriptive statistics, one-tailed <i>t</i> tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. RESULTS Participants in the web-based survey rated the VHS as positive (<i>affective attitude</i>; <i>t</i><sub>457</sub>=4.72; <i>P</i>&lt;.001); were confident using it (self-efficacy; <i>t</i><sub>457</sub>=9.54; <i>P</i>&lt;.001); felt they did not have to give up any benefits, profits, or values when using it (<i>opportunity costs</i>; <i>t</i><sub>439</sub>=−15.51; <i>P</i>&lt;.001); understood it and how it worked (<i>intervention coherence</i>; <i>t</i><sub>464</sub>=11.90; <i>P</i>&lt;.001); and were confident that it would achieve its purpose (<i>perceived effectiveness</i>; <i>t</i><sub>466</sub>=2.04; <i>P</i>=.04). The TFA domain <i>burden</i> appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (<i>burden</i>), the feature to add new situations and responses or amend existing ones (<i>ethicality</i>), and clearer instructions and further detail about the purpose of the VHS (<i>intervention coherence</i>). CONCLUSIONS Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.

scholarly journals Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation

10.2196/28349 ◽  
2021 ◽  
Vol 23 (9) ◽  
pp. e28349
Author(s):  
Chris Keyworth ◽  
Rory O'Connor ◽  
Leah Quinlivan ◽  
Christopher J Armitage
Keyword(s):  
Self Efficacy ◽  
Health Conditions ◽  
Opportunity Costs ◽  
Perceived Effectiveness ◽  
Younger Adults ◽  
Web Based ◽  
Affective Attitude ◽  
Self Harm ◽  
White Ethnic

Background The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=−15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.

scholarly journals P221 Treatment fidelity in the Gait Rehabilitation in Early Rheumatoid Arthritis Trial (GREAT) feasibility study

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Emma Godfrey ◽  
Mandeep Sekhon ◽  
Gordon Hendry ◽  
Nadine E Foster ◽  
Samantha Hider ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Motivational Interviewing ◽  
Feasibility Study ◽  
Early Rheumatoid Arthritis ◽  
Treatment Fidelity ◽  
Gait Rehabilitation ◽  
Behaviour Change Techniques ◽  
High Fidelity ◽  
Fidelity Assessment ◽  
Core Elements

Abstract Background Many people with early rheumatoid arthritis (RA) report foot pain and walking disability. Self-reported walking disability two years post-diagnosis is the main predictor of persistent disability. A psychologically informed gait rehabilitation intervention (Great Strides) for early RA was developed to address this, consisting of two compulsory sessions and up to four optional sessions delivered over three months. Physiotherapists and podiatrists received bespoke training to deliver Great Strides, incorporating motivational interviewing (MI) and behaviour change techniques (BCTs), to help patients to complete their walking exercises at home. The aim of this study was to assess fidelity of delivery within the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study. Methods Four physiotherapists and two podiatrists delivered 78 Great Strides sessions across three centres in the UK. All sessions were audio recorded and double coded. The Motivational Interviewing Treatment Integrity (MITI) Rating Scale (scoring ≥4 represents good proficiency) and tailored treatment fidelity measures of the six core elements and 17 BCTs delivered in session 1, five core elements delivered in session 2, and 12 BCTs in session 2-6, were developed to examine fidelity of delivery. Two trained, independent assessors rated audio recordings of Great Strides and assessed the extent to which core elements, aspects of MI and BCTs were delivered across sessions. Results Data from 28 (80%) adult participants across a total of 64 sessions were rated for core components and BCTs and 37 (50%) of sessions were analysed for MI. Relational (score=4.4) and technical (score=4.2) aspects of MI were delivered with good fidelity across the whole sample. The 6 core elements and 7 BCTs in Session 1 were conveyed with high (over 80%) treatment fidelity, but 10 further BCTs were not consistently delivered (range 23-69%). In session 2, the 5 core elements and 3 BCTs were provided with high fidelity, but another 9 BCTs were not reliably delivered (range 11-56%). Sessions 3 and 4 reliably delivered 3 out of 12 BCTs and only one session 5 and 6 was delivered. Inter-rater reliability showed agreement of over 80% was reached between raters for all sessions (range 82-87%). Conclusion Physiotherapists and podiatrists were able to deliver the core elements of GREAT sessions with high fidelity and fidelity assessment methods were appropriate. Results showed a maximum of 4 sessions was sufficient. However, treatment fidelity might be enhanced with further training or greater on-going support, as findings suggested clinicians (physiotherapists) with previous MI experience were more proficient at offering key elements of MI. Additionally, the Great Strides intervention could be amended to improve delivery, as research shows complex interventions should consider mandatory BCTs alongside optional ones, depending on the needs of individual participants. Disclosures E. Godfrey None. M. Sekhon None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

scholarly journals Gait Rehabilitation for Foot and Ankle Impairments in Early Rheumatoid Arthritis: a Feasibility Study of a New Gait Rehabilitation Programme (GREAT Strides)

2022 ◽  
Author(s):  
Gordon Hendry ◽  
Lindsay Bearne ◽  
Nadine E Foster ◽  
Emma L Godfrey ◽  
Samantha Hider ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Feasibility Study ◽  
Early Rheumatoid Arthritis ◽  
Lower Limb ◽  
Gait Rehabilitation ◽  
Future Trial ◽  
Intervention Acceptability ◽  
Foot Function ◽  
Lower Limb Function

Abstract BackgroundFoot impairments in early rheumatoid arthritis are common and lead to progressive deterioration of lower limb function. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. This study evaluated the feasibility of a novel gait rehabilitation intervention (GREAT Strides) and a future trial. MethodsThis was a mixed methods feasibility study with embedded qualitative components. People with early (<2 years) rheumatoid arthritis (RA) and foot pain were eligible. Intervention acceptability was evaluated using a questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Participants and therapists were interviewed to explore intervention acceptability. Deductive thematic analysis was applied using the Theoretical Framework of Acceptability. For fidelity, audio recordings of interventions sessions were assessed using the Motivational Interviewing Treatment Integrity (MITI) scale. Measurement properties of four candidate primary outcomes, rates of recruitment, attrition and data completeness were evaluated.Results35 participants (68.6% female) with median age (inter-quartile range [IQR]) 60.1 [49.4-68.4] years and disease duration 9.1 [4.0-16.2] months), were recruited and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5-22.5]. One serious adverse event that was unrelated to the study was reported. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but also highlighted some barriers to completion. Mean MITI scores for relational (4.38) and technical (4.19) aspects of motivational interviewing demonstrate good fidelity. The Foot Function Index disability subscale performed best in terms of theoretical consistency and was deemed most practical. ConclusionGREAT Strides was viewed as acceptable by patients and therapists, and we observed high intervention fidelity, good patient adherence and no safety concerns. A future trial to test the additional benefit of GREAT Strides to usual care will benefit from amended eligibility criteria, refinement of the intervention and strategies to ensure higher follow-up rates. The Foot Function Index disability subscale was identified as the primary outcome.Trial registrationISRCTN14277030

scholarly journals P125 A mixed methods feasibility study of a gait rehabilitation programme for people with early rheumatoid arthritis and foot pain

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Gordon J Hendry ◽  
Lindsay Bearne ◽  
Nadine Foster ◽  
Emma Godfrey ◽  
Samantha Hider ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Methods ◽  
Feasibility Study ◽  
Lower Limb ◽  
Primary Outcome ◽  
Rehabilitation Programme ◽  
Gait Rehabilitation ◽  
Foot Pain ◽  
Main Trial ◽  
Intervention Acceptability

Abstract Background Foot pain, a hallmark feature of rheumatoid arthritis (RA), is associated with slow and unsteady gait patterns, and persistent walking disability is common. Great Strides is a new gait rehabilitation programme designed to improve/preserve lower limb function in early RA. It is delivered by physiotherapists or podiatrists over 12-weeks and is supplemented with a home programme and support materials (DVD and illustrated booklet). It consists of a 6-task gait circuit and is underpinned by behaviour change techniques driven by motivational interviewing. The aims of this feasibility study were to 1) evaluate patient acceptability, adherence to, and safety of Great Strides, and 2) identify a suitable primary outcome measure for the main trial. Methods This study was a multi-centre (n = 3), single arm, repeated measures (pre- and post-intervention) design, with interviews exploring participants’ intervention perceptions. People with early (&lt;2 years) RA who had foot pain were invited to participate. Intervention acceptability was evaluated using a 3-item intervention acceptability questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Complementary mixed methods integrated descriptive quantitative acceptability, adherence, safety and thematic analyses to corroborate findings. Measurement properties of candidate primary outcomes (10-metre walking time, Foot Function Index disability subscale [FFI-DS], Recent Onset Arthritis Disability lower extremity subscale, and Patient-Reported Outcomes Measurement Information System physical function short-form) were evaluated against a 7-point Change in Walking Ability scale (CWA). Results 35 participants (68.6% female) with median age (inter-quartile range [IQR]) 60 [49-68] years and disease duration 9 [4-16] months), were recruited over 9 months and 23 (67%) completed 12-week follow-up. 12 participants completed interviews after the 12-week intervention period. Intervention acceptability was excellent; 21/23 were confident that it could help the problem; 21/23 reported that they would recommend it to a friend; 22/23 indicated it made sense to them. Intervention adherence was moderate, with a median [IQR] EARS score of 12/24 [7-19]. 1 participant reported transient post-exercise soreness. No serious adverse events were reported that were related to the intervention. From interviews, 10/12 participants reported they had continued with the intervention after 12-weeks. Participants revealed that the intervention provided structure and control to their day/week. Additional perceptions of benefit reported included improvements to lower limb joint health, and feelings of increased confidence to return to, or progress to further exercise in the community. The main challenge identified by some participants was lack of space to do the intervention at home. Correlations with the CWA were better for FFI-DS change-scores. Conclusion Great Strides has excellent acceptability and appears safe for people with early RA. Levels of adherence may be improved by intervention refinement. FFI-DS scores were theoretically consistent for selection as primary outcome for the main trial. Disclosures G.J. Hendry None. L. Bearne None. N. Foster None. E. Godfrey None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Sekhon None. A. Williams None. J. Woodburn None. M. Steultjens None.

scholarly journals AB0872-HPR IMPACT OF COVID-19 ON A PHYSICAL ACTIVITY FEASIBILITY PILOT STUDY: THE PIPPRA EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1459.1-1460
Author(s):  
L. Larkin ◽  
A. Moses ◽  
S. Gallagher ◽  
A. Fraser ◽  
B. A. Esbensen ◽  
...  
Keyword(s):  
Public Health ◽  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Feasibility Study ◽  
Intervention Group ◽  
Alternative Methods ◽  
Intervention Delivery ◽  
Assessment Protocol ◽  
Intervention Protocol ◽  
The Impact

Background:The PIPPRA (Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis) project is a feasibility project examining the impact of a physical activity behaviour change intervention in people who have rheumatoid arthritis (RA). The PIPPRA study recruitment commenced in October 2019, with participant assessment and intervention commencing in November 2019. In the Republic of Ireland people who have RA are categorised as high risk category for Covid-19, due to immunosuppression [1], although this categorisation contrasts with EULAR’s provisional recommendations [2].Objectives:To examine the impact of the Covid-19 pandemic and public health restrictions on a pilot randomised controlled feasibility study in 2020.Methods:Participants (aged 18 years+, diagnosis of RA, independently mobile and low levels of physical activity [3]) were recruited from a rheumatology clinic at an urban hospital. Target recruitment was four participants per month for one year (N=48). Assessments were planned at baseline, eight and twenty-four weeks (N=144). Participants were randomised to intervention group or control group. The intervention group received four 1:1 sixty minute sessions with a physiotherapist (N=96). The intervention was delivered over eight weeks. Intervention and control groups received a physical activity information leaflet.Results:The Covid-19 pandemic and associated public health restrictions forced the study to be formally paused in April 2020 and the study formally resumed in August 2020. N=48 participants were recruited between October 2019 and March 2020 (six months). N=20 participants have commenced in the study, N=16 are awaiting baseline assessment, N=6 withdrew and N=6 were lost to follow-up prior to baseline. Trial protocol planned for the delivery of N=55 assessments and N=36 intervention sessions for participants who had commenced in the study. N=22 assessments and N=26 intervention sessions were delivered between November 2019 and March 2020. N=5 assessments and N=6 intervention sessions were conducted between August and October 2020. No assessment or intervention delivery occurred in November-December 2020 due to participant hesitancy in attending for assessment and/or intervention with increased public health restrictions. The impact of Covid-19 restrictions resulted in N=33 (60%) deviations from assessment protocol and N=10 (27%) deviations from intervention delivery protocol (Figure 1).Figure 1.Deviations from assessment and intervention protocol in the PIPPRA studyConclusion:The Covid-19 pandemic has had a significant impact on the delivery of the PIPPRA study. Feasibility study outcomes, including participant retention rate, and study delivery as per protocol, have been affected due to the Covid-19 pandemic. Participant reluctance to attend face-to-face sessions demonstrates the need to consider alternative methods of delivery, e.g. virtual delivery of interventions, where attending in person is not acceptable to participants [4], in future studies.References:[1]Health Service Executive. (2019). People at higher risk from COVID-19.Accessed 5th Jan 2020 https://www2.hse.ie/conditions/coronavirus/people-at-higher-risk.html.[2]Landewé RB et al (2020). EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Annals of the Rheumatic Diseases 79:851-858.[3]Godin, G. (2011). The Godin-Shephard leisure-time physical activity questionnaire. The Health & Fitness Journal of Canada, 4(1):18-22.[4]Inan, OT et al. (2020). Digitizing clinical trials. npj Digit. Med. 3:10.Disclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document