scholarly journals What are the Most Important Problems in Functioning Among Patients with Shoulder Pain? An Analysis of the Patient-Specific Functional Scale

2020 ◽  
Author(s):  
Yngve Røe ◽  
Tarjei Rysstad ◽  
Anne Therese Tveter ◽  
Torill Bjugan Sandbakk ◽  
Marit Jæger ◽  
...  
Keyword(s):  
Primary Care ◽  
Shoulder Pain ◽  
Secondary Care ◽  
Activity Level ◽  
International Classification Of Functioning ◽  
Patient Specific ◽  
Functional Scale ◽  
Substantial Impact ◽  
Wide Range ◽  
Functional Problems

Abstract Background Shoulder pain is a common and often persistent health condition with substantial impact on daily functioning. The primary aim of the present study was to identify important functional problems among patients with shoulder pain, using the Patient-Specific Functional Scale (PSFS). A secondary aim was to investigate differences between primary- and secondary care patients.Methods The study had a cross-sectional design and included patients seeking care for shoulder pain in a primary- and a secondary outpatient clinic. Background variables, pain, physical activity level and the PSFS, were registered with a questionnaire package. Meaningful concepts from the PSFS responses were extracted and linked to the International Classification of Functioning, Disability and Health (ICF), according to the refined linking rules. Frequency for the ICF categories was estimated for primary- and secondary care, separately. Differences between primary and secondary care were investigated by calculating confidence intervals for the sample proportions, at ICF chapter level.Results Of the total 177 patients, 84 were recruited from primary care and 93 from secondary care. The primary care sample reported functional problems linked to 226 ICF categories, while 337 in secondary care. Of the linked ICF categories 87.7% belonged to the Activities and Participation component of the ICF. Seventeen categories were identified in > 3% of the patients, of those the most frequent were: Recreation and leisure (d920), Lifting and carrying objects (d430)’, Doing housework (d640), Hand and arm use (d445) and Remunerative employment (d850). Categories included in the ICF chapters Self-care (d5) and Domestic life (d6) were significantly more frequent in the secondary care sample, while there was a trend that b7 Neuromusculoskeletal and movement-related functions were more frequent in primary care.Conclusion The present findings indicate that patients with shoulder pain report a wide range of functional problems, from basic functions related to mobility to more complex functions related to work and leisure activities. This study also discovered differences in the report of functional problems between primary and secondary care patients. The large variation in the experiences between patients supports the use of an individualised measure to support assessment of functioning among shoulder patients.Trial registration Not applicable

scholarly journals Descriptive Analysis of Common Functional Limitations Identified by Patients With Shoulder Pain

2015 ◽  
Vol 24 (2) ◽  
pp. 179-188 ◽  
Author(s):  
Enrique V. Smith-Forbes ◽  
Stephanie D. Moore-Reed ◽  
Philip M. Westgate ◽  
W. Ben Kibler ◽  
Tim L. Uhl
Keyword(s):  
Shoulder Pain ◽  
Functional Limitations ◽  
The Body ◽  
Initial Evaluation ◽  
International Classification Of Functioning ◽  
Medical Attention ◽  
Patient Specific ◽  
Limited Information ◽  
Body Function ◽  
Function Domain

Context:Recent establishment of G-codes by the US government requires therapists to report function limitations at initial evaluation. Limited information exists specific to the most common limitations in patients with shoulder pain.Objective:To describe the most commonly expressed shoulder limitations with activities and their severity/level of impairment from a patient’s perspective on the initial evaluation.Design:Descriptive.Setting:Patients reporting pain with overhead activity and seeking medical attention from one orthopedic surgeon were recruited as part of a cohort study.Patients:176 with shoulder superior labral tear from anterior to posterior (SLAP), subacromial impingement, combined SLAP and rotator cuff, and nonspecific (female = 53, age = 41 ± 13 y; male = 123, age = 41 ± 12 y).Interventions:Data were obtained on the initial visit from the Patient-Specific Functional Scale (PSFS) questionnaire. Three researchers extracted meaningful concepts from the PSFS and linked them to the International Classification of Functioning (ICF) categories according to established ICF linking rules.Results:176 participants yielded 765 meaningful concepts that were linked to the ICF with a 66% agreement between researchers before consensus. There were no differences between diagnoses. Of all patients, 88% reported functional limitations coded into meaningful concepts as represented by 10 ICF codes; 634 (83%) meaningful concepts were linked to the activities and participation domain while 129 (17%) were linked to the body function domain. Only 2 reported functional limitations that were considered nondefinable (nd). The overall average initial impairment score on the PSFS = 4 ± 2.5 out of 10 points.Conclusion:Meaningful concepts from the activities and participation domain were most commonly identified as functional limitations and were more prevalent than limitations from the body function domain. This information helps identify some of the most common limitations in patients with shoulder pain that therapists can use to efficiently document patient functional impairment.

Blocked ears

2020 ◽  
Vol 13 (5) ◽  
pp. 289-296
Author(s):  
Oliver J Wright ◽  
James W Wright ◽  
William G Chambers
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Clinical Approach ◽  
Wide Range

Blocked ears are a common presenting complaint in primary care, and although the cause is usually benign, a structured clinical approach and examination are essential to avoid missing more significant causes. In this article, we discuss the clinical approach, aetiology and management of the wide range of conditions that lead to the sensation of blocked ears, and provide guidance on referral to secondary care.

scholarly journals Psychosomatic therapy for patients frequently attending primary care with medically unexplained symptoms, the CORPUS trial: study protocol for a randomised controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Margreet S. H. Wortman ◽  
Johannes C. van der Wouden ◽  
Janneke P. C. Grutters ◽  
Bart Visser ◽  
Willem J. J. Assendelft ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Usual Care ◽  
Secondary Care ◽  
Outcome Measure ◽  
Medically Unexplained Symptoms ◽  
Secondary Outcome ◽  
Patient Specific ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Abstract Background Medically unexplained symptoms (MUS) are highly prevalent and pose a burden both on patients and on health care. In a pilot study psychosomatic therapy delivered by specialised therapists for patients with MUS showed promising results with regard to patient’s acceptability, feasibility and effects on symptoms. The aim of this study is to establish whether psychosomatic therapy by specialised psychosomatic exercise therapists is cost- effective in decreasing symptoms and improving functioning in patients who frequently consult their general practitioner (GP) with MUS. Methods A randomised effectiveness trial with an economic evaluation in primary care with 158 patients aged 18 years and older who are frequently consulting their GP with MUS. Patients will be assigned to psychosomatic therapy in addition to usual care or usual care only. Psychosomatic therapy is a multi-component and tailored intervention, aiming to empower patients by applying psycho-education, relaxation techniques, mindfulness, cognitive approaches and/or graded activity. Patients assigned to the psychosomatic therapy receive 6 to 12 sessions of psychosomatic therapy, of 30–45 min each, delivered by a specialised exercise or physical therapist. Primary outcome measure is patient-specific functioning and disability, measured with the Patient-Specific Functional Scale (PSFS). Secondary outcome measures are symptom severity, consultation frequency and referrals to secondary care, patient satisfaction, quality of life and costs. Assessments will be carried out at baseline, and after 4 and 12 months. An economic evaluation alongside the trial will be conducted from a societal perspective, with quality-adjusted life years (QALYs) as outcome measure. Furthermore, a mixed-methods process evaluation will be conducted. Discussion We expect that psychosomatic therapy in primary care for patients who frequently attend the GP for MUS will improve symptoms and daily functioning and disability, while reducing consultation frequency and referrals to secondary care. We expect that the psychosomatic therapy provides value for money for patients with MUS. Trial registration Netherlands Trial Register, ID: NL7157 (NTR7356). Registered 13 July 2018.

scholarly journals Contextualizing the impact of snakebite envenoming on patients: A qualitative content analysis of Patient-Specific Functional Scale activities using the International Classification of Functioning, Disability and Health

2021 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Treatment Approach ◽  
Qualitative Content Analysis ◽  
International Classification Of Functioning ◽  
Patient Specific ◽  
Patient Centered ◽  
Functional Scale ◽  
Daily Lives ◽  
Icf Model ◽  
The Impact

Abstract: without Background and including Keywords: 251/275 wordsBackground: There are no disease specific theoretical models describing dysfunction in Snakebite Envenoming (SBE). The International Classification of Functioning, Disability, and Health (ICF) created by the WHO provides a conceptual basis for defining all aspects of functioning and disability within the biopsychosocial model. The Patient-Specific Functional Scale (PSFS) is a patient-centered and patient-reported outcome that assesses activities chosen by the patient as limiting and important. Objective: In this study, we analyze the PSFS activities in SBE and apply it to the existing ICF model in order to describe the impact of SBE in patients’ activities and daily lives’ that goes beyond the description of the physiological effects and to develop a theoretical SBE model of functioning. Design: This study performed a post-hoc analysis of two multi-center, prospective studies, conducted at 14 clinical sites across the southeastern United States. Participants: Patients undergoing treatment for mild, moderate and severe SBE.Main outcome measures: Activities listed in the PSFS were used for a combination of qualitative content analysis and Natural Language Processing to categorize responses using the ICF model.Results: Our sample included 86 patients. The mean age was 43.0 (SD 17.6) years, most had lower extremity injuries (62%). A total of 99 unique activities were chosen by patients when completing the PSFS, representing eight of the nine domains within the Activity and Participation component of the ICF model, with the majority in the Mobility and General Tasks and Demands domains.Conclusion: The main concerns of SBE patients are related to the ability to perform regular daily activities and to engage within their social environment, having a multifaceted impact in a variety of areas in their daily lives. Applying the ICF model to SBE can facilitate the creation of a patient centered treatment approach, moving beyond body-structural impairments towards a function-based treatment approach and facilitate early integration of rehabilitation services. Keywords: Snakebite envenoming, snake bite, PSFS, ICF, Function, Disability

scholarly journals Construct Validity and Validity to Change of the Patient-Specific Functional Scale in Patients with Shoulder and Low Back Pain: A Clinimetric Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Kromer TO ◽  
◽  
Saner J ◽  
Sieben JM ◽  
Bastiaenen CHG ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Construct Validity ◽  
Shoulder Pain ◽  
Outcome Measures ◽  
Patient Specific ◽  
Low Back ◽  
Group Level ◽  
Functional Scale ◽  
Specific Outcome

Background: Patient-specific and condition-specific measures are widely used in clinical practice and research to measure disability or change over time. While condition-specific outcome measures comprise a range of restrictions generally relevant for all patients, the Patient-Specific Functional Scale measures restrictions chosen by the individual patient. Objectives: Based on the hypothesis that patient-specific and conditionspecific scales deliver comparable results when used on group level. The aim of this study was to test for floor and ceiling effects, to evaluate construct validity and validity to change of the Patient-Specific Functional Scale when compared to condition-specific outcome measures. For this purpose, two datasets from patients with shoulder pain and low back pain were analyzed. Methods: Patient-Specific Functional Scale scores were compared to the Shoulder Pain and Disability Index and the Roland Morris Disability Questionnaire at 4 time-points using stem-and-leaf-plots and correlations using Pearson’s r. Hypothesis-driven correlation levels for data interpretation were predefined, with r ≥0.75=high, r ≥0.5=moderate, r ≥0.25=low. Results: Patient-Specific Functional Scale floor effects were comparable to condition-specific outcome measures in both samples. At none of the timepoints did the Patient-Specific Functional Scale correlate with the conditionspecific outcome measures in the expected manner. Conclusion: Hypotheses regarding expected ranges of correlation between the Patient-Specific Functional Scale and the condition-specific outcome measures for construct validity and validity to change were not met. While the use of the Patient-Specific Functional Scale in a clinical context has its advantages, the measure is not recommended for group-level evaluations.

scholarly journals Mapping Patient-Specific Functional Scale (PSFS) Items to the International Classification of Functioning, Disability and Health (ICF)

2012 ◽  
Vol 92 (2) ◽  
pp. 310-317 ◽  
Author(s):  
Kate Fairbairn ◽  
Kate May ◽  
Yvonne Yang ◽  
Sharan Balasundar ◽  
Cheryl Hefford ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
International Classification Of Functioning ◽  
Patient Specific ◽  
Disability And Health ◽  
Functional Scale ◽  
Activity Component ◽  
Subgroup Analyses

Background The International Classification of Functioning, Disability and Health (ICF) provides a common framework for clinical outcome measurement. Because the Patient-Specific Functional Scale (PSFS) is widely used for documenting change over time in individual patients receiving musculoskeletal physical therapy, investigation of the extent to which PSFS items reflect the ICF is needed. Objective The study objective was to investigate the extent to which patient-generated PSFS items reflect ICF domains. Design This investigation was an observational content validity study. Methods A total of 2,911 PSFS items from 1,050 files for patients with musculoskeletal disorders were analyzed. The data were from a random sample of participants in the Otago Outcome Measures Project at 4 clinics of the School of Physiotherapy, University of Otago, situated in 3 New Zealand cities. Patient-nominated PSFS items were categorized and mapped with thematic analysis techniques to ICF components, chapters, and categories. Subgroup analyses were conducted for body region of injury and age ranges. Results All (100%) of the analyzed items could be mapped to the ICF. Most patient-nominated items mapped to the activity component (80.0%), some items mapped to the participation component (7.7%), other items were related to impairment (7.4%), and the fourth group contained items that overlapped the activity and participation components (4.9%). Similar results were found for each of the 5 body regions and across age ranges in subgroup analyses. Limitations These results are limited to individual patients seeking musculoskeletal physical therapy. Patient-generated PSFS items were investigated. Conclusions The ICF activity component was most commonly represented by patient-nominated PSFS items, the participation component was moderately represented, and impairment was least represented. Hence, the PSFS would complement impairment-based clinical outcome measures.

scholarly journals SAT0653-HPR COMMUNITY RHEUMATOLOGY SERVICE IN THE UK – WHO BENEFITS THE MOST?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1285.2-1286
Author(s):  
K. Szabo-Kocsis ◽  
M. Dare
Keyword(s):  
Primary Care ◽  
Connective Tissue ◽  
Waiting Time ◽  
Secondary Care ◽  
List Type ◽  
Ehlers Danlos Syndrome ◽  
Specialist Services ◽  
Wide Range ◽  
Set Up ◽  
The Uk

Background:Community rheumatology (CR) in the UK is a new form of rheumatologic service provision established in the last few years and run by few organisations such as Connect Health Ltd.CR is based on the principle of sharing the management of rheumatologic patients between community service and secondary care aiming to reduce the unreasonable referral flow from primary care to secondary care and to share the care of stable inflammatory patients between the services.In the traditional service model patients are referred by General Practitioners (GP) to the secondary care with a wide spectrum of conditions: from fibromyalgia through soft tissues rheumatisms to inflammatory or connective tissue diseases. Many of these patients will be discharged from the specialist service after their first visit with fibromyalgia, osteoarthritis, chronic pain syndrome or MSK diagnoses. The proportion of these patients versus those who have an inflammatory rheumatologic condition or connective tissue disease (CTD) varies significantly and can contribute to oversaturated specialist rheumatologic services with long waiting time where specialists deal with less relevant cases.Objectives:To determine how CR can improve quality of care and decrease the waiting time for appointment in secondary care rheumatology services. To set standards for referral pathways and measured outcomes of effectiveness in patient care.In the UK the regional Clinical Commissioning Groups would accept a maximum waiting time from the referral until patient treatment of up to 18 weeks and specialist services often breach that limit. This long interval may have a significant negative impact for the care of patients with rheumatological condition, reducing patient satisfaction and/or jeopardize patient safety. The solution to the above problem is the creation of CR service.Methods:Extensive search about the available resources within UK NHS system in regards CR service creation and set up. Web search, literature review in relation to CR in the UKResults:From the research different models of CR can be identified and one of these will be presented in details based on the experience of one of the largest organisation running CR services in the UK (Connect Health Ltd). This service is organised within community care set up and can accept patients referred by the primary care physicians with non-inflammatory symptoms (e.g. osteoarthritis, Ehlers - Danlos Syndrome, fibromyalgia) or PMR or gout. The service also can review stable inflammatory patients who are treated with DMARDs and are transferred from the secondary care service by their consultant. This presentation will demonstrate how CR provides safer, faster and more accessible services to the patients assisting the specialist services and allowing them to concentrate on the inflammatory and CTD patients who need faster access to these services than it is possible now. Particularly the presentation will emphasise on:Patient population coverTeam structure, their experience and trainingReferral criteria and IT set up for multidisciplinary connectionTime interval for appointment and patient feedbackImpact on the secondary care rheumatology serviceCases of misdiagnosis and inappropriate referralsCost effectiveness of the CRChallenges in the CR serviceConclusion:The CR service can be a safe addition to the specialist services taking over significant workload and provide new career opportunities for a wide range of Allied Health Professionals (AHP) for the bigger satisfaction of the patients who can access rheumatology service earlier and easier.Disclosure of Interests:None declared

scholarly journals Love Labour as a Distinct and Non-Commodifiable Form of Care Labour

2007 ◽  
Vol 55 (3) ◽  
pp. 550-570 ◽  
Author(s):  
Kathleen Lynch
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Tertiary Care ◽  
Care Work ◽  
Central Theme ◽  
Wide Range ◽  
General Care ◽  
Over Time

This paper examines the nature of love labouring and explores how it can be distinguished from other forms of care work. It provides a three fold taxonomy for analysing other-centred work, distinguishing between work required to maintain primary care relations (love labour), secondary care relations (general care work) and tertiary care relations (solidarity work). A central theme of the paper is that primary care relations are not sustainable over time without love labour; that the realization of love, as opposed to the declaration of love, requires work. Drawing on a wide range of theoretical and empirical sources, including a study of caring undertaken by the author, the paper argues that there is mutuality, commitment, trust and responsibility at the heart of love labouring that makes it distinct from general care work and solidarity work. It sets out reasons why it is not possible to commodify the feelings, intentions and commitments of love labourers to supply them on a paid basis.

Tailoring Communications for Primary Care Settings

1998 ◽  
Vol 37 (02) ◽  
pp. 171-178 ◽  
Author(s):  
B. Glassman ◽  
B. K. Rimer
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Contact Time ◽  
Behavioral Changes ◽  
Patient Specific ◽  
Specific Information ◽  
Medical Settings ◽  
Primary Care Settings ◽  
Professional Contact ◽  
Tailored Communications

AbstractIn more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals and to give personalized, individualized massages in an era of shrinking professional contact time.

Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

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