Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? Perceptions of Body Weight, Weight Management Strategies, and Depressive Symptoms Among US College Students A Cost Analysis of Self-Management Programs for People with Chronic Illness A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations.
Osteoarthritis ( OA ) is a common and often disabling condition that predominately affects older adults . It is the commonest cause of locomotor disability and forms a major element of the workload in primary care . Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ' unmet ' information needs . This paper explores the patients ' perspective on the meaning and significance of living with arthritis , identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme . This paper draws on qualitative and quantitative data from : the baseline interview ( knowledge of arthritis , satisfaction with services and support received in primary care ) ; patient diaries ( individual goals and reflections on treatment ) ; and group teaching sessions ( themes describing the patient 's experience ) . The different data sources were interrogated for common and divergent themes . One hundred and ninety-four participants were identified and 170 completed baseline interviews . Participants were predominantly female ( 73 % ) , with a mean age of 63 and arthritis of long-st and ing ; 55 % reported that they had had it for 5 years or more .  Use of primary care services was high , with 41 % consulting their GP in the 2 weeks before interview . Levels of information were low , with less than 25 % receiving support/advice about the disease , pain management or its impact upon daily life . Set against negative perceptions of the quality of services , patients ' personal priorities were for improved pain management and enhanced mobility/functional ability . The combined quantitative and qualitative data provide insight into the patients ' perspective on the causes and impact of knee OA , individual goals desired from treatment and the quality of care . There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence . Even within a tightly defined study sample participating in the intervention , a diversity of experience and goals were revealed , which highlights the importance of taking account of context ual factors and individual differences when evaluating complex interventions Abstract Osteoarthritis ( OA ) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation . Behavioral self-management for OA symptomatology is commonly recommended ; but these interventions are underutilized , unst and ardized in application , and at times , unavailable in the context of clinical care . For people with chronic pain , rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms . Activity pacing is widely used in combination with other pharmacological and behavioral interventions but has not been studied as a singular behavioral intervention for people with OA . The purpose of this study was to evaluate the effectiveness of an occupational therapist-delivered , time-based activity pacing program for treatment of pain , fatigue , and physical function in people with symptomatic knee or hip OA . A 3-arm r and omized controlled trial was conducted in which 193 people were r and omized into tailored activity pacing , general activity pacing , or usual care arms . Assessment s were done at 10 weeks and 6 months after baseline . Using linear mixed models , Western Ontario and McMaster Universities Osteoarthritis Index pain scores changed over time , decreasing the most in the general and usual care groups ; only the usual care group had decreased pain over 6 months . The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks , but pacing was not sustained at 6 months . This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA Abstract Background Self-management has become increasingly popular in the management of chronic diseases . There are many different self-management models . Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study design s used to evaluate different programs . The Stanford Arthritis Self-Management Program ( ASMP ) , most commonly delivered by trained lay leaders , is a generic program widely used for people with rheumatological disorders . We have developed a more specific program expressly for people with osteoarthritis of the knee ( OAKP ) . It includes information design ed to be delivered by health professionals and results in improvements in pain , function and quality of life . Aim : To determine whether , for people with osteoarthritis ( OA ) of the knee , the OAKP implemented in a primary health care setting can achieve and maintain clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized study . Participants : 146 participants with established OA knee will be recruited . Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded . Interventions : Participants will be r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires and a VAS for pain . Secondary outcomes will include balance , tested using a timed single leg balance test and a timed step test and self-efficacy . Data will be analysed using repeated measures ANOVA . Discussion With an aging population the health care costs for people with arthritis are ever increasing . Although cost analysis is beyond the scope of this study , it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders . Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : Abstract Objective : To determine if inaccurate body weight perception predicts unhealthy weight management strategies and to determine the extent to which inaccurate body weight perception is associated with depressive symptoms among US college students . Participants : R and omly selected male and female college students in the United States ( N = 97,357 ) . Methods : Data were from the 2006 National College Health Assessment . Analyses were conducted on students ’ body weight perceptions , weight loss strategies , and feelings of depression . Results : Females with an inflated body weight perception were significantly more likely to engage in unhealthy weight management strategies and report depressive symptoms than were females with an accurate body weight perception . Conclusions : College women are concerned with weight and will take action to lose weight . Colleges may need to focus more on interventions targeting both diet and physical activity while also promoting positive body image The soaring cost of health care is a national problem that needs response at multiple levels , including that of the community . Reducing or limiting health care costs through interventions that emphasize the self-management of health may promote broader health care coverage , better quality of health care , and a sense of control over one 's health . Therefore , it behooves community psychologists to perform cost analyses when testing interventions for people in a community . The present study investigated the effects of social support and education interventions on psychosocial variables , health status , and health care costs in older people with osteoarthritis . Participants were 363 members of a health maintenance organization ( HMO ) , 60 years of age and older , with osteoarthritis . Participants were r and omly assigned to one of three intervention groups ( social support , education , or a combination of both ) or to a control group . The results indicated that feelings of helplessness decreased in the intervention groups but not in the control group . All groups showed increases in self-efficacy and overall health status . In addition , health care costs increased less in the intervention groups than in the control group . Cost analysis was used to demonstrate that the monetary savings of the intervention greatly outweighed the cost of conducting the intervention . It appears that interventions can limit health care costs while improving health and increasing feelings of control for older people with osteoarthritis . Further , this paper demonstrates how a cost-benefit focus can benefit community studies OBJECTIVE This study was undertaken to compare alternative strategies for the initial management of low- grade squamous intraepithelial lesion ( LSIL ) cytology . STUDY DESIGN A total of 1572 women with a community-based LSIL interpretation were r and omly assigned to immediate colposcopy , triage based on enrollment HPV DNA testing and liquid-based cytology at a colposcopy referral threshold of high- grade squamous intraepithelial lesion ( HSIL ) , or conservative management based on repeat cytology at a referral threshold of HSIL . All arms included 2 years of semiannual follow-up and colposcopy at exit . Loop electrosurgical excision procedure was offered to women with histologic diagnoses of cervical intraepithelial neoplasia ( CIN ) grade 2 or 3 at any visit or persistent CIN grade 1 at exit . The main study end point was 2-year cumulative diagnosis of CIN grade 3 . RESULTS The 2-year cumulative diagnosis of CIN grade 3 was approximately 15 % in all study arms . The HPV triage arm was closed early because more than 80 % of women were HPV positive , precluding efficient triage . The immediate colposcopy strategy yielded 55.9 % sensitivity for cumulative cases of CIN grade 3 diagnosed over 2 years . A conservative management strategy of repeat cytology at the HSIL threshold referred 18.8 % of women while detecting 48.4 % of cumulative CIN grade 3 . At lower cytology thresholds , sensitivity would improve but would ultimately yield unacceptably high referral rates . CONCLUSION LSIL cytology is best managed by colposcopy initially , because there was no useful triage strategy identified . Management of these patients , after colposcopy to rule out immediately overt CIN grade 2 or 3 , needs to be determined
The overarching themes indicated people with osteoarthritis delay their diagnosis , opting for self-management and informal information gathering .
This informal rather than health professional-led guidance is sought and maintained as an important re source throughout the care of this population and is valued .
There remains uncertainty regarding when this is required , but the expected failure of conservative treatment to manage pain and symptoms is common .
This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis
Abstract This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies .