Top

Published in:

Open Access 01-12-2023 | Musculoskeletal Pain | Research

Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study

Authors: Emma L. Healey, Martyn Lewis, Nadia Corp, Noureen A. Shivji, Danielle A. van der Windt, Opeyemi O. Babatunde, Joanna Simkins, Bernadette Bartlam, Gill Rowlands, Joanne Protheroe

Published in: BMC Musculoskeletal Disorders | Issue 1/2023

Abstract

Background

Supported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy.

Methods

A mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model.

Findings

Findings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face).

Conclusions

This research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.

Available only for authorised users

Public Health England. Why are musculoskeletal conditions the biggest contributor to morbidity? Health Profile for England. 2019. https://ukhsa.blog.gov.uk/2019/03/11/why-are-musculoskeletal-conditions-the-biggest-contributor-to-morbidity/ (accessed 07/11/2022).

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56.PubMedPubMedCentral

Loke YK, Hinz I, Wang X, Rowlands G, Scott D, Salter C. Impact of health literacy in patients with chronic musculoskeletal disease–Systematic review. PloS One. 2012;7(7):e40210.

Lowe W, Ballinger C, Protheroe J, Lueddeke J, Nutbeam D, Armstrong R, et al. Effectiveness of musculoskeletal education interventions in people with low literacy levels: a systematic review. Arthritis Care Res (Hoboken). 2013;65(12):1976–85. https://doi.org/10.1002/acr.22085.CrossRefPubMed

Kroon FPB, van der Burg LRA, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self-management education programmes for osteoarthritis. Cochrane Database Syst Rev. 2014; Issue 1:Art. No.: CD008963. https://doi.org/10.1002/14651858.CD008963.

Dodson S, Good S, Osborne RH. Health literacy toolkit for low and middle-income countries: a series of information sheets to empower communities and strengthen health systems. New Delhi: World Health Organization, Regional Office for South-East Asia, 2015. https://apps.who.int/iris/handle/10665/205244 (accessed 07/11/2022)

Rowlands G, Protheroe J, Winkley J, Richardson M, Seed PT, Rudd R. A mismatch between population health literacy and the complexity of health information: an observational study. Br J Gen Pract. 2015;65(635):e379–86. https://doi.org/10.3399/bjgp15X685285.CrossRefPubMedPubMedCentral

Protheroe J, Whittle R, Bartlam B, Estacio EV, Clark L, Kurth J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expect. 2016;20(1):112–9. https://doi.org/10.1111/hex.12440.CrossRefPubMedPubMedCentral

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.CrossRefPubMed

10.

Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ. 2012;344:e1602.

11.

Sorensen K, Pelikan JM, Rothlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25:1053–8. https://doi.org/10.1093/eurpub/ckv043.CrossRefPubMedPubMedCentral

12.

HLS-EU Consortium: Comparative report of health literacy in eight EU member states. The European health literacy survey HLS-EU, 2012 (first revised and extended version, July 5th, 2013). https://www.healthliteracyeurope.net/hls-eu (accessed 07/11/2022)

13.

Von Wagner C, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health. 2007;61(12):1086–90. https://doi.org/10.1136/jech.2006.053967.CrossRef

14.

World Health Organization. Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. 9th Global Conference on Health Promotion, Shanghai 21–24 November, 2016. https://www.who.int/publications/i/item/WHO-NMH-PND-17.5 (accessed 07/11/2022)

15.

May CR, Eton DT, Boehmer K, Gallacher K, Hunt K, MacDonald S, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014;14:281. https://doi.org/10.1186/1472-6963-14-281.CrossRefPubMedPubMedCentral

16.

Calderon-Larranaga A, Poblador-Plou B, Gonzalez-Rubio F, Gimeno-Feliu LA, Abad-Diez JM, Prados-Torres A. Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well? Br J Gen Pract. 2012;62(605):e821e826. https://doi.org/10.3399/bjgp12X659295.CrossRef

17.

Kongkaew C, Hann M, Mandal J, Williams SD, Metcalfe D, Noyce PR, et al. Risk factors for hospital admissions associated with adverse drug events. Pharmacotherapy. 2013;33(8):827–37. https://doi.org/10.1002/phar.1287.CrossRefPubMed

18.

Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B. Managing patients with mental and physical multimorbidity. BMJ. 2012;345:e5559.

19.

Adams J, Ballinger C, Lowe W, Rowley C, Lueddeke J, Armstrong R, et al. Personal impact of lower levels of health literacy on living with a musculoskeletal disease: a qualitative interview study. Rheumatology. 2016;55(Suppl 1):i8–9. https://doi.org/10.1093/RHEUMATOLOGY/KEW096.004.CrossRef

20.

Lacey RJ, Campbell P, Lewis M, Protheroe J. The Impact of Inadequate Health Literacy in a Population with Musculoskeletal Pain. Health Lit Res Pract. 2018;2(4):e215–20. https://doi.org/10.3928/24748307-20181101-01.CrossRefPubMedPubMedCentral

21.

Farin E, Ullrich A, Nagl M. Health education literacy in patients with chronic musculoskeletal diseases: development of a new questionnaire and sociodemographic predictors. Health Educ Res. 2013;28(6):1080–91. https://doi.org/10.1093/her/cyt095.CrossRefPubMed

22.

Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models an evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;73(6):913–34. https://doi.org/10.1177/0013164413495237.

23.

Campbell P, Hill JC, Protheroe J, Afolabi EK, Lewis M, Beardmore R, et al. Keele Aches and Pains Study protocol: validity, acceptability, and feasibility of the Keele STarT MSK tool for subgrouping musculoskeletal patients in primary care. J Pain Res. 2016;9:807–18. https://doi.org/10.2147/JPR.S116614.CrossRefPubMedPubMedCentral

24.

Hill JC, Garvin S, Chen Y, Cooper V, Wathall S, Saunders B, et al. Stratified primary care versus non-stratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial. BMC Fam Pract. 2020;21:30. https://doi.org/10.1186/s12875-019-1074-9.CrossRefPubMedPubMedCentral

25.

Bishop A, Ogollah RO, Jowett S, Kigozi J, Tooth S, Protheroe J, et al. STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain. BMJ Open. 2017;7(3):e012987. https://doi.org/10.1136/bmjopen-2016-012987.CrossRefPubMedPubMedCentral

26.

Morris NS, MacLean CD, Chew LD, Littenberg B. The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract. 2006;7:21. https://doi.org/10.1186/1471-2296-7-21.

27.

Dunn KM, Jordan K, Croft PR. Characterizing the course of low back pain: a latent class analysis. Am J Epidemiol. 2006;163(8):754–61. https://doi.org/10.1093/aje/kwj100.CrossRefPubMed

28.

Ware JE, Kosinski M, Keller SD. A 12-item short form health survey (SF-12): Construction and preliminary tests of reliability and validity. Med Care. 1996;32:220–33. https://doi.org/10.1097/00005650-199603000-00003.

29.

MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol. 2007;58:593–614. https://doi.org/10.1146/annurev.psych.58.110405.085542.CrossRefPubMedPubMedCentral

30.

Preacher KJ. Advances in mediation analysis: a survey and synthesis of new developments. Annu Rev Psychol. 2015;66:825–52. https://doi.org/10.1146/annurev-psych-010814-015258.CrossRefPubMed

31.

Nicholas MK. The Pain Self-Efficacy Questionnaire: taking pain into account. Eur J Pain. 2007;11(2):153–63. https://doi.org/10.1016/j.ejpain.2005.12.008.CrossRefPubMed

32.

Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–6. https://doi.org/10.1080/08870440290001494.CrossRef

33.

Harland NJ, Georgieff K. Development of the Coping Strategies Questionnaire 24, a clinically utilitarian version of the Coping Strategies Questionnaire. Rehabil Psychol. 2003;48(4):296–300. https://doi.org/10.1037/0090-5550.48.4.296.CrossRef

34.

Mead N, Bower P, Roland M. The general practice assessment questionnaire (GPAQ): development and psychometric characteristics. BMC Fam Pract. 2008;9:13. https://doi.org/10.1186/1471-2296-9-13.CrossRefPubMedPubMedCentral

35.

Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988;41(4):313–21. https://doi.org/10.1016/0895-4356(88)90138-2.CrossRefPubMed

36.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

37.

Babatunde OO, Corp N, Shivji N, et al. Interventions for supporting self-management in people with musculoskeletal pain, including focus on varying levels of health literacy: A systematic overview of reviews. healthopenres; 2023. https://doi.org/10.12688/healthopenres.13151.1.

38.

Kitzinger J. Qualitative Research: Introducing focus groups. BMJ. 1995;311(299). doi: https://doi.org/10.1136/bmj.311.7000.299

39.

Acocella I. The focus groups in social research: advantages and disadvantages. Qual Quant. 2012;46(4):1125–36. https://doi.org/10.1007/s11135-011-9600-4.CrossRef

40.

Bloor M, Frankland J, Thomas M, Robson K. Focus Groups in Social Research. London: Sage; 2001.CrossRef

41.

Palinkas L, Horwitz S, Green C, Wisdom J, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2015;42(5):533–44. https://doi.org/10.1007/s10488-013-0528-y.CrossRefPubMedPubMedCentral

42.

Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. Los Angeles: Sage; 2012.CrossRef

43.

Mason JD, A. Understanding social research: thinking creatively about method. London: Sage; 2011.

44.

O'Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. British Medical Journal. 2010;341:c4587. https://doi.org/10.1136/bmj.c4587.

45.

McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38(3):655–62. https://doi.org/10.1007/s11096-016-0257-x.CrossRefPubMedPubMedCentral

46.

Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424–67. https://doi.org/10.1136/rapm-2019-101243.CrossRefPubMedPubMedCentral

47.

Finney A, Porcheret M, Grime J, Jordan KP, Handy J, Healey E, et al. Defining the Content of an Opportunistic Osteoarthritis Consultation With Primary Health Care Professionals: A Delphi Consensus Study. Arthritis Care Res. 2013;65(6):962–8. https://doi.org/10.1002/acr.21917.CrossRef

48.

Powell C. The Delphi technique: myths and realities. J Advan Nurs. 2003;41:376–82. https://doi.org/10.1046/j.1365-2648.2003.02537.x.CrossRef

49.

Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook (accessed 07/11/2022).

50.

Bosworth HB, Olsen MK, Gentry P, Orr M, Dudley T, McCant F, et al. Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention. Patient Educ Couns. 2005;57(1):5–14. https://doi.org/10.1016/j.pec.2004.03.011.CrossRefPubMed

51.

Bosworth HB, Olsen MK, Grubber JM, Neary AM, Orr MM, Powers BJ, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med. 2009;151(10):687–95. https://doi.org/10.7326/0003-4819-151-10-200911170-00148.CrossRefPubMedPubMedCentral

52.

Bosworth HB, Olsen MK, McCant F, Stechuchak KM, Danus S, Crowley MJ, et al. Telemedicine cardiovascular risk reduction in veterans: The CITIES trial. Am Heart J. 2018;199:122–9. https://doi.org/10.1016/j.ahj.2018.02.002.CrossRefPubMed

53.

Carroll JK, Tobin JN, Luque A, Farah S, Sanders M, Cassells A, et al. “Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV. J Gen Intern Med. 2019. https://doi.org/10.1007/s11606-019-05102-7.

54.

Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes Care. 2009;32(12):2149–55. https://doi.org/10.2337/dc09-0563.CrossRefPubMedPubMedCentral

55.

DeWalt DA, Malone RM, Bryant ME, Kosnar MC, Corr KE, Rothman RL, et al. A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial. BMC Health Serv Res. 2006;6:30. https://doi.org/10.1186/1472-6963-6-30.CrossRefPubMedPubMedCentral

56.

DeWalt DA, Schillinger D, Ruo B, Bibbins-Domingo K, Baker DW, Holmes GM, et al. Multisite Randomized Trial of a Single-Session Versus Multisession Literacy-Sensitive Self-Care Intervention for Patients With Heart Failure. Circulation. 2012;125(23):2854–62. https://doi.org/10.1161/Circulationaha.111.081745.CrossRefPubMedPubMedCentral

57.

Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, et al. Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr. 2013;63(1):42–50. https://doi.org/10.1097/QAI.0b013e318286ce49.CrossRefPubMedPubMedCentral

58.

Kiser K, Jonas D, Warner Z, Scanlon K, Shilliday BB, DeWalt DA. A randomized controlled trial of a literacy-sensitive self-management intervention for chronic obstructive pulmonary disease patients. J Gen Intern Med. 2012;27(2):190–5. https://doi.org/10.1007/s11606-011-1867-6.CrossRefPubMed

59.

Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007;146(10):714–25. https://doi.org/10.7326/0003-4819-146-10-200705150-00005.CrossRefPubMed

60.

Press VG, Arora VM, Trela KC, Adhikari R, Zadravecz FJ, Liao C, et al. Effectiveness of Interventions to Teach Metered-Dose and Diskus Inhaler Techniques. A Randomized Trial. Annals of the American Thoracic Society. 2016;13(6):816–24. https://doi.org/10.1513/AnnalsATS.201509-603OC.

61.

Schillinger D, Hammer H, Wang F, Palacios J, McLean I, Tang A, et al. Seeing in 3-D: examining the reach of diabetes self-management support strategies in a public health care system. Health Educ Behav. 2008;35(5):664–82. https://doi.org/10.1177/1090198106296772.CrossRefPubMed

62.

Schillinger D, Handley M, Wang F, Hammer H. Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes A three-arm practical clinical trial. Diabetes Care. 2009;32(4):559–66. https://doi.org/10.2337/dc08-0787.CrossRefPubMedPubMedCentral

63.

Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Prim Care Diabetes. 2013;7(2):111–8. https://doi.org/10.1016/j.pcd.2012.11.001.CrossRefPubMed

64.

Eikelenboom N, Van Lieshout J, Jacobs A, Verhulst F, Lacroix J, Van Halteren A, et al. Effectiveness of personalised support for self-management in primary care: A cluster randomised controlled trial. Br J Gen Pract. 2016;66(646):e354–61. https://doi.org/10.3399/bjgp16X684985.CrossRefPubMedPubMedCentral

65.

Lee SJ, Song M, Im EO. Effect of a Health Literacy-Considered Diabetes Self-Management Program for Older Adults in South Korea. Res Gerontol Nurs. 2017;10(5):215–25. https://doi.org/10.3928/19404921-20170831-03.CrossRefPubMed

66.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. Int J Nurs Stud. 2013;50(5):587–92. https://doi.org/10.1016/j.ijnurstu.2012.09.010.CrossRefPubMed

67.

O’Cathain A, Croot L, Sworn K, Duncan E, Rousseau N, Turner K, et al. Taxonomy of approaches to developing interventions to improve health: a systematic methods overview. Pilot Feasibility Stud. 2019;5:41. https://doi.org/10.1186/s40814-019-0425-6.CrossRefPubMedPubMedCentral

68.

Kapoor S, Eyer J, Thorn B. Health literacy in individuals with chronic pain living in rural United States: Association with pain-related variables. Journal of Pain. 2016;17(Suppl. 4):S17–8. https://doi.org/10.1016/j.jpain.2016.01.071.CrossRef

69.

Du S, Yuan C, Xiao X, Chu J, Qiu Y, Qian H. Self-management programs for chronic musculoskeletal pain conditions: a systematic review and meta-analysis. Patient Educ Couns. 2011;85(3):e299-310. https://doi.org/10.1016/j.pec.2011.02.021.CrossRefPubMed

70.

Elbers S, Wittink H, Pool JJM, Smeets RJEM. The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis. Eur J Pain. 2018;22(9):1577–96. https://doi.org/10.1002/ejp.1253.CrossRefPubMedPubMedCentral

71.

Miles CL, Pincus T, Carnes D, Homer KE, Taylor SJ, Bremner SA, et al. Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs. Eur J Pain. 2011;15(8):775.e1-11. https://doi.org/10.1016/j.ejpain.2011.01.016.CrossRefPubMed

Title: Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study
Authors: Emma L. Healey
Martyn Lewis
Nadia Corp
Noureen A. Shivji
Danielle A. van der Windt
Opeyemi O. Babatunde
Joanna Simkins
Bernadette Bartlam
Gill Rowlands
Joanne Protheroe
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Musculoskeletal Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2023
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-023-06452-4

ERS Congress 2024

Springer Medicine

Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study

Abstract

Background

Methods

Findings

Conclusions

ERS Congress 2024

Springer Medicine

Abstract

Background

Methods

Findings

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Treatment strategies for recurrent dislocation following total hip arthroplasty: relationship between cause of dislocation and type of revision surgery

Feasibility of return to sports assessment 6 months after patellar instability surgery

The gap height in open wedge high tibial osteotomy is not affected by the starting point of the osteotomy

A participatory ergonomics intervention to re-design work and improve the musculoskeletal health of paramedics: protocol for a cluster randomised controlled trial

Correlation between inflammatory cytokine expression in paraspinal tissues and severity of disc degeneration in individuals with lumbar disc herniation

The effect of a digital-assisted group rehabilitation on clinical and functional outcomes after total hip and knee arthroplasty—a prospective randomized controlled pilot study