Jo Adams

Objectives To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of a pain management training intervention to support people with persistent musculoskeletal pain and their informal carers. Design Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. Setting National Health Service (NHS) providers in four English hospitals. Participants Adults receiving NHS care for persistent musculoskeletal pain and their informal carers. Intervention Control: usual NHS care. Experimental: usual NHS care plus a carer-patient pain management training intervention (JOINT SUPPORT), comprising five, 1-hour, group-based sessions for patients and carers, delivered by trained physiotherapists or occupational therapists. Content included understanding pain, pacing, graded activity, fear avoidance, goal-setting, understanding the benefits of physical activity and medication management. This was re-enforced with a workbook. After the group-based sessions, patients and carers were supported through three telephone sessions. Randomisation Central randomisation was computer-generated (2:1 Experimental:Control), stratified by hospital and patient-participant age (≤65 years). There was no blinding. Main outcome measures Data collected at baseline and 3 months post-randomisation included screening logs, intervention logs, fidelity checklists and clinical outcomes on quality of life, physical and emotional outcomes, adverse events and resource use. Interviews with 14 patient-carer participants and six health professionals who delivered the intervention. Results A total of 76 participants (38 patients; 38 carers) were enrolled. Sixty per cent (312/480) of patients screened were eligible with 12% consenting to be randomised (38/312). Fifty-four per cent (13/24) of the experimental group reached minimal compliance with the JOINT SUPPORT intervention. There was no evidence of treatment contamination. For patient-participant outcomes, within-group differences from baseline to 3 months favoured the control group when assessed by EQ-5D and Generalised Self-Efficacy total score, but favoured the intervention group when assessed by numerical rating scale pain, fatigue and Centre for Epidemiologic Studies Depression Scaletotal score. Qualitative data demonstrated the acceptability of the trial design and JOINT SUPPORT intervention with modifications to improve trial processes. Conclusions The JOINT SUPPORT intervention was acceptable to patient-carer dyads and health professionals. Modifications to trial design, particularly enhanced recruitment strategies, are required. Trial registration number ISRCTN78169443. Data availability statement The data that support the findings of this study are available from the corresponding author (TS) on reasonable request. This includes access to the full protocol, anonymised participant-level dataset and statistical code.

Introduction: Hospital readmission has a negative impact on older people and the healthcare system. Current hospital readmission research predominantly reports on clinical outcomes based on cross‐sectional data. Research exploring patients' experiences and priorities is limited. This study aimed to explore older people's experiences of hospital readmission in order to develop an understanding of what matters most to them.Methods: Semi‐structured qualitative interviews were conducted to generate data that were analysed using principles of interpretative phenomenological analysis.Results: Ten participants over 65 years old, who had experienced unplanned hospital readmission within a period of 30 days, were recruited from a large single tertiary referral centre. Four themes emerged: ‘All about me without me’, ‘Fragmented and ad hoc post‐discharge support’, ‘My readmission experience and what led me back’ and ‘Segregated health and social services that are detached from people's needs’.Conclusion: The study findings suggest that patients should be more involved in decisions about their care, and health professionals should endeavour to better understand the contexts, resources and access to formal and informal support of patients. Effective communication and stronger continuum of care could be a key to patients' recovery and avoidance of hospital readmission. This research highlights the importance of shared decision‐making and patient‐centred care to improve quality of care, maintain independence and preserve older adult's right to feel valued.

Objective: We aimed to advance understanding of how persons with rheumatoid arthritis (RA) experience decision‐making about adopting public health measures during the COVID‐19 pandemic.Methods: Persons living with RA partnered throughout this nested qualitative study. One‐to‐one semistructured telephone interviews were conducted with participants with RA between December 2020 and December 2021. They were strategically sampled from a randomized controlled trial that was underway to test a physical activity counseling intervention. Analysis was guided by reflexive thematic analysis.Results: Thirty‐nine participants (aged 26–86 years; 36 women) in British Columbia, Canada were interviewed. We developed three themes. Participants described how their decision‐making about public health measures related to 1) “upholding moral values of togetherness” because decisions were intertwined with moral values of neighborliness and reciprocity. Some adapted their self‐care routines to uphold these moral values; 2) “relational autonomy—supports and challenges,” because they sometimes felt supported and undermined in different relational settings (eg, by family, local community, or provincial government); and 3) “differing trust in information sources,” in which decisions were shaped by the degree of faith they had in various information sources, including their rheumatologists.Conclusion: Across themes, experiences of decision‐making about public health measures during the pandemic were embedded with moral concepts of solidarity, autonomy, and trust, with implications for how persons with RA chose and sustained their self‐care activities. Insights gained help sensitize researchers and clinicians to moral issues experienced by persons with RA, which may inform support for self‐care activities during and after the pandemic. image

Introduction: Chronic musculoskeletal (bone, joint or muscle) pain is disabling. People with it frequently have difficulties in managing everyday activities. Individuals may rely on family members or friends to support them. These people are known as informal caregivers. No interventions have previously addressed the health needs of people with chronic musculoskeletal pain and their caregivers. In response, the JOINT SUPPORT programme was developed. In this study, we will assess the feasibility and acceptability of conducting a pragmatic, multicentre, randomised controlled trial (RCT) to test the clinical and cost-effectiveness of the JOINT SUPPORT programme to support these individuals. Methods and analysis: This will be a mixed-methods feasibility RCT. We will recruit 80 patients with chronic musculoskeletal pain with their informal caregivers. Patients will be randomised to usual National Health Service (NHS) care OR usual NHS care plus a caregiver–patient dyad training programme (JOINT SUPPORT). This programme comprises of five, 1-hour, group-based sessions for patients and caregivers, delivered by trained physiotherapists or occupational therapists. It includes developing skills in: understanding pain, pacing, graded activity, fear avoidance and goal-setting, understanding benefits of physical activity and skills in medication management. This will be re-enforced with a workbook. After the group-based sessions, patients and caregivers will be supported through three telephone sessions with a therapist. Data collected at baseline and 3 months will include: screening logs, intervention logs, fidelity checklists and clinical outcomes on quality of life, physical and emotional outcomes, adverse events and resource use. Qualitative research with 24 patient–caregiver dyads and 12 healthcare professionals will explore the acceptability of trial processes. Stop–go criteria will inform the progression to a full trial. Ethics and dissemination: Ethical approval was obtained on 22 February 2022 (National Research Ethics Committee Number: 22/NW/0015). Results will be reported at conferences, peer-review publications and across social media channels. Trial registration number: ISRCTN78169443 .

Introduction: Arthritis gloves are prescribed in rheumatoid arthritis (RA) to reduce hand pain, stiffness, and improve hand function. As part of a randomised controlled trial, this study investigated participants' perceptions of wearing arthritis gloves.Method: Participants with RA and persistent hand pain (n = 206) were randomly assigned and prescribed either loose‐fitting gloves (control) or arthritis gloves (intervention), for day and/or night wear (as per individual need). At 12‐weeks, the trial follow‐up questionnaire also included items about whether the gloves prescribed were: beneficial or not; if yes, the benefits experienced; any problems encountered; if they stopped wearing gloves day and/or night, and why.Results: The questionnaire response rate was 154/206 (75%). In both groups, 73% reported gloves were beneficial (p = 0.97). There were no differences in types of benefits reported. The most common were: warmth (59% control: 54% intervention; p = 0.53); and comfort (54%: 62%; p = 0.29). Fewer reported problems with glove wear in the control group (33%), compared to the intervention group (49%); p = 0.05. In both groups, the most common daytime problem was inability to wear gloves for wet or dirty activities; and at night, gloves being too hot. Similar numbers in the control and intervention groups stopped wearing gloves either day or night (23%: 31%; p = 0.26), primarily for these reasons.Discussion: Participants' perceptions about wearing arthritis or loose‐fitting gloves were very similar. Wearing ordinary gloves could result in similar perceived benefits to arthritis gloves.

What does this mean for patients? The purpose of this study was to find out what patients and health professionals thought about taking part in fatigue-management sessions for people with inflammatory arthritis. We discussed the sessions with 22 patients who attended sessions and with eight health professionals who were trained in and delivered the sessions. Patients told us that they liked having an opportunity to talk about their fatigue. Although the information was not always new, they liked the resources, including the daily diaries. Sessions made them think about things in their day-to-day lives that might be making their fatigue worse. For some, it gave them ideas about things to change or do differently. Health professionals liked training with other health professionals and felt more confident about the fatigue sessions with practice. Some were using the fatigue information and resources in their usual consultations. Sometimes it was difficult to make sure everyone had enough time and to fit in all the appointments within the recommended 2-week time frame. The results show that patients value the opportunity to address their fatigue with a health professional, but also the challenges of providing these sessions in clinical practice.

Objectives Patients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive–behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis (FREE-IA) study tested the feasibility of RHP training, intervention delivery and outcome collection ahead of a potential trial of clinical and cost-effectiveness. Methods In this single-arm feasibility study, eligible patients were ≥18 years, had a clinician-confirmed diagnosis of an inflammatory arthritis and scored ≥6/10 on the Bristol Rheumatoid Arthritis Fatigue (BRAF) Numerical Rating Scale (NRS) Fatigue Effect. Following training, RHPs delivered two to four sessions to participants. Baseline data were collected before the first session (T0) and outcomes at 6 weeks (T1) and 6 months (T2). The proposed primary outcome was fatigue impact (BRAF NRS Fatigue Effect). Secondary outcomes included fatigue severity and coping, disease impact and disability, and measures of therapeutic mechanism (self-efficacy and confidence to manage health). Results Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 (9.4%) and 27 (19.6%) missing primary and secondary outcome responses, respectively. Results indicated improvements in all measures except disability, at either T1 or T2, or both. Conclusions This study showed it was feasible to deliver the intervention, including training RHPs, and recruit and follow-up participants with high retention. While there was no control group, observed within-group improvements suggest potential promise of the intervention and support for a definitive trial to test effectiveness.

Arthritis gloves are frequently prescribed to people with undifferentiated inflammatory arthritis (UIA) or RA to help reduce hand pain and improve function. Nested within a randomized controlled trial testing the effectiveness of arthritis gloves (Isotoner gloves vs loose-fitting placebo gloves) in people with RA and UIA, this qualitative study aimed to explore participants’ views on the impact of wearing arthritis gloves on their hand pain and function. Semi-structured one-to-one interviews were conducted with purposively selected participants following 12 weeks of glove wearing. Participants and the interviewer were blinded to the treatment allocation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants (intervention: n = 10; control: n = 9) recruited from 13 National Health Service hospital sites in the UK participated in the interviews. Two main themes, with sub-themes, were elicited from the data: mechanisms determining glove use: ‘As soon as your joints get a bit warmer, the pain actually eases’ (thermal qualities; glove use in daily activities; glove use during sleep); and ambivalence about benefits of arthritis gloves: ‘I suppose a normal pair of gloves would do the same sort of thing?’ (are they a help or hindrance?; aesthetic appeal; future use of gloves). Participants had ambivalent views on the impact of both the intervention and the loose-fitting placebo gloves on their hand pain and function, identifying warmth as the main benefit. Ordinary mid-finger-length gloves widely accessible from high street suppliers could deliver warmth and provide the perceived benefits to hand pain and function. Trial registration: ISRCTN, ISRCTN25892131; registered 5 September 2016 : retrospectively registered.