James Peter Gavin

Introduction: Physical activity (PA) is vital for managing long‐term health conditions (LTCs), yet maintaining regular PA remains a global challenge. Partnerships between healthcare, leisure, and community services can provide accessible PA opportunities, but current pathways focus on initiating, rather than maintaining PA. Understanding factors influencing progression along PA pathways and engagement of professionals is essential. Methods: Four focus groups of people with LTCs (n = 21; aged 39–82 years) were complemented by interviews with 19 professionals (aged 26–66) and five carers (aged 20–78 years). Inductive thematic analysis was used to generate understanding about recommendations for an integrated PA maintenance pathway, before mapping themes to the COM‐B (Capability, Opportunity, Motivation, Behaviour) model. Results: Key themes were: i) limited access to, and information about PA services; ii) a need for improved intersectoral collaboration; and iii) opportunities and barriers to developing a PA maintenance pathway. Primary care and community centres were deemed reliable and accessible locations to advertise local opportunities, but without digital platforms, lacked recency and condition‐appropriate activities. Intermediaries emerged as community navigators, working intersectorally with knowledge of local communities, and behaviour change techniques to support maintenance. However, funding cuts limited intersectoral working. Conclusion: Maintaining PA among people with LTCs and carers requires a coordinated, intersectoral pathway between healthcare and community services, which extends beyond initial consultation and referral. Investment in collaborative infrastructure, accessible digital systems, and sustainable funding is lacking. However, community‐based intermediaries trained in digital tools, can play a pivotal role in supporting maintenance by connecting individuals with appropriate opportunities and providing ongoing behaviour change.

Background: There is currently limited evidence on the long-term effectiveness of referral programs from healthcare to community sectors to help people with long-term conditions (LTCs) maintain physical activity. This study aimed to (i) identify the support needs of people with LTCs in maintaining physical activity following physical activity referral schemes (PARS); (ii) understand healthcare professionals’ experiences of referring and delivering on PARS, and; (iii) begin co-designing a pathway integrating healthcare, leisure and community to maintain physical activity for LTCs. Methods: A qualitative design involved (i) stakeholder mapping, ii) interviews with people with LTCs (n = 15) and healthcare professionals (n = 9), and; (iii) workshops with participants with LTCs (n = 6) and multi-sectoral professionals (n = 15). Workshops involved multi-sectoral professionals responsible for designing, delivering, referring and/or commissioning PARS across health, leisure and community sectors. Interviews and workshops were thematically analyzed, with themes mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model. Results: Participants with LTCs recognized that although PARS increased their psychological and physical capabilities, aging and symptoms impacted their day-to-day capabilities and motivation. Professional feedback and monitoring, complemented by peer support, were essential in mitigating this and maintaining physical activity behaviors. Healthcare professionals were challenged by the time taken to identify community-based opportunities, navigating referrals, and lacked sufficient feedback on client progress, but felt group activities, enjoyment and social support were integral. Workshops highlighted the need for an integrated pathway from medical intervention to community-based support, to improve physical activity maintenance for LTCs. Better partnership working between multi-sectoral agencies was prioritized to increase scheme accessibility, including simple, standardized referrals. Using behavior change techniques to personalize support was also valued, including ‘healthy conversations’ training for healthcare professionals. Conclusions: Healthcare, leisure, and community sectors should collaborate to create accessible local activities that promote social support, feedback and monitoring, and public partnership. Healthcare professionals should consider individual capabilities, foster motivation during and after PARS, and facilitate networks for resources and knowledge sharing.

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)’s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or ‘making sense’). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action–needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action–promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation.

Objective: To determine the impact of occupational therapy (OT) on the self‐management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA).Methods: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE‐ Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type.Results: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long‐term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self‐management for fatigue.Conclusion: Although patient education is promising for self‐managing RA, no strong evidence was found to support OT programs for self‐managing fatigue or patient experience and long‐term effectiveness. More research is required on lived experience, and the long‐term efficacy of self‐management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date.

Introduction: Public and health professional involvement (PHPI) is essential in healthcare research yet uncommonly integrated into systematic reviews. We incorporated and evaluated PHPI in a mixed methods review of occupational therapy for self-management of rheumatoid arthritis (RA). Methods: Public partners were living with or caring for someone with RA. Our steering group comprised two public, two professionals (one occupational therapist, one rheumatologist), and one reviewer who planned the review’s PHPI (August 2021). Involvement was evaluated from public and health professional (PHP) perspectives using a survey and workshops (August–October 2022) exploring reasons for involvement, challenges and learning opportunities. Results: Alongside the steering group, 16 public and 6 professionals were involved throughout the review. Five public refined the search strategy, with three assisting in subsequent review activities. PHPs helped interpret findings during three public ( n = 12) and one professional workshop ( n = 4). Three occupational therapists and one public co-authored (ED) publications. In evaluation, PHPs felt valued and that their involvement was well-integrated. The researchers underestimated the time required for communicating and conducting PHPI in the review. Conclusions: PHPI is worthwhile, feasible and can be integrated within a systematic review. PHP partners considered participation valuable; researchers must prioritise time to prepare and communicate PHPI activities.

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

Background and Objectives: Following discharge from hospital, there can be variability in the rehabilitation of patients who have undergone total hip or knee replacement surgery. We invited patients who had had hip or knee replacement surgery to take part in patient and public involvement sessions to help us understand their recovery needs and how rehabilitation services could potentially be improved to meet these needs better. Materials: Patients (n = 14) were invited to one of two patient advisory group sessions which took place in a university setting. Results: Feedback from patients highlighted the need for an inclusive, evidence-based intervention that would benefit patients experiencing all levels of pain, with differing motivations for recovery. Patients desired social support with others who have had similar surgery to reduce the burden of isolation during rehabilitation. Furthermore, patients valued the involvement of their partners and carers in their rehabilitation, to provide social support and guidance on recovery. Patients also expressed a need for consistent information and expert guidance on all aspects of their recovery. Conclusions: These findings can be used to guide the design of rehabilitation interventions following hip and knee replacement and ensure that patient perspectives inform future practice.

Introduction: Following traumatic injury, occupational therapists (OTs) are pivotal in supporting people to return-to-work (RTW) and regain independence. Aim: to identify priorities for RTW after traumatic injury and highlight barriers hindering the process. Method: We recruited 17 participants with direct (i.e. trauma survivor [ n = 11]; OT trauma survivor [ n = 2]) or indirect (i.e. OT [ n = 4]) experience of returning to work following traumatic injury. Online consultations, lasting 60 min, were guided by a semi-structured script ensuring relevant topics were covered. An inductive approach was used for coding themes using thematic analysis. Findings: Sense of purpose, identity and social interaction were greater priorities for RTW, than financial stability. Major barriers were: pain and fatigue; adapting to physical changes; impacts on mental health; and lack of support (healthcare and the workplace). Participants (public and healthcare professionals) reported a lack of vocational rehabilitation in supporting trauma survivors RTW, but advocated occupational therapy for psychological recovery; purposeful engagement in occupations; and community support. Conclusion: Restoring an individual’s self-identity and social connections, whilst helping control pain and fatigue, should be prioritised when planning occupational therapy for those returning to work after traumatic injury. This study was limited to ‘returners’, but can inform occupational therapy interventions for RTW.

Background: Occupational therapists can support people with rheumatoid arthritis to self‐manage their disease symptoms and engage in daily activities. This protocol reports a review to broaden understanding of what is known about the role of occupational therapy in the self‐management of rheumatoid arthritis.Methods: Studies involving adults with rheumatoid arthritis, having participated in self‐management involving occupational therapy, will be included. Patient involvement will help develop the search strategy by identifying patient‐centred interventions and outcomes to complement those identified by researchers. An electronic search will be performed using several bibliographic databases, including grey literature from subject‐specific, health‐related, and social care databases. Searches will run from the database inception until the date that the search is conducted (December 2021–May 2022). Retrieved studies will be de‐duplicated, and the remaining titles and abstracts will be screened by three reviewers. Full texts of all eligible studies will be independently reviewed by the reviewers to select papers for data extraction and quality assessment. Outcomes are function, pain, fatigue and lived experience. For quantitative studies, data will be synthesised using descriptive statistics in text and tables, whereas for qualitative studies, data will be synthesised using thematic synthesis.Discussion: This review will synthesise current evidence on how occupational therapy can help the self‐management of rheumatoid arthritis. It will include evidence of best practice, including advice, education and training provided by occupational therapists. These findings can inform future research and the selection of strategies to promote quality of life for people with rheumatoid arthritis.Systematic review registration: PROSPERO CRD42022302205

Objectives: This study aimed to explore the impact of the coronavirus disease 2019 (COVID‐19) pandemic on self‐care of individuals living with rheumatoid arthritis (RA).Methods: Guided by a constructivist, qualitative design, we conducted one‐to‐one in‐depth telephone interviews between March and October 2020 with participants with RA purposively sampled for maximum variation in age, sex and education, who were participating in one of two ongoing randomized‐controlled trials. An inductive, reflexive thematic analysis approach was used.Results: Twenty‐six participants (aged 27–73 years; 23 females) in British Columbia, Canada were interviewed. We identified three themes: (1) Adapting to maintain self‐care describes how participants took measures to continue self‐care activities while preventing virus transmissions. While spending more time at home, some participants reported improved self‐care. (2) Managing emotions describes resilience‐building strategies such as keeping perspective, positive reframing and avoiding negative thoughts. Participants described both letting go and maintaining a sense of control to accommodate difficulties and emotional responses. (3) Changing communication with health professionals outlined positive experiences of remote consultations with health professionals, particularly if good relationships had been established prepandemic.Conclusion: The insights gained may inform clinicians and researchers on ways to support the self‐care strategies of individuals with RA and other chronic illnesses during and after the COVID‐19 pandemic. The findings reveal opportunities to further examine remote consultations to optimize patient engagement and care.Patient or Public Contribution: This project is jointly designed and conducted with patient partners in British Columbia, Canada. Patient partners across the United Kingdom also played in a key role in providing interpretations of themes during data analysis.