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. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms. A prospective examination of mask anxiety during radiotherapy for head and neck cancer and patient perceptions of management strategies Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee. A randomized controlled study of the Arthritis Self-Management Programme in the UK. The effectiveness of self‐management educational interventions for osteoarthritis of the knee Pilot study of an energy conservation education program delivered by telephone conference call to people with multiple sclerosis. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Participants' experiences of care during a randomized controlled trial comparing a lay-facilitated angina management programme with usual care: a qualitative study using focus groups Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Task-Oriented Training with Computer Games for People with Rheumatoid Arthritis or Hand Osteoarthritis: A Feasibility Randomized Controlled Trial. Health promotion for frail older home care clients. Guidelines for the pharmacological treatment of anxiety disorders, obsessive–compulsive disorder and posttraumatic stress disorder in primary care Myofascial Pain of the Jaw Muscles: Comparison of Short-Term Effectiveness of Botulinum Toxin Injections and Fascial Manipulation Technique
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 AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients Patellofemoral pain ( PFP ) remains one of the most common conditions encountered in sports medicine . Characterised by anterior knee pain that is aggravated by activities such as running , squatting and stair ambulation ; PFP generally reduces or restricts physical activity . While PFP may subside with activity reduction , the natural history of this common condition is not one of spontaneous recovery . Indeed , PFP is often recalcitrant and can persist for many years . In a prospect i ve study of people with PFP , symptoms persisted in 25 % of people up to 20 years.1 Despite considerable evidence for the efficacy of conservative interventions for PFP , such as multimodal physiotherapy,2 these interventions do not appear to have long-lasting effects.2 Compounding the management of PFP is that surgery for PFP is widely considered to have poor outcomes . As mentioned in the 2014 consensus statement from the International Patellofemoral Pain Research Retreat3 there is speculation that PFP may be a prelude to degenerative joint changes and ultimately the development of patellofemoral osteoarthritis (PFOA).4 , 5 While no current studies have prospect ively studied people with PFP through to the development of PFOA ( and thus verify this relationship ) , a recent systematic review 4 observed that individuals undergoing arthroplasty for PFOA were more than twice as likely ( OR=2.31 , 95 % CI 1.37 to 3.88 ) to report having had PFP as an adolescent than patients undergoing an arthroplasty for isolated tibiofemoral OA . In the absence of rigorous OBJECTIVE To describe the potential psychological consequences of screening for abdominal aortic aneurysms ( AAAs ) . METHODS The participants were prospect ively and r and omly sample d from a r and omised screening trial for AAA and asked to complete a vali date d generic and global anonymous quality of life ( QL ) question naire by self- assessment ( ScreenQL ) . Material case-control study : ScreenQL was completed once by 168 ( 48 % ) of 350 non-responders to screening  , 271 ( 81 % ) of 335 attenders before screening , 286 ( 85 % ) of 335 attenders after screening , 127 ( 85 % ) of 149 with a small AAA diagnosed at screening , and 231 ( 66 % ) of 350 who were r and omised not to be offered screening for AAA ( controls ) . Prospect i ve study ( paired data ): 127 men having a small AAA diagnosed . Twenty-nine ( 81 % ) of 36 men operated after initial conservative treatment . RESULTS Initially , the QL score was 5 % lower among men with a small AAA compared to the controls ( p<0.05 ) , mainly because of poorer health perception . The QL score declined significantly further to 7 % below control values during the period of conservative treatment . This impairment was mainly due to a 21 % and 15 % reduction in scores relating to health perception and psychosomatic distress , respectively . However , all scores improved to control levels in patients operated on . The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening . No differences were noticed concerning the non-attenders . CONCLUSION The offer of screening causes transient psychological stress in subjects found not to have AAA . However , diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases . This impairment seems reversible by operation . Nevertheless , the impairment seems considerable , and must be considered in the management of AAA and in the final evaluation of screening for AAA Abstract Introduction Distress related to wearing an immobilisation mask for radiotherapy treatment ( RT ) is a common experience for the person undergoing RT for head and neck cancer ( HNC ) . Described as ‘ mask anxiety ’ , there is little known about the patterns of this distress through the course of the treatment or what strategies are being used by people to help alleviate mask anxiety . Methods The study used a prospect i ve cohort design to examine the patterns of patient – reported mask anxiety during the course of RT , using a modified Distress Thermometer ( DT ) and a survey to explore strategies patients used to assist their mask anxiety . Results Thirty‐five participants , who identified as experiencing mask anxiety , were followed throughout RT treatment . At baseline , females were more likely to experience higher mask anxiety ( P = 0.03 ) . Across the course of treatment , mask anxiety significantly ( P < 0.001 ) reduced within the total cohort . In 72 % of participants , the level of initial distress was found to reduce over time . Only 22 % experienced mask anxiety that remained constant . Few ( 6 % ) experienced an increase in mask anxiety across the course of RT . Participants reported relying on intervention from health professionals , self – taught strategies , music , visualisation and medication to manage their mask anxiety . Conclusions Due to its high prevalence and variable patterns over time , it is recommended that routine screening for mask anxiety be implemented as st and ard care throughout the course of RT for HNC . Multiple , diverse strategies are being used by patients and studies are needed to develop effective interventions for managing mask anxiety Abstract Objective : To determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia . Design : R and omised controlled trial . Setting : 31 UK primary care centres . Participants : 478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration . Interventions : Near patient testing for H pylori and open access endoscopy for patients with positive results . Control patients received acid suppressing drugs or specialist referral at general practitioner 's discretion . Main outcome measures : Cost effectiveness based on improvement in symptoms and use of re sources at 12 months ; quality of life . Results : 40 % of the study group tested positive for H pylori . 45 % of study patients had endoscopy compared with 25 % of controls . More peptic ulcers were diagnosed in the study group ( 7.4 % v 2.1 % , P=0.011 ) . Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups . No significant differences were observed in rates of prescribing , consultation , or referral . Costs were higher in the study group ( £ 367.85 v £ 253.16 per patient ) . Conclusions : The test and endoscopy strategy increases endoscopy rates over usual practice in primary care . The additional cost is not offset by benefits in symptom relief or quality of life . What is already known on this topic Patients younger than 50 without H pylori infection are unlikely to have treatable disease detected at endoscopy Such patients can be managed by acid suppression and reassurance alone Test and endoscopy ( referral of patients testing positive for H pyloriin primary care ) has been recommended as a way to reduce endoscopic workload What this paper adds Applying a test and endoscopy strategy increased the endoscopy referral rate from 25 % to 40 % The strategy produced no significant differences in symptoms or quality of life compared with usual management The increased costs of this strategy can not be OBJECTIVE The intent of this cross-sectional study was to broaden the range of variables examined in relationship to depression in osteoarthritis ( OA ) to include comorbidity , stressful life events , and the ways people respond to their disease . We examined the relationship of coping behaviors and perceptions , and medical treatments received for OA and depressive symptoms . METHODS In the fifth year of a prospect i ve cohort study , 1227 individuals > or= 62 years of age with hip/knee OA provided information about sociodemographics ( age , sex , living circumstances , education ) , arthritis severity ( WOMAC pain and function ; ClinHAQ fatigue ) , comorbidity , life events , coping behavior , coping efficacy , treatment ( pain management , treatment for depression ) , and depressed mood ( Centre for Epidemiological Studies Depression scale , CES-D ) . Using hierarchical linear regression , variables were entered in blocks to predict CES-D scores . In the final block , the interaction of coping behavior and coping efficacy was tested . RESULTS The response rate was 82.4 % ( n = 1227/1489 ) . The mean CES-D score was 9.4 , with 21.3 % of individuals scoring > or= 16 ( supporting depressed mood ) . Higher level of depressed mood was independently and significantly associated with being female , experiencing greater pain and fatigue , experiencing stressful life events , more coping behaviors , receiving treatment for depression/mental illness , and a coping behavior by coping efficacy interaction , with 63.4 % of the variance accounted for in the model . CONCLUSION Among older adults with OA , the prevalence of depressive symptoms is high . Longitudinal studies must consider OA management strategies , including both the amount of behavioral coping and its perceived efficacy , to eluci date potential interventions design ed to reduce depression in patients with OA BACKGROUND AND PURPOSE The knee is the weight-bearing joint most commonly affected by osteoarthritis ( OA ) . The symptoms of pain , morning stiffness of short duration and physical dysfunction in the activities of daily living ( ADL ) can have an effect on many aspects of health , affecting quality of life . Regular and moderate physical activity adapted to individuals ' life-styles and education , and joint protection strategies have been advocated as conservative management . The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA . METHOD The study design was a r and omized controlled clinical trial . The subjects comprised 50 elderly people , aged 65 or more , with knee OA who had been referred to the geriatric outpatient unit for rehabilitation . Changes in severity of pain and quality of life were compared between a control group ( CG ) and an experimental group ( EG ) . Both groups participated in an educational session and the EG also received a 12-week exercise and walking protocol . Both groups were assessed at baseline and after three and six months by an independent observer . The Lequesne Index of Knee OA Severity ( LI ) , the Health Assessment Question naire ( HAQ ) and the Medical Outcomes Short-Form Health Survey ( SF-36 ) were used as measurement instruments . RESULTS In the CG , the measures of quality of life ( SF-36 ) , the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points . For the EG , there was a significant improvement in function , measured by HAQ , and decreasing OA symptom severity , measured by LI . For the SF-36 there were significant improvements in physical function , functional role limitation and pain . Comparisons between the groups showed statistically significant differences after three and six months for all measures , except for the SF-36 emotional domains . CONCLUSION The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes OBJECTIVE To modify and pilot test a face-to-face group energy conservation education program for delivery by group telephone teleconference to people with multiple sclerosis . PARTICIPANTS 29 community dwelling individuals with multiple sclerosis . METHODS The first phase of the study involved the modification of an existing energy conservation education program to accommo date teleconference delivery . The second phase involved a pilot test of the intervention using a basic pre/post intervention design . Licensed occupational therapists delivered the intervention . OUTCOME MEASURES Fatigue severity , fatigue impact , health related quality of life , self-efficacy for performing energy conservation strategies , and use of energy conservation behaviors . FINDINGS Using an a priori alpha of p = 0.10 , paired t-tests found significant reductions in fatigue severity , fatigue impact , and improvements in the following aspects of quality of life : bodily pain and general health . Average effect size was 0.31 . The most used energy conservation strategies after the course were simplifying activities , adjusting priorities , changing body position , resting , and planning the day to balance work and rest . CONCLUSION The pilot study supports on-going development and testing of energy conservation education delivered by teleconference to people with multiple sclerosis OBJECTIVE This study was undertaken to compare alternative strategies for the initial management of a cytologic diagnosis of atypical squamous cells of undetermined significance ( ASCUS ) . STUDY DESIGN A total of 3488 women with a community-based ASCUS interpretation were r and omly assigned to immediate colposcopy , triage that was 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 study end point was 2-year cumulative diagnosis of CIN grade 3 . RESULTS The 2-year cumulative diagnosis of CIN grade 3 was 8 % to 9 % in all study arms . The immediate colposcopy strategy yielded 53.6 % sensitivity for cumulative cases of CIN grade 3 diagnosed over 2 years . The human papillomavirus ( HPV ) triage strategy referred 55.6 % of women and detected 72.3 % of cumulative cases of CIN grade 3 . A conservative management strategy of repeat cytology at the HSIL threshold referred 12.3 % of women while detecting 54.6 % of cumulative CIN grade 3 . To compare triage tests , we re-estimated the performance of HPV and cytology in successfully referring women with underlying CIN grade 3 ( ie , ignoring the insensitivity we discovered in colposcopically directed biopsies ) . A single enrollment HPV test identified 92.4 % of the women diagnosed with CIN grade 3 . Serial cytology , even at an ASCUS threshold , would have required two visits to achieve similar sensitivity ( 95.4 % ) and would have referred 67.1 % to colposcopy . CONCLUSION HPV triage is at least as sensitive as immediate colposcopy for detecting CIN grade 3 and refers about half as many women to colposcopy . Follow-up that used repeat cytology is sensitive at an ASCUS referral threshold but requires two follow-up visits and ultimately more colposcopic examinations than HPV triage Aim This paper is a report of a qualitative study conducted as part of a r and omized controlled trial comparing a lay-facilitated angina management programme with usual care . Its aim was to explore participants ' beliefs , experiences , and attitudes to the care they had received during the trial , particularly those who had received the angina management intervention . Background Angina affects over 50 million people worldwide . Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition . Design A nested qualitative study within a r and omized controlled trial of lay-facilitated angina management . Method We conducted four participant focus groups during 2008 ; three were with people r and omized to the intervention and one with those r and omized to control . We recruited a total of 14 participants to the focus groups , 10 intervention , and 4 control .  Findings Although recruitment to the focus groups was relatively low by comparison to conventional st and ards , each generated lively discussion s and a rich data set . Data analysis demonstrated both similarities and differences between control and intervention groups . Similarities included low levels of prior knowledge about angina , whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker . Conclusion Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management . However , clinical expertise is still required to meet the more complex information and care needs of people with stable angina Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted OBJECTIVES To examine the feasibility of a clinical trial on a novel , home-based task-oriented training with conventional h and exercises in people with rheumatoid arthritis or h and osteoarthritis . To explore the experiences of participants who completed their respective home exercise programmes .  MATERIAL S AND METHODS Thirty volunteer participants aged between 30 and 60 years and diagnosed with rheumatoid arthritis or h and osteoarthritis were proposed for a single-center , assessor-blinded , r and omized controlled trial ( Clinical Trials.gov : NCT01635582 ) . Participants received task-oriented training with interactive computer games and objects of daily life or finger mobility and strengthening exercises . Both programmes were home based and were done four sessions per week with 20 minutes each session for 6 weeks . Major feasibility outcomes were number of volunteers screened , r and omized , and retained ; completion of blinded assessment s , exercise training , and home exercise sessions ; equipment and data management ; and clinical outcomes of h and function . Reaching the recruitment target in 18 months and achieving exercise compliance > 80 % were set as success criteria . Concurrent with the trial , focus group interviews explored experiences of those participants who completed their respective programmes . RESULTS After trial initiation , revisions in inclusion criteria were required to promote recruitment . A total of 17 participants were r and omized and 15 were retained . Completion of assessment s , exercise training , and  home exercise  sessions ; equipment and data collection and management demonstrated excellent feasibility . Both groups improved in h and function outcomes and exercise compliance was above 85 % . Participants perceived both programmes as appropriate and acceptable . Participants who completed task-oriented training also agreed that playing different computer games was enjoyable , engaging , and motivating . CONCLUSIONS Findings demonstrate initial evidence on recruitment , feasibility of trial procedures , and acceptability of task-oriented training in people with rheumatoid arthritis or h and osteoarthritis . Since the pilot trial was unsuccessful in participant recruitment , a large trial will not follow AIM This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone . BACKGROUND An ageing population , budget constraints and technological advances in many countries have increased the pressure on home care re sources . The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care . For frail older people with long-term needs , these changes combine to create a fragmented system of health service delivery , characterized by providing nursing on dem and rather than proactively . METHODS A two-armed , single-blind , r and omized controlled trial was carried out with older people > or = 75 years and eligible for personal support services through a home care programme in Ontario , Canada . Participants were r and omly allocated either to usual home care ( control ) or to a nursing ( experimental ) group . In addition to usual home care , the nursing group received a health assessment combined with regular home visits or telephone contacts , health education about management of illness , coordination of community services , and use of empowerment strategies to enhance independence . The data were collected in 2001 - 2002 . RESULTS Of the 288 older people who were r and omly allocated at baseline , 242 ( 84 % ) completed the study ( 120 nursing group ; 122  control group ) . Proactively providing older people with nursing health promotion , compared with providing nursing services on-dem and , result ed in better mental health functioning ( P = 0.009 ) , a reduction in depression ( P = 0.009 ) , and enhanced perceptions of social support ( P = 0.009 ) at no additional cost from a societal perspective . CONCLUSIONS Home based nursing health promotion , proactively provided to frail older people with chronic health needs , enhances quality of life while not increasing the overall costs of health care . The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care Abstract Objective . Anxiety disorders are frequently under-diagnosed conditions in primary care , although they can be managed effectively by general practitioners . Methods . This paper is a short and practical summary of the World Federation of Biological Psychiatry ( WFSBP ) guidelines for the pharmacological treatment of anxiety disorders , obsessive – compulsive disorder ( OCD ) and posttraumatic stress disorder ( PTSD ) for the treatment in primary care . The recommendations were developed by a task force of 30 international experts in the field and are based on r and omized controlled studies . Results . First-line pharmacological treatments for these disorders are  selective serotonin reuptake inhibitors  ( for all disorders ) ,  serotonin-norepinephrine reuptake inhibitors  ( for some ) and  pregabalin  ( for generalized anxiety disorder only ) . A combination of  medication and cognitive behavior/exposure therapy  was shown to be a clinical ly desired treatment strategy . Conclusions . This short version of an evidence -based guideline may improve treatment of anxiety disorders , OCD , and PTSD in primary care Abstract A r and omized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles . Thirty patients with a Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) diagnosis of myofascial pain were r and omized to receive either single-session botulinum toxin injections ( Group A ) or multiple-session Fascial Manipulation ( Group B ) . Maximum pain levels ( VAS ratings ) and jaw range of motion in millimeters ( maximum mouth opening , protrusion , right and left laterotrusion ) were assessed at baseline , at the end of treatment , and at a three-month follow-up . Both treatment protocol s provided significant improvement over time for pain symptoms . The two treatments seem to be almost equally effective , Fascial Manipulation being slightly superior to reduce subjective pain perception , and botulinum toxin injections being slightly superior to increase jaw range of motion . Differences between the two treatment protocol s as to changes in the outcome parameters at the three-months follow-up were not relevant clinical ly . Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles . Future studies on larger sample s over a longer follow-up span are needed on the way to identify tailored treatment strategies
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 .