Walker A, Williams R, Sibley F, Stamp D, Carter A, Hurley M
St George's, University of London and Kingston University, UK.
Health Innovation Network, London, UK.
Musculoskeletal Care. 2018 Mar;16(1):222-232. doi: 10.1002/msc.1189. Epub 2017 Apr 12.
Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain.
At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods.
Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice.
AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.
慢性膝关节和髋关节疼痛很常见，会损害行动能力、功能和生活质量。与初级保健中的全科医生相比，专职医疗专业人员（AHP）接受过更好的培训，且有更多时间为人们提供建议并支持他们采用更健康的生活方式（保持健康体重、增加体育活动），从而减轻关节疼痛。我们评估了由AHP主导的、提供以人为本的实用生活方式指导的初级保健是否是管理慢性膝关节和/或髋关节疼痛的一种可行、有效的方法。
在初次评估时，“关节疼痛顾问”评估疼痛、功能、生活质量、体育活动、腰围和体重，教授简单的自我管理策略，并使用行为改变技巧（动机性访谈、设定目标、行动/应对计划）来改变参与者的生活方式。邀请参与者进行为期6周和6个月的复查，在此期间顾问会重新评估临床结果、反馈进展情况并强化健康信息。使用定量和定性方法评估该服务的可行性和有效性。
该服务的接受度良好：498人使用了该服务。在初次评估和复查之间，参与者的疼痛、功能、生活质量、体重、腰围和体育活动都有所改善（p < 0.005）。服务使用者满意度很高；他们表示更容易获得根据自身需求量身定制的建议和支持，这些建议和支持带来了临床益处，还形成了一条更高效的途径，减少了不必要的会诊和检查。相对较少的人回来进行6个月的复查，因为他们认为自己已经得到了足够的建议。
由AHP主导的护理是一种受欢迎、有效、高效且可持续的管理关节疼痛的方式，不会影响护理的安全性或质量。
