Law Rebecca-Jane, Nafees Sadia, Hiscock Julia, Wynne Cathy, Williams Nefyn Howard
North Wales Centre for Primary Care Research, Bangor Institute for Health and Medical Research, Bangor University, Wrexham, UK.
Physiotherapy Department, Betsi Cadwaladr University Health Board, Ysbyty Alltwen, Porthmadog, UK.
Musculoskeletal Care. 2019 Mar;17(1):145-151. doi: 10.1002/msc.1382. Epub 2019 Jan 24.
The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences of the LMP among patients and professionals, and offers insight for future programmes. Five referring clinicians and six delivering professionals participated in focus groups. Three referring GPs and nine patients who attended the LMP took part in semi-structured interviews. Topics included: referral, reasons for taking up and continuing the programme or not, and experiences and outcomes. Framework method was used to analyse the qualitative data. Overall, patients and professionals valued the multidisciplinary nature of the LMP. However, professionals explained feeling guilty about delaying patients on the orthopaedic waiting list and believed that the programme should be redirected to those with less severe OA and a lower BMI. Referring clinicians differed in their interpretation of the referral criteria and expressed varying levels of autonomy when making referrals. Patients referred after a consultation with their general practitioner appeared to be more satisfied with the referral process. Patients were also encouraged by the opportunity to improve health, their likelihood of surgery and social benefits. However, patients were discouraged by inconvenience, cost, lack of readiness to change and embarrassment. In conclusion, shared decision-making about lifestyle management without delaying orthopaedic opinion is preferable, and more psychological support may increase participation. Importantly, the programme may be better focused on rehabilitation for patients with a lower BMI and less severe symptoms.
生活方式管理计划（LMP）是一项运动和体重管理计划，为髋部或膝部骨关节炎（OA）且体重指数（BMI）超过35的患者提供物理治疗支持。这项定性研究探讨了患者和专业人员对LMP的看法和体验，并为未来的计划提供了见解。五位转诊临床医生和六位实施专业人员参加了焦点小组。三位转诊全科医生和九位参加LMP的患者参与了半结构化访谈。主题包括：转诊、参加和继续该计划与否的原因，以及体验和结果。采用框架法对定性数据进行分析。总体而言，患者和专业人员重视LMP的多学科性质。然而，专业人员解释说，他们对在骨科等候名单上拖延患者感到内疚，并认为该计划应转向病情较轻、BMI较低的患者。转诊临床医生对转诊标准的解释不同，在进行转诊时表现出不同程度的自主性。经与全科医生会诊后转诊的患者似乎对转诊过程更满意。改善健康的机会、手术可能性和社会效益也鼓励了患者。然而，不便、成本、缺乏改变的意愿和尴尬让患者感到气馁。总之，在不延迟骨科会诊的情况下，就生活方式管理进行共同决策更为可取，更多的心理支持可能会提高参与度。重要的是，该计划可能更适合关注BMI较低、症状较轻患者的康复。
