Musculoskeletal Programme, Health Innovation Network, London, UK.
Faculty of Health, Social Care and Education, St George's University of London and Kingston University, 6th Floor, Hunter Wing, Cranmer Terrace, London SW17 0RE, UK.
Perspect Public Health. 2019 Nov;139(6):308-315. doi: 10.1177/1757913919833721. Epub 2019 May 9.
Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer-led 'joint pain advice' (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain.
Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people's opinions of the service's effectiveness, acceptability and usefulness.
Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions.
Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.
慢性膝、髋和背痛极为普遍。管理指南强调保持身体活动和健康体重，以减轻疼痛，改善身心健康。然而，很少有人得到支持来改变生活方式。我们评估了健康教练主导的“关节疼痛建议”（JPA）服务，该服务提供以患者为中心的生活方式指导，对于膝、髋和背痛患者是否可行、可接受和有效。
通过记录健康教练是否能够提供 JPA 及其采用情况来评估提供 JPA 服务的可行性。九名健康教练提供 JPA。参与者最多可预约四次。在每次预约中，健康教练向患者提供有关其病情的信息，共同制定护理计划，提出自我管理策略，并使用行为改变技术（动机性访谈、目标设定和行动计划）来增加身体活动和减轻体重。在基线、3 周、6 周和 6 个月时收集疼痛、功能、身体活动和体重指数（BMI）。焦点小组收集了人们对服务有效性、可接受性和有用性的意见。
在询问 JPA 的 105 人中，有 85 人（81%）使用了该服务，之后他们的身体活动和功能得到改善，疼痛、镇痛药使用和 BMI 降低。他们感到更有知识，更有动力采取并维持更健康的行为。他们将这些改善归因于 JPA 服务，因为它的咨询更好，整体协作方法更优。由于他们觉得从最初的预约中获得了足够的建议，只有少数人参加了所有四次预约。健康教练获得了支持肌肉骨骼疾病患者的知识和技能。
使用整体、以患者为中心的方法，健康教练可以安全、有效、高效地为慢性膝、髋或背痛患者提供生活方式建议。该服务受到接受者和健康教练的欢迎，并帮助人们采取更健康的生活方式，从而减轻疼痛和其他临床改善。
