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Title: | Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements |
Authors: | Boniface, G White, N Tomlinson, C Norris, M O’Connell, NE Williamson, E Harries, P |
Keywords: | decision making;dose;hand exercise;judgement analysis;rheumatoid arthritis |
Issue Date: | 4-Dec-2023 |
Publisher: | Wiley |
Citation: | Boniface, G. et al. (2024) 'Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements', Musculoskeletal Care, 22 (1), e1849, pp. 1 - 11. doi: 10.1002/msc.1849. |
Abstract: | Copyright © 2023 The Authors. Objective: To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA). Methods: Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. Phase II: Therapists with ≥2 years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54 + 15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers. Results: Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β = −1.150, p < 0.001), (2) Disease activity (β = −0.425, p < 0.001) and (3) average hand pain over the last week (β = −0.353 p < 0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe. Conclusion: This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity. |
Description: | Acknowledgements: The authors acknowledge the therapists who took part in both phases of this study. This work was supported by Brunel University London and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust, and supported by the NIHR Biomedical Research Centre, Oxford. Data Availability Statement: The data that support the findings for phase 2 of this study are openly available in figshare at https://doi.org/10.6084/m9.figshare.24681309 . Supporting Information is available online at: https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1849#support-information-section . |
URI: | https://bura.brunel.ac.uk/handle/2438/27964 |
DOI: | https://doi.org/10.1002/msc.1849 |
ISSN: | 1478-2189 |
Other Identifiers: | ORCID iD: Graham Boniface https://orcid.org/0000-0003-1253-0060 ORCID iD: Nicola White https://orcid.org/0000-0002-7438-0072 ORCID iD: Christopher Tomlinson https://orcid.org/0000-0002-8634-6111 ORCID iD: Meriel Norris https://orcid.org/0000-0001-7779-5612 ORCID iD: Neil O’Connell https://orcid.org/0000-0003-1989-4537 ORCID iD: Esther Williamson https://orcid.org/0000-0003-0638-0406 ORCID iD: Priscilla Harries https://orcid.org/0000-0003-3123-6799 e1849 |
Appears in Collections: | Dept of Health Sciences Research Papers |
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FullText.pdf | Copyright © 2023 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. | 495.54 kB | Adobe PDF | View/Open |
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