A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: A qualitative study

Abstract

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. KEYWORDS body mass index, dietetics, exercise, health behaviour, osteoarthritis, qualitative 1 | BACKGROUND Hip and knee osteoarthritis (OA) is a common cause of pain and disability. Current guidelines from the Excellence, 2014), with National Health Service organisations across the UK offering different schemes and pathways to meet these recommendations. One example is the Lifestyle Management Programme (LMP), where patients with pain and functional limitation from OA of the hip or knee and with a body mass index (BMI) greater than 35 are triaged and referred to a weight management and exercise programme with physiotherapy support, unless they are excluded for clinical reasons such as severe pain, functional limitation or joint deterioration. The LMP has four aims: (a) to improve musculoskeletal and general health; (b) to ensure that patients are in an optimum condition to undergo surgery, if needed; (c) to reduce the BMI to ≤35; and (d) to reduce the overall cost of elective orthopaedic pathways. The programme consists of a physiotherapy assessment at a participating leisure centre, followed by weekly group exercise sessions led by the National Exercise Referral Scheme (NERS) (Murphy et al., 2012), with physiotherapy support for 32 weeks, including an 8-week weig...

Functionality of Physical Activity Referral Schemes (PARS): A Systematic Review

“…Sedentary/inactive reasons recorded the highest number of referral with sixteen (59.2%), of the twenty seven included studies referring participants to PA programmes for sedentary/inactive behavioral reasons ( 15 , 17 , 18 , 23 , 28 , 30 , 36 , 41 – 44 , 51 , 52 , 55 – 57 ). Referral for cardiovascular disease related reasons was recorded in thirteen (48.1%) studies ( 18 , 23 , 32 , 41 – 43 , 45 – 47 , 53 , 55 , 56 , 59 ), other reasons for referral were overweight/obesity (40.7%) ( 18 , 23 , 32 , 41 , 42 , 44 , 45 , 47 , 48 , 53 , 56 ), musculoskeletal/aging reasons (29.6%) ( 18 , 23 , 32 , 41 , 42 , 45 , 49 , 53 ), diabetes related reasons (22.2%) ( 18 , 23 , 45 , 46 , 53 , 56 ), psychological illness (22.2%) ( 18 , 32 , 41 , 45 , 55 , 58 ), at-risk smokers (18.5%) ( 28 , 42 , 47 , 53 , 56 ), people with diagnosis of cancer (3.7%) ( 54 ), and stroke (3.7%) ( 50 ). The major (80%) referrers were GPs, however, few st...…”

“…Criteria for measuring the success of the PARS process in this review included the intervention used, adherence/uptake by the participants and the reported health/PA related outcomes. As shown in Table 1 , the interventions reportedly used in the management of chronic diseases across different countries included: common group supervised activities which was reported in twelve studies (44.4%) ( 30 , 36 , 41 – 43 , 45 , 46 , 48 , 52 , 53 , 56 , 58 ), PA counseling and advice (37%) ( 15 , 17 , 23 , 28 , 41 , 46 , 47 , 50 , 51 , 55 ), individualized and supervised activities (33.3%) ( 18 , 23 , 28 , 44 , 45 , 50 , 54 , 55 , 59 ), referral to other health professionals (29.6%) ( 15 , 28 , 32 , 42 , 47 , 49 , 55 , 56 ), self-administered PA (14.8%) ( 15 , 18 , 47 , 51 ), and individualized PA prescription without supervision (14.8%) ( 23 , 36 , 49 , 57 ).…”

“…For overweight/obese referrals (18,23,32,41,42,44,45,47,48,53,56), common group supervised activities (41,42,45,48,53,56) was the most reported intervention (N = 6), counseling/advice (23,41,53), and individualized and supervised activities (18,23,45) were reported by three studies each, two studies each reported the use of self-administered PA (18,47) and referral to other health professionals (32,47). For musculoskeletal/aging reasons (18,23,32,41,42,45,48,49), individualized and supervised activities (18,45,49) was the most reported intervention (N = 3); while other interventions were reported by two studies each except self-administered PA which was reported by only one study (18). All the interventions reported positive outcomes except one which reported the referral of participants to other health professionals (32).…”

“…Overweight/obese participants preferred common group activities and found it to be effective. These participants recorded positive outcomes and good adherence to study intervention goals (41,42,44,48,53,56). Participants who were counseled/advised (18,23,41,53,54) recorded improved PA related outcomes after self-administered PA.…”

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

“…OA was mainly manifested as the degeneration and wear of cartilage and subchondral bone. The occurrence of OA is multifactorial, which is related to gender, age, body mass index (BMI), mechanical axis of the lower limb, biomechanical factors, and others [4][5][6][7][8]. OA of the knee should be treated with step care.…”