Effectiveness and Cost-effectiveness of Outpatient Physiotherapy After Knee Replacement for Osteoarthritis: Study Protocol for a Randomised Controlled Trial

Background: Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design: Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion: This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.

Identity, Well-being and Effectiveness: the Emotional Contexts of Teaching

This paper draws on findings from a four‐year longitudinal research project, commissioned by the Department for Education and Skills (DfES), which investigated Variations in Teachers’ Work, Lives and Effectiveness (VITAE). Drawing on data gathered from 300 teachers working in 100 primary and secondary schools in England, the research identified associations between commitment and effectiveness (perceived and in terms of pupil attainment) and found that there were more, and less, effective teachers in each of six professional life phases. It found that teachers in each of these phases experienced a number of different scenarios that challenged their abilities to sustain their commitment (i.e. remain resilient). This paper discusses how these impact, positively and negatively, on teachers’ capacities for sustaining their initial commitment and associations between identity, well‐being and effectiveness. It finds that teacher identities are neither intrinsically stable nor intrinsically fragmented, but that they can be more, or less, stable and more or less fragmented at different times and in different ways according to the influence of the interaction of a number of personal, professional and situated factors. The extent to which teachers are able to and are supported in managing the scenarios they experience will determine their sense of effectiveness.

Variations in the Work and Lives of Teachers: Relative and Relational Effectiveness

The VITAE project is a four‐year (2001–2005) research study, commissioned by the Department for Education and Skills, conducted with 300 teachers in 100 schools in seven local education authorities in England. The project aimed to identify factors that may affect their work and lives over time and how these factors may, in turn, impact on their teaching and subsequent pupil progress and outcomes. It combined quantitative and qualitative methods of data collection and analysis in order to define and examine notions of teachers' relational and relative effectiveness. The first part of the paper addresses the nature of effectiveness and three key themes relating to the changing contexts of teachers' work, lives and effectiveness: the challenge of reform to notions of professionalism; professional identities; changes in teachers' work and lives. The research design and early findings and their effects upon the development of the research form the second part. The final part of the paper discusses three sets of understandings which are fundamental to any consideration of teachers' work, lives and effectiveness: relative and relational effectiveness; teacher identities; teachers' life and work contexts. The research suggests that policy‐makers, school leaders and teachers themselves need to attend to these if teacher recruitment, retention and standards are to improve.

'Team GB', 'Team England' or 'Team Scotland'? Media Representations of 'Britishness', 'Englishness' and 'Scottishness' in London 2012 and Glasgow 2014

Given the timing of the Scottish independence referendum in September 2014, the hosting of both the London 2012 Olympic Games and the Glasgow 2014 Commonwealth Games coincided with a period of considerable political turmoil and reflection within the United Kingdom. The extensive levels of public, political and media scrutiny of both of these major sporting events can therefore be framed within a wider consideration of the contemporary dynamics of the political union between the constituent nations of the UK, as well as the multifarious forms of national identities expressed within the various regions of the ‘nation-state’. Despite the growing influence of social media forms within contemporary society, politics and sport within the UK, the ‘traditional’ print media retain a central (although arguably diminishing) role in the dissemination of information relating to major societal, political and sporting issues to the British public. This paper will therefore critically reflect upon the nature of print media representations of ‘Britishness’, ‘Englishness’ and ‘Scottishness’ at London 2012 and Glasgow 2014 from both London-based and Scotland-based publications, drawing upon empirical data from completed and ongoing doctoral theses from the respective authors. In particular, the implications of the contrasting competitive structures of each event will be considered, given the symbolic differences between the unitary ‘Team GB’ at the London 2012 Olympics and the separated representative teams for Scotland and England at the Glasgow 2014 Commonwealth Games.