Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

Skills and qualities and the effective project manager in the UK construction industry

The professional project manager is a sought after commodity (McManus, 1995:12). Many companies face increasing demands to complete projects faster, at lower costs and to higher specifications and as Lock (1996;50) comments; “This work, far from requiring specialisation, demands a sufficient general understanding of the work carried out by those participants for the project manager to be able to discuss the work sensibly”. Though for some the term project manager can be clearly identified, others believe the terms project manager and project management, as used in the construction industry, mean all things to all men and lead to confusion (The Chartered Institute of Building, 1982;12). The lack of clarity surrounding the role of project manager made this area worthy of investigation.

This research sought a deeper understanding of the project management role and an identification of the skills and professionals associated with it. The desk top study revealed definitions of the role and perceptions of the skills involved. The literature showed that authors believed in the need for a balance between knowledge, experience and training and the types of professions involved. The research methodology comprised a qualitative approach, with a questionnaire sent out to a non-random sample of practices specialising in project management. The data analysis adopted uni and bi-variant methods, using SPSS. The research found that the role of the project manager is very broad. Furthermore it is adopted by many construction professions as the background of the project manager is largely perceived as irrelevant to the role. A definition is proposed and relevant skills are identified, finally the importance of experience and training is highlighted.

Effects of contextual interference on children learning forehand tennis groundstrokes

Previous research on contextual interference theory in controlled laboratory situations consistently illustrated that random practice was superior to blocked practice when learning motor skills. However, when considered in relation to physical education class settings the findings of the contextual interference experiments were not as uniform. Furthermore, the results of the contextual interference research were ambiguous when an open skill was used as the experimental task, with no definite trend evident. Random practice was found more effective for learning (del Rey, 1989) whereas French, Rink and Werner (1990) demonstrated blocked practice to be superior. In the present study, the influence of high and low contextual interference as practice schedules was investigated within an applied sports setting using an open sports skill as the experimental task. Two groups of boys and girls, 8-9 and 10-12 years of age, were taught a forehand tennis groundstroke using both their preferred and non-preferred hands over a ten week coaching and practice period. The findings showed that male subjects were significantly better at the experimental task than female subjects at the pre-test stage only. The result also demonstrated that the 10-12 year old subjects were significantly better than the 8-9 year olds at the task with the exception of the preferred hand at the post and retention test stage. The contextual interference effect was demonstrated in the retention phase on the preferred hand of the 10-12 year old subjects where the random practice group was significantly better than the blocked practice group in an applied sports setting. These findings were discussed in relation to the role of cognition in the learning of these motor skills and the influence of the subjects related background experiences.

Information skills and the distance education student : an exploratory study into the approaches of Southern Cross University distance educators to the information needs of external students

This study unites the concepts of self-directed learning and information literacy in the external higher education environment. It asserts that many attempts by librarians at building better working relationships with distance educators have failed because the approaches of distance educators to the information needs of students are not adequately addressed. This exploratory and qualitatively based study examines the approaches of ten distance educators at Southern Cross University (SCU) to the information needs of their external students. It then makes recommendations based on these interviews which aim to improve relationships and co-operation between libraries and distance educators and to promote self-directed learning approaches by external students.

Media pressures and corporate disclosure of social responsibility performance : a case study of two global clothing and sports retail companies

This paper investigates the social and environmental disclosure practices of two large multi-national companies, specifically Nike and Hennes and Mauritz. Utilising a joint consideration of legitimacy theory and media agenda setting theory, we investigate the linkage between negative media attention, and positive corporate social and environmental disclosures. Our results generally support a view that for those issues attracting the greatest amount of negative media attention, corporations react by providing positive social and environmental disclosures. The results were particularly significant in relation to labour practices in developing countries – the issue attracting the greatest amount of negative media attention for the companies in question.

Media pressures and corporate disclosure of social responsibility performance information : a study of two global clothing and sports retail companies

This paper investigates the social and environmental disclosure practices of two large multinational companies, specifically Nike and Hennés & Mauritz. Utilising a joint consideration of legitimacy theory and media agenda setting theory, we investigate the linkage between negative media attention, and positive corporate social and environmental disclosures. Our results generally support a view that for those industry-related social and environmental issues attracting the greatest amount of negative media attention, these corporations react by providing positive social and environmental disclosures. The results were particularly significant in relation to labour practices in developing countries - the issue attracting the greatest amount of negative media attention for the companies in question.

Exercise and Sports Science Australia position statement on exercise training and chronic heart failure

Chronic heart failure (CHF) is a complex syndrome characterised by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Regular exercise participation has been shown to be a safe and effective treatment modality in the majority of CHF patients, partially reversing some of the maladaptations evident in myocardial and skeletal muscle function, and resulting in improvements in physical fitness and quality of life, and perhaps reduced mortality. The volume and intensity of exercise that is recommended depends on the syndrome severity, however in most patients it should consist of a combination of low-to-moderate intensity aerobic (endurance) exercise on most days of the week and individually prescribed low-to-moderate intensity resistance (strength) training at least twice per week. Additionally, all patients should be closely monitored prior to and during exercise for contraindications by an appropriately trained health professional. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise for patients with CHF.

Management as a contextual practice : the need to balance science, skills and practical wisdom

This paper contributes to the debate regarding whether or not management is, or should become, a profession. Using the principles of dialectic logic, arguments for the thesis that management is a profession and the antithesis that management is more akin to an art or a craft are critically reviewed. Aristotle’s intellectual virtues episteme (science), techne (skills) and phronesis (practical wisdom) are introduced as a synthesis to this debate. Rather than characterizing management as a profession, it is argued that management is a contextual practice that requires a blend of all three intellectual virtues.

Influencing health equity : role of the effective consumer scale in measuring skills and abilities in a middle income country

The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients’ involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.

Respiratory pattern in awake rats : effects of motor activity and of alerting stimuli

Our aim was to assess the impact of motor activity and of arousing stimuli on respiratory rate in the awake rats. The study was performed in male adult Sprague–Dawley (SD, n = 5) and Hooded Wistar (HW, n = 5) rats instrumented for ECG telemetry. Respiratory rate was recorded using whole-body plethysmograph, with a piezoelectric sensor attached for the simultaneous assessment of motor activity. All motor activity was found to be associated with an immediate increase in respiratory rate that remained elevated for the whole duration of movement; this was reflected by: i) bimodal distribution of respiratory intervals (modes for slow peak: 336 ± 19 and 532 ± 80 ms for HW and SD, p < 0.05; modes for fast peak 128 ± 6 and 132 ± 7 ms for HW and SD, NS); and ii) a tight correlation between total movement time and total time of tachypnoea, with an R2 ranging 0.96–0.99 (n = 10, p < 0001). The extent of motor-related tachypnoea was significantly correlated with the intensity of associated movement. Mild alerting stimuli produced stereotyped tachypnoeic responses, without affecting heart rate: tapping the chamber raised respiratory rate from 117 ± 7 to 430 ± 15 cpm; sudden side move — from 134 ± 13 to 487 ± 16 cpm, and turning on lights — from 136 ± 12 to 507 ± 14 cpm (n = 10; p < 0.01 for all; no inter-strain differences). We conclude that: i) sniffing is an integral part of the generalized arousal response and does not depend on the modality of sensory stimuli; ii) tachypnoea is a sensitive index of arousal; and iii) respiratory rate is tightly correlated with motor activity.