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Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: an effectiveness–implementation study

Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: an effectiveness–implementation study
Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: an effectiveness–implementation study

Introduction: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand programme is a hand exercise programme for people with rheumatoid arthritis. It was clinically effective when delivered during a clinical trial but there was a need to evaluate translation into routine care. Methods: We conducted an effectiveness–implementation study. We adapted the trial training into an online format for National Health Service hand therapists. Educational outcomes included confidence and capability to deliver the programme. Implementation outcomes included training reach and adoption. Therapists were invited to collect clinical outcomes. Patients receiving the programme provided data on function (Michigan Hand Questionnaire function scale), pain and grip strength at baseline, treatment discharge and four-month follow-up. Results: A total of 790 therapists (188 National Health Service organizations) enrolled in the training; 584/790 (74%) therapists (162 National Health Service organizations) completed the training; 448/790 therapists (145 National Health Service organizations) (57%) evaluated the training and were confident (447/448, 99.8%) and capable (443/448, 99%) to deliver the programme with 85% intending to adopt it (379/448). Follow-up data were provided by 116/448 (26%) therapists. Two-thirds (77/116; 51 National Health Service organizations) reported adopting the programme. One hundred and eighteen patients (15 National Health Service trusts) participated. Patients reported improved function (mean change Michigan Hand Questionnaire scores: 10 (95% CI 6.5–13.6) treatment discharge; 7 (95% CI 3.8–10.2) 4-month follow-up). Grip strength increased 24.5% (left) and 31% (right). Pain was stable. Discussion: Online training was an effective way to train therapists with good reach. Clinical outcomes were similar to the clinical trial providing preliminary evidence of successful translation into routine care.

Implementation, hand exercises, online training, rheumatoid arthritis
1758-9983
87-97
Williamson, Esther
8adb517c-ddbc-4474-ab04-2e6108d856a5
Srikesavan, Cynthia
9b35e197-ca5c-417c-bfb7-d0e6e8e348d7
Thompson, Jacqueline
75c1ba22-d9fa-4fab-80b8-6fc7e894bb76
Tonga, Eda
130b4254-bfa5-4836-a276-3082c5cfda80
Eldridge, Lucy
0a8fa8d2-db03-4894-a927-edfe315304ce
Adams, Jo
6e38b8bb-9467-4585-86e4-14062b02bcba
Lamb, Sarah E
10720635-b8c7-4450-9f1f-22509fed6db8
Williamson, Esther
8adb517c-ddbc-4474-ab04-2e6108d856a5
Srikesavan, Cynthia
9b35e197-ca5c-417c-bfb7-d0e6e8e348d7
Thompson, Jacqueline
75c1ba22-d9fa-4fab-80b8-6fc7e894bb76
Tonga, Eda
130b4254-bfa5-4836-a276-3082c5cfda80
Eldridge, Lucy
0a8fa8d2-db03-4894-a927-edfe315304ce
Adams, Jo
6e38b8bb-9467-4585-86e4-14062b02bcba
Lamb, Sarah E
10720635-b8c7-4450-9f1f-22509fed6db8

Williamson, Esther, Srikesavan, Cynthia, Thompson, Jacqueline, Tonga, Eda, Eldridge, Lucy, Adams, Jo and Lamb, Sarah E (2020) Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: an effectiveness–implementation study. Hand Therapy, 25 (3), 87-97. (doi:10.1177/1758998320948538).

Record type: Article

Abstract

Introduction: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand programme is a hand exercise programme for people with rheumatoid arthritis. It was clinically effective when delivered during a clinical trial but there was a need to evaluate translation into routine care. Methods: We conducted an effectiveness–implementation study. We adapted the trial training into an online format for National Health Service hand therapists. Educational outcomes included confidence and capability to deliver the programme. Implementation outcomes included training reach and adoption. Therapists were invited to collect clinical outcomes. Patients receiving the programme provided data on function (Michigan Hand Questionnaire function scale), pain and grip strength at baseline, treatment discharge and four-month follow-up. Results: A total of 790 therapists (188 National Health Service organizations) enrolled in the training; 584/790 (74%) therapists (162 National Health Service organizations) completed the training; 448/790 therapists (145 National Health Service organizations) (57%) evaluated the training and were confident (447/448, 99.8%) and capable (443/448, 99%) to deliver the programme with 85% intending to adopt it (379/448). Follow-up data were provided by 116/448 (26%) therapists. Two-thirds (77/116; 51 National Health Service organizations) reported adopting the programme. One hundred and eighteen patients (15 National Health Service trusts) participated. Patients reported improved function (mean change Michigan Hand Questionnaire scores: 10 (95% CI 6.5–13.6) treatment discharge; 7 (95% CI 3.8–10.2) 4-month follow-up). Grip strength increased 24.5% (left) and 31% (right). Pain was stable. Discussion: Online training was an effective way to train therapists with good reach. Clinical outcomes were similar to the clinical trial providing preliminary evidence of successful translation into routine care.

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More information

Submitted date: 20 July 2020
e-pub ahead of print date: 4 September 2020
Keywords: Implementation, hand exercises, online training, rheumatoid arthritis

Identifiers

Local EPrints ID: 444911
URI: http://eprints.soton.ac.uk/id/eprint/444911
ISSN: 1758-9983
PURE UUID: 94559885-8408-4ed9-9306-bd1c4b59d10b
ORCID for Jo Adams: ORCID iD orcid.org/0000-0003-1765-7060

Catalogue record

Date deposited: 11 Nov 2020 17:31
Last modified: 09 Jan 2022 02:48

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Contributors

Author: Esther Williamson
Author: Cynthia Srikesavan
Author: Jacqueline Thompson
Author: Eda Tonga
Author: Lucy Eldridge
Author: Jo Adams ORCID iD
Author: Sarah E Lamb

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