Increasing capacity for the treatment of common musculoskeletal problems: A non-inferiority RCT and economic analysis of corticosteroid injection for shoulder pain comparing a physiotherapist and orthopaedic surgeon

Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the physiotherapist and the orthopaedic surgeon, with 64 randomised (physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified physiotherapist is at least as clinically effective, and less expensive, compared with similar care delivered by an orthopaedic surgeon. Policy makers and service providers should consider implementing this model of care

Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial

BACKGROUND: Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients’ perceptions of the care provided. The purpose of this study was to evaluate patients’ perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice. METHODS: In a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded. The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers’ medical-technical competence and identity-orientated approach. Also, to what extent patients’ expectations were met, and their intention to follow advice was evaluated. RESULTS: For this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p < 0.001). This was also found in regards to receiving information about examination and treatment (p < 0.001), results (p < 0.001), and self-care (p < 0.001), the caregiver’s understanding (p < 0.001), respect (p < 0.001) and commitment (p < 0.001) as well as the opportunity to participate in decision-making (p = 0.01) (identity-orientated approach). Participants in the physiotherapist-led triage group reported to a significantly higher extent that their expectations of the treatment were met (p < 0.001), as well as the intent to follow the advice and instructions received (p = 0.019). CONCLUSIONS: This paper reports on patients’ perceptions of quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients’ expectations and result in a greater intention to follow advice and instructions for self-management. Our findings are in line with existing literature that this model of care provides an opportunity to shape patient-centered care that can improve access and offer care on the most appropriate level, with maintained good quality of care. TRIAL REGISTRATION: Clinical Trials NCT02265172. Registered 10 June 201

Physiotherapist-led orthopaedic triage - assessment and management of musculoskeletal disorders in primary care

The overall aim of this thesis was to evaluate physiotherapist-led orthopaedic triage of patients with musculoskeletal disorders in primary care in comparison to standard practice. The thesis comprises two studies (A and B) reported in four papers. Methods: Study A was a randomised controlled trial, where patients were randomised to either physiotherapist-led orthopaedic triage or standard practice (i.e. directly to orthopaedic surgeon consultation) with the aims; to evaluate selection accuracy for orthopaedic intervention (Paper I, n=203), to evaluate patients’ perceived quality of care (Paper II, n=163), and to report a long-term follow-up of the patient-reported out-comes (Paper III, n=203) with physiotherapist-led orthopaedic triage compared with standard practice. Study B was an exploratory qualitative study, with the aim to explore patients’ percep-tions and expectations of an upcoming orthopaedic consultation (Paper IV, n=13). Results: Study A showed that the selection accuracy was significantly higher, i.e. a significantly larger proportion of patients selected for orthopaedic surgeon consultation with physiotherapist-led orthopaedic triage was found appropriate for orthopaedic intervention compared with standard practice. Partic-ipants perceived significantly higher quality of care with physiotherapist-led orthopaedic triage than with standard practice. The long-term follow-up showed that the participants rated a signifi-cantly better health state three months after the physiotherapist-led orthopaedic triage, compared with standard practice; however, there were no other statistically significant differences in other patient-reported outcomes. The analysis in Study B resulted in five categories: Hoping for action, Meeting an expert, Having a respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! Conclusions: The findings in Study A suggest that physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders can provide timely access to assessment by an appropriately qualified healthcare professional who can direct patients to the most appropriate management pathway, and provide care with good perceived quality, without compromising long-term patient-reported outcomes. The main finding from Study B, that patients expect to be taken seriously and for something to happen during, or as a consequence, of the orthopaedic consultation, can serve to improve patient–clinician relationships and to inform the development of new models of care such as physiotherapist-led orthopaedic triage

Utformning av klimatkontroll knutet till företags identitet : Design av en inkapsling som säger Swegon… fast tyst

The project described in this report were done as a Bachelor thesis in the course MSGC12, for a bachelor degree at the Innovation and design-engineering program at Karlstad University. The course is 22,5hp and goes for 20 weeks over the whole spring term. The project originated from an earlier project done with Swegon AB. The project goal is to find a design of a room thermostat, and demonstrate notably important features that can create an added value to Swegon or their costumers. This will later collaborate with another project that is going on simultaneously. These will unite and present a mutual product. The room thermostats existing today often has very plastic feel to them and is not very adaptable to the environments that they are placed in. They are also not very distinctive and they look pretty much the same regardless of maker. The method used in this project follows the steps set for the industrial product development process. A big part of this process is the iterative cycle were problem solving and life cycle perspective is important pillars. It is here that the modularity comes in. The project is based on a feasibility study with focus on finding innovative ways for the user to get data and make changes to their environment. To arrive at the final prototype, the project have gone through different analyses, discussions with the company, idea generation, patent check, workshop work, and concept screenings and partners in the project picked the concept which from their view were the best at Swegon. When these opinions were in, a 3d model were developed during the creation of said model, problems were encountered these were solved along the way. The model was then printed in a 3d printer. The prototype were then fitted with a light frame where the light could shine through and be projected onto the material. A complete prototype is made up of five parts, these are back plate, frame, plexiglass, light frame and material to project the symbols on. The product is not final but it points in a direction for the coming products

Fast track-vård inom ortopedi : Sjuksköterskors upplevelser av att vårda patienter i Nordirland

Artros är en vanlig ledsjukdom som i svåra fall kräver operation. Snabba vårdförlopp, eller fast track-program, har utvecklats för att snabba på den perioperativa vården och patientens återhämtning, minska komplikationer samt sänka kostnader. För sjuksköterskan innebär snabba vårdförlopp att vården blir mer komplicerad och att hen får ta ansvar för fler patienter. Syftet med vår studie var att undersöka sjuksköterskors upplevelser av att vårda patienter i ett snabbt vårdförlopp. Detta gjordes genom en empirisk, kvalitativ intervjustudie. Intervjuerna analyserades enligt Lundman och Hällgren Graneheims (2017) metod. Utifrån resultatet bildades tre kategorier: “En stressig arbetsmiljö”, “En effektiv vårdkedja” och “Patienten i centrum”. Diskussionen fördjupar hur patientperspektivet och möjligheten till individuell vård påverkas av det snabba vårdförloppet. Informanterna kände sig pressade att på löpande band skriva ut patienter. Då vissa patienter inte var redo för hemgång kände informanterna det ibland som om de kastade ut dem. De ansåg att patienter som av olika anledningar behövde stanna längre än planerat på avdelningen, störde det snabba vårdförloppet. För att arbetet i fast track- systemet skulle fortgå krävdes god kommunikation mellan personal, patienter och anhöriga. I vår studie upplevde informanterna att vården inom fast track-systemet var individuell men att tiden inte alltid räckte till. Detta ansåg de dock inte vara relaterat till själva fast track-systemet. En risk med fast track-systemet menade de var att arbetet ibland kunde ske per automatik, utan reflektion. Slutsatsen är att för att fast track- systemet ska främja en patientcentrerad vård, så krävs att sjuksköterskor har en tydlig etisk professionalitet. Även hög medvetenhet om ansvarsfördelning och vikten av samarbete inom personalgruppen behövs för att fast track-systemet ska fungera utan att hota den vårdande vården

The guerrilla warfare : A qualitative study about occupied space

Forskningsfråga: Vad karaktäriserar framgångsrik gerillamarknadsföring?  Syfte: Syftet med denna uppsats är att tydliggöra de väsentliga inslagen i gerillamarknadsföring för att öka förståelsen för denna marknadsföringsmetod. Vi gör detta genom att analysera och klarlägga kärnan i gerillamarknadsföring, metodens olika inslag samt dess styrkor och svagheter. Vi kommer sedan att analysera den funktion gerillamarknadsföring kan ha i företags och organisationers samlade marknadsföring.  Metod: Uppsatsen baseras på en kvalitativ studie som utgått från en deduktiv ansats med en induktiv karaktär. Den empiriska datainsamlingen gjordes främst utifrån semistrukturerade intervjuer med respondenter med spetskompetens inom det valda forskningsämnet.  Slutsats: Vår studie visar att framgångsrik gerillamarknadsföring karaktäriseras av stor kreativitet, men att gerillaaktiviteten inte får ta över budskapet. Just för gerillamarknadsföring är det särskilt viktigt för marknadsföraren att definiera målgruppen, då detta är avgörande för kampanjens utfall. Slutligen är gerillamarknadsföringens syfte att skapa engagemang för att bidra till den ”buzz” som krävs för kampanjens framgång.Research question: What characterizes successful guerrilla marketing?  Purpose: The aim of this paper is to clarify the essential elements of guerrilla marketing to increase the understanding of this marketing method. We do this by analysing and clarifying the core of guerrilla marketing and its various elements, as well as strengths and weaknesses. We will analyse which role guerrilla marketing can play in companies’ and organizations’ overall marketing.  Methods: The thesis is based on a qualitative study that assumes a deductive approach with an inductive character. The empirical data collection was done mainly based on semi-structured interviews with respondents with expertise skills in the chosen research topic.  Conclusion: Our study shows that high level of creativity characterizes successful guerrilla marketing, but also that the guerrilla activity may not take over the message. For guerrilla marketing, it’s very important for the marketer to define the target audience, as this is crucial for the campaign’s outcome. Finally, the aim of guerrilla marketing is to create engagement to contribute to the “buzz” required for the success of the campaign

The guerrilla warfare : A qualitative study about occupied space

Forskningsfråga: Vad karaktäriserar framgångsrik gerillamarknadsföring?  Syfte: Syftet med denna uppsats är att tydliggöra de väsentliga inslagen i gerillamarknadsföring för att öka förståelsen för denna marknadsföringsmetod. Vi gör detta genom att analysera och klarlägga kärnan i gerillamarknadsföring, metodens olika inslag samt dess styrkor och svagheter. Vi kommer sedan att analysera den funktion gerillamarknadsföring kan ha i företags och organisationers samlade marknadsföring.  Metod: Uppsatsen baseras på en kvalitativ studie som utgått från en deduktiv ansats med en induktiv karaktär. Den empiriska datainsamlingen gjordes främst utifrån semistrukturerade intervjuer med respondenter med spetskompetens inom det valda forskningsämnet.  Slutsats: Vår studie visar att framgångsrik gerillamarknadsföring karaktäriseras av stor kreativitet, men att gerillaaktiviteten inte får ta över budskapet. Just för gerillamarknadsföring är det särskilt viktigt för marknadsföraren att definiera målgruppen, då detta är avgörande för kampanjens utfall. Slutligen är gerillamarknadsföringens syfte att skapa engagemang för att bidra till den ”buzz” som krävs för kampanjens framgång.Research question: What characterizes successful guerrilla marketing?  Purpose: The aim of this paper is to clarify the essential elements of guerrilla marketing to increase the understanding of this marketing method. We do this by analysing and clarifying the core of guerrilla marketing and its various elements, as well as strengths and weaknesses. We will analyse which role guerrilla marketing can play in companies’ and organizations’ overall marketing.  Methods: The thesis is based on a qualitative study that assumes a deductive approach with an inductive character. The empirical data collection was done mainly based on semi-structured interviews with respondents with expertise skills in the chosen research topic.  Conclusion: Our study shows that high level of creativity characterizes successful guerrilla marketing, but also that the guerrilla activity may not take over the message. For guerrilla marketing, it’s very important for the marketer to define the target audience, as this is crucial for the campaign’s outcome. Finally, the aim of guerrilla marketing is to create engagement to contribute to the “buzz” required for the success of the campaign