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Category Archives: Self-management

Occupational performance coaching in Hong Kong

Occupational Performance Coaching Logo

RTRU Senior Lecturer, Dr Fiona Graham,  work on Occupational Performance Coaching (OPC; a parent-coaching intervention) has lead to a new collaborative research partnership with clinical researchers in Hong Kong.  Recently this group was awarded a grant by the Research Fund Secretariat from Food and Health Bureau, under the Health Care Promotion Scheme in Hong Kong in order to study “A parent-coaching intervention to promote community participation of young children with developmental disability.”  This project will be lead by Dr Chi-Wen (Will) Chien with input from Dr Graham and co-investigators Dr Yuen-yi (Cynthia) Lai and Dr Chung-Ying Lin.

Participation in community activities is important for children to learn skills, make friends, and have fun. Children with a disability and their families, however, are reported to participate less in the activities in their communities. This project will examine the cultural appropriateness of OPC when used in Hong Kong and its effectiveness to enable community participation of young children with developmental disability. The effect of OPC on child well-being will also be examined as an important mediator of children’s participation. A randomised control trial (aim to recruit over 75 children) will be conducted in Hong Kong. Parents in the experimental group will receive OPC.  Parents in the control group will receive information about community resources by phone. Findings will provide important information about the effectiveness and cultural appropriateness of OPC for Hong Kong citizens and will inform future service design for children and families in Hong Kong.

Self-led management of rheumatoid arthritis

The management of rheumatoid arthritis (RA) has transformed in recent decades so the inflammatory arthritis is often well controlled with medications used in a treat-to-target strategy.  This “T2T” strategy requires measurement of RA disease activity using validated measures and increasing treatment until disease remission or at least a low disease activity state is achieved.  Currently the RA activity is determined during clinic visits however these are currently at arbitrary intervals so people are may be seen when they are well and appointments are not always available when people have increased arthritis activity and need medical help.  Some data suggest the assessment of RA activity by people with RA correlates fairly well with the assessment of disease activity by health professionals. RTRU academic, Dr Rebecca Grainger, has begun to explore the possibility of the assessment and monitoring of RA being led by the person with the disease rather than the health system.  In this new tech world, a phone app seem to be a good option to try.  Dr Grainger, in collaboration with her colleagues in RTRU, Hutt Hospital, and the Department of Information Science at University of Otago, first conducted a systematic review of all apps that could enable measurement of RA disease activity by people with RA and for those data to be transmitted to their rheumatology team for monitoring.  (This review can be downloaded for free here.)  They found the 19 potentially useable app for longitudinal assessment of disease activity,which fell into two categories: 1) simple calculators of disease activity or 2) data tracking tools for people with RA.  However, no apps used all the required validated instruments and allowed for data transmission. One high quality app “Arthritis Power” does a great job of longitudinal tracking of validated patient-reported outcomes (PRO’s) and is used for patient-led research but is not suitable for use in “telerheumatology” due to lack of measurement of tender and swollen joints, a key feature of RA activity measured by rheumatologists.

Next steps in this research has been to  involve people with RA and rheumatology health professionals to identify required features and functionality of an app for RA disease activity measurement, along with barriers to uptake and advantages of remote monitoring approach.  With this information, Dr Grainger’s team has built an app and currently planning how this may be integrated into clinical practice.  In parallel with this with, they have also co-designed with people with RA a training package of videos to teach joint count techniques.  This will be evaluated in clinics in Wellington, Christchurch and Dunedin in late 2017. Their goal is to enable people with RA to engage in their health care in ways that works for them while still providing appropriate assessment and oversight.  Not necessarily “self-management” but “self-led management:”.

Taking charge of chronic lung disease

Just this month, my colleagues and I were award a significant research grant from the Health Research Council of New Zealand to undertake a feasibility study to test a brief self-management intervention for people who have been admitted to hospital for problems with chronic obstructive lung disease.  I am undertaking this study with colleagues from the Department of Medicine (Bernadette Jones, Dr Tristram Ingham, and Prof. Mark Weatherall) in collaboration with Dr James Fingleton, a respiratory physician at the Capital & Coast DHB and researcher from the Medical Research Institute of New Zealand.  Also involved are Amanda McNaughton and Harry McNaughton who are currently living overseas.

The purpose of this study is to test a new intervention designed to help people more actively engage in the management of their own health and wellbeing after hopsitalisation for chronic obstructive lung disease (COPD), and to increase uptake of pulmonary rehabilitation – an existing programme of exercise and education that is known to reduce rehospitalisation rates for people with COPD. Every year in NZ there are over 12,000 hospital admissions for COPD, costing $60 million annually. Many of these are for repeat admission.  Our intervention,  if successful, could reduce costs of hospitalisation for COPD as well as improve people health and quality of life with the condition.  The intervention is cultural responsive and strength-based, focusing on empowering people to take charge of their own health rather than just providing them with inhalers, pills, instruction or information.  This research builds on our past work examining uptake of pulmonary rehabilitation in New Zealand, cultural factors influence uptake of pulmonary rehabilitation, and Dr Harry McNaughton past work with Dr Matire Harwood exploring a similar kind of self-management intervention for people with stroke.  We aim to begin work on this 2-year study this month.

A feasibility study, incidentally, is one that focuses on gathering information about the methods for a clinical trial to make sure that the clinical trial is a scientifically valid as possible before you begin.  Fully powered clinical trials are very expensive!  So you don’t want to begin one with question in your mind about whether participants will actually engage with your intervention or whether your assumption about your outcome measurements tool are correct.  In this feasibility study we will be testing our study methods, gathering information about clinical outcomes to inform a power calculation for a full clinical trial, and evaluate the acceptability of our intervention and study methods from the perspective of our study participants and their families.