Original ArticleSelf-management behaviour and knowledge of patients with musculoskeletal complaints attending an Australian osteopathy clinic: A consecutive sampling design
Introduction
Chronic diseases are long-term conditions with potential persistent, negative health effects that have a high burden both on the individual and the healthcare system [1]. Chronic disease is omnipresent with 50% of the Australian population reporting the presence of one chronic disease, and 23% having two or more [2]. These chronic diseases in the Australian population include arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions [3]. Over 7 in 10 deaths in 2013 were due to one of these eight preventable chronic diseases and these conditions represented 61% of the total burden of disease in Australia [3]. Importantly, 31% of the total burden of chronic disease is attributable to lifestyle factors such as smoking, overweight and obesity, alcohol, physical inactivity and high blood pressure [4]. As a result, it is imperative to manage the surmounting economic and personal burden by understanding and implementing self-management measures for patients with biomedical and behavioural risk factors to help prevent development of, and management of, chronic disease [3].
The primary health care system in Australia has been reported to be providing only half the recommended care for many chronic conditions [5]. Where appropriate care of chronic diseases is provided, improved health outcomes have been reported [5]. Chronic disease management requires collaboration between health care providers and patients, but also enhancing the patients’ self-efficacy (self-reported confidence to successfully perform specific tasks or behaviours) with respect to their own health care. Self-management is broadly defined as an individual working with their health professional/s to consider the symptoms of a condition and potential treatment options, to formulate a care plan, engage in health enhancing activities, monitor their own condition/s and manage the impacts of the condition(s) on their physical function, emotions and relationships [6]. In the musculoskeletal care context, guided self-management has been shown to positively influence pain, physical function, levels of distress and self-efficacy [e.g. [7,8,9]], with manual and physical therapists playing a key role in supporting patients to engage in self-care [10].
The absence of a questionnaire to evaluate patient self-management behaviours, and knowledge of a disease, led to the development of the Partners in Health (PiH) scale [6]. Despite evidence supporting the effectiveness of chronic condition self-management, no generic self-report measurement tool existed prior to the PIH scale [11]. This scale provides health professionals with an easy checklist of areas of self-management that could assist with the development and implementation of interventions targeted to the individual [11]. The 11-item scale consisted of 3 factors (core self-management, condition knowledge and response) with an internal consistency1 (Cronbach's α) of 0.88 and acceptable construct validity2 with respect to the self-management literature [11]. Additional work to include an item related to physical activity, emotion and social life resulted in a 12-item version of the PiH [12].
Work by various authors suggests the PiH scale demonstrates acceptable construct validity and internal consistency and can be used as both a self-report tool and outcome measure for patients with chronic diseases [[12], [13], [14], [15]]. Petkov, Harvey [12] initially demonstrated a four-factor structure: knowledge of illness, coping with illness, symptom management and adherence to treatment, with acceptable measurement properties. Baxter, Morello [16] also investigated the reliability and validity of the PiH scale but on a specific population – patients with end stage renal disease. This study demonstrated a high α coefficient (0.85) and a low to moderate retest correlation with a 2-4-week timeframe between administrations.
A revised PiH scale where focus groups proposed a four-factor structure was evaluated in a study by Smith, Harvey [13]. The factors included knowledge of illness and treatment; patient-health professional partnership; recognition and management of symptoms; and coping with chronic illness. The PiH was completed by 904 participants reporting a chronic illness, and the revised scale was found to be a relevant and structurally valid instrument for measuring self-management of chronic condition in the Australian community [13]. Peñarrieta-de Córdova, Barrios [15] suggest that the PiH scale is useful as a generic self-rated clinical tool for assessing self-management in a range of chronic conditions including hypertension, diabetes and cancer. Acceptable internal consistency (α = 0.80) and construct validity of the instrument were demonstrated in this Mexican study [15].
Together, the results of these studies suggest the PiH demonstrates acceptable measurement properties and is suitable for use as a tool to evaluate self-management behaviours in chronic disease populations, potentially including back pain and other musculoskeletal complaints. Osteopathy care is sought by Australians for the management of a range of musculoskeletal complaints [[17], [18], [19], [20]]. Given that back pain and other musculoskeletal disorders account for nearly 8% of the total disease burden in the Australian population [4], osteopaths may have a role in reducing this burden through their primary patient contact role, or through government initiatives such as the Chronic Disease Management plan [21]. The aim of the present study was to utilise the PiH to profile the self-management behaviours of acute and chronic musculoskeletal pain patients, including back pain, presenting to an Australian osteopathy student-led teaching clinic.
Section snippets
Methods
The study was approved by the Victoria University (VU, Australia) Human Research Ethics Committee (HRE15-005).
Results
Three-hundred and eighty-three (N = 383) new patients attended the clinic during the data collection period [30]. Data missing at random were imputed using a two-way imputation method. Data were imputed for 52 patients with the two-way imputation using the testdataimputation package [31] in R [29]. Three hundred and thirty-one (n = 331) data sets were available for analysis. Demographic and health information data are presented in Table 1. The PiH total mean was 70.9 (±14.3) and median was 72.
Discussion
The current study explored, through the PiH, the self-management behaviours of patients with a primary musculoskeletal complaint presenting to an osteopathy clinic. In this context, a primary musculoskeletal complaint is one that is the main reason for presenting to the clinic for care. Self-management often forms part of the management plan for a patient presenting to an Australian osteopath and includes education about their musculoskeletal condition, exercises, ergonomic advice, and
Conclusion
This study has demonstrated that patients who seek osteopathy care for a primary musculoskeletal complaint exhibit a relatively high disposition towards self-management of their health. The mean age in the present study was lower than previous studies utilising the PiH, thereby providing additional evidence to support its use in a broader population than was previously reported. Further, the use of the PiH with both acute and chronic musculoskeletal complaints is supported by the present study.
Declaration of competing interest
Brett Vaughan is a member of the Editorial Board of the International Journal of Osteopathic Medicine but was not involved in review or editorial decisions regarding this manuscript.
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