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To estimate the direction and magnitude of socioeconomic inequalities in outcome, experience and care among adults consulting for a musculoskeletal pain condition.
Multicentre, prospective observational cohort with repeated measures at three waves (baseline, 3 months and 6 months after index consultation).
30 general practices in North Staffordshire and Stoke-on-Trent, England.
1875 consecutive, eligible, consenting patients, aged 18 years and over, presenting with a relevant SNOMED CT-coded musculoskeletal pain condition between September 2021 and July 2022.
Standard care.
Primary outcome was patient-reported pain and function using the Musculoskeletal Health Questionnaire (MSK-HQ score, 0–56). Secondary outcomes were patient experience (overall dissatisfaction with consultation experience, dichotomised) and an indicator of care received (opioid prescription within 14 days of index consultation). Using multilevel models, we examined inequalities in primary and secondary outcomes by area deprivation (Index of Multiple Deprivation derived from patient residential postcode), before and after adjusting for sociodemographic and survey administration variables, clinical case-mix and selected practice-level covariates.
Compared with patients from the least deprived neighbourhoods, patients from the most deprived neighbourhoods had significantly poorer MSK-HQ scores at baseline (mean 22.6 (SD 10.4) vs 27.6 (10.1)). At 6 months, the inequality gap in MSK-HQ score widened (difference in mean score after adjustment for all covariates: 1.94; 95% CI: –0.70 to 4.58). Opioid prescription was more common for patients living in the most deprived neighbourhoods (30% vs 19%; fully adjusted OR: 0.69; 95% CI: 0.44 to 1.08). Only 6% of patients overall reported being dissatisfied with their consultation. Analysis of multiply imputed data produced a similar pattern of findings to complete-case analysis.
Substantial inequalities in the chronicity, severity and complexity of musculoskeletal pain problems are already present at the time of accessing care. Inequalities in pain and function do not reduce after accessing care and may even widen slightly.
ISRCTN18132064; Results.
To examine rehabilitation nurses' perspectives on their roles in caring for older patients in hospitals, emphasising how they fulfil these roles and their significance in geriatric rehabilitation (GR).
The need for rehabilitation services was rising with an aging population. Rehabilitation nurses provided evidence-based care to older patients and encouraged them to participate in their rehabilitation goals. Rehabilitation nurses were vital to recovery; their contributions needed to be appreciated and valued.
A qualitative systematic review.
A systematic review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative evidence and a PROSPERO protocol CRD42023435728 published beforehand. From inception to 9 October, 2023, a comprehensive database search was developed using Medline and translated into five databases, including CINAHL, Web of Science, Scopus, ProQuest and Ageline.
Thirty-three studies were reviewed, identifying six key themes, including decision-making, nursing role gaps, care coordination, communication, nursing skills and gender preference.
This review examined rehabilitation nurses' experiences working with older patients in rehabilitation services. It highlighted gaps in their recognition and decision-making involvement despite being care coordinators, caregivers and advocates who were undervalued as rehabilitation team members.
The review highlighted the importance of valuing nurses' contributions and re-evaluating the rehabilitation model.
Interviewing rehabilitation nurses can validate the findings, potentially improving rehabilitation nursing practices for older patients.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Not applied since it was a systematic review.
FreshRSS 