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    IAU knowledge mobilisation projects

    beefree-logo ‌

    BeeFree aims to improve awareness of and support for the mental health needs of people living with persistent back and neck pain.

    • Key contacts: kay.stevenson@mpft.nhs.uk and t.kingstone@keele.ac.uk
    • Stakeholders: Mind, Midlands Partnership NHS Foundation Trust, North Staffordshire Combined Healthcare NHS Trust, the Haywood Foundation, patients and the public, mental health researchers, IAU Knowledge Mobilisers

    beefree-graphic

     

    BeeFree underpinning research

    Persistent pain epidemiology
    • Fayaz, A., Croft, P., Langford, R. M., Donaldson, L. J., & Jones, G. T. (2016). Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open, 6(6), e010364.
    • Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May; 10(4):287-333.
    Persistent pain and mental health
    • Artus M, Campbell P, Mallen CD, Dunn KM, van der Windt DA. Generic prognostic factors for musculoskeletal pain in primary care: a systematic review. BMJ open. 2017 Jan 1;7(1):e012901.
    • Roddy E, Zwierska I, Dawes P, Hider SL, Jordan KP, Packham J, Stevenson K, Hay E. The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA) Study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service. BMC musculoskeletal disorders. 2010 Dec;11(1):67.
    • Rzewuska, M., Mallen, C.D., Strauss, V.Y., Belcher, J. and Peat, G., 2015. One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis. Journal of psychosomatic research, 79(3), pp.195-201.
    Sleep and pain
    • Wilcox S, Brenes GA, Levine D, Sevick MA, Shumaker SA, Craven T. Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis. J Am Geriatr Soc 2000;48:1241–51.
    • Baker S, McBeth J, Chew-Graham CA, Wilkie R. Musculoskeletal pain and co-morbid insomnia in adults; a population study of the prevalence and impact on restricted social participation. BMC family practice. 2017 Dec;18(1):17.
    Sleep and pain and depression
    • Nalajala N, Walls K, Hili E. Insomnia in chronic lower back pain: Non-pharmacological physiotherapy interventions. International Journal of Therapy and Rehabilitation. 2013 Oct;20(10):510-6.
    • Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms. Arthritis care & research. 2015 Mar;67(3):358-65.
    • Chen Q, Hayman LL, Shmerling RH, Bean JF, Leveille SG. Characteristics of chronic pain associated with sleep difficulty in the older population: the MOBILIZE Boston study. J Am Geriatr Soc 2011;59:1385–92.
    • McCurry SM, Von Korff M, Vitiello MV, Saunders K, Balderson BH, Moore AL, et al. Frequency of comorbid insomnia, pain, and depression in older adults with osteoarthritis: predictors of enrollment in a randomized treatment trial. J Psychosom Res 2011;71:296–9.
    • Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Curr Pain Headache Rep 2009;13:447–54.
    Sleep and mental health
    • Pasquale K. Alvaro, Rachel M. Roberts, Jodie K. Harris, A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression, Sleep, Volume 36, Issue 7, 1 July 2013, Pages 1059–1068.
    • Sleep matters report
    Diet and pain
    • Brain K, Burrows TL, Rollo ME, Chai LK, Clarke ED, Hayes C, Hodson FJ, Collins CE. A systematic review and meta‐analysis of nutrition interventions for chronic noncancer pain. Journal of Human Nutrition and Dietetics. 2019 Apr;32(2):198-225.
    Diet and mental health (depression, anxiety)
    • Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American journal of clinical nutrition. 2013 Nov 6;99(1):181-97.
    Physical activity and pain
    • BPS. Core standards for pain management services in the UK. CSPMS. UK: British Pain Society; 2015.
    • Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TP. European league against R. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125–1135. doi: 10.1136/annrheumdis-2012-202745.
    • NICE. Osteoarthritis care and management in adults. CG177. London: National Institute for Health and Care Excellence; 2014.
    • NICE. Non-specific low back pain and sciatica: management. CG [in development] London: National Institute for Health and Care Exellence; 2016.
    • SIGN. Management of Chronic Pain. Scottish Intercollegiate Guidelines Network: Scotland; 2013.
    • Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18(4):476–499. doi: 10.1016/j.joca.2010.01.013.Physical activity and mental healthJosefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: Meta‐analysis and systematic review. Scandinavian journal of medicine & science in sports. 2014 Apr;24(2):259-72.Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane database of systematic reviews. 2013(9).Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice–a systematic review and meta-analysis. BMC health services research. 2018 Dec;18(1):559.Mochcovitch MD, Deslandes AC, Freire RC, Garcia RF, Nardi AE. The effects of regular physical activity on anxiety symptoms in healthy older adults: a systematic review. Revista Brasileira de Psiquiatria. 2016 Sep;38(3):255-61.
    Creativity and pain
    • Ahlstrand I, Björk M, Thyberg I, Börsbo B, Falkmer T. Pain and daily activities in rheumatoid arthritis. Disability and Rehabilitation. 2012 Jul 1;34(15):1245-53.
    Creativity and mental health (depression, anxiety)
    • Dunphy K, Baker FA, Dumaresq E, Carroll-Haskins K, Eickholt J, Ercole M, Kaimal G, Meyer K, Sajnani N, Shamir OY, Wosch T. Creative arts interventions to address depression in older adults: A systematic review of outcomes, processes, and mechanisms. Frontiers in psychology. 2019 Jan 8;9:2655.
    • Evidence for behavioural activation
      • Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, Cape J, Pilling S, Araya R, Kessler D, Bland JM. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. Bmj. 2013 Aug 19;347:f4913.
    • Community groups to support mental health in older people
      • Kingstone T, Bartlam B, Burroughs H, Bullock P, Lovell K, Ray M, Bower P, Waheed W, Gilbody S, Nicholls E, Chew-Graham CA. Can support workers from AgeUK deliver an intervention to support older people with anxiety and depression? A qualitative evaluation. BMC family practice. 2019 Dec;20(1):16.
    Talking therapies and pain
    • Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, Reid MC. Association between psychological interventions and chronic pain outcomes in older adults: a systematic review and meta-analysis. JAMA internal medicine. 2018 Jun 1;178(6):830-9.
    Talking therapies and mental health
    • NICE. Depression in adults: recognition and management Clinical guideline [CG90] Published date: October 2009 Last updated: April 2018
    • NICE. Generalised anxiety disorder and panic disorder in adults: management Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019

     

    startback-logo

    STarT Back is an example of a stratified care approach. It matches patients with low back pain to treatments based on prognosis or risk of poor clinical outcome. It uses a simple tool to match patients to treatment packages appropriate for them. This has been shown to:

    Significantly decrease disability from back pain
    Reduce time off work
    Save money by making better use of health resources

    Underpinning research

    Archive

    jigsaw-e-logo

    JIGSAW-E implemented four key innovations to support patients to self-manage osteoarthritis across 5 European countries: the UK (West Midlands), the Netherlands, Denmark, Portugal and Norway. The innovations were:

    • Osteoarthritis Guidebook
    • Quality Care Measures
    • Model consultation
    • Training
    • Key contacts: k.dziedzic@keele.ac.uk
    • Stakeholders:  JIGSAW-E European partners, patients and the public, IAU Knowledge Mobilisers

    Underpinning research

    • Dziedzic KS, Healey EL, Porcheret M, Afolabi EK, Lewis M, Morden A, Jinks C, McHugh GA, Ryan S, Finney A, Main C, Edwards JJ, Paskins Z, Pushpa-Rajah A, Hay EM. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. Osteoarthritis Cartilage. 2018
    • Jordan KP, Edwards JJ, Porcheret M, Healey EL, Jinks C, Bedson J, Clarkson K, Hay EM, Dziedzic KS. Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care. Osteoarthritis Cartilage. 2017 
    • Blackburn S, Higginbottom A, Taylor R, Bird J, Østerås N, Hagen KB, Edwards JJ, Jordan KP, Jinks C, Dziedzic K. Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care. Res Involv Engagem. 2016 Mar 17;2:5
    • Morden A, Jinks C, Ong BN, Porcheret M, Dziedzic KS. Acceptability of a ‘guidebook’ for the management of Osteoarthritis: a qualitative study of patient and clinician’s perspectives. BMC Musculoskelet Disord. 2014 Dec 13;15:427
    • Edwards JJ, Jordan KP, Peat G, Bedson J, Croft PR, Hay EM, Dziedzic KS. Quality of care for OA: the effect of a point-of-care consultation recording template. Rheumatology (Oxford). 2015 May;54(5):844-53. 
    • Dziedzic KS, Healey EL, Porcheret M, Ong BN, Main CJ, Jordan KP, Lewis M, Edwards JJ, Jinks C, Morden A, McHugh GA, Ryan S, Finney A, Jowett S, Oppong R, Afolabi E, Pushpa-Rajah A, Handy J, Clarkson K, Mason E, Whitehurst T, Hughes RW, Croft PR, Hay EM. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care–the Management of OsteoArthritis In Consultations (MOSAICS) study protocol. Implement Sci. 2014 Aug 27;9:95
    • Dziedzic K, Bierma Zeinstra S, Vliet Vlieland T, Roos EM, Skou ST, Hagen KB, Osteras
    • N, Pais S, Cordeiro C, Duffy H, Hughes R. Joint Implementation of Guidelines for oSteoArthritis in Western Europe: JIGSAW-E Physiotherapy. 2016; 102S: eS138. [The 4th European Congress of the ER WCPT]
    • Schiphol D, Vliet Vlieland TP, van Ingen R, Peter WF, Meesters JJ, de Wit MP, van de Boogaard JN, Krol J, Buitelaar H, Evans N, Bierma-¬Zeinstra SM, Dziedzic KS. Joint Implementation of Guidelines for oSteoArthritis in Western Europe: JIGSAW¬E in progress in the Netherlands. Osteoarthritis and Cartilage. 2017; 25: S414
    • Funding statement: "JIGSAW-E has been funded by the international EIT Health Innovation Projects programme. EIT Health promotes healthy living, active ageing and improvements in healthcare. For more information, visit www.eithealth.eu."

    "It’s like having a friend in your pocket"

    StartBack logo SelfBack logo

    SelfStart is a joint initiative combining two evidence-based innovations to form a New Digital Musculoskeletal pathway for low back pain.

    SelfStart provides patients with an app that is designed to help them manage their low back pain. When a patient sees a First Contact Physiotherapist (FCP), they will complete a questionnaire called the  STarT Back tool. This tool helps to identify if patients have a low, medium or high risk of ongoing pain. If the patient is identified as low or medium risk, the FCP would offer the patient access to the SelfBack app. 

    Evidence shows that this early intervention pays off, as it reduces the risk of back pain developing into a chronic condition.

    Selfback is powered by Artificial Intelligence (AI). It has been proven to help patients improve. Within the app, the patient completes a series of questions, which then allows the app to create exercise and advice specific to that patient. The app also collects the patient view of their consultation and asks the patient about their symptoms at three and six months.

    The SelfBack app was co-created by a Danish Company (SelfBack) and tested in a randomised controlled trial. Patients were involved in the original app design and the Impact Accelerator Unit’s Patient and Public Involvement and Engagement group tested and refined the content and appearance of the app, commenting: “It’s like having a friend in your pocket.”

    The first part of the project was funded by former NHS Digital - now NHS England. It was rolled out across Stoke and Staffordshire Integrated Care System, Royal Wolverhampton Trust and Derby and Burton NHS Trust. It was taken up by 50% of those it was offered to.

    Community physiotherapy

    Staffordshire and Stoke on Trent Integrated Care System have funded a roll out of SelfStart into Midlands Partnership University Foundation Trust Musculoskeletal Physiotherapy and Pain Services until the end of December 2024.

    Training resources

    Training resources to support physiotherapists to offer the app to patients can be found here.

    Publications

    Stevenson, K., Hadley‐Barrows, T.,
    Evans, N., Campbell, L., Southam, J., Chudyk, A., Ellington, D.,
    Jeeves, B., Jenson, C., Kleberg, S., Birkinshaw, H., Mair, F.,
    Dziedzic, K., Peat, G., Jordan, K. P., Yu, D., Bailey, J.,
    Braybooke, A., Mallen, C. D., & Hill, J. C. (2024). The SelfSTarT intervention for low back pain patients presenting to first contact physiotherapists: A mixed methods service evaluation. Musculoskeletal Care, e1876. https://doi.org/10.
    1002/msc.1876

    This is the link to the paper -
    https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1876

    Self partners logos

    Underpinning research

    The MIDAS programme is funded by the Nuffield Foundation and Versus Arthritis and supported by Keele Clinical Trials Unit.

    Painful musculoskeletal conditions like back pain and osteoarthritis cause more disability in the general population than any other health condition. Poorer communities and individuals appear to be the hardest hit. To have a suitably 'joined up' response to this challenge we need accurate and meaningful joined-up information on musculoskeletal health, risk, and care in local populations.

    What is the MIDAS programme trying to achieve?

    Through a combination of research and knowledge exchange we want to:

    • raise awareness, improve understanding, and change attitudes towards current patterns and inequalities in musculoskeletal health and care
    • improve the capacity of health systems to get, link, and use better data on musculoskeletal health and care to improve services and benefit the health and wellbeing of people they serve

    Our work involves a series of research studies centred on North Staffordshire & Stoke-on-Trent and knowledge exchange with patients and members of the public, healthcare professionals, service managers, professional organisations, and policymakers at local and national levels.

    MIDAS GP Study

    What is it trying to achieve?

    MIDAS-GP aims to provide new research evidence on how to improve treatment for different groups of people with painful musculoskeletal conditions and between different general practices.

    Who can participate?

    Adult patients who have recently consulted their general practice with a painful musculoskeletal condition.

    What does the study involve?

    Patients who have recently consulted their general practice with a musculoskeletal condition will be invited to complete an initial pen-and-paper questionnaire or online questionnaire. Those who agree to take part will be asked to complete a follow-up questionnaire (either pen-and-paper or online questionnaire) after 3 and 6 months and one follow-up question (either pen-and-paper questionnaire or by SMS text message) about pain intensity after 1, 2, 4, and 5 months. A number of measurements will be taken including Musculoskeletal Health Questionnaire, Pain intensity (0-10 Scale) and Work productivity and activity impairment (WPAI). Participants will be asked if they give permission for their questionnaire responses to be linked with information held in their medical records to enable the type of care people are receiving with the kind of problem they have and the outcome of their care to be pieced together.

    MIDAS Population Study

    What is it trying to achieve?

    The MIDAS-Population Study aims to provide a detailed description of musculoskeletal health, key comorbidity and the impact of health inequalities and care within the general population.

    Who can participate?

    Adults aged 35 years and over who are registered with a participating general practice for the study period and are able to provide informed consent.

    What does the study involve?

    Eligible participants will be invited to participate via a text message from their general practice containing a link URL to the online survey.
    Patients who do not have a mobile telephone number registered with their practice will be invited to participate by post.

    MIDAS MSK Community Study

    What is it trying to achieve?

    MIDAS-Com aims to provide information about how to improve the care of people with painful musculoskeletal conditions when they are seen in Community MSK services such as Physiotherapy.

    Who can participate?

    Adult patients who have been referred by their general practice to the Community MSK Service with a painful musculoskeletal condition.

    What does the study involve?

    Patients who have an appointment with the Community MSK Service run by NHS Midlands Partnership Foundation Trust for a musculoskeletal condition will be invited to complete an initial pen-and-paper questionnaire or online questionnaire. Those who agree to take part will be asked to complete a follow-up questionnaire (either pen-and-paper or online questionnaire) after 3 and 6 months and one follow-up question (either pen-and-paper questionnaire or by SMS text message) about pain intensity after 1, 2, 4, and 5 months. A number of measurements will be taken including Musculoskeletal Health Questionnaire, Pain intensity (0-10 Scale) and Work productivity and activity impairment (WPAI). Participants will be asked if they give permission for their questionnaire responses to be linked with information held in their medical records to enable the type of care people are receiving with the kind of problem they have and the outcome of their care to be pieced together.

    Find out about a new research project aiming to improve the treatment of people with Musculoskeletal conditions in North Staffordshire and Stoke-on-Trent.

    Understanding why some areas of North Staffordshire and Stoke-on-Trent have better and poorer health is important to help to reduce differences and improve health for all. Please see our research findings here.

    Other work