Abstract
Background
Contextual factors (CFs) related to the patient, healthcare practitioners, and their therapeutic relationship are integral to the overall treatment effect of any given intervention (1). In osteoarthritis (OA), around 75% of the treatment effect is directly attributable to CFs (2). Identifying and understanding the role of CFs may encourage healthcare practitioners to develop and enhance the contextual aspects of care.
Objectives
To explore and understand the experience and perspectives of patients and health practitioners regarding CFs in consultations for OA.
Methods
A systematic search was conducted between March 15 and May 18, 2020, on the following databases: MEDLINE via Ovid, EMBASE, AMED, PsycINFO and CINAHL. The search for unpublished studies included ProQuest Dissertations and Google Scholar. The search was not limited to any language or publication year. The Joanna Briggs Institute (JBI) methodology for quality assessment, study selection, data extraction and synthesis were used. Findings were assessed for credibility, categorised based on similarity in meaning and subjected to a meta-aggregation. The ConQual approach was used to assess the confidence of the synthesised findings (3).
Results
Of 1808 records generated from the systematic search of databases and grey literature, eight studies were included in the meta-aggregation (Figure 1). All included papers were moderate to high quality based on the JBI qualitative critical appraisal tool. Meta-aggregation generated three synthesised findings. According to the ConQual criteria, all the synthesised findings’ level of evidence was rated as moderate (Table 1). The key, potentially modifiable, factors identified were positive communication; clear and relevant information provided by the health practitioner; patient expectation concerning their outcome and the consultation experience; sufficient consultation time; and easy access to consultations.
Table 1.
ConQual summary of findings
Synthesized finding
Type of research
Dependability
Credibility
ConQual score
I
. People with OA will likely experience comprehensive and satisfactory management of their condition if the key contextual enhancers are implemented.
Qualitative
Unchanged*
Downgrade 1 level**
Moderate
II
. Health providers acknowledged that information provision and efficient communication skills are likely to enhance management during consultations for OA.
Qualitative
Unchanged*
Downgrade 1 level**
Moderate
III
. Effective consultations are affected by an intersection of organizational challenges and patient and provider characteristics. Limited experience with OA of some practitioners, unrealistic patients’ expectations, and short consultation duration are barriers that need to be adjusted for better management.
Qualitative
Unchanged*
Downgrade 1 level**
Moderate
* The average score was (4/5) for dependability.
** Downgraded one level due to a mix of unequivocal and credible findings.
Figure 1.
PRISMA flowchart of the study selection and inclusion process
Conclusion
This qualitative systematic review has defined three synthesized findings. Identification of modifiable CFs that are deemed important by both patients and health practitioners can inform the development of a training package for healthcare professional.
References
[1]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review.
The Lancet
. 2001;357(9258):757-762.
[2]Zou K, Wong J, Abdullah N, Chen X, Smith T, Doherty M et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials.
Annals of the Rheumatic Diseases
. 2016;75(11):1964-1970.
[3]Munn, Z., Porritt, K., Lockwood, C., Aromataris, E. & Pearson, A. 2014. Establishing confidence in the output of qualitative research synthesis: the ConQual approach.
BMC medical research methodology
, 14, 1-7.
Disclosure of Interests
None declared