Promoting Movement Quality in Hip Osteoarthritis : Evaluation and treatment from the perspective of Basic Body Awareness Therapy
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Background Osteoarthritis (OA) may have consequences for individuals’ physical, social and personal functioning. In the physiotherapy modality Basic Body Awareness Therapy (BBAT), movement quality is promoted by movement awareness learning, and biopsychosocial as well as personal aspects of movement and health are implemented to support participants’ insight into how they move and engage in their daily lives. Originating from BBAT theory and practice, the movement quality evaluation tool Body Awareness Rating Scale–Movement Quality and Evaluation (BARS-MQE) quantifies movement quality as observed and analysed by the physiotherapist (part 1), and invites the participant to describe immediate movement experiences (part 2). Aims The objective of the present project was to study the evaluation and promotion of movement quality from the BBAT perspective in persons with hip OA. The project includes four studies regarding I) experiences from participating in patient education (PE) and BBAT groups for persons with hip OA, II) movement experiences in the BARS-MQE evaluation, part 2, described by persons with hip OA, III) associations between movement quality evaluated by the BARS-MQE, and recommended measures of function and health in hip OA, and IV) the effects on pain and functioning from participating in 12 weekly sessions of BBAT when added to PE. Materials and methods Multiple methodological approaches were applied. In connection with a pilot study of effects from PE and BBAT, personal interviews were conducted to explore the participants’ experienced outcome from the interventions (Study I). Seven persons participated in PE, and five of them additionally participated in BBAT groups. The data were analysed qualitatively using Systematic Text Condensation. Based on experiences from the pilot study, a randomized controlled trial (RCT) of treatment effects in 101 participants was conducted, using ANCOVA analysis to compare differences in change between the intervention (PE+BBAT) and the comparison (PE only) group (Study IV). Using data from the baseline assessments of the RCT, two studies of movement quality evaluated by the BARS-MQE were conducted. First, movement experiences verbalized by 35 persons as part of the BARS-MQE (part 2) evaluation were analysed using qualitative content analysis (Study II). Secondly, an explorative study of associations between movement quality scores (BARS-MQE, part 1) and measures that are commonly used for persons with hip OA was conducted, using correlation analysis of baseline measures in the 101 study participants (Study III). Results In Study I, the participants described aspects of the content and pedagogy in PE and BBAT that they perceived meaningful for their learning outcome. Central aspects were to receive trustworthy information from professionals and being supported by peers. When experiencing new possibilities for functional movement and becoming more aware of own needs, the informants described to also experience more well-being, functionality and self-management over time. In Study II, participants verbalized their immediate movement experiences as a part of the BARS-MQE evaluation. They provided insight into factors that influenced negatively on the way they moved, such as changed body perception, symptoms and compensational habits, and also described movement aspects that they became aware of in the BARS-MQE and perceived to be meaningful to practice, to obtain more healthy movement. Study III showed that movement quality was somewhat affected in the study sample, as compared to normative values. It was moderately associated with measures of physical capacity (Stairs test and 6MWT) and level of activity (UCLA), and weakly or not reflected in self-reported measures of problems with function and health (HOOS, EQ5D5L, ASES). In the main study, Study IV, we found no evidence that PE+BBAT was more effective than PE only on the primary outcomes; pain during walking (NRS) and function in activities of daily life (HOOS A). Movement quality (BARS-MQE) was, however, significantly more improved in the intervention group, and these participants reported more improvement in pain (p=0.03) and function (p=0.07) by the PGIC, than comparisons. In a per protocol analysis including 30 intervention participants who had attended to 10 or more BBAT sessions, we found differences in change on movement quality (BARS-MQE), self-efficacy (ASES pain), health (EQ5D5L VAS) and function (HHS), in favour of the PE+BBAT group. Conclusions This PhD project has shown that movement quality, evaluated by the BARS-MQE, was affected in many of the participants with hip OA, but with great variations. The movement quality scores were generally not well reflected in commonly used measures of function and health in hip OA, except for movement quality in walking. When focusing on movement experiences in the BARS-MQE, individuals with hip OA provided insight into experiences of movement challenges and resources. By participating in the BBAT and practicing the integration of functional movement aspects into their movement habits, they improved their movement quality significantly. The clinical impact of improved movement quality by the BARS-MQE score is still unclear, as it was not reflected in improvements on the hip-related measures used, including the primary outcomes in our RCT; pain during walking and ADL function. Participants described experiencing PE and BBAT as beneficial for function and self-management on short and long term. However, the RCT did not show evidence that PE and BBAT in groups were more beneficial than PE alone. This may be due to the fact that 1) there was a ceiling effect on the primary outcomes, 2) not all participants demonstrated dysfunctional movement quality, 3) the majority of comparison patients were found to receive other physiotherapy, and 4) poor compliance in some intervention participants. We found that a minimum of 10 BBAT sessions was needed to obtain a satisfactory outcome.
Består avPaper I. Olsen AL, Strand LI, Skjaerven LH, Sundal M-A, Magnussen LH. Patient education and basic body awareness therapy in hip osteoarthritis – a qualitative study of patients' movement learning experiences. Disability and Rehabilitation 2017; 39(16): 1631-1638. Full text not available in BORA due to publisher restrictions. The article is available at: https://doi.org/10.1080/09638288.2016.1209578
Paper II. Olsen AL, Strand LI, Magnussen LH, Sundal M-A, Skjaerven LH. Descriptions of movement experiences in the Body Awareness Rating Scale – Movement Quality and Experience evaluation. A qualitative study of patients diagnosed with hip osteoarthritis. Physiotherapy Theory and Practice 2019; Jul 1:1-11. Full text not available in BORA due to publisher restrictions. The article is available at: https://doi.org/10.1080/09593985.2019.1636434
Paper III. Olsen AL, Magnussen LH, Skjaerven LH, Sundal M-A, Assmus J, Ostelo R, Strand LI. Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis. Physiotherapy Research International 2020, May 24;e1848. The article is available at: https://hdl.handle.net/11250/2730009
Paper IV. Olsen AL, Magnussen LH, Skjaerven LH, Assmus J, Sundal M-A, Furnes O, Hallan G, Strand LI. Basic Body Awareness Therapy improves movement quality, not pain and daily life activities in people with hip osteoarthritis: a randomised controlled trial. Full text not available in BORA