BMJ Open

doi: 10.1136/bmjopen-2022-063931corr1pmid: 37263707

Griffin, James; Davis, Edward T; Parsons, Helen; Gemperle Mannion, Elke; Khatri, Chetan; Ellard, David R; Blyth, Mark J; Clement, Nicholas David; Deehan, David; Flynn, Nicholas; Fox, Josephine; Grant, Nicholas J; Haddad, Fares S; Hutchinson, Charles E; Mason, James; Mohindru, Bishal; Scott, Chloe E H; Smith, Toby O; Skinner, John A; Toms, Andrew D; Rees, Sophie; Underwood, Martin; Metcalfe, Andrew

doi: 10.1136/bmjopen-2022-068255pmid: 37295832

IntroductionRobotic-assisted knee replacement systems have been introduced to healthcare services worldwide in an effort to improve clinical outcomes for people, although high-quality evidence that they are clinically, or cost-effective remains sparse. Robotic-arm systems may improve surgical accuracy and could contribute to reduced pain, improved function and lower overall cost of total knee replacement (TKR) surgery. However, TKR with conventional instruments may be just as effective and may be quicker and cheaper. There is a need for a robust evaluation of this technology, including cost-effectiveness analyses using both within-trial and modelling approaches. This trial will compare robotic-assisted against conventional TKR to provide high-quality evidence on whether robotic-assisted knee replacement is beneficial to patients and cost-effective for healthcare systems.Methods and analysisThe Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial-Knee is a multicentre, participant-assessor blinded, randomised controlled trial to evaluate the clinical and cost-effectiveness of robotic-assisted TKR compared with TKR using conventional instruments. A total of 332 participants will be randomised (1:1) to provide 90% power for a 12-point difference in the primary outcome measure; the Forgotten Joint Score at 12 months postrandomisation. Allocation concealment will be achieved using computer-based randomisation performed on the day of surgery and methods for blinding will include sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will be reported in line with the Consolidated Standards of Reporting Trials statement. A parallel study will collect data on the learning effects associated with robotic-arm systems.Ethics and disseminationThe trial has been approved by an ethics committee for patient participation (East Midlands—Nottingham 2 Research Ethics Committee, 29 July 2020. NRES number: 20/EM/0159). All results from the study will be disseminated using peer-reviewed publications, presentations at international conferences, lay summaries and social media as appropriate.Trial registration numberISRCTN27624068.

Rahman, Md Tahidur; Jahangir Alam, Md; Ahmed, Noyon; Roy, Dulal Chandra; Sultana, Papia

doi: 10.1136/bmjopen-2022-070480pmid: 37308267

ObjectivesThe objectives of this study are to identify the trend of undernutrition risk among under-five children (U5C) in Bangladesh and the trend of its correlates.DesignMultiple cross-sectional data sets from different time points were used.SettingNationally representative Bangladesh Demographic and Health Surveys (BDHSs) were conducted in 2007, 2011, 2014 and 2017/2018.ParticipantsIn the BDHSs, the sample sizes for ever-married women (age: 15–49 years) were 5300 in 2007, 7647 in 2011, 6965 in 2014 and 7902 in 2017/2018.OutcomesExtant indicators of undernutrition (stunted, wasted and underweight) have been considered as the outcome variables.Materials and methodsDescriptive statistics, bivariate analysis and factor loadings from factor analysis have been used to determine the prevalence of undernutrition over the years and find the trend of risk and its correlates.ResultsRisks of stunting among the U5C were 41.70%, 40.67%, 36.57% and 31.14%; that of wasting were 16.94%, 15.48%, 14.43% and 8.44%; and that of underweight were 39.79%, 35.80%, 32.45% and 22.46% in 2007, 2011, 2014 and 2017/2018, respectively. From the factor analysis, it has been found that the top five potential correlates of undernutrition are the wealth index, the education of the father and mother, the frequency of antenatal visits during pregnancy, the father’s occupation and/or the type of place of residence in the last four consecutive surveys.ConclusionThis study helps us gain a better understanding of the impact of the top correlates on child undernutrition. To accelerate the reduction of child undernutrition more by 2030, Government and non-government organisations should focus on improving education and household income-generating activities among poor households and raising awareness among women about the importance of receiving antenatal care during pregnancy.

Wang, Meijiao; Chen, Xiaotong; Sun, Yu; Wang, Qi; Liu, Gordon

doi: 10.1136/bmjopen-2022-069381pmid: 37336542

ObjectivesThe medical reform in 2009 stimulated the growth of private healthcare organisations in China, but there is still room for their further development in the healthcare market. The objectives of the study were to provide more information about the healthcare market in China and to explore the challenges private healthcare organisations faced.DesignQualitative descriptive study using a web-based open-ended questionnaire and thematic content analysis. Data were collected between 12 February and 20 February 2020.SettingThis study was conducted in China.Participants124 respondents from private healthcare organisations across 20 provinces in China.ResultsOur content analysis identified three themes: (1) functioning and positioning of the healthcare institutions: current private healthcare organisations generally serve as a supplement to public hospitals and focus more on specialised medical and high-end services; (2) institutions’ advantages: private healthcare organisations can flexibly respond to market demands, formulate effective strategies, introduce advanced management concepts and methods, provide personalised and diversified services, and introduce new technologies which can stimulate market vitality and promote healthy competition; and (3) institutions’ challenges: private healthcare organisations face difficulties in professional development and talent cultivation, branding and establishing a reputation, and the policies for institution establishment, tax and medical insurance pose drawbacks to their development.ConclusionThis study illustrates that private healthcare organisations need more government support for further development, such as providing a fairer insurance strategy and taxation policy, affording ground for a more equitable scientific research environment and promotion opportunities, and evaluating reputation score for healthcare institutions.

Getahun, Genanew Kassie; Goshu, Bizunesh Yadeta; Goshu, Dejuma Yadeta; Mekuria, Zelalem Negash

doi: 10.1136/bmjopen-2022-068948pmid: 37339829

ObjectiveThe aim of this study was to assess the level of cardiovascular disease (CVD) risk and associated factors among hypertensive patients having follow-up at selected hospitals in Addis Ababa, Ethiopia, in 2022.SettingA hospital-based cross-sectional study was conducted in public and tertiary hospitals in Addis Ababa, Ethiopia, from 15 January 2022 to 30 July 2022.ParticipantsA total of 326 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study.Primary and secondary outcome measuresA high predicted 10-year CVD risk level was assessed using an interviewer-administered questionnaire and physical measurement (primary data) and reviews of medical data records (secondary data) by using a non-laboratory WHO risk prediction chart. Logistic regression with an adjusted OR (AOR) using a 95% CI was calculated for independent variables associated with 10-year CVD risk.ResultsThe prevalence of a high predicted 10-year CVD risk level was 28.2% (95% CI 10.34% to 33.2%) among the study participants. A higher CVD risk level was found to be associated with age (AOR 4.2 for age 64–74, 95% CI 1.67 to 10.66), being male (AOR 2.1, 95% CI 1.18, 3.67), unemployment (AOR 3.2, 95% CI 1.06 to 6.25) and stage 2 systolic blood pressure (AOR 11.32; 95% CI 3.43 to 37.46).ConclusionThe study showed that the respondent’s age, gender, occupation and high systolic blood pressure were determinant factors for CVD risks. Therefore, routine screening for the presence of CVD risk factors and assessment of CVD risk are recommended for hypertensive patients for CVD risk reduction.

Longhurst, Phaedra; Full, Wayne

doi: 10.1136/bmjopen-2022-069204pmid: 37339834

IntroductionEvidence indicates that, compared with their non-disabled counterparts, disabled people are likely to face greater mental health challenges as well as significant inequalities in accessing appropriate therapeutic support. Currently, little is known about how disabled people perceive and experience counselling and psychotherapy, what barriers/facilitators to therapy delivery and/or therapy participation exist for disabled clients and whether clinicians sufficiently adapt their practice to meet the needs of this diverse but marginalised population. In this paper, we outline a proposal for undertaking a scoping review that aims to identify and synthesise current research relating to disabled individuals’ perceptions of accessibility and experiences of counselling and psychotherapy. The review aims to identify current gaps in the evidence base and inform how future research, practice and policy may develop and foster inclusive strategies and approaches which will support the psychological well-being of disabled clients accessing counselling and psychotherapy.Methods and analysisThe undertaking and reporting of the proposed scoping review will be guided by the framework outlined by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. Systematic searches of the PsycINFO, CINAHL, EMBASE, EBSCO and Cochrane Library electronic databases will be conducted. Reference lists of relevant studies will be reviewed to identify additional studies. Eligible studies will be limited to those published from 1 January 2010 to 31 December 2022 and in the English language. Empirical studies involving disabled individuals receiving and/or who have received a form of therapeutic intervention will be included. Data will be extracted, collated and charted, and will be summarised quantitatively through descriptive numerical analysis and qualitatively through a narrative synthesis.Ethics and disseminationThe proposed scoping review of published research will not require ethical approval. Results will be disseminated through publication in a peer-reviewed journal.

Acharya, Shrikala; Allam, Ramesh Reddy; Karanjkar, Vijay Kumar; Rathod, Dhirubhai; Mahajan, Raman; Deshpande, Prashant; Palkar, Amol; Todmal, Shashikant; Koli, Sagar; Dhande, Sachin; Dale, Jayesh; Yeldandi, Vijay V; Harshana, Amit; Agarwal, Reshu; Upadhyaya, Sunita; Nyendak, Melissa

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Verdonck, Caroline; Willems, Ruben; Liesbeth, Borgermans

doi: 10.1136/bmjopen-2023-072031pmid: 37385742

ObjectivesGlobally, patients with osteoporosis have unmet needs in terms of care accessibility, patient-centredness and care comprehensiveness. The WHO developed the Integrated, People-Centred Health Services (IPCHS) framework to reorient and integrate healthcare systems using 5 interdependent strategies and 20 substrategies. Patients’ perspectives with regard to these strategies are poorly understood. We sought to relate patient-experienced gaps in osteoporosis care to the IPCHS strategies and identify key strategies to guide osteoporosis care reforms.Design, setting and participantsQualitative online study of the experiences of international patients with osteoporosis.ProcedureTwo researchers conducted semi-structured interviews in English, Dutch, Spanish and French that were recorded and transcribed verbatim. Patients were categorised according to their countries’ healthcare systems (universal, public/private and private) and fracture status. A hybrid (sequential theory-driven and data-driven) analysis was performed, with the IPCHS framework used for the theory-driven analysis.ResultsThirty-five patients (33 women) from 14 countries participated. Twenty-two patients had universal healthcare and 18 had experienced fragility fractures. Prioritised substrategies overlapped among healthcare systems, with reported shortcomings related primarily to ‘empowering and engaging individuals and families’ and ‘coordinating care’ (at varying levels). Patients with all healthcare types prioritised ‘reorienting care’, with different substrategies prioritised. Patients with private healthcare called for ‘improving funding and reforming payment systems’. Substrategy prioritisation did not differ between those receiving primary and secondary fracture prevention.ConclusionPatients’ experiences with osteoporosis care are universal. Given the current care gaps and associated patient burdens, policymakers should make osteoporosis a(n) (inter)national health priority. Integrated osteoporosis care reforms should focus on patient-reported experiences with and be guided by priorities in IPCHS strategies, taking into account the healthcare system context.

Aragaw, Fantu Mamo; Teklu, Rediet Eristu; Belay, Daniel Gashaneh; Negash, Wubshet Debebe; Fetene, Samrawit Mihret; Alemu, Tewodros Getaneh; Eshetu, Habitu Birhan; Fentie, Elsa Awoke; Shewarega, Ever Siyoum; Asmamaw, Desale Bihonegn

doi: 10.1136/bmjopen-2022-066975pmid: 37399440

ObjectiveThe autonomy of young women in healthcare decision-making has been reported to be lower, particularly in low-income and middle-income countries. This study was conducted to estimate the magnitude and the factors associated with autonomy in healthcare decision-making among youth in East African countries.Design and settingA population-based, cross-sectional study was conducted with data from the most recent Demographic and Health Surveys conducted in 11 East African countries (Burundi, Ethiopia, Kenya, Comoros, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe) conducted from 2011 to 2019.ParticipantsWeighted sample of 24 135 women aged 15–24 years.Primary outcomesHealthcare decision-making autonomy.MethodsA multi-level logistic regression model was used to identify factors associated with women’s autonomy in making decisions about their healthcare. Statistical significance was determined using an adjusted OR with 95% CI at a p value less than 0.05.ResultsHealthcare decision-making autonomy among youth in East Africa was 68.37% (95% CI 68%, 70%). In a multivariable analysis older aged youths (20–24 years) (adjusted OR (AOR)=1.27; 95% CI 1.19, 1.36), youths having an occupation (AOR=1.34; 95% CI 1.25, 1.53), having employed husband (AOR=1.12 95% CI 1.00, 1.26), exposure to media (AOR=1.18 95% CI 1.08, 1.29), rich wealth index 1.18 (AOR=1.18 95% CI 1.08, 1.29), female household head, youths having secondary and higher education, youths whose husband had secondary and higher education, and country were significant predictors of healthcare decision making autonomy.ConclusionAlmost one-third of young women have no autonomy in healthcare decision-making. Older youth, being educated, having an educated husband, having an occupation, having an employed husband, exposure to media, female household head, rich wealth index and country are significant predictors for being autonomous in healthcare decision-making. Public health interventions should target uneducated and unemployed youth, poor families and those without media exposure to increase autonomy in health decisions.

Tveter, Anne Therese; Kleven, Linn; Osteras, Nina; Nossum, Randi; Eide, Ruth Else Mehl; Klokkeide, Åse; Matre, Karin Hoegh; Olsen, Monika; Kjeken, Ingvild

doi: 10.1136/bmjopen-2022-063103pmid: 37355263

ObjectiveThe aim was to evaluate the cost-utility of a 3-month multimodal occupational therapy intervention in addition to usual care in patients with thumb carpometacarpal osteoarthritis (CMC1 OA).MethodsA cost-utility analysis was performed alongside a multicentre randomised controlled trial including three rheumatology departments in Norway. A total of 180 patients referred to surgical consultation due to CMC1 OA were randomised to either multimodal occupational therapy including patient education, hand exercises, assistive devices and orthoses (n=90), or usual care receiving only information on OA (n=90). The outcome measure was quality-adjusted life-years (QALYs) derived from the generic questionnaire EQ-5D-5L over a 2-year period. Resource use and health-related quality of life of the patients were prospectively collected at baseline, 4, 18 and 24 months. Costs were estimated by taking a healthcare and societal perspective. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis with 1000 replications following intention-to-treat principle was done to account for uncertainty in the analysis.ResultsDuring the 2-year follow-up period, patients receiving multimodal occupational therapy gained 0.06 more QALYs than patients receiving usual care. The mean (SD) direct costs were €3227 (3546) in the intervention group and €4378 (5487) in the usual care group, mean difference €−1151 (95% CI −2564, 262). The intervention was the dominant treatment with a probability of 94.5% being cost-effective given the willingness-to-pay threshold of €27 500.ConclusionsThe within-trial analysis demonstrated that the multimodal occupational therapy in addition to usual care was cost-effective at 2 years in patients with CMC1 OA.Trial registration number NCT01794754.