Introduction:Carpometacarpal osteoarthritis (CMC OA) is a common problem in mid-older aged adults. Existing guidelines are ambiguous with respect to materials, design and duration of use of orthoses to manage hand OA. A limitation of studies to date is the low dose (hours per day) of orthosis wearing. This study aimed to evaluate the feasibility of investigating the effectiveness of a soft prefabricated orthosis worn at high dose in conjunction with best practice usual care for CMC OA. Methods:Study design: Pragmatic, 2-arm parallel-group feasibility RCT. Adults aged ≥40 years with symptomatic CMC OA were randomised to either best practice usual care or usual care in conjunction with a soft neoprene orthosis prescribed to wear 20 h per day, for 4 weeks. A priori feasibility criteria were: (1) enrolment of 30 participants in 4 months; (2) retention >85% at 6 months; (3) intervention adherence on >80% days; (4) interventions acceptable >90% of participants. Outcome measures were collected at baseline, 4 weeks, and 6 months; analysis used descriptive statistics. Results:Thirty participants were enrolled within 4 months; 97% retained at 6 months. Orthosis wearing achieved ≥20 h on 68% of days. Exercise adherence was 80% on ≥89% of days in both groups. Interventions were acceptable. Clinically significant improvements in pain occurred in both groups. Discussion:High dose orthosis wearing may be acceptable and feasible for managing CMC OA. Orthosis amendments and a wear target of 18 h are recommended for future investigation of this intervention.

ABSTRACT Background Prostate cancer (PCa) is a significant health burden within New Zealand (NZ). Survival gains from prostate cancer have created a shift in focus from survival towards quality of life (QoL) and supportive care during extended survivorship. Method We launched a nation‐wide cross‐sectional survey and recruited three cohorts of 1000 men with prostate cancer (men diagnosed with prostate cancer within 1 year, between 1 and 3 years, and between 3 and 5 years) as well as an additional Māori men group ( N = 4000 in total). The survey instruments measured quality of life, supportive care needs, and care service utilization. Results Analysis of 1075 responses revealed that Māori men experienced lower quality of life and reported greater unmet supportive care needs. Information and psychology needs were mostly reported in both Māori and non‐ Māori groups. Key predictors of these needs included mental health conditions, hormonal imbalances, and employment status. Conclusion The study highlights significant ethnic disparities in the supportive care needs of New Zealand prostate cancer survivors (PCS), emphasizing the necessity for tailored, culturally sensitive healthcare interventions. Addressing the complex determinants of these needs is crucial for enhancing the well‐being of all PCS. Implications for Cancer Survivors Actively seeking health information and mental health counselling would significantly benefit PCS by reducing unmet supportive care needs and improving overall quality of life. This approach encourages survivors to take an active role in their healthcare, potentially leading to better health outcomes and enhanced well‐being.

Prostate cancer treatment can lead to significant long-term side effects that impact patients’ quality of life and supportive care needs (SCN). This study explores the associations between quality of life (QoL) and SCN among prostate cancer survivors, with a focus on the impact of treatment received, care service utilization, and the differences between Māori and non-Māori patients. Random stratified sampling data were collected from 1075 prostate cancer survivors who were diagnosed within the past 5 years. Hierarchical regression analyses examined the associations between QoL domains and SCN, adjusting for demographic, clinical, and treatment-related factors. LASSO (Least Absolute Shrinkage and Selection Operator) was used to select variables to test the interaction effects of different treatments. Significant disparities were found between Māori and non-Māori patients in physical and mental health scores, care service utilization, and overall SCN. Māori men had lower scores in these areas. Most QoL domains were negatively associated with more SCN, particularly mental health and hormonal issues. Androgen deprivation therapy (ADT) exacerbates some negative effects of poor mental health and hormonal issues for non-Māori, while the use of care services and radical prostatectomy (RP) was associated with mitigating SCN for Māori patients. This study highlights the complex interplay between QoL, SCN, and treatment modalities among prostate cancer survivors in New Zealand. The findings underscore the need for culturally tailored supportive care services to address the unique needs of Māori patients.

Background Chronic low back pain (cLBP) is a global health complaint. Acupuncture is an effective therapy for cLBP; however, evidence for an optimal acupuncture practice scheme is limited. Objective This study aimed to determine the feasibility of conducting a randomized controlled trial (RCT) to assess the effectiveness of two acupuncture regimes (sensitized-points acupuncture and routine integrative acupuncture package) for cLBP. Methods This was a two-arm, assessor-blind, randomized-controlled feasibility study. Thirty adult participants with cLBP were randomly assigned into two groups. Each group received 8 sessions of either sensitized-points acupuncture or routine integrative acupuncture package, respectively. Treatments were conducted twice per week. Outcomes were assessed at baseline (week 0), on a weekly basis for four weeks (week 1, 2, 3, 4), and follow-up (week 12). Student's t-tests, Mann-Whitney U tests, Fisher's exact tests, descriptive analyses, and power analyses were used for statistics. Results Participants were recruited over 10 weeks with a recruitment rate of 12 participants per month. The treatment plan in both groups was well accepted and tolerated. Besides, the study was characterized by low adverse event rates (8.0% in Group A, 11.7% in Group B), high completion of the outcome measures (97.8% in Group A, 94.3% in Group B), and high participant retention rate (100% in Group A, 93.8% in Group B). Furthermore, preliminary analyses showed that both regimes of acupuncture were potentially efficacious and safe. Conclusions Conducting a fully powered RCT to evaluate efficacy and safety of two acupuncture regimes in the management of cLBP is feasible.

Abstract Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many. Conclusion Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Background Prostate cancer treatment can lead to significant long-term side effects that impact patients’ quality of life and supportive care needs (SCN). This study explores the associations between quality of life (QoL) and SCN among prostate cancer survivors, with a focus on the impact of treatment choices, care service utilization, and the differences between Māori and non-Māori patients. Methods Random stratified sampling data were collected from 1,075 prostate cancer survivors who were diagnosed within the past five years. Hierarchical regression analyses examined the associations between QoL domains and SCN, adjusting for demographic, clinical, and treatment-related factors. LASSO (Least Absolute Shrinkage and Selection Operator) was used to select variables to test the interaction effects of different treatments. Results Significant disparities were found between Māori and non-Māori patients in physical and mental health scores, care service utilization, and overall SCN. Māori men had lower scores in these areas. Most QoL domains were negatively associated with more SCN, particularly mental health and hormonal issues. Androgen deprivation therapy (ADT) exacerbates some negative effects of poor mental health and hormonal issues for non-Māori, while the use of care services and radical prostatectomy were associated with mitigating SCN for Māori patients. Conclusion This study highlights the complex interplay between QoL, SCN, and treatment modalities among prostate cancer survivors in New Zealand. The findings underscore the need for culturally tailored supportive care services to address the unique needs of Māori patients.

The study aim was to explore the health and well-being experiences of a cohort of older men (>= 45 years old) in the Southern region of New Zealand (Otago and Southland), and how these experiences corresponded with their expectations of ageing. It was hoped this examination of the lived experiences of older men would enhance our understanding of the enablers and challenges to ageing well for older men. Six focus groups were undertaken (n = 28) at three different locations in New Zealand. Participants ranged in age (45-92 years old) and varied in socioeconomic status. Critical studies of men and masculinities theoretical framework was adopted to underpin the study, with narrative data analyzed using a reflexive thematic approach. Three core themes were identified, including finding purpose in work and life, navigating masculine expectations in the ageing process, concerning challenges associated with social role transition. Each of these core themes incorporates a central organizing concept. Rather than steering older men toward predetermined male social roles, our findings suggest the achievement of ageing well to empower them to have life purpose and engagement should become a new expectation for policymaking.

The authors of the manuscript ‘Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review’ [1] disagree with the assertion by McDowell et al. that our manuscript has extrapolation errors.

Objective Performance standards are critical to service design and quality improvement. There are no published standards defining the care inpatients should receive from physiotherapists in Aotearoa New Zealand. This study aims to explore the potential of using clinical practice guidelines (CPGs) to develop a set of evidence-based standards for physiotherapy in inpatient settings.Design A systematic review and content analysis of CPGs.Data sources Scholarly databases (Web of Science, CINAHL and Scopus, PEDro) and grey literature (guideline databases – NICE, SIGN, ECRI guideline trust, Guidelines International Network (GIN)) were searched between July and September 2021.Eligibility criteria CPGs related to conditions and treatments common to physiotherapy in a secondary care setting were included. Mental health conditions, paediatrics, COVID-19 and conditions common to tertiary care were excluded.Data extraction and synthesis A pragmatic approach was taken to group guidelines aligned with common physiotherapy services and select only the most recent and comprehensive guidelines for final analysis. The quality of CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II). Data from guideline recommendations of relevance to inpatient physiotherapy were grouped into themes. Summative ‘statements’ were drafted to represent the content of each theme; these were given a confidence rating based on the number of supporting guidelines and the strength or grade of evidence awarded by the guideline group.Results The recommendations of 32 CPGs yielded 27 statements.Conclusion Twenty-seven statements represent a distillation of the best evidence-based practice recommendations from CPGs in inpatient physiotherapy. Statements of physiotherapy dosage (frequency, intensity and duration) are not available for many areas of practice; researchers and CPG groups should consider the importance of these data for service commissioning.

Little is known about how New Zealand men understand their health and wellbeing as they age and what are the determinants of their healthy ageing. Contiguous and exploratory sequential mixed methods study were conducted with the collection of both focus group and survey data. Methodologically, this abductive process was incorporated within an intersectional framework, providing a comprehensive picture of healthy aging in men across life stages and socioeconomic statuses. Integrated results revealed that for respondents the most significant factors influencing their healthy aging were, life engagement purpose, substance misuse, and masculinity norms. This article contributes to mixed methods research by providing practical applications of incorporating the intersectional model to enhance rigor in designing, conducting, and interpreting mixed methods research.

This pilot survey aimed to explore the feasibility of conducting a nationwide survey investigating the current practice and attitudes towards complementary and alternative medicine (CAM) in New Zealand registered physiotherapists. This was a cross-sectional, online study using a questionnaire developed from previous survey instruments. An electronic link to the questionnaire was distributed via email to members of the Otago Branch of Physiotherapy New Zealand (n = 344). Questions included current clinical practice and use of CAM as well as attitudes and opinions on its effectiveness. Feasibility outcomes of this survey included the response rate and completion rate. Data were analysed in Microsoft Excel®. The response rate was 10.5% (n = 36) and the completion rate was 86.1% (n = 31/36). A range of conditions treated with CAM were cited by respondents; the most frequently treated condition was “back and neck pain” (n = 10/36). Physiotherapists in this sample believed acupuncture and massage are the most effective CAM modalities used for “back and neck pain” treatment and were most likely to use acupuncture and massage as CAM modalities when treating these conditions. Acupuncture was found to be the most common CAM practiced by respondents, and an acupuncturist was the CAM practitioner to which patients are most commonly referred by respondents. This study demonstrated that conducting a nationwide survey is feasible, subject to an improved survey design and increased response rate.

BACKGROUND: Acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. In pathological states, disease-related acupoints are believed to be activated, which is known as acupoint sensitization. OBJECTIVE: This study aimed to investigate the major manifestations of acupoint sensitization in patients with chronic low back pain (cLBP) to provide better understanding of acupoint sensitization phenomena in the context of cLBP. METHODS: This study was a matched-sample cross-sectional study 16 participants diagnosed with cLBP and 16 healthy controls matched in age, sex, and ethnicity were included. The following aspects of sensitization phenomena of targeted points were compared: pressure pain threshold (PPT), skin temperature, surface electrical conductance, receptive field, and morphological change of skin. RESULTS: PPT at points of interest were significantly lower in cLBP participants compared with healthy controls (P < 0.05); in addition, receptive field was found to be larger at left BL 23 in cLBP participants (P < 0.05). There was no statistically significant difference in skin temperature, electrical conductance, or morphology between the two groups. CONCLUSIONS: Reduced PPT at all detected points and enlarged receptive field at left BL 23 were found in cLBP participants. These two features appear key in defining acupoint sensitization in cLBP, and provide evidence for selecting and locating acupuncture points in future clinical studies.

Background: Many men with Parkinson's Disease (PD) do not meet the recommended levels of physical activity (PA) for health benefits. Tailored, meaningful, and culturally sensitive PA health messages may be a catalyst to shape men's motivations toward participation. Objective: We explored the views of New Zealand (NZ) men with PD about existing PA health messages, and how these could be adapted to be more effective.Methods: This qualitative study recruited six community dwelling, regularly physically active, NZ Eu-ropean men with PD (aged 54-69 years, 2-18 years post-diagnosis) from a community exercise class in Canterbury, NZ. Participants engaged in semi-structured interviews which were audio-recorded, tran-scribed verbatim, and analyzed inductively for themes.Results: Participants expressed that effective PA health messages should reflect men's motivations for PA which included physical and mental well-being and social connection. Inclusive, positive, and relatable language and imagery were considered crucial PA message communication strategies. Participants viewed health professionals' PA advice as superficial and unhelpful; however, celebrities with PD were considered inspirational messengers. Messages endorsed by trustworthy sources, such as the Parkinson's Society, were perceived to enhance the credibility.Conclusions: Effective PA messages should be gain framed and tailored to the target audience. We recommend health professionals provide comprehensive PA advice or consider onward referral. Future research which uses a co-design participatory methodology to collaborate with men with PD from culturally diverse backgrounds and represent all stages of PA behaviour change is recommended to provide comprehensive insights for meaningful, effective, and culturally sensitive PA health messaging. (c) 2022 Elsevier Inc. All rights reserved.

STarT Back is a stratified care approach to identify and manage psycho-social factors for persisting low back pain and associated disability. A STarT Back course was held at the School of Physiotherapy, University of Otago, in June 2019, introducing a small cohort of physiotherapists (n = 20) to the approach, including psychologically informed interventions. The study aim was to gain insight into these physiotherapists’ perceptions of the feasibility of implementing STarT Back in their own practice and more widely in New Zealand. Semi-structured focus group interviews were conducted with 14 physiotherapists who attended the training course and had subsequently used STarT Back to different extents in their own practice. Data were analysed using reflexive thematic analysis. Six themes were identified: confidence in current practice; STarT Back as a useful framework; concerns over the low-risk group; difficulties in translation; education is essential; and behaviour change. The need for behaviour change was a unifying theme with interpretation aided by the Capability, Opportunity, and Motivation Behaviour (COM-B) model. Practical suggestions to enhance implementation were made, with participants identifying strategies that promoted use of STarT Back in their practice. Issues identified included concerns about care for low-risk patients, health system structure and funding, and resistance to changing usual practice. Participants were cautious about the feasibility of wider implementation of STarT Back in New Zealand.

PURPOSE:The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. MATERIALS AND METHODS:A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. RESULTS:The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. CONCLUSION:The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.

Background Pain affects the majority of patients with inflammatory bowel disease (IBD), where pain experiences may be influenced by multiple patient factors and changes within central pain processing pathways, termed central sensitization. The current study aimed to investigate pain processing pathways in patients with IBD through somatosensory testing and associations with multiple patient factors. Methods A cross-sectional study of adults with IBD. Assessments included: somatosensory tests [i.e. pressure pain thresholds (PPT), temporal summation (TS), conditioned pain modulation (CPM)], and patient factors (i.e. demographics, comorbidity, sleep quality, psychological, pain severity and interference, and IBD features). Multiple regression analyses explored associations between somatosensory tests and multiple patient factors. Results Decreased CPM in participants (N = 51) was associated with worse abdominal pain severity and use of biologic therapies (R-2 = 0.30, F(5,44) = 5.18, P = 0.001). Increased TS was associated with biologic use (R-2 = 0.11, F(1,49) = 6.13, P = 0.017). Decreased PPT at the low back (R-2 = 0.29, F(2,48) = 11.21, P < 0.001) and Tibialis anterior (R-2 = 0.41, F(2,48) = 18.26, P < 0.001) were associated with female sex and the absence of a stoma. Conclusion Study results demonstrated associations between multiple patient factors and somatosensory tests in patients with IBD. The absence of a stoma and female sex was associated with greater sensitivity to pressure in two remote body regions, suggestive of widespread hyperalgesia. Worse abdominal pain severity and biologic use were associated with decreased pain inhibition, and biologic use was also associated with increased pain facilitation. These findings suggest the presence of altered pain processing and mechanisms of central sensitization in patients with IBD.

Background: Healthcare clinical decision makers' (CDMs) attitudes, beliefs, and biases can negatively contribute to both clinical conversations and subsequent inequitable management decisions in persistent musculoskeletal pain (PMP). Understanding the factors that may contribute to CDMs' decisions is particularly important for vulnerable patient populations. Objectives: The aim of this systematic review was to synthesize the current research investigating the impact of CDM's attitudes, beliefs, and biases on the process of care in PMP management in adults. Methods: A systematic search following PRISMA guidelines was run in five databases: CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science. Included studies: vulnerable adult populations with chronic pain. Methodological quality was assessed with the Downs and Black tool. Results: Nine studies were included. Studies examined CDMs' perceptions of case vignettes used in medical schools, allied health professional programs, and in healthcare settings. Implicit biases related to pain severity and favoring medical evidence influenced CDMs' perceptions of case legitimacy. Pharmaceutical management decisions were influenced by race/ethnicity, gender, pain severity, medical evidence, and non-verbal patient behavior. Pain severity influenced non-pharmaceutical management decisions. Conclusion: Implicit biases related to race/ethnicity, gender, supporting medical evidence, and pain severity were demonstrated in educational settings and persisted in clinical settings. Health professional curricula should include training with a focus on outcomes that demonstrate increased awareness of the factors that could lead to inequitable management decisions. Addressing biases during the training of CDMs will be necessary to improve congruency of clinical conversations and minimize marginalization of patient care in PMP.

Objective Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables, including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. Design The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and health care providers (HCPs) involved in the clinical conversation about CMP, and 2) examine whether and how these perceptions impacted the process of care. Methods A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Included studies were those investigating vulnerable adult populations with chronic pain. Study bias was examined with the Downs and Black tool. Results Seven retrospective studies were included. When making pharmaceutical management decisions, HCPs demonstrated negative implicit biases toward minorities and women. When making referrals to multidisciplinary care, HCPs demonstrated negative implicit biases toward women with lower educational attainment. Unmet patient expectations resulted in higher dropout rates at multidisciplinary pain management programs. Patients' trust was influenced by the health care setting, and patients often had limited options secondary to health insurance type/status. Conclusion These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and the health care setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited health care choices.