Table 8 Integration of efficacy findings
Topic/domain | Quantitative findings | Qualitative findings | Level of consensus | Key interpretations |
|---|---|---|---|---|
Pain | BPI domains Worst pain, least pain, pain now • No change in group median Pain interference • Group median decrease of 1.58 points PSEQ • Group median decrease of 6 points | (Adam, SHA) — “What I mean by that is it’s not so much the pain is necessarily less, it’s the confidence with which you can cope with it has improved.” (Bill, SHA) — “I’ve got… It’s just less pain. All the pain is less, if that makes sense. The pain is a little less. It’s still there but… Like, for example, bending … that kind of movement is now not sparking as many issues.” (Adam, SHA) — “you kind of… it sort of carries the pain. I don’t know how to put it. It’s like the pain becomes a passenger as opposed to a driver. It’s not the dominant thing that I’m thinking about now.” (Carl, SHA) — “It’s always maintained the same, my pain is consistent. So whether I felt any extra pain after doing the exercises – no more than I normally would from doing those kind of exercises, which I’ve done my whole life. So there was nothing… no difference in pain to report over the six weeks period” | Expansion | PROMs suggest limited effect of intervention; however, qualitative data highlight positive individual changes on day-to-day activity despite pain Highlights value and importance of evaluating the personal experience of interventions targeting pain |
Function | HAL • Small increase group median of 5.4 points PSFS • No change | (Hugh, SHA) — “It does make you realise that it’s one of those things where the strength of your body will help with the arthritis. I think that’s something I didn’t really consider that much, whereas now I’m a bit more aware of it.” (Mark, SHA) — “Well, it was just showing me that actually I… I find certain things difficult to do and I realised that they all find them difficult to do as well, so it’s not just me being particularly bad.” (Adam, SHA) — “There’s still a bit of pain going upstairs – the most tangible thing that’s improved is going up and down stairs with both legs as opposed to one… using my left leg only and my right leg, with the weak quads and things, the one where I had the knee replacement… So, I just feel more in control of it. And your balance is a little bit better.” | Expansion | Appears to be a functional improvement which is only noticed after taking part Identifying goals upfront may not be effective if people are unaware what has potential to change |
Quality of life | EQ5D5L — VAS • Increase in group median of 5 points EQ5D5L — Utility • Decrease in group median = 0.26 MSK-HQ • Group median increase = 9 points | (Adam, SHA) — “It really opened my eyes to how important it is, how quickly it can make a difference to your body. And I just wish I’d been doing this much earlier.” (Luke, SHA) — “This really makes you feel like someone’s listening and someone’s caring enough to do something –that’s another hidden benefit, is that you’re feeling part of… you and the unit are feeling part of the same thing. Which is great.” (Liam, SHA) — “I feel better… I mean, for exercising. And I think the process of doing the exercising is good mentally and afterwards you feel “Yeah, I’ve done it.” | Discrepancy | Minimal change in QoL measures — however, qualitative findings indicate individual positive changes in mood and seeing/feeling physical changes |
Subjective view of improvement | Patient global impression of change (n = 7) • Worse (n = 1) • No/minimum change (n = 4) • Much improved (n = 2) | (Luke, SHA) — “It was very useful, it was very beneficial. I could see a need for it, I could see a desire for it, even if the person is not necessarily aware of the desire for it. I felt good doing it. I think it would be useful to me.” (John, SHB) — “And there’s no doubt that if you’re doing structured exercises they have a positive impact on your wellbeing and your health because you get more adept at doing them, then you can have more of an exertion because you’re putting more into them, and you do… it does uplift you that kind of physical activity” (Adam, SHA) — “I think I do feel a bit bouncier. And that has effects on mood as well as your general… the mobility that goes with greater fitness. It’s not that it’s affecting the target joints particularly; it’s more that it’s affecting everything around it.“ | Discrepancy | |
Behavioural modifications | (Liam, SHA) — “Yes, it’s probably given me a bit more impetus, again, to do more now I’ve been shown… you know, doing exercises at home and ways of doing it and different types of exercises.” (Carl, SHA) — “To be honest with you, I could be doing more.” And she said, “Right, ok, cool.” And so I said, “So, you’re all right if I just do more… obviously not pushing it or going to crazy levels, but just… If you’re in a position where you can do your exercises…” So, I did it every other day.” (Jack, SHA) — “at the moment, yes, I still have that enthusiasm and want to do it and get on with it and do something about it. But in a month, two months later… I can’t say anything.” (John, SHB) — “Since the programme finished – it was only a week or so ago, a couple of weeks ago – I’ve tried doing some of those exercises on my own because I think they’re worth carrying on with.” | Silence in quantitative data | Inclusion of BCTs to encourage participation was successful — some participants describe a desire to change or actively implementing changes to change |