Generated by All in One SEO v5.0.0.1, this is an llms.txt file, used by LLMs to index the site. # JIGSAW-E Supported self-management for joint pain ## Sitemaps - [XML Sitemap](http://172.26.8.185/sitemap.xml): Contains all public & indexable URLs for this website. ## Pages - [Home](http://172.26.8.185/) - [Contact Us](http://172.26.8.185/contact-us/) - To contact the JIGSAW-E team, email health.iau@keele.ac.uk - [Guidebook](http://172.26.8.185/patient-focus/guidebook/) - Osteoarthritis Guidebook You can read the osteoarthritis guidebook using the links below to navigate through the different chapters to learn more about this condition and how you can manage it. You can also download your copy of the guidebook by clicking this link - Osteoarthritis Guidebook Personal experiences of joint pain Understanding OA Seeking - [Laura Swaithes](http://172.26.8.185/jigsaw-e-team/laura-swaithes/) - PhD Student Laura Swaithes is a Physiotherapist and a Clinical Academic Research Fellow at Keele University. Her Ph.D. work focusses on knowledge mobilisation and the barriers and facilitators to implementation in primary care. This is a multiple-methods qualitative project looking at the 'lessons learned' from MOSAICS and JIGSAW to identify the components required to optimise - [Tina Hadley-Barrows](http://172.26.8.185/jigsaw-e-team/tina-hadley-barrows/) - JIGSAW-E Physiotherapy Champion Tina Hadley-Barrows qualified from the Queen Elizabeth School of Physiotherapy, University of Birmingham 1991 and went on to complete MSc in Human Factors at Nottingham University 1999. She has sought out and created opportunities to be involved with research throughout her career. Currently Tina has a Dual role: Physiotherapy Research Facilitator and - [Laura Campbell](http://172.26.8.185/jigsaw-e-team/laura-campbell/) - Impact Accelerator Unit Project Support / JIGSAW-E Knowledge Broker Laura supports the coordination of implementing quality innovations into real world practice, bridging the evidence to practice gap. The role supports clinical and academic members of the IAU to deliver key innovation projects through collaborations between the West Midlands Academic Health Science Network (AHSN), national and - [Steven Blackburn](http://172.26.8.185/jigsaw-e-team/steven-blackburn/) - Research Design Service / JIGSAW-E Patient Involvement Lead In his role with the Research Design Service, Steven provides methodological expertise for Patient and Public Involvement and Engagement (PPIE) in research for the West Midlands region, including the iPCHS and Faculty of Medicine and Health Sciences, Keele University. As the lead of the iPCHS’ Patient and - [Simon Wathall](http://172.26.8.185/jigsaw-e-team/simon-wathall/) - Health Informatics Specialist Simon Wathall works as a member of the Research Institute for Primary Care & Health Sciences assisting researchers, study teams, the Clinical Trials Unit, the Impact Accelerator Unit, AHSN and CRN West Midlands to provide advice and skills on using existing GP clinical systems for research and implementation. Responsible for the design - [Colin Stanford](http://172.26.8.185/jigsaw-e-team/colin-stanford/) - JIGSAW-E GP Champion Dr Colin Stanford, MbChB, DRCOG, MRCGP General Practitioner Clinical Champion OA Member Shropshire’s Primary Care Commissioning Committee Dr. Colin Stanford has been a GP in Much Wenlock and Cressage for 28years and a former board member of Shropshire Clinical Commissioning Group. As the chair of the South Shropshire Locality group for three - [Hazel Lambourne](http://172.26.8.185/jigsaw-e-team/hazel-lambourne/) - OA Nurse Champion My role has involved supporting practice nurses and health care assistants in promoting self management amongst patients suffering with Osteoarthritis. This covers areas such as assessment of pain and use of relevant analgesia, advice and demonstration of exercises relevant to the affected joints, advice on diet and weight loss if appropriate, signposting - [Johny Quicke](http://172.26.8.185/jigsaw-e-team/johny-quicke/) - NIHR Academic Clinical Lecturer in Physiotherapy / JIGSAW-E Physiotherapy Champion I am an NIHR Academic Clinical Lecturer in Physiotherapy with a focus on osteoarthritis and long-term conditions. Through this varied role I am involved with osteoarthritis research, implementation (helping facilitate the uptake of the latest osteoarthritis research evidence into clinical practice), and clinical work as - [Andrew Finney](http://172.26.8.185/jigsaw-e-team/andrew-finney/) - Clinical Academic, JIGSAW-E Nurse Champion Andrew has been a nurse for 18 years and in that time has developed expertise in rheumatology nursing and primary care musculoskeletal research. Andrew is a clinical academic at Keele University undertaking roles in education, research and clinical practice. Andrew’s PhD allowed him to research and to work with patients - [Louise Warburton](http://172.26.8.185/jigsaw-e-team/louise-warburton/) - GPwSI in Rheumatology and Musculoskeletal Medicine / JIGSAW-E GP Champion • I graduated from Manchester University in 1985 and have worked as a GP since then. • I obtained the Diploma in Musculoskeletal Medicine in 2009. • I am a fellow of the Royal College of General Practitioners • I am currently a GPwSI in - [Vince Cooper](http://172.26.8.185/jigsaw-e-team/vince-cooper/) - Senior Lecturer in General Practice / JIGSAW-E GP Champion Dr. Vince Cooper’s main role within the Implementation Team is to lead the roll-out of the Osteoarthritis (JIGSAW) programme in Shropshire, with a view to implementing it more widely, including our European initiative, JIGSAW-E. Vince’s main interest and expertise is in education; in this context, developing - [Lizzie Cottrell](http://172.26.8.185/jigsaw-e-team/lizzie-cottrell/) - General Practitioner Partner, NIHR Academic Clinical Lecturer in Primary Care and Senior Lecturer in General Practice/ JIGSAW-E PI Dr Lizzie Cottrell is a General Practitioner Partner and an NIHR Academic Clinical Lecturer in Primary Care. Her Ph.D. focussed on the attitudes and beliefs of GPs regarding clinical knee osteoarthritis. She has now taken this work - [Helen Duffy](http://172.26.8.185/jigsaw-e-team/helen-duffy/) - Head of NHS Partnerships and Engagement / Impact Accelerator Unit Deputy Director As Head of NHS Partnerships Helen works closely with Keele’s local, regional and national partners to drive forward high quality evidence based practice. A Keele graduate in 1990 Helen quickly joined the NHS in North Staffordshire, always enjoying a strong partnership with Keele - [Krysia Dziedzic](http://172.26.8.185/jigsaw-e-team/krysia-dziedzic/) - JIGSAW-E Academic Project Lead / Impact Accelerator Unit Director Biography to follow - [Nicki Evans](http://172.26.8.185/jigsaw-e-team/nicki-evans/) - Impact Accelerator Unit Project Manager Nicki Evans’ role is to support the evidence to practice gap by managing the operational delivery of key innovation projects for the Impact Accelerator Unit supported through the Research Institute for Primary Care and Health Sciences (iPCHS), Keele University. She takes the lead for the project management of all impact projects and - [Home](http://172.26.8.185/home-2/) - [Guidebook flipbook](http://172.26.8.185/guidebookflipbook/) - [Guidebook](http://172.26.8.185/delivery-toolkit/guidebook/) - Patient information (Osteoarthritis Guidebook) The full pages of the guidebook can be found here: https://www.jigsaw-e.com/patient-focus/guidebook/ England Background: Within MOSAICS, the Keele University Osteoarthritis Guidebook was developed by patients for patients. This was updated in 2014, in line with the NICE guideline update. Within the trial, positive patient and professional feedback about the guidebook was obtained. - [Support for mental health and long term pain](http://172.26.8.185/patient-focus/support-for-mental-health-and-long-term-pain/) - BeeFree is a new website which offers support for patients and clinicians who are dealing with mental health challenges in the context of long term pain, such as osteoarthritis pain. BeeFree offers: An information resource for local help An animation about living with long term pain and how it affects mental health Training for clinicians - [Links to external resources](http://172.26.8.185/delivery-toolkit/links-to-external-resources/) - Resources Versus Arthritis - https://www.versusarthritis.org/ Keele Pain Recorder app - https://www.keele.ac.uk/kpr/ STarT Back – https://www.keele.ac.uk/sbst/startbacktool/ Impact Accelerator Unit – tbc INVOLVE - http://www.invo.org.uk/ EULAR - https://www.eular.org/index.cfm Keele University & Royal Collage of General Practitioners Training:https://www.arthritisresearchuk.org/health-professionals-and-students/core-skills-in-msk-care.aspx MSK-HQ - https://www.keele.ac.uk/pchs/implementingourresearch/makinganimpact/musculoskeletalpain/msk-hqhealthquestionnaire/ CSP physiotherapy innovations database (Leek JIGSAW physio model service evaluation): https://innovations.csp.org.uk/innvocation/implementing-and-evaluating-pilot-physiotherapist-led-osteoarthritis-clinic-general BeeFree - Support for mental health and - [Delivery toolkit](http://172.26.8.185/delivery-toolkit/) - In this section you will find information and resources you may find useful to deliver JIGSAW-E. This includes patient information and posters for health practices, an area where you can download the e-template, guides to the project for patients and partners and links to external resources. Training Materials Template Downloads Guidebook Patient Information Leaflets/Posters GP - [Patient co-produced resources](http://172.26.8.185/patient-focus/patient-co-produced-resources/) - What is co-production? Co-production varies greatly, but usually involves a team of professionals working together with patients to create research, or to implement that research. Co-production can be a deliberative process which requires public members and professionals to be involved on an equal footing throughout every stage. How has co-production been used in JIGSAW-E? - [Patient focus](http://172.26.8.185/patient-focus/) - Patient Focus Within these pages you will find information for patients with osteoarthritis. In partciualar: Osteoarthritis Guidebook Patient Champions and Patient Champion Stories Patient Co-Produced Resources Community of Practice and the Patient Panel Influencing the Wider Public How Patients have Shaped JIGSAW-E Support for mental health and long term pain All the information has been - [Natural History](http://172.26.8.185/prioritising-osteoarthritis/natural-history/) - Prioritising OA: natural history It is a myth that osteoarthritis inevitably gets worse. We now know that various patterns for patient symptoms exist, including a group who has mild, non-progressive symptoms. Flares, which are often characterised to patients as a worsening of their symptoms (such as pain), are common and can last for a variable - [JIGSAW-E](http://172.26.8.185/enhancing-care/journey-from-research-to-implementation/jigsaw-e/) - JIGSAW-E Joint Implementation of Guidelines for oSteoArthritis in Western Europe (JIGSAW-E) Osteoarthritis (OA) is a leading cause of joint pain and years lived with disability worldwide. OA causes considerable detrimental impact on patients’ daily activities and quality of life. People with OA desire high quality care, support and information about OA. The internationally recognised UK - [How patients have shaped JIGSAW-E](http://172.26.8.185/patient-focus/how-patients-have-shaped-jigsaw-e/) - How patients have shaped the JIGSAW-E project The views of Patient Champions about their involvement in the JIGSAW-E project (15 responses) Illustrative quotes: “I had read information provided throughout my involvement and I had also asked questions wherever relevant” “I take my understanding of the overall objectives and then, as an individual, apply - [Influencing the wider public](http://172.26.8.185/patient-focus/influencing-the-wider-public/) - Influencing the wider public The LINK group (Lay Involvement in Knowledge Mobilisation) champion the patient voice in Impact Accelerator Unit projects, ensuring that the implementation of evidence based innovations into healthcare practice maintains a strong patient focus and maximises positive health benefits nationally and internationally. The LINK consists of members of the patient groups and - [Patient champions and patient champion stories](http://172.26.8.185/patient-focus/patient-champions-and-patient-champion-stories/) - What is a Patient Champion? The JIGSAW-E Community of Practice is made up of various champions, all tasked with promoting and supporting the project in their respective fields of expertise. Just as there are physiotherapy champions, nurse champions and GP champions, there are also patient champions. Patient Champions are a core group of patients with - [Understanding OA](http://172.26.8.185/patient-focus/guidebook/understanding-oa/) - What is OA? OA has been identified in skeletons of humans and animals that lived hundreds of years ago. Any of the joints in the body can be affected, though it is most common in the hands, knees, hips and spine. Joint pain is more common amongst people in certain occupations. For example, OA of - [Feeling positive](http://172.26.8.185/patient-focus/guidebook/feeling-positive/) - Feeling positive Adjusting to change Having joint pain may affect a person’s ability to get out and about, carry out tasks at work and in the home, and pursue hobbies and interests. This understandably can lead to feelings of frustration and depression. “I knew I was depressed, but I went with the understanding that the - [Adding to the Essentials](http://172.26.8.185/patient-focus/guidebook/addingtotheessentials/) - Managing and treating joint pain: Adding to the essentials The treatments described in this chapter will probably sound more like ‘medical treatments’ than those described in chapter 4. They are not, however, meant to replace those essential ways of managing joint pain for which there is evidence of effectiveness – physical activity, suitable footwear, losing - [Examining the Essentials](http://172.26.8.185/patient-focus/guidebook/examining-the-essentials/) - Examining the essentials The main concern of most people who have joint pain is to continue to be active, and to be able to do the things they want to do, despite problems with their joints. This chapter will consider basic ways of dealing with the symptoms of OA. You may not think of these - [Seeking professional help](http://172.26.8.185/patient-focus/guidebook/seeking-professional-help/) - Seeking professional help About one in six of all consultations with GPs is for joint or muscle pain. In a one-year period about a half of people aged over 50 have a spell of knee pain, though only one in three of them see their doctor about their problem. Many people who have painful joints - [Personal experiences of joint pain](http://172.26.8.185/patient-focus/guidebook/personal-experiences-of-joint-pain/) - Personal experiences of joint pain On this page you will find experiences of osteoarthritis from the point of view of people who have it. Experiencing symptoms Joint pain and stiffness are very common in people after middle age. While pain usually goes away with rest, stiffness may get worse. Some people’s symptoms start so very - [Privacy and Cookies](http://172.26.8.185/privacy-and-cookies/) - Keele University is committed to ensuring visitors’ privacy whilst viewing University web pages. This page explains the types of data collected and how this information will be used. Access to information Keele University web servers automatically log each visit that they receive. This data contains some information about you; The Internet address of the computer - [Joint Pain in Physiotherapy Video Training](http://172.26.8.185/joint-pain-in-physiotherapy-video-training/) - How first contact physiotherapists can enhance care for people with osteoarthritis Welcome: Welcome to the “First contact physiotherapist osteoarthritis training programme”. These modules will provide high quality training for implementing best practice consultations & care for people with osteoarthritis. Course format and aims: This course is split into 5 sections of between 5 and - [Resources for physiotherapists](http://172.26.8.185/delivery-toolkit/resources-for-physiotherapists/) - Physio workshop slides Physio workshop outline OA vignettes for physios - [Training materials](http://172.26.8.185/delivery-toolkit/training-materials/) - Best Practice for Osteoarthritis Top tips for diagnosis Unhelpful and helpful comments The role of GPs and Rheumatologists Health Professionals - understanding roles In this section you will find links to training guides and narratives from patients who have had treatment for the osteoarthritis which is based on the JIGSAW-E innovations. - [Recommended care and NICE guidance](http://172.26.8.185/prioritising-osteoarthritis/recommended-care-and-nice-guidance/) - Exercise and Self Management NICE Guidelines The National Institute for Health and Care Excellence (NICE) has recommended core, evidence-based management approaches that should be undertaken for everyone with osteoarthritis and a suite of approaches that can be used to support patients to undertake core treatment and manage their symptoms. Core treatment for osteoarthritis - [Patient information](http://172.26.8.185/enhancing-care/jigsaw-e-innovations/patient-information/) - Osteoarthritis Guidebook You can read more about the osteoarthritis guidebook, developed for patients by patients, here - https://www.jigsaw-e.com/patient-focus/guidebook/ - [Prioritising osteoarthritis](http://172.26.8.185/prioritising-osteoarthritis/) - Prioritising osteoarthritis Osteoarthritis is common and particularly so in people aged 45 years and older. It causes joint pain and stiffness and, consequently, problems with mobility and function. These symptoms, which occur most frequently in knees, hips, hands/wrists and feet/ankles, can result in negative outcomes such as lost days from work, inability to undertake caring - [Vocational advice - EMIS template](http://172.26.8.185/delivery-toolkit/vocational-advice-emis-template/) - Here you will find EMIS install and usage instructions for the AHP fit note, which was developed by Keele as part of the I-SWAP project (Implementation of the study of work and pain - equipping First Contact Practitioners with vocational advice knowledge and training to better support patients to get back to, or stay in - [Osteoarthritis leaflet](http://172.26.8.185/osteoarthritis-leaflet/) - Osteoarthritis leaflet You can download a shorter version of the Osteoarthritis Guidebook in pdf format here: OA guidebook short version 2019 FINAL 4.12.19 - [Leaflet word version](http://172.26.8.185/leaflet-word-version/) - Please click here to download a pdf of the word only version of the short osteoarthritis leaflet. This can be uploaded into clinical systems for easier distribution to patients. Osteoarthritis short version - word - [Further information](http://172.26.8.185/patient-focus/guidebook/further-information/) - Further information NHS THERAPISTS OFFICIAL BODIES Telephone or visit the web sites to find a therapist in your area. Physiotherapy: The Chartered Society of Physiotherapy (CSP) 14 Bedford Row London WC1R 4ED Telephone: 020 7306 6666 Website: www.csp.org.uk Occupational Therapy: Royal College of Occupational Therapists 106-114 Borough High Street Southwark London SE1 1LB. Telephone: - [Managing and treating joint pain: Examining the essentials](http://172.26.8.185/delivery-toolkit/guidebook/managing-and-treating-joint-pain-examining-the-essentials/) - Examining the essentials The main concern of most people who have joint pain is to continue to be active, and to be able to do the things they want to do, despite problems with their joints. This chapter will consider basic ways of dealing with the symptoms of OA. You may not think of these - [Managing and treating joint pain: Adding to the essentials](http://172.26.8.185/delivery-toolkit/guidebook/managing-and-treating-joint-pain-adding-to-the-essentials/) - Managing and treating joint pain: Adding to the essentials The treatments described in this chapter will probably sound more like ‘medical treatments’ than those described in chapter 4. They are not, however, meant to replace those essential ways of managing joint pain for which there is evidence of effectiveness – physical activity, suitable footwear, losing - [Hand osteoarthritis education](http://172.26.8.185/delivery-toolkit/hand-osteoarthritis-education/) - Osteoarthritis of the hand - educational videos Core elements of the 2018 EULAR recommendations for the management of hand osteoarthritis include patient information, hand exercises and information on joint health and education. However, these recommendations do not provide information about the specific type of exercises and the specific content of patient education. To fill this - [Patient information leaflets / posters](http://172.26.8.185/delivery-toolkit/patient-information-leaflets-posters/) - The Impact Accelerator LINK group (Lay Involvement in Knowledge Mobilisation), along with members of Keele’s Research User Group, have co-produced the following information resources for the public to raise awareness of the JIGSAW-E approach. Tasked with answering the question ‘how do we make the public aware that this resource is available’, members of the LINK - [Training Guides](http://172.26.8.185/delivery-toolkit/training-materials/training-guides/) - On line training for support staff OA single workshop for GPs 2016 Keele Physio OA workshop combined slides with refs JIGSAW-E Training Outline ARUK Hands-on leaflet GPN JIGSAW Workshop 1 (June 2018) GPN JIGSAW workshops GPN plan (June 2018) GPN JIGSAW Workshop 2 (June 2018) (1) Flowchart for pharmacies JIGSAW PHARMACY PILOT INFOGRAPHICS - [Lessons](http://172.26.8.185/lessons/) - [Courses](http://172.26.8.185/courses/) - Prioritising osteoarthritis Osteoarthritis is common and particularly so in people aged 45 years and older. It causes joint pain and stiffness and, consequently, problems with mobility and function. These symptoms, which occur most frequently in knees, hips, hands/wrists and feet/ankles, can result in negative outcomes such as lost days from work, inability to undertake caring - [JIGSAW / E innovations](http://172.26.8.185/enhancing-care/jigsaw-e-innovations/) - JIGSAW(-E) innovations https://youtu.be/9rFzDnjhf5E Four key innovations are at the heart of JIGSAW(-E). Each was tested within MOSAICS. Osteoarthritis Guidebook Quality Care Measures Model consultation Training - [MOSAICS research project](http://172.26.8.185/enhancing-care/journey-from-research-to-implementation/mosaics-research-project/) - The MOSAICS study is a mixed methods study with a nested cluster Randomised Controlled Trial (RCT), based in eight general practices (four intervention and four control), to investigate the feasibility, acceptability and impact of implementing a new approach to supporting self-management for OA in primary care; the Model OA Consultation (MOAC) intervention, developed according to - [Jigsaw-E Team](http://172.26.8.185/jigsaw-e-team/) - To contact the JIGSAW-E team, email health.iau@keele.ac.uk - [Quality indicators of care](http://172.26.8.185/enhancing-care/jigsaw-e-innovations/quality-indicators-of-care/) - Quality indicators of care Two tools to support collection of data regarding quality indicators of care have been developed and implemented: E-template Patient reported quality indicators of care questionnaire E-template Background: Within MOSAICS, an e-template was developed to aid recording of indicators of high-quality care that were historically poorly captured on within routine primary - [Journey from research to implementation](http://172.26.8.185/enhancing-care/journey-from-research-to-implementation/) - Journey from research to implementation JIGSAW-E is the result of a linked series of projects from research (MOSAICS) through local implementation of innovations (JIGSAW) to international pilots (JIGSAW-E) MOSAICS - Eight general practices in collaboration with /Keele University JIGSAW - Fifteen pilot general practices in South Shropshire, UK JIGSAW-E - UK practices and European pilot - [Enhancing care](http://172.26.8.185/enhancing-care/) - JIGSAW-E Enhancing Care Welcome to JIGSAW-E. https://youtu.be/PQO5aWfG-UE In this section you will find out about the history of the project, from the original MOSAICS research trial, to the first implementation pilot JIGSAW in the West Midlands, onto the European roll out of JIGSAW-E. You will also find more information about the four key innovations, our - [Training](http://172.26.8.185/enhancing-care/jigsaw-e-innovations/training/) - Training Background: Within MOSAICS, training was provided to GPs and practice nurses. The GP training was undertaken in three two-hour sessions and a single one-hour session, a four-day training course for practice nurses was delivered. Training was designed to equip healthcare professionals to deliver the model osteoarthritis consultation (MOAC) and to support and enable patients - [Model consultation](http://172.26.8.185/enhancing-care/jigsaw-e-innovations/model-consultation/) - Model Consultation Background: The content of a model osteoarthritis consultation (MOAC) was developed through a consensus exercise involving clinicians and osteoarthritis experts for MOSAICS. Healthcare professionals were subsequently trained to deliver the content of the MOAC, supported by the e-template and Keele University Osteoarthritis Guidebook. Supporting evidence MOSAICS protocol paper: Dziedzic KS, Healey EL, Porcheret - [Template downloads](http://172.26.8.185/delivery-toolkit/template-downloads/) - Here you will find the e-template to download. Please submit your details in the form provided and the download of the e-template will begin once you have submitted your details. JIGSAW-e EMIS files for sharing SystmOneTemplates OA eTemplate JIGSAW-e If you have any problems please contact Simon Wathall, s.wathall@keele.ac.uk - [The global burden of OA](http://172.26.8.185/prioritising-osteoarthritis/the-global-burden-of-oa/) - Prioritising OA: the global burden of OA Globally, osteoarthritis has been rising as one of the leading causes of years lived with disability both due to its functional effects and high world-wide prevalence. In the UK alone, 8.75 million people have sought treatment for osteoarthritis and frequent consultation rates for osteoarthritis are consistent internationally. Given - [JIGSAW](http://172.26.8.185/enhancing-care/journey-from-research-to-implementation/jigsaw/) - JIGSAW Joint Implementation of Guidelines for oSteoArthritis in the West Midlands (JIGSAW) The aim of JIGSAW was to translate successful research findings into real world clinical practice to improve the quality of primary care in consultations for osteoarthritis (OA) across the West Midlands. Osteoarthritis (OA) is a leading cause of joint pain and years lived - [Patient and project partners guides](http://172.26.8.185/delivery-toolkit/patient-and-project-partners-guides/) - The JIGSAW-E team have created a series of 7 guides to support both patients and project partners in the implementation of the JIGSAW-E approach. These guides cover patient involvement, aims of the project and tips and advice around communication. - [Quality indicator questionnaires](http://172.26.8.185/delivery-toolkit/quality-indicator-questionnaires/) - These Quality Indicators for osteoarthritis have been refined by UK members of the Patient Panel. They took existing Quality Indicators developed by UK and Norway researchers and combined what they felt were the most appropriate questions to use. - [Pain app](http://172.26.8.185/delivery-toolkit/pain-app/) - The Keele Pain Recorder (KPR) is a mobile application (app) which was developed by patients for patients, to improve the management of pain. Led by Dr John Bedson, a Senior Lecturer at the Research Institute for Primary Care and Health Sciences and General Practitioner. The app, which was designed by a team of researchers and - [GP screen slide set](http://172.26.8.185/delivery-toolkit/gp-screen-slide-set/) - [Patient narratives](http://172.26.8.185/delivery-toolkit/training-materials/patient-narratives/) - Overcoming joint pain Angela’s story My feet are killing me! How often have we said this when actually - we’re killing them! Why? Because we’re over­weight! Arthritic joints and weight gain are all too common, but I know now that it is possible to reverse the trend, relieve the pain and get moving again - - [Terms and Conditions](http://172.26.8.185/terms-and-conditions/) - Terms and Conditions This page tells you the terms of use which you agree to when you use JIGSAW-E.com Using JIGSAW-E.com You agree to use this site only for lawful purposes, and in a manner that does not infringe the rights of, or restrict or inhibit the use and enjoyment of, this site by any - [Reset Password](http://172.26.8.185/register/resetpass/) - [Lost Password](http://172.26.8.185/register/lostpassword/) - [Log Out](http://172.26.8.185/register/logout/) - [Register](http://172.26.8.185/register/) - [Log In](http://172.26.8.185/register/login/) - [Glossary](http://172.26.8.185/glossary/) - [Impact on other diseases](http://172.26.8.185/prioritising-osteoarthritis/impact-on-other-diseases/) - Prioritising OA: impact on other diseases Osteoarthritis commonly occurs alongside conditions such as cardiovascular disease, diabetes, obesity and depression. Further, among all patients with two or more long-term conditions, osteoarthritis is commonly one of these. This is problematic for a number of reasons, firstly, pain and mobility problems can present barriers to patients engaging completely - [Impact on patients](http://172.26.8.185/prioritising-osteoarthritis/impact-on-patients/) - Prioritising OA: the impact on patients Osteoarthritis is associated with many negative consequences for patients, the population and society. Not least, osteoarthritis is consistently found to have a negative impact on patients’ quality of life. There are multiple contributors to this, including pain, reduced ability to function, low mood and fatigue. Further, misconceptions about osteoarthritis - [Implementation models in JIGSAW-E](http://172.26.8.185/enhancing-care/implementation-models-in-jigsaw-e/) - Implementation models in JIGSAW-E JIGSAW-E has been implemented using a variety of models of: Organisational engagement Service delivery Quality care recording Such variation has been required due to variations in the priorities of local commissioners (which has influenced organisational engagement), availability of healthcare professionals (which has influenced service delivery models used) and cultural differences (which - [Service delivery models](http://172.26.8.185/enhancing-care/implementation-models-in-jigsaw-e/service-delivery-models/) - Service delivery models Provided that the four key innovations were being delivered, the professionals delivering the model and the timing and structure of follow-up were not prescribed in JIGSAW(-E). This has facilitated organisations to engage when they may not have had capacity to do so, in the event of a more prescribed service model. It - [Roles](http://172.26.8.185/enhancing-care/implementation-models-in-jigsaw-e/service-delivery-models/roles/) - Roles - [Practice Engagement models](http://172.26.8.185/enhancing-care/implementation-models-in-jigsaw-e/practice-engagement-models/) - Practice engagement models Due to varying engagement and priorities of commissioners three different approaches have been used in the engagement of organisations in JIGSAW-E within the UK: Top-down incentivised scheme Top-down pilot sites Ground-up Top-down incentivised scheme The top-down incentivised scheme was offered across practices associated with one clinical commissioning group. Practices were offered a - [Community of practice and the patient panel](http://172.26.8.185/patient-focus/community-of-practice-and-the-patient-panel/) - What is the International Community of Practice? In 2016, the Keele project team brought together key stakeholders and networks linked to JIGSAW-E to share knowledge and learn from each other - the ‘Community of Practice’. A Community of Practice is a practical approach to knowledge mobilisation. It brings people together as a way of exchanging - [Champions](http://172.26.8.185/enhancing-care/implementation-models-in-jigsaw-e/service-delivery-models/champions/) ## Courses - [GPN and ANP training](http://172.26.8.185/courses/general-practitioner-nurse/) - How General Practice Nurses and Advanced Nurse Practitioners can enhance care for people with osteoarthritis Welcome: Welcome to the “Primary Care Nurse osteoarthritis training programme”. These modules will provide high quality training for implementing best practice consultations & care for people with osteoarthritis. Course format and aims: This course is split into 5 sections - [Joint Pain in Physiotherapy](http://172.26.8.185/courses/joint-pain-in-physiotherapy/) - How first contact physiotherapists can enhance care for people with osteoarthritis Welcome: Welcome to the “First contact physiotherapist osteoarthritis training programme”. These modules will provide high quality training for implementing best practice consultations & care for people with osteoarthritis. Course format and aims: This course is split into 5 sections of between 5 and - [Joint Pain in Pharmacy - JPiP](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/) - Welcome: Welcome to the Joint Pain in Pharmacy (JPiP) training programme. These modules will provide high quality training for implementing best practice consultations and support for Osteoarthritis. Course format and aims: This training programme will equip Pharmacists and pharmacy staff to support the implementation of the NICE guidelines on core treatments for Osteoarthritis, including: ## Lessons - [Complete](http://172.26.8.185/courses/general-practitioner-nurse/lessons/complete-3/) - Thank you for completing the GPN and ANP training. Please click the 'Mark Complete' button to complete this course and access your certificate. The JIGSAW-E website provides links and resources that can support you further in consultation with patients. Back to Course Overview - [Section 5: The unique role of the Advanced Nurse Practitioner](http://172.26.8.185/courses/general-practitioner-nurse/lessons/section-5-the-unique-role-of-the-advanced-nurse-practitioner/) - [Section 4: Helping people manage their joint pain](http://172.26.8.185/courses/general-practitioner-nurse/lessons/section-4-helping-people-manage-their-joint-pain-2/) - [Section 3: What is osteoarthritis and how can we explain it well?](http://172.26.8.185/courses/general-practitioner-nurse/lessons/section-3-what-is-osteoarthritis-and-how-can-we-explain-it-well-2/) - [Section 2: OA and its impact on individuals, families and the NHS](http://172.26.8.185/courses/general-practitioner-nurse/lessons/section-2-oa-and-its-impact-on-individuals-families-and-the-nhs-2/) - [Section 1: Introduction to the project and this training](http://172.26.8.185/courses/general-practitioner-nurse/lessons/section-1-introduction-to-the-project-and-this-training-2/) - [Lesson](http://172.26.8.185/lessons/lesson/) - [Section 1: Introduction to the project and this training](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/section-1-introduction-to-the-project-and-this-training/) - https://www.jigsaw-e.com https://www.jigsaw-e.com/patient-focus/guidebook/ Porcheret M, Grime J, Main C, Dziedzic K. Developing a model osteoarthritis consultation: a Delphi consensus exercise. BMC Musculoskelet Disord, 2013;14, 25. Dziedzic KS, Healey EL, PorcheretMet al. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care–the Management of OsteoArthritis In Consultations - [Section 5: The unique role of the First Contact Practitioner](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/section-5-the-unique-role-of-the-first-contact-practitioner/) - Twitter: @KeeleOACOP https://www.csp.org.uk/system/files/musculoskeletal_framework2.pdf https://www.e-lfh.org.uk/programmes/pain-management/ Please access module 6 (musculoskeletal) there are a range of available modules including our assessment and management of osteoarthritis module (time=1/2 hour) https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/obesity.aspx Free BMJ online learning module on Motivational Interviewing (time= 1 hour). Please copy and paste the following link into your browser: https://learning.bmj.com/learning/moduleintro/motivationalinterviewing.html?moduleId=10051582 Thorlund, J. B., Juhl, C. B., - [Section 4: Helping people manage their joint pain](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/section-4-helping-people-manage-their-joint-pain/) - Uthman, O. A, van der Windt, D. A, Jordan, J. L., Dziedzic, K. S., Healey, E. L., Peat, G. M., & Foster, N. E. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta analysis. British Medical Journal. 2013; 347, f5555. Quicke JG, Foster NE, Ogollah RO, Croft PR, Holden MA. - [Section 3: What is osteoarthritis and how can we explain it well?](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/section-3-what-is-osteoarthritis-and-how-can-we-explain-it-well/) - Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23(4):507-15 Nicholls, E., Thomas, E., van der Windt, D. A., Croft, P. R., Peat G. Pain trajectory groups in persons with, or at high risk - [Section 2: OA and its impact on individuals, families and the NHS](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/section-2-oa-and-its-impact-on-individuals-families-and-the-nhs/) - National Institute for Health Care and Excellence. (2014). Osteoarthritis: Care and management in adults. Nice Guideline 177. Hunter, D. J., Schofield, D., & Callander, E. The individual and socioeconomic impact of osteoarthritis. Nature Reviews Rheumatology, 2014;10(7), 437-441. - [test](http://172.26.8.185/lessons/test/) - [Complete](http://172.26.8.185/courses/joint-pain-in-physiotherapy/lessons/complete-2/) - Thank you for completing the Joint Pain in Physiotherapy training. Please click the 'Mark Complete' button to complete this course and access your certificate. The JIGSAW-E website provides links and resources that can support you further in consultation with patients. Back to Course Overview - [Complete](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/complete/) - Thank you for completing the Joint Pain in Pharmacy - JPiP training. Please see below the Flowchart and JPiP handbook for future reference. JPiP handbook JPiP Flowchart Please click the 'Mark Complete' button to complete this course and access your certificate. The JIGSAW-E website provides links and resources that can support you further in consultation - [The important role and pharmacists and their teams](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/the-important-role-and-pharmacists-and-their-teams/) - Please watch the video below titled The important role and pharmacists and their teams. [ld_video] Please note: to progress to the next lesson you need to watch the video to the end. Back to Course Overview - [Helping people manage their joint pain](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/helping-people-manage-their-joint-pain/) - Please watch the video below titled Helping people manage their joint pain. [ld_video] Please note: to progress to the next lesson you need to watch the video to the end. Back to Course Overview - [What is osteoarthritis and how can we explain it well?](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/what-is-osteoarthritis-and-how-can-we-explain-it-well/) - Please watch the video below titled What is osteoarthritis and how can we explain it well? [ld_video] Please note: to progress to the next lesson you need to watch the video to the end. Back to Course Overview - [Joint pain and its impact on individuals, families and the NHS](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/joint-pain-and-its-impact-on-individuals-families-and-the-nhs/) - Please watch the video below titled Joint pain and its impact on individuals, families and the NHS. [ld_video] Please note: to progress to the next lesson you need to watch the video to the end. Back to Course Overview - [Introduction to the project and this training](http://172.26.8.185/courses/joint-pain-in-pharmacy-jpip/lessons/introduction-to-the-project-and-this-training/) - Please watch the video below titled Introduction to the project and this training. [ld_video] Please note: to progress to the next lesson you need to watch the video to the end. Back to Course Overview - [Resources & Review](http://172.26.8.185/lessons/resources-review/) - < Course Content - [Supporting patients with self-management](http://172.26.8.185/lessons/supporting-patients-with-self-management/) - < Course Content Try to think how you would explain key messages to someone who has recently been diagnosed with Osteoarthritis of the knee… - [What you say, what patients hear](http://172.26.8.185/lessons/what-you-say-what-patients-hear/) - < Course Content Researchers have investigated the use of language in explaining the diagnosis of Osteoarthritis…. The following lesson summarises the findings of the researchers below: Drew Moore, Keele Univ. personal communication from MOSAICS study Paskins et al. Ann Fam Med. 2015; 13(6): 537-44. Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [Diagnosis of OA and explaining](http://172.26.8.185/lessons/diagnosis-and-explaining-oa/) - < Course Content - [What is Osteoarthritis?](http://172.26.8.185/lessons/what-is-osteoarthritis/) - < Course Content Osteoarthritis is not simply mechanical wearing out of a joint. Although it is commonly referred to as ‘wear & tear’ it is an active condition with the body seeking to repair itself. So the term ‘wear & repair’ is a better description. - [How does OA affect in individual: The Facts](http://172.26.8.185/lessons/how-does-oa-affect-in-individual-the-facts/) - < Course Content Let’s see what the evidence says about the impact of Osteoarthritis… - [How does OA affect an individual?](http://172.26.8.185/lessons/how-does-oa-affect-an-individual/) - < Course Content You may find it useful to consider the affects Osteoarthritis has on many aspects of the person and their lives…. - [Aims of the programme](http://172.26.8.185/lessons/aims-of-the-programme/) - < Course Content Raise awareness of the possible impact of osteoarthritis on individuals Raise awareness of Osteoarthritis and its affect on the body Raise awareness of the core treatments currently recommended for the effective management of Osteoarthritis Before you continue, take a few minutes to complete the Quiz to note a few thoughts on - [Protection](http://172.26.8.185/lessons/protection/) - [Medications](http://172.26.8.185/lessons/medications/) - [Diet / lifestyle](http://172.26.8.185/lessons/diet-lifestyle/) - [Stress](http://172.26.8.185/lessons/stress/) - [Exercise](http://172.26.8.185/lessons/exercise/) - [Explanation](http://172.26.8.185/lessons/explanation/) ## Topics - [Useful Resources](http://172.26.8.185/topic/useful-resources/) - < Course Content Consider the following resources... - [Supporting self-management of osteoarthritis](http://172.26.8.185/topic/supporting-self-management-of-osteoarthritis/) - < Course Content Ensure the diagnosis has been made by a health professional and the problem is understood with any ideas or concerns discussed and expectations understood Back up any advice given with good quality written information Ensure people are supported to gain the knowledge, skills and confidence to care for their symptoms and limitations - [Supporting self-care](http://172.26.8.185/topic/supporting-self-care/) - < Course Content Self-care or self management is key to people managing any long term condition including osteoarthritis Supporting self-care is vital along with reassurance and guidance to seek help when needed. This was a real diagram drawn by a patient describing their thoughts around living with a long term condition (LTC). They also said - [Osteoarthritis treatments recommended by NICE guidelines](http://172.26.8.185/topic/osteoarthritis-treatments-recommended-by-nice-guidelines/) - < Course Content NICE Osteoarthritis guidelines are a summary of current treatments recommended for the treatment of Osteoarthritis and they are outlined below. The central core is essential for all. - [Movement Matters](http://172.26.8.185/topic/movement-matters/) - < Course Content Movement keeps the joints supple and the muscles strong Moving and being physically is good for everyone’s general health It’s beneficial to be more active every day and avoid sitting or lying down for too long Aiming to do at least 30 minutes of activity 5 days a week, including activities that - [Weight Matters](http://172.26.8.185/topic/weight-matters/) - < Course Content Being a healthy weight helps. General advice is to: Aim for 5 portions of fruit and vegetables a day Cut down on refined (white) sugar, fat and salt Eat smaller portion sizes If it’s appropriate lose some weight, if unsure GPs or local pharmacists can check BMI and if necessary an NHS - [Advice Matters](http://172.26.8.185/topic/advice-matters/) - < Course Content Diagnosis clear? Concerns discussed? Expectations understood Access to good quality information…written….online Support to gain knowledge and skills to manage condition Local resources and networks Professional support and help when needed - [What you say, what patients hear: Part 5](http://172.26.8.185/topic/what-you-say-what-patients-hear-part-5/) - < Course Content [table id=6 /] Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [What you say, what patients hear: Part 4](http://172.26.8.185/topic/what-you-say-what-patients-hear-part-4/) - < Course Content [table id=5 /] Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [What you say, what patients hear: Part 3](http://172.26.8.185/topic/what-you-say-what-patients-hear-part-3/) - < Course Content [table id=4 /] Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [What you say, what patients hear: Part 2](http://172.26.8.185/topic/what-you-say-what-patients-hear-part-2/) - < Course Content [table id=3 /] Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [What you say, what patients hear: Part 1](http://172.26.8.185/topic/what-you-say-what-patients-hear-part-1/) - < Course Content [table id=2 /] Drew Moore, Keele Univ. personal communication from MOSAICS study Paskins et al. Ann Fam Med. 2015; 13(6): 537-44. Barker et al. Disabil Rhabil. 2013; DOI: 10.3109/09638288.2013.793409 - [Back it up with written information](http://172.26.8.185/topic/back-it-up-with-written-information/) - < Course Content Research has also shown that any explanation should be backed up with good quality written information - [Results of getting it wrong](http://172.26.8.185/topic/risks-of-getting-it-wrong/) - < Course Content Results of getting it wrong Research has shown that for any explanation it is important to use the term… - [Targets of an OA Explanation](http://172.26.8.185/topic/targets-of-oa-explanation/) - < Course Content What is the target of an explanation? - [Explaining OA](http://172.26.8.185/topic/explaining-oa/) - < Course Content Explaining osteoarthritis Once a diagnosis has been made people need to be told in a way that is meaningful to them. Asking the person what they think their problem is due to and addressing any ideas or concerns is vital Why is this important? An explanation of a diagnosis of osteoarthritis is - [OA Diagnosis](http://172.26.8.185/topic/oa-diagnosis/) - < Course Content How does a health practitioner diagnose Osteoarthritis? When an alternative diagnosis is unlikely, for Osteoarthritis of the knee, hip, hand or foot a working diagnosis is made if the person is aged 45 years and over and reports: Persistent joint pain that is worse with use Morning stiffness less than half an - [Myth 2: Everyone with Osteoarthritis needs joint replacements](http://172.26.8.185/topic/myth-2-everyone-with-osteoarthritis-needs-joint-replacements/) - < Course Content Myth 2: Many people believe that everyone with Osteoarthritis needs joint replacements 4 years after going to see their GP with hip osteoarthritis only 25% of patients will have had a hip replacement…….75% of patients won’t have needed to have a joint replacement ...but if a joint replacement is needed it has - [Myth 1: Osteoarthritis is inevitably progressive and disabling](http://172.26.8.185/topic/myth-1-osteoarthritis-is-inevitably-progressive-and-disabling/) - < Course Content Myth 1: Many people believe Osteoarthritis is inevitably progressive and disabling, and that ‘nothing can be done’ On studying 600 people over 6 years with knee pain due to Osteoarthritis… Less than one third of people have progressive symptoms and knee pain can improve over time! - [Impact on Co-existing Health Issues](http://172.26.8.185/topic/impact-on-co-existing-health-issues/) - < Course Content Impact on co-existing health conditions is variable… Pain may restrict walking and physical activities which often help with other health conditions including diabetes, breathing problems or heart disease - [Treatment Options](http://172.26.8.185/topic/treatment-options/) - < Course Content Treatment options are variable Surgery is not inevitable…it is not the only treatment choice Any recommended treatments should be tailored to individuals needs dependant upon how their lives are affected Research evidence has identified three vital core elements for everyone Education and advice with access to information Strengthening and aerobic fitness training - [Emotional Wellbeing](http://172.26.8.185/topic/emotional-wellbeing/) - < Course Content The emotional impact of OA is very variable The affect on mood and emotions may alter a persons abilities adjusting to coping with pain and altered lifestyles including work Some people may have co-existing conditions of anxiety and depression to come to terms with and manage too - [Social Activity](http://172.26.8.185/topic/social-activity/) - < Course Content The impact on social activity is very variable General mobility and activities may be reduced due to pain affecting all aspects of peoples lives at home, work, hobbies and leisure and even sleep Symptoms may lead to time off work or being unable to join in with friends and family activities - [Time to face the facts!](http://172.26.8.185/topic/time-to-face-the-facts/) - < Course Content Let’s see what the evidence says about the impact of Osteoarthritis… - [How does OA affect an individual?](http://172.26.8.185/topic/how-does-oa-affect-an-individual/) - < Course Content You may find it useful to consider the affects Osteoarthritis has on many aspects of the person and their lives…. - [Physical Wellbeing](http://172.26.8.185/topic/physical-wellbeing/) - < Course Content The physical impact of Osteoarthritis is very variable People may describe a variety of symptoms including: Pain Joint stiffness especially after rest (sometimes described as gelling) Reduced joint movement Muscle weakness Bony enlargement may occur Crepitus or noises on moving their joints Some may have had x-rays with descriptions of ‘OA changes’ ## Quizzes - [test](http://172.26.8.185/quizzes/test/) - [Test SM](http://172.26.8.185/quizzes/test-sm/) - Please provide the following information to continue with the training. - [Quiz](http://172.26.8.185/quizzes/quiz/) - [Course Review](http://172.26.8.185/quizzes/course-review/) - < Course Content As a recap please consider the following questions… - [Pause for thought: Local resources](http://172.26.8.185/quizzes/local-resources/) - < Course Content Take some time to consider any resources which could help people as they manage their symptoms of osteoarthritis - [How would you explain...](http://172.26.8.185/quizzes/how-would-you-explain/) - < Course Content - [Pause for thought: Osteoarthritis?...](http://172.26.8.185/quizzes/pause-for-thought-osteoarthritis/) - < Course Content - [Thoughts to begin?](http://172.26.8.185/quizzes/thoughts-to-begin/) - < Course Content - [Pause for thought: Thoughts to begin](http://172.26.8.185/quizzes/pause-for-thought-thoughts-to-begin/) ## Certificates - [General Practitioner Nurse](http://172.26.8.185/certificates/general-practitioner-nurse/) - This is to certify that completed the online course ' JIGSAW-E nurse training on the management of OA and Joint Pain' - [Joint Pain in Physiotherapy](http://172.26.8.185/certificates/joint-pain-in-physiotherapy/) - This is to certify that completed the online course 'Joint Pain in Physiotherapy' - [Joint Pain in Pharmacy – JPiP](http://172.26.8.185/certificates/joint-pain-in-pharmacy-jpip/) - This is to certify that completed the online course 'Joint Pain in Pharmacy – JPiP' - [Supporting Patients with Osteoarthritis - Certificate of Completion](http://172.26.8.185/certificates/supporting-patients-with-osteoarthritis-certificate-of-completion/) - This is to certify that completed the online course 'Supporting Patients with Osteoarthritis' ## Downloads - [SystmOneTemplates OA eTemplate JIGSAW-e](http://172.26.8.185/sdm_downloads/systmonetemplates-oa-etemplate-jigsaw-e/) - [JIGSAW-e EMIS files for sharing](http://172.26.8.185/sdm_downloads/jigsaw-e-emis-files-for-sharing/)