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Linda C Li

Publications and source records attributed to Linda C Li.

9 recordsLinked to original sources
PubMed2006

Primary therapist model for patients referred for rheumatoid arthritis rehabilitation: a cost-effectiveness analysis.

OBJECTIVE: To estimate the incremental cost-effectiveness (ICE) of services from a primary therapist compared with traditional physical therapists and/or occupational therapists for managing rheumatoid arthritis (RA), from the societal perspective. METHODS: Patients with RA were randomly assigned to the primary therapist model (PTM) or traditional treatment model (TTM) for approximately 6 weeks of rehabilitation treatment. Health outcomes were expressed in terms of quality-adjusted life years (QALYs), measured with the EuroQol instrument at baseline, 6 weeks, and 6 months. Direct and indirect costs, including visits to health professionals, use of investigative tests, hospital visits, use of medications, purchases of adaptive aids, and productivity losses incurred by patients and their caregivers, were collected monthly. RESULTS: Of 144 consenting patients, 111 remained in the study after the baseline assessment: 63 PTM (87.3% women, mean age 54.2 years, disease duration 10.6 years) and 48 TTM (79.2% women, mean age 56.8 years, disease duration 13.2 years). From a societal perspective, PTM generated higher QALYs (mean +/- SD 0.068 +/- 0.22) and resulted in a higher mean cost ($6,848 Canadian, interquartile range [IQR] $1,984-$9,320) compared with TTM (mean +/- SD QALY -0.017 +/- 0.24; mean costs $6,266, IQR $1,938-$10,194) in 6 months, although differences were not statistically significant. The estimated ICE ratio was $13,700 per QALY gained (95% nonparametric confidence interval -$73,500, $230,000). CONCLUSION: The PTM has potential to be an alternative to traditional physical/occupational therapy, although it is premature to recommend widespread use of this model in other regions. Further research should focus on strategies to reduce costs of the model and assess the long-term economic consequences in managing RA and other rheumatologic conditions.

Arthritis, Rheumatoid↗
PubMed2006

Effectiveness of the primary therapist model for rheumatoid arthritis rehabilitation: a randomized controlled trial.

OBJECTIVE: To compare the primary therapist model (PTM), provided by a single rheumatology-trained primary therapist, with the traditional treatment model (TTM), provided by a physical therapy (PT) and/or occupational therapy (OT) generalist, for treating patients with rheumatoid arthritis (RA). METHODS: Eligible patients were adults requiring rehabilitation treatment who had not received PT/OT in the past 2 years. Participants were randomized to the PTM or TTM group. The primary outcome was defined as the proportion of clinical responders who experienced a > or =20% improvement in 2 of the following measures from baseline to 6 months: Health Assessment Questionnaire, pain visual analog scale, and Arthritis Community Research and Evaluation Unit RA Knowledge Questionnaire. RESULTS: Of 144 consenting patients, 33 (10 PTM participants, 23 TTM participants) dropped out without completing any followup assessment, leaving 111 for analysis (63 PTM participants, 48 TTM participants). The majority were women (PTM 87.3%, TTM 79.2%), with a mean age of 54.2 years and 56.8 years for the PTM and TTM groups, respectively. Average disease duration was 10.6 years and 13.2 years for each group, respectively. At 6 months, 44.4% of patients in the PTM group were clinical responders versus 18.8% in the TTM group (chi(2) = 8.09, P = 0.004). CONCLUSION: Compared with the TTM, the PTM was associated with better outcomes in patients with RA. The results, however, should be interpreted with caution due to the high dropout rate in the TTM group.

Adult↗
PubMed2006

Setting priorities in arthritis care: Care III Conference.

The disparity between supply and demand in arthritis services can lead to delays in diagnosis and access to effective treatments. The focus of 2005 CARE III Conference was to develop a research agenda to improve care for people with arthritis. Topics included models of care, nonpharmacological/nonsurgical interventions for arthritis, and issues around study design, outcome measures and knowledge translation and exchange. Seven priority areas emerged from the discussion: (1) Develop new, innovative arthritis care strategies; (2) Adapt and implement effective service models to address local needs; (3) Understand factors related to successful team care; (4) Match patients' needs with appropriate care models; (5) Design new or improve outcome measures for participation and quality of life; (6) Foster partnerships in sharing research evidence; and (7) Address needs for training and quality assurance.

Arthritis↗
PubMed2006

Does everybody need a team?

Multidisciplinary team care, defined as care provided by a group of health professionals from various disciplines, has been widely used in arthritis management since the 1950s. Its effectiveness in comparison with regular outpatient care has mainly been established in patients with rheumatoid arthritis (RA). Recent studies have shown that similar outcomes can be achieved in patients with RA at lower costs using care provided by a clinical nurse specialist. These latter findings suggest that the active components of the multidisciplinary team care model may not be related to the number or professional backgrounds of the health professionals involved, nor with their physical proximity, but rather to the provider's skills in rheumatology and the coordination of services. Because many patients with arthritis have healthcare needs that are not met through treatment by the rheumatologist alone and since traditional multidisciplinary team care in many countries is unavailable or may be undesirable in specific situations, the development and evaluation of alternative, comprehensive models of care delivery is recommended.

Arthritis↗
PubMed2006

Current topics on models of care in the management of inflammatory arthritis.

While there is strong evidence supporting a multidisciplinary team approach in arthritis management, access and use are hindered by limited human and financial resources. To safeguard the provision of comprehensive care throughout the disease trajectory, alternative care models are being developed. Three promising arthritis care models include the use of information technology and telemedicine, patient initiated care, and extended roles of health professionals. Future research projects should focus on: (1) the cost-effectiveness of information technology for exchange of patient-based data and education and management support; (2) the characteristics and needs of patients who can versus those who cannot self-manage; (3) strategies to improve access to care for patients with early arthritis, such as extending roles of health professionals to include triage; and (4) further structuring and standardizing rheumatology training of nursing and allied health professionals.

Arthritis↗
PubMed2005

Outcomes of patients with rheumatoid arthritis receiving rehabilitation.

PURPOSE OF REVIEW: Rehabilitation, including physical therapy and occupational therapy, complements drug therapy in the management of symptoms in patients with rheumatoid arthritis. Approximately 26% of patients with rheumatoid arthritis receive a referral for rehabilitation by rheumatologists. This review summarizes findings on the effectiveness and economic outcomes of physical therapy and occupational therapy in managing rheumatoid arthritis. RECENT FINDINGS: Studies evaluating the outcomes of various service delivery models for physical therapy and occupational therapy demonstrate improvements, especially in physical function, among people with rheumatoid arthritis. A recent pilot study examining the primary therapist model also suggests that the primary therapist model may be a viable option for delivering rheumatoid arthritis rehabilitation services. However, the evidence on other alternative models such as the physical therapy/occupational therapy practitioner model is limited. Only a few economic evaluations have been performed, and among those, none examine the cost-effectiveness of different service models. SUMMARY: Systematically interpreting the findings of service delivery models in rehabilitation is challenging because of the wide range of interventions and outcome measures used. A thorough understanding of the value of different rehabilitation models will require the guidance of a sound evaluation framework. Future clinical trials should consider including a component for evaluating cost-effectiveness. Such knowledge can contribute to evidence-informed resource allocation.

Arthritis, Rheumatoid↗
PubMed2005

What else can I do but take drugs? The future of research in nonpharmacological treatment in early inflammatory arthritis.

Nonpharmacological treatments, including physiotherapy and occupational therapy, have assumed a complementary role to drug therapy in managing inflammatory arthritis. Clinicians and researchers are facing 3 major challenges concerning the use of these treatments. First, strong evidence is only present in a few nonpharmacological interventions, such as exercise, patient education, and low level laser in the treatment of rheumatoid arthritis. The evidence on the majority of interventions is, however, weak or inconclusive. Second, knowledge is lacking on the elements associated with models of nonpharmacological care. The multidisciplinary team approach has been viewed as the standard for arthritis treatment; however, the team structure and the communication style among team members vary around the world. The influence of these elements on treatment success remains unclear. Finally, disparities in knowledge management and translation in nonpharmacological research have hindered the clinical use of these treatments and the growth of research in the field. To address the challenges, the author is recommending 4 research priorities for nonpharmacological treatments: 1. Evaluation of less well-studied interventions; 2. Understanding the relationships among rehabilitation-related variables and disability; 3. Development and evaluation of innovative care models; and 4. Design and evaluation of knowledge transfer innovations.

Arthritis, Rheumatoid↗
PubMed2004

Use of mainstream nonpharmacologic treatment by patients with arthritis.

OBJECTIVE: To examine the use of nonpharmacologic treatment by patients with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Patients were recruited from physicians' offices in Ontario, Canada. All participants completed questionnaires that asked about their health status, use of medications and nonpharmacologic treatments, and use of health care resources. RESULTS: A total of 326 patients with OA and 253 patients with RA completed the survey on the use of nonpharmacologic treatment. Only 73% of patients with OA had been told to use nonpharmacologic modalities, but 98.8% had tried at least 1 type of treatment. About 97% of those with RA had been told to use and had tried at least 1 type of treatment. Most patients continued to use a treatment once they had tried it. CONCLUSION: The use of nonpharmacologic modalities is common among patients with arthritis. It is important that clinicians address with their patients the appropriate use of and barriers to continuing these treatments.

Aged↗