key: cord-0742949-xt9nrlwb
authors: Smith, Toby O; Durrant, Karen; Birt, Linda; Belderson, Pippa; Chipping, Jackie; Yates, Max; Tsigarides, Jordan; Notley, Caitlin; Naughton, Felix; Shepstone, Lee; Macgregor, Alex
title: Accessing health services for musculoskeletal diseases during early COVID-19 lockdown: results from a UK population survey
date: 2020-09-22
journal: Rheumatol Adv Pract
DOI: 10.1093/rap/rkaa047
sha: d5316220eca10115ecbc0ec7ea9f307668f6e3d7
doc_id: 742949
cord_uid: xt9nrlwb

nan

Restricting the spread of COVID-19 in the UK required radical changes to the structure of society and the delivery of healthcare. This has the potential for wide ranging adverse consequences for people with musculoskeletal diseases. For the period between March 23 rd and August 1 st , those determinised to be most at risk were required to 'shield' at home, avoiding all social contact. Primary and secondary care services postponed or cancelled non-urgent appointments. Remote consultations were provided by telephone or video. [1] The public were encouraged only to use healthcare services for urgent needs. Local pharmacies, whilst remaining open, reported reduced patient consultations. Non-NHS providers of musculoskeletal health services including physiotherapists and podiatrists closed. [2] In late April 2020, five weeks after the start of the UK 'lockdown', we conducted an online survey in a group of patients with a range of musculoskeletal diseases to assess the impact measures had on their wellbeing and ability to access healthcare. The survey was conducted using the Qualtrics platform (XM Platform, Qualtrics LLC, USA). It targeted 1,376 subjects enrolled on the Norfolk Arthritis Register (NOAR), a large population based cohort of patients originally identified as having inflammatory arthritis [3] , and was also distributed to the wider UK population through social media and email lists from organisations including Arthritis Action, National Rheumatoid Arthritis Society, National Ankylosing Spondylitis Society, Fibromyalgia UK and Scope. The survey was open from 28 th April 2020 to 27 th May 2020. Respondents provided informed consent and were asked a series of questions relating to demographic characteristics, use of health care services, disease activity, disability status, perceived isolation (measured using the Lubben Social Network Scale-6 [4] ) and loneliness (measured using the revised UCLA Loneliness Score-3 item [5] ). Descriptive statistics were used to summarise the characteristics of the sample and their access to health service provision. Student's T-Tests were used to assess the association between participants' access to healthcare (yes/no) and continuous measures of pain, stiffness, perceived general health, Lubben Social Isolation (scored 0 to 30; higher scores equate to greater social isolation) and UCLA loneliness score (scored 3 to 9; higher scores equate to greater loneliness). The statistical analyses were conducted on STATA version 16.0 (StataCorp, Texas, USA). In total, 264 responded from the NOAR cohort (19%) and 414 from the wider population completed the survey. This provided a combined cohort of 678 respondents for analysis. Their characteristics and survey responses are summarised in Table 1 . A wide range of inflammatory and non-inflammatory diseases were represented with rheumatoid arthritis (43.5%) and osteoarthritis (21.7%) reported most commonly. There were no important difference in the characteristics or responses in the NOAR and non-NOAR rheumatoid arthritis patients, and the results were pooled for analysis.

The majority (52.1%) reported that their musculoskeletal symptoms had increased since the start of 'lockdown'. Most respondents (88.2%) reported little difficulty accessing medication. Forty-four percent of respondents needed the assistance of others to do this. A third of patients reported needing to access either their general practitioner or hospital rheumatology department in this period. The respondents gave equivocal responses when asked about the challenges in obtaining advice from health professionals. As might be expected, those who accessed healthcare reported significantly greater pain, stiffness and poorer general health (p<0.01). Individuals who reported greater social isolation (mean difference 1.0 points (p=0.02) and greater loneliness (mean difference 0.6 points p<0.01) were less likely to access healthcare. Whilst these differences reflect relatively small differences in degrees of social isolation, their statistical significance indicates the wider impact on patient's health seeking behaviours.

This survey, conducted in the early stages of the UK 'lockdown', suggests that there have been immediate negative consequences for people with musculoskeletal disease. Despite the swift transformations in the configuration of healthcare that have taken place, patients have in the main been able to access primary care and hospital rheumatology departments. However, those with higher levels of social isolation access healthcare the least.

Should further isolation measures need to be enforced as the pandemic continues, particular efforts should be made to protect and support the socially isolated as a vulnerable group. In designing musculoskeletal services, healthcare providers need to use their resources to reach out to individual patients who do not come forward for advice, and who might be silently struggling with their disease A&E-accident and emergency; CI -confidence intervals; JIA -Juvenile Inflammatory Arthritis; MSKmusculoskeletal; NHS -National Health Service; SD -standard deviation; UCLA -University of California Los Angeles Loneliness Score

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COVID-19: infection prevention and control guidance

The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register

Assessing social networks among elderly populations

UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure

The authors thank the following organisations who assisted in distributing the survey across their networks: Pain Concern; Arthritis Action; National Rheumatoid Arthritis Society; National Ankylosing Spondylitis Society; Paget's Association; Parathyroid UK; The Health Policy Partnership; and Scope.