Developing a personalised self management support intervention for older adults living with osteoarthritis and multiple long term conditions [Abstract]

Button, Kate ORCID: https://orcid.org/0000-0003-1073-9901, Otter, Paula, Deere, Rachel, Jones, Fiona and Busse-Morris, Monica ORCID: https://orcid.org/0000-0002-5331-5909 2026. Developing a personalised self management support intervention for older adults living with osteoarthritis and multiple long term conditions [Abstract]. Osteoarthritis and Cartilage 34 (6) , pp. 951-952. 10.1016/j.joca.2026.03.026

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Abstract

Purpose (the aim of the study): Older adults living with osteoarthritis (OA) commonly experience multiple long term conditions (MLTCs), leading to complex interaction of symptoms including pain, swelling, muscle weakness, fatigue and reduced independence, with uncoordinated healthcare. Effective self management support addressing both OA and MLTCs in older adults is lacking. There is a need for a new approach that enables the individual and their nominated supporter, to make the decisions about their health, live well and prevent unnecessary treatments. The aim of this study was to develop TIPTOE, a personalised self-management support intervention for adults aged 65+ with OA and MLTC’s. Methods: A six step Intervention Mapping (IM) approach, supplemented with Experience Based Co Design principles, guided intervention development. Step 1 included a needs assessment involving patient and public involvement representatives (PPIE) and healthcare practitioners. Step 2 comprised filmed narrative interviews to construct a logic model of change. Steps 3 and 4 involved iterative co design of intervention components, including a personalised coaching programme and a co designed “Living Well with Joint Pain” handbook. Step 5 focused on planning for implementation through practitioner training, fidelity checklists, and resource development. Step 6 outlined evaluation planning for a future randomised controlled trial. Results: Stakeholder engagement included nine PPIE representatives and 16 adults aged 65+ with OA and MLTCs, recruited to participate in co design. Findings from the needs assessment (IM step 1) highlighted pain, functional decline, poor confidence and fear of falling. Participants described uncertainty in knowing when and from whom to seek help, limited integration between services, and a strong desire for personalised, accessible, holistic support. Data from the narrative interviews and the needs assessment were synthesised to identify key change and performance objectives that informed the TIPTOE logic model of change (IM step 2) (Figure 1). The TIPTOE intervention was designed (IM step 3), guided by social cognitive programme theory. We defined the key skills for intervention implementers (nurses or allied health professionals), who would provide self management support and the relevant accessible information materials, presented in the form of a user friendly handbook. The emerging co designed intervention (IM step 4) comprises of two components: Up to six personalised one to one coaching sessions delivered by trained healthcare implementers, with optional inclusion of a nominated support person, such as a family member, fried or carer. Delivery formats include in person, online, or telephone consultations. A co designed ‘Living Well with Joint Pain’ handbook, featuring narratives, practical strategies, goal setting tools, and resources to support day to day self management. Training for practitioners was informed by existing methods used in Bridges Self-Management with content adapted for TIPTOE to incorporate core principles (figure 2) (IM step 5), which were reflected in a fidelity checklist. Training was four, two hour sessions with a Bridges trainer and an individual with joint pain. An with ongoing programme of support included drop in sessions and access to training materials. The TIPTOE intervention is being evaluated (IM step 6), in a multi centre, two arm, individually randomised controlled trial, comparing TIPTOE to usual care. Conclusions: The TIPTOE intervention has been developed through IM with co design to ensure relevance for older adults with OA and MLTCs, including individuals from underserved groups. TIPTOE is underpinned by the integration of social cognitive theory and existing interventions informed by Bridges Self Management, which draw upon sources of self efficacy. TIPTOE addresses gaps in existing self management approaches for OA and MLTC’s. This personalised self management intervention aims to support individual develop the knowledge, confidence and skills to make decisions about their health and care so that they have a better quality of life and wellbeing. TIPTOE is being evaluated in a randomised controlled trial.

Item Type:	Short Communication
Date Type:	Publication
Status:	Published
Schools:	Schools > Healthcare Sciences Schools > Medicine
Publisher:	Elsevier
ISSN:	1063-4584
Last Modified:	01 Jun 2026 10:16
URI:	https://orca.cardiff.ac.uk/id/eprint/187303

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