This study was designed to test the feasibility of running a trial to compare the effectiveness of a combined weight management and physical function programme for patients with knee osteoarthritis ARMED (Arthritis Rehabilitation through the Management of Exercise and Diet) with usual care ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise). The COVID-19 pandemic interruption allowed additional measurement of the qualitative ‘lived in’ experiences of this patient group during the pandemic and also their appetite for virtual health.

Thirty-two patients with knee osteoarthritis were recruited from a combined primary/secondary care waiting list and were allocated to either a six-week intervention group (ARMED) or to the six-week usual care ESCAPE pain group (Enabling Self-management and Coping with Arthritic Pain using Exercise) group.

The intervention programme was interrupted after three weeks by COVID-19. Fifteen patients were reassessed after the first stage. The average attendance was 92% with 6 patients attending all sessions, 5 attending 5/6, 1 attending 4/6 and 2 attending 3/6. One subject dropped out and 15/16 patients completed all outcome measurements. All patients completed the KOOS knee score and the Short Warwick-Edinburgh Mental Well Being Scale to evaluate anxiety and depression. There was a statistically significant improvement in pain, activities of daily living, quality of life and mental health and well-being scores from time one to time 2. The mean weight, BMI and waist measurements were reduced also from time one to time 2, but these failed to reach significance. The semi-structured interviews provided rich information on enablers and barriers to coping in lockdown, benefits of the ARMED programme to increasing physical activity and weight management and enablers and barriers to redesigning the programme for online delivery.

Evaluation of preliminary data from this feasibility study supports the three-week intervention combining education, exercise and weight management in this patient group even during a pandemic. Based on the results of the qualitative interviews, we have now redesigned our programme to present it virtually. We hope to present the results of our virtual feasibility study later in 2021.

Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).

Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU–24©) to determine family satisfaction, we measured the impact of a “family communication pathway” facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU.

There was no statistically significant difference noted in family satisfaction as determined by FSICU–24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.

This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.