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Chepeha JC, Silveira A, Sheps D, Beaupre LA. Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach. Phys Ther 2020; 100:225-237. [PMID: 31750521 DOI: 10.1093/ptj/pzz161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2019] [Accepted: 06/30/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. OBJECTIVE The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. DESIGN A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. METHODS Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. RESULTS Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as "very useful" or "quite useful." Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. LIMITATIONS The survey sample was relatively small and did not directly assess patient outcomes. CONCLUSIONS An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.
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Affiliation(s)
- Judy C Chepeha
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, 8205-114 Street NW, Edmonton, Alberta, T6G 2G4, Canada
| | - Anelise Silveira
- Department of Surgery, Alberta Health Services, Edmonton, Alberta, Canada
| | - David Sheps
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta
| | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta and Department of Surgery, Alberta Health Services
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Leung N, Tao X, Bernacki EJ. Response to the Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers' Compensation System. J Occup Environ Med 2019; 62:e82. [PMID: 31815815 DOI: 10.1097/jom.0000000000001758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nina Leung
- Dell Medical School - The University of Texas at Austin, Austin, Texas.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuguang Tao
- Division of Occupational and Environmental Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward J Bernacki
- Dell Medical School - The University of Texas at Austin, Austin, Texas.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Dehghan Nayeri N, Samadi N, Larijani B, Sayadi L. Effect of nurse-led care on quality of care and level of HbA1C in patients with diabetic foot ulcer: A randomized clinical trial. Wound Repair Regen 2019; 28:338-346. [PMID: 31811674 DOI: 10.1111/wrr.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/05/2019] [Accepted: 11/22/2019] [Indexed: 01/25/2023]
Abstract
Diabetic foot ulcer (DFU) is a serious and costly complication in diabetes which affects different aspects of life and can reduce patient's quality of life. Various views to manage DFU have been introduced. The nurse-led team, as a multidisciplinary team, can be effective due to a holistic approach to some disease management; but in patients with DFU it has not been assessed. Therefore, this study was designed to determine the effect of nurse-led care on quality of care (QOC) and improvement of HbA1C in Patients with DFU. This was a randomized clinical trial study performed on 52 patients with DFU. Patients were randomly assigned into two groups: nurse-led care intervention and standard care. The study was conducted in one of the hospitals affiliated to Tehran University of Medical Sciences. Data were collected using two questionnaires: Demographic characteristics and Quality Patient Care Scale (QUALPACS) and taking a blood sample for HbA1C. The nurse-led Care interventions were conducted in three stages: Integrated, Interdisciplinary, and Comprehensive. Descriptive and analytic statistical methods were used to analyze the data. P < .05 was considered significant. The results demonstrated that according to repeated measures test, (before, 4 and 12 weeks after the intervention), the level of QOC dimensions (Psychosocial, communication and physical aspect) in the nurse-led group had a significant difference with control group (P < .0001). Also, according to the results of Independent t test, there was a significant difference in total QOC scoring and HbA1c between intervention and control groups after the intervention and follow up (P < .0001). Considering the burden of diabetes and DFUs, it seems that the establishment of a nurse-led care approach can be an effective strategy to manage and treat these patients, and eliminate the disruption of care and achieve optimal care quality.
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Affiliation(s)
- Nahid Dehghan Nayeri
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Samadi
- Diabetes Researcher Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Sayadi
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Akindele M, Rabiu M, Useh E. Assessment of the awareness, adherence, and barriers to low back pain clinical practice guidelines by practicing physiotherapists in a low‐resourced country. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1811. [DOI: 10.1002/pri.1811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/27/2019] [Accepted: 08/25/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mukadas Akindele
- Department of Physiotherapy, Faculty of Allied Health SciencesBayero University Kano Nigeria
| | - Mubasshir Rabiu
- Department of Physiotherapy, Faculty of Allied Health SciencesBayero University Kano Nigeria
| | - Efe Useh
- Lifestyle Diseases Research Entity, Faculty of Health SciencesNorth West University Mahikeng South Africa
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Price AJ, Ogollah R, Kang S, Hay E, Barker KL, Benedetto E, Smith S, Smith J, Galloway JB, Ellis B, Rees J, Glyn-Jones S, Beard D, Fitzpatrick R, Hill JC. Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open 2019; 9:e025357. [PMID: 31585967 PMCID: PMC6797397 DOI: 10.1136/bmjopen-2018-025357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We have previously developed and validated the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways, showing encouraging psychometric test results. The objective of this study was to determine the responsiveness of MSK-HQ following MSK treatments and to determine the minimally important change (MIC). SETTING We collected data in four cohorts from community physiotherapy and secondary-care orthopaedic hip, knee and shoulder clinics. PARTICIPANTS 592 individuals were recruited; 210 patients treated with physiotherapy for a range of MSK conditions in primary care; 150 patients undergoing hip replacement, 150 patients undergoing knee replacement and 82 undergoing shoulder surgery in secondary care. OUTCOME MEASURES Preoperative data were collected including the MSK-HQ, European Quality of Life-5D (EQ-5D) and the OHS, OKS or OSS in each joint-specific group. The same scores, together with anchor questions, were collected postintervention at 3 months for the physiotherapy group and 6 months for all others. Following COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines, responsiveness was assessed using correlation between scores and the MIC was calculated for the entire cohort using receiver operating characteristic curve analysis. RESULTS The MSK-HQ demonstrated strong correlation (R=0.73) with EQ-5D across the entire cohort and with each of the joint-specific Oxford scores (hip R=0.87, knee R=0.92 and shoulder R=0.77). Moderate correlation was seen between MSK-HQ and EQ-5D across each individual group (R value range 0.60-0.68), apart from the hip group where correlation was strong (R=0.77). The effect size with MSK-HQ was 0.93, in the entire cohort, double that measured with EQ-5D (0.43). In all subgroups, MSK-HQ measured a greater treatment effect compared with EQ-5D. The MIC is 5.5 (95% CI 2.7 to 8.3). CONCLUSION Our study demonstrates that the MSK-HQ questionnaire is responsive to change across a range of musculoskeletal conditions, supporting its use as a generic MSK measurement instrument.
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Affiliation(s)
- Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Reuben Ogollah
- Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Sujin Kang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elaine Hay
- Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elena Benedetto
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Jonathan Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan C Hill
- Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
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Abstract
BACKGROUND AND PURPOSE The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems. We propose that, going forward, diagnostic classifications of movement system problems need to be developed, tested, and validated. The Academy of Neurologic Physical Therapy's Movement System Task Force was convened to address these issues with respect to management of movement system problems in patients with neurologic conditions. The purpose of this article is to report on the work and recommendations of the Task Force. SUMMARY OF KEY FINDINGS The Task Force identified 4 essential elements necessary to develop and implement movement system diagnoses for patients with primarily neurologic involvement from existing movement system classifications. The Task Force considered the potential impact of using movement system diagnoses on clinical practice, education and, research. Recommendations were developed and provided recommendations for potential next steps to broaden this discussion and foster the development of movement system diagnostic classifications. RECOMMENDATIONS FOR CLINICAL PRACTICE The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).
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Bernhardsson S, Larsson MEH. Does a tailored guideline implementation strategy have an impact on clinical physiotherapy practice? A nonrandomized controlled study. J Eval Clin Pract 2019; 25:575-584. [PMID: 29806112 DOI: 10.1111/jep.12958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice. METHODS A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire. RESULTS Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups). CONCLUSIONS Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.
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Affiliation(s)
- Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Jarrar M, Al‐Bsheish M, Dardas LA, Meri A, Sobri Minai M. Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status. Int J Health Plann Manage 2019; 35:104-119. [DOI: 10.1002/hpm.2822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mu'taman Jarrar
- Vice Deanship for Quality and Development, College of MedicineImam Abdulrahman Bin Faisal University Dammam Saudi Arabia
- Medical--> Education DepartmentKing Fahd Hospital of the University Al‐Khobar Saudi Arabia
| | - Mohammad Al‐Bsheish
- Healthcare Administration DepartmentBatterjee Medical College Jeddah Saudi Arabia
| | - Latefa Ali Dardas
- Community Mental Health Nursing Department, School of NursingThe University of Jordan Amman Jordan
| | - Ahmed Meri
- Department of Medical Instrumentation Techniques EngineeringAl‐Hussain University College Karbala Iraq
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Complementing or conflicting? A qualitative study of osteopaths’ perceptions of NICE low back pain and sciatica guidelines in the UK. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis. PLoS One 2019; 14:e0211877. [PMID: 30759118 PMCID: PMC6373960 DOI: 10.1371/journal.pone.0211877] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP). Data sources Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018. Study selection Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria. Study appraisal and synthesis methods Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0–100%; 0 = no disability). Results Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up. Limitations The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence. Conclusions TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. Trial registration PROSPERO CRD42017068287
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Kwok AK, O’Hara NN, Pollak AN, O’Hara LM, Herman A, Welsh CJ, Slobogean GP. Are injured workers with higher rehabilitation service utilization less likely to be persistent opioid users? A cross-sectional study. BMC Health Serv Res 2019; 19:32. [PMID: 30642319 PMCID: PMC6332665 DOI: 10.1186/s12913-019-3879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Given its role in treating musculoskeletal conditions, rehabilitation medicine may be an important factor in decreasing the use of opioids among injured workers. The primary objective was to determine if increased utilization of rehabilitation services was associated with decreased persistent opioid use among workers' compensation claimants. The secondary objective was to determine the combined association of rehabilitation service utilization and persistent opioid use with days of work lost due to injury. METHODS Using Chesapeake Employers' Insurance Company claims data from 2008 to 2016, claimants with at least one filled opioid prescription within 90 days of injury were eligible for inclusion. The primary outcome was persistent opioid use, defined as at least one filled opioid prescription more than 90 days from injury. The secondary outcome was days lost due to injury. The primary variable of interest, rehabilitation service utilization, was quantified based on the number of rehabilitation service claims and grouped into five levels (no utilization, and four quartiles - low, medium, high, very high). RESULTS Of the 9596 claimants included, 29% were persistent opioid users. Compared to claimants that did not utilize rehabilitation services, patients with very high rehabilitation utilization were nearly three times more likely (OR: 2.71, 95% CI: 2.28-3.23, p < 0.001) to be persistent opioid users and claimants with low and medium levels of rehabilitation utilization were less likely to be persistent opioid users (low OR: 0.20, 95%: 0.14-0.27, p < 0.001) (medium OR: 0.26, 95% CI: 0.21-0.32, p < 0.001). Compared to claimants that did not utilize rehabilitation services, very high rehabilitation utilization was associated with a 27% increase in days lost due to the injury (95% CI: 21.9-32.3, p < 0.001), while low (- 16.4, 95% CI: -21.3 - -11.5, p < 0.001) and medium (- 11.5, 95% CI: -21.6 - -13.8, p < 0.001) levels of rehabilitation utilization were associated with a decrease in days lost due to injury, adjusting for persistent opioid use. CONCLUSION Our analysis of insurance claims data revealed that low to moderate levels of rehabilitation was associated with reduced persistent opioid use and days lost to injury. Very high rehabilitation utilization was associated with increased persistent opioid use and increased time from work.
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Fujimoto S, Kobayashi M, Fujimoto S, Komukai K, Nakayama T. Inclusion of rehabilitation approach in Japanese clinical practice guidelines: a descriptive analysis. J Phys Ther Sci 2019; 31:429-434. [PMID: 31164780 PMCID: PMC6511511 DOI: 10.1589/jpts.31.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shuhei Fujimoto
- Department of Public Health, Kyoto University Graduate School of Medicine: Yoshidakonoe-cho, Sakyo-ku, Kyoto city, Kyoto 606-8501, Japan
| | | | - Shizuka Fujimoto
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Japan
| | | | - Takeo Nakayama
- Department of Public Health, Kyoto University Graduate School of Medicine: Yoshidakonoe-cho, Sakyo-ku, Kyoto city, Kyoto 606-8501, Japan
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Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open 2018; 1:e185909. [PMID: 30646297 PMCID: PMC6324326 DOI: 10.1001/jamanetworkopen.2018.5909] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Nonpharmacologic methods of reducing the risk of new chronic opioid use among patients with musculoskeletal pain are important given the burden of the opioid epidemic in the United States. OBJECTIVE To determine the association between early physical therapy and subsequent opioid use in patients with new musculoskeletal pain diagnosis. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of health care insurance claims data between January 1, 2007, and December 31, 2015, included privately insured patients who presented with musculoskeletal pain to an outpatient physician office or an emergency department at various US facilities from January 1, 2008, to December 31, 2014. The sample comprised 88 985 opioid-naive patients aged 18 to 64 years with a new diagnosis of musculoskeletal shoulder, neck, knee, or low back pain. The data set (obtained from the IBM MarketScan Commercial database) included person-level International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis codes, Current Procedural Terminology codes, and date of service as well as pharmaceutical information (National Drug Code, generic name, dose, and number of days supplied). Early physical therapy was defined as at least 1 session received within 90 days of the index date, the earliest date a relevant diagnosis was provided. Data analysis was conducted from March 1, 2018, to May 18, 2018. MAIN OUTCOMES AND MEASURES Opioid use between 91 and 365 days after the index date. RESULTS Of the 88 985 patients included, 51 351 (57.7%) were male and 37 634 (42.3%) were female with a mean (SD) age of 46 (11.0) years. Among these patients, 26 096 (29.3%) received early physical therapy. After adjusting for potential confounders, early physical therapy was associated with a statistically significant reduction in the incidence of any opioid use between 91 and 365 days after the index date for patients with shoulder pain (odds ratio [OR], 0.85; 95% CI, 0.77-0.95; P = .003), neck pain (OR, 0.92; 95% CI, 0.85-0.99; P = .03), knee pain (OR, 0.84; 95% CI, 0.77-0.91; P < .001), and low back pain (OR, 0.93; 95% CI, 0.88-0.98; P = .004). For patients who did use opioids, early physical therapy was associated with an approximately 10% statistically significant reduction in the amount of opioid use, measured in oral morphine milligram equivalents, for shoulder pain (-9.7%; 95% CI, -18.5% to -0.8%; P = .03), knee pain (-10.3%; 95% CI, -17.8% to -2.7%; P = .007), and low back pain (-5.1%; 95% CI, -10.2% to 0.0%; P = .046), but not for neck pain (-3.8%; 95% CI, -10.8% to 3.3%; P = .30). CONCLUSIONS AND RELEVANCE Early physical therapy appears to be associated with subsequent reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined.
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Affiliation(s)
- Eric Sun
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Jasmin Moshfegh
- Center for Health Policy, Stanford University School of Medicine, Stanford, California
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Chris A. Rishel
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Chad E. Cook
- Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Adam P. Goode
- Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Steven Z. George
- Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
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65
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Hudon A, Hunt M, Ehrmann Feldman D. Physiotherapy for injured workers in Canada: are insurers' and clinics' policies threatening good quality and equity of care? Results of a qualitative study. BMC Health Serv Res 2018; 18:682. [PMID: 30176873 PMCID: PMC6122715 DOI: 10.1186/s12913-018-3491-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/22/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers' practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists' practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers' compensation boards' and 2) physiotherapy clinics' policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces. METHODS The Interpretive Description framework, a qualitative methodological approach, guided this inquiry. Forty participants (30 physiotherapists and 10 leaders and administrators from physiotherapy professional groups and workers' compensation boards) were recruited in British Columbia, Ontario and Quebec to participate in an in-depth interview. Inductive analysis was conducted using constant comparative techniques. RESULTS Narratives from participants show that policies of workers' compensation boards and individual physiotherapy clinics have significant impacts on physiotherapists' clinical practices. Policies found at both levels often place physiotherapists in uncomfortable positions where they cannot always do what they believe to be best for their patients. Because of these policies, treatments provided to compensated injured workers markedly differ from those provided to other patients receiving physiotherapy care at the same clinic. Workers' compensation board policies such as reimbursement rates, end points for treatment and communication mechanisms, and clinic policies such as physiotherapists' remuneration schemes and restrictions on the choice of professionals had negative influences on care. Policies that were viewed as positive were board policies that recognize, promote and support physiotherapists' duties and clinics that provide organisational support for administrative tasks. CONCLUSION In Canada, workers' compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.
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Affiliation(s)
- Anne Hudon
- Faculty of Medicine, School of Rehabilitation, University of Montreal, Pavillon du Parc, office 402-27, C.P. 6128, Succ. Centre-ville, Montréal, Québec H3C 3J7 Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
- Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), Montréal, Canada
| | - Matthew Hunt
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
- School of Physical and Occupational Therapy, McGill University, Hosmer House, Room 205, 3630 Promenade Sir William Osler, Montréal, Québec H3G 1Y5 Canada
| | - Debbie Ehrmann Feldman
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
- Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), Montréal, Canada
- Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine, University of Montreal, Pavillon du Parc, C.P. 6128, Succ. Centre-ville, Montréal, Québec H3C 3J7 Canada
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Petit A, Begue C, Richard I, Roquelaure Y. Factors influencing physiotherapists' attitudes and beliefs toward chronic low back pain: Impact of a care network belonging. Physiother Theory Pract 2018. [PMID: 29521556 DOI: 10.1080/09593985.2018.1444119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the attitudes and beliefs of physiotherapists (PTs) regarding the management of chronic LBP and to investigate the factors which influence them. METHODS A cross-sectional study conducted in the French Loire Valley region by a questionnaire sent to the private PTs between June and September 2014. Demographic data and modalities of practices were collected in association with the Pain Attitudes and Beliefs Scale (PABS) which is a specific self-administered questionnaire designed to assess the "biomedical" or "behavioral" (i.e., biopsychosocial) management orientation of PTs toward chronic LBP. RESULTS One hundred and sixty-eight of the 704 PTs entirely completed the questionnaire (63% of men, 58% >40 years of age) of whom 15 were involved in a LBP care network. A higher biomechanical score was observed with a higher age and lower with full-time employment, less than 20 years of length of practice and a recent LBP-specific training (p < 0.005). Belonging to a LBP care network was associated with a lower biomedical score (p < 0.01) and a higher biopsychosocial score (p < 0.005). CONCLUSIONS Belonging to a LBP care network, which implies closer collaboration with multidisciplinary rehabilitation teams, was the most significant factor associated with higher biopsychosocial beliefs in PTs toward chronic LBP management.
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Affiliation(s)
- Audrey Petit
- a Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST) , LUNAM, University of Angers , Angers , France.,b Occupational Health Department , University Hospital of Angers , Angers , France
| | - Cyril Begue
- a Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST) , LUNAM, University of Angers , Angers , France.,c Department of General Practice , University of Angers, Faculty of Medicine , Angers , France
| | - Isabelle Richard
- a Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST) , LUNAM, University of Angers , Angers , France.,d Department of Physical Medicine and Rehabilitation , University Hospital of Angers , Angers , France
| | - Yves Roquelaure
- a Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST) , LUNAM, University of Angers , Angers , France.,b Occupational Health Department , University Hospital of Angers , Angers , France
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The Effect of Following Clinical Practice Guidelines on the Pain and Disability Outcomes of Patients With Low Back Pain-A Critically Appraised Topic. J Sport Rehabil 2018; 27:189-193. [PMID: 28095110 DOI: 10.1123/jsr.2015-0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Health care clinicians are encouraged to practice according to the best available evidence for the purpose of improving patient outcomes. Clinical practice guidelines are one form of evidence that has been developed to enhance the care that patients receive for particular conditions. Low back pain is a common condition in rehabilitation medicine that places a significant financial burden on the healthcare system. Patients with low back pain often suffer great pain and disability that can last a long time, making effective and efficient care a priority. Several guidelines for the treatment of low back pain have been created; however, there is no consensus on whether following these guidelines will positively reduce the pain and disability experienced by patients. CLINICAL QUESTION Does adherence to clinical practice guidelines for patients with nonspecific low back pain reduce pain and disability? Summary of Key Findings: A total of 4 studies of level 3 or higher were found. Four studies noted an improvement in disability following guidelines adherent care. Two studies reported greater reduction in pain with guideline adherent care and 2 did not. Clinical Bottom Line: Moderate evidence exists to support adherence to clinical practice guidelines to improve pain and disability ratings in patients with nonspecific low back pain.
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Marshall TF, Groves JR, Holan GP, Lacamera J, Choudhary S, Pietrucha RJ, Tjokro M. The Feasibility of Community-Based, Supervised Exercise Programs to Engage and Monitor Patients in a Postrehabilitation Setting. Am J Lifestyle Med 2018; 14:443-461. [PMID: 33281525 DOI: 10.1177/1559827617750385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective. To evaluate the feasibility of disease-specific, community-based supervised exercise programs (CSEPs) to improve biometric and functional outcomes among persons with a variety of chronic medical conditions. Design. Feasibility, cohort study. Subjects were recruited through community placed flyers and provider offices. Exercise programs consisted of aerobic and resistance training that adhered to American College of Sports Medicine guidelines. A Wilcoxon signed rank test was used to assess program outcomes. Setting. Ten, community-based, medical fitness centers. Subjects. A total of 382 total participants. The number of participants in each CSEP ranged from 38 to 119. Individuals were 18 years of age or older and treated for various chronic medical conditions. Results. Varied by cohort, but generally consisted of (a) favorable changes in body composition ( P < .05), (b) significant improvements in submaximal exercise tolerance and functional outcome measures ( P < .05), and (3) significant increase in self-reported exercise behaviors ( P < .05). Conclusion. CSEPs improve outcomes in patients with chronic medical conditions and may be relevant within the continuum of care in outpatient rehabilitation medicine, particularly among bundled or value-based payment models. Further research is needed to evaluate outcomes from CSEPs versus controls.
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Affiliation(s)
- Timothy F Marshall
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Jay R Groves
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - George P Holan
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Jonathan Lacamera
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Shaloo Choudhary
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Ronald J Pietrucha
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
| | - Moorissa Tjokro
- School of Physical Therapy, Kean University, Union, New Jersey (TFM, GPH, JL).,Fitness & Wellness Professional Services, Princeton, New Jersey (TFM, JRG, RJP).,Outpatient PT&OT Department, RWJ BarnabasHealth, New Brunswick, New Jersey (SC).,School of Engineering & Applied Science, Columbia University, New York, New York (MT)
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Lemmon R, Roseen EJ. Chronic Low Back Pain. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wilson A, Vento M, Shah PS, Saugstad O, Finer N, Rich W, Morton RL, Rabi Y, Tarnow-Mordi W, Suzuki K, Wright IM, Oei JL. A review of international clinical practice guidelines for the use of oxygen in the delivery room resuscitation of preterm infants. Acta Paediatr 2018; 107:20-27. [PMID: 28792628 DOI: 10.1111/apa.14012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/05/2017] [Accepted: 08/03/2017] [Indexed: 01/20/2023]
Abstract
AIM To collate and assess international clinical practice guidelines (CPG) to determine current recommendations guiding oxygen management for respiratory stabilisation of preterm infants at delivery. METHODS A search of public databases using the terms 'clinical practice guidelines', 'preterm', 'oxygen' and 'resuscitation' was made and complemented by direct query to consensus groups, resuscitation expert committees and clinicians. Data were extracted to include the three criteria for assessment: country of origin, gestation and initial FiO2 and target SpO2 for the first 10 minutes of life. RESULTS A total of 45 CPGs were identified: 36 provided gestation specific recommendations (<28 to <37 weeks) while eight distinguished only between 'preterm' and 'term'. The most frequently recommended initial FiO2 were between 0.21 and 0.3 (n = 17). Most countries suggested altering FiO2 to meet SpO2 targets recommended by expert committees, However, specific five-minute SpO2 targets differed by up to 20% (70-90%) between guidelines. Five countries did not specify SpO2 targets. CONCLUSION CPG recommendations for delivery room oxygen management of preterm infants vary greatly, particularly in regard to gestational ages, initial FiO2 and SpO2 targets and most acknowledge the lack of evidence behind these recommendations. Sufficiently large and well-designed randomised studies are needed to inform on this important practice.
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Affiliation(s)
- A Wilson
- Department of Newborn Care; the Royal Hospital for Women; Randwick NSW Australia
| | - M Vento
- Division of Neonatology; University and Polytechnic Hospital La Fe; Valencia Spain
| | - PS Shah
- Department of Pediatrics; Mount Sinai Hospital and University of Toronto; Toronto ON Canada
| | - O Saugstad
- Department of Pediatric Research; the University of Oslo; Oslo University Hospital; Oslo Norway
| | - N Finer
- University of California; San Diego CA USA
| | - W Rich
- University of California; San Diego CA USA
| | - RL Morton
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
| | - Y Rabi
- University of Calgary; Calgary AB Canada
- Alberta Children's Hospital Research Institute; Calgary AB Canada
| | - W Tarnow-Mordi
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
| | - K Suzuki
- Department of Pediatrics; Tokai University School of Medicine; Isehara Kanagawa Japan
| | - IM Wright
- Illawarra Health and Medical Research Institute and Graduate Medicine; The University of Wollongong; Wollongong NSW Australia
| | - JL Oei
- Department of Newborn Care; the Royal Hospital for Women; Randwick NSW Australia
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
- School of Women's and Children's Health; the University of New South Wales; Kensington NSW Australia
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Student Physical Therapists Achieve Similar Patient Outcomes as Licensed Physical Therapists. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jte.0000000000000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- Alan M Jette
- A.M. Jette, PT, PhD, FAPTA, is editor in chief of PTJ. Readers can contact Dr Jette at
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Miller J, Barber D, Donnelly C, French S, Green M, Hill J, MacDermid J, Marsh J, Norman K, Richardson J, Taljaard M, Wideman T, Cooper L, McPhee C. Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial. Trials 2017; 18:526. [PMID: 29121989 PMCID: PMC5680754 DOI: 10.1186/s13063-017-2279-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. METHODS This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. DISCUSSION If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. TRIAL REGISTRATION ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.
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Affiliation(s)
- Jordan Miller
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, Canada
| | | | - Joy MacDermid
- Physical Therapy, Western University, London, Canada
| | | | - Kathleen Norman
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | | | - Timothy Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Adherence to Back Pain Clinical Practice Guidelines by Brazilian Physical Therapists: A Cross-sectional Study. Spine (Phila Pa 1976) 2017; 42:E1251-E1258. [PMID: 28399548 DOI: 10.1097/brs.0000000000002190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a cross-sectional observational study. OBJECTIVES (i) to investigate whether Brazilian physical therapists make clinical decisions for patients with low back pain based upon clinical practice guidelines and (ii) to determine whether the physical therapists are able to recognize differential diagnoses of low back pain associated with red or yellow flags. SUMMARY OF BACKGROUND DATA Early adherence to clinical practice guidelines may accelerate recovery and reduce the costs associated with low back pain. It is unknown whether Brazilian physical therapists follow clinical practice guidelines to make their clinical decisions in the treatment of patients with low back pain. METHODS The sample consisted of physical therapists from two Brazilian physical therapy associations. The data were collected via electronic survey and face-to-face interviews. The survey was composed of six hypothetical clinical cases of low back pain, which served as a basis to evaluate clinical decisions and adherence to clinical practice guidelines for low back pain. The study participants had 27 possible answers for each clinical case and could choose up to five answers. The results were analyzed in three ways: full adherence, partial adherence, or no adherence to the recommendations from clinical practice guidelines. RESULTS A total of 530 physical therapists were invited and 189 participated in the study (response rate = 35.6%). Full adherence to the guidelines was low for all six cases (rates ranging from 5%-24%). Partial adherence to the guidelines was higher when compared with full adherence (rates ranging from 32%-75%). The participants were more likely to identify differential diagnoses associated with yellow flags than with red flags. CONCLUSION Brazilian physical therapists are not using the best available evidence in their clinical decision making for patients with low back pain. Wider dissemination of clinical practice guidelines should be urgently undertaken. LEVEL OF EVIDENCE 2.
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Abstract
PURPOSE This study describes survey responses about implementation of the congenital muscular torticollis clinical practice guideline (CMT-CPG) by pediatric physical therapists (PT) and successes and challenges with knowledge-brokering activities. METHODS An online survey was distributed to pediatric PTs who self-identified with practice experience with congenital muscular torticollis. Data were analyzed for implementation frequency of guideline recommendations and differences pre and postpublication of the CMT-CPG. RESULTS After publication, guideline recommendation implementation improved such that no recommendation was being implemented by less than 50% of respondents, and most were implemented by greater than 90%. The majority of respondents participated in knowledge brokering; however, many indicated minimal effectiveness of those activities. CONCLUSIONS The CMT-CPG has successfully aided in changing practice. Participants identified areas of challenge and success in translating recommendations into practice and in knowledge brokering that may be helpful for the development of future CPGs.
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Nonsurgical Treatment Choices by Individuals with Lumbar Intervertebral Disc Herniation in the United States: Associations with Long-term Outcomes. Am J Phys Med Rehabil 2017; 96:557-564. [PMID: 28045705 DOI: 10.1097/phm.0000000000000685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The objectives of this study were to (1) evaluate differences between patients with lumbar intervertebral disc herniation who received physical therapy (PT) and those who did not; (2) identify factors associated with receiving PT; and (3) examine the influence of PT on clinical outcomes over the course of 1 yr. DESIGN An observational cohort study using data from the Spine Patient Outcomes Research Trial was conducted. This study included 363 patients with intervertebral disc herniation who received nonsurgical management within 6 wks of enrollment. Baseline characteristics were compared between patients who received PT and those who did not. Multivariate logistic regression examined factors predictive of patients receiving PT. Mixed effects models were used to compare primary outcomes (Short-Form Survey 36 bodily pain and physical function and modified Oswestry Index) at 3 and 6 mos and 1 yr after enrollment. RESULTS Forty percent of the nonsurgical cohort received PT. Higher disability scores, neurological deficit, and patient preference predicted PT use. Compared with other nonsurgical management strategies, standard care PT was not associated with a significant difference in pain, disability, or surgery over 1 yr. CONCLUSIONS Many patients with intervertebral disc herniation seek secondary care for persisting symptoms and pursue nonsurgical management. The best management strategy is unclear and further research is needed to examine appropriate sequencing and selection of treatment.
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Collins CK, Masaracchio M, Brismée JM. The future of orthopedic manual therapy: what are we missing? J Man Manip Ther 2017; 25:169-171. [PMID: 28912628 DOI: 10.1080/10669817.2017.1358249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Jean-Michel Brismée
- Editor-in-Chief, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of US Physical Therapists. J Orthop Sports Phys Ther 2017; 47:347-358. [PMID: 28257618 DOI: 10.2519/jospt.2017.6561] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs. Conclusion Physical therapists who were PTFOs and PTOs adhered better to the CPG than did PTMSs. Based on our preliminary results, further education on the CPG for LBP management is needed, particularly for managing LBP with coordination impairment and with fear-avoidance behavior. J Orthop Sports Phys Ther 2017;47(5):347-358. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6561.
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Jette AM. Overcoming Ignorance and Ineptitude in 21st Century Rehabilitation. Phys Ther 2017; 97:497-498. [PMID: 28605558 DOI: 10.1093/ptj/pzx037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/14/2022]
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Christensen C, Wessells D, Byars M, Marrie J, Coffman S, Gates E, Selhorst M. The impact of a unique knowledge translation programme implemented in a large multisite paediatric hospital. J Eval Clin Pract 2017; 23:344-353. [PMID: 27594577 DOI: 10.1111/jep.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Physical therapists (PTs) display positive attitudes toward evidence-based practice (EBP), and implementing it can improve patient outcomes and reduce costs. However, barriers can lead to inconsistent use of EBP. The objectives of this manuscript are to (i) describe the initiation and revisions to a knowledge translation (KT) programme, (ii) assess staff participation in KT, and (iii) evaluate availability, internal use and external dissemination of evidence-based recommendations and research. TARGET SETTING The KT programme was implemented in a large paediatric hospital employing 66 PTs who provide services in the inpatient, outpatient developmental and sports and orthopaedics settings in 15 locations. DEVELOPMENT OF KT PROGRAMME The KT programme was initiated 9 years ago but underwent improvements over the past 3 years. Five key revisions included the subdivision of the EBP and Research Coordinator positions by area of practice, increasing the structure of the KT programme, implementing strategies to encourage use of local recommendations, obtaining leadership support to emphasize KT and providing staff education. OUTCOMES With the revisions, staff participation in local recommendation development increased from 16.3-68.2%. Research involvement increased from 4.1-50%. The number of local recommendations increased from 1 to 9, and an overall compliance rate of 79% was achieved for the recommendations presented in an algorithm format. External dissemination increased from 1 to 44 for presentations and 0 to 7 for publications. DISCUSSION Revisions to a KT programme improved PT engagement in KT activities, increased the availability of local recommendations, encouraged use of EBP and increased external dissemination of information.
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Affiliation(s)
- Catie Christensen
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - David Wessells
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michelle Byars
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - James Marrie
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shaun Coffman
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Gates
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mitch Selhorst
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
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81
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Luna EG, Hanney WJ, Rothschild CE, Kolber MJ, Liu X, Masaracchio M. The Influence of an Active Treatment Approach in Patients With Low Back Pain: A Systematic Review. Am J Lifestyle Med 2017; 13:190-203. [PMID: 30800026 DOI: 10.1177/1559827617697273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction. Low back pain (LBP) is one of the most common medical conditions in the United States. Clinical practice guidelines recommend active treatment approaches; however, there continues to be a significant disparity in how patients with LBP are treated. Therefore, the purpose of this systematic review is to evaluate the reported efficacy of active treatment approaches as recommended by clinical practice guidelines on LBP treatment on patient outcomes. Methods. Between the months of June and August 2015, a comprehensive search of the PubMed, Medline (EBSCO Host), and CINAHL (EBSCO Host) databases was performed. The search was restricted to articles that were published in a peer-reviewed journal, published in the English language, examined patient outcomes with a determined scale, determined the usage of an established clinical practice guideline for LBP treatment, reported at least one outcome measure, and specified either nonspecific or acute LBP. Results. Fifty-three articles were initially identified, with 4 articles ultimately meeting the criteria after screening. Articles scored between 17 and 20 points based on a maximum total score of 26 on the modified Downs and Black checklist. Conclusion. Studies identified in this review indicate that adherence to an active treatment approach as recommended by clinical practice guidelines may result in improved patient outcomes.
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Affiliation(s)
- Emiangeliz Gonzalez Luna
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
| | - William J Hanney
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
| | - Carey E Rothschild
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
| | - Morey J Kolber
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
| | - Xinliang Liu
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
| | - Michael Masaracchio
- Departments of Health Professions (EGL, WJH, CER), University of Central Florida, Orlando, Florida.,Health Management and Informatics (XL), University of Central Florida, Orlando, Florida.,Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida (MJK).,Department of Physical Therapy, Long Island University, Brooklyn, New York (MM)
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82
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Karvelas DA, Rundell SD, Friedly JL, Gellhorn AC, Gold LS, Comstock BA, Heagerty PJ, Bresnahan BW, Nerenz DR, Jarvik JG. Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults. Spine J 2017; 17:380-389. [PMID: 27765707 DOI: 10.1016/j.spinee.2016.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain. PURPOSE This study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain-specific health-care utilization in older adults. DESIGN/SETTING This is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry. PATIENT SAMPLE We recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain. OUTCOME MEASURES Primary outcome was total back pain-specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use. METHODS We compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables. RESULTS Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72-1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17-3.03, p<.001). The early PT group had greater imaging RVUs; the ratio of means was 1.37 (95% CI of 1.09-1.71, p=.01.) CONCLUSIONS: We found that in a group of older adults presenting for a new episode of low back pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain-specific health-care utilization compared with patients not receiving early PT.
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Affiliation(s)
- Deven A Karvelas
- Rebound Orthopedics and Neurosurgery 200 NE Mother Joseph Place Suite 210 Vancouver, WA, 98664.
| | - Sean D Rundell
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105
| | - Janna L Friedly
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105
| | - Alfred C Gellhorn
- Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medical Center, 525 East 68th St., 16th Floor New York, NY 10065
| | - Laura S Gold
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105
| | - Bryan A Comstock
- Center for Biomedical Statistics, University of Washington, Box 357232 Seattle, WA 98195
| | - Patrick J Heagerty
- Center for Biomedical Statistics, University of Washington, Box 357232 Seattle, WA 98195
| | - Brian W Bresnahan
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105
| | - David R Nerenz
- Neuroscience Institute, Henry Ford Hospital, 2799 West Grand Blvd Detroit, MI 48202
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105
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83
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Cost-Effectiveness of Primary Care Management With or Without Early Physical Therapy for Acute Low Back Pain: Economic Evaluation of a Randomized Clinical Trial. Spine (Phila Pa 1976) 2017; 42:285-290. [PMID: 27270641 DOI: 10.1097/brs.0000000000001729] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Economic evaluation of a randomized clinical trial. OBJECTIVE Compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain (LBP) with or without the addition of early physical therapy. SUMMARY OF BACKGROUND DATA Low back pain is among the most common and costly conditions encountered in primary care. Early physical therapy after a new primary care consultation for acute LBP results in small clinical improvement but cost-effectiveness of a strategy of early physical therapy is unknown. METHODS Economic evaluation was conducted alongside a randomized clinical trial of patients with acute, nonspecific LBP consulting a primary care provider. All patients received usual primary care management and education, and were randomly assigned to receive four sessions of physical therapy or usual care of delaying referral consideration to permit spontaneous recovery. Data were collected in a randomized trial involving 220 participants age 18 to 60 with LBP <16 days duration without red flags or signs of nerve root compression. The EuroQoL EQ-5D health states were collected at baseline and after 1-year and used to compute the quality adjusted life year (QALY) gained. Direct (health care utilization) and indirect (work absence or reduced productivity) costs related to LBP were collected monthly and valued using standard costs. The incremental cost-effectiveness ratio was computed as incremental total costs divided by incremental QALYs. RESULTS Early physical therapy resulted in higher total 1-year costs (mean difference in adjusted total costs = $580, 95% CI: $175, $984, P = 0.005) and better quality of life (mean difference in QALYs = 0.02, 95% CI: 0.005, 0.35, P = 0.008) after 1-year. The incremental cost-effectiveness ratio was $32,058 (95% CI: $10,629, $151,161) per QALY. CONCLUSION Our results support early physical therapy as cost-effective relative to usual primary care after 1 year for patients with acute, nonspecific LBP. LEVEL OF EVIDENCE 2.
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84
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Fujimoto S, Kon N, Takasugi J, Nakayama T. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey. J Phys Ther Sci 2017; 29:198-208. [PMID: 28265139 PMCID: PMC5332970 DOI: 10.1589/jpts.29.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of
evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014,
a cross-sectional postal mail survey using a self-administered questionnaire was
conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical
Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items
pertaining to the attitudes of and behavior toward evidence-based practice and clinical
practice guidelines. It was investigated to reveal the relationship between clinical
practice guidelines/evidence-based practice and therapist characteristics. [Results] The
response rate was 39.6%, and 384 questionnaires were available. The main results were as
follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1%
agree to that evidence-based practice supports clinical decision of physical therapists,
and about 11% agreed to have been educated about evidence-based practice. Then, 29.2%
used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical
practice guidelines. An important factor related mostly to a positive attitude, knowledge
and behavior of evidence-based practice and clinical practice guidelines was participating
in research activities. [Conclusion] Many of physical therapists do not use and understand
the importance of clinical practice guidelines. Participating in research activities may
partially contribute to improving these conditions.
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Affiliation(s)
| | | | - Jun Takasugi
- Chiba Prefectural University of Health Sciences, Japan
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85
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Amorin-Woods LG, Losco BE. 'PICO-D Management'; a decision-aid for evidence-based chiropractic education and clinical practice. Chiropr Man Therap 2016; 24:49. [PMID: 27999660 PMCID: PMC5151136 DOI: 10.1186/s12998-016-0130-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022] Open
Abstract
Background Various models and decision-making aids exist for chiropractic clinical practice. Results “PICO-D Man” (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice. Clinical decision-making involves understanding and evaluating both the proposed clinicalintervention(s) and the relevant and available management options with respect to describing the patient and their problem, clinical and cost effectiveness, safety, feasibility and time-frame. Conclusions For people consulting chiropractors this decision-aid usually requires the practitioner to consider a comparison of usual chiropractic care, (clinical management including a combination of active care and passive manual interventions), to usual medical care usually including medications, or other allied healthmanagement options while being mindful of the natural history of the persons’ condition.
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Affiliation(s)
- Lyndon G Amorin-Woods
- School of Health Professions, Discipline of Chiropractic 90 South St Murdoch, Perth, 6150 Western Australia
| | - Barrett E Losco
- School of Health Professions, Discipline of Chiropractic 90 South St Murdoch, Perth, 6150 Western Australia
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86
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Mitchell JM, Reschovsky JD, Franzini L, Reicherter EA. Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures. Forum Health Econ Policy 2016; 19:179-199. [PMID: 31419896 DOI: 10.1515/fhep-2015-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008-2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as "self-referral." Only 10% of "non-self-referral" episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical - about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of "active" (hands on or patient engaged) as opposed to "passive" treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians' referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.
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Affiliation(s)
- Jean M Mitchell
- Georgetown University - McCourt School of Public Policy, Old North 314, 37th & "O" Sts, NW Washington, DC 20057,United States of America
| | - James D Reschovsky
- Mathematica Policy Research, Washington, District of Columbia,United States of America
| | - Luisa Franzini
- University of Maryland School of Public Health - Health Services Administration, College Park, MD,United States of America
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87
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Amoakoh-Coleman M, Klipstein-Grobusch K, Agyepong IA, Kayode GA, Grobbee DE, Ansah EK. Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study. BMC Pregnancy Childbirth 2016; 16:369. [PMID: 27881104 PMCID: PMC5121950 DOI: 10.1186/s12884-016-1167-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting. METHODS Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities. RESULTS Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04]. CONCLUSION Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.
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Affiliation(s)
- Mary Amoakoh-Coleman
- Postdoctoral Unit, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. .,Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Irene Akua Agyepong
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.,Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Gbenga A Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evelyn K Ansah
- Research and Development Division, Ghana Health Service, Accra, Ghana
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88
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Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis. BMC Health Serv Res 2016; 16:253. [PMID: 27405318 PMCID: PMC4942887 DOI: 10.1186/s12913-016-1504-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain. METHODS One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing "early" management and patients with duration of symptoms greater than 4 weeks were designated as receiving "delayed" management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency. RESULTS Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit. CONCLUSIONS These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.
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Affiliation(s)
- Maggie E Horn
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, Oklahoma, OK, 73117, USA.
| | - Gerard P Brennan
- Director of Clinical Quality and Outcomes Research, Intermountain Healthcare, 389 South 900 East, Salt Lake, UT, 84102, USA
| | - Steven Z George
- Department of Physical Therapy, University of Florida, UFHSC, Box 100154, Gainesville, FL, 32610, USA
| | - Jeffrey S Harman
- Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32606, USA
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, UFHSC, Box 100154, Gainesville, FL, 32610, USA
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89
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Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. Clinical Outcomes, Utilization, and Charges in Persons With Neck Pain Receiving Guideline Adherent Physical Therapy. Eval Health Prof 2016; 39:421-434. [DOI: 10.1177/0163278715583510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In efforts to decrease practice variation, clinical practice guidelines for neck pain have been published. The purpose of this study was to determine the effect of receiving guideline adherent physical therapy (PT) on clinical outcomes, health care utilization, and charges for health care services in patients with neck pain. A retrospective review of 298 patients with neck pain receiving PT from 2008 to 2011 was performed. Clinical outcomes, utilization, and charges were compared between patients who received guideline adherent care and nonadherent care. Patients in the adherent care group experienced a lower percentage improvement in pain score compared to nonadherent care group ( p = .01), but groups did not significantly differ on percentage improvement in disability ( p = .32). However, patients receiving adherent care had an average 3.6 fewer PT visits ( p < .001) and less charges for PT ( p < .001). Additionally, patients receiving adherent care had 7.3 fewer visits to other health care providers ( p < .001), one less prescription medication ( p = .02) and 43% fewer diagnostic images ( p = .02) but did not differ in their charges to other health care providers ( p = .68) during the calendar year of undergoing PT. Although receiving guideline adherent care demonstrated positive effects on health care utilization and financial outcomes, there appears to be a trade-off with clinical outcomes.
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Affiliation(s)
- Maggie E. Horn
- School of Physical Therapy, Langston University, Langston, OK, USA
| | | | - Steven Z. George
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Brooks Rehabilitation, Jacksonville, FL, USA
| | - Jeffrey S. Harman
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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90
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Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature. PLoS One 2016; 11:e0156799. [PMID: 27285608 PMCID: PMC4902217 DOI: 10.1371/journal.pone.0156799] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/19/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. METHODS An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. RESULTS A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. CONCLUSION Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the impact of guideline adherence among patients with LBP.
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Affiliation(s)
- William J. Hanney
- Department of Health Professions, University of Central Florida, Orlando, Florida, United States of America
| | - Michael Masaracchio
- Department of Physical Therapy, Long Island University, Brooklyn, New York, United States of America
| | - Xinliang Liu
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America
| | - Morey J. Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
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91
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Roberts ET, DuGoff EH, Heins SE, Swedler DI, Castillo RC, Feldman DR, Wegener ST, Canudas‐Romo V, Anderson GF. Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data. Health Serv Res 2016; 51:953-80. [PMID: 26368813 PMCID: PMC4874815 DOI: 10.1111/1475-6773.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries. DATA SOURCES/STUDY SETTING Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer. STUDY DESIGN Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable. DATA COLLECTION Collected by the insurer from the time an injury was reported, through recovery or last follow-up. PRINCIPAL FINDINGS Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW. CONCLUSIONS There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.
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Affiliation(s)
- Eric T. Roberts
- Department of Health Care PolicyHarvard Medical SchoolBostonMA
| | - Eva H. DuGoff
- Department of Population Health SciencesUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Sara E. Heins
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - David I. Swedler
- University of Illinois at Chicago School of Public HealthChicagoIL
| | - Renan C. Castillo
- METRC Coordinating CenterJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | - Vladimir Canudas‐Romo
- Department of Population, Family, and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Gerard F. Anderson
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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92
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Utilization and Payments of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance in New York State. Phys Ther 2016; 96:202-11. [PMID: 26658150 DOI: 10.2522/ptj.20150060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance. OBJECTIVE This study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State. DESIGN This was a retrospective descriptive study with a cross-sectional design. METHODS A cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses. RESULTS Physical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between. LIMITATIONS This study was based on commercial insurance claims data from one state. CONCLUSIONS Findings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions.
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93
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Martin-Gill C, Gaither JB, Bigham BL, Myers J, Kupas DF, Spaite DW. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders. PREHOSP EMERG CARE 2016; 20:175-83. [DOI: 10.3109/10903127.2015.1102995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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94
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Diermayr G, Schachner H, Eidenberger M, Lohkamp M, Salbach NM. Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement. J Eval Clin Pract 2015. [PMID: 26200235 DOI: 10.1111/jep.12415] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). METHODS A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. RESULTS The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. CONCLUSION Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.
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Affiliation(s)
- Gudrun Diermayr
- Physical Therapy Program, Department of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany.,Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Herbert Schachner
- Physical Therapy Program, Fachhochschule für Gesundheitsberufe Oberösterreich, Linz, Austria
| | - Margit Eidenberger
- Physical Therapy Program, Fachhochschule für Gesundheitsberufe Oberösterreich, Linz, Austria
| | - Monika Lohkamp
- Physical Therapy Program, Department of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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95
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"Lovely Pie in the Sky Plans": A Qualitative Study of Clinicians' Perspectives on Guidelines for Managing Low Back Pain in Primary Care in England. Spine (Phila Pa 1976) 2015; 40:1842-50. [PMID: 26571064 DOI: 10.1097/brs.0000000000001215] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A qualitative study in south-west England primary care. OBJECTIVE To clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians' perspectives on the English National Institute for Health and Care Excellence (NICE) clinical guidelines for managing LBP in primary care. SUMMARY OF BACKGROUND DATA Merely publishing clinical guidelines is known to be insufficient to ensure their implementation. Gaining an in-depth understanding of clinicians' perspectives on specific clinical guidelines can suggest ways to improve the relevance of guidelines for clinical practice. METHODS We conducted semi-structured interviews with 53 purposively sampled clinicians. Participants were 16 general practitioners (GPs), 10 chiropractors, 8 acupuncturists, 8 physiotherapists, 7 osteopaths, and 4 nurses, from the public sector (20), private sector (21), or both (12). We used thematic analysis. RESULTS Official guidelines comprised just 1 of many inputs to clinical decision-making. Clinicians drew on personal experience and inter-professional networks and were constrained by organizational factors when deciding which treatment to prescribe, refer for, or deliver to an individual patient with LBP. Some found the guideline terminology-"non-specific LBP"-unfamiliar and of limited relevance to practice. They were frustrated by disparities between recommendations in the guidelines and the real-world situation of short consultation times, difficult-to-access specialist services, and sparse commissioning of guideline-recommended treatments. CONCLUSION The NICE guidelines for managing LBP in primary care are one, relatively peripheral, influence on clinical decision-making among GPs, chiropractors, acupuncturists, physiotherapists, osteopaths, and nurses. When revised, these guidelines could be made more clinically relevant by: ensuring that guideline terminology reflects clinical practice terminology; dispelling the image of guidelines as rigid and prohibiting patient-centered care; providing opportunities for clinicians to engage in experiential learning about guideline-recommended complementary therapies; and commissioning guideline-recommended treatments for public sector patients. LEVEL OF EVIDENCE N/A.
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96
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Sigsbee B, Bever CT, Jones LK. Practice improvement requires more than guidelines and quality measures. Neurology 2015; 86:188-93. [DOI: 10.1212/wnl.0000000000002116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/19/2015] [Indexed: 11/15/2022] Open
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97
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Jarrar M, Abdul Rahman H, Don MS. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions. Glob J Health Sci 2015; 8:44132. [PMID: 26755459 PMCID: PMC4954916 DOI: 10.5539/gjhs.v8n6p75] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. DESIGN Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. RESULTS The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. CONCLUSIONS There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.
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Affiliation(s)
- Mu'taman Jarrar
- College of Business, Universiti Utara Malaysia, Kedah, Malaysia.
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98
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Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain. Arch Phys Med Rehabil 2015; 96:1756-62. [PMID: 26166733 DOI: 10.1016/j.apmr.2015.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the effect of clinical presentations of neck pain on short-term physical therapy outcomes. DESIGN Retrospective analysis of pair-matched groups from a clinical cohort. SETTING Thirteen outpatient physical therapy clinics in 1 health care system. PARTICIPANTS Patients (N=1069) grouped by common clinical presentations of neck pain: nonspecific neck pain (NSNP) with duration <4 weeks; NSNP with duration >4 weeks; neck pain with arm pain; neck pain with headache; and neck pain from whiplash. INTERVENTION Conservative interventions provided by physical therapists. MAIN OUTCOME MEASURES Neck Disability Index (NDI) and numerical pain rating scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Changes in NDI and NPRS were compared between clinical presentation groups. RESULTS Compared with patients presenting with NSNP >4 weeks, patients with NSNP <4 weeks had increased odds of achieving recovery status on the NDI (P<.0001) and demonstrated the greatest changes in clinical outcomes of pain (P≤.0001) and disability (P≤.0001). Patients with neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (P=.04) compared with patients presenting with NSNP >4 weeks. CONCLUSIONS Treating patients with NSNP within <4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared with other common clinical presentations.
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Affiliation(s)
- Maggie E Horn
- Department of Physical Therapy, Langston University, Langston, OK.
| | | | - Steven Z George
- Department of Physical Therapy, Brooks-PHHP Research Collaboration, University of Florida, Gainesville, FL
| | - Jeffrey S Harman
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL
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Campanella P, Lovato E, Marone C, Fallacara L, Mancuso A, Ricciardi W, Specchia ML. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Eur J Public Health 2015; 26:60-4. [PMID: 26136462 DOI: 10.1093/eurpub/ckv122] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic. METHODS PubMed, Web of Knowledge, Scopus and Cochrane Library databases were searched to identify studies that investigated the association between the EHR implementation and process or outcome indicators. Two reviewers screened identified citations and extracted data according to the PRISMA guidelines. Meta-analysis was performed using the random effects model for each indicator. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger's test. RESULTS Of the 23 398 citations identified, 47 articles were included in the analysis. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of -22.4% [95% confidence interval (CI) = -38.8 to -6.0%; P < 0.007]. EHR resulted also associated with a higher guideline adherence with a risk ratio (RR) of 1.33 (95% CI = 1.01 to 1.76; P = 0.049) and a lower number of medication errors with an overall RR of 0.46 (95% CI = 0.38 to 0.55; P < 0.001), and adverse drug effects (ADEs) with an overall RR of 0.66 (95% CI = 0.44 to 0.99; P = 0.045). No association with mortality was evident (P = 0.936). High heterogeneity among the studies was evident. Publication bias was not evident. CONCLUSIONS EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Strategies for EHR implementation should be therefore recommended and promoted.
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Affiliation(s)
- Paolo Campanella
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Emanuela Lovato
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Claudio Marone
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Lucia Fallacara
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Agostino Mancuso
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Walter Ricciardi
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
| | - Maria Lucia Specchia
- Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy
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100
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Ladeira CE, Samuel Cheng M, Hill CJ. Physical therapists' treatment choices for non-specific low back pain in Florida: an electronic survey. J Man Manip Ther 2015; 23:109-18. [PMID: 26109832 DOI: 10.1179/2042618613y.0000000065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES No study has described low back pain (LBP) treatment choices among physical therapists (PTs) in the United States (US) in the new millennium. Intervention for LBP in the new millennium is largely based on evidence-based practice (EBP) recommendations. The purpose of this study was twofold: (a) to describe PTs' preferences for treating acute and subacute non-specific LBP in Florida and to compare these preferences to EBP guideline recommendations and (b) to compare outpatient musculoskeletal therapist (MSPT) choices for management of acute and subacute LBP to non-outpatient musculoskeletal therapist (NMSPT) choices. METHODS The data were collected with an electronic survey. Study participants selected treatment choices for acute and subacute LBP clinical vignettes. RESULTS A total of 327 PTs participated in the study, of which 128 worked in outpatient musculoskeletal settings. The most common treatment choices for acute and subacute LBP were home exercise program, exercise in the clinic, back care education, joint mobilization, ice/heat, and interferential current. The EBP adherence rate for acute LBP was 30% for MSPTs and 15% for NMSPTs. Thirty-seven percent (37%) of MSPTs and 30% of NMSPTs adhered to EBP guidelines for subacute LBP. DISCUSSION The EBP adherence rate for management of acute and subacute LBP was low. Spinal manipulation was underutilized for management of acute LBP, and passive therapeutic procedures were overutilized for subacute LBP. Physical Therapy schools and professional associations should reemphasize the benefits of spinal manipulation to manage non-specific acute LBP and active interventional procedures to manage subacute LBP.
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Affiliation(s)
- Carlos E Ladeira
- Physical Therapy Program, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - M Samuel Cheng
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Cheryl J Hill
- Physical Therapy Department, IJAHSP, Nova Southeastern University, Fort Lauderdale, FL, USA
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