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Abdel Shaheed C, Ivers R, Vizza L, McLachlan A, Kelly PJ, Blyth F, Stanaway F, Clare PJ, Thompson R, Lung T, Degenhardt L, Reid S, Martin B, Wright M, Osman R, French S, McCaffery K, Campbell G, Jenkins H, Mathieson S, Boogs M, McMaugh J, Bennett C, Maher C. Clinical Observation, Management and Function Of low back pain Relief Therapies (COMFORT): A cluster randomised controlled trial protocol. BMJ Open 2023; 13:e075286. [PMID: 37989377 PMCID: PMC10668201 DOI: 10.1136/bmjopen-2023-075286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Low back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines. METHODS AND ANALYSIS This is a cluster randomised controlled trial that will evaluate the effect of educational outreach visits to GPs promoting opioid stewardship alongside non-pharmacological interventions including heat wrap and patient education about the possible harms and benefits of opioids, on GP prescribing of opioids medicines dispensed. At least 40 general practices will be randomised in a 1:1 ratio to either the intervention or control (no outreach visits; GP provides usual care). A total of 410 patient-participants (205 in each arm) who have been prescribed an opioid for LBP will be enrolled via participating general practices. Follow-up of patient-participants will occur over a 1-year period. The primary outcome will be the cumulative dose of opioid dispensed that was prescribed by study GPs over 1 year from the enrolment visit (in morphine milligram equivalent dose). Secondary outcomes include prescription of opioid medicines, benzodiazepines, gabapentinoids, non-steroidal anti-inflammatory drugs by study GPs or any GP, health services utilisation and patient-reported outcomes such as pain, quality of life and adverse events. Analysis will be by intention to treat, with a health economics analysis also planned. ETHICS AND DISSEMINATION The trial received ethics approval from The University of Sydney Human Research Ethics Committee (2022/511). The results will be disseminated via publications in journals, media and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12622001505796.
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Affiliation(s)
- Christina Abdel Shaheed
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Sydney, New South Wales, Australia
| | - Lisa Vizza
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Stanaway
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Philip James Clare
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Prevention Research Collaboration, University of Sydney, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre (NDARC), Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Lung
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bradley Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences College of Pharmacy, Arkansas, Arkansas, USA
| | - Michael Wright
- Centre for Health Economics Research Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rawa Osman
- Quality Use of Medicines (QUM) Connect, Sydney, New South Wales, Australia
| | - Simon French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- School of Psychology, University of Queensland, Queensland, Queensland, Australia
| | - Hazel Jenkins
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Monika Boogs
- Painaustralia Consumer Advisory Group, Canberra, ACT, Australia
| | - Jarrod McMaugh
- Pharmaceutical Society of Australia, Canberra, ACT, Australia
| | - Carol Bennett
- Alliance for Gambling Reform, National, Victoria, Australia
- College of Arts and Social Sciences, The Australian National University, Canberra, ACT, Australia
- Department of Health, Therapeutic Goods Administration National Medicines Scheduling Advisory Committee, Canberra, ACT, Australia
- Faculty of Health Science, University of Canberra, Canberra, ACT, Australia
| | - Christopher Maher
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
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Grøn S, Bülow K, Jonsson TD, Degn J, Kongsted A. What do people believe to be the cause of low back pain? A scoping review. Braz J Phys Ther 2023; 27:100562. [PMID: 37972538 PMCID: PMC10679815 DOI: 10.1016/j.bjpt.2023.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated. METHODS A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains. RESULTS A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]). CONCLUSION There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.
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Affiliation(s)
- Søren Grøn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark.
| | - Kasper Bülow
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | | | - Jakob Degn
- Independent researcher (chiropractic practice)
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
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McGhie-Fraser B, Lucassen P, Ballering A, Abma I, Brouwers E, van Dulmen S, Olde Hartman T. Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments. J Psychosom Res 2023; 166:111161. [PMID: 36753936 DOI: 10.1016/j.jpsychores.2023.111161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. METHODS A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. RESULTS We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. CONCLUSION No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.
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Affiliation(s)
- Brodie McGhie-Fraser
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Aranka Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Inger Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
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Fernandes DA, Freire APC, Santos JM, Lemes IR, Diniz LM, Franco MR, Ocarino JM, Pinto RZ. The Modified Back Beliefs Questionnaire as a tool to screen for incorrect beliefs regarding back pain: Cross-cultural adaptation and measurement properties. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Facione J, Daste C, Verdaguer C, Lapeyre É, Lefèvre-Colau MM, Rannou F, Nguyen C. Core qualities of an educational program to reduce fears and beliefs of GPs about low back pain: Results of a GPs, experts and literature survey. J Back Musculoskelet Rehabil 2021; 34:221-233. [PMID: 33164922 DOI: 10.3233/bmr-191596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the fact that non-specific low back pain (LBP) is a frequent symptom, its management remains suboptimal in primary care. A plausible reason is the persistence of erroneous fears and beliefs among general practitioners (GPs). OBJECTIVE We aimed to determine the core qualities an educational program should have to reduce erroneous fears and beliefs about LBP among GPs. METHODS We used a two step-approach. In the first step, meaningful qualities were collected using comprehensive data source triangulation from GPs, experts and literature. In the second step, qualities were extracted by three independent investigators in a standardized manner using the Template for Intervention Description and Replication checklist. RESULTS Qualities were collected from 8 GPs, 24 experts and 15 articles. Extraction revealed a wide range of qualities depending on participants' background and literature. After consensus between investigators, the most meaningful qualities included evidence-based messages and web-based interventions (videos and classes) delivered by a multidisciplinary panel of experts. We found no systematic trend for when and how much, and how to tailor the intervention. CONCLUSIONS Data source triangulation revealed that the core qualities of an educational program targeting fears and beliefs about LBP among GPs should include evidence-based information, web-based interventions and a multidisciplinary panel of experts. Our findings will help us to design a provisional targeted educational intervention. This will be further assessed in a mixed-method feasibility study and then in a randomized controlled trial.
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Affiliation(s)
- Julia Facione
- Service de Médecine Physique et de Réadaptation, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Daste
- Université de Paris, Faculté de Santé, UFR de Médecine de l'Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, Paris, France
| | - Claire Verdaguer
- AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France
| | - Éric Lapeyre
- Service de Médecine Physique et de Réadaptation, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, UFR de Médecine de l'Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - François Rannou
- Université de Paris, Faculté de Santé, UFR de Médecine de l'Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Christelle Nguyen
- Université de Paris, Faculté de Santé, UFR de Médecine de l'Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
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Mankelow J, Ryan C, Taylor P, Atkinson G, Martin D. A Systematic Review and Meta-Analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes, Knowledge, Behavior and Patient Outcomes. THE JOURNAL OF PAIN 2021; 23:1-24. [PMID: 34237464 DOI: 10.1016/j.jpain.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Pain is a significant health burden globally and its management frequently fails to comply with evidence based, biopsychosocial guidelines. This may be partly attributable to inadequate biopsychosocial focussed pain education for students and clinicians. We aimed to undertake a systematic review, using Cochrane methodology, of randomized controlled trials with meta-analysis to quantify the effects of biopsychosocial education strategies in changing student/qualified health care professionals (HCPs) pain related attitudes, knowledge, clinical behaviour or patient outcomes. A systematic search of the literature was undertaken using CINAHL, AMED, PEDro, Cochrane Central Library, MEDLINE, ScienceDirect, Rehabdata, SportDiscus, EMBASE, ASSIA, Dentistry and Oral Science, Psycinfo, Education Research Complete and OpenGrey from 1977 to November 2020. Pooled effect sizes were quantified in random effects meta-analyses for attitudes, knowledge, and clinical behaviors. From a sample of 1812 records, 6 were narratively analysed and 15 were included in the meta-analyses. These studies represented 3022 patients and 3163 HCPs and students. Education improved attitudes by 11.3% (95% confidence interval: 2.2-20.4%, P = .02), and knowledge by 18.8% (12.4-25.3%, P = .01). The effects of education on clinical behavior favoured a clinically relevant improvement (OR = 2.4, 0.9-5.9, P = .06). Narrative analysis of the effect of biopsychosocial education for student HCPs/HCPs upon patient outcomes was inconclusive. These findings demonstrate that biopsychosocial focussed pain education strategies can improve student/qualified HCPs' pain related knowledge and attitudes and increase the likelihood that they will behave more in keeping with evidence-based practice. This should result in improved patient outcomes, however, evidence to support or refute this is lacking. PROSPERO systematic review record number, CRD42018082251. Perspective: We outline the effectiveness of biopsychosocial pain education for health care professionals and students in improving pain knowledge, attitudes, and evidence-based behaviors. These improvements should enhance clinical outcomes in patients with pain but further evidence is needed to confirm this.
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Affiliation(s)
- Jagjit Mankelow
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Cormac Ryan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Paul Taylor
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Mishriky J, Stupans I, Chan V. Low back pain management - What Australian community pharmacists recommend and how this compares to current clinical guidelines. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:336-343. [PMID: 33950187 DOI: 10.1093/ijpp/riab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/12/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is a serious and debilitating condition that necessitates proper assessment and management. Community pharmacists are ideally positioned to interact with these patients and provide therapeutic recommendations in line with LBP clinical guidelines, which have changed in recent years. Understanding what therapeutic strategies pharmacists recommend and why, can provide insights into whether these recommendations are in line with current clinical resources. OBJECTIVES The objectives of this study were to examine community pharmacists' views, knowledge and practices in LBP management compared to current clinical guidelines; and investigate their views regarding the accessibility and use of clinical LBP resources. METHODS A cross-sectional study of Australian community pharmacists was conducted using a structured, self-administered, anonymous online survey. Primary outcomes assessed were pharmacists' views, practices and recommendations in low back pain of different severities, as well as views on the use and accessibility of clinical guidelines. KEY FINDINGS A total of 176 pharmacists completed the survey. Most recommended non-pharmacological strategies to manage mild symptoms for both adult and teenage groups, escalating to pharmacological with increasing symptom severity. Approximately 75% reported they would recommend ibuprofen over paracetamol for low back pain. Approximately 40% agreed there is difficulty in finding and accessing clinical resources and more than 40% reported being unaware that there are specific guidelines available for the management of LBP symptoms. CONCLUSION Results from this study highlight an important need to further improve the knowledge and awareness of pharmacists in low back pain management, including locating and accessing clinical resources.
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Affiliation(s)
- John Mishriky
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Community Pharmacist's Role in Detecting Low Back Pain, and Patient Attitudes-A Cross-Sectional Observational Study in Italian Community Pharmacies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165965. [PMID: 32824541 PMCID: PMC7460157 DOI: 10.3390/ijerph17165965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low back pain (LBP) is one of the most frequent diseases for which patients seek advice in a community pharmacy. The study aimed to evaluate the feasibility of the administration by community pharmacists of questionnaires to assess the LBP intensity and disability degree in patients entering community pharmacies and the attitudes they have toward pain management by pharmacological and non-pharmacological strategies. METHODS An explorative, cross-sectional, observational, and quantitative study was performed. Twelve Italian community pharmacists were asked to submit a questionnaire on LBP to patients visiting their pharmacies. The questionnaire included a pain intensity scale, and two validated tools: the Roland and Morris Disability Questionnaire (RMDQ) and the Start Back Screening Tool (SBST) to determine the degree and risk of patient disability, respectively. RESULTS 872 patients filled out the questionnaires in 6 months. No statistical differences between genders (p > 0.30) were recorded for pain intensity (Female: median score 6, IQR 4-7; Male: median scores 5, IQR 4-7; p > 0.30) and disability associated with LBP (RMDQ high-disability level: Females, 14.7%, Males, 15.0%; p > 0.90). Most of the patients (69%) reported a low degree of disability, but the risk of disability was medium and high in 36% and 18% of them, respectively (p < 0.05). About 14% of patients declare to never seek for physician's advice despite their medium-high degree of disability. CONCLUSION The study demonstrated the feasibility of validated tools for assessing the degree and risk of disability in LBP patients administrable in community pharmacies. Moreover, the community pharmacy resulted in an important care portal for patients suffering from moderate LBP and for intercepting patients who suffered from severe LBP but had never reported their problem to their physician.
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Zekan L, Mestrovic A, Perisin AS, Bukic J, Leskur D, Rusic D, Modun D. Improving community pharmacists' clinical knowledge to detect and resolve drug-related problems in Croatia: a before/after survey study investigating the efficacy of an educational intervention. BMJ Open 2020; 10:e034674. [PMID: 32487573 PMCID: PMC7265009 DOI: 10.1136/bmjopen-2019-034674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The aim of this study was to increase the knowledge level of community pharmacists in Croatia to identify and resolve drug-related problems (DRPs). DESIGN Before/after survey study. SETTING University of Split School of Medicine. PARTICIPANTS 115 community pharmacists from all over the Croatia. INTERVENTIONS An interactive 3-day clinical pharmacy workshop with the goal of increasing the knowledge level of community pharmacists in Croatia to identify and resolve DRPs in routine practice. Teaching methods were based on interactive clinical case solving. OUTCOME MEASURE Change of the community pharmacists' knowledge based on preworkshop and postworkshop evaluation. A survey-based clinical knowledge measurement tool was used in order to evaluate the efficacy of the workshop. The lowest possible total score was 0 and the highest was 80. A higher survey score indicates a higher level of clinical knowledge to identify and resolve DRPs. RESULTS Participating pharmacists had significantly higher postworkshop mean survey score (49.1±8.0) than the preworkshop mean survey score (42.9±8.2), with the mean score difference of 6.2 (95% CI 4.3 to 8.1). Furthermore, it was found that community pharmacists significantly increased their survey scores, regardless of their age. CONCLUSIONS Interactive and case-based clinical pharmacy workshop could be a valuable tool to increase the knowledge of community pharmacists about identification and management of DRPs in routine practice. However, further studies are necessary to evaluate the long-term knowledge maintenance and the improvement in patients' clinical outcomes.
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Affiliation(s)
- Lovre Zekan
- Split-Dalmatia County Pharmacy, Split, Croatia
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
| | - Arijana Mestrovic
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
- Pharmaexpert LLC, Zagreb, Croatia
| | - Ana Seselja Perisin
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
| | - Josipa Bukic
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
| | - Dario Leskur
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
| | - Doris Rusic
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
| | - Darko Modun
- Department of Pharmacy, School of Medicine, University of Split, Split, Croatia
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Downie AS, Hancock M, Abdel Shaheed C, McLachlan AJ, Kocaballi AB, Williams CM, Michaleff ZA, Maher CG. An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study. JMIR Med Inform 2020; 8:e17203. [PMID: 32390593 PMCID: PMC7248808 DOI: 10.2196/17203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. Objective This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. Methods A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Results Pharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. Conclusions A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development.
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Affiliation(s)
- Aron Simon Downie
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Faculty of Science and Engineering, Macquarie University, Macquarie Park, Australia
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ahmet Baki Kocaballi
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Australia.,Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Christopher M Williams
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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11
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Leahy A, O’Keeffe M, Robinson K, O’Sullivan K. The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aoife Leahy
- Barking Havering and Redbridge University Trust, Romford, England
| | - Mary O’Keeffe
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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12
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The effects of a brief educational intervention on medical students’ knowledge, attitudes and beliefs towards low back pain. Scand J Pain 2017; 16:101-104. [DOI: 10.1016/j.sjpain.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 11/21/2022]
Abstract
Abstract
Background and aims
Knowledge, attitudes and beliefs towards low back pain (LBP) can significantly impact a health care provider’s clinical decision making. Several studies have investigated interventions designed to change practitioner attitudes and beliefs towards LBP, however no such studies involving medical students have been identified.
Methods
This study explored medical students ‚ knowledge, attitudes and beliefs towards LBP before and after a brief educational intervention on LBP. Responses from medical students (n = 93) were evaluated before and after a 15-min educational video on back pain. The intervention was developed using Camtasia™ video editor and screen recorder. Knowledge, attitudes and beliefs were measured using the “Modified Back Beliefs Questionnaire”, with items from two previously reported questionnaires on back beliefs. The questionnaire asks participants to indicate their agreement with statements about LBP on a 5-point Likert scale. Preferred responses were based on guidelines for the evidence-based management of LBP. The primary analysis evaluated total score on the nine-inevitability items of the Back Beliefs Questionnaire (“inevitability score”).
Results
Following the brief intervention there was a significant improvement in the inevitability score (post-workshop mean [SD] 20.8 [4.9] vs pre-workshop mean [SD] 26.9 [4.2]; mean difference (MD) 6.1, p < 0.001; lower score more favourable 1) and large improvements in the proportion of students providing correct responses to items on activity (pre: 49% vs post: 79%), bed rest (41% vs 75%), imaging (44% vs 74%) and recovery (25% vs 66%).
Conclusions
After watching the educational video students’ knowledge, beliefs and attitudes towards LBP improved and thus aligned more closely with evidence-based guidelines.
Implications
Medical doctors are at the forefront of managing low back pain in the community, however there is a need to strengthen musculoskeletal education in medical training programmes. The results from this research suggest educational interventions on back pain do not need to be extensive in order to have favourable outcomes on medical students’ knowledge, attitudes and beliefs towards back pain. The translational effects of these changes into clinical practice are not known.
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13
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Gheewala PA, Peterson GM, Zaidi STR, Bereznicki L, Jose MD, Castelino RL. A web-based training program to support chronic kidney disease screening by community pharmacists. Int J Clin Pharm 2016; 38:1080-6. [PMID: 27329381 DOI: 10.1007/s11096-016-0330-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
Background Community pharmacists' role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high; however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1-3. Therefore, a web-based training program was developed to enhance pharmacists' knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists' knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists' satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists' satisfaction with the training program. Main outcome measure Pharmacists' knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the individual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p < 0.001) and skills scores (p < 0.001) at pre- and post-training. Cronbach's alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1-100 %) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists' knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.
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Affiliation(s)
- Pankti A Gheewala
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart, 7001, Australia.
| | - Gregory M Peterson
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart, 7001, Australia
| | - Syed Tabish R Zaidi
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart, 7001, Australia
| | - Luke Bereznicki
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart, 7001, Australia
| | - Matthew D Jose
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Ronald L Castelino
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart, 7001, Australia
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14
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Abdel Shaheed C, McFarlane B, Maher CG, Williams KA, Bergin J, Matthews A, McLachlan AJ. Investigating the Primary Care Management of Low Back Pain: A Simulated Patient Study. THE JOURNAL OF PAIN 2016; 17:27-35. [DOI: 10.1016/j.jpain.2015.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 09/20/2015] [Accepted: 09/24/2015] [Indexed: 12/22/2022]
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