Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study

Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery-a study protocol of a randomized feasibility study

BACKGROUND

Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content.

METHODS

Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be displayed graphically and data from telephone interviews will be analysed using content analysis with a descriptive manifest approach.

DISCUSSION

The results will provide information on whether Get Back in its present format is feasible and can be evaluated for effectiveness in a larger randomized controlled trial, for patients with a low physical activity level and a high fear of movement who are undergoing decompression surgery.

TRIAL REGISTRATION

Registered at ClinicalTrails.gov 04/08/2023, registration no. NCT05806593.

Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study

OBJECTIVE

The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing.

DESIGN

A three-round Delphi study was conducted.

SETTING

This study was conducted virtually using an online survey platform.

PARTICIPANTS

This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 countries across five continents, numerous expert groups and a variety of years of experience with social prescribing, with the average being 5 years (range=1-20 years).

RESULTS

After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework.

CONCLUSION

This foundational work offers a common thread-a shared sense of what social prescribing is, which may be woven into social prescribing research, policy and practice to foster common understanding of this concept.

Establishing Internationally Accepted Conceptual and Operational Definitions of Social Prescribing Through Expert Consensus: A Delphi Study Protocol

Introduction

There is currently no agreed definition of social prescribing. This is problematic for research, policy, and practice, as the use of common language is the crux of establishing a common understanding. Both conceptual and operational definitions of social prescribing are needed to address this gap. Therefore, the aim of the study that is outlined in this protocol is to establish internationally accepted conceptual and operational definitions of social prescribing.

Methodology

A Delphi study will be conducted to develop internationally accepted conceptual and operational definitions of social prescribing with an international, multidisciplinary panel of experts. It is anticipated that this study will involve approximately 40 participants (range = 20-60 participants) and consist of 3-5 rounds. Consensus will be defined a priori as ≥80% agreement.

Discussion

Not only will these definitions serve to unite the social prescribing community, but they will also inform research, policy, and practice. By laying the groundwork for the formation of a robust evidence base, this foundational work will support the advancement of social prescribing and help to unlock the full potential of the social prescribing movement.

Conclusion

This important work will be foundational and timely, given the rapid spread of the social prescribing movement around the world.

It is time to Go All In: a call to action

Even though there have been numerous advances in medicine and technology in the past few decades, the length and quality of life vary significantly based on a person’s race, ethnicity, gender identity, sexual orientation, disability status, geographic residence, and/or socioeconomic status. In fact, membership in one or more marginalized sociodemographic groups is particularly associated with worse healthcare access and health outcomes. Behavioral medicine is uniquely equipped to advance health equity through inclusive and innovative research and practice and exerted influence on policies and practices that contribute to health disparities.

Mental and Physical Health Concerns in the Context of COVID-19: Opportunities and Applications for Behavioral Medicine

Numerous physical and mental health concerns have been documented in the context of COVID-19, and it is likely that patients, survivors, frontline health care workers, and other affected individuals will present to psychiatry for treatment. Behavioral medicine, an interdisciplinary field that is defined by a behavioral and biomedical conceptualization of clinical care, offers an opportunity for collaboration with psychiatry and other health care providers to meet the myriad needs resulting from the pandemic. This review summarizes a conceptual framework of behavioral medicine and clinical health psychology, COVID-19-related quality of life concerns that may be applicable to behavioral medicine referrals, clinical assessment directions, and intervention opportunities. The review combines both findings specific to COVID-19 and general behavioral medicine principles with an overall goal of providing a basic introduction to behavioral medicine practice, applications, and opportunities for management of medical and psychological symptoms.

Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study

Effective interventions are needed for return-to-work (RTW) for individuals with chronic pain on long-term sick leave. In this study, a behavioral medicine physiotherapy protocol was systematically replicated and added to workplace components. The intervention was evaluated for fidelity and effects on target activities and work ability. A single-case experimental design was used with five participants. Daily and weekly ratings of personalized target activities at work as well as work ability were carried out throughout the study period of 26-28 weeks. Effects of the behavioral medicine physiotherapy intervention were evaluated for each individual using visual analysis of displayed graphs and quantitative non-overlap methods. Goal achievement for target activities was reviewed. Three participants completed the intervention. The results indicated an effect from the behavioral medicine physiotherapy intervention on task-specific self-efficacy for target activities, but no consistent effect on experience of target activities or work ability. All three participants had increased function in target activities in line with pre-defined goals. Fidelity to the intervention manual was good. Behavioral medicine physiotherapy can be successfully adapted to work disability and was here replicated in an RTW context for individuals with chronic pain. The intervention protocol should be further evaluated in large-scale studies.

The Definition of Paramedicine: An International Delphi Study

Introduction

Although paramedicine is an integral element of healthcare systems, there is a lack of universal consensus on its definition. This study aimed to derive a global consensus definition of paramedicine.

Methods

Key attributes pertaining to paramedicine were identified from existing definitions within the literature. Utilising text analysis, common attribute themes were identified and six initial domains were developed. These domains formed the basis for a four-round Delphi study with a panel of 58 global experts within paramedicine to develop an international consensus definition.

Results

Response rates across the study varied from 96.6% (round 1) to 63.8% (round 4). Participant feedback on appropriate attributes to include in the definition reflected the high level of specialized clinical care inherent within paramedicine, and its status as an essential element of healthcare systems. In addition, the results highlighted the extensive range of paramedicine capabilities and roles, and the diverse environments within which paramedics work.

Conclusion

Delphi methodology was utilized to develop a global consensus definition of paramedicine. This definition is as follows: paramedicine is a domain of practice and health profession that specialises across a range of settings including, but not limited to, emergency and primary care. Paramedics work in a variety of clinical settings such as emergency medical services, ambulance services, hospitals and clinics as well as non-clinical roles, such as education, leadership, public health and research. Paramedics possess complex knowledge and skills, a broad scope of practice and are an essential part of the healthcare system. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable or dynamic settings. We believe that the generation and provision of this consensus definition is essential to enable the further development and maturation of the discipline of paramedicine.

Augmented behavioral medicine competencies in physical therapy students' clinical reasoning with a targeted curriculum: a final-semester cohort-comparison study

Background: Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students' clinical reasoning skills is lacking. Objectives: The primary objective was to compare the clinical reasoning skills, focusing on clients' behavioral change, of entry-level PT students with or without BMCC in their curricula. The secondary objective was to compare students' attitudes and beliefs in a biomedical and biopsychosocial practice orientation.Methods: Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used.Results: Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups.Conclusions: Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students' clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students' self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed.