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Chan BHT, Snowdon DA, Williams CM. Describing characteristics clinicians believe predictive of patient reported outcomes after adult's ankle fracture - A modified Delphi study. Musculoskelet Sci Pract 2022; 62:102632. [PMID: 35933826 DOI: 10.1016/j.msksp.2022.102632] [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: 05/14/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite explanatory studies have identified a wide range of modifiable and non-modifiable characteristics, uncertainty persists as to what characteristics are predictive of patient reported outcome following ankle fracture in adults, therefore hindering the selection of candidate variables in prognostic models without compromising the accuracy. OBJECTIVE To establish consensus-based characteristics which clinicians believe are predictive of patient reported outcomes following ankle fracture. DESIGN Three-round online modified Delphi survey. METHODS In Round 1, participants provided responses to open-ended questions, as to what characteristics within the first eight weeks following ankle fracture are predictive of short- (<6 months), medium- (6 months-2 years) and long-term (>2 years) patient reported outcome. Rounds 2 and 3 presented consensus and gathered agreement on statements. RESULTS Twenty participants answered the open-ended questions, including 13 physiotherapists and seven orthopaedic/trauma surgeons. Participants reached consensus for fracture characteristics and agreement for age, recovery of signs and symptoms, fracture management complexity, medical comorbidities, mental health status and patient journey at the short-term timepoint; agreement for age, engagement in recovery process, recovery of signs and symptoms, fracture characteristics, medical comorbidities and socioeconomic status at the medium-term timepoint; agreement for engagement in recovery process, fracture characteristics and medical comorbidities at the long-term timepoint. CONCLUSION Clinicians believed in certain modifiable and non-modifiable characteristics predictive of patient reported outcome following ankle fracture. Our findings may provide insights about characteristics which can be selected in prognostic model development and future explanatory studies, allowing targeting adults at risk of developing long-standing symptoms and disability.
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Affiliation(s)
- Billy H T Chan
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia.
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, 3199, Australia; Peninsula Health, Academic Unit, Frankston, Victoria, 3199, Australia; National Centre for Healthy Ageing, Melbourne, Australia.
| | - Cylie M Williams
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia; Peninsula Health, Academic Unit, Frankston, Victoria, 3199, Australia.
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Bright FAS, Kayes NM, Worrall L, McPherson KM. A conceptual review of engagement in healthcare and rehabilitation. Disabil Rehabil 2014; 37:643-54. [DOI: 10.3109/09638288.2014.933899] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kobeissi L, Mahfoud Z, Khoury B, El Kak F, Ghantous Z, Khawaja M, Nakkash R, Ramia S, Zurayk H, Araya R, Peters TJ. The Relaxation Exercise and Social Support Trial (RESST): a community-based randomized controlled trial to alleviate medically unexplained vaginal discharge symptoms. BMC Psychiatry 2012; 12:195. [PMID: 23140480 PMCID: PMC3534445 DOI: 10.1186/1471-244x-12-195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms such as medically unexplained vaginal discharge (MUVD) are common and bothersome, leading to potentially unnecessary use of resources. METHODS A community-based individually randomized controlled trial to assess the effectiveness of a relatively simple, culturally appropriate multi-component intervention on reducing reported MUVD, among women suffering from low-moderate levels of common mental distress. The setting was a socio-economically deprived, informal settlement in the southern suburbs of Beirut, Lebanon. The intervention comprised up to 12 group sessions implemented over a six-week period, each divided into a psychosocial and a relaxation exercise component. The primary outcome was self-reported MUVD, which was defined as a complaint of vaginal discharge upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Blinding on the intervention status was not possible for both logistic and ethical reasons, especially as knowledge of involvement in the intervention was integral to its delivery. Intent to treat analysis was used. RESULTS Of 75 women randomized to the intervention, 48% reported MUVD at 6 months compared with 63% of 73 in the control group (difference of -15%, 95% confidence interval (CI) -31%, 0%, p=0.067). Adjustments for baseline imbalances and any factors relating to consent had no appreciable effect on these results. The risk of MUVD was reduced in absolute terms by 2.4% for each intervention session attended (95% CI -4.9%, 0.0%, p=0.049). While there was also marginal evidence of a beneficial effect on anxiety, there was no evidence of mediation of the effect on MUVD through measures of common mental disorders. CONCLUSION This study confirms that MUVD is an important public health problem. While the benefits of this intervention may appear modest, the intervention offers an opportunity for women to enhance their problem-solving skills as well as use physical relaxation techniques that can help them deal with stressful in their lives. Further research is needed in a variety of contexts, for different populations and preferably involving larger randomized trials of such an intervention. TRIAL REGISTRATION * Title of trial: The Relaxation Exercise and Social Support Trial ISRCTN assigned: ISRCTN98441241 Date of assignation: 10/09/2010 Link: http://www.controlled-trials.com/ISRCTN98441241* Also registered at the Wellcome Trust register:http://www.controlled-trials.com/mrct/trial/469943/98441241.
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Affiliation(s)
- Loulou Kobeissi
- Epidemiology and Biostatistics Division, Center for Middle Eastern Studies, University of Arizona, Tucson, Arizona, USA,Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ziyad Mahfoud
- Department of Public Health, Weill Cornell Medical College, Doha, Qatar
| | - Brigitte Khoury
- Department of Psychiatry-Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fayssal El Kak
- Department of Health Promotion and Community Health Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeina Ghantous
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwan Khawaja
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Center for Research on Population and Health Department of Health Promotion and Community Health Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sami Ramia
- Medical Lab Sciences Program Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Huda Zurayk
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ricardo Araya
- Academic Unit of Psychiatry School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
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Kobeissi L, Araya R, Kak FE, Ghantous Z, Khawaja M, Khoury B, Mahfoud Z, Nakkash R, Peters TJ, Ramia S, Zurayk H. The relaxation exercise and social support trial-resst: study protocol for a randomized community based trial. BMC Psychiatry 2011; 11:142. [PMID: 21864414 PMCID: PMC3184263 DOI: 10.1186/1471-244x-11-142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health. METHODS/DESIGN This is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used. DISCUSSION The results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress). TRIAL REGISTRATION The trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241.
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Affiliation(s)
- Loulou Kobeissi
- UCLA, School of Public Health, Community Health Sciences Department, Los Angeles, California 90095, USA.
| | - Ricardo Araya
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fayssal El Kak
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeina Ghantous
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwan Khawaja
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Brigitte Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ziyad Mahfoud
- Department of Public Health, Weill Cornell Medical College, Doha, Qatar
| | - Rima Nakkash
- Center for Research on Population and Health, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Sami Ramia
- Medical Lab Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Huda Zurayk
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Zhang L, Layne C, Lowder T, Liu J. A review focused on the psychological effectiveness of tai chi on different populations. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2011; 2012:678107. [PMID: 21792371 PMCID: PMC3140024 DOI: 10.1155/2012/678107] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/16/2011] [Indexed: 11/17/2022]
Abstract
As a popular exercise form, Tai Chi (TC) has been investigated to determine its contributions to an active and healthy lifestyle. There are an increasing number of researchers who focus on exploring the potential physiological and psychological benefits of TC but only a few systematic reviews of these benefits to a variety of populations. The purpose of this paper is to comprehensively evaluate the reported psychological benefits associated with practicing TC. Although many investigators have reported possible psychological benefits of TC for children, young adults, older healthy adults, and for a variety of patient populations, many of the reports suffer one or more methodological flaws. These flaws include inadequate study design, including lack of control groups, small sample sizes, unsophisticated statistical techniques, or publication without rigorous peer review. After reviewing the results of the existing literature regarding the potential psychological benefits of TC, we recommend that future investigations be conducted with additional adherence to the traditional scientific process.
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Affiliation(s)
- Long Zhang
- Department Of Physical Education, Shenzhen Polytechnic, Shenzhen 518055, China
| | - Charles Layne
- Department of Health And Human Performance, The University of Houston, Houston, TX 77204-6015, USA
| | - Thomas Lowder
- Department of Health And Human Performance, The University of Houston, Houston, TX 77204-6015, USA
| | - Jian Liu
- Department of Health And Human Performance, The University of Houston, Houston, TX 77204-6015, USA
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Carr JL, Klaber Moffett JA, Howarth E, Richmond SJ, Torgerson DJ, Jackson DA, Metcalfe CJ. A randomized trial comparing a group exercise programme for back pain patients with individual physiotherapy in a severely deprived area. Disabil Rehabil 2009; 27:929-37. [PMID: 16096246 DOI: 10.1080/09638280500030639] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare a group exercise programme known as the Back to Fitness programme with individual physiotherapy for patients with non-specific low back pain from a materially deprived area. METHOD This was a randomized controlled trial including 237 physiotherapy patients with back pain lasting more than six weeks. Participants were allocated to either the Back to Fitness programme or to individual physiotherapy, and followed up at three months and 12 months after randomization. The main outcome measure was the Roland Disability Questionnaire. Secondary measures were: SF12, EQ5D, Pain Self-Efficacy Scale. Health care diaries recording patients' use of health care resources were also collected over a 12-month period. RESULTS There were no statistically significant differences in change scores between groups on the primary outcome measure at three months (CI - 2.24 to 0.49) and at 12 months (CI - 1.68 to 1.39). Only minor improvements in disability scores were observed in the Back to Fitness group at three months and 12 months respectively (mean change scores; - 0.89, - 0.77) and in the individual physiotherapy arm (mean change scores; - 0.02, - 0.63). Further analysis showed that patients from the most severely deprived areas were marginally worse at three month follow-up whereas those from more affluent areas tended to improve (CI 0.43 to 3.15).
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Affiliation(s)
- Jane L Carr
- Institute of Rehabilitation, University of Hull, UK
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Brady B, Redfern J, MacDougal G, Williams J. The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2009; 13:153-61. [PMID: 18548557 DOI: 10.1002/pri.403] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Rotator cuff tears are frequently encountered in medical outpatient settings and often require surgical repair to achieve desirable functional outcomes. However, the optimal form of post-operative rehabilitation of rotator cuff repairs remains unidentified by the research literature. The aim of this study was to determine the feasibility of implementing and investigating the effect of a combined aquatic and land-based rehabilitation programme in the post-operative rehabilitation of rotator cuff tears. METHODS A cohort of 18 subjects undergoing rotator cuff repair were examined over a treatment period of 12 weeks. Twelve subjects participated in a combined aquatic and land-based programme, while six subjects received a standard land-based protocol. Passive range of motion and the Western Ontario Rotator Cuff Index outcomes were measured pre-operatively and at three, six and 12 weeks, post-operatively. Subjective responses on patient's assurance and confidence in the value of the exercises (questionnaire using an 11-point Visual Analogue Scale (VAS)) were collected at 12 weeks for both groups. RESULTS There was a significant improvement in both range of motion and Western Ontario Rotator Cuff scores in all subjects with treatment (p < 0.001). Furthermore, participation in aquatic therapy significantly improved passive flexion range of motion measures at three weeks (mean 46 degrees , 95% CI 17-75, p = 0.005) and six weeks (30 degrees , 95% CI 8-51, p = 0.01). There was no significant difference in the attendance rates (80% in both groups) or patients perceptions of the programmes (100% confidence and assurance in both groups). CONCLUSION The implementation of a combined aquatic and land-based physiotherapy programme following surgical repair of the rotator cuff is feasible and presents a potential viable alternative to conventional land-based exercise with comparable outcomes.
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Affiliation(s)
- Bernadette Brady
- Discipline of Physiotherapy, School of Health Sciences, University of Sydney, NSW, Australia.
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Stanley IM, Peters S, Salmon P. A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms. Int J Psychiatry Med 2003; 32:125-40. [PMID: 12269594 DOI: 10.2190/avm3-8gu8-jw70-5rx5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To re-examine the widespread assumption that medically unexplained physical symptoms represent discrete syndromes resulting from somatization of mental illness. METHOD Primary care patients (N = 223) with medically unexplained symptoms of at least one year's duration were recruited to a study of exercise therapy. Data gathered from patients, from their general practitioners, and from medical records were used to examine relationships between self-defined disability, symptoms, mental state, and use of health care. RESULTS Levels of disability and health care use were both raised, but were only weakly correlated. While most patients were depressed and/or anxious, a minority (14 percent) were neither. Although mental state correlated with disability, health care use was unrelated to either. Among a wide range of recorded symptoms, few correlations were found to support the existence of discrete syndromes. Analysis of agreement between patients and their doctors in assigning symptoms to broadly defined "syndromes" appears to reflect collaboration that is largely expedient CONCLUSIONS In this sample of primary care patients with persistent unexplained physical symptoms, we found little evidence of discrete somatic syndromes. The level of health care use is no indication of mental state or level of disability, and the findings are equally consistent with depression or anxiety being secondary to disability and its consequences as with them being primary. The observed collaboration between patients and their doctors carries the risk of shaping, reinforcing, and legitimizing dubious syndromes.
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Affiliation(s)
- Ian M Stanley
- University of Liverpool, Department of Clinical Psychology, England
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Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 2001; 21:33-61. [PMID: 11148895 DOI: 10.1016/s0272-7358(99)00032-x] [Citation(s) in RCA: 646] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable.
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Affiliation(s)
- P Salmon
- Department of Clinical Psychology, University of Liverpool, Whelan Building, Liverpool L69 3GB, United Kingdom.
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Tai Chi Chuan's role in maintaining independence in ageing people with chronic disease. J Bodyw Mov Ther 2001. [DOI: 10.1054/jbmt.2000.0178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rose M, Stanley I, Peters S, Salmon P, Stott R, Crook P. Wrong Problem, Wrong Treatment Unrecognised inappropriate referral to physiotherapy. Physiotherapy 1999. [DOI: 10.1016/s0031-9406(05)67136-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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