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Venkatraman V, Heo H, Kaplan S, Parente BA, Lad SP. Digital Health for Patients Undergoing Spine Surgery: A Systematic Review. World Neurosurg 2024; 182:70-82. [PMID: 37967741 DOI: 10.1016/j.wneu.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Digital health tools, including smartphone applications (apps), websites, and online search engines, are increasingly being utilized for health data collection and patient education. Studies have shown that these tools can help disseminate information widely and even help guide patients through acute surgical episodes. We aimed to search the literature to summarize available studies on using digital health tools for patients undergoing spine surgery. METHODS We conducted a systematic review of PubMed MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases, as well as ClinicalTrials.gov up to March 11, 2022. RESULTS Forty-four full-text articles were included and qualitatively analyzed. Studies were broadly grouped into those that analyzed the quality of web-based materials for patients, the quality of YouTube videos for spine surgery, the development, feasibility, and implementation of mobile apps for patients, and randomized controlled trials for integrating mobile apps into perioperative care. CONCLUSIONS We presented a systematic review analyzing the current landscape of digital health for patients undergoing spine surgery. Internet patient education materials in searchable websites and YouTube videos are of poor quality, lacking in readability to the average patient and robustness of information needed for patients to make informed decisions about pursuing spine surgery. However, there lies promise in digital apps developed to guide patients through surgery and collect postoperative outcomes.
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Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Helen Heo
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Beth A Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
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Kilgallen W, Earp B, Zhang D. Internet Search Trends for Common Hand Surgery Diagnoses. Cureus 2023; 15:e49755. [PMID: 38161884 PMCID: PMC10757678 DOI: 10.7759/cureus.49755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The internet is a common resource for patients seeking health information. Trends in internet search interests for common hand surgery diagnoses and their seasonal variations have not been previously studied. The objectives of this study were (1) to describe the temporal trends in internet search interest for common hand surgery diagnoses in the recent five-year time period and (2) to assess seasonal variations in search term interest. METHODS An internet-based study of internet search term interest of 10 common hand surgery diagnoses was performed using Google Trends (Google, Inc., Mountain View, CA) from January 2017 to December 2021. The 10 diagnoses were "carpal tunnel syndrome," "trigger finger," "thumb arthritis," "ganglion cyst," "de Quervain's tenosynovitis," "lateral epicondylitis," "Dupuytren disease," "distal radius fracture," "finger fracture," and "scaphoid fracture." Analysis of variance (ANOVA) was used to assess for seasonal differences in search interest, and temporal trends were assessed using the two-tailed Mann-Kendall trend test. RESULTS During the study period, there was an increasing trend for search interest for "carpal tunnel syndrome," "trigger finger," "thumb arthritis," "Dupuytren disease," and "finger fracture," both in the United States and worldwide. There was no significant temporal trend for "ganglion cyst," "de Quervain's tenosynovitis," "lateral epicondylitis," and "distal radius fracture." There were no significant temporal trend for "scaphoid fracture" in the United States and a decreasing trend worldwide. There was significant seasonal variation in search term interest for "finger fracture" in the United States, "finger fracture" worldwide, and "scaphoid fracture" in the United States, with popularity peaking in the fall. CONCLUSIONS Despite growth in global internet usage, internet search interest has remained stagnant for many common hand surgery conditions, which may represent a shifting preference for patients to obtain health information from other resources. Internet search interest for traumatic hand conditions corresponds to seasonal variations in fracture epidemiology and peaks in the fall season.
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Affiliation(s)
| | - Brandon Earp
- Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA
| | - Dafang Zhang
- Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA
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Yamamura A, Watanabe S, Yamaguchi S, Iwata K, Kimura S, Mikami Y, Toguchi K, Sakamoto T, Ito R, Nakajima H, Sasho T, Ohtori S. Readability and quality of online patient resources regarding knee osteoarthritis and lumbar spinal stenosis in Japan. J Orthop Sci 2023:S0949-2658(23)00212-9. [PMID: 37599135 DOI: 10.1016/j.jos.2023.08.003] [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: 02/22/2023] [Revised: 06/10/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND This study aimed to quantify the readability and quality of online patient resources on knee osteoarthritis and lumbar spinal stenosis in Japan. METHODS Three search engines (Google, Yahoo, and Bing) were searched for the terms knee osteoarthritis and lumbar spinal stenosis. The first 30 websites of each search were screened. Duplicate websites and those unrelated to the searched diseases were excluded. The remaining 125 websites (62 on knee osteoarthritis, 63 on lumbar spinal stenosis) were analyzed. The text readability was assessed using two web-based programs (Obi-3 and Readability Research Lab) and lexical density. Website quality was evaluated using the DISCERN score, Clear Communication Index, and Journal of American Medical Association benchmark criteria. RESULTS Readability scores were high, indicating that the texts were difficult to understand. Only 24 (19%) and six (5%) websites were classified as average difficulty readability according to Obi-3 and Readability Research Lab, respectively. The overall quality of information was low, with only four (3%) being rated as having sufficient quality based on the Clear Communication Index and Journal of American Medical Association benchmark criteria. None of the websites satisfied the DISCERN quality criteria. CONCLUSIONS Patient information on Japanese websites regarding knee osteoarthritis and lumbar spinal stenosis were difficult to understand. Moreover, the quality of the websites was insufficient. Orthopaedic surgeons should contribute to the creation of high-quality easy-to-read websites to facilitate patient-physician communication.
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Affiliation(s)
- Atsushi Yamamura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Kazunari Iwata
- Department of Japanese Language and Literature, University of the Sacred Heart, Tokyo, Japan
| | - Seji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Yukio Mikami
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Kaoru Toguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Takuya Sakamoto
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Ryu Ito
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Hirofumi Nakajima
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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Muller AL, Baker JF. Analysis of Lumbar Fusion and Lumbar Arthroplasty Videos on YouTube. Int J Spine Surg 2022; 16:283-290. [PMID: 35444037 PMCID: PMC9930656 DOI: 10.14444/8216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients often use the internet for information on their spinal surgeries. The goal of this study was to assess and compare the quality of lumbar fusion and arthroplasty videos on YouTube and to identify predictors of video quality. STUDY DESIGN Cross-sectional. METHODS YouTube was searched utilizing 3 search terms for both lumbar fusion and lumbar arthroplasty. Fifty videos from each search were categorized and analyzed. Videos were analyzed using 3 scoring systems: JAMA, informative, and clinical scores. The JAMA score rates online information based on 4 factors: authorship, attribution, disclosure, and currency. The informative score previously devised by Zhang et al was also applied to each video. Finally, 2 surgery-specific scores were created for lumbar fusion and lumbar arthroplasty based on peer-reviewed information. These were modeled on the informed consent procedure. Data analysis was conducted using the Jamovi 1.1.9.0. RESULTS Eighty-four unique lumbar fusion videos and 82 lumbar arthroplasty videos were analyzed. Educational videos were the most common in fusion (78%) and arthroplasty (47%) groups; however, arthroplasty videos were more likely to be commercial (17%, P = 0.01). Fusion videos were more viewed (P < 0.001); however, arthroplasty videos had higher positivity ratings (P < 0.01). Overall, quality was poor for videos in both categories. Mean JAMA scores were 1.57 and 1.70 for fusion and arthroplasty, respectively, and did not differ significantly (P = 0.32). Fusion videos had higher informative scores (1.57 vs 1.23, P = 0.02) and higher clinical scores (21.8% vs 15.9%, P = 0.06). CONCLUSION Information on YouTube for lumbar fusion and arthroplasty is poor. However, information on fusion is better than arthroplasty. Metadata can be used to help patients pick higher quality videos. CLINICAL RELEVANCE This paper provides clinicians with an oversight of what their patients may accessing on the internet. Patients may have incorrect information regarding the surgical proceedure they are being offered. These misconceptions must be resovled in order to gain true informed consent from the patient and avoid damage to the surgeon-patient relationship. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Andrew Lee Muller
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Joseph F. Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand,Department of Surgery, University of Auckland, Auckland, New Zealand
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Zhang D, Earp BE, Kilgallen EE, Blazar P. Readability of Online Hand Surgery Patient Educational Materials: Evaluating the Trend Since 2008. J Hand Surg Am 2022; 47:186.e1-186.e8. [PMID: 34023192 DOI: 10.1016/j.jhsa.2021.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/27/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Online patient educational materials have historically been written at a higher-than-recommended sixth grade reading level. The objectives of this study were to assess the readability of online hand surgery patient educational materials from the official online patient resource website of the American Society for Surgery of the Hand (ASSH) and to compare changes in the readability of the current ASSH online patient educational materials with those in 2008 and 2015. METHODS An internet-based study of all 88 English language patient educational materials on HandCare.org, the official online patient resource website of the ASSH, was performed. The readability of each article was assessed using the Flesch reading ease formula, Flesch-Kincaid grade level, Coleman-Liau index, Gunning-Fog index, and Simple Measure of Gobbledygook grade level. To evaluate the trend in the readability of ASSH online hand surgery patient educational materials, the Flesch-Kincaid grade levels of articles published in 2020 were compared with those of data published in 2008 and 2015. RESULTS The average Flesch reading ease score of the patient educational materials was 57.6, which is at the high-school reading level. The average reading grade level of patient educational materials ranged from 9.0 to 12.3 depending on the readability metric used. The average Flesch-Kincaid grade level of all the ASSH patient educational materials was 9.8 in 2020, which is significantly better than 10.4 in 2008 but significantly worse than 8.5 in 2015. CONCLUSIONS Online hand surgery patient educational materials continue to be written for the general public at a higher-than-recommended reading grade level. There has been no substantial improvement in the readability of online hand surgery patient educational materials since 2008. CLINICAL RELEVANCE Improvements are needed in the readability of online patient educational materials to ensure that patients with all health literacy levels are able to comprehend and benefit from health information.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital; Harvard Medical School, Boston, MA.
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital; Harvard Medical School, Boston, MA
| | | | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital; Harvard Medical School, Boston, MA
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Rodríguez-Fortúnez P, Franch-Nadal J, Fornos-Pérez JA, Martínez-Martínez F, de Paz HD, Orera-Peña ML. Cross-sectional study about the use of telemedicine for type 2 diabetes mellitus management in Spain: patient's perspective. The EnREDa2 Study. BMJ Open 2019; 9:e028467. [PMID: 31230025 PMCID: PMC6596977 DOI: 10.1136/bmjopen-2018-028467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The usefulness of telemedicine (TM) in type 2 diabetes mellitus (T2DM) has been discussed in recent years. The aim of this study is to describe patients' perceptions about TM and to identify preferences on TM resources, in Spain. DESIGN An observational, cross-sectional study was conducted using a structured questionnaire. PARTICIPANTS 1036 patients with T2DM accepted to participate in the study (response rate: 68%). RESULTS Blood glucose values were recorded by 85.9% of the patients while data such as lifestyle habits were only recorded by 14.4% of the patients. Previous experience in TM was reported by 9.8% of the patients, out of which 70.5% were satisfied with its service and 73.5% considered that the use of TM had optimised their T2DM management. However, most of these patients noted aspects to be improved such as user-friendliness (81.4%), interaction with the medical team (78.4%) and time required for recording/transferring data (78.4%). Experienced patients had better perception about TM usefulness than naïve patients for all listed aspects (p<0.05). Among naïve patients, 38.2% expressed their willingness to participate in TM programmes, but only 4.7% were invited to do so. Patients considered that physicians' (77.5%) and pharmacists' (75.5%) encouragement can boost the use of TM. CONCLUSIONS In Spain, nearly 10% of patients with T2DM have experience with TM and it is well accepted, especially one based on glucometers. Nevertheless, in order to promote TM use, easier and time-saving programmes for patient-physician interaction should be optimised.
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Affiliation(s)
| | - Josep Franch-Nadal
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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Hicks D, Melkers M, Barna J, Isett KR, Gilbert GH. Comparison of the accuracy of CBCT effective radiation dose information in peer-reviewed journals and dental media. GENERAL DENTISTRY 2019; 67:38-46. [PMID: 31199743 PMCID: PMC7189219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Accessible sources of clinical information have proliferated over the past decade. Although these new sources that contextualize information for practice are user friendly, there are questions about their accuracy because much of the material is not peer reviewed. On the other hand, traditional peer-reviewed material can be somewhat removed from the needs of practicing dentists, and recently questions have been raised about the accuracy of journals. This study assessed the accuracy of cone beam computed tomography (CBCT) radiation safety information in both professional media and peer-reviewed journals. Articles introducing CBCT technology to dentists and published in peer-reviewed journals were compared to articles appearing in professional magazines, clinically oriented news sites, and blogs written by clinicians for clinicians. The reported radiation doses of CBCT and conventional dental radiographs were recorded, as were conclusions about the comparative doses of these 2 imaging modalities. The proportion of articles reporting CBCT dose to be greater than, equal to, or less than that of conventional dental radiographs was not different between the peer-reviewed and professional media articles during the period 2003-2016. There is weak evidence that the conclusions of peer-reviewed journal articles, but not professional media sources, became more conservative after the 2010 publication of an article in The New York Times that was critical of misinformation concerning the safety and efficacy of CBCT in dentistry. Professional media articles that were not peer reviewed were as accurate as peer-reviewed journals for this topic and during the time period assessed. However, the method used here necessitated a narrow focus, and more studies are needed to broaden understanding.
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Affiliation(s)
- Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 20332-0345
| | | | | | - Kimberley R. Isett
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 20332-0345
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Roberts HJ, Zhang D, Earp BE, Blazar P, Dyer GSM. Patient self-reported utility of hand surgery online patient education materials. Musculoskeletal Care 2018; 16:458-462. [PMID: 30160821 DOI: 10.1002/msc.1360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Online patient education materials in orthopaedic surgery are consistently written above the recommended grade level. However, no algorithmic measure of readability has been validated in a medical context. The primary objective of the present study was to determine whether Flesch-Kincaid readability scores correlate with patient self-reported utility of online education materials from the American Society for Surgery of the Hand (ASSH). METHODS This was a prospective survey study of 35 patients with one of five common upper extremity diagnoses. Study outcomes included self-reported utility, understandability, clarity, novelty and scope of the information of the ASSH online patient education material. Flesch-Kincaid Grade Level and Flesch Reading Ease were calculated for each article and correlated with self-reported utility. RESULTS The majority of patients found the articles useful, understandable and clear. Self-reported utility was not correlated with Flesch-Kincaid Grade Level (ρ = 0.017) or Flesch Reading Ease (ρ = -0.020). Patients with high school education or below found the articles less useful and more difficult to understand than those with post-secondary education. CONCLUSIONS Flesch-Kincaid readability scores do not correlate with self-reported utility of ASSH online patient education materials. In the evaluation of these materials, metrics other than algorithmic readability scores should be considered.
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Affiliation(s)
- Heather J Roberts
- Department of Orthopedic Surgery, University of California, San Francisco, California, USA
| | - Dafang Zhang
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon E Earp
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Blazar
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George S M Dyer
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Lynch AD, Bove AM, Ammendolia C, Schneider M. Individuals with lumbar spinal stenosis seek education and care focused on self-management-results of focus groups among participants enrolled in a randomized controlled trial. Spine J 2018; 18:1303-1312. [PMID: 29246847 DOI: 10.1016/j.spinee.2017.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/10/2017] [Accepted: 11/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment. PURPOSE The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding different nonsurgical treatments. These factors were considered within the context of each treatment received as a part of the parent randomized controlled trial (RCT). STUDY DESIGN Focus group study of RCT participants. PATIENT SAMPLE Convenience sample of 50 individuals with LSS (28 female, average age 73±7.7 years) from an RCT participated in one of six focus groups. Focus groups consisted of patients previously randomized to one of three nonsurgical treatments: (1) medical care; (2) community-based group exercise; and (3) clinic-based manual therapy and individualized exercise. OUTCOME MEASURES Experiences, opinions, and preferences of individuals with LSS who participated in an RCT. Inter-coder agreement for qualitative analysis was conducted with kappa statistics. METHODS Participants discussed their experiences and perceptions regarding study treatment and their general experience with LSS using open-ended questions provided by a facilitator. Transcripts were coded according to modified grounded theory in an open approach, using codes that addressed the primary focus group discussion topics (primary coding) and codes for emerging topics (secondary coding). Secondary coding sought to identify themes concerning living with LSS and seeking treatment that were emergent from the focus groups. This study was funded by the Patient-Centered Research Outcomes Institute. The authors report no conflicts of interest. RESULTS Three themes related to medical treatment and symptom management arose from analyses: (1) an emotional response to LSS; (2) a desire for education about LSS and motivation to pursue education from any available source; and (3) a desire for individualized care based on self-management techniques and lifestyle changes. Emotional responses were more evident in individuals receiving medical care, whereas the other two themes were consistent across all three treatment groups. CONCLUSIONS The chronic pain associated with LSS may result in negative emotional responses. Individuals with LSS may believe misinformation and information from nonmedical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with LSS.
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Affiliation(s)
- Andrew D Lynch
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA.
| | - Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College St, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh; 100 Technology Drive, Suite 210, Pittsburgh, 15219, PA, USA
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