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Beales D, Boyle E, Fary R, Mikhailov A, Saunders B, Coates S, Evans K, Simic M, Sterling M, Bennell K, Rebbeck T. Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study. Musculoskelet Sci Pract 2024; 74:103178. [PMID: 39270531 DOI: 10.1016/j.msksp.2024.103178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/11/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis). DESIGN Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction). RESULTS Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of 'ethicality', 'intervention coherence', 'self-efficacy' and 'affective attitude'. Divergence was identified in 'perceived effectiveness'. DISCUSSION In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists' care was perceived as a positive addition to usual care.
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Affiliation(s)
- Darren Beales
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845. https://twitter.com/DBealesPhysio
| | - Eileen Boyle
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Robyn Fary
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Anton Mikhailov
- Curtin EnAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 6845.
| | - Benjamin Saunders
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; School of Allied Health, Australian Catholic University, 33 Berry Street, North Sydney, New South Wales, 2060, Australia.
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia; Healthia Limited, Brisbane, Queensland, 4006, Australia.
| | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR CRE: Better Health Outcomes for Compensable Injuries University of Queensland, Level 7 STARS Building, Herston Road, Herston, 4006, Australia.
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria, 3053, Australia.
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Western Ave, Sydney, New South Wales, 2006, Australia.
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Greenough MJ, Lewis KB, Bucknall T, Jibb L, Leese J, Lamontagne C, Squires JE. Triage Decision-Making in Interdisciplinary Pediatric Chronic Pain Programs. Pain Manag Nurs 2024; 25:170-180. [PMID: 38448311 DOI: 10.1016/j.pmn.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/23/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Interdisciplinary pediatric chronic pain programs are ideal treatment settings for youth with chronic pain who are complex from a biopsychosocial perspective. There is currently no evidence-based clinical decision support to guide nurses triaging patients to such programs, which increases the risk for haphazard triage decisions. AIMS To explore and describe the decision-making practices of and contextual influences on nurses triaging patients to interdisciplinary pediatric chronic pain programs. DESIGN A qualitative exploratory descriptive design. SETTINGS Interdisciplinary Pediatric Chronic Pain Programs. PARTICIPANTS/SUBJECTS In all, 12 nurses across 11 different interdisciplinary pediatric chronic pain programs participated in this study. METHODS Individual, semi-structured interviews were conducted, transcribed verbatim, and analyzed using concurrent content analysis, guided by the Cognitive Continuum Theory and the Theoretical Domains Framework. RESULTS Findings focused on the complexity of the pediatric chronic pain population and the leading role nurses play in triage without evidence-based guidance. Analysis generated three prominent themes: (1) nurse-led triage determinants; (2) process of triage decision-making; and (3) external influences on triage decision-making. CONCLUSIONS Triage decision making in the setting of interdisciplinary pediatric chronic pain programs is complex and often led by nurses. There is a desire amongst nurses to adopt an evidence-based clinical decision support triage tool (CDS), which may streamline the referral and triage process and foster a system whereby patients in highest need for interdisciplinary care are best prioritized.
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Affiliation(s)
- Megan J Greenough
- From the University of Ottawa, School of Nursing; Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | - Krystina B Lewis
- From the University of Ottawa, School of Nursing; Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Tracey Bucknall
- School of Nursing, Deakin University, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, Australia
| | - Lindsay Jibb
- Bloomberg Faculty of Nursing, University of Toronto, Pediatric Nursing Research, SickKids Hospital, Toronto, Canada
| | - Jennifer Leese
- School of Epidemiology and Public Health, University of Ottawa Centre for Implementation Research, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Christine Lamontagne
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Anesthesiology and Pain Medicine at University of Ottawa, Ottawa, Canada
| | - Janet E Squires
- From the University of Ottawa, School of Nursing; Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, Canada
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Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
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Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
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Smith T, Singh G, Mcnamee G, Newton C. Musculoskeletal physiotherapists' discharge practices for people treated with low back pain: A United Kingdom survey. Musculoskeletal Care 2023. [PMID: 38036768 DOI: 10.1002/msc.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Persistent low back pain (LBP) is the leading cause of disability, and a major burden on the healthcare system globally. Many people with LBP experience recurrent pain flares and receive repeated appointments and re-referrals to services such as physiotherapy. However, it is not clear what the criteria are for discharging people with LBP from physiotherapy services. This study aims to describe the current practices for discharging people from physiotherapy for LBP in the United Kingdom (UK). METHODS A cross-sectional study using an anonymous online national (UK) survey was conducted among qualified physiotherapists who treat people with LBP in UK musculoskeletal out-patient services. RESULTS A total of 104 surveys were completed. The majority of respondents reported using (i) a shared decision-making (77%) and (ii) person-physiotherapist goal attainment (74%) approach to discharging people with LBP. Sixty-three percent of respondents reported using a patient-initiated follow-up (PIFU) approach. Only 8% of respondents reported using a graded discharge approach with 'booster' appointments. A PIFU or graded discharge approach was considered most pertinent for people at higher risk of a pain flare (97%; 86%) and with low self-efficacy to self-manage their LBP. CONCLUSIONS This UK survey established that discharge practices for people with LBP after physiotherapy vary. Whilst the majority of people are currently discharged with a PIFU appointment, a graded discharge approach may be more beneficial for people who are less likely to initiate a PIFU appointment. Further consideration on the development of such a pathway is now required.
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Affiliation(s)
- Toby Smith
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - George Mcnamee
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
- School of Health and Care, University of Coventry, Coventry, UK
| | - Christopher Newton
- Physiotherapy Department, University Hospitals Coventry and Warwickshire, Coventry, UK
- School of Health and Care, University of Coventry, Coventry, UK
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