1
|
Natoli AR, Jones MD, Walker ED, Gibbs MT. "I could 100% see myself getting hurt if I did it wrong": a qualitative exploration of exercise perceptions in people with chronic low back pain. Disabil Rehabil 2024:1-10. [PMID: 39264041 DOI: 10.1080/09638288.2024.2400592] [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: 03/13/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Traditionally, a specific "core" exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. MATERIALS AND METHODS Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. RESULTS All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. "Core" exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. CONCLUSION People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.
Collapse
Affiliation(s)
- Andrew R Natoli
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Emily D Walker
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- Faculty of Medicine & Health, School of Health Sciences, UNSW Sydney, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
2
|
Loughlin M. Inspecting the links: Knowledge, evidence and value in healthcare. J Eval Clin Pract 2024; 30:729-734. [PMID: 39083553 DOI: 10.1111/jep.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
|
3
|
Thomas A, Chin-Yee B, Mercuri M. Thirty years of teaching evidence-based medicine: have we been getting it all wrong? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:263-276. [PMID: 34559327 DOI: 10.1007/s10459-021-10077-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
Evidence based medicine (EBM) has been synonymous to delivery of quality care for almost thirty years. Since the movement's inception, the assumption has been that decisions based on high quality evidence would translate to better care for patients. Despite EBM's many attractive features and the substantive attention it has received in the contemporary clinical and medical education literature, how it is defined and operationalized as a component of training is often unclear and problematic. How to practice EBM is not well articulated in the literature; therefore, it becomes difficult to teach and equally challenging to assess. In this paper, we put forward a call for deeper consideration of how EBM is taught, and for clarification on how it is defined and operationalized in medical education. In preparing this paper, we considered questions such as what it means to practice EBM, the role that medical education plays in helping realize EBM, how the teaching of EBM can change to reflect recent developments in clinical practice and education, and whether transformations in the practice of medicine necessitate a change in how we teach EBM. We end with four avenues that may be pursued to advance the teaching of EBM in medical education: (1) consensus on what we mean by EBM; (2) clear articulation of EBM-associated competencies; (3) empirically and theoretically supported means of promoting EBM competencies; (4) ways to assess both skill acquisition and use of EBM. We discuss implications for educators of EBM.
Collapse
Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University and Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3654 Promenade Sir William Osler, Montreal, QC, H3G-1Y5, Canada.
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine and Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Mathew Mercuri
- Department of Medicine, McMaster University, Hamilton, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for the Future of Knowledge, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
4
|
Loughlin M, Wyer P, Tanenbaum SJ. Teaching by (bad) example: what a confused attempt to "advance" EBM reveals about its underlying problems: commentary on Jenicek, M. (2015). Do we need another discipline in medicine? From epidemiology and evidence-based medicine to cognitive medicine and medical thinking. Journal of evaluation in clinical practice, 21:1028-1034. J Eval Clin Pract 2016; 22:628-33. [PMID: 27225855 DOI: 10.1111/jep.12552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/26/2023]
Abstract
Professor Jenicek's paper is confused in that his proposal to 'integrate' what he means by 'evidence-based scientific theory and cognitive approaches to medical thinking' actually embodies a contradiction. But, although confused, he succeeds in teaching us more about the EBM debate than those who seem keen to forge ahead without addressing the underlying epistemological problems that Jenicek brings to our attention. Fundamental questions about the relationship between evidence, knowledge and reason still require resolution if we are to see a genuine advance in this debate.
Collapse
Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | - Peter Wyer
- Columbia University Medical Center, New York, NY, USA.
| | - Sandra J Tanenbaum
- Department of Health Services Management and Policy College of Public Health, The Ohio State University, Columbus Ohio, USA
| |
Collapse
|
5
|
Aas RW, Alexanderson K. Challenging Evidence-based Decision-making: A Hypothetical Case Study about Return to Work. Occup Ther Int 2011; 19:28-44. [DOI: 10.1002/oti.326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 09/10/2011] [Accepted: 09/14/2011] [Indexed: 12/14/2022] Open
Affiliation(s)
- Randi W. Aas
- PreSenter; International Research Institute of Stavanger (IRIS); Stavanger Norway
- Division of Insurance Medicine, Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- PreSenter, Faculty of Health Sciences; Institute of Occupational Therapy, Oslo and Akershus University College; Oslo Norway
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| |
Collapse
|
6
|
Sestini P. Epistemology and ethics of evidence-based medicine: a response to comments. J Eval Clin Pract 2011; 17:1002-3; discussion 1004-5. [PMID: 21951935 DOI: 10.1111/j.1365-2753.2011.01736.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Piersante Sestini
- Department of Clinical Medicine and Immunological Sciences, Section of Respiratory Diseases, University of Siena, Siena, Italy.
| |
Collapse
|
7
|
Loughlin M, Bluhm R, Buetow S, Upshur REG, Goldenberg MJ, Borgerson K, Entwistle V. Virtue, progress and practice. J Eval Clin Pract 2011; 17:839-46. [PMID: 21951924 DOI: 10.1111/j.1365-2753.2011.01748.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Silva SA, Charon R, Wyer PC. The marriage of evidence and narrative: scientific nurturance within clinical practice. J Eval Clin Pract 2011; 17:585-93. [PMID: 21062389 DOI: 10.1111/j.1365-2753.2010.01551.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Published elaborations of evidence-based medicine (EBM) have failed to materially integrate the domains of interpersonal sensibility and relationship with tools intended to facilitate attention to biomedical research and knowledge within clinical practice. Furthermore, the elaboration of EBM skills has been confined to a narrow range of clinical research. As a result, crucial tools required to connect much clinically relevant research and practice remain hidden, and explorations of the deeper challenges faced by practitioners in their struggle to integrate sound science and shared clinical action remain elusive. METHODS We developed a model for scientifically informed, individualized, medical practice and learning that embraces the goals, resources and skills of EBM within a larger framework of practice defined by narrative process: 'attention', 'representation' and 'affiliation'. We drew from published elaborations of EBM, narrative medicine (NM) and the results of a project to develop tools for assessment of the cognitive skills embedded within a practice based EBM domain. RESULTS Within the resulting model, a tool of representation, whose components are Problem delineation, Actions, Choices and Targets, enables the clinical problem to be delineated and the patient and practitioner perspectives to be concretely defined with reference to four classes of clinical interaction: 'therapy', 'diagnosis', 'prognosis' and 'harm'. As a result, the 'information literacy' skills required to access, evaluate and apply clinical research using electronic resources are well defined but subordinated to shared appreciation of patient need. The model acknowledges the relevance of the full range and scope of scientifically derived medical knowledge. CONCLUSION A model based on integration of NM and EBM can lead to instructional tools that integrate clinical epidemiological knowledge with enforced consideration of differing patient and practitioner perspectives. It also may inform avenues for qualitative research into the processes through which such differing perspectives can be productively identified and shared.
Collapse
|
9
|
Lin JW, Chang CH, Lin MW, Ebell MH, Chiang JH. Automating the process of critical appraisal and assessing the strength of evidence with information extraction technology. J Eval Clin Pract 2011; 17:832-8. [PMID: 21707873 DOI: 10.1111/j.1365-2753.2011.01712.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Critical appraisal, one of the most crucial steps in the practice of evidence-based medicine, is expertise-dependent and time-consuming. The objective of this study was to develop and evaluate an automated text-mining system that could determine the evidence level provided by a medical article. METHODS A text processor was designed and built to interpret the abstracts of medical literature. The system extracted information about: (1) the impact factor of the journal; (2) study design; (3) human subject involvement; (4) number of subjects; (5) P-value; and (6) confidence intervals. We used a classification tree algorithm (C4.5) to create a decision tree using supervised classification. Each article was categorized into evidence level A, B or C, and the output was compared to that determined by domain experts (the reference standard). RESULTS We used a corpus of 3180 cardiovascular disease original research articles, of which 1108 were previously assigned evidence level A, 1705 level B and 367 level C by domain experts. The abstracts were analysed by our automated system and an evidence level was assigned. The algorithm accurately classified 85% of the articles. The agreement between computer and domain experts was substantial (κ-value: 0.78). Cross-validation showed consistent results across repeated tests. CONCLUSION The automated engine accurately classified the evidence level. Misclassification might have resulted from incomplete information retrieval and inaccurate data extraction. Further efforts will focus on assessing relevance and using additional study design features to refine evidence level classification.
Collapse
Affiliation(s)
- Jou-Wei Lin
- Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan
| | | | | | | | | |
Collapse
|
10
|
Maudsley G. Mixing it but not mixed-up: mixed methods research in medical education (a critical narrative review). MEDICAL TEACHER 2011; 33:e92-104. [PMID: 21275539 DOI: 10.3109/0142159x.2011.542523] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Some important research questions in medical education and health services research need 'mixed methods research' (particularly synthesizing quantitative and qualitative findings). The approach is not new, but should be more explicitly reported. AIM The broad search question here, of a disjointed literature, was thus: What is mixed methods research - how should it relate to medical education research?, focused on explicit acknowledgement of 'mixing'. METHODS Literature searching focused on Web of Knowledge supplemented by other databases across disciplines. FINDINGS Five main messages emerged: - Thinking quantitative and qualitative, not quantitative versus qualitative - Appreciating that mixed methods research blends different knowledge claims, enquiry strategies, and methods - Using a 'horses for courses' [whatever works] approach to the question, and clarifying the mix - Appreciating how medical education research competes with the 'evidence-based' movement, health services research, and the 'RCT' - Being more explicit about the role of mixed methods in medical education research, and the required expertise CONCLUSION Mixed methods research is valuable, yet the literature relevant to medical education is fragmented and poorly indexed. The required time, effort, expertise, and techniques deserve better recognition. More write-ups should explicitly discuss the 'mixing' (particularly of findings), rather than report separate components.
Collapse
Affiliation(s)
- Gillian Maudsley
- Division of Public Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool L69 3GB, UK.
| |
Collapse
|
11
|
Loughlin M, Upshur REG, Goldenberg MJ, Bluhm R, Borgerson K. Philosophy, ethics, medicine and health care: the urgent need for critical practice. J Eval Clin Pract 2010; 16:249-59. [PMID: 20367844 DOI: 10.1111/j.1365-2753.2010.01411.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Goldenberg MJ. From Popperian science to normal science. Commentary on Sestini (2009) 'Epistemology and ethics of evidence-based medicine'. J Eval Clin Pract 2010; 16:306-9. [PMID: 20367853 DOI: 10.1111/j.1365-2753.2010.01389.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maya J Goldenberg
- Assistant Professor, Department of Philosophy, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|