1
|
Cowan S, Moran L, Garad R, Sturgiss E, Lim S, Ee C. Translating evidence into practice in primary care management of adolescents and women with polycystic ovary syndrome: a mixed-methods study. Fam Pract 2024; 41:175-184. [PMID: 38438311 PMCID: PMC11017779 DOI: 10.1093/fampra/cmae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The international guideline on polycystic ovary syndrome (PCOS) provides evidence-based recommendations on the management of PCOS. Guideline implementation tools (GItools) were developed for general practitioner (GP) use to aid rapid translation of guidelines into practice. This mixed-methods study aimed to evaluate barriers and enablers of the uptake of PCOS GItools in general practice. DESIGN AND SETTING A cross-sectional survey was distributed through professional networks and social media to GPs and GPs in training in Australia. Survey respondents were invited to contribute to semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Qualitative data were thematically analysed and mapped deductively to the Theoretical Domains Framework and Capability, Opportunity, Motivation and Behaviour model. RESULTS The study engaged 146 GPs through surveys, supplemented by interviews with 14 participants. A key enabler to capability was reflective practice. Barriers relating to opportunity included limited awareness and difficulty locating and using GItools due to length and lack of integration into practice software, while enablers included ensuring recommendations were relevant to GP scope of practice. Enablers relevant to motivation included co-use with patients, and evidence of improved outcomes with the use of GItools. DISCUSSION This study highlights inherent barriers within the Australian healthcare system that hinder GPs from integrating evidence for PCOS. Findings will underpin behaviour change interventions to assist GPs in effectively utilising guidelines in clinical practice, therefore minimising variations in care. While our findings will have a direct influence on guideline translation initiatives, changes at organisational and policy levels are also needed to address identified barriers.
Collapse
Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| |
Collapse
|
2
|
Parvar SY, Mojgani P, Lankarani KB, Poursaeed F, Mohamadi Jahromi LS, Mishra V, Abbasi A, Shahabi S. Barriers and facilitators to reducing low-value care for the management of low back pain in Iran: a qualitative multi-professional study. BMC Public Health 2024; 24:204. [PMID: 38233835 PMCID: PMC10792884 DOI: 10.1186/s12889-023-17597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Low back pain (LBP) is a prevalent musculoskeletal disorder with a wide range of etiologies, ranging from self-limiting conditions to life-threatening diseases. Various modalities are available for the diagnosis and management of patients with LBP. However, many of these health services, known as low-value care (LVC), are unnecessary and impose undue financial costs on patients and health systems. The present study aimed to explore the perceptions of service providers regarding the facilitators and barriers to reducing LVC in the management of LBP in Iran. METHODS This qualitative descriptive study interviewed a total of 20 participants, including neurosurgeons, physiatrists, orthopedists, and physiotherapists, who were selected through purposive and snowball sampling strategies. The collected data were analyzed using the thematic content analysis approach. RESULTS Thirty-nine sub-themes, with 183 citations, were identified as barriers, and 31 sub-themes, with 120 citations, were defined as facilitators. Facilitators and barriers to reducing LVC for LBP, according to the interviewees, were categorized into five themes, including: (1) individual provider characteristics; (2) individual patient characteristics; (3) social context; (4) organizational context; and (5) economic and political context. The ten most commonly cited barriers included unrealistic tariffs, provider-induced demand, patient distrust, insufficient time allocation, a lack of insurance coverage, a lack of a comprehensive referral system, a lack of teamwork, cultural challenges, a lack of awareness, and defensive medicine. Barriers such as adherence to clinical guidelines, improving the referral system, improving the cultural status of patients, and facilitators such as strengthening teamwork, developing an appropriate provider-patient relationship, improving the cultural status of the public, motivating the patients, considering an individualized approach, establishing a desirable payment mechanism, and raising the medical tariffs were most repeatedly stated by participants. CONCLUSION This study has pointed out a great number of barriers and facilitators that shape the provision of LVC in the management of LBP in Iran. Therefore, it is essential for relevant stakeholders to consider these findings in order to de-implement LVC interventions in the process of LBP management.
Collapse
Affiliation(s)
- Seyedeh Yasamin Parvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Poursaeed
- Transitional Doctor of Physical Therapy Program, College of Professional Studies, Northeastern University, Boston, USA
| | - Leila Sadat Mohamadi Jahromi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, UAE
| | - Alireza Abbasi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
3
|
Mathieu J, Robert MÈ, Châtillon CÉ, Descarreaux M, Marchand AA. Appropriateness of specialized care referrals for LBP: a cross-sectional analysis. Front Med (Lausanne) 2024; 10:1292481. [PMID: 38249968 PMCID: PMC10797061 DOI: 10.3389/fmed.2023.1292481] [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: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background Low back pain (LBP) accounts for a significant proportion of primary care visits. Despite the development of evidence-based guidelines, studies point to the inefficient use of healthcare resources, resulting in over 60.0% of patients with LBP being referred to spine surgeons without any surgical indication. Centralized waiting lists (CWLs) have been implemented to improve access to specialized care by managing asymmetry between supply and demands. To date, no study has provided data on patients' clinical profiles and referral patterns to medical specialists for LBP in the context of a publicly funded healthcare system operating a prioritization model. The objective of this study was to evaluate the appropriateness of specialized care referrals for LBP after the implementation of a CWL. Methods A retrospective cross-sectional analysis of 500 randomly selected electronic health records of patients who attended the outpatient neurosurgery clinic of the administrative Mauricie-et-Centre-du-Québec region was performed. Inclusion criteria were neurosurgery consultation referrals for adults ≥18 years suffering from a primary complaint of LBP, and performed between September 1st, 2018, and September 1st, 2021. Data relevant for drawing a comprehensive portrait of patients referred to the neurosurgery service and for judging referrals appropriateness were manually extracted. Results Of the 500 cases analyzed, only 112 (22.4%) were surgical candidates, while 221 (44.2%) were discharge from the neurosurgery service upon initial assessment. Key information was inconsistently documented in medical files, thus preventing the establishment of a comprehensive portrait of patients referred to the neurosurgery service for LBP. Nevertheless, over 80.0% of referrals made during the study period were deemed inappropriate. Inappropriate referrals were characterized by higher proportion of patients symptomatically improved, presenting a back-dominant chief complaint, exhibiting no objective neurological symptoms, and diagnosed with non-specific LBP. Conclusion This study reveals a significant proportion of inappropriate referrals to specialized care for LBP. Further research is needed to better understand the factors that prompt referrals to medical specialists for LBP, and the criteria considered by neurosurgeons when selecting the appropriate management strategy. Recent studies suggest that triaging approaches led by musculoskeletal experts may improve referral appropriateness to specialized care.
Collapse
Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marie-Ève Robert
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Claude-Édouard Châtillon
- Centre intégré universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
- Division of Neurosurgery, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| |
Collapse
|
4
|
Malliaras P, O'Keeffe M, Ridgway J, Whale R, Vasan V, L'Huillier P, Towers M, Farlie MK. Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study. Disabil Rehabil 2023:1-8. [PMID: 38153258 DOI: 10.1080/09638288.2023.2296986] [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: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging. MATERIALS AND METHODS Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset. RESULTS Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making. CONCLUSION Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.IMPLICATIONS FOR REHABILITATIONPatients with shoulder pain may believe imaging is necessary for diagnosis and defining treatment yet do not consider potential indirect harms (e.g., unnecessary treatment for findings that are not relevant).Health professionals should ensure patients are aware of imaging limitations and harms and facilitate shared decision-making about whether to have imaging.Health professionals also have an important role in the appropriate contextualisation of imaging findings (i.e., they do not necessarily relate to pain nor guide treatment).
Collapse
Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jacqueline Ridgway
- Physiotherapy Department, Frankston Hospital, Peninsula Health, Victoria, Australia
| | - Rhiannon Whale
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Vasish Vasan
- Physiotherapy Department, Monash University, Melbourne, Australia
| | | | - Mitch Towers
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Melanie K Farlie
- Physiotherapy Department, Monash University, Melbourne, Australia
| |
Collapse
|
5
|
Manansala C, Ferbers S, Johnson M, Passmore S. Factors associated with non-pharmacological, non-operative treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian Spine Outcomes Research Network (CSORN) study. Musculoskelet Sci Pract 2023; 63:102695. [PMID: 36473826 DOI: 10.1016/j.msksp.2022.102695] [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: 07/14/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment. OBJECTIVES This study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population. DESIGN Retrospective cohort design. METHODS Canadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement. RESULTS A total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61-90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0-10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4-9.2, p = .010; 3) body mass index (BMI) score 25-29.9 (OR 6.7, 95% CI 2.2-20.9, p < .001) and BMI ≥ 30 (OR 4.2, 95% CI 1.4-12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0-5.6, p = .039. CONCLUSIONS In total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.
Collapse
Affiliation(s)
- Christian Manansala
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - Spencer Ferbers
- Max Rady College of Medicine, University of Manitoba, 260 Brodie Centre - 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Michael Johnson
- Departments of Orthopedics and Neurosurgery, AD401 - 820 Sherbrook Street, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Steven Passmore
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada
| |
Collapse
|
6
|
Mavragani A, Röttele N, van der Keylen P, Schöpf-Lazzarino AC, Klimmek M, Körner M, Schnitzius K, Voigt-Radloff S, Maun A, Sofroniou M, Farin-Glattacker E. The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients. JMIR Form Res 2022; 6:e38748. [PMID: 36580365 PMCID: PMC9837709 DOI: 10.2196/38748] [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] [Received: 04/14/2022] [Accepted: 11/14/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. OBJECTIVE In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. METHODS This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. RESULTS A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. CONCLUSIONS Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12875-019-0925-8.
Collapse
Affiliation(s)
| | - Nicole Röttele
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Piet van der Keylen
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Christina Schöpf-Lazzarino
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Klimmek
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Schnitzius
- Institute of General Practice, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mario Sofroniou
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
7
|
Primary care first contact practitioner’s (FCP) challenges and learning and development needs in providing fitness for work and sickness absence certification: consensus development. Physiotherapy 2022; 116:79-89. [DOI: 10.1016/j.physio.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/11/2021] [Accepted: 02/03/2022] [Indexed: 11/20/2022]
|
8
|
Murtagh S, Bryant E, Hebron C, Ridehalgh C, Horler C, Trosh C, Olivier G. Management of low back pain: Treatment provision within private practice in the UK in the context of clinical guidelines. Musculoskeletal Care 2021; 19:540-549. [PMID: 33713545 DOI: 10.1002/msc.1553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To summarise the combination of treatments private UK-based physiotherapists use with patients who have low back pain (LBP) and the extent to which the treatments used are consistent with clinical guideline recommendations. DESIGN Cross-sectional observational survey. METHODS Data were collected from physiotherapists within private UK-based clinics using an online standardised data collection system to record the treatment they provided for patients who had LBP with/without leg pain. Treatment data were classified into those that are 'recommended', 'not recommended' and had 'no recommendation'. RESULTS/FINDINGS Treatment provided to 8003 patients were included in the analyses. Most patients (95.0%) were provided with a 'recommended' treatment. Approximately half of the patients who received 'recommended' treatment were also provided with other treatments that were either 'not recommended' (16.7%), had 'no recommendation' (16.6%) or a combination of both (13.0%). Few patients were provided with only treatments that were 'not recommended' and/or treatment with 'no recommendation' (4.6%). CONCLUSION This study provides insight into the self-reported practice of participating physiotherapists and highlights how they generally adopted a multimodal treatment model for patients with LBP. Consistent with the National Institute for Health and Care Excellence guidelines, most patients received information and advice often in conjunction with exercise and manual therapy. Only a small proportion of patients were provided with treatments that are 'not recommended' and/or treatment that had 'no recommendation'. These findings are useful in documenting the implementation of clinical guidelines given the need for practitioners to balance the best available evidence with patient expectation and preference and to facilitate the therapeutic alliance.
Collapse
Affiliation(s)
- Shemane Murtagh
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Elizabeth Bryant
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | | | - Christopher Horler
- School of Health Sciences, University of Brighton, Eastbourne, UK.,Physiotherapy Department, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Caroline Trosh
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - George Olivier
- School of Pharmacy and Bimolecular Sciences, University of Brighton, Brighton, UK
| |
Collapse
|
9
|
Madani Larijani M, Dumba C, Thiessen H, Palen A, Carr T, Vanstone JR, Fourney DR, Hartness C, Parker R, Groot G. Development of a Patient-Oriented Intervention to Support Patient-Provider Conversations about Unnecessary Lower Back Pain Imaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052786. [PMID: 33803431 PMCID: PMC7967489 DOI: 10.3390/ijerph18052786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
Background: despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to develop an intervention that addresses lower back pain imaging overuse. Methods: to develop this intervention, we collaborated with a multidisciplinary advisory team, including two patient partners with lower back pain, researchers, clinicians, healthcare administrators, and the Choosing Wisely Canada lead for Saskatchewan. For this qualitative study, data were collected through two advisory team meetings, two individual interviews with lower back pain patient partners, and three focus groups with lower back pain patient participants. A lower back pain prescription pad was developed as an outcome of these consultations. Results: participants reported a lack of interactive and informative communication was a significant barrier to receiving appropriate care. The most cited content information for inclusion in this intervention was treatments known to work, including physical activity, useful equipment, and reliable sources of educational material. Participants also suggested it was important that benefits and risks of imaging were explained on the pad. Three key themes derived from the data were also used to guide development of the intervention: (a) the role of imaging in LBP diagnosis; (b) the impact of the patient-physician relationship on LBP diagnosis and treatment; and (c) the lack of patient awareness of Choosing Wisely Canada and their recommendations. Conclusions: the lower back pain patient-developed prescription pad may help patients and clinicians engage in informed conversations and shared decision making that could support reduce unnecessary lower back pain imaging.
Collapse
Affiliation(s)
- Maryam Madani Larijani
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
| | - Cindy Dumba
- Patient and Public Partner of Choosing Wisely Canada, Regina, SK S4S 4V4, Canada;
| | - Heather Thiessen
- Saskatchewan Patient & Family Leadership Council, Saskatoon, SK S7K 7P8, Canada;
| | - Angie Palen
- Choosing Wisely Saskatchewan, Saskatoon, SK S7K 1P3, Canada;
| | - Tracey Carr
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
| | - Jason R. Vanstone
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Daryl R. Fourney
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada;
| | - Collin Hartness
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Robert Parker
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
- Correspondence: ; Tel.: +1-(306)-966-1670
| |
Collapse
|
10
|
Malliaras P, Cridland K, Hopmans R, Ashton S, Littlewood C, Page R, Harris I, Skouteris H, Haines T. Internet and Telerehabilitation-Delivered Management of Rotator Cuff-Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e24311. [PMID: 33206059 PMCID: PMC7710452 DOI: 10.2196/24311] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. OBJECTIVE The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation. METHODS Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70% or greater of participants, (3) 80% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively. RESULTS We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83% (10/12) to 92% (11/12) were female. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other time points was 83% or greater. We found acceptable adherence (defined as greater than 70% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition). CONCLUSIONS Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5.
Collapse
Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Kate Cridland
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ruben Hopmans
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Simon Ashton
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Chris Littlewood
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Page
- Barwon Orthopaedic Research and Education, Barwon Health and School of Medicine, Deakin University, Geelong, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| |
Collapse
|
11
|
Macedo LG. Clinician's Commentary on Benny and Evans 1. Physiother Can 2020; 72:364-365. [PMID: 35110809 PMCID: PMC8781497 DOI: 10.3138/ptc-2019-0026-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Luciana Gazzi Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ont.;
| |
Collapse
|
12
|
Correa VC, Lugo-Agudelo LH, Aguirre-Acevedo DC, Contreras JAP, Borrero AMP, Patiño-Lugo DF, Valencia DAC. Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview. Health Res Policy Syst 2020; 18:74. [PMID: 32600417 PMCID: PMC7322919 DOI: 10.1186/s12961-020-00588-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 06/11/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. Methods A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. Results Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. Conclusions The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.
Collapse
Affiliation(s)
- Verónica Ciro Correa
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Luz Helena Lugo-Agudelo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Daniel Camilo Aguirre-Acevedo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Jesús Alberto Plata Contreras
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Ana María Posada Borrero
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Daniel F Patiño-Lugo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia.
| | - Dolly Andrea Castaño Valencia
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| |
Collapse
|
13
|
Schröder K, Öberg B, Enthoven P, Kongsted A, Abbott A. Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care. BMC Health Serv Res 2020; 20:443. [PMID: 32430047 PMCID: PMC7238530 DOI: 10.1186/s12913-020-05197-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implementing clinical guidelines is challenging. To facilitate uptake, we developed a model of care (BetterBack Model of Care) and an implementation strategy to support management of low back pain in primary care. The aim of this study was to evaluate physiotherapists´ confidence, attitudes and beliefs in managing patients with low back pain before and after a multifaceted implementation of the BetterBack Model of Care. A further aim was to evaluate determinants of implementation behaviours among physiotherapists. METHODS This clinical trial was an experimental before and after study within a hybrid type 2 effectiveness-implementation trial. The primary outcome was Practitioner Self-Confidence Scale (PCS), secondary outcomes were the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PT) and Determinants of Implementation Behaviour Questionnaire (DIBQ). Data was analysed using repeated measures ANOVA and pairwise comparisons. RESULTS One hundred sixteen physiotherapists answered a questionnaire before, directly after, as well as 3 and 12 months after implementation of the Model of Care. PCS improved over time with a large effect size post implementation (ηp2 = 0.197, p < 0.001). Changes in PABS-PT were only significant after 12 months with higher biopsychosocial orientation, (ηp2 = 0.071, p < 0.01) and lower biomedical orientation, (ηp2 = 0.136, p < 0.001). Directly after the workshop, after 3 and 12 months, physiotherapists had high ratings on all DIBQ domains, (scores > 50) implying that all were potential facilitators of the implementation. However, after 3 months, all domains had significantly decreased except for organisation, social influence and patient expectation domains. However, after 12 months, organisation and social influence domains had significantly decreased while domains such as knowledge, skills and beliefs about capabilities returned to initial levels. CONCLUSIONS Physiotherapists´ confidence and biopsychosocial orientation increased after implementation and may have the potential to improve management of low back pain in primary care. The implementation behaviour showed mostly facilitating patterns but changed over time, pinpointing a need to repeatedly monitor these changes. This can inform the need for changes of implementation efforts in different phases and support sustainability strategies. TRAIL REGISTRATION ClinicalTrials.gov NCT03147300 3 May 2017, prospectivly registered.
Collapse
Affiliation(s)
- Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| | - Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense, Denmark
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| |
Collapse
|
14
|
Carroll SP, Augeard N, Tennant J, Seenan C. How do the attitudes, confidence, knowledge and understanding differ in pre-registration healthcare students towards treating people with chronic pain: an observational, cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1746830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sean Paul Carroll
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Nathan Augeard
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jacob Tennant
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
15
|
Baker B, Kessler K, Kaiser B, Waller R, Ingle M, Brambilla S, Viscardi E, Richards K, O'Sullivan P, Goucke R, Smith A, Yao F, Lin I. Non-traumatic musculoskeletal pain in Western Australian hospital emergency departments: A clinical audit of the prevalence, management practices and evidence-to-practice gaps. Emerg Med Australas 2019; 31:1037-1044. [PMID: 31090200 DOI: 10.1111/1742-6723.13305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Musculoskeletal pain (MSP) conditions are a leading cause of morbidity worldwide and a common reason for ED presentation. Little is currently known about non-traumatic MSP (NTMSP) presenting to EDs. The present study described the prevalence and management practices of NTMSP in EDs. METHODS The design was a retrospective clinical audit in two hospital EDs in Western Australia covering 3 months beginning 1 January 2016. We defined NTMSP as pain of musculoskeletal origin occurring in the absence of external force or excessive physical loading. The outcomes measured included: patient, condition and hospital-episode characteristics, as well as management practices. Management practices were compared to recommended care derived from guideline recommendations. These included: assessment for red flags and psychosocial risk factors, appropriate use of diagnostic imaging, provision of patient education, administration and prescription of analgesic medication, and assessment of risk factors for opioid-related harm. RESULTS Eight hundred and eighty-eight patients were included in the present study. NTMSP accounted for 3.0% of all ED presentations. According to clinician documentation, red flag and psychosocial assessments were recorded in 73.3 and 10.5% of patients. Forty-one percent of patients were referred for imaging, of which 39.7% were inconsistent with guideline recommendations. Education was recorded 52.0% of the time. At least one opioid medication was administered to 55.3% of patients and there was no documented assessment of risk factors for opioid-related harm. CONCLUSIONS NTMSP is a relatively common reason for ED presentation. Documented management practices are discordant with guideline recommendations. Strategies to improve the concordance between management and guideline recommendations are needed.
Collapse
Affiliation(s)
- Briarley Baker
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Kenny Kessler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Bronwyn Kaiser
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Robert Waller
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michael Ingle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Simone Brambilla
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Elena Viscardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Karen Richards
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Roger Goucke
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Felix Yao
- St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
| |
Collapse
|
16
|
Page MJ, O'Connor DA, Malek M, Haas R, Beaton D, Huang H, Ramiro S, Richards P, Voshaar MJH, Shea B, Verhagen AP, Whittle SL, van der Windt DA, Gagnier JJ, Buchbinder R. Patients' experience of shoulder disorders: a systematic review of qualitative studies for the OMERACT Shoulder Core Domain Set. Rheumatology (Oxford) 2019; 58:kez046. [PMID: 30843587 DOI: 10.1093/rheumatology/kez046] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the experiences (including symptoms and perceived impacts on daily living) of people with a shoulder disorder. METHODS Systematic review of qualitative studies. We searched for eligible qualitative studies indexed in Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), SportDiscus (EBSCO) and Ovid PsycINFO up until November 2017. Two authors independently screened studies for inclusion, appraised their methodological quality using the Critical Appraisal Skills Programme checklist, used thematic synthesis methods to generate themes describing the experiences reported by participants and assessed the confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. RESULTS The inclusion criteria were met by eight studies, which included 133 participants (49 females and 84 males) with either rotator cuff disease, adhesive capsulitis, proximal humeral fracture, shoulder instability or unspecified shoulder pain. We generated seven themes to describe what people in the included studies reported experiencing: pain; physical function/activity limitations; participation restriction; sleep disruption; cognitive dysfunction; emotional distress; and other pathophysiological manifestations (other than pain). There were interactions between the themes, with particular experiences impacting on others (e.g. pain leading to reduced activities and sleep disruption). Following grading of the evidence, we considered it likely that most of the review findings were a reasonable representation of the experiences of people with shoulder disorders. CONCLUSION Patients with shoulder disorders contend with considerable disruption to their life. The experiences described should be considered by researchers seeking to select the most appropriate outcomes to measure in clinical trials and other research studies in people with shoulder disorders.
Collapse
Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Mary Malek
- Monash University, Clayton, Victoria, Australia
| | - Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Dorcas Beaton
- Institute of Health & Work and the University of Toronto, Toronto, Ontario, Canada
| | - Hsiaomin Huang
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Pamela Richards
- Academic Rheumatology Bristol, University of Bristol, Bristol, UK
| | - Marieke J H Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Beverley Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Samuel L Whittle
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| |
Collapse
|
17
|
Voigt-Radloff S, Schöpf AC, Boeker M, Frank L, Farin E, Kaier K, Körner M, Wollmann K, Lang B, Meerpohl JJ, Möhler R, Niebling W, Serong J, Lange R, van der Keylen P, Maun A. Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC FAMILY PRACTICE 2019; 20:33. [PMID: 30803433 PMCID: PMC6388488 DOI: 10.1186/s12875-019-0925-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Back pain is one of the most frequent causes of health-related work absence. In Germany, more than 70% of adults suffer from at least one back pain episode per annum. It has strong impact on health care costs and patients' quality of life. Patients increasingly seek health information on the internet. However, judging its trustworthiness is difficult. In addition, physicians who are being confronted with this type of information often experience it to complicate the physician-patient interaction. The GAP trial aims to develop, implement and evaluate an evidence-based, easy-to-understand and trustworthy internet information portal on lower back pain to be used by general practitioners and patients during and after the consultation. Effectiveness of GAP portal use compared to routine consultation on improving communication and informedness of both physicians and patients will be assessed. In addition, effects on health care costs and patients' days of sick leave will be evaluated. METHODS We will conduct a prospective multi-centre, cluster-randomized parallel group trial including 1500 patients and 150 recruiting general practitioners. The intervention group will have access to the GAP portal. The portal will contain brief guides for patients and physicians on how to improve the consultation as well as information on epidemiology, aetiology, symptoms, benefits and harms of treatment options for acute, sub-acute and chronic lower back pain. The GAP portal will be designed to be user-friendly and present information on back pain tailored for either patients or physicians in form of brief fact sheets, educative videos, info-graphics, animations and glossaries. Physicians and patients will assess their informedness and the physician-patient communication in consultations at baseline and at two time points after the consultations under investigation. Days of sick leave and health care costs related to back pain will be compared between control and intervention group using routine data of company health insurance funds. DISCUSSION The GAP-trial intends to improve the communication between physicians and their patients and the informedness of both groups. If proven beneficial, the evidence-based and user-friendly portal will be made accessible for all patients and health professionals in back pain care. Inclusion of further indications might be implemented and evaluated in the long term. TRIAL REGISTRATION German Clinical Trials Register DRKS00014279 (registered 27th of April 2018).
Collapse
Affiliation(s)
- Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Andrea C. Schöpf
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Luca Frank
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Division Methods in Clinical Epidemiology, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Britta Lang
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Ralph Möhler
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wilhelm Niebling
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Serong
- Institute for Journalism, Technical University of Dortmund, Dortmund, Germany
| | - Renate Lange
- Bavarian State Association of Company Health Insurance Funds, Bavarian, Germany
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Andy Maun
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
French SD, Green ME, Bhatia RS, Peng Y, Hayden JA, Hartvigsen J, Ivers NM, Grimshaw JM, Booth CM, Rühland L, Norman KE. Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study. BMC Musculoskelet Disord 2019; 20:50. [PMID: 30711002 PMCID: PMC6359752 DOI: 10.1186/s12891-019-2427-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. METHODS The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. DISCUSSION This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.
Collapse
Affiliation(s)
- Simon D French
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. .,Department of Chiropractic, Macquarie University, Macquarie, NSW, 2109, Australia. .,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
| | - Michael E Green
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - R Sacha Bhatia
- Choosing Wisely Canada, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jill A Hayden
- Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Lucia Rühland
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| |
Collapse
|
19
|
Jenkins HJ, Moloney NA, French SD, Maher CG, Dear BF, Magnussen JS, Hancock MJ. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res 2018; 18:734. [PMID: 30249241 PMCID: PMC6154885 DOI: 10.1186/s12913-018-3526-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. METHODS The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPs and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. RESULTS Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPs to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPs of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPs, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. CONCLUSIONS The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.
Collapse
Affiliation(s)
- Hazel J Jenkins
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. .,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
| | - Niamh A Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Chris G Maher
- Musculoskeletal Health Sydney, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Blake F Dear
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - John S Magnussen
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
20
|
Toye F, Seers K, Hannink E, Barker K. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med Res Methodol 2017; 17:116. [PMID: 28764666 PMCID: PMC5540410 DOI: 10.1186/s12874-017-0392-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Each year over five million people develop chronic non-malignant pain and can experience healthcare as an adversarial struggle. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients' experience of living with chronic non-malignant pain and develop conceptual understanding of what it is like to live with chronic non-malignant pain for improved healthcare; (2) to undertake the first mega-ethnography of qualitative evidence syntheses using the methods of meta-ethnography. METHODS We used the seven stages of meta-ethnography refined for large studies. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched 7 bibliographic databases from inception until February 2016 to identify qualitative evidence syntheses that explored patients' experience of living with chronic non-malignant pain. RESULTS We identified 82 potential studies from 556 titles, screened 34 full text articles and included 11 qualitative evidence syntheses synthesising a total of 187 qualitative studies reporting more than 5000 international participants living with chronic pain. We abstracted concepts into 7 conceptual categories: (1) my life is impoverished and confined; (2) struggling against my body to be me; (3) the quest for the diagnostic 'holy grail'; (4) lost personal credibility; (5) trying to keep up appearances; (6) need to be treated with dignity; and (7) deciding to end the quest for the grail is not easy. Each conceptual category was supported by at least 7 of the 11 qualitative evidence syntheses. CONCLUSIONS This is the first mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Findings help us to understand that the decision to end the quest for a diagnosis can leave patients feeling vulnerable and this may contribute to the adversarial nature of the clinical encounter. This knowledge demonstrates that treating a patient with a sense that they are worthy of care and hearing their story is not an adjunct to, but integral to health care.
Collapse
Affiliation(s)
- Fran Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Erin Hannink
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain. Clin J Pain 2016; 32:800-16. [DOI: 10.1097/ajp.0000000000000324] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Egerton T, Diamond L, Buchbinder R, Bennell K, Slade SC. Barriers and enablers in primary care clinicians' management of osteoarthritis: protocol for a systematic review and qualitative evidence synthesis. BMJ Open 2016; 6:e011618. [PMID: 27235303 PMCID: PMC4885472 DOI: 10.1136/bmjopen-2016-011618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/20/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Osteoarthritis is a highly prevalent and disabling condition. Primary care management of osteoarthritis is generally suboptimal despite evidence for several modestly effective interventions and the availability of high-quality clinical practice guidelines. This report describes a planned study to synthesise the views of primary care clinicians on the barriers and enablers to following recommended management of osteoarthritis, with the aim of providing new interpretations that may facilitate the uptake of recommended treatments, and in turn improve patient care. METHODS AND ANALYSIS A systematic review and meta-synthesis of qualitative studies. 5 databases will be searched using key search terms for qualitative research, evidence-based practice, clinical practice guidelines, osteoarthritis, beliefs, perceptions, barriers, enablers and adherence. A priori inclusion/exclusion criteria include availability of data from primary care clinicians, reports on views regarding management of osteoarthritis, and studies using qualitative methods for both data collection and analysis. At least 2 independent reviewers will identify eligible reports, conduct a critical appraisal of study conduct, extract data and synthesise reported findings and interpretations. Synthesis will follow thematic analysis within a grounded theory framework of inductive coding and iterative theme identification. The reviewers plus co-authors will contribute to the meta-synthesis to find new themes and theories. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be used to determine a confidence profile of each finding from the meta-synthesis. The protocol has been registered on PROSPERO and is reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The results will help to inform policy and practice and assist in the optimisation of management for people with osteoarthritis. PROSPERO REGISTRATION NUMBER CRD42015027543.
Collapse
Affiliation(s)
- T Egerton
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - L Diamond
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - R Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Victoria, Australia
| | - K Bennell
- Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - S C Slade
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Victoria, Australia
| |
Collapse
|