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O'Hagan ET, Cashin AG, Traeger AC, McAuley JH. Person-centred education and advice for people with low back pain: Making the best of what we know. Braz J Phys Ther 2023; 27:100478. [PMID: 36657216 PMCID: PMC9868342 DOI: 10.1016/j.bjpt.2022.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care. OBJECTIVE This Masterclass will draw on recent evidence to explore how physical therapy clinicians could deliver person-centred education and advice to people with low back pain to refine their clinical consultation. DISCUSSION First, we highlight the potential value of providing validation to acknowledge the distressing experience and consequences of low back pain. Second, we describe a tool to open channels of communication to provide education and advice in a patient-centred and efficient way. Clinicians could consider using the Attitude toward Education and advice for Low back pain Questionnaire to gain an insight into patient attitudes toward education and advice at the outset of a clinical encounter. Finally, we provide options for tailoring patient education and advice to promote self-management of low back pain based on patient attitudes. We present evidence that a positive attitude toward messages about causes rather than messages about physical activity predicts intention to self-manage low back pain. We combine this evidence to suggest a pathway for clinicians to provide education and advice to people with low back pain within the time constraints of a clinical consultation.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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O'Hagan ET, Di Pietro F, Traeger AC, Cashin AG, Hodges PW, Wand BM, O'Neill S, Schabrun SM, Harris IA, McAuley JH. What messages predict intention to self-manage low back pain? A study of attitudes towards patient education. Pain 2022; 163:1489-1496. [PMID: 34784310 DOI: 10.1097/j.pain.0000000000002530] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT This observational study evaluated people's attitudes towards educational statements and tested whether this predicted intention to self-manage low back pain (LBP). People with or without LBP who were older than 18 years and fluent in written English were recruited. Participants completed an online survey asking demographic questions and questions on the presence or absence of LBP, its duration, and intensity. We assessed attitude toward educational statements and conducted linear regression analyses to investigate the relationship between attitude toward each statement and intention to self-manage. We recruited 656 participants, n = 345 (53.6%), with LBP of varying duration. On average, participants had a positive attitude toward all statements except one; participants with chronic LBP had a negative attitude toward a statement relating to the cause of LBP. The effect of attitude on intention to self-manage was dependent on whether someone had LBP and for how long. For example, increased intention to self-manage was predicted by a positive attitude toward educational statements related to staying active (β = 0.22 [CI 0.11-0.33]) in participants without pain, statements about reassurance (β = 0.33 [CI 0.16-0.49]) for participants with acute or subacute LBP, and statements about the severity of back pain (β = 0.25 [CI 0.18-0.33]) for participants with chronic LBP. We noted differences in attitude toward educational messages and individuals' intention to self-manage LBP depending on pain duration. Self-management could be encouraged with specific reassurance in people with acute or subacute LBP and education about severity in people with chronic LBP.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Flavia Di Pietro
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Sean O'Neill
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, New South Wales, Australia
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
OBJECTIVE The evidence base for social prescribing is inconclusive, and evaluations have been criticised for lacking rigour. This realist review sought to understand how and why social prescribing evaluations work or do not work. Findings from this review will contribute to the development of an evidence-based evaluation framework and reporting standards for social prescribing. DESIGN A realist review. DATA SOURCES ASSIA, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus Online, Social Care Online, Web of Science and grey literature. ELIGIBILITY CRITERIA Documents reporting on social prescribing evaluations using any methods, published between 1998 and 2020 were included. Documents not reporting findings or lacking detail on methods for data collection and outcomes were excluded. ANALYSIS Included documents were segregated into subcases based on methodology. Data relating to context, mechanisms and outcomes and the programme theory were extracted and context-mechanism-outcome configurations were developed. Meta-inferences were drawn from all subcases to refine the programme theory. RESULTS 83 documents contributed to analysis. Generally, studies lacked in-depth descriptions of the methods and evaluation processes employed. A cyclical process of social prescribing evaluation was identified, involving preparation, conducting the study and interpretation. The analysis found that coproduction, alignment, research agency, sequential mixed-methods design and integration of findings all contributed to the development of an acceptable, high-quality social prescribing evaluation design. Context-mechanism-outcome configurations relating to these themes are reported. CONCLUSIONS To develop the social prescribing evidence base and address gaps in our knowledge about the impact of social prescribing and how it works, evaluations must be high quality and acceptable to stakeholders. Development of an evaluation framework and reporting standards drawing on the findings of this realist review will support this aim. PROSPERO REGISTRATION NUMBER CRD42020183065.
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Affiliation(s)
- Megan Elliott
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Mark Davies
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Julie Davies
- Valleys Regional Park, Bridgend County Borough Council, Bridgend, UK
| | - Carolyn Wallace
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
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Satisfaction with Social Support Received from Social Relationships in Cases of Chronic Pain: The Influence of Personal Network Characteristics in Terms of Structure, Composition and Functional Content. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082706. [PMID: 32326411 PMCID: PMC7215382 DOI: 10.3390/ijerph17082706] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 11/17/2022]
Abstract
The worldwide burden of chronic illnesses, constitutes a major public health concern and a serious challenge for health systems. In addition to the strategies of self-management support developed by nursing and health organizations, an individual’s personal network represents a major resource of social support in the long-term. Adopting a cross-sectional design based on personal network analysis methods, the main aim of this study is to explore the relationship between satisfaction with the social support received by individuals suffering chronic pain and the structure, composition, and functional content in social support of their personal networks. We collected personal and support network data from 30 people with chronic pain (20 person’s contacts (alters) for each individual (ego), 600 relationships in total). Additionally, we examined the level of satisfaction with social support in each of the 600 relationships. Bivariate and multivariate tests were performed to analyze the satisfaction with the social support received. Using cluster analysis, we established a typology of the 600 relationships under study. Results showed that higher satisfaction was associated with a balance between degree centrality and betweenness (i.e., measures of network cohesion and network modularity, respectively). Finally, new lines of research are proposed in order to broaden our understanding of this subject.
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Apidechkul T. Prevalence and factors associated with type 2 diabetes mellitus and hypertension among the hill tribe elderly populations in northern Thailand. BMC Public Health 2018; 18:694. [PMID: 29871598 PMCID: PMC5989444 DOI: 10.1186/s12889-018-5607-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and hypertension (HT) are major noncommunicable health problems in both developing and developed countries, including Thailand. Each year, a large amount of money is budgeted for treatment and care. Hill tribe people are a marginalized population in Thailand, and members of its elderly population are vulnerable to health problems due to language barriers, lifestyles, and daily dietary intake. METHODS An analytic cross-sectional study was conducted to estimate the prevalence of T2DM and HT and to assess the factors associated with T2DM and HT. The study populations were hill tribe elderly adults aged ≥ 60 years living in Chiang Rai Province, Thailand. A simple random method was used to select the targeted hill tribe villages and participants into the study. A validated questionnaire, physical examination form, and 5-mL blood specimen were used as research instruments. Fasting plasma glucose and blood pressure were examined and used as outcome measurements. Chi-square tests and logistic regression were used for detecting the associations between variables at the significance level alpha=0.05. RESULTS In total, 793 participants participated in the study; 49.6% were male, and 51.7% were aged 60-69 years. A total of 71.5% were Buddhist, 93.8% were uneducated, 62.9% were unemployed, and 89 % earned an income of < 5,000 baht/month. The overall prevalence of T2DM and HT was 16.8% and 45.5%, respectively. Approximately 9.0% individuals had comorbidity of T2DM and HT. Members of the Lahu, Yao, Karen, and Lisu tribes had a greater odds of developing T2DM than did those of the Akha tribe. Being overweight, having a parental history of T2DM, and having high cholesterol were associated with T2DM development. In contrast, those who engaged in highly physical activities and exercise had lower odds of developing T2DM than did those who did not. Regarding HT, being female, having a high dietary salt intake, being overweight, and having a parental history of HT were associated with HT development among the hill tribe elderly populations. CONCLUSIONS The prevalence of T2DH and HT among the hill tribe elderly populations is higher than that among the general Thai population. Public health interventions should focus on encouraging physical activity and reducing personal weight, dietary salt intake, and greasy food consumption among the hill tribe elderly.
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Affiliation(s)
- Tawatchai Apidechkul
- Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand.
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand.
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Davies F, Wood F, Bullock A, Wallace C, Edwards A. Shifting mindsets: a realist synthesis of evidence from self-management support training. MEDICAL EDUCATION 2018; 52:274-287. [PMID: 29314172 DOI: 10.1111/medu.13492] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/02/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. METHODS We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. RESULTS Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. CONCLUSION The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational constraints) influences this process. Proactively addressing potential contextual barriers may facilitate implementation. These findings could be applied to other types of training designed to shift attitudes amongst HCPs.
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Affiliation(s)
- Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Carolyn Wallace
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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