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Koios D, Kuhnert R, Dräger D, Wenzel A, Kreutz R, Budnick A. The use of nonpharmacological interventions for chronic pain treatment in community-dwelling older adults with a certified need for care. BMC Geriatr 2024; 24:731. [PMID: 39232649 PMCID: PMC11373195 DOI: 10.1186/s12877-024-05317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Chronic pain is a major health issue and rapid population ageing exacerbates the burden to health systems in countries like Germany. Nonpharmacological interventions (NPIs) are essential in pain care and the prioritization of active NPIs is emphasized in guidelines. This paper examines the utilization of NPIs for chronic pain management in community-dwelling older adults with a certified need of care in Berlin, Germany. METHODS Cross-sectional data was collected through standardized face-to-face surveys with older adults (≥65 years), using validated instruments (e.g., Brief Pain Inventory), and structured lists for NPI utilization. Categorization into active and passive NPIs was performed through a literature-based, iterative process by an interdisciplinary team. For not normally distributed data, non-parametric tests were used as appropriate. Logistic regression was conducted for multivariate analysis. RESULTS In total, 250 participants were included in this analysis (aged 65-104, x̅ = 81.8, 68.8% female). Most (92%) use NPIs for chronic pain management: 85.6% use active NPIs, 50.4% active movement and only 5.6% use solely passive approaches. Most common NPIs are distraction, thermotherapy/compresses, and physiotherapy. The odds of utilizing physiotherapy are three times higher for those with high educational status when compared to those with low education while those with low educational status had higher odds of using thermotherapy/compresses. CONCLUSIONS In our sample, most community-dwelling older adults with a certified need of care use active NPIs for chronic pain management with about half using active movement approaches. Considering the high vulnerability of this population, physiotherapy (in the form of therapeutic exercise) is a particularly appropriate intervention, and it was the third most frequent NPI in our sample. However, there is a social gradient in the utilization of physiotherapy for chronic pain management which might be rooted in issues around awareness, appeal, and access to such measures. It is important to take socioeconomic differences into account when planning the care for older chronic pain patients but also when designing research or user-friendly guidelines for this target group. TRIAL REGISTRATION Ethical approval from the Ethics Committee of Charité - Universitätsmedizin Berlin (EA1/368/14) and study registration with the Central Study Register (ZSR no. 20009093).
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Affiliation(s)
- Daniela Koios
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ronny Kuhnert
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dagmar Dräger
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Arlett Wenzel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andrea Budnick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Adalja B, Aplin T, Sterling M, Johnston V. Implementation of the "clinical framework for the delivery of health services" by treating healthcare professionals: perspectives of regulators and insurers. Disabil Rehabil 2024; 46:556-564. [PMID: 36762623 DOI: 10.1080/09638288.2023.2171496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To understand the current utilisation of the clinical framework for delivery of health services to manage compensable musculoskeletal injuries from the perspectives of insurer case managers and clinical panel members. MATERIALS AND METHODS Using a qualitative descriptive approach, 15 semi-structured interviews were conducted with members of key organisations including WorkSafe Victoria and Transport Accident Commission Victoria. All interviews were recorded and transcribed verbatim and analysed using thematic analysis. RESULTS Four over-arching themes were identified: (i) current use of the framework and principles is suboptimal leading to several problems including lack of evidence-based treatment by clinicians; (ii) barriers to optimal use of the framework include lack of adequate training of healthcare professionals on the framework principles and financial aspects of the compensation system; (iii) utilisation of the framework could be improved with training from peak associations, insurers, and regulating bodies; and (iv) optimal use of the framework will result in better health and work outcomes. CONCLUSIONS The current use of the framework and its principles is suboptimal but can be improved by addressing the identified barriers.IMPLICATIONS FOR REHABILITATIONRehabilitation of compensable musculoskeletal injuries is often complex.Implementing the "Clinical Framework for Delivery of Health Services" can lead to provision of time and cost effective, evidence-based rehabilitation for compensable injuries, ultimately improving patient outcomes.Clinicians can enhance the implementation of the framework principles by integrating evidence-based practice and recommendations from clinical practice guidelines in treatment of compensable musculoskeletal injuries.Implementation of the framework principles may be enhanced by reviewing the compensation funding model to allow the healthcare practitioners adequate time and remuneration to adopt the framework principles when treating persons with compensable injuries.
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Affiliation(s)
- Bhavya Adalja
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Callaghan MJ, Gala JP, Roddy E. Ankle osteoarthritis: an online survey of current treatment practices of UK-based podiatrists and physiotherapists. J Foot Ankle Res 2023; 16:89. [PMID: 38082323 PMCID: PMC10714609 DOI: 10.1186/s13047-023-00683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients with painful ankle osteoarthritis (OA) have a mixed experience of non-surgical management which they may attribute to a lack of guidance for clinicians on usual care treatment. Therefore, the purpose of this study was to survey the current clinical practices of UK-based physiotherapists and podiatrists for the treatment of painful ankle osteoarthritis (OA). METHODS UK-based physiotherapists and podiatrists who treat patients with ankle OA completed a self-administered online questionnaire about their professional and clinical service characteristics, diagnostic criteria, treatment aims, preferred treatment options, and treatment outcome measures. Data were collected anonymously and stored on JISC online survey. 'Usual care' was defined as a combination of 'Always', and 'Frequently', and 'Not usual care' was defined as 'Sometimes' 'Rarely,' 'Never', and 'not applicable' combined. Statistically significant differences in responses between the physiotherapists and podiatrists were analysed using X2 tests for each treatment modality. Statistical significance was set at p < 0.05. RESULTS Between 1st June 2021 and 31st August 2021, 100 responses were received; 2 were invalid. Of the 98 valid responses, 63 were from physiotherapists and 35 from podiatrists. The most common treatment aims in both professions were to reduce pain (n = 87, 89%) and improve quality of life (n = 82, 84%). 50 respondents (51%) offered 3 or 4 treatment sessions and 53 respondents (54%) saw patients for 30-40 min at the first treatment session. The five most common modalities used by physiotherapists were patient education (n = 63, 100%), teaching self-management (n = 58, 92%), lifestyle modification (n = 54, 86%), ankle strengthening (n = 55, 87%), and proprioception exercises (n = 54, 86%). For podiatrists, these were patient education (n = 35, 100%), ankle strengthening (n = 31, 89%), activity pacing (n = 28, 80%), lifestyle modification (n = 27, 77%), and gait training (n = 27, 77%). CONCLUSIONS This first-ever survey revealed physiotherapists' and podiatrists' current practices to treat painful ankle OA. This study provides a better understanding of how ankle OA is treated in UK current clinical practice and can inform future clinical trials to compare current practice with new treatment modalities.
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Affiliation(s)
- Michael J Callaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
- Department of Physiotherapy, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - Jinal Pravin Gala
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Edward Roddy
- School of Medicine, Keele University, Staffordshire, UK
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Parkinson M, Ryan C, Avery L, Hand A, Ramaswamy B, Jones J, Lindop F, Silverdale M, Baker K, Naisby J. What is available to support pain management in Parkinson's: a scoping review protocol. Int J Equity Health 2023; 22:244. [PMID: 37993895 PMCID: PMC10666362 DOI: 10.1186/s12939-023-02046-7] [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: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE A scoping review will be undertaken to examine and map the available evidence that has been produced in relation to pain management in Parkinson's, with a focus on behavioural interventions, resources and/or how professionals support people with Parkinson's self-management of pain. METHODS This review will be based on the methodological framework given by Arksey and O'Malley's (2005), including enhancements by Levac et al., Peters et al. and the Joanna Briggs Institute. We will include studies from PubMed, SCOPUS, CINAHL, MEDLINE Web of Science, APA PsycINFO and ASSIA from January, 2010 onwards. Both quantitative and qualitative data will be analysed separately to identify the characteristics of support for pain management available, orientation of the approach and any identifiable behaviour change components and their outcomes. The COM-B behaviour change model and Theoretical Domains Framework will provide a theoretical framework for synthesising evidence in this review. CONCLUSION This scoping review will help to explore studies focusing on the evidence supporting a range of interventions relating to the management of pain experienced by people living with Parkinson's. The focus will be on describing what is available to support self-management, identify what behaviour change components have been used and their effectiveness, identify barriers and enablers to pain management and explore gaps in current provision of pain management. This review will identify implications and priorities for the follow-up phases to the larger 'Pain in Parkinson's' Project which is designed to support clinicians and individuals living with Parkinson's.
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Affiliation(s)
- Mark Parkinson
- Faculty of Health & Life Sciences, Department of Sport, Northumbria University, Exercise & Rehabilitation, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne, UK.
| | - Cormac Ryan
- Teesside University, Centre for Rehabilitation, Middlesbrough, Tees Valley, UK
| | - Leah Avery
- Teesside University, Centre for Rehabilitation, Middlesbrough, Tees Valley, UK
| | - Annette Hand
- Faculty of Health & Life Sciences, Department: Nursing, Northumbria University, Midwifery & Health, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | | | - Julie Jones
- Robert Gordon University, School of Health Sciences, Garthdee Road, Aberdeen, UK
| | - Fiona Lindop
- University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Monty Silverdale
- Department of Neurology, Manchester University, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Katherine Baker
- Faculty of Health & Life Sciences, Department of Sport, Northumbria University, Exercise & Rehabilitation, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne, UK
| | - Jenni Naisby
- Faculty of Health & Life Sciences, Department of Sport, Northumbria University, Exercise & Rehabilitation, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne, UK
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Griffiths GS, Thompson BL, Snell DL, Dunn JA. Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. HAND THERAPY 2023; 28:16-32. [PMID: 37904811 PMCID: PMC10584071 DOI: 10.1177/17589983221138610] [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: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 11/01/2023]
Abstract
Introduction Complex Regional Pain Syndrome (CRPS) is most common in the upper limb and associated with high disability. The purpose of this review was to critically appraise and synthesise literature exploring non-pharmacological treatment for upper limb CRPS, to guide upper-limb-specific management. Methods Using an integrative review methodology, 13 databases were searched to identify all published studies on non-pharmacological management of upper limb CRPS. The Crowe Critical Appraisal Tool was used to provide quality ratings for included studies, and analysis employed a qualitative descriptive approach. Results From 236 abstracts reviewed, 113 full texts were read, and 38 articles selected for data extraction. Designs included single case (n = 14), randomised controlled trial (n = 8), prospective cohort (n = 8), case series (n = 4), retrospective (n = 3), and mixed methods (n = 1). Interventions were categorised as sensory retraining (n = 13), kinesiotherapy (n = 7), manual therapies (n = 7), physical modalities (n = 6), and interdisciplinary treatment programmes (n = 5). All studies measured pain intensity, and most (n = 24) measured physical parameters such as strength, movement, or perceptual abilities. Few measured patient-rated function (n = 13) or psychological factors (n = 4). Quality ratings ranged from 30% to 93%, with a median of 60%. Conclusion Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. Movement, desensitisation, and graded functional activity remain the mainstays of intervention. However, despite the impact of CRPS on wellbeing and function, psychological factors and functional outcomes are infrequently addressed. Further robust research is required to determine which aspects of treatment have the greatest influence on which symptoms, and when and how these should be introduced and progressed.
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Affiliation(s)
- Grace S Griffiths
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Kelton K, Young JR, Evans MK, Eshera YM, Blakey SM, Mann AJD, Pugh MJ, Calhoun PS, Beckham JC, Kimbrel NA. Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness. Complement Ther Clin Pract 2022; 49:101644. [PMID: 35947938 PMCID: PMC9669216 DOI: 10.1016/j.ctcp.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.
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Affiliation(s)
- Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX, USA; National Center for Homelessness Among Veterans, USA.
| | - Jonathan R Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Mariah K Evans
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Yasmine M Eshera
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Shannon M Blakey
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System and IDEAS Center of Innovation, Salt Lake City UT, USA; University of Utah School of Medicine, Department of Medicine, Salt Lake City UT, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
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Ziegler AML, Shannon Z, Long CR, Vining RD, Walter JA, Coulter ID, Goertz CM. Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial. J Manipulative Physiol Ther 2022; 44:690-698. [PMID: 35752500 DOI: 10.1016/j.jmpt.2022.03.009] [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: 05/05/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). METHODS This was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. RESULTS The most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). CONCLUSION For the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.
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Affiliation(s)
- Anna-Marie L Ziegler
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | | | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | | | - Christine M Goertz
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina
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Pesata V, Colverson A, Sonke J, Morgan-Daniel J, Schaefer N, Sams K, Carrion FME, Hanson S. Engaging the Arts for Wellbeing in the United States of America: A Scoping Review. Front Psychol 2022; 12:791773. [PMID: 35222154 PMCID: PMC8863598 DOI: 10.3389/fpsyg.2021.791773] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
There is increasing interest today in how the arts contribute to individual and community wellbeing. This scoping review identified and examined ways in which the arts have been used to address wellbeing in communities in the United States. The review examined 44 publications, with combined study populations representing a total of 5,080 research participants, including marginalized populations. It identified the types of artistic practices and interventions being conducted, research methods, and outcomes measured. It highlights positive associations found across a broad spectrum of psychological, physical, and social outcomes, including improvements in self-esteem and identity formation, cognition, physical balance, and physical conditioning. It also reports negative outcomes of arts interventions that may be underreported. The study identifies the need for core outcomes sets and reporting guidelines for advancing evidence synthesis in this area.
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Affiliation(s)
- Virginia Pesata
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Aaron Colverson
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Jill Sonke
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Jane Morgan-Daniel
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States
| | - Kelley Sams
- University of Florida Center for Arts in Medicine Interdisciplinary Research Lab, University of Florida, Center of Arts in Medicine, Gainesville, FL, United States
| | - Flor Maria-Enid Carrion
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Sarah Hanson
- UF Department of Surgery, University of Florida, Gainesville, FL, United States
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Hui KY, Haines C, Bammann S, Hallandal M, Langone N, Williams C, McEvoy M. To what extent is telehealth reported to be incorporated into undergraduate and postgraduate allied health curricula: A scoping review. PLoS One 2021; 16:e0256425. [PMID: 34411171 PMCID: PMC8376028 DOI: 10.1371/journal.pone.0256425] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Telehealth has become a necessity within the medical and allied health professions since the COVID-19 Pandemic generated a rapid uptake worldwide. It is now evident that this health delivery format will remain in use well into the future. However, health education training, most particularly allied health, has been slow to 'catch up' and adapt curriculum to ensure graduates are equipped with the knowledge and skills to implement telehealth in the workplace. The aim of this study was to gain a comprehensive understanding of current telehealth curricula in undergraduate and postgraduate allied health education training programs, with a focus on the aims, objectives, content, format, delivery, timeline and assessments. METHODS A systematic search of Medline, Embase, PsychINFO, Scopus, ERIC and relevant grey literature was conducted. Students studying allied health degrees through formal education at either postgraduate or undergraduate level were included, while nursing, dentistry and medical students were excluded. The data from the included studies was extracted and tabulated by country, participants, program and content. RESULTS Of the 4484 studies screened, eleven met the eligibility criteria. All studies were published after 2012, highlighting the recency of research in this area. The studies were conducted in four countries (Australia, United Sates of America, United Kingdom, Norway) and participants were from various allied health professions. Of the included studies, four related to undergraduate programs, four to postgraduate programs and for the remaining three, this was not specified. Curricula were delivered through a combination of online and face-to-face delivery, with assessment tasks, where reported, comprising mainly multiple-choice and written tests. CONCLUSION Published reporting of telehealth curricula within allied health programs is limited. Even the minority of programs that do include a telehealth component lack a systematic approach. This indicates that further primary research would be beneficial in this area.
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Affiliation(s)
- Kay Yan Hui
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Claudia Haines
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Sophie Bammann
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Matthew Hallandal
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Nathan Langone
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Ciara Williams
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
| | - Maureen McEvoy
- Allied Health and Human Performance, Unit, University of South Australia, Adelaide, Australia
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Lewis GN, Bean DJ. What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:504-523. [PMID: 33883414 DOI: 10.1097/ajp.0000000000000941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge. MATERIALS AND METHODS Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings. RESULTS In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time. DISCUSSION Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/acceptance-based therapies.
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Affiliation(s)
- Gwyn N Lewis
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
| | - Debbie J Bean
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
- Chronic Pain Service, Department of Anaesthesiology & Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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Anandkumar S, Manivasagam M. Physical therapist guided active intervention of chronic temporomandibular disorder presenting as ear pain: A case report. Physiother Theory Pract 2021; 38:3146-3158. [PMID: 34152897 DOI: 10.1080/09593985.2021.1938307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This case report describes the successful physical therapy management of a 40-year-old female who presented with left ear pain referred from the temporomandibular joint. Diagnosis was primarily based on clinical examination findings and ruling out of red flags. Guidance was given on active self-care approaches consisting of pain neuroscience education designed with individualized pain curriculum, exercise therapy, manual therapy, and breathing exercises for a period of sixweeks. Clinically meaningful improvements were obtained in the outcome measures of Numeric Pain Rating Scale (NPRS), Patient-Specific Functional Scale (PSFS), and Global Rating of Change (GROC) scale and progress in Pain-Self Efficacy Questionnaire (PSEQ) and Tampa Scale for Kinesiophobia (TSK) scores. Positive changes were achieved with functional activities (chewing, eating, yawing, brushing teeth and physical intimacy), and the patient was pain-free on discharge, which was maintained at a six-month follow-up.
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Affiliation(s)
- Sudarshan Anandkumar
- Synergy Rehab Clayton Heights Physiotherapy and Sports Injury Clinic, Surrey, British Columbia, Canada
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Golden TL, Springs S, Kimmel HJ, Gupta S, Tiedemann A, Sandu CC, Magsamen S. The Use of Music in the Treatment and Management of Serious Mental Illness: A Global Scoping Review of the Literature. Front Psychol 2021; 12:649840. [PMID: 33868127 PMCID: PMC8044514 DOI: 10.3389/fpsyg.2021.649840] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.
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Affiliation(s)
| | - Stacey Springs
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, United States
| | - Hannah J. Kimmel
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Sonakshi Gupta
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, India
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13
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Abdelnaeem AO, Rehan Youssef A, Mahmoud NF, Fayaz NA, Vining R. Psychometric properties of chronic low back pain diagnostic classification systems: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:957-989. [PMID: 33471180 DOI: 10.1007/s00586-020-06712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/23/2020] [Accepted: 12/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify and critically appraise studies evaluating psychometric properties of functionally oriented diagnostic classification systems for Non-Specific Chronic Low Back Pain (NS-CLBP). METHODS This review employed methodology consistent with PRISMA guidelines. Electronic databases and journals: (PubMed, EMBASE, Cochrane, PEDro, CINAHL, Index to chiropractic literature, ProQuest, Physical Therapy, Journal of Physiotherapy, Canadian Physiotherapy and Physiotherapy Theory and Practice) were searched from inception until January 2020. Included studies evaluated the validity and reliability of NS-CLBP diagnostic classification systems in adults. Risk of bias was assessed using a Critical Appraisal Tool. RESULTS Twenty-two studies were eligible: Five investigated inter-rater reliability, and 17 studies analyzed validity of O'Sullivan's classification system (OCS, n = 15), motor control impairment (MCI) test battery (n = 1), and Pain Behavior Assessment (PBA, n = 1). Evidence from multiple low risk of bias studies demonstrates that OCS has moderate to excellent inter-rater reliability (kappa > 0.4). Also, two low risk of bias studies support of OCS-MCI subcategory. Three tests within the MCI test battery show acceptable inter- and intra-rater reliability for clinical use (the "sitting knee extension," the "one leg stance," and the "pelvic tilt" tests). Evidence for the reliability and validity of the PBA is limited to one high bias risk study. CONCLUSIONS Multiple low risk of bias studies demonstrate strong inter-rater reliability for OCS classification specifically OCS-MCI subcategory. Future studies with low risk of bias are needed to evaluate reliability and validity of the MCI test battery and the PBA.
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Affiliation(s)
| | - Aliaa Rehan Youssef
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | | | | | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
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Zeliadt SB, Coggeshall S, Thomas E, Gelman H, Taylor SL. The APPROACH trial: Assessing pain, patient-reported outcomes, and complementary and integrative health. Clin Trials 2020; 17:351-359. [PMID: 32522024 DOI: 10.1177/1740774520928399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Electronic health record data can be used in multiple ways to facilitate real-world pragmatic studies. Electronic health record data can provide detailed information about utilization of treatment options to help identify appropriate comparison groups, access historical clinical characteristics of participants, and facilitate measuring longitudinal outcomes for the treatments being studied. An additional novel use of electronic health record data is to assess and understand referral pathways and other business practices that encourage or discourage patients from using different types of care. We describe an ongoing study utilizing access to real-time electronic health record data about changing patterns of complementary and integrative health services to demonstrate how electronic health record data can provide the foundation for a pragmatic study when randomization is not feasible. Conducting explanatory trials of the value of emerging therapies within a healthcare system poses ethical and pragmatic challenges, such as withholding access to specific services that are becoming widely available to patients. We describe how prospective examination of real-time electronic health record data can be used to construct and understand business practices as potential surrogates for direct randomization through an instrumental variables analytic approach. In this context, an example of a business practice is the internal hiring of acupuncturists who also provide yoga or Tai Chi classes and can offer these classes without additional cost compared to community acupuncturists. Here, the business practice of hiring internal acupuncturists is likely to encourage much higher rates of combined complementary and integrative health use compared to community referrals. We highlight the tradeoff in efficiency of this pragmatic approach and describe use of simulations to estimate the potential sample sizes needed for a variety of instrument strengths. While real-time monitoring of business practices from electronic health records provides insights into the validity of key independence assumptions associated with the instrumental variable approaches, we note that there may be some residual confounding by indication or selection bias and describe how alternative sources of electronic health record data can be used to assess the robustness of instrumental variable assumptions to address these challenges. Finally, we also highlight that while some clinical outcomes can be obtained directly from the electronic health record, such as longitudinal opioid utilization and pain intensity levels for the study of the value of complementary and integrative health, it is often critical to supplement clinical electronic health record-based measures with patient-reported outcomes. The experience of this example in evaluating complementary and integrative health demonstrates the use of electronic health record data in several novel ways that may be of use for designing future pragmatic trials.
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Affiliation(s)
- Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Scott Coggeshall
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Eva Thomas
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Hannah Gelman
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Health Administration, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, CA, USA
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Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process. J Manipulative Physiol Ther 2019; 42:677-693. [PMID: 31864769 DOI: 10.1016/j.jmpt.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. METHODS A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. RESULTS Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. CONCLUSION This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.
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