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Chung Z, Mbuagbaw L, Mokete L, Bhandari M, Thabane L. Quality and completeness of, and spin in reporting of, pilot and feasibility studies in hip and knee arthroplasty: a protocol for a methodological survey. BMJ Open 2024; 14:e085441. [PMID: 39384225 DOI: 10.1136/bmjopen-2024-085441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2024] Open
Abstract
INTRODUCTION Pilot or feasibility trials examine the feasibility, viability and recruitment potential of larger, main trials. Specifically, a pilot trial can be instrumental in identifying methodological issues essential to the development of an effective research protocol. However, numerous studies published as pilot or feasibility studies have demonstrated notable inconsistencies in the nature of information reported, resulting in poor-quality and incomplete reporting. It is unclear whether such low quality or incompleteness of reporting is also prevalent in arthroplasty pilot trials. METHODS AND ANALYSIS This protocol outlines a methodological survey examining the completeness of reporting among hip and knee arthroplasty pilot trials in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 extension to pilot trials. Secondary objectives include: (1) determining the prevalence of 'spin' practices, defined as: (a) placing a focus on statistical significance rather than feasibility, (b) presenting results that show the trial to be non-feasible as feasible or (c) emphasising the effectiveness or potential intervention benefits rather than feasibility; (2) determining factors associated with incomplete reporting, and 'spin'. A search of PubMed will be conducted for pilot trials in hip or knee arthroplasty published between 01 January 2017 and 31 December 2023. Following screening, appropriate data will be extracted from eligible publications and reported as descriptive statistics, encompassing elements of the CONSORT checklist associated with completeness of reporting. Logistic regression analysis and Poisson regression will be used to analyse factors associated with completeness of reporting and spin. ETHICS AND DISSEMINATION This methodological review does not require formal ethical approval, as it will solely involve the use of published and publicly reported literature. The results of this study will be disseminated through submission to peer-reviewed journals and academic conference presentations. Study details will be sent to McMaster University's media coordinators to be shared through the institution's research-focused platforms.
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Affiliation(s)
- Zinnia Chung
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lipalo Mokete
- Division of Orthopaedic Surgery, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Research Institute, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Lawrence M, Davis B, Clark NE, Booth J, Donald G, Dougall N, Grealy M, Jani B, MacDonald J, Mason H, Maxwell M, Parkinson B, Pieri M, Wang X, Mercer S. In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression. Pilot Feasibility Stud 2024; 10:119. [PMID: 39267177 PMCID: PMC11391595 DOI: 10.1186/s40814-024-01545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 08/30/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. METHODS We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could 'enrol' a family member/ 'other' to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. RESULTS Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.
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Affiliation(s)
- Maggie Lawrence
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK.
| | - Bridget Davis
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | - Naomi E Clark
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | - Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | - Graeme Donald
- School of Health and Society, University of Salford, Salford, M6 6PU, UK
| | - Nadine Dougall
- Health and Social Care Sciences, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Madeleine Grealy
- Psychological Services and Health, University of Strathclyde, Glasgow, G1 1XQ, UK
| | - Bhautesh Jani
- General Practice and Primary Care, School of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, G12 9LJ, UK
| | - Jennifer MacDonald
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | | | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Ben Parkinson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | - Matilde Pieri
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow, Scotland, G4 0BA, UK
| | - Xu Wang
- School of Humanities and Social Sciences, Leeds Beckett University, PD405 Portland Building, City Campus, Leeds, LS1 3HE, UK
| | - Stewart Mercer
- Primary Care and Multimorbidity, Usher Institute, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
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Sremanakova J, Sowerbutts AM, Todd C, Cooke R, Pearce L, Leiberman D, McLaughlin J, Hill J, Ashby H, Ramesh A, Burden S. Healthy Eating and Active Lifestyle after Bowel Cancer (HEAL ABC)-feasibility randomised controlled trial. Eur J Clin Nutr 2024:10.1038/s41430-024-01491-z. [PMID: 39191956 DOI: 10.1038/s41430-024-01491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Evidence from cohort studies indicates that a healthy lifestyle can improve cancer survival but evidence from randomised controlled trials (RCT) is lacking. Thus, this study tested the feasibility of conducting a lifestyle intervention in patients after colorectal cancer (CRC) treatment. METHODS An intervention was developed based on World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) recommendations, the Health Action Process Approach, Motivational Interviewing and tested a feasibility, mixed-methods RCT. Participants were allocated to a three-month telephone-based intervention versus standard care control group. The follow up period was six months. Data on feasibility and secondary outcomes were collected and analysed using Stata (V15, StataCorp LLC) and NVivo 12 (QSR International Pty Ltd., Doncaster, VIC). RESULTS Recruitment was challenging (31 ineligible, 37 declined; recruitment rate = 48.6%.). In total, 34/35 participants completed the intervention, and 31 (89%) completed follow up; all 31 completers participated in six telephone calls during intervention and six months follow up. Study retention was 97% (34/35) and 89% (31/35) at three and six months, respectively. Data completion rates were high (>90%). Intervention was acceptable to participants, met their needs and kept them accountable towards their goals. Participants in the intervention group showed significant improvement in WCRF/AICR, Diet Quality Index-International score and a 10% reduction in ultra-processed food consumption. CONCLUSIONS The HEAL ABC intervention was feasible for 87% of intervention participants, supporting them in healthy lifestyle changes. However, alternative recruitment strategies are needed for a fully powered RCT to determine the effectiveness of the intervention.
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Affiliation(s)
- Jana Sremanakova
- School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Anne Marie Sowerbutts
- School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester, Manchester, M13 9NQ, UK
- Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Richard Cooke
- Department of Psychology, School of Health, Education, Policing and Sciences, Staffordshire University, Stoke-on-Trent, ST4 2DE, UK
| | - Lyndsay Pearce
- Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
- School of Medical Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | | | - John McLaughlin
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
- School of Medical Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jim Hill
- Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Helen Ashby
- Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Aswatha Ramesh
- Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NIHR Applied Research Collaboration Greater Manchester, Manchester, M13 9NQ, UK
- Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
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Sandreva T, Larsen MN, Rasmussen MK, Nielsen TL, von Sydow C, Schmidt TA, Fischer TK. Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study. J Telemed Telecare 2024:1357633X241254572. [PMID: 38780386 DOI: 10.1177/1357633x241254572] [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: 05/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. METHODS A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. RESULTS Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. CONCLUSIONS The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.
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Affiliation(s)
- Tatjana Sandreva
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maria Normand Larsen
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Infectious and Pulmonary Disease, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Charlotte von Sydow
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
| | - Thomas Andersen Schmidt
- Department of Emergency Medicine, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea K Fischer
- Department of Clinical Research, Nordsjaelland Hospital, Hillerød, Capital Region, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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French C, Burden S, Stanmore E. Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e50922. [PMID: 38687981 PMCID: PMC11094602 DOI: 10.2196/50922] [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: 07/17/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. OBJECTIVE This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). METHODS This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). RESULTS Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants' self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. CONCLUSIONS The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. TRIAL REGISTRATION ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50922.
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Affiliation(s)
- Chloe French
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Emma Stanmore
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Fairhurst K, Potter S, Blazeby JM, Avery KNL. Recommendations for optimising pilot and feasibility work in surgery. Pilot Feasibility Stud 2024; 10:64. [PMID: 38637818 PMCID: PMC11025276 DOI: 10.1186/s40814-024-01489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Surgical trials are recognised as inherently challenging. Pilot and feasibility studies (PAFS) are increasingly acknowledged as a key method to optimise the design and conduct of randomised trials but remain limited in surgery. We used a mixed methods approach to develop recommendations for how surgical PAFS could be optimised. METHODS The findings from a quantitative analysis of funded surgical PAFS over a 10-year period and in-depth qualitative interviews with surgeons, methodologists and funders were triangulated and synthesised with available methodological guidance on PAFS. RESULTS The synthesis informed the development of an explanatory model describing root causes and compounding challenges that contribute to how and why surgical PAFS is not currently optimised. The four root causes identified include issues relating to (i) understanding the full scope of PAFS; (ii) design and conduct of PAFS; (iii) reporting of PAFS; and (iv) lack of appreciation of the value of PAFS by all stakeholder groups. Compounding challenges relate to both cultural issues and access to and interpretation of available methodological PAFS guidance. The study findings and explanatory model were used to inform the development of a practical guidance tool for surgeons and study teams to improve research practice. CONCLUSIONS Optimisation of PAFS in surgery requires a cultural shift in research practice amongst funders, academic institutions, regulatory bodies and journal editors, as well as amongst surgeons. Our 'Top Tips' guidance tool offers an accessible framework for surgeons designing PAFS. Adoption and utilisation of these recommendations will optimise surgical PAFS, facilitating successful and efficient future surgical trials.
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Affiliation(s)
- K Fairhurst
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK.
| | - S Potter
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - J M Blazeby
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - K N L Avery
- Centre for Surgical Research, Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Biomedical Research Centre, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
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Swales B, Ryde GC, Whittaker AC. A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II. J Aging Phys Act 2024; 32:244-263. [PMID: 38262397 DOI: 10.1123/japa.2022-0170] [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: 05/11/2022] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 01/25/2024]
Abstract
Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.
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Affiliation(s)
- Bridgitte Swales
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Gemma C Ryde
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, Crowe L, McColl E. The Gestational Obesity Weight Management: Implementation of National Guidelines (GLOWING) study: a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2024; 10:47. [PMID: 38429853 PMCID: PMC10905942 DOI: 10.1186/s40814-024-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives' implementation of weight management guidelines into routine practice. This paper reports the pilot trial outcomes relating to feasibility and acceptability of intervention delivery and trial procedures. METHODS GLOWING was a multi-centre parallel-group pilot cluster RCT comparing the delivery of a behaviour change intervention for midwives (delivered as training workshops) with usual practice. The clusters were four NHS Trusts in Northeast England, randomised to intervention or control arms. Blinding of allocation was not possible due to the nature of the intervention. We aimed to deliver the intervention to all eligible midwives in the intervention arm, in groups of 6 midwives per workshop, and to pilot questionnaire data collection for a future definitive trial. Intervention arm midwives' acceptability of GLOWING content and delivery was assessed using a mixed methods questionnaire, and pregnant women's acceptability of trial procedures by interviews. Quantitative data were analysed descriptively and qualitative data thematically. RESULTS In intervention arm Trusts, 100% of eligible midwives (n = 67) were recruited to, and received, the intervention; however, not all workshops had the planned number of attendees (range 3-8). The consent rate amongst midwives randomised (n = 100) to complete questionnaires was 74% (n = 74) (95% CI 65%, 83%), and overall completion rate 89% (n = 66) (95% CI 82%, 96%). Follow-up response rate was 66% (n = 49) (95% CI 55%, 77%), with a marked difference between intervention (39%, n = 15) and control (94%, n = 34) groups potentially due to the volume of research activities. Overall, 64% (n = 47) (95% CI 53%, 75%) completed both baseline and follow-up questionnaires. Midwives viewed the intervention as acceptable and directly relevant to routine practice. The least popular components related to scripted role-plays. Pregnant women viewed the recruitment and trial processes to be acceptable. CONCLUSIONS This rigorously conducted pilot study demonstrated feasibility intervention delivery and a high level of acceptability amongst participants. It has provided information required to refine the intervention and trial protocol, enhancing confidence that a definitive trial could be carried out. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016, www.isrctn.com/ISRCTN46869894 .
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
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Richmond JP, Kelly MG, Johnston A, Murphy PJ, O'Connor L, Gillespie P, Hobbins A, Alvarez-Iglesias A, Murphy AW. A community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anticancer medication: a pilot study. Pilot Feasibility Stud 2024; 10:46. [PMID: 38424625 PMCID: PMC10902979 DOI: 10.1186/s40814-024-01461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Oral anti-cancer medications (OAMs) are being used increasingly within cancer care. OAMs offer the potential to improve patient convenience and increase hospital capacity. The clinical assessment for each cycle of OAMs requires specialist patient review often performed in hospital-based oncology units. Consequently, any potential improvement in patient expediency or increased hospital capacity that OAMs can offer is not realised. This study aimed to develop and pilot the specialist assessment of patients receiving OAMs by an Advanced Nurse Practitioner (ANP) in a community-based location.The primary aim of this pilot study was to assess the feasibility of a community-based ANP-led integrated oncology care model for adults receiving OAMs in Ireland who met the pre-specified eligibility criteria. The objectives were to determine the feasibility of a definitive trial of this intervention by measuring patient safety, acceptability to patients and staff and cost of the new model of care.This single-centre pilot study provided patient care (n = 37) to those receiving OAM therapies within a community setting for a 4-month period. Consent rate was high with no attrition other than for clinical reasons. There were 151 contacts with the sample during that time.Results demonstrated that the ANP-led intervention and new model for OAM care was safe, highly acceptable to patients and staff and that related healthcare costs could be captured. Based on the success of this pilot study, the authors conclude that a community-based ANP-led integrated oncology care model for adults receiving OAMs is feasible, and a definitive trial is warranted.Trial registration ISRCTN, ISRCTN10401455 . Registered 30 November 2020.
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Affiliation(s)
| | | | | | - Patrick J Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Laura O'Connor
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Paddy Gillespie
- Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland
| | - Anna Hobbins
- Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland
| | | | - Andrew W Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
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Gill JK, Pucci M, Samudio A, Ahmed T, Siddiqui R, Edwards N, Marticorena RM, Donnelly S, Lok C, Wentlandt K, Wolofsky K, Mucsi I. Self-reported MeasUrement of Physical and PsychosOcial Symptoms Response Tool (SUPPORT-dialysis): systematic symptom assessment and management in patients on in-centre haemodialysis - a parallel arm, non-randomised feasibility pilot study protocol. BMJ Open 2024; 14:e080712. [PMID: 38296283 PMCID: PMC10828879 DOI: 10.1136/bmjopen-2023-080712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Patients with kidney failure experience symptoms that are often under-recognised and undermanaged. These symptoms negatively impact health-related quality of life and are associated with adverse clinical outcomes. Regular symptom assessment, using electronic patient reported outcomes measure (ePROMs) linked to systematic symptom management, could improve such outcomes. Clinical implementation of ePROMs have been successful in routine oncology care, but not used for patients on dialysis. In this study, we describe a pilot study of ePROM-based systematic symptom monitoring and management intervention in patients treated with in-centre haemodialysis. METHODS AND ANALYSIS This is a parallel-arm, controlled pilot of adult patients receiving in-centre maintenance haemodialysis. Participants in the intervention arm will complete ePROMs once a month for 6 months. ePROMs will be scored real time and the results will be shared with participants and with the clinical team. Moderate-severe symptoms will be flagged using established cut-off scores. Referral options for those symptoms will be shared with the clinical team, and additional symptom management resources will also be provided for both participants and clinicians. Participants in the control arm will be recruited at a different dialysis unit, to prevent contamination. They will receive usual care, except that they will complete ePROMs without the presentation of results to participants of the clinical team. The primary objectives of the pilot are to assess (1) the feasibility of a larger, randomised clinical effectiveness trial and (2) the acceptability of the intervention. Interviews conducted with participants and staff will be assessed using a content analysis approach. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the University Health Network (REB#21-5199) and the William Osler Health System (#23-0005). All study procedures will be conducted in accordance with the standards of University Health Network research ethics board and with the 1964 Helsinki declaration and its later amendments. Results of this study will be shared with participants, patients on dialysis and other stakeholders using lay language summaries, oral presentations to patients and nephrology professionals. We will also be publishing the results in a peer-reviewed journal and at scientific meetings. PROTOCOL VERSION 4 (16 November 2022). TRIAL REGISTRATION NUMBER NCT05515991.
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Affiliation(s)
- Jasleen Kaur Gill
- Institute of Medical Science, University of Toronto-St George Campus, Toronto, Ontario, Canada
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Maria Pucci
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Ana Samudio
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Tibyan Ahmed
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | | | | | - Rosa M Marticorena
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Sandra Donnelly
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Charmaine Lok
- Division of Nephrology, UHN, Toronto, Ontario, Canada
| | | | - Kayla Wolofsky
- Department of Supportive Care, UHN, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Medicine, Multiorgan Transplant Program, University of Toronto, Toronto, Ontario, Canada
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11
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Cousins S, Gormley A, Chalmers K, Campbell MK, Beard DJ, Blencowe NS, Blazeby JM. How do pilot and feasibility studies inform randomised placebo-controlled trials in surgery? A systematic review. BMJ Open 2023; 13:e071094. [PMID: 37989384 PMCID: PMC10660967 DOI: 10.1136/bmjopen-2022-071094] [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] [Received: 12/16/2022] [Accepted: 09/28/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs) with a placebo comparator are considered the gold standard study design when evaluating healthcare interventions. These are challenging to design and deliver in surgery. Guidance recommends pilot and feasibility work to optimise main trial design and conduct; however, the extent to which this occurs in surgery is unknown. METHOD A systematic review identified randomised placebo-controlled surgical trials. Articles published from database inception to 31 December 2020 were retrieved from Ovid-MEDLINE, Ovid-EMBASE and CENTRAL electronic databases, hand-searching and expert knowledge. Pilot/feasibility work conducted prior to the RCTs was then identified from examining citations and reference lists. Where studies explicitly stated their intent to inform the design and/or conduct of the future main placebo-controlled surgical trial, they were included. Publication type, clinical area, treatment intervention, number of centres, sample size, comparators, aims and text about the invasive placebo intervention were extracted. RESULTS From 131 placebo surgical RCTs included in the systematic review, 47 potentially eligible pilot/feasibility studies were identified. Of these, four were included as true pilot/feasibility work. Three were original articles, one a conference abstract; three were conducted in orthopaedic surgery and one in oral and maxillofacial surgery. All four included pilot RCTs, with an invasive surgical placebo intervention, randomising 9-49 participants in 1 or 2 centres. They explored the acceptability of recruitment and the invasive placebo intervention to patients and trial personnel, and whether blinding was possible. One study examined the characteristics of the proposed invasive placebo intervention using in-depth interviews. CONCLUSION Published studies reporting feasibility/pilot work undertaken to inform main placebo surgical trials are scarce. In view of the difficulties of undertaking placebo surgical trials, it is recommended that pilot/feasibility studies are conducted, and more are reported to share key findings and optimise the design of main RCTs. PROSPERO REGISTRATION NUMBER CRD42021287371.
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Affiliation(s)
- Sian Cousins
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Katy Chalmers
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marion K Campbell
- Royal College of Surgeons of England, Aberdeen Surgical Trials Centre; Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; RCSEng Surgical Intervention Trials Unit; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Natalie S Blencowe
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Surgical Innovation theme, Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre; Royal College of Surgeons of England (RCSEng) Bristol Surgical Trials Centre, Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Lygre RB, Gjestad R, Norekvål TM, Mercer SW, Elgen IB. An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study. BMC Health Serv Res 2023; 23:1241. [PMID: 37951903 PMCID: PMC10638682 DOI: 10.1186/s12913-023-10250-y] [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: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents. METHODS In all, 47 children and adolescents aged 6-16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent's condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences. RESULTS Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18-30 (47-77%) rated relational empathy in the intervention as "Very good" or "Excellent". Of the parents, 35-39 (92-100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001). CONCLUSIONS The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.
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Affiliation(s)
- Ragnhild B Lygre
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-Reported Outcomes, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Irene Bircow Elgen
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway
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13
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Wang X, Cai S, Tang S, Yang L, Tan J, Sun X, Gong F. Effect of lifestyle or metformin interventions before IVF/ICSI treatment on infertile women with overweight/obese and insulin resistance: a factorial design randomised controlled pilot trial. Pilot Feasibility Stud 2023; 9:160. [PMID: 37700375 PMCID: PMC10496164 DOI: 10.1186/s40814-023-01388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND For infertile women with overweight/obesity and insulin resistance (IR), it is uncertain whether intervention before infertility treatment can improve live birth rate (LBR). We implemented a factorial-design study to explore the effectiveness of lifestyle and metformin interventions. This pilot study aimed to evaluate the feasibility of a definitive study. METHODS We randomised 80 women without polycystic ovarian syndrome (PCOS) who planned to start their first or second IVF/ICSI treatment with a body mass index ≥ 25 kg/m2 and IR. Participants were randomised (1:1:1:1) into four groups: (A) lifestyle intervention, (B) metformin intervention, (C) lifestyle + metformin intervention, or (D) no intervention. All interventions were performed before IVF/ICSI treatment. RESULTS During 10 months, 114 women were screened and eligible; 80 were randomised, and 72 received the assigned treatment. The recruitment rate was 70.18% (80/114, 95% CI 61.65%-78.70%). An average of 10 participants were randomised each month. None of the participants crossed over from one group to another. Approximately 93.15% (68/73) of the participants achieved good intervention compliance. Only 77.78% (56/72) of the recruited participants started infertility treatment after achieving the goal of the intervention. All randomised participants completed the follow-up. Mild adverse events after metformin administration were reported in 43.24% (16/37) of the cases, although no serious adverse events related to the interventions occurred. The LBR for groups A + C and B + D were 33.33% (12/36) and 33.33% (12/36) (RR = 1.00, 95%CI:0.52-1.92) (lifestyle intervention effect). The LBR for groups B + C and A + D were 43.24% (16/37) and 22.86% (8/35) (RR = 1.89, 95% CI:0.93-3.86) (metformin intervention effect). There was no evidence for an intervention interaction between lifestyle and metformin. We cannot yet confirm the effects of lifestyle, metformin, or their interaction owing to the insufficient sample size in this pilot study. CONCLUSIONS Instituting a 2 × 2 factorial design randomized controlled trial (RCT) is feasible, as the pilot study showed a high recruitment rate and compliance. There is no evidence that lifestyle or metformin improves live birth, and adequately powered clinical trials are required. TRIAL REGISTRATION clinicaltrials.gov NCT03898037. Registered: April 1, 2019.
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Affiliation(s)
- Xiaojuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, 410008 Hunan China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, 410008 Hunan China
| | - Sufen Cai
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, 410008 Hunan China
| | - Sha Tang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, 410008 Hunan China
| | - Lanlin Yang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, 410008 Hunan China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, 410008 Hunan China
- Laboratory of Reproductive and Stem Cell Engineering, Key Laboratory of National Health and Family Planning Commission, Central South University, Changsha, 410008 Hunan China
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Pfledderer CD, von Klinggraeff L, Burkart S, Wolfenden L, Ioannidis JPA, Beets MW. Feasibility indicators in obesity-related behavioral intervention preliminary studies: a historical scoping review. Pilot Feasibility Stud 2023; 9:46. [PMID: 36949541 PMCID: PMC10032007 DOI: 10.1186/s40814-023-01270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Behavioral interventions are often complex, operate at multiple levels, across settings, and employ a range of behavior change techniques. Collecting and reporting key indicators of initial trial and intervention feasibility is essential to decisions for progressing to larger-scale trials. The extent of reporting on feasibility indicators and how this may have changed over time is unknown. The aims of this study were to (1) conduct a historical scoping review of the reporting of feasibility indicators in behavioral pilot/feasibility studies related to obesity published through 2020, and (2) describe trends in the amount and type of feasibility indicators reported in studies published across three time periods: 1982-2006, 2011-2013, and 2018-2020. METHODS A search of online databases (PubMed, Embase, EBSCOhost, Web of Science) for health behavior pilot/feasibility studies related to obesity published up to 12/31/2020 was conducted and a random sample of 600 studies, 200 from each of the three timepoints (1982-2006, 2011-2013, and 2018-2020), was included in this review. The presence/absence of feasibility indicators, including recruitment, retention, participant acceptability, attendance, compliance, and fidelity, were identified/coded for each study. Univariate logistic regression models were employed to assess changes in the reporting of feasibility indicators across time. RESULTS A total of 16,365 unique articles were identified of which 6873 of these were reviewed to arrive at the final sample of 600 studies. For the total sample, 428 (71.3%) studies provided recruitment information, 595 (99.2%) provided retention information, 219 (36.5%) reported quantitative acceptability outcomes, 157 (26.2%) reported qualitative acceptability outcomes, 199 (33.2%) reported attendance, 187 (31.2%) reported participant compliance, 23 (3.8%) reported cost information, and 85 (14.2%) reported treatment fidelity outcomes. When compared to the Early Group (1982-2006), studies in the Late Group (2018-2020) were more likely to report recruitment information (OR=1.60, 95%CI 1.03-2.49), acceptability-related quantitative (OR=2.68, 95%CI 1.76-4.08) and qualitative (OR=2.32, 95%CI 1.48-3.65) outcomes, compliance outcomes (OR=2.29, 95%CI 1.49-3.52), and fidelity outcomes (OR=2.13, 95%CI 1.21, 3.77). CONCLUSION The reporting of feasibility indicators within behavioral pilot/feasibility studies has improved across time, but key aspects of feasibility, such as fidelity, are still not reported in the majority of studies. Given the importance of behavioral intervention pilot/feasibility studies in the translational science spectrum, there is a need for improving the reporting of feasibility indicators.
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Affiliation(s)
- Christopher D Pfledderer
- Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29205, USA.
| | - Lauren von Klinggraeff
- Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29205, USA
| | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29205, USA
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, 2318, Australia
- Australia and Hunter New England Population Health, Locked Bag 10, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Michael W Beets
- Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29205, USA
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Melia R, Francis K, Duggan J, Bogue J, O'Sullivan M, Young K, Chambers D, McInerney SJ, O'Dea E, Bernert R. Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44205. [PMID: 36809171 PMCID: PMC9993232 DOI: 10.2196/44205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. OBJECTIVE The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. METHODS A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. RESULTS As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. CONCLUSIONS The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. TRIAL REGISTRATION OSF Registries osf.io/3y54m; https://osf.io/3y54m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44205.
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Affiliation(s)
- Ruth Melia
- Department of Psychology, University of Limerick, Limerick, Ireland.,School of Psychology, University of Galway, Galway, Ireland.,Health Service Executive Community Healthcare Mid West, Limerick, Ireland
| | - Kady Francis
- School of Psychology, University of Galway, Galway, Ireland.,Health Service Executive Community Healthcare West, Galway, Ireland
| | - Jim Duggan
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - John Bogue
- School of Psychology, University of Galway, Galway, Ireland
| | - Mary O'Sullivan
- Health Service Executive Community Healthcare West, Galway, Ireland
| | - Karen Young
- College of Engineering and Informatics, University of Galway, Galway, Ireland
| | | | - Shane J McInerney
- Health Service Executive Community Healthcare West, Galway, Ireland.,Department of Psychiatry, University of Galway, Galway, Ireland
| | - Edmond O'Dea
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Rebecca Bernert
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, United States
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Shrestha S, Blebil AQ, Teoh SL, Sapkota S, KC B, Paudyal V, Gan SH. Clinical pharmacists' intervention on pain management in cancer patients (PharmaCAP trial): study protocol for a randomized controlled trial. J Pharm Policy Pract 2023; 16:14. [PMID: 36694232 PMCID: PMC9875431 DOI: 10.1186/s40545-022-00505-0] [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: 04/22/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Evidence-based services to support cancer patients with pain via clinical pharmacy services are currently lacking. Therefore, there is a need to undertake a randomized controlled trial (RCT) to explore the effectiveness of clinical pharmacists (CPs)' input into the multidisciplinary team (MDT) in providing better therapeutic outcomes for cancer pain management. OBJECTIVES The main aim of this pilot RCT is to determine the feasibility and preliminary efficacy of integrating CPs into the MDT for cancer pain management on the clinical outcomes of cancer patients experiencing pain. METHODS This study protocol outlines two-armed multicenter pilot RCT. Cancer patients suffering from pain will be randomly allocated to receive either clinical pharmacy services, i.e., PharmaCAP trial intervention from the CP, or the usual standard care (i.e., control group). Patients will be recruited consecutively from two hospitals in Kathmandu valley, Nepal. The outcomes will be assessed at baseline (pre-intervention) and 4 weeks post-intervention. The primary feasibility outcomes will include eligibility rate, recruitment rate, willingness to participate, acceptability of screening procedures and random allocation, possible contamination between the groups, intervention fidelity and compliance, treatment satisfaction, and patient understanding of the provided interventions. Subsequently, the primary clinical outcome, i.e., pain intensity of cancer patients, will be assessed. The secondary clinical outcomes will include health-related quality of life (HRQoL), anxiety, depression, adverse drug reactions, and patient medication compliance following the integration of CP into the healthcare team. DISCUSSION The feasibility and potential for integrating CP involvement in MDT to improve clinical outcomes of cancer patients with pain will be evaluated through the PharmaCAP trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.
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Affiliation(s)
- Sunil Shrestha
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Ali Qais Blebil
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Siew Li Teoh
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal ,grid.459414.90000 0004 7535 1294Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
| | - Bhuvan KC
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia ,grid.1002.30000 0004 1936 7857Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Parkville Campus Parkville, Melbourne, VIC 3052 Australia
| | - Vibhu Paudyal
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, B15 2TT UK
| | - Siew Hua Gan
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
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Occupational therapist-guided cognitive interventions in critically ill patients: a feasibility randomized controlled trial. Can J Anaesth 2023; 70:139-150. [PMID: 36385466 PMCID: PMC9668395 DOI: 10.1007/s12630-022-02351-9] [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: 11/02/2021] [Revised: 06/25/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Intensive care unit (ICU) delirium is a common complication of critical illness requiring a multimodal approach to management. We assessed the feasibility of a novel occupational therapist (OT)-guided cognitive intervention protocol, titrated according to sedation level, in critically ill patients. METHODS Patients aged ≥ 18 yr admitted to a medical/surgical ICU were randomized to the standard delirium prevention protocol or to the OT-guided cognitive intervention protocol in addition to standard of care. The target enrolment number was N = 112. Due to the COVID-19 pandemic, the study enrolment period was truncated. The primary outcome was feasibility of the intervention as measured by the proportion of eligible cognitive interventions delivered by the OT. Secondary outcomes included feasibility of goal session length (20 min), participant clinical outcomes (delirium prevalence and duration, cognitive status, functional status, quality of life, and ICU length of stay), and a description of methodological challenges and solutions for future research. RESULTS Seventy patients were enrolled and 69 patients were included in the final analysis. The majority of OT-guided sessions (110/137; 80%) were completed. The mean (standard deviation [SD]) number of sessions per patient was 4.1 (3.8). The goal session length was achieved (mean [SD], 19.8 [3.1] min), with few sessions (8/110; 7%) terminated early per patient request. CONCLUSION This novel OT-guided cognitive intervention protocol is feasible in medical/surgical ICU patients. A larger randomized controlled trial is required to determine the impact of such a protocol on delirium prevalence or duration. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT03604809); registered 18 June 2018.
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Kearns Murphy C, Kemps L, McDonough C, McDonough S. Operation recovery: a feasibility study of an 8 week exercise and lifestyle programme within an Irish first episode psychosis service. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-03-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose
Early interventions focusing on exercise and lifestyle are important for individuals with a diagnosis of psychosis due to increased risk of poor physical health and reduced life expectancy. This study aims to test the feasibility of a multicomponent lifestyle intervention for individuals with first episode psychosis (FEP).
Design/methodology/approach
Individuals attending an Irish FEP service were invited to engage in an eight-week programme including individual and group exercise sessions, group educational sessions and one dietician consultation. Physical activity, physical health, mental health, cognition and personal goals measures were completed pre- and post-intervention and analysed using descriptive statistics. Feasibility data was collected via a non-standardised participant questionnaire and informal data on completion of measures and engagement with the programme.
Findings
Ten participants with a diagnosis of FEP completed the intervention. Participants were satisfied with the intervention and adherence rates were high for weekly individual gym sessions but lower for group exercise and education sessions. Mean time spent engaging in physical activity increased and sedentary behaviours decreased. Participants indicated increased readiness for change with 90% moving to the action or maintenance stages of change. Participants attained 74% of their personal goals. There were no changes in average body mass index, cognition or mental health. Data relating to blood pressure, blood tests and steps was missing or incomplete.
Originality/value
This study indicates an eight-week exercise and lifestyle programme is feasible and acceptable in a clinical setting. Recommendations relating to satisfaction, clinical markers and resource requirements are made for future studies.
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Chen WT, Huang YY, Chen WW, Liu YP, Shih CL, Shiao YC, Wang CC. Fostering guardians for frontline medical disputes: a government-led medical dispute mediator training program in Taiwan. BMC Health Serv Res 2022; 22:1478. [PMID: 36471357 PMCID: PMC9720959 DOI: 10.1186/s12913-022-08909-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mediation is increasingly used for medical dispute resolution, and the particularity of such mediation necessitates specialized training. In response to the promotion of compulsory mediation ahead of a legislation in Taiwan, we invited experts with an interdisciplinary team to design a case-based mediator training workshop. Our study aimed to investigate the learning outcomes of trainees and analyze their perspectives. METHODS We recruited 129 trainees of a non-probability convenience sample who served as mediators or have dealt with medical dispute-related cases to undergo 2.5 h of lectures (introduction; procedure; roles of two mediators; principles and techniques of mediation; dispute arrangement; and issue analysis) and 1.5 h of case-based exercises. An after-class survey was conducted using a 4-point Likert-type scale to evaluate trainees' viewpoints and learning outcomes. A total of 104 questionnaires were collected (response rate: 80.6%). RESULTS The professions of the participants were medical (56%), law (16%), and administration and others (28%). Males considered the course more helpful (3.79 vs. 3.63, p = 0.053) and more important (3.88 vs. 3.74, p = 0.042) than did females. Participants with a legal background scored the highest in helpfulness (3.84), followed by medical (3.74) and administrative (3.63) professionals. Medical and administrative professionals scored the highest (3.85) and lowest (3.76), respectively, on importance. Respondents with more than 10 years (3.81) and less than 1 year (3.79) of experience produced higher scores in helpfulness. Respondents with 1-5 years of experience (3.68) were found to be less likely to agree with the practical importance of course content compared with other groups of trainees. Administrative professionals obtained the highest scores (89.68) in written examinations. CONCLUSIONS There are variations in mediators' perspectives based on gender, occupation, and work experience. Our nationwide mediation training workshop can be utilized to cultivate capabilities of mediators for handling medical disputes to achieve the goal of non-litigation in medical disputes.
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Affiliation(s)
- Wan-Ting Chen
- grid.260565.20000 0004 0634 0356Department of Psychiatry, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114 Taiwan
| | - Yu-Ying Huang
- Taiwan Drug Relief Foundation, 10F., No. 22, Aiguo E. Rd., Zhongzheng Dist., Taipei City, 100 Taiwan
| | - Wen-Wen Chen
- Taiwan Drug Relief Foundation, 10F., No. 22, Aiguo E. Rd., Zhongzheng Dist., Taipei City, 100 Taiwan
| | - Yueh-Ping Liu
- grid.454740.6Department of Medical Affairs, Ministry of Health and Welfare, No. 488, Section 6, Zhongxiao E Rd, Nangang District, Taipei City, 115 Taiwan
| | - Chung-Liang Shih
- grid.454740.6Ministry of Health and Welfare, No. 488, Section 6, Zhongxiao E Rd, Nangang District, Taipei City, 115 Taiwan
| | - Yi-Chih Shiao
- grid.260565.20000 0004 0634 0356Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114 Taiwan ,grid.412042.10000 0001 2106 6277College of Law, National Chengchi University, No.64, Sec.2, ZhiNan Rd., Wenshan District, Taipei City, 116 Taiwan
| | - Chih-Chia Wang
- grid.260565.20000 0004 0634 0356Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114 Taiwan
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Cruwys T, Haslam C, Haslam SA, Rathbone JA, Donaldson JL. Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health. Behav Ther 2022; 53:1233-1249. [PMID: 36229119 DOI: 10.1016/j.beth.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/02/2022]
Abstract
Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program's wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings >7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was >5/7. Retention was >80%. Homework completion was high, with <10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.
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21
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Kirwan C, Hynes L, Hart N, Mulligan S, Leathem C, McQuillan L, Maxwell M, Carr E, Roche K, Walkin S, McCarthy C, Bradley C, Byrne M, Smith SM, Hughes C, Corry M, Kearney PM, McCarthy G, Cupples M, Gillespie P, Hobbins A, Newell J, Glynn L, Roshan D, Sinnott C, Murphy AW. The multimorbidity collaborative medication review and decision making (MyComrade) study: a pilot cluster randomised trial in two healthcare systems. Pilot Feasibility Stud 2022; 8:225. [PMID: 36195963 PMCID: PMC9531225 DOI: 10.1186/s40814-022-01107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 07/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication Review And Decision Making) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. AIM The pilot study aimed to assess the feasibility of a definitive trial of the MyComrade intervention across two healthcare systems (Republic of Ireland (ROI) and Northern Ireland (NI)). DESIGN A pilot cluster-randomised controlled trial was conducted (clustered at general practice level), using specific progression criteria and a process evaluation framework. SETTING General practices in the ROI and NI. PARTICIPANTS Eligible practices were those in defined geographical areas who had GP's and Practice Based Pharmacists (PBP's) (in NI) willing to conduct medication reviews. Eligible patients were those aged 18 years and over, with multi morbidity and on ten or more medications. INTERVENTION The MyComrade intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care, using a planned collaborative approach guided by an agreed checklist, within a specified timeframe. OUTCOME MEASURES Feasibility outcomes, using pre-determined progression criteria, assessed practice and patient recruitment and retention and intervention acceptability and fidelity. Anonymised patient-related quantitative data, from practice medical records and patient questionnaires were collected at baseline, 4 and 8 months, to inform potential outcome measures for a definitive trial. These included (i) practice outcomes-completion of medication reviews; (ii) patient outcomes-treatment burden and quality of life; (iii) prescribing outcomes-number and changes of prescribed medications and incidents of potentially inappropriate prescribing; and (iv) economic cost analysis. The framework Decision-making after Pilot and feasibility Trials (ADePT) in conjunction with a priori progression criteria and process evaluation was used to guide the collection and analysis of quantitative and qualitative data. RESULTS The recruitment of practices (n = 15) and patients (n = 121, mean age 73 years and 51% female), representing 94% and 38% of a priori targets respectively, was more complex and took longer than anticipated; impacted by the global COVID-19 pandemic. Retention rates of 100% of practices and 85% of patients were achieved. Both practice staff and patients found the intervention acceptable and reported strong fidelity to the My Comrade intervention components. Some practice staff highlighted concerns such as poor communication of the reviews to patients, dissatisfaction regarding incentivisation and in ROI the sustainability of two GPs collaboratively conducting the medication reviews. Assessing outcomes from the collected data was found feasible and appropriate for a definitive trial. Two progression criteria met the 'Go' criterion (practice and patient retention), two met the 'Amend' criterion (practice recruitment and intervention implementation) and one indicated a 'Stop - unless changes possible' (patient recruitment). CONCLUSION The MyComrade intervention was found to be feasible to conduct within two different healthcare systems. Recruitment of participants requires significant time and effort given the nature of this population and the pairing of GP and pharmacist may be more sustainable to implement in routine practice. TRIAL REGISTRATION Registry: ISRCTN, ISRCTN80017020 ; date of confirmation 4/11/2019; retrospectively registered.
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Affiliation(s)
- Collette Kirwan
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland.
- College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland.
| | - Lisa Hynes
- Croí, West of Ireland Cardiac and Stroke Foundation, Galway, Ireland
| | - Nigel Hart
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Sarah Mulligan
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Claire Leathem
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Laura McQuillan
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Marina Maxwell
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Emma Carr
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Kevin Roche
- College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Scott Walkin
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Caroline McCarthy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- General Practice, Discipline of Public Health & Primary Care, Trinity College, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queen's University, Belfast, Northern Ireland
| | - Maura Corry
- General Practice Federation, Belfast, Northern Ireland
| | | | - Geraldine McCarthy
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
- Mental Health Services, Health Services Executive, Sligo, Ireland
| | - Margaret Cupples
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation of Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - Anna Hobbins
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation of Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematical & Statistical Sciences, National University of Ireland, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Davood Roshan
- School of Mathematical & Statistical Sciences, National University of Ireland, Galway, Ireland
| | - Carol Sinnott
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
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22
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Jacobsen JS, Thorborg K, Sørensen D, Jakobsen SS, Nielsen RO, Oestergaard LG, Søballe K, Mechlenburg I. Feasibility and acceptability of a six-month exercise and patient education intervention for patients with hip dysplasia: A mixed methods study. Musculoskelet Sci Pract 2022; 61:102615. [PMID: 35820302 DOI: 10.1016/j.msksp.2022.102615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery. DESIGN Feasibility study. METHODS The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms. RESULTS Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5-17) HAGOS pain points, improvements in all subscales were 1-11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04-0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64-74) to 75 (IQR: 72-80) centimetres; posteromedial: 104 (IQR: 94-112) to 119 (IQR: 112-122) centimetres and posterolateral: 98 (IQR: 89-109) to 116 (IQR: 108-121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30-44) to 52 (IQR: 45-58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1,581:1,872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harms. CONCLUSION Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.
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Affiliation(s)
- Julie S Jacobsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, 8200, Aarhus N, Denmark; Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus, Denmark.
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark; Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, 8200, Aarhus N, Denmark.
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
| | - Rasmus O Nielsen
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.
| | - Lisa G Oestergaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørums Gade 11, 8000, Aarhus C, Denmark; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.
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Ribeiro DC, Jafarian Tangrood Z, Wilson R, Sole G, Abbott JH. Tailored exercise and manual therapy versus standardised exercise for patients with shoulder subacromial pain: a feasibility randomised controlled trial (the Otago MASTER trial). BMJ Open 2022; 12:e053572. [PMID: 35710235 PMCID: PMC9207741 DOI: 10.1136/bmjopen-2021-053572] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess whether it was feasible to conduct a full trial comparing a tailored versus a standardised exercise programme for patients with shoulder subacromial pain. DESIGN Two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial. METHODS Twenty-eight participants with shoulder subacromial pain were randomly allocated into one of two intervention groups-tailored or standardised exercise. Participants in the tailored exercise programme received exercises and manual therapy tailored to their scapular and shoulder movement impairments. Participants in the standardised exercise programme received progressive strengthening exercise. The primary outcome measures were (1) the participant recruitment rate; (2) the proportion of participants enrolled from the total number screened; (3) drop-out rates; and (4) adherence to the rehabilitation programme. Other outcome measures were: (5) pain levels; (6) Patient-Specific Functional Scale; (7) the Shoulder Pain and Disability Index; and (8) pain self-efficacy. We compared changes in pain and disability scores between groups using a repeated mixed-model analysis of variance. Since this is a feasibility study, we did not adjust alpha for multiple comparisons, and considered 75% CI as the probability threshold at 3-month follow-up. Health-related quality of life was assessed using the Short-Form 12 and quality-adjusted life years (QALYs) were estimated. RESULTS The recruitment rate was 3 participants per month, the proportion of participants enrolled was 23%, the drop-out rate was 14% and the overall adherence to the rehabilitation programme was 85%. No between-group differences were found for most outcome measures. Adverse events (n=2, only in the tailored group) were minor in nature and included skin injury or pain following taping. CONCLUSIONS Our feasibility trial showed that additional strategies are required for improving recruitment, enrolment and minimising drop-out of participants into the trial and making it feasible to conduct a full trial. TRIAL REGISTRATION NUMBER ANZCTR: 12617001405303.
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Affiliation(s)
- Daniel C Ribeiro
- School of Physiotherapy, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | | | - Ross Wilson
- Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - Gisela Sole
- School of Physiotherapy, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand
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Munir A, Huws A, Khan S, Sharaiha Y, Holt S, Khawaja S. Geriatric assessment tool application in treatment recommendations for older women with breast cancer. Breast 2022; 63:101-107. [PMID: 35366503 PMCID: PMC8972005 DOI: 10.1016/j.breast.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Asma Munir
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK.
| | - Anita Huws
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Sohail Khan
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Yousef Sharaiha
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Simon Holt
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
| | - Saira Khawaja
- Department of Breast Surgery, Prince Philip Hospital, Llanelli, UK
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Yoshioka-Maeda K, Katayama T, Shiomi M, Hosoya N, Fujii H, Mayama T. Feasibility of an educational program for public health nurses to promote local healthcare planning: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:92. [PMID: 35477498 PMCID: PMC9043510 DOI: 10.1186/s40814-022-01054-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Promoting of local healthcare planning is crucial for assisting public health nurses in improving community health inequities. However, there is no effective educational program for developing relevant skills and knowledge among these nurses. Therefore, this study aims to assess the feasibility of a newly developed web-based self-learning program to promote the involvement of public health nurses in the local healthcare planning process. METHODS A pilot randomized control trial randomly allocated eligible public health nurses to intervention and control wait-list groups [1:1]. The former will be exposed to six web-based learning modules from July to October 2021. After collecting post-test data, the wait-list group will be exposed to the same modules to ensure learning equity. The primary outcome will be evaluated by implementing a validated and standardized scale designed to measure public health policy competencies at the baseline and post-intervention, while secondary outcome will be measured on an action scale to demonstrate the necessity of healthcare activities. The third outcome will be the knowledge and skills related to local healthcare planning by public health nurses. The participants will provide feedback through free descriptions on the trial feasibility and a web-based self-learning program to identify improvement points for continual refinement. DISCUSSION The results will provide suggestions in preparation for a future definitive randomized controlled trial. This will provide preliminary data for an intervention aimed at improving relevant competencies among public health nurses who are tasked with resolving health inequities in their respective communities through local health planning. TRIAL REGISTRATION The protocol for this study was registered with the University Hospital Medical Information Network Clinical Trials Registry and approved by the International Committee of Medical Journal Editors (No. UMIN000043628 , March 23, 2021).
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Statistic and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan.
| | - Takafumi Katayama
- Department of Statistic and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan
| | - Misa Shiomi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Hosoya
- Department of Nursing, Faculty of Healthcare Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Hitoshi Fujii
- Department of Medical Statistics, School of Nursing, Mejiro University, Saitama, Japan
| | - Tatsushi Mayama
- Faculty of Policy Studies, Doshisya University, Kyoto, Japan
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The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial. Crit Care Med 2022; 50:1224-1235. [PMID: 35404327 PMCID: PMC9288529 DOI: 10.1097/ccm.0000000000005558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Deep sedation in the emergency department (ED) is common, increases deep sedation in the ICU, and is negatively associated with outcome. Limiting ED deep sedation may, therefore, be a high-yield intervention to improve outcome. However, the feasibility of conducting an adequately powered ED-based clinical sedation trial is unknown. Our objectives were to assess trial feasibility in terms of: 1) recruitment, 2) protocol implementation and practice change, and 3) safety. Patient-centered clinical outcomes were assessed to better plan for a future large-scale clinical trial. DESIGN Pragmatic, multicenter (n = 3), prospective before-after pilot and feasibility trial. SETTING The ED and ICUs at three medical centers. PATIENTS Consecutive, adult mechanically ventilation ED patients. INTERVENTIONS An educational initiative aimed at reliable ED sedation depth documentation and reducing the proportion of deeply sedated patients (primary outcome). MEASUREMENTS AND MAIN RESULTS Sedation-related data in the ED and the first 48 ICU hours were recorded. Deep sedation was defined as a Richmond Agitation-Sedation Scale of -3 to -5 or a Sedation-Agitation Scale of 1-3. One thousand three hundred fifty-six patients were screened; 415 comprised the final population. Lighter ED sedation was achieved in the intervention group, and the proportion of deeply sedated patients was reduced from 60.2% to 38.8% (p < 0.01). There were no concerning trends in adverse events (i.e., inadvertent extubation, device removal, and awareness with paralysis). Mortality was 10.0% in the intervention group and 20.4% in the preintervention group (p < 0.01). Compared with preintervention, the intervention group experienced more ventilator-free days [22.0 (9.0) vs 19.9 (10.6)] and ICU-free days [20.8 (8.7) vs 18.1 (10.4)], p < 0.05 for both. CONCLUSIONS This pilot trial confirmed the feasibility of targeting the ED in order to improve sedation practices and reduce deep sedation. These findings justify an appropriately powered clinical trial regarding ED-based sedation to improve clinical outcomes.
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Lawson DO, Mellor K, Eddy S, Lee C, Kim KH, Kim K, Mbuagbaw L, Thabane L. Pilot and Feasibility Studies in Rehabilitation Research: A Review and Educational Primer for the Physiatrist Researcher. Am J Phys Med Rehabil 2022; 101:372-383. [PMID: 34091466 DOI: 10.1097/phm.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pilot and feasibility studies are conducted early in the clinical research pathway to evaluate whether a future, definitive study can or should be done and, if so, how. Poor planning and reporting of pilot and feasibility studies can compromise subsequent research efforts. Inappropriate labeling of studies as pilots also compromises education. In this review, first, a systematic survey of the current state of pilot and feasibility studies in rehabilitation research was performed, and second, recommendations were made for improvements to their design and reporting. In a random sample of 100 studies, half (49.5%) were randomized trials. Thirty (30.0%) and three (3.0%) studies used "pilot" and "feasibility" in the study title, respectively. Only one third (34.0%) of studies provided a primary objective related to feasibility. Most studies (92.0%) stated an intent for hypothesis testing. Although many studies (70.0%) mentioned outcomes related to feasibility in the methods, a third (30.0%) reported additional outcomes in the results and discussion only or commented on feasibility anecdotally. The reporting of progression plans to a main study (21.0%) and progression criteria (4.0%) was infrequent. Based on these findings, it is recommended that researchers correctly label studies as a pilot or feasibility design based on accepted definitions, explicitly state feasibility objectives, outcomes, and criteria for determining success of feasibility, justify the sample size, and appropriately interpret and report the implications of feasibility findings for the main future study.
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Affiliation(s)
- Daeria O Lawson
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (DOL, LM, LT); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom (KM); Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom (SE); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (CL, KHK, KK); and Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (LM, LT)
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Promoting the health and wellbeing of children: A feasibility study of a digital tool among professionals. PLoS One 2022; 17:e0265355. [PMID: 35316279 PMCID: PMC8939777 DOI: 10.1371/journal.pone.0265355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
The foundations of children’s health and wellbeing are laid in early childhood. A gamified app (EmpowerKids tool) was designed to support professionals to have discussions with 6- to 12-year-olds from low-income families about their health and wellbeing. The aim of this feasibility study was to evaluate the usability and acceptability of the tool from the perspective of professionals in social, health and education settings. The study was conducted using a one-group post-test-only design. The usability data were collected using System Usability Scale and the acceptability data were collected using an open-ended questionnaire distributed to professionals (n = 24) in Estonia, Finland and Latvia. The data were collected during two phases. The tool was modified further on the basis of the results. The total usability scores were 82/100 (first testing) and 84/100 (second testing), indicating excellent usability. The answers related to acceptability were divided into four categories: suitability for the context; satisfaction and quality; attractiveness; modification needs. The professionals perceived that the tool helped them to build an overall picture of a child’s health and wellbeing, and to gain information about the child’s individual needs. The requirements for modification detected during the first testing were mostly related to difficulties with textual expressions and graphics. No major modification requirements were expressed during the second testing. The tool is considered feasible and may be used by professionals from different settings to support children’s health and wellbeing. Further studies are needed to evaluate the effectiveness of the tool from the perspective of child outcomes.
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Wanner M, Schönherr G, Kiechl S, Knoflach M, Müller C, Seebacher B. Feasibility of an individualised, task-oriented, video-supported home exercise programme for arm function in patients in the subacute phase after stroke: protocol of a randomised controlled pilot study. BMJ Open 2022; 12:e051504. [PMID: 34983759 PMCID: PMC8728417 DOI: 10.1136/bmjopen-2021-051504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stroke rehabilitation guidelines suggest a high-frequency task-oriented training at high intensity. A targeted and self-paced daily training with intermittent supervision is recommended to improve patients' self-management and functional output. So far, there is conflicting evidence concerning the most effective home-training delivery method. METHODS AND ANALYSIS The purpose of this pilot study is to compare the feasibility and preliminary effects of task-oriented home-exercises in patients in the subacute stage after stroke. Twenty-four patients will be randomised (1:1) to a Video group (a) or Paper group (b) of an individualised, task-oriented home-training (50 min, 6×/week, for 4 weeks) based on Wulf and Lewthwaite's Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory of motor learning. Patient-relevant goals will be identified using Goal Attainment Scaling and exercises progressively adapted. Semistructured interviews and a logbook will be used to monitor adherence, arm use and acceptability. Primary outcome will be the feasibility of the methods and a full-scale trial employing predefined feasibility criteria (recruitment, retention and adherence rates, patients' satisfaction with the home-exercise programme and their progress, affected hand use and acceptance of the intervention). Assessed at baseline, post intervention and 4-week follow-up, secondary outcomes include self-perceived hand and arm use, actual upper extremity function and dexterity, hand strength, independence in activities of daily living and health-related quality of life. Interview data will be analysed using qualitative content analysis. Medians (ranges) will be reported for ordinal data, means (SD) for continuous and frequency (percentage) for nominal data. ETHICS AND DISSEMINATION This study follows the Standard Protocol Items: Recommendations for Interventional Trials-Patient-Reported Outcome (PRO) Extension guideline. Ethical approval was received from the Ethics Committee of the Medical University of Innsbruck, Austria (1304/2020). Written informed consent will be obtained from all participants prior to data collection. Study results will be disseminated to participating patients, patient organisations, via the clinic's homepage, relevant conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS-ID: DRKS00023395.Study protocol, second revision, 5 December 2021.
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Affiliation(s)
- Miriam Wanner
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Schönherr
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Müller
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Research Centre on Vascular Ageing and Stroke, VASCage, Innsbruck, Austria
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Kaushal T, Satapathy S, Bakhshi S, Sagar R, Chadda RK. A parent-child conjoint psychological intervention for children in maintenance phase of acute lymphoblastic leukemia: Feasibility and preliminary outcomes from a randomized control pilot trial. Arch Pediatr 2021; 29:145-152. [PMID: 34955301 DOI: 10.1016/j.arcped.2021.11.004] [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: 02/22/2021] [Revised: 09/27/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop and test a brief Composite Intervention Module for Pre-adolescents with Acute Lymphoblastic Leukemia (CIMPALL). DESIGN Single-center randomized controlled design. SETTING A tertiary care center of national importance PARTICIPANTS: A total of 36 children with acute lymphoblastic leukemia in the maintenance phase of the treatment. INTERVENTION A five-session (540 min) brief, multidomain, audiovisually aided, therapist-facilitated conjoint intervention module for children with cancer and their parents. MAIN OUTCOME MEASURES Standardized psychological tools for children including CBCL, CPSS (Child Posttraumatic Stress Disorder Symptoms Scale), PedsQol (Pediatric Quality of Life), and NIMHANS (National Institute of Mental Health and Neurosciences) neuropsychological battery and parents including PTSD CC (Posttraumatic Stress Disorder Civilian Checklist), CHIP (Coping Health Inventory for Parents), CBS (Caregiver Burden Scale), and SRQ (Self-Reporting Questionnaire). RESULTS A total of 36 patients were randomized to an experimental or a control group. Over 80% agreement was observed on indices of expert evaluation; 100% of participants found the sessions to be helpful, useful, appropriate in terms of time, duration, and place, and interventionist. The participation rate in the sessions was 94% and the study flow was smooth; 97.3% eligible candidates agreed to participate. Furthermore, 100% agreement on performance of activities was observed and the attrition rate was 5.26%. CONCLUSION This pilot study presents the CIMPALL, which to the best of our knowledge is the first of its kind in India. The data suggest that the CIMPALL intervention is feasibly delivered by a clinical psychologist and that the CIMPALL intervention has an impact on important psychosocial variables for children with acute lymphoblastic leukemia and their parents.
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Affiliation(s)
- Tanuja Kaushal
- Clinical Psychology, Office of the Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Sujata Satapathy
- Clinical Psychology, Office of the Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Office of the Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Office of the Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh K Chadda
- Office of the Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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McFadden A, Fitzpatrick B, Shinwell S, Tosh K, Donnan P, Wallace LM, Johnson E, MacGillivray S, Gavine A, Farre A, Mactier H. Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study. Health Technol Assess 2021; 25:1-146. [PMID: 34878383 DOI: 10.3310/hta25740] [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: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of evidence of the effect of cue-based feeding compared with scheduled feeding on important outcomes for preterm infants. OBJECTIVES The objectives were as follows: (1) to describe the characteristics, components, theoretical basis and outcomes of approaches to feeding preterm infants transitioning from tube to oral feeding; (2) to identify operational policies, barriers and facilitators, and staff and parents' educational needs in neonatal units implementing cue-based feeding; (3) to co-produce an intervention for feeding preterm infants in response to feeding cues; (4) to appraise the willingness of parents and staff to implement and sustain the intervention; (5) to assess associated costs of implementing cue-based feeding; (6) to determine the feasibility and acceptability of a future trial; (7) to scope existing data-recording systems and potential outcome measures; and (8) to determine stakeholders' views of whether or not a randomised controlled trial of this approach is feasible. DESIGN This was a mixed-methods intervention development and feasibility study comprising (1) a systematic review, case studies, qualitative research and stakeholder consensus; (2) the co-production of the intervention; (3) a mixed-methods feasibility study; and (4) an assessment of stakeholder preferences for a future evaluation. SETTING Three neonatal units in the UK (two level 3 units and one level 2 unit). PARTICIPANTS Developmentally normal, clinically stable preterm infants receiving enteral feeds (n = 50), parents (n = 15 pre intervention development; n = 14 in the feasibility study) and health-care practitioners (n = 54 pre intervention development; n = 16 in the feasibility study). INTERVENTION An evidence-informed multicomponent intervention comprising training, a feeding protocol, feeding assessment tools, supplementary training materials [including posters, a film and a narrated PowerPoint (Microsoft Corporation, Redmond, WA, USA) presentation] and the 'Our Feeding Journey' document. MAIN OUTCOME MEASURES The main outcome measures were recruitment and screening rates, infant weight gain, duration of the intervention, feeding outcomes, implementation outcomes (contextual facilitators and barriers, acceptability, adoption, appropriateness and fidelity) and stakeholder preferences for a future evaluation. RESULTS The systematic review of 25 studies concluded that evidence in favour of cue-based feeding should be treated cautiously. The case studies and qualitative research highlighted contextual barriers to and facilitators of the implementation of cue-based feeding. The telephone survey found that many neonatal units are considering implementing cue-based feeding. We recruited 37% of eligible infants, and there was good retention in the study until discharge but a high loss to follow-up at 2 weeks post discharge. The mean number of days from intervention to transition to full oral feeding was 10.8, and the mean daily change in weight gain was 25 g. The intervention was acceptable to parents and staff, although there was dissatisfaction with the study documentation. Intervention training did not reach all staff. A cluster-randomised design with a composite outcome was suggested by stakeholders for a future study. LIMITATIONS The intervention was available only in English. Intervention training did not reach all staff. There was low recruitment to qualitative interviews and observations. Only a small number of medical staff engaged in either the training or the interviews. CONCLUSIONS It is feasible to implement a cue-based feeding intervention with improved training and documentation. Further work is needed to assess the feasibility of a future trial, noting evidence of existing lack of equipoise. FUTURE WORK The next steps are to digitalise the intervention and conduct a survey of all neonatal units in the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42018097317 and ISRCTN13414304. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 74. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Shona Shinwell
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Karen Tosh
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Louise M Wallace
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | | | | | - Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Helen Mactier
- Princess Royal Maternity, NHS Greater Glasgow and Clyde, Glasgow, UK
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El-Khechen HA, Khan MIU, Leenus S, Olaiya O, Durrani Z, Masood Z, Leenus A, Akhter S, Mbuagbaw L. Design, analysis, and reporting of pilot studies in HIV: a systematic review and methodological study. Pilot Feasibility Stud 2021; 7:211. [PMID: 34847957 PMCID: PMC8630899 DOI: 10.1186/s40814-021-00934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Pilot studies are essential in determining if a larger study is feasible. This is especially true when targeting populations that experience stigma and may be difficult to include in research, such as people with HIV. We sought to describe how pilot studies have been used to inform HIV clinical trials. Methods We conducted a methodological study of pilot studies of interventions in people living with HIV published until November 25, 2020, using Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL). We extracted data on their nomenclature, primary objective, use of progression criteria, sample size, use of qualitative methods, and other contextual information (region, income, level, type of intervention, study design). Results Our search retrieved 10,597 studies, of which 248 were eligible. The number of pilot studies increased steadily over time. We found that 179 studies (72.2%) used the terms “pilot” or “feasibility” in their title, 65.3% tested feasibility as a primary objective, only 2% used progression criteria, 23.9% provided a sample size estimation and only 30.2% used qualitative methods. Conclusions Pilot studies are increasingly being used to inform HIV research. However, the titles and objectives are not always consistent with piloting. The design and reporting of pilot studies in HIV could be improved. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00934-9.
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Affiliation(s)
- Hussein Ali El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
| | - Mohammed Inam Ullah Khan
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Selvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Oluwatobi Olaiya
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zoha Durrani
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Alvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Shakib Akhter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.,Center for the Development of Best Practices in Health, Yaoundé, Cameroon
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Steinskog TLD, Tranvåg O, Ciliska D, Nortvedt MW, Graverholt B. Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses. BMC Health Serv Res 2021; 21:1283. [PMID: 34844600 PMCID: PMC8628377 DOI: 10.1186/s12913-021-07282-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Practice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs’ experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2. Methods This is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery. Results The PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a “big black box of implementation” to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs’ individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2. Conclusions This study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07282-7.
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Affiliation(s)
| | - Oscar Tranvåg
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424, Oslo, Norway
| | - Donna Ciliska
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Birgitte Graverholt
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
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Papatzikis E, Elhalik M, Inocencio SAM, Agapaki M, Selvan RN, Muhammed FS, Haroon NA, Dash SK, Sofologi M, Bezoni A. Key Challenges and Future Directions When Running Auditory Brainstem Response (ABR) Research Protocols with Newborns: A Music and Language EEG Feasibility Study. Brain Sci 2021; 11:brainsci11121562. [PMID: 34942864 PMCID: PMC8699561 DOI: 10.3390/brainsci11121562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Although many musical intervention studies exist in the wider framework of neuroscience and psychology, the preliminary importance of feasibility studies is rarely discussed. Adding to this fact the limited research existing on the therapeutic and restorative potential of music exposure during early developmental periods, pushed us to concentrate on investigating newborns’ perception of music and its impact on the brain. Here, we explore the feasibility of a randomized controlled trial (RCT) approach when measuring and comparing the neurophysiological perception of music versus language on the brainstem of newborns using auditory brainstem response (ABR). Twenty-five healthy full-term infants were recruited, eight of which were measured within their first 10 days postpartum. The evaluation of the study’s feasibility appealed to five main objectives that essentially answer the question: Can our protocol work? Each objective proposes questions based on Orsmond and Cohn’s guiding framework, designed to assess, and assist feasibility in understanding barriers toward a study’s success. Our results justify that newborns are well capable of undergoing the study and given meticulous considerations and improvements on the intervention resources. The procedure’s communication and technical obstacles are resoluble. Moreover, assimilation of external factors to adapt, such as the culture variation and the ABR protocol implementation are necessary. The study was well received in the selected region (Middle East), and the recording procedure showed potential outcomes for a comprehensive RCT.
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Affiliation(s)
- Efthymios Papatzikis
- Department of Early Childhood Education and Care, Oslo Metropolitan University, 0167 Oslo, Norway
- Correspondence:
| | - Mahmoud Elhalik
- Neonatal Intensive Care Unit, Latifa Women and Children’s Hospital, Dubai 9115, United Arab Emirates; (M.E.); (F.S.M.); (N.A.H.); (S.K.D.)
| | | | | | - Rosari Naveena Selvan
- Institute for Physics 3—Biophysics and Bernstein Center for Computational Neuroscience, University of Göttingen, 37073 Göttingen, Germany;
- Department of Psychology, University of Münster, 48149 Münster, Germany
| | - Faseela Shejeed Muhammed
- Neonatal Intensive Care Unit, Latifa Women and Children’s Hospital, Dubai 9115, United Arab Emirates; (M.E.); (F.S.M.); (N.A.H.); (S.K.D.)
| | - Nazreen Abdulla Haroon
- Neonatal Intensive Care Unit, Latifa Women and Children’s Hospital, Dubai 9115, United Arab Emirates; (M.E.); (F.S.M.); (N.A.H.); (S.K.D.)
| | - Swarup Kumar Dash
- Neonatal Intensive Care Unit, Latifa Women and Children’s Hospital, Dubai 9115, United Arab Emirates; (M.E.); (F.S.M.); (N.A.H.); (S.K.D.)
| | - Maria Sofologi
- Psychology Laboratory, Department of Early Childhood Education, School of Education, University of Ioannina, 45110 Ioannina, Greece;
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina, 45110 Ioannina, Greece
| | - Antonia Bezoni
- Department of Midwifery, Røyken Health Station, 3440 Røyken, Norway;
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Hargreaves EA, Haszard JJ, Shaw S, Peddie MC. Protocol for a pilot trial to assess the feasibility of the Move More @ Work intervention to encourage employees to take the opportunity to move (be physically active) after every 30 min of sitting. Pilot Feasibility Stud 2021; 7:172. [PMID: 34493322 PMCID: PMC8422613 DOI: 10.1186/s40814-021-00903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Prolonged sitting increases the risk of cardio-metabolic disease. Office-based employees are particularly susceptible to high rates of this sedentary behaviour during work hours. Laboratory studies indicate that regularly interrupting periods of prolonged sitting with short bouts (2 min) of physical activity can improve markers of cardio-metabolic health. This method of interrupting sitting time is yet to be tested in an occupational setting and may provide an alternative to providing sit-to-stand desks. Drawing on the Behaviour Change Wheel and evidence on the barriers and motivators to performing regular activity breaks, the Move More @ Work intervention was developed. The objectives of this pilot study are to examine the feasibility, and preliminary outcomes, of this intervention designed to encourage participants to perform 1–2 min of activity after every 30 min of continuous sitting throughout the work day. The study will inform if progress to a full effectiveness trial is warranted. Methods An interrupted time series design consisting of a 4-week baseline (control period), a 12-week intervention, and a 12-week follow-up will be utilised. At least 57 university employees who self-report spending > 5 h per day sitting at work on at least 3 days per week will be recruited to participate. The intervention consists of (1) a structured consultation with a Move More @ Work coach, containing a number of behaviour change techniques to create an individualised plan of how to incorporate the activity breaks into the working day, and (2) strategies to create a supportive workplace culture for performing the activity breaks. Feasibility will be assessed by recruitment and retention rates, and acceptability of the intervention. Pilot outcomes are the number of regular activity breaks taken during the workday, cardio-metabolic risk score and self-reported health, and work-related productivity outcomes. Discussion If the Move More @ Work intervention is shown to be feasible, acceptable, and shows evidence of effectiveness, this will provide justification for the progression to a full scale evaluation of the intervention. In the longer-term, this intervention may provide an alternative means of improving health outcomes through interrupting sedentary time than that offered by current sedentary behaviour interventions. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12620000354987. Registered on 12 March 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00903-2.
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Affiliation(s)
- Elaine A Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Sally Shaw
- School of Physical Education, Sport and Exercise Sciences, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Meredith C Peddie
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
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Khan MI, Mbuagbaw L, Holek M, Bdair F, Durrani ZH, Mellor K, Eddy S, Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Lancaster GA, Thabane L. Transparency of informed consent in pilot and feasibility studies is inadequate: a single-center quality assurance study. Pilot Feasibility Stud 2021; 7:96. [PMID: 33863400 PMCID: PMC8051114 DOI: 10.1186/s40814-021-00828-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pilot and feasibility studies (PAFS) often have complex objectives aimed at assessing feasibility of conducting a larger study. These may not be clear to participants in pilot studies. METHODS Here, we aimed to assess the transparency of informed consent in PAFS by investigating whether researchers communicate, through patient information leaflets and consent forms, key features of the studies. We collected this data from original versions of these documents submitted for ethics approval and the final approved documents for PAFS submitted to the Hamilton Integrated Research Ethics Board, Canada. RESULTS One hundred eighty-four PAFS, submitted for ethics approval from 2004 to 2020, were included, and we found that of the approved consent documents which were provided to participants, 83.2% (153) stated the terms "pilot" or "feasibility" in their title, 12% (22) stated the definition of a pilot/feasibility study, 42.4% (78) of the studies stated their intent to assess feasibility, 19.6% (36) stated the specific feasibility objectives, 1.6% (3) stated the criteria for success of the pilot study, and 0.5% (1) stated all five of these criteria. After ethics review, a small increase in transparency occurred, ranging from 1.6 to 2.8% depending on the criteria. By extracting data from the protocols of the PAFS, we found that 73.9% (136) stated intent to assess feasibility, 71.2% (131) stated specific feasibility objectives, and 33.7% (62) stated criteria for success of the study to lead to a larger study. CONCLUSION The transparency of informed consent in PAFS is inadequate and needs to be specifically addressed by research ethics guidelines. Research ethics boards and researchers ought to be made aware and mindful of best practices of informed consent in the context of PAFS.
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Affiliation(s)
- Mohammed I.U. Khan
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
- University of Toronto, Toronto, Ontario Canada
| | - Lawrence Mbuagbaw
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8S 4L8 Canada
| | - Matthew Holek
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
| | - Faris Bdair
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
| | | | - Katie Mellor
- Oxford Clinical Trials Research Unit/Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Saskia Eddy
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra M. Eldridge
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire L. Chan
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael J. Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire UK
| | - Christine M. Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit/Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Lehana Thabane
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8S 4L8 Canada
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Torrens I, Esteva M, Vicens C, Pizá-Portell MR, Vidal-Thomàs MC, Vidal-Ribas C, Lorente-Montalvo P, Torres-Solera E. Assessing the feasibility and acceptability of a cluster-randomized study of cognitive behavioral therapy for chronic insomnia in a primary care setting. BMC FAMILY PRACTICE 2021; 22:77. [PMID: 33863276 PMCID: PMC8052716 DOI: 10.1186/s12875-021-01429-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive behavioral therapy for chronic insomnia (CBT-i) is the treatment of choice for this condition but is underutilized in patients who attend primary care. The purpose of the present feasibility-pilot study was to assess the feasibility and acceptability of a cluster-randomized study of CBT-i in a primary care setting. METHODS This study, performed at two primary health care centers in Majorca, Spain, was a mixed methods feasibility-pilot study of a parallel cluster-randomized design comparing CBT-i and usual care (UC). Patients were included if they were 18 to 65 years-old; had diagnoses of chronic insomnia according to the Insomnia Severity Index (ISI ≥ 8); had insomnia for more than 3 months. Twenty-five GPs and nurses and 32 patients were randomly allocated to two groups. The main outcome of the intervention was improvement of dimensions of sleep quality, measured using the Spanish version of the Pittsburgh Sleep Quality Index, at baseline and at 3 months after the intervention. Other primary outcomes of the study were the feasibility and applicability of the intervention, collected through nominal groups. A thematic analysis was performed to classify primary care provider (PCP) proposals. Additionally, we assessed the recruitment process, compliance with the intervention sessions, and patient retention. RESULTS We adapted the CBT-i approach of Morin to a primary care context. After intervention training, PCPs expressed the need for more extensive training in the different aspects of the therapy and the discussion of more cases. PCPs considered the intervention as adequate but wanted fewer but longer sessions as well as to discard the cognitive restructuring component. PCPs considered it crucial to prepare each session in advance and to establish a specific agenda for the CBT-i. Regular reminders given to PCPs and patients were suggested to improve study participation. Compared to the UC group, higher proportions of patients in the intervention group had short sleep latency, slept for longer than 5 h, and had fewer sleep disruptions. CONCLUSIONS This feasibility-pilot study identified several key issues that must be addressed before performing a CBT-i intervention in future clinical trial in a primary care setting. TRIAL REGISTRATION NCT04565223 . (Clinical trials.gov) Registered 1 September 2020-Retrospectively registered.
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Affiliation(s)
- Isabel Torrens
- Santa Ponsa Health Center, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Riu Síl, 25, 07180, Santa Ponça, Majorca, Spain
- Balearic Islands Health Research Institute (IdISBa), Edificio S, University Hospital Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain
| | - Magdalena Esteva
- Balearic Islands Health Research Institute (IdISBa), Edificio S, University Hospital Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain.
- Primary Care Research Unit, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Escola Graduada 3, 07001, Palma, Spain.
- Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.
| | - Caterina Vicens
- Balearic Islands Health Research Institute (IdISBa), Edificio S, University Hospital Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain
- Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain
- Son Serra Health Center, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Carrer de Matamusinos, 22, 07013, Palma, Majorca, Spain
| | - María Rosa Pizá-Portell
- Santa Ponsa Health Center, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Riu Síl, 25, 07180, Santa Ponça, Majorca, Spain
| | - María Clara Vidal-Thomàs
- Balearic Islands Health Research Institute (IdISBa), Edificio S, University Hospital Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain
- Primary Care Research Unit, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Escola Graduada 3, 07001, Palma, Spain
- Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain
| | - Cristina Vidal-Ribas
- Santa Ponsa Health Center, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Riu Síl, 25, 07180, Santa Ponça, Majorca, Spain
| | - Patricia Lorente-Montalvo
- Santa Ponsa Health Center, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Riu Síl, 25, 07180, Santa Ponça, Majorca, Spain
| | - Elena Torres-Solera
- Primary Care Research Unit, Majorca Department of Primary Care, Baleares Health Service [IbSalut], Escola Graduada 3, 07001, Palma, Spain
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Effectiveness and Safety of Moxibustion Robots on Primary Dysmenorrhea: A Randomized Controlled Pilot Trial. Chin J Integr Med 2021; 27:578-584. [PMID: 33837481 DOI: 10.1007/s11655-021-3287-8] [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] [Accepted: 01/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To conduct a pilot trial to explore the effectiveness and safety of moxibustion robots in treating primary dysmenorrhea (PD) and evaluate its feasibility in clinic. METHODS A total of 70 participants with PD were allocated to either moxibustion robot (MR) group (35 cases) or manual moxibustion (MM) group (35 cases) using computer-generated randomization. One acupoint Guanyuan (CV 4) was selected to receive moxa heat stimulation. Two groups of participants were given 3 menstrual cycles of MM and MR treatment respectively (once a day, 5 days a session) and received another 3 menstrual cycles follow-up. The degree of pain was evaluated by short-form McGill pain questionnaire (SF-MPQ) and the symptoms of dysmenorrhea were evaluated by Cox Menstrual Symptom Scale (CMSS). The safety was measured by the occurrence rate of adverse events (AEs), including burns (blisters, red and swollen), itching, bowel changes, menstrual cycle disorder, menorrhagia and fatigue, etc. RESULTS: A total of 62 patients completed the trial, 32 in MR group and 30 in MM group. Compared with baseline, scores of SF-MPQ and CMSS significantly decreased in both groups (P<0.05), and no significant difference was observed between the two groups in the 3rd and 6th menstrual cycles (P>0.05). The total occurrence rate of AEs in MR group was 2.1%, which was significantly lower than MM group (7.2%, P<0.05). CONCLUSIONS MR has the same effect as MM at SF-MPQ and CMSS in patients with PD. However, MR is safer than MM (Trial registration No. ChiCTR1800018236).
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Bendig E, Bauereiß N, Buntrock C, Habibović M, Ebert DD, Baumeister H. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - An internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv 2021; 24:100375. [PMID: 33732627 PMCID: PMC7941156 DOI: 10.1016/j.invent.2021.100375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite the high prevalence of comorbid depression in people living with coronary artery disease (CAD), uptake of psychological treatment is generally low. This study was designed to investigate the feasibility of an internet-based cognitive-behavioral (iCBT) depression intervention for people with CAD and depressive symptoms. METHODS People with CAD and depressive symptoms (PHQ-9 ≥ 5) were randomly assigned to the eight modules comprising iCBT (N = 18), or waitlist-control (N = 16). Measures were taken at baseline (t1) and at post-treatment (eight weeks after randomization, t2). Feasibility-related outcomes were recruitment strategy, study attrition, intervention dropout, satisfaction, negative effects as well as the potential of the intervention to affect likely outcomes in a future full-scale trial (depression, anxiety, quality of life, fear of progression). Data analyses were based on intention-to-treat principles. Linear regression models were used to detect between group differences. Linear Mixed Models were used to model potential changes over time. RESULTS This trial was terminated prior to a-priori defined sample size has been reached given low recruitment success as well as high intervention dropout (88%) and study attrition (23%). On average, participants in the intervention group completed M = 2.78 (SD = 3.23) modules. Participants in the waitlist control group barely started one module (M = 0.82, SD = 1.81). The satisfaction with the intervention was low (M = 20.6, SD = 0.88). Participants reported no negative effects attributed to the iCBT. Differences between groups with regard to depression, anxiety, fear of progression and quality of life remained non-significant (p > 0.05). CONCLUSION This trial failed to recruit a sufficient number of participants. Future work should explore potential pitfalls with regards to the reach and persuasiveness of internet interventions for people living with CAD. The study gives important indications for future studies with regard to the need for new ideas to reach and treat people with CAD and depression.
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Key Words
- APOI, Attitudes towards Psychological Online Interventions Questionnaire
- AQoL-8D, Inventory for the Assessment of Quality of Life
- CAD, Coronary artery disease
- CBT, Cognitive Behavioral Therapy
- CG, waitlist control group
- CSQ, Client Satisfaction Questionnaire
- Cognitive behavioral therapy
- Coronary artery disease
- Depression
- EG, intervention group
- FOP-Q-SF, Fear of Progression Questionnaire
- GAD-7, Generalized Anxiety Disorder 7-item Scale
- HADS, Hospital Anxiety and Depression Scale
- INEP, Inventory for the assessment of negative effects of psychotherapy
- ITT, intention-to-treat
- Internet and mobile-based intervention
- PHQ-9, Patient Health Questionnaire
- Psychological intervention
- SMS, short message service
- WIDeCAD, Web- and mobile-based Intervention for DEpression in people with CAD
- iCBT, internet-based cognitive behavioral therapy
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
| | - David Daniel Ebert
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, Vrije University Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
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Reynolds H, Steinfort S, Tillyard J, Ellis S, Hayes A, Hanson ED, Wijeratne T, Skinner EH. Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial. BMC Neurol 2021; 21:132. [PMID: 33745454 PMCID: PMC7983371 DOI: 10.1186/s12883-021-02052-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. METHODS A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). RESULTS Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. CONCLUSIONS Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. TRIAL REGISTRATION The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN 12613000822785 ) on 25/07/2013.
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Affiliation(s)
- Hanna Reynolds
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Steinfort
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Jane Tillyard
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Ellis
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Alan Hayes
- Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia.,The Institute for Health and Sport, Victoria University, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Erik D Hanson
- The Institute for Health and Sport, Victoria University, Melbourne, Australia.,University of North Carolina, Chapel Hill, NC, USA
| | - Tissa Wijeratne
- The University of Melbourne, Melbourne, Australia.,Department of Neurology, Western Health, Melbourne, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia. .,Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia. .,The University of Melbourne, Melbourne, Australia. .,Monash University, Melbourne, Victoria, Australia.
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Wells BM, Nightingale LM, Derby DC, Salsbury SA, Lawrence D. Aromatherapy for test anxiety in chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:50-58. [PMID: 32543886 PMCID: PMC7958665 DOI: 10.7899/jce-18-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/09/2019] [Accepted: 09/30/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Up to 85% of college students experience test anxiety, which may contribute to decreased academic performance. The purpose of this study was to assess the feasibility of recruiting chiropractic students for a randomized trial involving aromatherapy for anxiety reduction. METHODS This study enrolled chiropractic students who were randomly assigned to separate rooms during a biochemistry test. Waterless diffusers dispersed a lemon and rosemary blend of essential oils in the experimental room and water in the control room. Students completed pretest surveys rating current and general anxiety. Posttest surveys included rating current anxiety. Analysis of covariance (ANCOVA) was preformed to determine within- and between-group differences for current anxiety. Feasibility was the primary aim, and the statistical significance of anxiety test scores between rooms was the secondary aim. RESULTS Sixty-four students were included in the study. The feasibility of research methods was noted for adherence to the study protocol (informed consent, randomization, and survey distribution and completion) and resource allocation. Design improvements are required in recruitment methods, follow-up surveys, and intervention blinding. ANCOVA for between-group comparisons showed no statistically significant difference between groups' pre- and posttest anxiety scores (p = .22). Two reported side effects, eye and sinus irritation, could not be attributed to treatment group. Most students were willing to use aromatherapy for test anxiety in the future. CONCLUSION We demonstrated feasibility in conducting a randomized study to measure the influence of aromatherapy on test anxiety in chiropractic students. A powered, randomized study is needed to determine if aromatherapy may be effective in reducing test anxiety.
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Hubbard EA, Motl RW, Elmer DJ. Feasibility and initial efficacy of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability: study protocol for a single-group, feasibility trial. Trials 2020; 21:972. [PMID: 33239079 PMCID: PMC7687792 DOI: 10.1186/s13063-020-04887-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is considerable evidence for the efficacy of moderate-intensity continuous exercise benefitting clinically relevant outcomes in persons with multiple sclerosis (MS). However, persons with MS who have walking disability (pwMS-wd) are severely deconditioned and may achieve superior benefits by engaging in high-intensity interval training (HIIT), especially while utilizing adaptive equipment, such as recumbent arm/leg stepping (RSTEP). The proposed study will assess the feasibility of a 12-week, RSTEP HIIT program in pwMS-wd. The secondary aim will examine changes in aerobic fitness, physical activity, ambulation, upper arm function, cognition, fatigue, and depression as clinically relevant efficacy outcomes following the 12-week, RSTEP HIIT intervention. Methods The study will recruit 15 pwMS-wd. Feasibility will be measured via process, resource, management, and scientific outcomes throughout the entirety of the research study. The secondary, clinically relevant outcomes will consist of a neurological exam, aerobic capacity, physical activity, ambulation, cognition, upper arm function, fatigue, and depression. Outcomes will be assessed at baseline (T1), midpoint (T2, following 6 weeks), and post-intervention (T3, following 12 weeks). The intervention will involve 12 weeks of supervised, individualized HIIT sessions two to three times per week. The individual HIIT sessions will each involve 10 cycles of 60-s intervals at the wattage associated with 90% VO2peak followed by 60 s of active recovery intervals at 15 W, totaling 20 min in length plus 5-min warm-up and cool-down periods. Discussion The feasibility design of the proposed study will provide experience and preliminary data for advancing towards a proof-of-concept study comparing HIIT to moderate-intensity continuous RSTEP for improving clinically relevant outcomes in a randomized control trial design. The results will be disseminated via manuscripts for publication and a report for distribution among the National Multiple Sclerosis Society. Trial registration ClinicalTrials.gov NCT04416243. Retrospectively registered on June 4, 2020
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Affiliation(s)
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David J Elmer
- Department of Kinesiology, Berry College, Mount Berry, GA, USA
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Husbands S, Elliott D, Davis TRC, Blazeby JM, Harrison EF, Montgomery AA, Sprange K, Duley L, Karantana A, Hollingworth W, Mills N. Optimising recruitment to the HAND-1 RCT feasibility study: integration of the QuinteT Recruitment Intervention (QRI). Pilot Feasibility Stud 2020; 6:173. [PMID: 33292646 PMCID: PMC7650179 DOI: 10.1186/s40814-020-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Recruitment to randomised controlled trials (RCTs) can be challenging, with most trials not reaching recruitment targets. Randomised feasibility studies can be set up prior to a main trial to identify and overcome recruitment obstacles. This paper reports on an intervention—the QuinteT Recruitment Intervention (QRI)—to optimise recruitment within a randomised feasibility study of surgical treatments for patients with Dupuytren’s contracture (the HAND-1 study). Methods The QRI was introduced in 2-phases: phase 1 sought to understand the recruitment challenges by interviewing trial staff, scrutinising screening logs and analysing audio-recorded patient consultations; in phase 2 a tailored plan of action consisting of recruiter feedback and training was delivered to address the identified challenges. Results Two key recruitment obstacles emerged: (1) issues with the recruitment pathway, in particular methods to identify potentially eligible patients and (2) equipoise of recruiters and patients. These were addressed by liaising with centres to share good practice and refine their pathway and by providing bespoke feedback and training on consent discussions to individual recruiters and centres whilst recruitment was ongoing. The HAND-1 study subsequently achieved its recruitment target. Conclusions Transferable lessons learnt from the QRI in the feasibility study will be implemented in the definitive RCT, enabling a “head start” in the tackling of wider issues around screening methods and consent discussions in the set up/early recruitment study phases, with ongoing QRI addressing specific issues with new centres and recruiters. Findings from this study are likely to be relevant to other surgical and similar trials that are anticipated to encounter issues around patient and recruiter equipoise of treatments and variation in recruitment pathways across centres. The study also highlights the value of feasibility studies in fine-tuning design and conduct issues for definitive RCTs. Embedding a QRI in an RCT, at feasibility or main stage, offers an opportunity for a detailed and nuanced understanding of key recruitment challenges and the chance to address them in “real-time” as recruitment proceeds.
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Affiliation(s)
- Samantha Husbands
- Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Daisy Elliott
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tim R C Davis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Jane M Blazeby
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Eleanor F Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Alexia Karantana
- Department of Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - William Hollingworth
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Pearson N, Naylor PJ, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for conducting feasibility and pilot studies for implementation trials. Pilot Feasibility Stud 2020; 6:167. [PMID: 33292770 PMCID: PMC7603668 DOI: 10.1186/s40814-020-00634-w] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Implementation trials aim to test the effects of implementation strategies on the adoption, integration or uptake of an evidence-based intervention within organisations or settings. Feasibility and pilot studies can assist with building and testing effective implementation strategies by helping to address uncertainties around design and methods, assessing potential implementation strategy effects and identifying potential causal mechanisms. This paper aims to provide broad guidance for the conduct of feasibility and pilot studies for implementation trials. METHODS We convened a group with a mutual interest in the use of feasibility and pilot trials in implementation science including implementation and behavioural science experts and public health researchers. We conducted a literature review to identify existing recommendations for feasibility and pilot studies, as well as publications describing formative processes for implementation trials. In the absence of previous explicit guidance for the conduct of feasibility or pilot implementation trials specifically, we used the effectiveness-implementation hybrid trial design typology proposed by Curran and colleagues as a framework for conceptualising the application of feasibility and pilot testing of implementation interventions. We discuss and offer guidance regarding the aims, methods, design, measures, progression criteria and reporting for implementation feasibility and pilot studies. CONCLUSIONS This paper provides a resource for those undertaking preliminary work to enrich and inform larger scale implementation trials.
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Affiliation(s)
- Nicole Pearson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia.
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, PO Box 3015 STN CSC, Victoria, BC, V8W 3P1, Canada
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia (UBC) and Centre for Hip Health and Mobility, University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Maria Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, 77204, USA
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
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Hamilton J, Saxon D, Best E, Glover V, Walters SJ, Kerr IB. A randomized, controlled pilot study of cognitive analytic therapy for stressed pregnant women with underlying anxiety and depression in a routine health service setting. Clin Psychol Psychother 2020; 28:394-408. [PMID: 32997871 DOI: 10.1002/cpp.2520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
A pilot study of cognitive analytic therapy (CAT) plus treatment as usual (TAU), versus TAU in stressed pregnant women with anxiety and depression, was undertaken as an essential preliminary to any definitive, randomized controlled trial (RCT). The trial was pragmatic, multicentre, parallel, randomized, controlled, and unblinded. Participants were pregnant women screened using the Hospital Anxiety and Depression Scale (HADS). Treatment was standard 16-session CAT. Main outcome measures were Spielberger State/Trait Anxiety Inventory (STAI) (primary outcome measure) at 24 weeks after randomization, therefore 1 month after therapy for the CAT group; HADS; Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); Edinburgh Postnatal Depression Scale (EPDS); 36-item Short Form Health Survey (SF-36); and a brief Experiences of Therapy Questionnaire, completed at baseline and on average at 12, 24, 40, and 82 weeks after randomization. Thirty-nine patients (CAT + TAU, n = 20; TAU, n = 19) were randomized with mean baseline STAI State scores of 50.8 (SD 11.4) and 51.1 (SD 13.3), respectively. Sixteen patients had missing primary outcome data leaving 23 (n = 11 and n = 12) patients for analysis. The mean STAI State score was 38.5 (SD 13.8) and 45.7 (SD 16.8) in the CAT and TAU groups respectively at 24 weeks after randomization, with an adjusted difference in means of 7.2 (95% confidence interval [CI]: -7.9 to 20.6). No safety issues were reported. Patient retention for the CAT group was high (18/20; 90% of patients completed therapy). Ten out of 11 (90.9%) respondents 'agreed' or 'strongly agreed' that having CAT had been 'very helpful'. The study demonstrated the feasibility of safely undertaking CAT in this setting. Outcomes showed positive trends compatible with a clinically important effect, although statistically definitive conclusions cannot be drawn in such a study.
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Affiliation(s)
- Jane Hamilton
- Department of Psychiatry, Sheffield Care and Social NHS Foundation Trust, Sheffield, UK
| | - David Saxon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Best
- Department of Perinatal Psychiatry/MIMHS, Kent and Medway NHS & Social Care Partnership Trust, Maidstone, UK
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ian B Kerr
- Department of Psychotherapy, Sheffield Care and Social NHS Foundation Trust, Sheffield, UK
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Allan LM, Wheatley A, Smith A, Flynn E, Homer T, Robalino S, Beyer FR, Fox C, Howel D, Barber R, Connolly JA, Robinson L, Parry SW, Rochester L, Corner L, Bamford C. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess 2020; 23:1-208. [PMID: 31661058 DOI: 10.3310/hta23590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING This study was set in the community. PARTICIPANTS The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Smith
- Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Elizabeth Flynn
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Anthony Connolly
- Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steve Wayne Parry
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynne Corner
- VOICE, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Sørensen CA, Olesen C, Lisby M, Enemark U, de Thurah A. Self-administration of medication during hospitalization-a randomized pilot study. Pilot Feasibility Stud 2020; 6:116. [PMID: 32821422 PMCID: PMC7433129 DOI: 10.1186/s40814-020-00665-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Self-administration of medication (SAM) during hospitalization is a complex intervention where patients are involved in their course of treatment. The study aim was to pilot test the SAM intervention. The objectives were to assess the feasibility of conducting a randomized controlled trial on the safety and cost-consequences of SAM during hospitalization. Methods The study was performed in a Danish cardiology unit. Patients ≥ 18 years capable of self-administering medication during hospitalization were eligible. Patients were excluded if they did not self-administer medication at home, were incapable of self-administering medication, were not prescribed medication suitable for self-administration, did not bring their medication, or were unable to speak Danish. Feasibility was assessed as part of the pilot study. A future randomized controlled trial was considered feasible if it was possible to recruit 60 patients within 3 months, if outcome measurement method was capable of detecting dispensing errors in both groups, and if patients in the intervention group were more satisfied with the medication management during hospitalization compared to the control group. Forty patients were recruited to gain experience about the intervention (self-administration). Additionally, 20 patients were randomized to the intervention or control group (nurse-led dispensing) to gain experience about the randomization procedure. Dispensing error proportions were based on data collected through disguised observation of patients and nurses during dispensing. The error proportion in the control group was used for the sample size calculation. Patient acceptability was assessed through telephone calls. Results Of the 60 patients recruited, one withdrew and 11 were discharged before observation resulting in analysis of 39 patients in the intervention group and nine in the control group. A dispensing error proportion of 3.4% was found in the intervention group and 16.1% in the control group. A total of 91.7% of patients in the intervention group and 66.7% in the control group were highly satisfied with the medication management during hospitalization. The overall protocol worked as planned. Minor changes in exclusion criteria, intervention, and outcome measures were considered. Conclusions It may be feasible to perform a pragmatic randomized controlled trial of the safety and cost-consequences of self-administration of medication during hospitalization. Trial registration ClinicalTrials.gov, NCT03541421, retrospectively registered on 30 May 2018.
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Affiliation(s)
- Charlotte Arp Sørensen
- Hospital Pharmacy Central Denmark Region, Aarhus, Denmark.,Medical Department, Randers Regional Hospital, Dronningborg Boulevard 16D, 8930 Randers, NØ Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Olesen
- Hospital Pharmacy Central Denmark Region, Aarhus, Denmark.,Clinical Pharmacy, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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48
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Positively Mindful: A Mixed Method Feasibility Study of Mindfulness Meditation for People Living with HIV in the UK. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Khan MI, Holek M, Bdair F, Mbuagbaw L, Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Lancaster GA, Thabane L. Assessing the transparency of informed consent in feasibility and pilot studies: a single-centre quality assurance study protocol. BMJ Open 2020; 10:e036226. [PMID: 32571863 PMCID: PMC7311004 DOI: 10.1136/bmjopen-2019-036226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/20/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pilot/feasibility studies assess the feasibility of conducting a larger study. Although researchers ought to communicate the feasibility objectives to their participants, many research ethics guidelines do not comment on how informed consent applies to pilot studies. It is unclear whether researchers and research ethics boards clearly communicate the purpose of pilot studies to participants consenting.The primary objective of this study is to assess whether pilot/feasibility studies submitted for ethics approval to a research ethics board transparently communicate the purpose of the study to participants through their informed consent practice. A highly transparent consent practice entails the consent documents communicate: (1) the term 'pilot' or 'feasibility' in the title; (2) the definition of a pilot/feasibility study; (3) the primary objectives of the study are to assess feasibility; (4) the specific feasibility objectives; and (5) the criteria for the study to successfully lead to the main study. The secondary objectives are to assess whether there is a difference between submitted and revised versions of the consent documents (revisions are made to obtain research ethics approval), to determine factors associated with transparent consent practices and to assess the consistency with which pilot and feasibility studies assess feasibility outcomes as their primary objectives. METHODS AND ANALYSIS This is a retrospective review of informed consent information for pilot/feasibility studies submitted to the Hamilton integrated Research Ethics Board, Canada. We will look at submitted and revised consent documents for pilot/feasibility studies submitted over a 14-year period. We will use descriptive statistics to summarise data, reporting results as percentages with 95% CIs, and conduct logistic regression to determine characteristics associated with transparent consent practices. ETHICS AND DISSEMINATION The study protocol was approved by the Hamilton integrated Research Ethics Board, and the results of this study will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Mohammed I Khan
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Matthew Holek
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Faris Bdair
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sandra M Eldridge
- Barts and The London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Claire L Chan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Michael J Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Christine M Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Gillian A Lancaster
- School of Primary, Community and Social Care; Keele Clinical Trials Unit, Keele University, Newcastle under Lyme, UK
| | - Lehana Thabane
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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50
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Murea M, Geary RL, Houston DK, Edwards MS, Robinson TW, Davis RP, Hurie JB, Williams TK, Velazquez-Ramirez G, Bagwell B, Tuttle AB, Moossavi S, Rocco MV, Freedman BI, Williamson JD, Chen H, Divers J. A randomized pilot study to evaluate graft versus fistula vascular access strategy in older patients with advanced kidney disease: results of a feasibility study. Pilot Feasibility Stud 2020; 6:86. [PMID: 32551134 PMCID: PMC7298797 DOI: 10.1186/s40814-020-00619-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/24/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although older adults encompass almost half of patients with advanced chronic kidney disease, it remains unclear which long-term hemodialysis vascular access type, arteriovenous fistula or arteriovenous graft, is optimal with respect to effectiveness and patient satisfaction. Clinical outcomes based on the initial AV access type have not been evaluated in randomized controlled trials. This pilot study tested the feasibility of randomizing older adults with advanced kidney disease to initial arteriovenous fistula versus graft vascular access surgery. METHODS Patients 65 years or older with pre-dialysis chronic kidney disease or incident end-stage kidney disease and no prior arteriovenous vascular access intervention were randomized in a 1:1 ratio to undergo surgical placement of a fistula or a graft after providing informed consent. Trial feasibility was evaluated as (i) recruitment of ≥ 70% of eligible participants, (ii) ≥ 50 to 70% of participants undergo placement of index arteriovenous access within 90 to 180 days of enrollment, respectively, (iii) ≥ 80% adherence to study-related assessments, and (iv) ≥ 70% of participants who underwent index arteriovenous access placement will have a follow-up duration of ≥ 12 months after index surgery date. RESULTS Between September 2018 and October 2019, 81% (44/54) of eligible participants consented and were enrolled in the study; 11 had pre-dialysis chronic kidney disease, and 33 had incident or prevalent end-stage kidney disease. After randomization, 100% (21/21) assigned to arteriovenous fistula surgery and 78% (18/23) assigned to arteriovenous graft surgery underwent index arteriovenous access placement within a median (1st, 3rd quartile) of 5.0 (1.0, 14.0) days and 13.0 (5.0, 44.3) days, respectively, after referral to vascular surgery. The completion rates for study-specific assessments ranged between 40.0 and 88.6%. At median follow-up of 215.0 days, 5 participants expired, 7 completed 12 months of follow-up, and 29 are actively being followed. Assessments of grip strength, functional independence, and vascular access satisfaction were completed by > 85% of patients who reached pre-specified post-operative assessment time point. CONCLUSIONS Results from this study reveal it is feasible to enroll and randomize older adults with advanced kidney disease to one of two different arteriovenous vascular access placement surgeries. The study can progress with minor protocol adjustments to a multisite clinical trial. TRIAL REGISTRATION Clinical Trials ID, NCT03545113.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Randolph L. Geary
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Denise K. Houston
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Matthew S. Edwards
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Todd W. Robinson
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Ross P. Davis
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Justin B. Hurie
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Timothy K. Williams
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Benjamin Bagwell
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Audrey B. Tuttle
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Shahriar Moossavi
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Michael V. Rocco
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1053 USA
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Long Island, NY USA
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