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Lyon MF, Mitchell K, Medley A, Roddey T, Gleeson P. The impact of standardized balance measurement on physical therapist decision-making in acquired brain injury: a survey. Physiother Theory Pract 2022:1-15. [PMID: 35189771 DOI: 10.1080/09593985.2022.2040067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The use of balance outcome measures (OM) is proposed to enhance physical therapy services and patient outcomes. OBJECTIVE Explore current practices of balance OM use and OM's role in United States physical therapists' decision-making with patient's acquired brain injury (ABI). METHODS Cross-sectional survey utilizing snowball sampling, n = 373. Survey items required ranking agreement with statements on Likert scale. Multinomial logistic regression used to determine the relationship between survey answers and participant characteristics. RESULTS Ninety-three percent of therapists reported using outcome measures with patients with ABI. Those who reported not using outcome measures with patients with ABI were significantly different on setting, primary patient population, APTA section membership, and ANPT membership. All respondents who primarily treated neurologic diagnoses used outcome measure with clients with ABI, compared to 87% of respondents who worked primarily with orthopedic clients. Comfort, equipment availability, and psychometric properties were the most frequent reasons for choosing a measure. Therapist decision-making was impacted by outcome measures; this frequency was dependent on practice setting, primary patient population, and specialty certifications. CONCLUSIONS Physical therapists use a low diversity of outcome measures to assess balance. Respondents rated psychometric properties as more important than past published research. This is the first study to demonstrate that outcome measures play a role for most United States PTs in decision-making in all stages of the patient management model including identification of problems, diagnosis, prognosis, intervention selection, termination of services, and discharge planning, as well justifying service delivery.
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Affiliation(s)
- Marissa F Lyon
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Katy Mitchell
- School of Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Toni Roddey
- School of Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Peggy Gleeson
- School of Physical Therapy, Texas Woman's University, Houston, TX, USA
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Alary Gauvreau C, Le Dorze G, Kairy D, Croteau C. Evaluation of a community of practice for speech-language pathologists in aphasia rehabilitation: a logic analysis. BMC Health Serv Res 2019; 19:530. [PMID: 31358002 PMCID: PMC6664764 DOI: 10.1186/s12913-019-4338-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aphasia is a communication disorder affecting participation. Although there are evidence-based practice recommendations about participation and aphasia rehabilitation, it may be challenging for speech-language pathologists to ensure that rehabilitation activities have an impact on the person's participation, in part due to time limitations. Participation remains limited after rehabilitation for persons who have aphasia. Communities of practice (CoPs) are a collaborative knowledge transfer strategy that can be used for evidence-based practice implementation. The aim of this study was to describe the components and evaluate a CoP for speech-language pathologists about participation and aphasia rehabilitation. METHODS Logic analysis was used to determine the adequacy between resources, implemented activities, outputs and short-term outcomes of the CoP. Qualitative and quantitative descriptive data were collected through observation and participants' logbooks. Outputs and outcomes of the CoP were revealed through thematic analysis and interpretation of descriptive statistics. RESULTS Resources including CoP design and educational aims, human and material resources were combined to create various web-based, online and offline activities. Participants invested more time per week than expected in the CoP, shared and created clinical tools and appreciated the array of suggested activities. Participant engagement allowed them to reflect, interact and collaborate with each other. All 13 participants reported they acquired knowledge about clinical tools and 12 mentioned they reflected on their practice. While the CoP was ongoing, six participants noticed evidence-practice gaps, seven prepared to change their practice, and three changed their practice towards including more participation-based considerations. CONCLUSIONS This study showed that speech-language pathologists can include more participation-based approaches in aphasia rehabilitation as a result of participating in a time-bound, web-based CoP.
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Affiliation(s)
- Christine Alary Gauvreau
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada. .,Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, Quebec, Canada.
| | - Guylaine Le Dorze
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Claire Croteau
- School of Speech-Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Levac DE, Glegg SMN, Sveistrup H, Colquhoun H, Miller P, Finestone H, DePaul V, Harris JE, Velikonja D. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation. PLoS One 2016; 11:e0168311. [PMID: 27992492 PMCID: PMC5167266 DOI: 10.1371/journal.pone.0168311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. METHOD A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. RESULTS The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. CONCLUSION The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
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Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Stephanie M. N. Glegg
- Therapy Department, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hillel Finestone
- Physiatry, Élisabeth Bruyère Hospital and Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jocelyn E. Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Regional Rehabilitation Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Buchanan H, Jelsma J, Siegfried N. Measuring evidence-based practice knowledge and skills in occupational therapy--a brief instrument. BMC MEDICAL EDUCATION 2015; 15:191. [PMID: 26519165 PMCID: PMC4628364 DOI: 10.1186/s12909-015-0475-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Valid and reliable instruments are required to measure the effect of educational interventions to improve evidence-based practice (EBP) knowledge and skills in occupational therapy. The aims of this paper are to: 1) describe amendments to the Adapted Fresno Test of Competence in EBP (AFT), and 2) report the psychometric properties of the modified instrument when used with South African occupational therapists. METHODS The clinical utility of the AFT was evaluated for use with South African occupational therapists and modifications made. The modified AFT was used in two studies to assess its reliability and validity. In Study 1 a convenience sample of 26 occupational therapists in private practice or government-funded health facilities in a South African province were recruited to complete the modified AFT on two occasions 1 week apart. Completed questionnaires were scored independently by two raters. Inter-rater, test-retest reliability and internal consistency were determined. Study 2 was a pragmatic randomised controlled trial involving occupational therapists in four Western Cape Department of Health district municipalities (n = 58). Therapists were randomised in matched pairs to one of two educational interventions (interactive or didactic), and completed the modified AFT at baseline and 12 weeks after the intervention. An intention-to-treat analysis was performed. Data were not normally distributed, thus non-parametric statistics were used. RESULTS In Study 1, 21 of 26 participants completed the questionnaire twice. Test-retest (ICC = 0.95, 95 % CI = 0.88-0.98) and inter-rater reliability (Time 1: ICC = 0.995, 95 % CI = 0.99-0.998; Time 2: ICC = 0.99, 95 % CI = 0.97-0.995) were excellent for total scores. Internal consistency based on time 1 scores was satisfactory (α = 0.70). In Study 2, 28 participants received an interactive educational intervention and completed the modified AFT at baseline and 12 weeks later. Median total SAFT scores increased significantly from baseline to 12-weeks (Z = -4.078, p < 0.001) with a moderate effect size (r = 0.55). CONCLUSION The modified AFT has demonstrated validity for detecting differences in EBP knowledge between two groups. It also has excellent test-retest and inter-rater reliability. The instrument is recommended for contexts where EBP is an emerging approach and time is at a premium. TRIAL REGISTRATION Pan African Controlled Trials Register PACTR201201000346141 . Registered 31 January 2012. Clinical Trials NCT01512823 . Registered 1 February 2012. South African National Clinical Trial Register DOH2710093067 . Registered 27 October 2009.
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Affiliation(s)
- Helen Buchanan
- Department of Health & Rehabilitation Sciences, University of Cape Town, F45 Old Groote Schuur Hospital Building, Observatory, 7925, Cape Town, South Africa.
| | - Jennifer Jelsma
- Department of Health & Rehabilitation Sciences, University of Cape Town, F45 Old Groote Schuur Hospital Building, Observatory, 7925, Cape Town, South Africa.
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa.
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Auger C, Miller WC, Jutai JW, Tamblyn R. Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project. BMC Health Serv Res 2015; 15:386. [PMID: 26376853 PMCID: PMC4572692 DOI: 10.1186/s12913-015-1048-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/07/2015] [Indexed: 11/15/2022] Open
Abstract
Background Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use. Methods A two-phase mixed methods approach was used. Phase I involved user-centered development and face validation of a monitoring questionnaire with end-users (seven wheelchair users and five healthcare providers). Phase II tested the feasibility of monitoring outcomes using automated calls to administer the MOvIT questionnaire 1 and 3 months after wheelchair delivery with a prospective cohort of older adults (50–84 years of age). When problems were identified, the computer monitoring system notified a clinical coordinator who followed up with respondents requiring interventions. Feasibility data were extracted from the web database and from individual interviews covering perceived ease of use, usefulness and intention to use the MOvIT questionnaire in the future. Results The MOvIT monitoring questionnaire developed in phase I tracks nine potential wheelchair-related adverse outcomes considered important for end-users: 1) non-use of wheelchair, 2) pain, 3) skin condition, 4) positioning, 5) wheelchair incidents, 6) psychosocial issues, 7) restricted wheelchair participation, 8) limited wheelchair skills and knowledge, and 9) technical problems. In phase II, 92 individuals who received a wheelchair were eligible, 71 out of 92 accepted (77 %) and 65 out of 71 (92 %) completed the 3-month follow-up. In the sample of 65 participants, a wheelchair-related adverse outcome was confirmed by a rehabilitation professional for 58.5 %, and at least one recommendation was given to 66.2 % during the 3-month monitoring period. A majority of participants found the intervention useful (82.8 %) and said they intended to use the MOvIT monitoring questionnaire in the future (81.5 %). Participants made suggestions to make the calls more adaptive to various ability profiles. Conclusions Automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.
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Affiliation(s)
- Claudine Auger
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal and School of Rehabilitation, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada.
| | - William C Miller
- GF Strong Rehabilitation Center and Graduate Program in Rehabilitation Sciences, Department of Occupational Science & Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Jeffrey W Jutai
- Bruyère Research Institute and Interdisciplinary School of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada.
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Department of Medicine, and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1140 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.
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Buchanan H, Siegfried N, Jelsma J, Lombard C. Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial. Trials 2014; 15:216. [PMID: 24916176 PMCID: PMC4061109 DOI: 10.1186/1745-6215-15-216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks. Methods A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants’ places of employment. Audit raters were blinded, but participants and the provider could not be blinded. Results Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour. Conclusions The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect. Trial registration Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.
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Affiliation(s)
- Helen Buchanan
- Department of Health & Rehabilitation Sciences, F45 Old Groote Schuur Hospital Building, University of Cape Town, Observatory, 7925 Cape Town, South Africa.
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Shirazi M, Lonka K, Parikh SV, Ristner G, Alaeddini F, Sadeghi M, Wahlstrom R. A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial. J Eval Clin Pract 2013; 19:16-24. [PMID: 21883718 DOI: 10.1111/j.1365-2753.2011.01761.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
RATIONAL AND OBJECTIVES To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders. METHODS Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change ('intention') and a 2-day interactive large group meeting for those with lower propensity to change ('attitude') at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention. RESULTS GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001). CONCLUSIONS Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.
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MacDermid JC, Law M, Buckley N, Haynes RB. "Push" versus "Pull" for mobilizing pain evidence into practice across different health professions: a protocol for a randomized trial. Implement Sci 2012; 7:115. [PMID: 23176444 PMCID: PMC3520813 DOI: 10.1186/1748-5908-7-115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings. The purpose of this randomized trial is to determine whether a technology-based "push" of new, high-quality pain research to physicians, nurses, and rehabilitation and psychology professionals results in better knowledge and clinical decision making around pain, when offered in addition to traditional "pull" evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence. METHODS Physicians, nurses, occupational/physical therapists, and psychologists (n = 670) will be randomly allocated in a crossover design to receive a pain evidence resource in one of two different ways. Evidence is extracted from medical, nursing, psychology, and rehabilitation journals; appraised for quality/relevance; and sent out (PUSHed) to clinicians by email alerts or available for searches of the accumulated database (PULL). Participants are allocated to either PULL or PUSH + PULL in a randomized crossover design. The PULL intervention has a similar interface but does not send alerts; clinicians can only go to the site and enter search terms to retrieve evidence from the cumulative and continuously updated online database. Upon entry to the trial, there is three months of access to PULL, then random allocation. After six months, crossover takes place. The study ends with a final three months of access to PUSH + PULL. The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/ discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management at baseline and 9 months. A different random subset of 30 participants/ discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviors measured at baseline, 3, 9, 15 and 18 months. DISCUSSION The trial will inform our understanding of information preferences and behaviors across disciplines/practice settings. If this intervention is effective, sustained support will be sought from professional/health system initiatives with an interest in optimizing pain management. TRIAL REGISTRATION Registered as NCT01348802 on clinicaltrials.gov.
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Affiliation(s)
- Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
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Sheaves B, Jones RB, Williamson GR, Chauhan R. Phase 1 pilot study of e-mail support for people with long term conditions using the Internet. BMC Med Inform Decis Mak 2011; 11:20. [PMID: 21466699 PMCID: PMC3078836 DOI: 10.1186/1472-6947-11-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 04/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. METHODS Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. RESULTS Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. CONCLUSION E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs.
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Affiliation(s)
- Bryony Sheaves
- Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK
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10
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Shirazi M, Parikh SV, Alaeddini F, Lonka K, Zeinaloo AA, Sadeghi M, Arbabi M, Nejatisafa AA, Shahrivar Z, Wahlström R. Effects on knowledge and attitudes of using stages of change to train general practitioners on management of depression: a randomized controlled study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:693-700. [PMID: 19835676 DOI: 10.1177/070674370905401006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the impact on knowledge and attitudes of a tailored educational intervention on depression using a modified version of the Prochaska stages of change model, compared with standard continuing medical education, for general practitioners (GPs) in primary care in Iran. METHOD Using a randomized controlled trial, a total of 192 GPs were evenly randomized to intervention or control arm. The topic for the educational intervention was depressive disorders. The participants were divided in to small and large groups, depending on their initial stage of change. The GPs' knowledge and skills regarding management of depressive disorders were assessed through a questionnaire with 7 multiple choice questions, 11 Likert statements, 3 case vignettes, and 1 essay question. Attitudes toward management of depressive disorders were also assessed. Both questionnaires were validated. RESULTS There was a significant improvement in knowledge mean scores regarding multiple choice and Likert questions (intervention effect 6%; P = 0.002), as well as for the case vignettes and essay question (intervention effect 12%; P = 0.011) in the intervention arm, in comparison with the control arm. There were significant changes in mean attitude scores in both study arms, but no difference between them. CONCLUSIONS A theoretical model of medical learning and behavioural change can be used to devise educational formats that suit different stages of learning. Such tailored educational formats can improve GPs' knowledge and skills regarding management of depressive disorders.
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Affiliation(s)
- Mandana Shirazi
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Tempelhof MW. Personal digital assistants: a review of current and potential utilization among medical residents. TEACHING AND LEARNING IN MEDICINE 2009; 21:100-104. [PMID: 19330686 DOI: 10.1080/10401330902791321] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Increases in the daily work load of medical residents, coupled with constraints on their work hours have made personal digital assistants (PDAs) an increasingly popular management resource. No comprehensive review of PDA utilization among medical residents has been published. PURPOSE The purpose is to review and analyze current literature addressing PDA use by medical residents and to asses the future impact handheld computers may have on the daily practices of residents. METHOD A systematic literature search was completed to identify publications that describe the use of PDAs by medical residents. Particular attention and priority was given to articles addressing patient care, information management, and educational outcomes. RESULTS The rate of PDA utilization has dramatically increased in the past decade. Today, 70% of residents report using a PDA daily. PDAs are most commonly used for referencing medication-prescribing guides, medical textbooks, patient documentation programs, and medical calculators. No articles have reported the impact of housestaff PDA use on educational or patient care outcomes. CONCLUSION PDAs are perceived as a valuable resource by most medical residents. Further studies are necessary to confirm that daily PDA use by housestaff confers an educational, institutional, and patient care benefit.
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Affiliation(s)
- Michael W Tempelhof
- Department of Internal Medicine, Duke University Medical Center, Durham, NC 27713, USA.
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MacDermid JC, Grewal R, MacIntyre NJ. Using an evidence-based approach to measure outcomes in clinical practice. Hand Clin 2009; 25:97-111, vii. [PMID: 19232920 DOI: 10.1016/j.hcl.2008.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Evaluation of the outcome of evidence-based practice decisions in individual patients or patient groups is step five in the evidence-based practice approach. Outcome measures are any measures that reflect patient status. Status or outcome measures can be used to detect change over time (eg, treatment effects), to discriminate among clinical groups, or to predict future outcomes (eg, return to work). A variety of reliable and valid physical impairment and disability measures are available to assess treatment outcomes in hand surgery and therapy. Evidence from research studies that includes normative data, standard error of measurement, or comparative scores for important clinical subgroups can be used to set treatment goals, monitor recovery, and compare individual patient outcomes to those reported in the literature. Clinicians tend to rely on impairment measures, such as radiographic measures, grip strength, and range of motion, although self-report measures are known to be equally reliable and more related to global effects, such as return-to-work. The process of selecting and implementing outcome measures is crucial. This process works best when team members are involved and willing to trial new measures. In this way, the team can develop customized outcome assessment procedures that meet their needs for assessing individual patients and providing data for program evaluation.
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Affiliation(s)
- Joy C MacDermid
- Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor Street, London, Ontario, Canada.
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Michener LA, Snyder AR. Evaluation of health-related quality of life in patients with shoulder pain: are we doing the best we can? Clin Sports Med 2008; 27:491-505, x. [PMID: 18503880 DOI: 10.1016/j.csm.2008.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article provides an understanding of patient-based shoulder outcome tools and the conceptual framework of disablement models from which the patient-based outcome tools are based. To allow for the evaluation of function, disability, and health-related quality of life in patients suffering from shoulder pain and in particular those whose shoulders have high physical demands, the use of shoulder self-report patient-oriented outcome tools must become standard of practice. A wide variety of available outcome tools demonstrate acceptable levels of measurement properties and are appropriate for virtually every patient with a shoulder disorder.
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Affiliation(s)
- Lori A Michener
- Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, P.O. Box 980224, Rm 100, 12(th) and Broad Streets, Richmond, VA 23298, USA.
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