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Linnerud S, Kvæl LAH, Bjerk M, Taraldsen K, Skelton DA, Brovold T. Feasibility of an implementation strategy for preventing falls in homecare services. Implement Sci Commun 2024; 5:79. [PMID: 39030646 PMCID: PMC11264773 DOI: 10.1186/s43058-024-00615-7] [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: 12/03/2023] [Accepted: 07/10/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial. METHODS This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory. RESULTS Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was. CONCLUSIONS Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge. TRIAL REGISTRATION The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/2JFHV Registered: January 11, 2023.
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Affiliation(s)
- Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway.
| | - Linda Aimée Hartford Kvæl
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Department of Housing and Ageing Research, Norwegian Social Science, OsloMet - Oslo Metropolitan University, Olavs plass, P.O. Box 4 St, N-0130, Oslo, Norway
| | - Maria Bjerk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
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Ong RHS, Nurjono M, Oh HC, Lien CTC, Jumala J, Teo RCC, Gan P, Kan KLM, Rosle LF, Wee MK, Low SL. Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model. Clin Interv Aging 2024; 19:857-871. [PMID: 38770185 PMCID: PMC11104366 DOI: 10.2147/cia.s454043] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of "Steady Feet" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. Material and Methods This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Results Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Conclusion Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.
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Affiliation(s)
| | | | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
- Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | | | - Junisha Jumala
- Rehabilitative Services, Changi General Hospital, Singapore
| | | | - Peiying Gan
- Community Nursing, Changi General Hospital, Singapore
| | | | | | - Moi Kim Wee
- Community and Mental Health, Changi General Hospital, Singapore
| | - Shou Lin Low
- Geriatric Medicine, Changi General Hospital, Singapore
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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Romney WM, Wormley ME, Veneri D, Oberlander A, Catizone V, Grevelding P. Physical and occupational therapists' perceptions of sustainability of a knowledge translation intervention to improve the use of outcome measures in inpatient rehabilitation: a qualitative study. Qual Life Res 2024; 33:653-665. [PMID: 37966686 DOI: 10.1007/s11136-023-03550-7] [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] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention. METHODS A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook. RESULTS Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests. CONCLUSIONS This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability.
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Affiliation(s)
- Wendy M Romney
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA.
| | - Michelle E Wormley
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Diana Veneri
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Andrea Oberlander
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Victoria Catizone
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Pete Grevelding
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
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van Scherpenseel MC, te Velde SJ, Veenhof C, Emmelot-Vonk MH, Barten JA. Contextual determinants influencing the implementation of fall prevention in the community: a scoping review. FRONTIERS IN HEALTH SERVICES 2023; 3:1138517. [PMID: 37249947 PMCID: PMC10210634 DOI: 10.3389/frhs.2023.1138517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023]
Abstract
Background Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. Methods A scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Results Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as "networks and communications", "formally appointed internal implementation leaders", "available resources" and "patient needs and resources". The other constructs (n = 14) were identified only in the . Discussion Findings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.
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Affiliation(s)
- M. C. van Scherpenseel
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - S. J. te Velde
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - C. Veenhof
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M. H. Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. A. Barten
- Research Group Innovation of Human Movement Care, Research Center for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Gibson J, Sampford J, Myers-Ingram R, Jones GD. Embedding the rehabilitation treatment specification system (RTSS) into clinical practice: an evaluation of a pilot teaching programme. BMC MEDICAL EDUCATION 2023; 23:85. [PMID: 36732729 PMCID: PMC9896736 DOI: 10.1186/s12909-022-03861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/03/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Deficiency in the provision and quality of treatment specification by rehabilitation clinicians impairs the ability to differentiate effective from ineffective elements of treatment. The standardised language of the rehabilitation treatment specification system (RTSS) has been proposed as a countermeasure. To date, there is no evidence of its use in clinical practice and what effect it may have. This study aimed to assess the ability of a pilot teaching programme to embed the RTSS into the clinical practice of an inpatient oncology physiotherapy team. The objectives were to evaluate the teaching programme's effect on; participants' familiarity and perceived benefit of the RTSS, its uptake, participants' clinical reasoning, and their feelings and attitudes towards adopting the RTSS. This study provides an evaluation of the pilot teaching programme which will subsequently inform a larger iteration in an ongoing Health Education England (HEE) project aiming to disseminate and embed the RTSS into physiotherapy practice to improve physiotherapists' treatment specification. METHODS A 6-week, multi-modal RTSS pilot teaching programme based upon socio-constructivist theory was delivered to 10 inpatient oncology physiotherapists at a large urban UK trust in 2021. Self-reported measures and clinical case note audits were assessed before and after the RTSS teaching programme to evaluate its effect on RTSS familiarity and perceived benefit, uptake, and clinical reasoning. A post-teaching focus group was undertaken. It was qualitatively analysed using an inductive, independent thematic approach to evaluate clinicians' reflection and adoption. RESULTS Ten participants (8F, 29.4(±3.5) years) with variable clinical experience completed the RTSS teaching programme (six 1-hour lecture/case-based-learning sessions weekly) with 85% mean attendance. Nine yielded complete data for analyses, and 7 participated in the focus group. There was significant improvements in self-reported familiarity and confidence using the RTSS. Furthermore, there was a significant effect of the teaching on self-reported clinical reasoning overall and specifically in knowledge and theory application. But this was not reflected in clinicians' uptake of RTSS language, nor in the quality of clinical reasoning emergent in their case notes. Qualitative analyses revealed that while clinicians' conceptual understanding and the relative advantage of using the RTSS in practice was pervasive, they articulated that translating its perceived academic disposition into their clinical practice a challenge. CONCLUSIONS The RTSS teaching programme was shown to be effective in improving self-reported measures of clinical reasoning, despite clinical uptake of the RTSS remaining low. Future iterations should be tested across physiotherapy specialisms and in a larger sample with consideration of pedagogical and cultural measures to support the clinical diffusion of the RTSS.
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Affiliation(s)
- Jamie Gibson
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK.
- Health Education England (HEE), Leeds, UK.
| | - Jade Sampford
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Richard Myers-Ingram
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Gareth D Jones
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences (CHAPS), Faculty of Life Sciences & Medicine, King's College London, London, UK
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Dadich A, Vaughan P, Boydell K. The unintended negative consequences of knowledge translation in healthcare: A systematic scoping review. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:1-19. [PMID: 36680321 DOI: 10.1080/14461242.2022.2151372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Knowledge translation represents an avenue to address the oft-cited chasm between what should and what does happen in healthcare. Knowledge translation encompasses myriad processes through which different knowledges coalesce to inform practice. However, some reports suggest that experiences with knowledge translation are less than favourable. To better understand these experiences, a systematic scoping review of academic literature was conducted to unveil the unintended negative consequences of knowledge translation and how they were addressed. After screening 9,598 publications, six reported evidence of unintended negative consequences. The most prevalent was emotional labour - negative emotional or psychological sequelae, depression, anxiety, powerlessness, and frustration. These consequences were experienced by knowledge translation brokers, knowledge translation recipients, and knowledge translation producers. All but one publication offered some discussion of strategies to manage or mitigate these unintended negative consequences, including co-design, collaboration, and supported dialogue. These findings suggest there is limited research that explicates the unintended negative consequences of knowledge translation. Given the importance of knowledge translation, this review indicates there is considerable opportunity to advance it, in a better-informed way. Only by considering the unintended negative consequences of knowledge translation can they be identified, addressed, and potentially moderated, if not averted.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Parramatta, Australia
| | - Priya Vaughan
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Randwick, Australia
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Peng Y, Yi J, Zhang Y, Sha L, Jin S, Liu Y. The effectiveness of a group-based Otago exercise program on physical function, frailty and health status in older nursing home residents: A systematic review and meta-analysis. Geriatr Nurs 2023; 49:30-43. [PMID: 36413811 DOI: 10.1016/j.gerinurse.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore the effects of a group-based Otago exercise program (OEP) on physical function (mobility, balance, lower limb strength), frailty and health status in older nursing home residents to determine the optimal scheme and format. METHODS This systematic review and meta-analysis was conducted to estimate group-based OEP effects. Subgroup analysis was performed to identify the influences of the participant and intervention characteristics on the effects. RESULTS Twelve studies met the eligibility criteria and were included in this meta-analysis, and the overall quality was relatively high. The results showed that the group-based OEP significantly improved physical function, including mobility [SMD=-0.64, 95% CI (-0.83,-0.45), Z=6.55, p<0.001], balance [MD=4.72, 95% CI (3.54, 5.90), Z=7.84, p<0.001], lower limb strength [SMD=-1.09, 95% CI (-1.40, -0.79), Z=7.01, p<0.001]; frailty [SMD=-0.73, 95% CI (-1.01, -0.45), Z=5.13, p<0.001] and health status [SMD=0.47, 95% CI (0.20, 0.74), Z=3.44, p=0.0006]. Subgroup analysis revealed that 30-minute sessions were more beneficial for improving balance than >30-minute sessions (p=0.0004). The training was coordinated with physiotherapists, who were more skilled at improving mobility than providing health training education (p=0.04). CONCLUSIONS Group-based OEP is helpful for improving physical function, frailty and health status in older nursing home residents. Specifically, 30-minute sessions and coordinating with physiotherapists may be the most appropriate and effective options.
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Affiliation(s)
- Yu Peng
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jing Yi
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yuhan Zhang
- Department of Nursing, School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Liyan Sha
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Shixiao Jin
- Department of Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Yang Liu
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Mériade L, Rochette C. Governance tensions in the healthcare sector: a contrasting case study in France. BMC Health Serv Res 2022; 22:39. [PMID: 34991583 PMCID: PMC8739355 DOI: 10.1186/s12913-021-07401-4] [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: 06/21/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, these tensions come from the diffusion of management principles and practices from the business world. These tensions manifest at four levels: institutional, organisational, managerial and instrumental. The aim of this research is to understand how these tensions are expressed in healthcare organisations of different status. Methods We conduct a contrasting case study exploring the cases of two French healthcare organisations, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two organisations. Results Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare organisation and its main management characteristics. Conclusions Unexpectedly, in the for-profit organisation, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit organisation. These analyses can help guide policy makers and healthcare managers to better integrate these tensions into their political and managerial decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07401-4.
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Affiliation(s)
- Laurent Mériade
- University Clermont Auvergne, IAE Clermont Auvergne, CleRMa, Research Chair "Santé et Territoires", 11 Boulevard Charles de Gaulle, 63 000, Clermont-Ferrand, France.
| | - Corinne Rochette
- University Clermont Auvergne, IAE Clermont Auvergne, CleRMa, Research Chair "Santé et Territoires", 11 Boulevard Charles de Gaulle, 63 000, Clermont-Ferrand, France
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services. BMC Health Serv Res 2021; 21:497. [PMID: 34030691 PMCID: PMC8147019 DOI: 10.1186/s12913-021-06467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. METHODS Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. RESULTS The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. CONCLUSIONS This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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