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Longtin C, Décary S, Cook CE, Tousignant M, Lacasse A, Tousignant-Laflamme Y. Optimising management of low back pain through the pain and disability drivers management model: Findings from a pilot cluster nonrandomised controlled trial. Musculoskeletal Care 2023; 21:667-682. [PMID: 36749025 DOI: 10.1002/msc.1738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Low back pain (LBP) remains the leading cause of disability. The Low Back Pain and Disability Drivers Management (PDDM) model aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the feasibility of conducting a pragmatic controlled trial of the PDDM model and to explore its effectiveness compared to clinical practice guidelines' recommendations for LBP management. METHODS A pilot cluster nonrandomised controlled trial. Participants included physiotherapists and their patients aged 18 years or older presenting with a primary complaint of LBP. Primary outcomes were the feasibility of the trial design. Secondary exploratory analyses were conducted on LBP-related outcomes such as pain severity and interference at 12-week follow-up. RESULTS Feasibility of study procedures were confirmed, recruitment exceeded our target number of participants, and the eligibility criteria were deemed suitable. Lost to follow-up at 12 weeks was higher than expected (43.0%) and physiotherapists' compliance rates to the study protocol was lower than our predefined threshold (75.0% vs. 57.5%). A total of 44 physiotherapists and 91 patients were recruited. Recommendations for a larger scale trial were formulated. The PDDM model group demonstrated slightly better improvements in all clinical outcome measures compared to the control group at 12 weeks. CONCLUSION The findings support the feasibility of conducting such trial contingent upon a few recommendations to foster proper future planning to determine the effectiveness of the PDDM model. Our results provide preliminary evidence of the PDDM model effectiveness to optimise LBP management. CLINICAL TRIAL REGISTRATION Clinicaltrial.gov, NCT04893369.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michel Tousignant
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Departement of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie, Sherbrooke, Quebec, Canada
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Berry SD, Baier RR, Syme M, Gouskova N, Bishnoi C, Patel U, Leitson M, Gharpure R, Stone ND, Link-Gelles R, Gifford DR. Strategies associated with COVID-19 vaccine coverage among nursing home staff. J Am Geriatr Soc 2021; 70:19-28. [PMID: 34741529 PMCID: PMC8657529 DOI: 10.1111/jgs.17559] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
Background After the first of three COVID‐19 vaccination clinics in U.S. nursing homes (NHs), the median vaccination coverage of staff was 37.5%, indicating the need to identify strategies to increase staff coverage. We aimed at comparing the facility‐level activities, policies, incentives, and communication methods associated with higher staff COVID‐19 vaccination coverage. Methods Design. Case–control analysis. Setting. Nationally stratified random sample of 1338 U.S. NHs participating in the Pharmacy Partnership for Long‐Term Care Program. Participants. Nursing home leadership. Measurement. During February 4–March 2, 2021, we surveyed NHs with low (<35%), medium (40%–60%), and high (>75%) staff vaccination coverage, to collect information on facility strategies used to encourage staff vaccination. Cases were respondents with medium and high vaccination coverage, whereas controls were respondents with low coverage. We used logistic regression modeling, adjusted for county and NH characteristics, to identify strategies associated with facility‐level vaccination coverage. Results We obtained responses from 413 of 1338 NHs (30.9%). Compared with facilities with lower staff vaccination coverage, facilities with medium or high coverage were more likely to have designated frontline staff champions (medium: adjusted odds ratio [aOR] 3.6, 95% CI 1.3–10.3; high: aOR 2.9, 95% CI 1.1–7.7) and set vaccination goals (medium: aOR 2.4, 95% 1.0–5.5; high: aOR 3.7, 95% CI 1.6–8.3). NHs with high vaccination coverage were more likely to have given vaccinated staff rewards such as T‐shirts compared with NHs with low coverage (aOR 3.8, 95% CI 1.3–11.0). Use of multiple strategies was associated with greater likelihood of facilities having medium or high vaccination coverage: For example, facilities that used ≥9 strategies were three times more likely to have high staff vaccination coverage than facilities using <6 strategies (aOR 3.3, 95% CI 1.2–8.9). Conclusions Use of designated champions, setting targets, and use of non‐monetary awards were associated with high NH staff COVID‐19 vaccination coverage.
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Affiliation(s)
- Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Maggie Syme
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Natalia Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Courtney Bishnoi
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Urvi Patel
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Michael Leitson
- Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Radhika Gharpure
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimalie D Stone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - David R Gifford
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, DC, USA
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