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Marwaa MN, Guidetti S, Ytterberg C, Kristensen HK. Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation. Ann Med 2024; 56:2302979. [PMID: 38466794 DOI: 10.1080/07853890.2024.2302979] [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] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 03/13/2024] Open
Abstract
AIM To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. SETTING The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. METHODS, PARTICIPANTS AND ANALYSIS A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. RESULTS Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. CONCLUSION Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.
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Affiliation(s)
- Mille Nabsen Marwaa
- Department of Physiotherapy Education, University College Southern Denmark, Esbjerg, Denmark
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
| | - Susanne Guidetti
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Geriatric Research Unit, Department of Clinical Research, University Hospital Odense, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
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Grech J, Norman IJ, Sammut R. Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes. PUBLIC HEALTH IN PRACTICE 2024; 7:100487. [PMID: 38486708 PMCID: PMC10937220 DOI: 10.1016/j.puhip.2024.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
Background The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes. Study design Validity study. Methods The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha. Results After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires' versions were found to have a high internal consistency (>0.8). Conclusions These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.
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Affiliation(s)
- Joseph Grech
- Department of Nursing, Faculty of Health Sciences, University of Malta, Mater Dei Hospital, Msida MSD, 2080, Malta
| | - Ian James Norman
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, United Kingdom
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Mater Dei Hospital, Msida MSD, 2080, Malta
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3
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Maunder A, Arentz S, Armour M, Costello MF, Ee C. Effectiveness of naturopathy for pregnancy in women with diminished ovarian reserve: feasibility randomized controlled trial. Reprod Biomed Online 2024; 48:103844. [PMID: 38579664 DOI: 10.1016/j.rbmo.2024.103844] [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: 10/30/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
RESEARCH QUESTION Is conducting a randomized control trial (RCT) to assess the effectiveness of whole-system naturopathy in improving pregnancy rates among women with diminished ovarian reserve (DOR) feasible? DESIGN A two-arm, parallel group, assessor-blinded feasibility RCT was conducted. Women with DOR, trying to conceive naturally or by ART, were randomly assigned to naturopathy plus usual care, or usual care alone for 16 weeks. Primary outcomes were feasibility (recruitment, adherence, retention rates), acceptability and safety. Secondary outcomes included ongoing pregnancy rates, live birth rates and health-related outcomes (mental health, quality of life, diet, exercise, sleep and weight). Statistical significance of the differences between the two groups (P-values) were exploratory. RESULTS One hundred and fifteen women completed the screening survey between March and November 2022. Of these, 66 women were assessed for eligibility and 41 (62%) consented. Recruitment resulted in seven enrolments each month. All 41 participants (100%) adhered to the intervention, 38 (93%) completed end-point questionnaires, 32 (78%) found study participation to be acceptable and 18 out of 21 (86%) from the intervention group would recommend a naturopathic intervention to other women with DOR. The naturopathic treatment was associated with only mild and temporary adverse events. No between-group differences were observed for pregnancy and live birth rates. CONCLUSION The evaluation of whole-system naturopathy through a RCT was feasible and the treatment was acceptable and well tolerated according to women with DOR. Outcomes from this study will help inform sample size calculations powered for fertility outcomes for future RCTs on this topic.
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Affiliation(s)
- Alison Maunder
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia..
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
| | - Michael F Costello
- Women's Health, UNSW and Royal Hospital for Women and Monash IVF, Sydney NSW Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
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Werther L, Thorén E, Brännström J, Andersson G, Öberg M. Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study. Internet Interv 2024; 36:100734. [PMID: 38524894 PMCID: PMC10958056 DOI: 10.1016/j.invent.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.
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Affiliation(s)
- Louise Werther
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Thorén
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology Clinic, Skåne University Hospital, Lund, Sweden
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Jonas Brännström
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Gerhard Andersson
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Marie Öberg
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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5
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Murali M, Charlesworth M. How to write pilot and feasibility studies. Anaesthesia 2024; 79:650-655. [PMID: 38489827 DOI: 10.1111/anae.16283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Affiliation(s)
- M Murali
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
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Segrott J, Channon S, Lloyd A, Glarou E, Henley J, Hughes J, Jacob N, Milosevic S, Moriarty Y, Pell B, Robling M, Strange H, Townson J, Brookes-Howell L. Integrating qualitative research within a clinical trials unit: developing strategies and understanding their implementation in contexts. Trials 2024; 25:323. [PMID: 38750606 PMCID: PMC11097452 DOI: 10.1186/s13063-024-08124-7] [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] [Received: 10/20/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND/AIMS The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University's Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration. METHODS We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper. RESULTS Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies. CONCLUSIONS Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit's experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations.
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Affiliation(s)
- Jeremy Segrott
- Centre for Trials Research, DECIPHer Centre, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Amy Lloyd
- Wales Centre for Public Policy, Cardiff University, Sbarc I Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Josie Henley
- School of Social Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3WA, UK
| | - Jacqueline Hughes
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Sarah Milosevic
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Bethan Pell
- DECIPHer Centre, School of Social Sciences, Cardiff University, Sbarc I Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Mike Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Heather Strange
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Lucy Brookes-Howell
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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7
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Sampson FC, Hughes J, Long J, Buykx P, Goodacre SW, Snooks H, Edwards A, Evans B, Jones J, Moore C, Johnston S. Is a randomised controlled trial of take home naloxone distributed in emergency settings likely to be feasible and acceptable? Findings from a UK qualitative study exploring perspectives of people who use opioids and emergency services staff. BMC Emerg Med 2024; 24:75. [PMID: 38679713 PMCID: PMC11057101 DOI: 10.1186/s12873-024-00987-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: 11/10/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Distribution of take-home naloxone (THN) by emergency services may increase access to THN and reduce deaths and morbidity from opioid overdose. As part of a feasibility study for a randomised controlled trial (RCT) of distribution of THN kits and education within ambulance services and Emergency Departments (EDs), we used qualitative methods to explore key stakeholders' perceptions of feasibility and acceptability of delivering the trial. METHODS We undertook semi-structured interviews and focus groups with 26 people who use opioids and with 20 paramedics and ED staff from two intervention sites between 2019 and 2021. Interviews and focus groups were recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS People using opioids reported high awareness of overdose management, including personal experience of THN use. Staff perceived emergency service provision of THN as a low-cost, low-risk intervention with potential to reduce mortality, morbidity and health service use. Staff understood the trial aims and considered it compatible with their work. All participants supported widening access to THN but reported limited trial recruitment opportunities partly due to difficulties in consenting patients during overdose. Procedural problems, restrictive recruitment protocols, limited staff buy-in and patients already owning THN limited trial recruitment. Determining trial effectiveness was challenging due to high levels of alternative community provision of THN. CONCLUSIONS Distribution of THN in emergency settings was considered feasible and acceptable for stakeholders but an RCT to establish the effectiveness of THN delivery is unlikely to generate further useful evidence due to difficulties in recruiting patients and assessing benefits.
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Affiliation(s)
- F C Sampson
- Division of Population Health, University of Sheffield, Sheffield, UK.
| | - J Hughes
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - J Long
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - P Buykx
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Newcastle, Australia
| | - S W Goodacre
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - H Snooks
- Department of Medicine, Swansea University, Swansea, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Bridie Evans
- Department of Medicine, Swansea University, Swansea, UK
| | - Jenna Jones
- Department of Medicine, Swansea University, Swansea, UK
| | - Chris Moore
- Welsh Ambulance Service NHS Trust, Cardiff, UK
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Rakers M, van Hattem N, Simic I, Chavannes N, van Peet P, Bonten T, Vos R, van Os H. Tailoring remote patient management in cardiovascular risk management for healthcare professionals using panel management: a qualitative study. BMC PRIMARY CARE 2024; 25:122. [PMID: 38643103 PMCID: PMC11031879 DOI: 10.1186/s12875-024-02355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND While remote patient management (RPM) has the potential to assist in achieving treatment targets for cardiovascular risk factors in primary care, its effectiveness may vary among different patient subgroups. Panel management, which involves proactive care for specific patient risk groups, could offer a promising approach to tailor RPM to these groups. This study aims to (i) assess the perception of healthcare professionals and other stakeholders regarding the adoption and (ii) identify the barriers and facilitators for successfully implementing such a panel management approach. METHODS In total, nineteen semi-structured interviews and two focus groups were conducted in the Netherlands. Three authors reviewed the audited transcripts. The Consolidated Framework for Implementation Strategies (CFIR) domains were used for the thematic analysis. RESULTS A total of 24 participants (GPs, nurses, health insurers, project managers, and IT consultants) participated. Overall, a panel management approach to RPM in primary care was considered valuable by various stakeholders. Implementation barriers encompassed concerns about missing necessary risk factors for patient stratification, additional clinical and technical tasks for nurses, and reimbursement agreements. Facilitators included tailoring consultation frequency and early detection of at-risk patients, an implementation manager accountable for supervising project procedures and establishing agreements on assessing implementation metrics, and ambassador roles. CONCLUSION Panel management could enhance proactive care and accurately identify which patients could benefit most from RPM to mitigate CVD risk. For successful implementation, we recommend having clear agreements on technical support, financial infrastructure and the criteria for measuring evaluation outcomes.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands.
| | - Nicoline van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Iris Simic
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Tobias Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
| | - Rimke Vos
- Health Campus the Hague, Leiden University Medical Center, The Hague, 2511 DP, The Netherlands
| | - Hendrikus van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2333 ZA, The Netherlands
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Chavez JV, Ewart LD, Ilyas O, Ghanooni D, Diaz JE, Atkins L, Ramos R, Garayua AH, Stewart A, Horvath KJ, Hirshfield S, Carrico AW. I was like sh*t this is gonna hurt': Implementing Self-Sampling of Dried Blood Spots to Measure HIV Viral Load. RESEARCH SQUARE 2024:rs.3.rs-4132978. [PMID: 38645181 PMCID: PMC11030538 DOI: 10.21203/rs.3.rs-4132978/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Sexual minority men (SMM) with HIV who use stimulants may experience greater difficulties with antiretroviral therapy adherence which amplifies risk for unsuppressed HIV viral load (VL). Remote monitoring of VL could support efforts to rapidly respond to sub-optimal adherence. Methods This qualitative study enrolled 24 SMM with HIV who use stimulants to examine experiences with two different dried blood spots (DBS) self-sampling devices (i.e., Tasso-M20 vs. HemaSpot HD) to measure VL. Participants were asked to complete self-sampling of DBS using both devices, and then participated in a 45-minute semi-structured interview. Interviews focused on ease of use, device preference, experiences with receiving and mailing kits, and barriers to participating in research. A thematic analysis was conducted to analyze interviews transcripts. Results Twenty-two participants (92%) returned the Tasso-M20 and 21 (88%) returned the Hemaspot HD devices. Among the 22 participants that completed qualitative interviews, twenty-three codes were identified and collapsed within seven themes. Preferences for devices were based on convenience, pain and prior experiences with finger-pricking technology. Participants emphasized that clearer instructions with contingency plans for self-sampling of DBS would improve the user experience with self-sampling of DBS. Intersectional stigma (e.g., HIV, sexual minority status, and substance use) was noted as an important consideration in implementing self-sampling of DBS. Promoting decision making, or the option to choose sampling method based on personal preferences, may improve engagement and likelihood of DBS completion. Conclusions Findings will guide the broader implementation of self-sampling of DBS to optimize VL monitoring in SMM with HIV who use stimulants.
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Gélinas-Gagné C, D'Amico M. Enhancing sibling support in oncology: Collaborative care for families facing cancer in young people. Can Oncol Nurs J 2024; 34:196-204. [PMID: 38706652 PMCID: PMC11068350 DOI: 10.5737/23688076342196] [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: 05/07/2024] Open
Abstract
Purpose This study investigates the support systems and needs of siblings of young people with cancer, shedding light on the emotional and informational challenges siblings face. This topic area has had relatively little attention. Design and methods Qualitative interviews were conducted, and thematic analysis was employed to gain in-depth insights into the experiences and perspectives of siblings. While the study's relatively small sample size and participant homogeneity are acknowledged limitations, the approach offers several strengths, including relevance and participant diversity across age cohorts. Results The findings underscore the essential role of healthcare professionals, particularly nurses, in providing emotional and informational support to siblings. Family-centred care, psychosocial support, tailored interventions, and ongoing research and education are recommended to address the unique needs of siblings effectively. Conclusion Overall, this study highlights the importance of recognizing and addressing the support needs of siblings in pediatric oncology care, emphasizing their role as a vital component of the family system and advocating for holistic support throughout the cancer journey and beyond.
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McGrady ME, Ketterl TG, Webster RT, Schwartz LE, Brock MY, Szulczewski L, Burke M, Hommel KA, Pai ALH, Mara CA, Steele AC, Regan GG, Norris RE. Feasibility pilot trial of a tailored medication adherence-promotion intervention for adolescents and young adults with cancer: Study design and protocol. Contemp Clin Trials 2024; 139:107483. [PMID: 38431133 PMCID: PMC10960689 DOI: 10.1016/j.cct.2024.107483] [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: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication non-adherence is common among adolescents and young adults (AYAs) with cancer and associated with poor health outcomes. AYAs with cancer endorse multiple barriers to adherence that differ across individuals, suggesting that tailoring intervention content to an AYA's specific barriers may have the potential to improve adherence. The purpose of this manuscript is to report on ORBIT-guided Phase I design efforts to create the first tailored adherence-promotion intervention for AYAs with cancer and the study protocol for the ongoing Phase II pilot feasibility trial. METHODS Phase I design included qualitative interviews (n = 15 AYAs) to understand patient preferences for adherence-promotion care, development and refinement of a best-worst scaling exercise barriers tool (n = 5 AYAs), and development of intervention modules and a tailoring algorithm. In the ongoing Phase II pilot feasibility trial, AYAs (ages 15-24 years) with cancer currently taking oral chemotherapy or prophylactic medication will be recruited from three children's hospitals. Feasibility, acceptability, and usability will be assessed and these outcomes along with data on medication adherence will be used to inform the next phases of intervention development and testing. CONCLUSIONS If promising, this program of research ultimately has the potential to equip clinicians with additional strategies for supporting adherence among AYAs with cancer. NCT05706610.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel Tillery Webster
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laura E Schwartz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Margaret Y Brock
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Szulczewski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amii C Steele
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Gillian G Regan
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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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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13
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Gélinas-Gagné C, D'Amico M. Soutien des frères et sœurs d’un jeune touché de cancer: soins collaboratifs pour les familles. Can Oncol Nurs J 2024; 34:205-214. [PMID: 38706649 PMCID: PMC11068340 DOI: 10.5737/23688076342205] [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: 05/07/2024] Open
Abstract
Objectif Cette étude examine les systèmes de soutien et les besoins des frères et sœurs des jeunes touchés par un cancer, mettant en lumière les défis émotionnels et informationnels auxquels les frères et sœurs sont confrontés. Ce domaine a reçu relativement peu d’attention. Devis et méthodologie Des entretiens qualitatifs ont été menés et une analyse thématique a été utilisée pour obtenir des perspectives approfondies sur les expériences et les points de vue des frères et sœurs. Bien que la taille relativement petite de l’échantillon de l’étude et l’homogénéité des participants soient reconnues comme des limites, l’approche présente plusieurs forces, notamment la pertinence et la diversité des participants dans les cohortes d’âge. Résultats Les résultats soulignent le rôle essentiel des professionnels de la santé, en particulier des infirmières pour fournir du soutien émotionnel et informationnel aux frères et sœurs. Une approche centré sur la famille, un soutien psycho-social, et des interventions personnalisées sont recommandés pour répondre de manière efficace aux besoins spécifiques de la fratrie. Conclusion Dans l’ensemble, cette étude met en lumière l’importance de reconnaître et de répondre aux besoins de soutien des frères et sœurs dans les soins en oncologie pédiatrique, en mettant en avant leur rôle en tant que composante essentielle du système familial. Cette étude souligne l’importance de fournir un soutien à la fratrie pendant et après l’expérience du cancer.
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Affiliation(s)
| | - Miranda D'Amico
- Département de l'éducation, Université Concordia, Montréal, Canada
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14
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Knight RL, Chalabaev A, Mackintosh KA, McNarry MA, Hudson J. Moving together: Increasing physical activity in older adults with an intergenerational technology-based intervention. A feasibility study. PLoS One 2024; 19:e0301279. [PMID: 38536850 PMCID: PMC10971589 DOI: 10.1371/journal.pone.0301279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Robust evidence supports the role of physical activity and exercise in increasing longevity, decreasing morbidity and helping older adults maintain the highest quality of life attainable. However, the majority of older adults are not sufficiently physically active and interventions are needed to change their behaviors. Familial or intergenerational contact has been positively linked to health and well-being in older adults. Therefore, this study aimed to i) establish acceptability and test the functionality and useability of a novel technology-driven intergenerational intervention targeting physical activity and age stereotypes, and ii) identify any potential issues with recruitment and retention. Four familial dyads (adult ≥ 65 and child 7-11 years) engaged with the intervention. Working collaboratively during a four-week trial, they combined daily step-counts (acquired via any activity of their choice, using PA trackers) to complete a virtual walk route using online platform World Walking. Thematic analysis of three post-intervention focus groups (one older adult; one child; one additional parental cohort) identified eight subthemes: Engagement; Provision of a Positive Experience; Participant Stimuli; Generated Outcomes; Operationality; Limitations; Mediators; Facilitators, and Perceptions. Participants enjoyed and successfully engaged with the intervention; when designing behaviour change interventions for older adults, flexibility within pre-established routines, individual choice, and avoiding rigidly imposed structures, is important. Strategies to challenge negative perceptions of older adults' engagement with technology and PA should be integrated into recruitment processes.
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Affiliation(s)
- Rachel L. Knight
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
- SENS, Univ. Grenoble Alpes, Grenoble, France
| | | | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
| | - Joanne Hudson
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, United Kingdom
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15
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Bateman M, Saunders B, Cooper K, Littlewood C, Hill JC. Exploring the feasibility and acceptance of an optimised physiotherapy approach for lateral elbow tendinopathy: a qualitative investigation within the OPTimisE trial. BMJ Open 2024; 14:e073816. [PMID: 38485170 PMCID: PMC10941140 DOI: 10.1136/bmjopen-2023-073816] [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] [Received: 03/20/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial. DESIGN Semistructured interviews, analysed using thematic analysis and mapped onto the COM-B model of behaviour change. SETTING Conducted as part of the OPTimisE Pilot & Feasibility randomised controlled trial within physiotherapy departments in the United Kingdom National Health Service. PARTICIPANTS 17 patients with LET (purposively sampled to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation) and all 8 physiotherapists involved as treating clinicians or site principal investigators. RESULTS Four themes were identified. First, participants reported the OPTimisE intervention as acceptable. Second, differences between the OPTimisE intervention and usual care were identified, including the use of an orthosis, holistic advice/education including modifiable risk factors, forearm stretches, general upper body strengthening and a more prescriptive exercise-dosing regimen. Third, participants provided feedback related to the trial resources, which were viewed positively, but identified language translation as a need. Fourth, feedback related to trial processes identified the need for changes to outcome collection and reduction of administrative burden. From the perspective of adopting the OPTimisE intervention, we found evidence that participants were able to change their behaviour. Considering the findings through the lens of the COM-B model, the intervention is likely to be deliverable in practice and the trial can be delivered at scale with some additional support for physiotherapists. CONCLUSIONS Overall, the OPTimisE intervention was found to be different to usual care and acceptable to patients and physiotherapists. The study highlighted the need to refine trial processes and resources prior to a full-scale trial, to reduce administrative burden, increase support for physiotherapists, improve return rate of outcome questionnaires and provide language translation. TRIAL REGISTRATION NUMBER ISRCTN database 19 July 2021. https://www.isrctn.com/ISRCTN64444585.
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Affiliation(s)
- Marcus Bateman
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine & Health Sciences, Keele University, Keele, UK
| | | | | | - Chris Littlewood
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Jonathan C Hill
- Faculty of Medicine & Health Sciences, Keele University, Keele, UK
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McKenzie AH, Friedman BG, Carpentier FRD, Lazard AJ, Salazar LF, Shegog R. Recognize & Resist: An Online Health Intervention to Promote Writing About Sexual Consent and Egalitarian Gender Roles Among One Direction Fanfiction Writers. HEALTH COMMUNICATION 2024; 39:529-540. [PMID: 36734475 PMCID: PMC10397359 DOI: 10.1080/10410236.2023.2171950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper focuses on the development and feasibility of a digitally-based educational intervention, titled Recognize & Resist (R&R), for writers of One Direction (1D) fanfiction on Wattpad.com. The goal of R&R is to reduce the prevalence of social norms that are supportive of sexual violence within 1D fanfiction. 1D fanfictions, or fictional romance stories written by fans of this British boy band, have hundreds of millions of views on Wattpad.com. Formative research has found that social norms supportive of sexual violence are prevalent in 1D fanfictions and that some authors have internalized these norms. R&R aims to motivate 1D fanfiction writers to highlight sexual consent and egalitarian gender roles in their writing. To evaluate the intervention's feasibility, 15 1D fanfiction authors completed a survey and participated in an interview or focus group. Results demonstrate R&R's feasibility, with high ratings of its acceptability and demand. Insights from the interviews and focus groups provide suggestions for revising R&R before rigorously evaluating its efficacy. Additionally, results demonstrate the utility of using popular culture as a vehicle for attitude-change regarding sensitive health issues.
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Affiliation(s)
| | - Barbara G. Friedman
- University of North Carolina at Chapel Hill, Hussman School of Journalism and Media
| | | | - Allison J. Lazard
- University of North Carolina at Chapel Hill, Hussman School of Journalism and Media
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
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17
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Oulton K, Williams A, Gibson F. Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'. J Child Health Care 2024; 28:53-68. [PMID: 35544716 DOI: 10.1177/13674935221098297] [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: 11/15/2022]
Abstract
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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18
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Soejbjerg A, Rasmussen SE, Christensen KS, Christensen B, Pedersen AF, Maindal HT, Mygind A. Managing mental health in chronic care in general practice: a feasibility study of the Healthy Mind intervention. Scand J Prim Health Care 2024; 42:72-81. [PMID: 38095546 PMCID: PMC10851809 DOI: 10.1080/02813432.2023.2289525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Mental health issues are common among patients with chronic physical conditions. This study aims to evaluate the feasibility of the Healthy Mind intervention, a general practice-based programme that provides problem-solving therapy (PST) to patients with poor mental well-being and type 2 diabetes (T2D) and/or ischaemic heart disease (IHD). DESIGN AND SETTING A one-arm feasibility study was conducted in three general practices in the Central Denmark Region. INTERVENTION Eight healthcare providers from the included general practices underwent a two-day course to acquire PST skills. Screening for poor mental health was carried out at the annual chronic care consultation for T2D or IHD, and PST sessions were offered to patients on indication of poor mental health. Nine patients received PST. METHODS Semi-structured interviews with eight healthcare providers and six patients were conducted. Data were analysed deductively focusing on appropriateness, acceptability and fidelity of the intervention. RESULTS The intervention was considered appropriate for the patient group and the general practice setting. The providers acknowledged PST as a valuable tool for managing psychological issues in general practice, and the patients perceived PST as an effective and tangible treatment. Since practice nurses' schedules were generally better suited for longer consultations, they were often the preferred intervention providers. The intervention was largely delivered as intended. However, the GPs generally expected patients to prefer a more directive approach, which sometimes challenged their role as facilitator and guide. CONCLUSION The Healthy Mind intervention was found to be feasible, and the results support proceeding to a full-scale evaluation trial.
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Affiliation(s)
- Anne Soejbjerg
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Stinne Eika Rasmussen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Bo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Anna Mygind
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
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19
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Wolf F, Folkerts AK, Zimmer P, Nielsen J. Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study. BMJ Open 2024; 14:e076333. [PMID: 38346883 PMCID: PMC10862272 DOI: 10.1136/bmjopen-2023-076333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES (1) To explore experiences of fatigued persons with multiple sclerosis (pwMS) with a new multimodal agility-based exercise training (MAT) framework and (2) to investigate the demands of the Rehabilitation, Fatigue, and Exercise (ReFEx) study protocol, which compares high-frequency MAT and 'traditional' strength and endurance training (SET) to identify possible adaptations for a powered randomised controlled trial (RCT). DESIGN A qualitative interview study nested within a feasibility RCT, comparing MAT and SET. SETTING Neurological inpatient rehabilitation centre in Germany. PARTICIPANTS Twenty-two pwMS were recruited for the feasibility study. Six were selected from MAT and SET, respectively, for semistructured face-to-face interviews prior to discharge, following a purposive sampling strategy. Participants had low physical disability but were at least moderately fatigued. INTERVENTIONS During inpatient rehabilitation (4-6 weeks) MAT participants attended group-based and manual-based MAT sessions in the gym (5×/week, 30 min) and the pool (3×/week, 30 min). SET participants exercised individually on a cycle ergometer (5×/week, 22 min) and on strength training machines (3×/week, 30 min). RESULTS Three key categories emerged from the interviews: (1) facilitators regarding MAT were variety and playfulness, group setting and challenging exercises. Barriers regarding MAT were feeling overburdened, feeling pressured in the group setting and the wish to perform 'traditional' strength training (not part of MAT). (2) MAT benefits were of physical and psychological nature, with improved balance stated the most. (3) Demands described the perceived exertion during MAT and SET, reflecting that there is no accumulation of fatigue during the intervention. CONCLUSIONS MAT is appreciated by pwMS and includes facilitators less attainable with 'traditional' SET. Evaluation of MAT in a powered RCT is indicated, if rest breaks postsession, and screening for negative self-evaluation and social comparison are considered. Future (qualitative) research should investigate the important factors of inpatient rehabilitation contributing to fatigue reduction in pwMS. TRIAL REGISTRATION NUMBER DRKS00023943; German Clinical Trials Register.
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Affiliation(s)
- Florian Wolf
- Neurological Rehabilitation Centre Godeshoehe GmbH, Bonn, Germany
- Division of Performance and Health, Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Ann-Kristin Folkerts
- Department of Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Jörn Nielsen
- Neurological Rehabilitation Centre Godeshoehe GmbH, Bonn, Germany
- Department of Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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20
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Wales J, Moore J, Naisby J, Ratcliffe N, Barry G, Amjad A, Godfrey A, Standerline G, Webster E, Morris R. Coproduction and Usability of a Smartphone App for Falls Reporting in Parkinson Disease. Phys Ther 2024; 104:pzad076. [PMID: 37369034 PMCID: PMC10851851 DOI: 10.1093/ptj/pzad076] [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: 10/10/2022] [Revised: 01/10/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The purpose of this study was to coproduce a smart-phone application for digital falls reporting in people with Parkinson disease (PD) and to determine usability using an explanatory mixed-methods approach. METHODS This study was undertaken in 3 phases. Phase 1 was the development phase, in which people with PD were recruited as co-researchers to the project. The researchers, alongside a project advisory group, coproduced the app over 6 months. Phase 2 was the implementation phase, in which 15 people with PD were invited to test the usability of the app. Phase 3 was the evaluation phase, in which usability was assessed using the systems usability scale by 2 focus groups with 10 people with PD from phase 2. RESULTS A prototype was successfully developed by researchers and the project advisory group. The usability of the app was determined as good (75.8%) by people with PD when rating using the systems usability scale. Two focus groups (n = 5 per group) identified themes of 1) usability, 2) enhancing and understanding management of falls, and 3) recommendations and future developments. CONCLUSIONS A successful prototype of the iFall app was developed and deemed easy to use by people with PD. The iFall app has potential use as a self-management tool for people with PD alongside integration into clinical care and research studies. IMPACT This is the first digital outcome tool to offer reporting of falls and near-miss fall events. The app may benefit people with PD by supporting self-management, aiding clinical decisions in practice, and providing an accurate and reliable outcome measure for future research. LAY SUMMARY A smartphone application designed in collaboration with people who have PD to record their falls was acceptable and easy to use by people with PD.
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Affiliation(s)
- Jill Wales
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jason Moore
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | | | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | | | | | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
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21
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Deja E, Donohue C, Semple MG, Woolfall K. Stakeholders' perspectives on clinical trial acceptability and approach to consent within a limited timeframe: a mixed methods study. BMJ Open 2024; 14:e077023. [PMID: 38167280 PMCID: PMC10773389 DOI: 10.1136/bmjopen-2023-077023] [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: 06/23/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES The Bronchiolitis Endotracheal Surfactant Study (BESS) is a randomised controlled trial to determine the efficacy of endo-tracheal surfactant therapy for critically ill infants with bronchiolitis. To explore acceptability of BESS, including approach to consent within a limited time frame, we explored parent and staff experiences of trial involvement in the first two bronchiolitis seasons to inform subsequent trial conduct. DESIGN A mixed-method embedded study involving a site staff survey, questionnaires and interviews with parents approached about BESS. SETTING Fourteen UK paediatric intensive care units. PARTICIPANTS Of the 179 parents of children approached to take part in BESS, 75 parents (of 69 children) took part in the embedded study. Of these, 55/69 (78%) completed a questionnaire, and 15/69 (21%) were interviewed. Thirty-eight staff completed a questionnaire. RESULTS Parents and staff found the trial acceptable. All constructs of the Adapted Theoretical Framework of Acceptability were met. Parents viewed surfactant as being low risk and hoped their child's participation would help others in the future. Although parents supported research without prior consent in studies of time critical interventions, they believed there was sufficient time to consider this trial. Parents recommended that prospective informed consent should continue to be sought for BESS. Many felt that the time between the consent process and intervention being administered took too long and should be 'streamlined' to avoid delays in administration of trial interventions. Staff described how the training and trial processes worked well, yet patients were missed due to lack of staff to deliver the intervention, particularly at weekends. CONCLUSION Parents and staff supported BESS trial and highlighted aspects of the protocol, which should be refined, including a streamlined informed consent process. Findings will be useful to inform proportionate approaches to consent in future paediatric trials where there is a short timeframe for consent discussions. TRIAL REGISTRATION NUMBER ISRCTN11746266.
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Affiliation(s)
- Elizabeth Deja
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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22
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Kaittila A, Isoniemi H, Viitasalo K, Moisio M, Raijas A, Toikka E, Tuominen J, Hakovirta M. A Pilot Randomized Controlled Trial of Intervention for Social Work Clients with Children Facing Complex Financial Problems in Finland (FinSoc): A Study Protocol. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:32-49. [PMID: 37712670 DOI: 10.1080/26408066.2023.2257174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE Social work clients often face complex financial problems. We have developed a financial social work intervention, FinSoc, to increase financial literacy and economic self-efficacy and reduce financial anxiety among parents with financial problems in Finland. The aim of this pilot randomized controlled trial is to explore the feasibility, acceptability, and preliminary effectiveness of the intervention. This paper, a study protocol, describes the design and implementation of the trial. Study protocols are articles detailing a priori the research plan, rationale, proposed methods and plans for how a clinical trial will be conducted. METHOD This study is a pilot randomized controlled trial with a mixed methods approach applying both quantitative measures and qualitative interviews. Participating social work clients with children are randomly assigned to either the treatment or the waiting list control group at a ratio of 1:1. The treatment group receives the intervention and the control group receives services as usual. The quantitative data from social work clients are collected at three measurement points. Qualitative interviews are conducted post-intervention with both clients receiving, and professionals implementing the intervention. The feasibility is assessed through recruitment and retention rates and the interviews with social work professionals providing the intervention. Acceptability is assessed through feedback from participants on satisfaction with the intervention and usefulness of the specific intervention components. Potential effectiveness is measured by financial literacy, economic self-efficacy and financial anxiety. DISCUSSION The intervention is hypothesized to increase financial literacy and economic self-efficacy and reduce financial anxiety among social work clients with children. The results of this pilot study will increase the evidence base of financial social work and offer new insights for developing interventions for clients experiencing financial difficulties.
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Affiliation(s)
| | | | - Katri Viitasalo
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Meri Moisio
- INVEST Flagship, University of Turku, Turku, Finland
| | - Anu Raijas
- Bank of Finland Museum, Bank of Finland, Helsinki, Finland
| | - Enna Toikka
- Department of Social Research, University of Turku, Turku, Finland
| | - Jarno Tuominen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Mia Hakovirta
- INVEST Flagship, University of Turku, Turku, Finland
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23
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Frawley E, Heary C, Berry C, Cella M, Fowler D, Wykes T, Donohoe G. Participant perspectives on cognitive remediation and social recovery in early psychosis (CReSt-R): An acceptability study. Early Interv Psychiatry 2024; 18:34-41. [PMID: 37186460 DOI: 10.1111/eip.13424] [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: 10/28/2022] [Revised: 02/12/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
AIM Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well-known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy. METHODS We employed a qualitative research design, based on semi-structured interviews and reflexive thematic analysis. Six participants with early psychosis were recruited from the intervention arm of a randomized pilot study, three women and three men, aged between 22 and 27 years. RESULTS Four themes were developed through the analytical process, namely, (1) a solid therapeutic foundation, (2) multi-directional flow of knowledge, (3) a tailored toolset, and (4) an individual pathway to recovery. Participants also provided pragmatic feedback about how to improve the delivery of the therapy assessments and intervention. Both the themes and pragmatic feedback are described. CONCLUSIONS People with early psychosis described the intervention as acceptable, engaging, helpful and person-centred, suggesting its potential role in a multicomponent therapy model of early intervention in psychosis services. Participants in this study also highlight the importance of an individualized approach to therapy, the vital role of the therapeutic relationship and the ecological validity and value of adopting an assertive outreach delivery, providing therapy outside a conventional clinic setting.
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Affiliation(s)
- Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Clio Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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Pattison N, O'Gara G, Thomas K, Wigmore T, Dyer J. An aromatherapy massage intervention on sleep in the ICU: A randomized controlled feasibility study. Nurs Crit Care 2024; 29:14-21. [PMID: 37533150 DOI: 10.1111/nicc.12957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
We conducted a feasibility randomized controlled trial exploring the effect of aromatherapy massage on sleep in critically ill patients. Patients were randomized to receive aromatherapy massage or usual care, and feasibility of recruitment and outcome data completion was captured. Sleep (depth) was assessed through Bispectral Index monitoring and self/nurse-reported Richards-Campbell Sleep Questionnaires, and the Sleep in the ICU Questionnaire. Thirty-four patients participated: 17 were randomized to aromatherapy massage and 17 to control. Five participants who received the intervention completed outcomes for analysis (alongside eight controls). A larger study was deemed unfeasible in this population, highlighting the value of testing feasibility of complex interventions, such as massage for sleep in ICU.
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Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | | | - Karen Thomas
- Intensive Care National Audit and Research Centre, London, UK
| | - Tim Wigmore
- Royal Marsden NHS Foundation Trust, London, UK
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Larisch LM, Kallings LV, Thedin Jakobsson B, Blom V. "It depends on the boss" - a qualitative study of multi-level interventions aiming at office workers' movement behaviour and mental health. Int J Qual Stud Health Well-being 2023; 18:2258564. [PMID: 37731364 PMCID: PMC10515662 DOI: 10.1080/17482631.2023.2258564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level. METHODS Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis. RESULTS The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult. CONCLUSIONS The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.
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Affiliation(s)
- Lisa-Marie Larisch
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
| | - Lena V. Kallings
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Britta Thedin Jakobsson
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Department of Movement, Culture and Society, Stockholm, Sweden
| | - Victoria Blom
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
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Bayes N, Mason C, Haycraft E, Holley CE. Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs. Public Health Nutr 2023; 26:2868-2881. [PMID: 37886798 PMCID: PMC10755445 DOI: 10.1017/s1368980023002276] [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: 02/12/2023] [Revised: 09/17/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices. DESIGN During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation). SETTING UK holiday clubs. PARTICIPANTS Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers). RESULTS Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers. CONCLUSIONS Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.
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Affiliation(s)
- Natasha Bayes
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, LiverpoolL69 7ZA, UK
| | - Carolynne Mason
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK
| | - Clare E Holley
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK
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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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Blake H, Chaplin WJ, Wainwright E, Taylor G, McNamee P, McWilliams D, Abbott-Fleming V, Holmes J, Fecowycz A, Walsh DA, Walker-Bone K. The Web-Based Pain-at-Work Toolkit With Telephone Support for Employees With Chronic or Persistent Pain: Protocol for a Cluster Randomized Feasibility Trial. JMIR Res Protoc 2023; 12:e51474. [PMID: 37902814 PMCID: PMC10644198 DOI: 10.2196/51474] [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: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Chronic or persistent pain affects one's ability to work or be productive at work, generating high societal and economic burden. However, the provision of work-related advice and support for people with chronic pain is variable or lacking. The Pain-at-Work (PAW) Toolkit was cocreated with people who live with pain, health care professionals, and employers. It aims to increase knowledge about employee rights and how to access support for managing a painful chronic condition in the workplace and provides advice on lifestyle behaviors that facilitate the management of chronic pain. OBJECTIVE We aimed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing access to the PAW Toolkit and telephone support calls from an occupational therapist (PAW) with treatment as usual (ie, standard support from their employer). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, and safety of this digital workplace health intervention. We will assess the candidate primary and secondary outcomes' feasibility and test research processes for a definitive trial. METHODS This is an open-label, parallel 2-arm pragmatic feasibility cluster randomized controlled trial with exploratory health economics analysis and a nested qualitative interview study. We aim to recruit 120 participants from at least 8 workplace clusters (any type, >10 employees) in England. The recruitment of workplaces occurs via personal approach, and the recruitment of individual participants is web based. Eligible participants are vocationally active adults aged ≥18 years with internet access and self-reporting chronic pain interfering with their ability to undertake or enjoy productive work. A restricted 1:1 cluster-level randomization is used to allocate employment settings to PAW or treatment as usual; participants are unblinded to group allocation. Following site- and individual-level consent, participants complete a web-based baseline survey (time 0), including measures of work capacity, health and well-being, and health care resource use. Follow-up is performed at 3 months (time 1) and 6 months (time 2). Feasibility outcomes relate to recruitment; intervention fidelity (eg, delivery, reach, uptake, and engagement); retention; and follow-up. Qualitative evaluation (time 2) is mapped to the Capability, Opportunity, Motivation-Behavior model and will explore intervention acceptability to employees and employers, along with individual and contextual factors influencing the delivery and uptake of the intervention. RESULTS Ethics approval was obtained in March 2023. Trial recruitment began in June 2023. CONCLUSIONS The PAW Toolkit is the first evidence-based digital health intervention aimed at supporting the self-management of chronic or persistent pain at work. This study will inform the design of a definitive trial, including sample size estimation, approaches to cluster site identification, primary and secondary outcomes' selection, and the final health economic model. Findings will inform approaches for the future delivery of this digital health intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05838677; https://clinicaltrials.gov/study/NCT05838677. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51474.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Wendy J Chaplin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jain Holmes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Aaron Fecowycz
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David Andrew Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Karen Walker-Bone
- School of Public Health and Preventive Medicine, Monash University, Australia, United Kingdom
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Hagström N, Lövestam E, Koochek A, Berntson L. A qualitative evaluation of the specific carbohydrate diet for juvenile idiopathic arthritis based on children's and parents' experiences. Pediatr Rheumatol Online J 2023; 21:127. [PMID: 37858222 PMCID: PMC10588234 DOI: 10.1186/s12969-023-00914-8] [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: 08/19/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Insights into the immunological role of the gastrointestinal tract in autoimmune conditions have led to the investigation of diet as a potential adjunctive treatment option for juvenile idiopathic arthritis (JIA). The specific carbohydrate diet (SCD) has shown promising results. However, studies on participants' experiences of dietary interventions in JIA are rare. In this study we investigated the experiences of children and parents' who had participated in a four-week intervention with SCD aiming to examine the potential anti-inflammatory effects. OBJECTIVES To conduct a qualitative evaluation exploring children's and parents' experiences of the dietary intervention, how they navigated challenges, and their support requirements. METHODS Semi-structured interviews were conducted with 12 children and 15 parents from 13 families, who were interviewed individually and together. The transcripts were analysed using systematic text condensation. RESULTS Most participants interviewed found the intervention beneficial, with 12 out of 13 reporting positive effects, such as reduced pain and morning stiffness, and improved gastrointestinal function. Many participants reported being willing to repeat the intervention in the current form. Despite facing challenges, all children followed the diet for one to three months, with some continuing to follow a modified version. Facing the socio-emotional consequences of adhering to the diet was challenging for children. These were handled by focusing on the positive aspects and by relying on the supportive environment available. Parents struggled with practical issues since the diet required hard work, time, and money. Areas identified as requiring additional support include finding simple, quick, and child-friendly solutions, strengthening organizational food skills such as meal planning, and preparation prior to starting the intervention regarding socio-emotional aspects. CONCLUSION Navigating the dietary treatment was considered challenging, practically for the parents and socio-emotionally for the children. Based on the reported challenges and participants' suggestions the intervention could be optimised by providing support and solutions in relation to the practical issues and better preparation regarding dealing with the socio-emotional consequences. Despite the difficulties, the participants reported overall positive experiences of, and attitudes towards, the current setup. Consequently, dietary interventions, such as the SCD, may be regarded as suitable targets for further research.
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Affiliation(s)
- Naima Hagström
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Afsaneh Koochek
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Wright C, Kelly JT, Byrnes J, Campbell KL, Healy R, Musial J, Hamilton K. A non-randomised feasibility study of a mHealth follow-up program in bariatric surgery. Pilot Feasibility Stud 2023; 9:176. [PMID: 37848959 PMCID: PMC10580544 DOI: 10.1186/s40814-023-01401-3] [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: 12/08/2022] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Behavioural support via mobile health (mHealth) is emerging. This study aimed to assess the feasibility, acceptability, cost, and potential effect on weight of a mHealth follow-up program in bariatric surgery. METHODS This was a non-randomised feasibility study describing intervention development and proof in the concept of a mHealth follow-up program in bariatric surgery. The study compares a prospective cohort with a historical control group and was conducted in a tertiary bariatric surgery service in Australia. The intervention group included individuals who had bariatric surgery (2019-2021) and owned a smart device, and the historical control group received usual postoperative care (2018). The intervention involved usual care plus codesigned biweekly text messages, monthly email newsletters, and online resources/videos over a 6-month period. The primary outcome measures included feasibility (via recruitment and retention rate), acceptability (via mixed methods), marginal costs, and weight 12 months postoperatively. Quantitative analysis was performed, including descriptive statistics and inferential and regression analysis. Multivariate linear regression and mixed-effects models were undertaken to test the potential intervention effect. Qualitative analysis was performed using inductive content analysis. RESULTS The study included 176 participants (n = 129 historical control, n = 47 intervention group; mean age 56 years). Of the 50 eligible patients, 48 consented to participate (96% recruitment rate). One participant opted out of the mHealth program entirely without disclosing their reason (98% retention rate). The survey response rate was low (n = 16/47, 34%). Participants agreed/strongly agreed that text messages supported new behaviours (n = 13/15, 87%); however, few agreed/strongly agreed that the messages motivated goal setting and self-monitoring (n = 8/15, 53%), dietary change (n = 6/15, 40%), or physical activity (n = 5/15, 33%). Interviews generated four main themes (n = 12): 'motivators and expectations', 'preferences and relevance', 'reinforced information", and 'wanting social support'. The intervention reinforced information, email newsletters were lengthy/challenging to read, and text messages were favoured, yet tailoring was recommended. The intervention cost AUD 11.04 per person. The mean 12-month weight was 86 ± 16 kg and 90 ± 16 kg (intervention and historical control) with no statistically significant difference. Intervention recipients enrolled at 3 months postoperatively demonstrated a statistically significant difference in 12-month weight (p = 0.014). CONCLUSION Although this study observed high rates of recruitment and retention, findings should be considered with caution as mHealth may have been embraced more by the intervention cohort as a result of the 2019 coronavirus pandemic. Of the various digital strategies developed and tested, the text message approach was the most acceptable; however, future intervention iterations could be strengthened through tailoring information when possible. The use of email newsletters and online resources/videos requires further testing of effectiveness to determine their value for continued use in bariatric surgery services.
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Affiliation(s)
- Charlene Wright
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia.
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, Australia
| | - Katrina L Campbell
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Butterfield St, Herston, QLD, Australia
| | - Rebecca Healy
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, Australia
| | - Jane Musial
- Nutrition and Dietetics Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD, 4122, Australia
- Health Sciences Research Institute, University of California, 5200 Lake Road, Merced, CA, 95343, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Johnson RW, White BK, Gibson N, Gucciardi DF, Williams SA. A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability. Phys Occup Ther Pediatr 2023; 44:586-603. [PMID: 37814984 DOI: 10.1080/01942638.2023.2263576] [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] [Received: 01/16/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
AIM Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app). METHOD A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods. RESULTS Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of "app as motivator" for therapy. CONCLUSIONS Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.
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Affiliation(s)
- Rowan W Johnson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Therapy Services, Ability WA, Perth, Australia
| | - Becky K White
- Curtin School of Population Health, Curtin University, Perth, Australia
- Reach Health Promotion Innovations, Perth, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Physiotherapy, Perth Children's Hospital, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sîan A Williams
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Pearce G, Holliday N, Sandhu H, Eftekhari H, Bruce J, Timms E, Ablett L, Kavi L, Simmonds J, Evans R, Magee P, Powell R, Keogh S, McGregor G. Co-creation of a complex, multicomponent rehabilitation intervention and feasibility trial protocol for the PostUraL tachycardia Syndrome Exercise (PULSE) study. Pilot Feasibility Stud 2023; 9:143. [PMID: 37582801 PMCID: PMC10426060 DOI: 10.1186/s40814-023-01365-4] [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: 03/01/2023] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND There is a dearth of research to support the treatment of people with postural tachycardia syndrome (PoTS). Despite expert consensus suggesting exercise is recommended for this patient group, there are no randomised control trials examining this rigorously. The aim was to co-create a feasibility trial protocol and a rehabilitation intervention for people living with PoTS. METHODS The intervention and feasibility trial design were co-created as part of the PostUraL tachycardia Syndrome Exercise (PULSE) study. We used the 'three co's framework' of co-define, co-design and co-refine. Recruitment included key national charities and National Health Service Trusts treating people living with PoTS in the UK. Eighteen patient and public involvement members attended the co-define session, and 16 co-creators with a mix of expertise attended the subsequent co-design and co-refine sessions. Seven intervention practitioners were trained in the rehabilitation intervention, providing feedback for further co-refinement. RESULTS The final co-created intervention comprises online physical activity, and lifestyle and behaviour change support sessions. It is based on functional movement activities using a patient-centred approach tailored to individual needs. Physical activity intensity is guided by individuals' perception of effort rather than by objective measures. Recumbent bikes are provided for home use. Patients deemed randomisation to be acceptable because research in this area was considered important. CONCLUSIONS An innovative approach was used to co-create the PULSE intervention and feasibility trial protocol to meet the evidence-based and logistical needs of people living with PoTS, clinicians, service deliverers, third-sector organisations, academics and funders. This can be used as a successful example and template for future research internationally. People living with PoTS were recognised as experts and involved in every aspect of conceptualisation, design and refinement. This complex rehabilitation intervention is currently being tested in a randomised feasibility trial comparing the PULSE intervention with best-practice usual care for people living with PoTS. TRIAL REGISTRATION ISRCTN45323485 was registered on April 7, 2020.
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Affiliation(s)
| | | | | | - Helen Eftekhari
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Julie Bruce
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Emma Timms
- Patient and Public Involvement, Coventry University, Coventry, UK
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Laura Ablett
- Patient and Public Involvement, Coventry University, Coventry, UK
| | | | | | - Rebecca Evans
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Richard Powell
- Coventry University, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Gordon McGregor
- Coventry University, Coventry, UK
- University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Adamson B, Wyatt N, Key L, Boone C, Motl RW. Results of the MOVE MS Program: A Feasibility Study on Group Exercise for Individuals with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6567. [PMID: 37623153 PMCID: PMC10454660 DOI: 10.3390/ijerph20166567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Exercise improves a wide range of symptoms experienced by those living with multiple sclerosis (MS) and may foster community and a positive sense of disability identity. However, exercise rates remain low. Sustained exercise participation has the greatest likelihood of improving symptoms and requires a theory-based approach accounting for the barriers faced by people with MS that impede exercise participation long-term. MOVE MS is a once weekly group exercise program based on Social Cognitive Theory supporting long-term exercise participation through peer instruction, behavior change education, multiple exercise modalities, and seated instruction. This feasibility study evaluated MOVE MS with a 7-month trial. The primary scientific outcome was exercise participation and the secondary outcomes were MS symptoms/impact, self-efficacy, depression, anxiety, disability identity, and quality of life, among others. We further conducted semi-structured formative interviews post-intervention. Thirty-three participants began the program. The onset of COVID-19 necessitated a shift toward online delivery. Seventeen participants completed the program. There were non-significant improvements in exercise participation (Godin Leisure-Time Exercise Questionnaire, baseline mean = 14.2 (SD = 11.8), post-intervention mean = 16.6 (SD = 11.2), F-value = 0.53 (Partial Eta2 = 0.08), and several secondary outcomes (including the MS Impact Scale, MS Walking Scale, and the Leeds MS Quality of Life Scale). Sixteen participants were interviewed, and analysis yielded five themes on program components and feedback. MOVE MS-delivered in-person or online-may be a feasible option for long-term exercise programming for people with MS.
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Affiliation(s)
- Brynn Adamson
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Nic Wyatt
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Latashia Key
- Department of Recreation, Sport, and Tourism, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Carrena Boone
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1200 West Harrison St., Chicago, IL 60607, USA
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Husain N, Lunat F, Lovell K, Sharma D, Zaidi N, Bokhari A, Syed A, Tomenson B, Islam A, Chaudhry N, Waheed W. Exploratory RCT of a group psychological intervention for postnatal depression in British mothers of South Asian origin - ROSHNI-D. Acta Psychol (Amst) 2023; 238:103974. [PMID: 37413896 PMCID: PMC10415672 DOI: 10.1016/j.actpsy.2023.103974] [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: 01/18/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND. METHODS The study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation. RESULTS Using an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores. LIMITATIONS The sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations. CONCLUSION The recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group. TRIAL REGISTRATION Clinicaltrials.govNCT01838889.
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Affiliation(s)
- Nusrat Husain
- The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Farah Lunat
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Lantern Centre, Vicarage Lane, Fulwood PR2 5NT, United Kingdom.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Deepali Sharma
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nosheen Zaidi
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Asad Bokhari
- Cheetamhill Medical Centre, 244 Cheetham Hill Rd, Cheetham Hill, Manchester M8 8UP, United Kingdom
| | - Aleena Syed
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Barbara Tomenson
- School of Health Sciences, The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Anharul Islam
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Dow University of Health Sciences, Pakistan
| | - Waquas Waheed
- Centre for Primary Care and Health Services Research, Williamson Building, The University of Manchester, M13 9PL, United Kingdom
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Plazy M, Doucet MH, Timbo Songbono C, Sanon A, Issiaka B, Martin C, Da I, L'hostellier A, Marcy O, Malvy D, Poda A, Delamou A, Berthé A, Orne-Gliemann J. Acceptability and feasibility of home and hospital follow-up in Burkina Faso and Guinea: A mixed-method study among patients of the COVID-19 Coverage-Africa clinical trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001545. [PMID: 37437024 DOI: 10.1371/journal.pgph.0001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
Patient experiences and perspectives on trial participation and follow-up may influence their compliance with research procedures or negatively impact their well-being. We aimed to explore the acceptability and feasibility of home-based and hospital-based follow-up modalities among COVID-19 patients enrolled in the ANTICOV ANRS COV33 Coverage-Africa trial in Burkina Faso and Guinea. The trial (2021-2022) evaluated the efficacy of treatments to prevent clinical worsening among COVID-19 patients with mild to moderate symptoms. Patients were either based at home or hospitalized, as per national recommendations, and followed-up through face-to-face visits and phone calls. We conducted a mixed-methods sub-study administering a questionnaire to all consenting participants and individually interviewing purposively selected participants. We performed descriptive analyses of Likert scale questions for the questionnaires and thematic analysis for the interviews. We conducted framework analysis and interpretation. Of the 400 trial patients, 220 completed the questionnaire (n = 182 in Burkina Faso, n = 38 in Guinea) and 24 were interviewed (n = 16 and n = 8, respectively). Participants were mostly followed-up at home in Burkina Faso; all patients from Guinea were first hospitalized, then followed-up at home. Over 90% of participants were satisfied with follow-up. Home follow-up was considered acceptable if (i) participants perceived they were not severely ill, (ii) it was combined with telemedicine, and (iii) the risk of stigma could be avoided. Hospital-based follow-up was viewed as a way to prevent contamination of family members, but could be badly experienced when mandatory and conflicting with family responsibilities and commitments. Phone calls were seen as reassuring and as a way to ensure continuity of care. These overall positive findings support the development of home-based follow-up for mildly ill patients in West-Africa, provided that both emotional and cognitive factors at individual, familial/inter-relational, healthcare and national levels be addressed when planning the implementation of a trial, or developing any public health strategy.
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Affiliation(s)
- Mélanie Plazy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Marie-Hélène Doucet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Christine Timbo Songbono
- African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- The Alliance for International Medical Action (ALIMA), Conakry, Republic of Guinea
| | - Anselme Sanon
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Bamba Issiaka
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Caroline Martin
- The Alliance for International Medical Action (ALIMA), Conakry, Republic of Guinea
| | - Inès Da
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Anthony L'hostellier
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Olivier Marcy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Denis Malvy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Division of Tropical Medicine and Clinical International Health, Department of Infectious Diseases and Tropical Medicine, CHU Pellegrin, Bordeaux, France
| | - Armel Poda
- Superior Institute of Health Sciences, Nazi Boni University, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Alexandre Delamou
- African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Abdramane Berthé
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Joanna Orne-Gliemann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
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Ortega-Martínez A, Palomo-Carrión R, Varela-Ferro C, Bagur-Calafat MC. Feasibility of a Home-Based Mirror Therapy Program in Children with Unilateral Spastic Cerebral Palsy. Healthcare (Basel) 2023; 11:1797. [PMID: 37372915 DOI: 10.3390/healthcare11121797] [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: 04/30/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children's bimanual performance and quality of life. Intensive home-based therapies have been developed and have demonstrated their feasibility for children with US CP and their parents, especially when therapies are designed with the proper coaching of families. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy suitable for children with US CP. The aim of this study is to analyze the feasibility of a five-week home-based program of MT for children with US CP that includes coaching by the therapist. Six children aged 8-12 years old performed the therapy for five days per week, 30 min per day. A minimum of 80% of compliance was required. The feasibility included compliance evaluations, total dosage, perceived difficulty of the exercises, and losses of follow-ups. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2.37 to 4.51 out of 10. In conclusion, a home-based program of Mirror Therapy is a safe, cost-efficient, and feasible therapy for children with US CP when the therapist is involved as a coach during the entire program.
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Affiliation(s)
- Anna Ortega-Martínez
- Physiotherapy Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Physiotherapy Department, Fundació Aspace Catalunya, 08038 Barcelona, Spain
| | - Rocío Palomo-Carrión
- Physiotherapy Department, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
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Alvarez M, Hotton EJ, Harding S, Ives J, Crofts JF, Wade J. Women's and midwives' views on the optimum process for informed consent for research in a feasibility study involving an intrapartum intervention: a qualitative study. Pilot Feasibility Stud 2023; 9:98. [PMID: 37322539 DOI: 10.1186/s40814-023-01330-1] [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: 12/19/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Recruitment to intrapartum research is complex. Women are expected to understand unfamiliar terminology and assess potential harm versus benefit to their baby and themselves, often when an urgent intervention is required. Time pressures of intrapartum interventions are a major challenge for recruitment discussions taking place during labour, with research midwives expected to present, discuss and answer questions whilst maintaining equipoise. However, little is known about these interactions. An integrated qualitative study (IQS) was used to investigate information provision for women invited to participate in the Assist II feasibility study investigating the OdonAssist™-a novel device for use in assisted vaginal birth with an aim to generate a framework of good practice for information provision. METHODS Transcripts of in-depth interviews with women participants (n = 25), with recruiting midwives (n = 6) and recruitment discussions between midwives and women (n = 21), accepting or declining participation, were coded and interpreted using thematic analysis and content analysis to investigate what was helpful to women and what could be improved. RESULTS Recruiting women to intrapartum research is complicated by factors that impact on women's understanding and decision-making. Three key themes were derived from the data: (i) a woman-centred recruitment process, (ii) optimising the recruitment discussion and (iii) making a decision for two. CONCLUSION Despite evidence from the literature that women would like information provision and the research discussion to take place in the antenatal period, intrapartum studies still vary in the recruitment processes they offer women. Particularly concerning is that some women are given information for the first time whilst in labour, when they are known to feel particularly vulnerable, and contextual factors may influence decision-making; therefore, we propose a framework for good practice for information provision for research involving interventions initiated in the intrapartum period as a woman centred, and acceptable model of recruitment, which addresses the concerns of women and midwives and facilitates fair inclusion into intrapartum trials. TRIAL REGISTRATION ISRCTN. This qualitative research was undertaken as part of the ASSIST II Trial (trial registration number: ISRCTN38829082. Prospectively registered on 26/06/2019).
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Affiliation(s)
- Mary Alvarez
- Department of Women's and Children's Health, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, UK.
- Bristol Medical School, Bristol University, BS8 2PS, Bristol, UK.
| | - Emily J Hotton
- Department of Women's and Children's Health, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, UK
- Translational Health Sciences, Bristol University, Bristol, UK
| | - Sam Harding
- Department of Women's and Children's Health, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, UK
- Research and Innovation, Learning and Research Building, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, UK
| | - Jonathan Ives
- Bristol Medical School, Bristol University, BS8 2PS, Bristol, UK
- Centre for Ethics in Medicine, Bristol University, Bristol, UK
| | - Joanna F Crofts
- Department of Women's and Children's Health, Southmead Hospital, North Bristol NHS Trust, BS10 5NB, Bristol, UK
| | - Julia Wade
- Bristol Medical School, Bristol University, BS8 2PS, Bristol, UK
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Svendsen EJ, Killi EM, Rohrer-Baumgartner N, Holthe IL, Sandhaug M, Borgen IMH, Wade SL, Hauger SL, Løvstad M, Bragstad LK. Children's, parents', and teachers' experiences of the feasibility of a telerehabilitation intervention for children with acquired brain injury in the chronic phase - a qualitative study of acceptability and participation in the Child In Context Intervention (CICI). BMC Health Serv Res 2023; 23:603. [PMID: 37291543 DOI: 10.1186/s12913-023-09589-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: 10/14/2022] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This is a qualitative feasibility study of the Child in Context Intervention (CICI). The CICI is an individualized, goal-oriented and home-based tele-rehabilitation intervention which targets everyday functioning of children (6-16 years) with acquired brain injury in the chronic stage, and their families, one year or more after insult, who have ongoing challenges (physical, cognitive, behavioral, social and/or psychological). The aim of this study is to better understand how children, parents and teachers experienced participation and acceptability; to develop knowledge about the mechanisms of change, and to explore how the CICI was tailored to the context. METHODS Six families and schools participated in the intervention, which comprised seven tele-rehabilitation sessions in which the child and parent participated, one in-person parent seminar and four digital school meetings. A multidisciplinary team delivered the intervention to 23 participants over a 4- to 5-month period. The intervention involved psychoeducation about targeted acquired brain injury-related problems, such as fatigue, pain, or social challenges. All but one consented to participate in the current digital interview study. The data were analyzed using content analysis. RESULTS The experience of participation and acceptability varied among the children. Attendance was consistently high; the child participants felt mostly listened to and could influence goal setting and strategies. However, engaging and motivating the child participants proved somewhat challenging. The parents found the CICI rewarding, useful and relevant. However, they had different experiences regarding which intervention component they perceived as most helpful. Some argued in favor of the 'whole intervention', while others highlighted new knowledge, SMART goals or the school collaboration. The teachers found the intervention acceptable and useful but wanted a better meeting plan. They had difficulties in finding time for meetings, emphasized the involvement of school leaders, and appreciated the digital format. CONCLUSIONS Overall, the intervention was perceived as acceptable, and the participants felt that the various intervention components contributed to improvements. The CICI's flexibility facilitated tailoring to different contexts based on the children's functional level. The digital format saved time and provided flexibility regarding the amount of attendance but limited full participation from children with more severe cognitive impairments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04186182.
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Affiliation(s)
- Edel Jannecke Svendsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.
- Oslo Metropolitan University, Oslo, Norway.
- CHARM - Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eli Marie Killi
- Department of Profession Strategy and Knowledge Brokering, Norwegian Service for Special Needs Education, Oslo, Norway
| | | | - Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Maria Sandhaug
- Department of Profession Strategy and Knowledge Brokering, Norwegian Service for Special Needs Education, Oslo, Norway
| | - Ida M H Borgen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, OH, 45229, Cincinnati, USA
- University of Cincinnati College of Medicine, OH, Cincinnati, USA
| | - Solveig Laegreid Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Line Kildal Bragstad
- Oslo Metropolitan University, Oslo, Norway
- CHARM - Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ferreira G, Bernardo AC, Carvalho A, Pereira MG. Relax to Heal? Perspectives of Patients with Diabetic Foot Ulcers and Health Professionals on Relaxation Sessions for Wound Healing. Adv Skin Wound Care 2023; 36:1-10. [PMID: 37017401 DOI: 10.1097/01.asw.0000922832.62539.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To explore patients' and healthcare professionals' (HPs') perspectives on the suitability/acceptability of a relaxation intervention, its effects on patients' well-being and diabetic foot ulcer (DFU) healing, and its incorporation into the multidisciplinary management of patients with diabetic foot. METHODS This qualitative study was nested within a three-arm pilot randomized controlled trial. Patients with a chronic DFU received four relaxation sessions. Investigators then interviewed patients, physicians, and nurses involved with diabetic foot consultations. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. RESULTS Five themes emerged from patient's interviews about the suitability/acceptability of the relaxation intervention: perceptions regarding the psychological intervention, distress, the relaxation technique, changes in the patient's life, and changes in DFU/contribution to healing. Three themes emerged from interviews with HPs: perceptions regarding relaxation, changes in the patient, and changes in DFU/healing. Regarding the feasibility of the relaxation intervention, three themes emerged for both patients and HPs: suggested modifications, stressors/difficulties, and impact of COVID-19 pandemic. The utility theme emerged only in HP interviews, with subthemes of patients' distress, psychological interventions, relaxation intervention, and integration of the psychologist in the team. CONCLUSIONS These findings provide evidence for the suitability/acceptability, feasibility, and utility of a relaxation intervention in diabetic foot consultations.
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Affiliation(s)
- Gabriela Ferreira
- At the Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal, Gabriela Ferreira, PhD, is Research Collaborator, Health & Family Research Group; and Ana Cristina Bernardo, MSc, is PhD Student in Psychology. André Carvalho, MD, PhD, is a Consultant in Endocrinology and Diabetes, at Centro Hospitalar Universitário do Porto. M. Graça Pereira, PhD, is the Coordinator of the Health, Well-being and Performance Research Lab, and the coordinator of the Health & Family Research Group in the Psychology Research Centre. She is also an Associate Professor with Habilitation in the School of Psychology, University of Minho
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Johnsen H, Lichtenberg VD, Rydahl E, Karentius SM, Dueholm SCH, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, Juhl M. The Feasibility and Acceptability of the Adverse Childhood Experiences Questionnaire in Danish Antenatal Care-A Qualitative Study of Midwives' Implementation Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105897. [PMID: 37239623 DOI: 10.3390/ijerph20105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | | | - Mette Grønbæk Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Katrine Røhder
- Institute for Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen K, Denmark
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
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Maas J, Simeunovic-Ostojic M, Bodde NMG. Is a dissonance-based group intervention targeting thin-ideal internalization a successful potential add-on for specialized eating disorder care? A randomized feasibility and acceptability pilot study. J Eat Disord 2023; 11:68. [PMID: 37131211 PMCID: PMC10152706 DOI: 10.1186/s40337-023-00784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Dissonance-based eating disorder programs have successfully targeted body dissatisfaction by challenging the thin beauty ideal in the preventive context and in groups of patients with a subthreshold and full threshold DSM-5 eating disorder. As there is a need for interventions specifically targeting thin-ideal internalization in (highly) specialized treatment centres, the present study adapted Stice's et al.'s Body Project for its use as an add-on treatment for severe eating disorders with the aims to identify whether it was feasible and acceptable in this treatment context, to determine any necessary modifications with regard to the treatment and study procedures, and to test preliminary effectiveness. METHODS The study was a randomized controlled pilot/feasibility trial. Thirty patients started in the Body Project group and 25 in the Psycho-education group. Measurements took place pre- and post-intervention, and at three and six months follow-up. Patients and staff evaluated treatment and study procedures, and patients completed questionnaires on thin-ideal internalization, body dissatisfaction, self-objectification, negative affect and eating disorder pathology. RESULTS The Body Project group and Psycho-education group both proved highly feasible and acceptable, as well as preliminarily effective, based on quantitative scores and qualitative feedback. Preliminary analyses showed that treatment effects did not differ between treatment groups. As both groups were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. Qualitative feedback for the Body Project group included several recommendations for future implementation: increasing the number of treatment sessions, creating homogeneous therapy groups, and optimizing timing of the treatment. CONCLUSIONS Future research should examine further modifications to the Body Project group for severe eating disorders, as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group. We tested the feasibility and acceptability of a group intervention targeting the thin beauty ideal (Body Project group) in patients with severe eating disorders and compared this intervention to a group intervention focusing on psycho-education about eating disorders (Psycho-education group). Both interventions were added to standard treatment. We adapted the protocol for patients with severe eating disorders. Both the Body Project group and the Psycho-education group were evaluated by patients as well as staff as highly feasible and acceptable, and effects were positive. Treatment effects did not differ between treatment groups. As both treatments were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. The study suggested further modifications to the Body Project group. Future research should examine these modifications as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group.
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Affiliation(s)
- Joyce Maas
- Centre for Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA, Helmond, The Netherlands.
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.
| | | | - Nynke M G Bodde
- Centre for Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA, Helmond, The Netherlands
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Airody A, Baseler HA, Seymour J, Allgar V, Mukherjee R, Downey L, Dhar-Munshi S, Mahmood S, Balaskas K, Empeslidis T, Hanson RLW, Dorey T, Szczerbicki T, Sivaprasad S, Gale RP. The MATE trial: a multicentre, mixed-methodology, pilot, randomised controlled trial in neovascular age-related macular degeneration. Pilot Feasibility Stud 2023; 9:63. [PMID: 37081576 PMCID: PMC10116669 DOI: 10.1186/s40814-023-01288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND/OBJECTIVES In healthcare research investigating complex interventions, gaps in understanding of processes can be filled by using qualitative methods alongside a quantitative approach. The aim of this mixed-methods pilot trial was to provide feasibility evidence comparing two treatment regimens for neovascular age-related macular degeneration (nAMD) to inform a future large-scale randomised controlled trial (RCT). SUBJECTS/METHODS Forty-four treatment-naïve nAMD patients were followed over 24 months and randomised to one of two treatment regimens: standard care (SC) or treat and extend (T&E). The primary objective evaluated feasibility of the MATE trial via evaluations of screening logs for recruitment rates, nonparticipation and screen fails, whilst qualitative in-depth interviews with key study staff evaluated the recruitment phase and running of the trial. The secondary objective assessed changes in visual acuity and central retinal thickness (CRT) between the two treatment arms. RESULTS The overall recruitment rate was 3.07 participants per month with a 40.8% non-participation rate, 18.51% screen-failure rate and 15% withdrawal/non-completion rate. Key themes in the recruitment phase included human factors, protocol-related issues, recruitment processes and challenges. Both treatment regimens showed a trend towards a visual acuity gain at month 12 which was not maintained at month 24, whilst CRT reduced similarly in both regimens over the same time period. These were achieved with one less treatment following a T&E regimen. CONCLUSION This mixed-methodology, pilot RCT achieved its pre-defined recruitment, nonparticipation and screen failure rates, thus deeming it a success. With some minor protocol amendments, progression to a large-scale RCT will be achievable.
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Affiliation(s)
- Archana Airody
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK.
| | - Heidi A Baseler
- Department of Psychology, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Julie Seymour
- Hull York Medical School, University of Hull, Hull, UK
| | - Victoria Allgar
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | | | - Sushma Dhar-Munshi
- Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | | | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Theo Empeslidis
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachel L W Hanson
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK
| | - Tracey Dorey
- Research and Development, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Tom Szczerbicki
- Research and Development, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK
- Hull York Medical School, University of York, York, UK
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Mellor K, Albury C, Dutton SJ, Eldridge S, Hopewell S. Recommendations for progression criteria during external randomised pilot trial design, conduct, analysis and reporting. Pilot Feasibility Stud 2023; 9:59. [PMID: 37061720 PMCID: PMC10105402 DOI: 10.1186/s40814-023-01291-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/30/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND External randomised pilot trials aim to assess whether a future definitive Randomised Controlled Trial (RCT) is feasible. Prespecified progression criteria help guide the interpretation of pilot trial findings to decide whether, and how, a definitive RCT should be conducted. This commentary presents a set of proposed recommendations for progression criteria to guide researchers when (i) designing, (ii) conducting, (iii) analysing and (iv) reporting external randomised pilot trials. METHODS Recommendations were developed following a mixed methods approach. This involved (i) a methodological review of pilot trial publications, (ii) a cross-sectional study of pilot trial research funding applications, (iii) qualitative interviews with pilot trial researchers and (iv) a survey of corresponding authors of identified pilot trial publications. Initial recommendations were refined following two consultation stakeholder workshops held in July 2022. Recommendations for progression criteria for external randomised pilot trials: i. DESIGN consider progression criteria from the earliest opportunity; map progression criteria to feasibility objectives; consider quantitative and qualitative interpretations of feasibility; provide justification; develop guidelines rather than rules; seek input from relevant stakeholders. ii. Conduct: regularly monitor pilot trial data against progression criteria. iii. ANALYSIS avoid considering each progression criterion in isolation; engage in discussion with relevant stakeholders; consider context and other factors external to the pilot trial; consider feasibility (can we?) and progression (will we?). iv. Reporting: we propose a reporting checklist in relation to progression criteria and recommend reporting in a table format for clarity. CONCLUSION These recommendations provide a helpful resource for researchers to consider progression criteria at different stages of external randomised pilot trials. We have produced a simple infographic tool to summarise these recommendations for researchers to refer to. Further research is needed to evaluate whether these proposed recommendations should inform future development, or update, of established guidelines for the design, conduct, analysis and reporting of external randomised pilot trials.
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Affiliation(s)
- Katie Mellor
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England.
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Sandra Eldridge
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
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Ryan D, Rio E, O'Donoghue G, O'Sullivan C. "I've got a spring in my step" participants experience of action observation therapy and eccentric exercises, a telehealth study for mid-portion Achilles Tendinopathy: a qualitative study. J Foot Ankle Res 2023; 16:19. [PMID: 37041594 PMCID: PMC10088142 DOI: 10.1186/s13047-023-00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Quantitative research has dominated the field of Achilles Tendinopathy. The use of qualitative research allows in-depth exploration of participants' perspectives, offering great insight in the evaluation of a trial's processes, particularly when exploring a novel intervention such as Action Observation Therapy combined with eccentric exercises which has not been previously researched. This study aimed to qualitatively explore participants' experiences of partaking in a telehealth study including the acceptability of the intervention, motivators for participation, and perspectives on the trial processes. METHOD A thematic analysis as guided by Braun and Clarke was used to analyse the semi-structured interviews conducted on a purposive sample of participants with mid-portion Achilles Tendinopathy who recently completed a pilot feasibility study. The study adhered to the criteria for reporting qualitative research guidelines (COREQ). RESULTS/DISCUSSION Sixteen participants were interviewed. The five themes identified were: (i) The impact of Achilles Tendinopathy is commonly not prioritised with 'The acceptance and minimisation of pain' as a sub-theme (ii) Therapeutic alliance has the greatest impact on support (iii) Factors which influenced adherence (iv) Action Observation Therapy is valued and recommended (v) Recommendations for future interventions. CONCLUSION This study provides insightful recommendations around; exploring the use of Action Observation Therapy in Achilles Tendinopathy, the relative importance of therapeutic alliance rather than mode of therapy delivery, and that sufferers of Achilles Tendinopathy may not prioritise health seeking for this condition.
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Affiliation(s)
- Deirdre Ryan
- UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.
| | - Ebonie Rio
- UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- School of Allied Health, La Trobe University Melbourne, Melbourne, Australia
| | - Grainne O'Donoghue
- UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Cliona O'Sullivan
- UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
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Samper-Ternent R, Silveira SL, Stevens A, Volpi E, Naik AD. Considerations When Designing and Implementing Pragmatic Clinical Trials That Include Older Hispanics. Ethn Dis 2023; 33:76-83. [PMID: 38845738 PMCID: PMC11145730 DOI: 10.18865/ed.33.2-3.076] [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] [Indexed: 06/09/2024] Open
Abstract
Introduction Pragmatic clinical trials (PCTs) are designed to connect researchers with clinicians to assess the real-world effectiveness and feasibility of interventions, treatments, or health care delivery strategies in routine practice. Within PCTs larger, more representative sampling is possible to improve the external validity of the research. Older adults from underrepresented groups can benefit from PCTs given their historically lower engagement in clinical research. The current article focuses on older Hispanic adults with Alzheimer disease and related dementias (ADRDs). Older Hispanic adults represent 19% of the US population and have a higher prevalence of ADRDs than Whites. We provide data from 2 PCTs about the recruitment of older Hispanics with ADRDs and discuss unique challenges associated with conducting PCTs and propose strategies to overcome challenges. Data and Methods The first PCT outlined is the Patient Priorities Care for Hispanics with Dementia (PPC-HD) trial. PPC-HD is testing the feasibility of implementing a culturally adapted version of the Patient Priorities Care approach for older Hispanic adults with multiple chronic conditions and dementia. The second PCT is the Dementia Care (D-CARE) Study, which is a multisite pragmatic study comparing the effectiveness of a health care system-based approach and a community-based approach to dementia care to usual care in patients with ADRDs and their family caregivers. Lessons Learned and Recommendations for Future Studies The lessons learned are summarized according to the various stakeholders that need to work together to effectively recruit diverse participants for PCTs: individuals, health care systems, research teams, and communities. Individual-level considerations include communication, priorities, and flexibility. Health care system-level considerations are grounded in 4 principles of Community-Based Participatory Research and include collaboration/partnership, available resources, priorities of the health care system, and sustainability. Research team-level considerations include team members, intentionality, and communication. Community-level considerations highlight the importance of partnerships, community members, and appropriate incentives. Discussion PCTs provide a unique and potentially impactful opportunity to test interventions in real-world settings that must be culturally appropriate to reach underrepresented groups. Collectively, considering variables at multiple levels to address the needs of older adults with ADRDs is crucial, and the examples and suggestions provided in this report are a foundation for future research.
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Affiliation(s)
- Rafael Samper-Ternent
- Department of Management, Population, and Community Health, School
of Public Health, UTHealth Houston, Houston, TX
| | - Stephanie L. Silveira
- Department of Management, Population, and Community Health, School
of Public Health, UTHealth Houston, Houston, TX
| | - Alan Stevens
- Baylor Scott and White Research Institute, Texas A&M Health
Sciences Center, Temple, TX
| | - Elena Volpi
- Sealy Center on Aging, The University of Texas Medical Branch,
Galveston, TX
| | - Aanand D. Naik
- Department of Management, Population, and Community Health, School
of Public Health, UTHealth Houston, Houston, TX
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Willett M, Rushton A, Stephens G, Fenton S, Rich S, Greig C, Duda J. Feasibility of a theoretically grounded, multicomponent, physiotherapy intervention aiming to promote autonomous motivation to adopt and maintain physical activity in patients with lower-limb osteoarthritis: protocol for a single-arm trial. Pilot Feasibility Stud 2023; 9:54. [PMID: 37004124 PMCID: PMC10064730 DOI: 10.1186/s40814-023-01274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lower-limb osteoarthritis (OA) causes high levels of pain and disability in adults over 45 years of age. Adopting and maintaining appropriate levels of physical activity (PA) can help patients with lower-limb OA self-manage their symptoms and reduce the likelihood of developing secondary noncommunicable diseases. However, patients with lower-limb OA are less active than people without musculoskeletal pain. This single-arm feasibility trial seeks to determine the feasibility and acceptability of a complex multicomponent physiotherapy behaviour change intervention that aims to aid patients with lower-limb OA to adopt and maintain optimal levels of PA. METHODS This trial will be conducted at one site in a National Health Service physiotherapy outpatient setting in the West Midlands of England. Up to thirty-five participants with lower-limb OA will be recruited to receive a physiotherapy intervention of six sessions that aims to optimise their PA levels during phases of behavioural change: adoption, routine formation and maintenance. The intervention is underpinned by self-determination theory (and other motivational frameworks) and seeks to foster a motivationally optimal (empowering) treatment environment and implement behaviour change techniques (BCTs) that target PA behaviours across the three phases of the intervention. Physiotherapists (n = 5-6) will receive training in the why and how of developing a more empowering motivational environment and the delivery of the intervention BCTs. Participants will complete patient-reported and performance-based outcome measures at baseline and 3-month (to reflect behavioural adoption) and 6-month (maintenance) post-baseline. Feasibility and acceptability will be primarily assessed through semi-structured interviews (purposively recruiting participants) and focus groups (inviting all physiotherapists and research staff). Further evaluation will include descriptive analysis of recruitment rates, loss of follow-up and intervention fidelity. DISCUSSION A novel complex, multicomponent theoretical physiotherapy behaviour change intervention that aims to create a more empowering motivational treatment environment to assist patients with lower-limb OA to adopt and maintain optimal PA levels has been developed. Testing the feasibility and acceptability of the intervention and its associated physiotherapist training and related trial procedures is required to determine whether a full-scale parallel group (1:1) randomised controlled trial to evaluate the interventions effectiveness in clinical practice is indicated. TRIAL REGISTRATION Trial register: International Standard Randomised Controlled Trial identification number: ISRCTN12002764 . Date of registration: 15 February 2022.
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Affiliation(s)
- Matthew Willett
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Physical Therapy, Elborn College, Western University, London, Canada
| | - Gareth Stephens
- Research and Development, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Sally Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sarah Rich
- Research and Development, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Seed PT, Brien SB, Oakley LL, Robinson V, Sharif J, Thompson H, Joseph J, Oteng-Ntim E. Serial prophylactic exchange blood transfusion in pregnant women with sickle cell disease (TAPS-2): statistical and qualitative analysis plan for a randomised controlled feasibility trial. Trials 2023; 24:225. [PMID: 36964626 PMCID: PMC10037353 DOI: 10.1186/s13063-023-07235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There are significant knowledge gaps regarding the effectiveness of serial prophylactic exchange blood transfusion (SPEBT) for pregnant women with sickle cell disease (SCD). The protocol for the randomised feasibility trial assessing SPEBT versus usual care in women with SCD (TAPS2 trial) has previously been published. This publication outlines the statistical and qualitative analysis plan for the study. METHODS AND DESIGN TAPS2 is a randomised two-arm phase 2 feasibility trial with a nested qualitative study and health economic evaluation. Up to 50 pregnant women with SCD and a singleton pregnancy will be recruited and individually randomised to either SPEBT approximately every 6-10 weeks until delivery (intervention arm) or to usual care (control arm). Information will be collected on a range of feasibility and clinical outcomes. RESULTS Due to the impact of COVID-19 on study recruitment, the initial study period of 24 months was extended to 48 months. Other protocol updates designed to mitigate the impact of COVID-19-related disruption included allowing for remote consent and conducting all qualitative interviews by telephone. The primary outcome for the trial is the overall recruitment rate. The number of women screened, eligible, consented, randomised and withdrawn will be summarised as a CONSORT flow diagram. Differences in clinical outcomes will additionally be presented as an initial assessment of efficacy and to inform sample size calculations for a future definitive trial. Qualitative interviews with trial participants and clinicians will be analysed using reflexive thematic analysis; data from interviews with participants who declined to participate in the trial will be extracted and incorporated into summary tables to report key findings. The health economic analysis plan is not covered by this update. CONCLUSION The publication of this analysis plan is designed to aid transparency and to reduce the potential for reporting bias. TRIAL REGISTRATION NIH registry ( www. CLINICALTRIALS gov ), registration number NCT03975894 (registered 05/06/19); ISRCTN ( www.isrctn.com ), registration number ISRCTN52684446 (retrospectively registered 02/08/19).
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Affiliation(s)
- Paul T Seed
- Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Sarah B Brien
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Laura L Oakley
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, P.O. box 222, N-0213, Oslo, Norway.
| | - Vicky Robinson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Hilary Thompson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jeannine Joseph
- Patient author, c/o Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Eugene Oteng-Ntim
- Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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Kaur D, Mehta RL, Jarrett H, Jowett S, Gale NK, Turner AM, Spiteri M, Patel N. Phase III, two arm, multi-centre, open label, parallel-group randomised designed clinical investigation of the use of a personalised early warning decision support system to predict and prevent acute exacerbations of chronic obstructive pulmonary disease: 'Predict & Prevent AECOPD' - study protocol. BMJ Open 2023; 13:e061050. [PMID: 36914185 PMCID: PMC10016266 DOI: 10.1136/bmjopen-2022-061050] [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] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION With 65 million cases globally, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and imposes a heavy burden on patients' lives and healthcare resources worldwide. Around half of all patients with COPD have frequent (≥2 per year) acute exacerbations of COPD (AECOPD). Rapid readmissions are also common. Exacerbations impact significantly on COPD outcomes, causing significant lung function decline. Prompt exacerbation management optimises recovery and delays the time to the next acute episode. METHODS/ANALYSIS The Predict & Prevent AECOPD trial is a phase III, two arm, multi-centre, open label, parallel-group individually randomised clinical trial investigating the use of a personalised early warning decision support system (COPDPredict) to predict and prevent AECOPD. We aim to recruit 384 participants and randomise each individual in a 1:1 ratio to either standard self-management plans with rescue medication (RM) (control arm) or COPDPredict with RM (intervention arm).The trial will inform the future standard of care regarding management of exacerbations in COPD patients. The main outcome measure is to provide further validation, as compared with usual care, for the clinical effectiveness of COPDPredict to help guide and support COPD patients and their respective clinical teams in identifying exacerbations early, with an aim to reduce the total number of AECOPD-induced hospital admissions in the 12 months following each patient's randomisation. ETHICS AND DISSEMINATION This study protocol is reported in accordance with the guidance set out in the Standard Protocol Items: Recommendations for Interventional Trials statement. Predict & Prevent AECOPD has obtained ethical approval in England (19/LO/1939). On completion of the trial and publication of results a lay findings summary will be disseminated to trial participants. TRIAL REGISTRATION NUMBER NCT04136418.
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Affiliation(s)
- Dalbir Kaur
- Warwick Clinical Trials Unit (BWCTU), Warwick Medical School University of Warwick Coventry, Coventry, UK
| | - Rajnikant L Mehta
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hugh Jarrett
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola K Gale
- Health Services Management Centre, School of Social Policy Director of Postgraduate Research, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Respiratory Medicine, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Monica Spiteri
- Respiratory Research, Academic Research Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
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Do U, Pook M, Najafi T, Rajabiyazdi F, El-Kefraoui C, Balvardi S, Barone N, Elhaj H, Nguyen-Powanda P, Lee L, Baldini G, Feldman LS, Fiore JF. S110-Opioid-free analgesia after outpatient general surgery: A qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial. Surg Endosc 2023; 37:2269-2280. [PMID: 35918552 DOI: 10.1007/s00464-022-09472-8] [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: 03/26/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Opioid-free analgesia (OFA) may mitigate opioid-related harms after outpatient general surgery; however, the comparative effectiveness of this approach should be assessed in robust randomized controlled trials (RCTs). Undertaking an RCT on OFA raises important practical concerns, including surgeon and patient hesitation regarding pain management without opioids. We conducted a qualitative study to explore patients' and clinicians' perspectives and experiences with a pilot trial focused on OFA after outpatient general surgery. METHODS Patients undergoing outpatient abdominal and breast procedures were randomized to receive post-discharge opioid analgesia (OA) or OFA. Semi-structured interviews with patients and clinicians involved in the trial were conducted to elicit personal perspectives and experiences. Purposive sampling for maximum variation was used to recruit participants with diverse characteristics. Transcribed interviews were assessed using inductive thematic analysis. RESULTS Ten patients (5 abdominal, 5 breast) and 10 clinicians (6 surgeons, 2 anesthesiologists, 2 nurses) were interviewed. Five major themes emerged: readiness for trial engagement, pre-trial thoughts about the interventions, postoperative pain experiences, intervention acceptability, and trial refinement. Most patients were open to OFA. Clinicians expressed willingness to prescribe OFA, particularly after less invasive procedures and when using peripheral nerve blocks (PNBs). Concerns were raised regarding the adequacy of pain control and side effects of non-opioid drugs (e.g., NSAID-induced bleeding, kidney injury). Overall, participants were enthusiastic about the trial and recognized its relevance; clinicians praised the study design and organization; and patients valued the use of electronic questionnaires. Suggestions for improvements included preventing potential bias arising from the use of PNBs (i.e., via standardization or stratification) and reducing patient burden (i.e., decreasing postoperative questionnaires). CONCLUSION Patients and clinicians who participated in a pilot RCT generally accept the clinical equipoise between OA versus OFA after outpatient general surgery and recognize the need for methodologically robust trials to inform evidence-based analgesia prescribing.
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Affiliation(s)
- Uyen Do
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Makena Pook
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Tahereh Najafi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Charbel El-Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Saba Balvardi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Philip Nguyen-Powanda
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gabriele Baldini
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. .,Division of Experimental Surgery, McGill University, Montreal, QC, Canada. .,Department of Surgery, McGill University, Montreal, QC, Canada. .,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada. .,Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
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Gagnon MA, Batcho CS, Bird ML, Labbé B, Best KL. Feasibility of a remotely supervised home-based group eHealth Fitness and Mobility Exercise program for stroke: French-Canadian version preliminary study. Top Stroke Rehabil 2023; 30:169-179. [PMID: 34994303 DOI: 10.1080/10749357.2021.2012008] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND The numerous barriers to community-based physical activity programs have been exacerbated by the COVID-19 pandemic, especially among individuals with disabilities. eHealth programs may provide an alternative approach to address the physical activity needs of stroke survivors, but little is known about their feasibility or acceptance. OBJECTIVE The aims of this study were to 1) evaluate the feasibility of a remotely supervised home-based group eHealth program called Fitness and Mobility Exercise (FAME@home); 2) explore the influence of FAME@home on physical condition, mobility, self-efficacy, depression and anxiety; and 3) describe participants' satisfaction and experiences. METHODS A pre-post pilot study was used to recruit stroke survivors (>1 y post stroke) to complete a 12-week (2 days/week) eHealth program in small groups (n = 3). Feasibility indicators were assessed for process (e.g. inclusion criteria), resources (e.g. ability to use technology), management (e.g. major challenges), and treatment (e.g. influence on clinical outcomes and adverse events). RESULTS Nine participants were recruited with a mean (SD) of 60 (13) years of age and 7 (4) years post-stroke; eight completed the program. FAME@home was feasible for indicators of process, management, and treatment. Minor considerations to improve resources were suggested (i.e. support for technology use). There were statistically significant improvements in mobility after completion of FAME@home and 100% of the participants reported satisfaction. No adverse events occurred. CONCLUSION FAME@home was feasible to deliver as a remotely supervised group exercise program to community-dwelling stroke survivors, with high levels of retention and adherence. FAME@home improved accessibility to exercise and facilitated engagement by having a class schedule and social interaction.
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Affiliation(s)
- Marie-Andrée Gagnon
- Department of Rehabilitation, Faculty of Medicine Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
| | - Charles Sèbiyo Batcho
- Department of Rehabilitation, Faculty of Medicine Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
| | - Marie-Louise Bird
- University of Tasmania, Launceston Tasmania, Australia.,University of British Columbia, Vancouver, BC, Canada
| | | | - Krista L Best
- Department of Rehabilitation, Faculty of Medicine Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
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