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Munneke W, Demoulin C, Nijs J, Morin C, Kool E, Berquin A, Meeus M, De Kooning M. Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach for healthcare professionals: part of a hybrid effectiveness-implementation study. BMC MEDICAL EDUCATION 2024; 24:331. [PMID: 38519899 PMCID: PMC10960450 DOI: 10.1186/s12909-024-05308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain. METHODS This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders. RESULTS The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals' possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; 'capability', 'opportunity', and 'motivation'. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice. CONCLUSION We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.
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Affiliation(s)
- Wouter Munneke
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group (PiM)
- Department of Sport and Rehabilitation Sciences, University of Liège, Liege, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Liege, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group (PiM)
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of rehabilitation medicine and physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Carine Morin
- Société Scientifique de Médecine Générale (SSMG), Brussels, Belgium
| | | | - Anne Berquin
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group (PiM)
- MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Antwerp, Belgium
| | - Margot De Kooning
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Pain in Motion International Research Group (PiM), .
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Young JJ, Kongsted A, Hartvigsen J, Ammendolia C, Jensen RK. Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program. BMC Musculoskelet Disord 2023; 24:839. [PMID: 37880624 PMCID: PMC10599001 DOI: 10.1186/s12891-023-06950-5] [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: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND People with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program for NSLBP patients with and without comorbid LSS symptoms. METHODS This was a longitudinal analysis of 655 Danish participants in the GLA:D® Back program; an education and exercise therapy program for people with persistent NSLBP. Participants were classified as having comorbid LSS symptoms based on self-report. Linear mixed models were used to assess differences in change in disability (Oswestry Disability Index [0-100]) and back and leg pain intensity (Numeric Rating Scale [0-10]) at 3-, 6-, and 12-months between those with and without LSS symptoms. RESULTS 28% of participants reported LSS symptoms. No certain differences in change in disability or back pain intensity improvement were observed at any time-point between those with and without LSS symptoms. Participants with LSS symptoms had slightly greater improvement in leg pain intensity at 6- (-0.7, 95% CI -1.2 to -0.2) and 12-months (-0.6, 95% CI -1.2 to -0.1). CONCLUSION Compared to those without LSS symptoms, patients with persistent NSLBP and LSS symptoms can expect similar improvements in disability and back pain intensity, and slightly greater improvements in leg pain intensity with treatment. Therefore, education and exercise therapy programs designed for NSLBP are likely helpful for those also experiencing LSS symptoms.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Chiropractic Knowledge Hub, Odense, 5230, Denmark
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Nim CG, Kongsted A, Downie A, Vach W. Temporal stability of self-reported visual back pain trajectories. Pain 2022; 163:e1104-e1114. [PMID: 35467586 PMCID: PMC9578527 DOI: 10.1097/j.pain.0000000000002661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
ABSTRACT Low back pain (LBP) follows different pain trajectories, and patients seem to recognize their trajectory. This allows self-reported visual pain trajectories (SRVTs) to support patient-provider communication. Pain trajectories appear stable over time for many patients, but the evidence is sparse. Our objectives were to investigate the (1) temporal stability of SRVTs over 1 year concerning pain intensity and course patterns and (2) association of transitions between SRVTs and changes in pain and disability. This study used data from 2 prospective primary care cohorts: the Danish Chiropractic LBP Cohort (n = 1323) and the GLA:D Back cohort (n = 1135). Participants identified one of the 8 SRVTs at baseline and 12-month follow-up, each asking about LBP trajectories the preceding year. Trajectories were described using 2 subscales (intensity and pattern). Temporal stability was quantified by "stability odds ratios" (ORs), depicting the likelihood of staying in the same SRVT after 12 months compared with baseline, and by "preference ORs," depicting the likelihood of choosing a specific alternative SRVT at follow-up. Both ORs compare the observed proportion with the chance level. Finally, we examined associations between transitioning to a different trajectory and changes in clinical outcomes. Approximately 30% stayed in the same SRVT. The stability ORs were all >1. The preference ORs indicated that transitions occurred mainly to similar SRVTs differing in only 1 subscale. Transitions to less or more intense SRVTs were associated with changes in clinical outcomes in the expected direction. Despite distinctly different SRVTs identified, individuals reported relatively stable LBP phenotypes but with potential for change.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Aron Downie
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Werner Vach
- Chiropractic Knowledge Hub, Odense, Denmark
- Basel Academy for Quality and Research in Medicine, Switzerland
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Hartvigsen J, Kamper SJ, French SD. Low-value care in musculoskeletal health care: Is there a way forward? Pain Pract 2022; 22 Suppl 2:65-70. [PMID: 36109843 PMCID: PMC9545107 DOI: 10.1111/papr.13142] [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: 03/02/2022] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-value care that wastes resources and harms patients is prevalent in health systems everywhere. METHODS As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions. RESULTS Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks. CONCLUSION Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.
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Affiliation(s)
- Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense M, Denmark.,Chiropractic Knowledge Hub, Odense M, Denmark
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
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Morsø L, Lykkegaard J, Andersen MK, Hansen A, Stochkendahl MJ, Madsen SD, Christensen BS. Providing information at the initial consultation to patients with low back pain across general practice, chiropractic and physiotherapy - a cross-sectorial study of Danish primary care. Scand J Prim Health Care 2022; 40:370-378. [PMID: 36314134 PMCID: PMC9848345 DOI: 10.1080/02813432.2022.2139465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Clinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to patients with LBP. DESIGN AND SETTING This cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark. INTERVENTION Clinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220). SUBJECTS 33 GPs, 43 DCs and 61 PTs registered first-time consultations. MAIN OUTCOME MEASURES The primary outcome was provision of information, overall and across care settings. RESULTS The overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00). CONCLUSION In more than a quarter of first-time consultations, patient information was not provided. Large variation in providing information was found across the settings. The proportion provided with information increased for sub-populations having elevated distress or back-related leg pain below the knee.Key Points Clinical guidelines recommend patient information, patient education and physical activity for managing low back pain (LBP) • Information is not provided in more than a quarter of first-time consultations in Danish primary care settings that manage these patients. • Information increased for the sub-populations having elevated distress and back-related leg pain below the knee. • The conducted primary care surveys monitored clinical activity and illustrated variations in provision of information.
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Affiliation(s)
- Lars Morsø
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- CONTACT Lars Morsø Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Merethe Kirstine Andersen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Anders Hansen
- Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Mette Jensen Stochkendahl
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Simon Dyrløv Madsen
- Chiropractic Knowledge Hub, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Berit Schiøttz Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Fillipo R, Pruka K, Carvalho M, Horn ME, Moore J, Ramger B, Clewley D. Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review. Implement Sci Commun 2022; 3:57. [PMID: 35659117 PMCID: PMC9164354 DOI: 10.1186/s43058-022-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical therapy for neck and low back pain is highly variable despite the availability of clinical practice guidelines (CPG). This review aimed to determine the impact of CPG implementation on patient-level outcomes for spinal pain. Implementation strategies were also examined to determine prevalence and potential impact. METHODS Multiple databases were searched through April 2021 for studies assessing CPG implementation in physical therapy for neck and low back pain. Articles were screened for eligibility. The Modified Downs and Black checklist was utilized to determine study quality. Due to the heterogeneity between studies, a meta-analysis was not performed. RESULTS Twenty-one studies were included in this review. Implementation strategies were significantly varied between studies. Outcomes pertaining to healthcare utilization, pain, and physical functioning were assessed in relation to the implementation of CPGs. Multiple implementation strategies were identified, with Managing Quality as the most frequently utilized key implementation process. Findings indicate CPG implementation decreased healthcare utilization, but inconsistent results were found with physical functioning and pain outcomes. CONCLUSIONS CPG implementation appears to have a beneficial effect on healthcare utilization outcomes, but may not impact pain and physical functioning outcomes. Effective CPG implementation strategies remain unknown, though utilizing implementation framework may improve outcomes. More research is needed to determine the most effective implementation strategies and effects on pain and physical function outcomes.
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Affiliation(s)
- Rebecca Fillipo
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA.
| | - Katie Pruka
- Department of Outpatient Rehabilitation, Duke University Health System, Durham, North Carolina, USA
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Maggie E Horn
- Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jordan Moore
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Benjamin Ramger
- Department of Outpatient Rehabilitation, Duke University Health System, Durham, North Carolina, USA
| | - Derek Clewley
- Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
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GLA:D® Back Australia: a mixed methods feasibility study for implementation. Chiropr Man Therap 2022; 30:17. [PMID: 35392935 PMCID: PMC8989099 DOI: 10.1186/s12998-022-00427-3] [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: 12/14/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00427-3.
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Joern L, Kongsted A, Thomassen L, Hartvigsen J, Ravn S. Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study. Chiropr Man Therap 2022; 30:8. [PMID: 35189908 PMCID: PMC8862196 DOI: 10.1186/s12998-022-00416-6] [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: 10/19/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Benefits from low back pain (LBP) treatments seem to be related to patients changing their pain cognitions and developing an increased sense of control. Still, little is known about how these changes occur. The objective of this study was to gain insights into possible shifts in the understanding of LBP and the sense of being able to manage pain among patients participating in a LBP self-management intervention. Methods Using a qualitative study and a content analytic framework, we investigated the experiences of patients with LBP who participated in ‘GLA:D® Back’, a group-based structured patient education and exercise program. Data were generated through qualitative semi-structured interviews conducted between January 2019 and October 2019. Interviews focused on experiences with pain and were analysed using a thematic analytical approach. The Common Sense Model and self-efficacy theory formed the theoretical framework for the interpretations. Participants were sampled to represent people who were either dissatisfied or satisfied with their participation in GLA:D® Back. Fifteen participants aged 26–62, eight women and seven men, were interviewed from February to April 2020. Results Four main themes, corresponding to the characterisation of four patient groups, were identified: ‘Feeling miscast, ‘Maintaining reservations', ‘Struggling with habits’ and ‘Handling it’. The participants within each group differed in how they understood, managed, and communicated about their LBP. Some retained the perception of LBP as a threatening disease, some expressed a changed understanding that did not translate into new behaviors, while others had changed their understanding of pain and their reaction to pain. Conclusions The same intervention was experienced very differently by different people dependent on how messages and communication resonated with the individual patient's experiences and prior understanding of LBP. Awareness of the ways that individuals’ understanding of LBP interact with behaviour and physical activities appear central for providing adaptive professional support and meeting the needs of individual patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00416-6.
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Affiliation(s)
- Lise Joern
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Chiropractic Knowledge Hub, 5230, Odense M, Denmark.
| | - Line Thomassen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, 5230, Odense M, Denmark
| | - Susanne Ravn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Young JJ, Hartvigsen J, Roos EM, Ammendolia C, Kongsted A, Skou ST, Grønne DT, Jensen RK. Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10,234 participants in primary care. Osteoarthritis Cartilage 2021; 29:1515-1520. [PMID: 34343677 DOI: 10.1016/j.joca.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate: the proportion of people reporting symptoms associated with lumbar spinal stenosis (LSS) in primary care programs for knee or hip osteoarthritis (OA) or persistent low back pain (LBP) and; the prevalence of self-reported clinical LSS in these three cohorts, according to two sets of adapted criteria. METHOD A cross-sectional analysis of baseline data from the Good Life with osteoArthritis in Denmark primary care programs. Self-report LSS symptom questions were administered to participants with knee OA, hip OA, and persistent LBP. The prevalence of eleven LSS symptoms and clinical LSS were calculated for each cohort. RESULTS A total of 10,234 participants were included in the analysis. A similar proportion of participants in each cohort were female (69%), with a 6- and 7-year older mean age in the knee and hip cohorts compared to the back cohort. A greater proportion of participants with LBP reported LSS symptoms (range 11-71%) than in the hip (11-50%) and knee (8-40%) cohorts. This pattern was observed for all but one symptom. The same pattern was observed for the prevalence of clinical LSS with less than 10% of people in each cohort satisfying the clinical criteria. CONCLUSION Self-reported LSS symptoms are commonly reported by people treated in primary care for knee or hip OA, although not as frequently as reported by those with LBP. Despite symptoms of LSS being common, only a small proportion of people were classified as having self-reported clinical LSS.
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Affiliation(s)
- J J Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - J Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
| | - E M Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - C Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - A Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
| | - S T Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark.
| | - D T Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
| | - R K Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Chiropractic Knowledge Hub, Odense, 5230, Denmark.
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Morsø L, Bogh SB, Ris I, Kongsted A. Mind the gap - Evaluation of the promotion initiatives for implementation of the GLA:D® back clinician courses. Musculoskelet Sci Pract 2021; 53:102373. [PMID: 33823485 DOI: 10.1016/j.msksp.2021.102373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Translation of research into practice is a methodological challenge. The GLA:D® Back program was initiated to implement evidence-based care for people with low back pain inspired by GLA:D® (Good Life with osteoArthritis in Denmark) that has succeeded in implementing evidence-based care for knee and hip osteoarthritis. This study evaluates the spread and reach of promotion initiatives for GLA:D® Back clinician courses, and the adoption of the GLA:D® Back intervention in clinical practice. METHODS Pre-defined success criteria addressed; i) spread; achievement of intended promotion activities (e.g. social media), ii) reach; recruitment of clinicians with certain profiles (e.g. gender balance). Adoption was defined as patient enrollment in the GLA:D® Back registry by course participants. Univariate and multivariate logistic regression was used to investigate associations between adoption and clinician characteristics. RESULTS Most clinicians signed up based on information from colleagues (22%). Pre-defined goals for reach, except one, was obtained. 23% (140) of clinicians initiated the GLA:D® Back program in clinical practice within <90 days of course participation; mainly physiotherapists (p < 0.001). The odds ratio for starting GLA:D® Back patient care in a chiropractic setting was 7.4 [2.5; 21.4], indicating that physiotherapists employed by chiropractors mostly handled the intervention. CONCLUSION Future promotion strategies should recognize the influence of colleagues and professional networks. Converting clinician courses into patient care was mostly adopted physiotherapists. Although, evaluation processes were less useful in this study, future evaluation of health care processes has potential to inform the implementation of new models in future studies.
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Affiliation(s)
- Lars Morsø
- Open Patient Explorative Network (OPEN), Region of Suothern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Søren Bie Bogh
- Open Patient Explorative Network (OPEN), Region of Suothern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB), Odense, Denmark
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Ris I, Broholm D, Hartvigsen J, Andersen TE, Kongsted A. Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study. BMC Musculoskelet Disord 2021; 22:473. [PMID: 34022826 PMCID: PMC8141215 DOI: 10.1186/s12891-021-04329-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To assess how the intervention was received and factors influencing adherence to the program, we aimed to evaluate participants' adherence to the intervention and identified characteristics related to the completion of GLA:D® Back. Specifically, we investigated: 1) level of attendance of participants enrolled in the programme, and 2) participant-related factors associated with low attendance. METHODS Primary care clinicians delivered GLA:D® Back, a standardised 10-week programme of 2 educational and 16 supervised exercise sessions, to patients with low back pain. Attendance was defined as low, medium or high based on self-reported number of attended sessions. Additional participant-reported data included demographic characteristics, pain, prognostic risk profiles, self-efficacy, illness-beliefs, function and clinician-reported physical performance tests. Results for high, medium, low, and unknown attendance were reported descriptively. Odds ratios for low attendance compared to medium/high attendance were calculated by including all baseline factors in a mixed-model logistic regression model. RESULTS Of 1730 participants, 52% had high, 23% medium, and 25% low levels of attendance. Level of attendance was not strongly associated with participants' individual factors, but in combination, prediction of low attendance was fair (AUC 0.77; 95% CI 0.74-0.79). The strongest indicator of low attendance was not completing the baseline questionnaire. CONCLUSIONS Most participants of a 10-week low back pain programme attended almost all session. Non-response to the baseline questionnaire was strongly associated with low attendance, whereas individual patient characteristics were weakly related to attendance. Not completing baseline questionnaires might be an early indicator of poor adherence in programs for people with persistent low back pain. TRIAL REGISTRATION The Health Research Ethics for Southern Denmark decided there was no need for ethical approval (S-20172000-93). The Danish data collection has obtained authorisation from the Danish Data Protection Agency as part of the University of Southern Denmark's institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591). The trial was registred at ClinicalTrials.gov NCT03570463 .
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Affiliation(s)
- Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Daniel Broholm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Anaesthesiology, Multidisciplinary Pain Centre, Vejle and Middelfart Hospitals, Østre Hougvej 55, 5500 Middelfart, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
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12
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Factors influencing implementation of the GLA: D Back, an educational/exercise intervention for low back pain: a mixed-methods study. JBI Evid Implement 2021; 19:394-408. [PMID: 33965996 PMCID: PMC8635265 DOI: 10.1097/xeb.0000000000000284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction and aims: Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives were to describe profiles of implementers and nonimplementers by demographics, and responses to the tailored version of the Determinants of Implementation Behaviour Questionnaire (DIBQ-t) qualitatively explore clinician perspectives on implementation, and compare the results of the DIBQ-t with the interview data to evaluate their fit of integration for facilitators, barriers, and new insights. Methods: A mixed-methods parallel design study was conducted. Physiotherapists and chiropractors, educated in the GLA:D Back program, were asked to complete the DIBQ-t (measuring theoretical determinants of implementation) 6 months after their training. Implementers and nonimplementers of the program were selected for interviews. Qualitative data were used to understand clinicians’ viewpoints on implementation, providing a broader perspective on the quantitative data and exploring new aspects. Results: More physiotherapists than chiropractors implemented the program. Implementers responded more positively on most domains of the DIBQ-t. The interviews revealed three themes important for implementation: personal gain, practicalities, and buying-in on the program. Clinicians’ attitudes to the program appeared additionally as relevant to implementation. Conclusion: The profession of the clinician was associated with implementation behavior. Implementers and nonimplementers identified the same themes but perceived them as either positive or negative. Both groups reported high levels of knowledge and skills, indicating that training alone is insufficient for implementation.
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Molgaard Nielsen A, Hartvigsen J, Kongsted A, Öberg B, Enthoven P, Abbott A, Lauridsen HH. The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness. Health Qual Life Outcomes 2021; 19:116. [PMID: 33836764 PMCID: PMC8033700 DOI: 10.1186/s12955-021-01758-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Currently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the ‘Patient Enablement Instrument’, we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Instrument for Back Pain (PEI-BP) and investigate content validity, construct validity, internal consistency, test–retest reliability, measurement error, responsiveness and floor and ceiling effects. Methods The PEI-BP consists of 6 items that are rated on a 0–10 Numeric Rating Scale. Measurement properties were evaluated using the COSMIN taxonomy and were based on three cohorts from primary care with low back pain: The content validity cohort (N = 14) which participated in semi-structured interviews, the GLA:D® Back cohort (N = 272) and the test–retest cohort (N = 37) which both completed self-reported questionnaires. For construct validity and responsiveness, enablement was compared to disability (Oswestry Disability Index), back pain beliefs (Brief Illness Perception Questionnaire), fear avoidance (Fear-Avoidance Beliefs Questionnaire—physical activity), mental health (SF-36), educational level and number of previous episodes of low back pain. Results The PEI-BP was found to have acceptable content validity, construct validity, reliability (internal consistency, test–retest reliability and measurement error) and responsiveness. The Smallest Detectable Change was 10.1 points illustrating that a patient would have to change more than 1/6 of the scale range for it to be a true change. A skewed distribution towards the high scores were found at baseline indicating a potentially problematic ceiling effect in the current population. Conclusions The PEI-BP can be considered a valid and reliable tool to measure enablement on people seeking care for non-specific LBP. Further testing of the PEI-BP in populations with more severe LBP is recommended. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01758-0.
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Affiliation(s)
- A Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - J Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark
| | - A Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark
| | - B Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - P Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - A Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - H H Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Lemieux J, Kawchuk G, Kongsted A, Hartvigsen J, Abdollah V, Jones A. The feasibility of implementing an English language version of GLA:D Back. Pilot Feasibility Stud 2021; 7:38. [PMID: 33522956 PMCID: PMC7849100 DOI: 10.1186/s40814-020-00758-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidenced-based clinical guidelines for the treatment of low back pain (LBP) consistently suggest educating patients about their back pain, its natural course, and providing advice to keep active and continue working. Despite this evidence, clinicians routinely do not follow these recommendations resulting in ineffective and fragmented care. GLA:D® Back, a standardized care package, was originally developed in Denmark to assist clinicians in implementing evidence-based care. This study will evaluate the feasibility of implementing the English version of the Danish GLA:D® Back program in Alberta, Canada. METHODS Thirty-five clinicians from nineteen clinics in Alberta, Canada, participated. Feasibility of program implementation, our primary objective, was evaluated within 3 months. Feasibility success was defined as 50% clinician/clinic adoption in addition to 66-88 enrolled participants registered in the database. Our secondary objectives included collecting data pertaining to clinician confidence, attitudes and behaviour of treating patients, perceived barriers and facilitators of program in addition to collecting patient-data regarding pain, function, general health and self-efficacy. RESULTS The majority of the clinics (15/19, 79%) offered GLA:D® Back to their patients within the study period. Of the participating clinicians, GLA:D® Back was delivered by (25/35, 71%) of clinicians. In total, 78 patients were enrolled in the program and (69/78, 88%) participants attended the final assessment. Secondarily, clinicians demonstrated a biomedical and behavioural orientation along with high confidence when treating LBP patients while patient outcomes trended toward improvement. CONCLUSION The English translation of the Danish GLA:D Back program was feasible for Albertan clinicians to implement into practice in both urban and rural settings.
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Affiliation(s)
- J Lemieux
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - G Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
| | - A Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - V Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - A Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Mendonça CR, Noll M, Castro MCR, Silveira EA. Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients 2020; 12:nu12103075. [PMID: 33050122 PMCID: PMC7601187 DOI: 10.3390/nu12103075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
Food consumption has significant positive effects on an individual’s health status, including the reduction of symptoms associated with musculoskeletal pain. However, specific food groups indicated for the treatment of pain are not yet determined. Hence, this review aimed to analyze the effects of nutritional interventions with specific diets, oils and/or fatty acids, and foodstuffs in natura in the reduction of musculoskeletal pain. An integrative review was conducted in the following databases: Embase, PubMed, LILACS, and Google Scholar. Clinical trials written in English, Spanish, and Portuguese and published between 2000 and March 2020 were included in this review. Seventeen studies were included. Among these, a reduction of musculoskeletal pain with different types of nutritional interventions, such as vegan and Mediterranean diets and the consumption of blueberry, strawberry, passion fruit peel extract, argan oil, fish oil (omega-3), olive oil, and undenatured type II collagen and vitamin D gel capsules, was observed in 14 studies. Eight studies evaluated the profiles of several inflammatory markers, and of these, decreased interleukin (IL)-6, IL-1β, and tumor necrosis factor-α levels were observed in two studies. This review suggests that different nutritional interventions with specific diets, oils and/or fatty acids, and foodstuffs in natura reduce musculoskeletal pain, specifically in adults with osteoarthritis. Besides pain improvement, nutritional interventions, including the consumption of strawberry and vitamin D gel capsules, decrease the levels of several inflammatory markers.
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Affiliation(s)
- Carolina Rodrigues Mendonça
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia 74605-050, Goiás, Brazil; (M.N.); (M.C.R.C.); (E.A.S.)
- Correspondence:
| | - Matias Noll
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia 74605-050, Goiás, Brazil; (M.N.); (M.C.R.C.); (E.A.S.)
- Instituto Federal Goiano, Campus Ceres, Ceres 76300-000, Goiás, Brazil
| | - Maria Clara Rezende Castro
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia 74605-050, Goiás, Brazil; (M.N.); (M.C.R.C.); (E.A.S.)
| | - Erika Aparecida Silveira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia 74605-050, Goiás, Brazil; (M.N.); (M.C.R.C.); (E.A.S.)
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Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud 2019; 5:114. [PMID: 31608150 PMCID: PMC6778655 DOI: 10.1186/s40814-019-0499-1] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023] Open
Abstract
As the number of submissions to Pilot and Feasibility Studies increases, there is a need for good quality reporting guidelines to help researchers tailor their reports in a way that is consistent and helpful to other readers. The publication in 2016 of the CONSORT extension to pilot and feasibility trials filled a much-needed gap, but there still remains some uncertainty as to how to report pilot and feasibility studies that are not randomised. This editorial aims to provide some general guidance on how to report the most common types of non-randomised pilot and feasibility studies that are submitted to the journal. We recommend using the CONSORT extension to pilot and feasibility trials as the main reference document—it includes detailed elaboration and explanation of each item, and in most cases, simple adaptation, or non-use of items that are not applicable, will suffice. Several checklists found on the Equator website may provide helpful supplementary guidance, when used alongside the CONSORT extension, and we give some examples.
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Affiliation(s)
- Gillian A Lancaster
- School of Primary, Social and Community Care, Keele University, Newcastle-under-Lyme, UK
| | - Lehana Thabane
- School of Primary, Social and Community Care, Keele University, Newcastle-under-Lyme, UK
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