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Carter B, Bray L, al-Najjar N, Piella AT, Tudur-Smith C, Spowart C, Collingwood A, Crudgington H, Currier J, Hughes DA, Wood E, Martin R, Morris C, Roberts D, Rouncefield-Swales A, Sutherland H, Watson V, Cook G, Wiggs L, Gringras P, Pal D. The impact of parent treatment preference and other factors on recruitment: lessons learned from a paediatric epilepsy randomised controlled trial. Trials 2023; 24:83. [PMID: 36747248 PMCID: PMC9900533 DOI: 10.1186/s13063-023-07091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In paediatric epilepsy, the evidence of effectiveness of antiseizure treatment is inconclusive for some types of epilepsy. As with other paediatric clinical trials, researchers undertaking paediatric epilepsy clinical trials face a range of challenges that may compromise external validity MAIN BODY: In this paper, we critically reflect upon the factors which impacted recruitment to the pilot phase of a phase IV unblinded, randomised controlled 3×2 factorial trial examining the effectiveness of two antiseizure medications (ASMs) and a sleep behaviour intervention in children with Rolandic epilepsy. We consider the processes established to support recruitment, public and patient involvement and engagement (PPIE), site induction, our oversight of recruitment targets and figures, and the actions we took to help us understand why we failed to recruit sufficient children to continue to the substantive trial phase. The key lessons learned were about parent preference, children's involvement and collaboration in decision-making, potential and alternative trial designs, and elicitation of stated preferences pre-trial design. Despite pre-funding PPIE during the trial design phase, we failed to anticipate the scale of parental treatment preference for or against antiseizure medication (ASMs) and consequent unwillingness to be randomised. Future studies should ensure more detailed and in-depth consultation to ascertain parent and/or patient preferences. More intense engagement with parents and children exploring their ideas about treatment preferences could, perhaps, have helped predict some recruitment issues. Infrequent seizures or screening children close to natural remission were possible explanations for non-consent. It is possible some clinicians were unintentionally unable to convey clinical equipoise influencing parental decision against participation. We wanted children to be involved in decisions about trial participation. However, despite having tailored written and video information to explain the trial to children we do not know whether these materials were viewed in each consent conversation or how much input children had towards parents' decisions to participate. Novel methods such as parent/patient preference trials and/or discrete choice experiments may be the way forward. CONCLUSION The importance of diligent consultation, the consideration of novel methods such as parent/patient preference trials and/or discrete choice experiments in studies examining the effectiveness of ASMs versus no-ASMs cannot be overemphasised even in the presence of widespread clinician equipoise.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
| | - Lucy Bray
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nadia al-Najjar
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Agnès Tort Piella
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Amber Collingwood
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Holly Crudgington
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Dyfrig A. Hughes
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Eifiona Wood
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Rachael Martin
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Christopher Morris
- grid.8391.30000 0004 1936 8024University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Alison Rouncefield-Swales
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Heather Sutherland
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Victoria Watson
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Georgia Cook
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Luci Wiggs
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Paul Gringras
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK. .,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Deb Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK. .,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK. .,King's College Hospital, London, UK.
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Barnestein-Fonseca P, Cotta-Luque VM, Aguiar-Leiva VP, Leiva-Fernández J, Martos-Crespo F, Leiva-Fernández F. The importance of reminders and patient preferences to improve inhaler technique in older adults with COPD. Front Pharmacol 2023; 13:989362. [PMID: 36686678 PMCID: PMC9846566 DOI: 10.3389/fphar.2022.989362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives: Medication non-adherence in patients with chronic obstructive pulmonary disease is common. The aim is to evaluate the efficacy of two interventions to improve the inhalation technique (IT) in patients with pulmonary disease is common. Also determine optimal IT reminder time and to test the role of preferences in the intervention selection. Method: 726 pulmonary disease in common patients (consecutive sampling) from two trials: 1) TECEPOC-study (patients' preference trial/comprehensive cohort design) 2) TIEPOC-study (randomised controlled trial). Interventions: intervention-A (ad-hoc leaflet with instructions about correct IT according Spanish Respiratory Society), intervention B (intervention A+ individual training by instructors). Four visits were performed (baseline, 3, 6 and 12 months). Data on IT, sociodemographic and clinical characteristics, quality of life and respiratory drugs were recorded. Analysis under intention to treat principle. Multivariate analysis was conducted to measure the potential modifying factors of improvement in the IT along follow-up. Results: 660 patients (90.9%) did not perform a correct IT at baseline 89.75% with Handihaler, 86.95% with Turbuhaler, 84.75% with Accuhaler and 87.35% with pMDI. At 12 months, 221 patients 29.9% performed correctly the IT; a decrease in the slope of the curve (correct IT) was detected at 3 months follow-up. Intervention B was the most effective in both trials compared to control group or intervention A, regardless of preferences: 1) TECEPOC Study (preference trial): Intervention B versus control group, NNT = 3.22 (IC95%, 2.27-5.52); and versus Intervention A, NNT = 3.57 (CI95%, 2.41-6.8). Preferences improved 6.7% in the correct IT without statistical significance. 2) TIEPOC Study (randomized controlled trial): Intervention B versus control group, NNT = 1.74 (IC95%, 1.47-2.17), and versus intervention A, NNT = 3.33 (CI 95%, 2.43-5.55). No differences were measured between Intervention A and control group. Conclusion: Individual training significantly improves IT. Reminders every 3 months are recommended. Preferences do not influence the intervention effectiveness.
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Affiliation(s)
- P. Barnestein-Fonseca
- Research Unit Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos Fundación CUDECA, IBIMA Plataforma BIONAND, Málaga, Spain
| | - VM. Cotta-Luque
- Multiprofesional Teaching Unit of Community and Family Care Primary Care District Málaga-Guadalhorce Knowledge Management Unit Málaga-Guadalhorce Health District, Andalusian Health Services, IBIMA Plataforma BIONAND, Málaga, Spain
| | - VP. Aguiar-Leiva
- Research Unit Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos Fundación CUDECA, IBIMA Plataforma BIONAND, Málaga, Spain
| | - J. Leiva-Fernández
- UGC Vélez Sur Area Sanitaria Málaga Este-Axarquía, Andalusian Health Services, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Francisco Martos-Crespo
- Department of Pharmacology and Paediatrics, School of Medicine, University of Malaga (UMA)- IBIMA Plataforma BIONAND, Malaga, Spain,*Correspondence: Francisco Martos-Crespo,
| | - F. Leiva-Fernández
- Multiprofesional Teaching Unit of Community and Family Care Primary Care District Málaga-Guadalhorce Knowledge Management Unit Málaga-Guadalhorce Health District, Andalusian Health Services, IBIMA Plataforma BIONAND, Málaga, Spain
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Choi KE(A, Lindert L, Schlomann L, Pfaff H. "I'll leave that to the case managers." Healthcare Service Providers' Perceptions of Organizational Readiness for Change in a Randomized Controlled Trial-A Qualitative Analysis Exploring Implementation Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095782. [PMID: 35565177 PMCID: PMC9104361 DOI: 10.3390/ijerph19095782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Abstract
Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive-inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner's model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.
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Affiliation(s)
- Kyung-Eun (Anna) Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
- Health Services Research, MIAAI group, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstr. 124, 3500 Krems an der Donau, Austria
- Correspondence: ; Tel.: +49-(0)33638-83987
| | - Lara Lindert
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Lara Schlomann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
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Choi KE(A, Lindert L, Schlomann L, Samel C, Hellmich M, Pfaff H. A Cross-Provider Healthcare Management Program for Musculoskeletal Disorders: Results of a Randomized Controlled Trial in 22 German Companies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211844. [PMID: 34831600 PMCID: PMC8618626 DOI: 10.3390/ijerph182211844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
Musculoskeletal disorders (MSDs) are among the most common cause for reduced work capacity and sick leave. Workplace health promotion programs are often neither tailored to the workplace nor the individual needs of the employees. To counteract lacking intersectional care, this four-year randomized controlled trial (RCT) aimed to investigate the effects of modular coordinating case management (treatment group) compared to supported self-management (control group) on MSD specific sick leave days (routine data), workability (WAI), self-efficacy (self-efficacy scale), and pain (German pain questionnaire, GPQ). The study network comprised 22 companies, 15 company health insurance funds, and 12 pension funds in Germany. Overall, 852 participants (Module A/early intervention: n = 651, Module B/rehabilitation: n = 190, Module C/reintegration: n = 10) participated. Both groups achieved fewer sick leave days, higher workability, and less pain (p < 0.0001) at follow-up compared to baseline. At follow-up, the coordinating case management group showed fewer disability days (GPQ), lower disability scores (GPQ), and lower pain intensities (GPQ) than the supported self-management group (p < 0.05), but no superiority regarding MSD specific sick leave days, workability, nor self-efficacy. Module A showed more comprehensive differences. The accompanying process evaluation shows barriers and facilitators for the implementation of the program, especially in a RCT setting.
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Affiliation(s)
- Kyung-Eun (Anna) Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
- Correspondence: ; Tel.: +49-(0)33638-83996
| | - Lara Lindert
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Lara Schlomann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany; (C.S.); (M.H.)
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany; (C.S.); (M.H.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
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Calitri R, Carter M, Code C, Lamont R, Dean S, Tarrant M. Challenges of Recruiting Patients Into Group-Based Stroke Rehabilitation Research: Reflections on Clinician Equipoise Within the Singing for People With Aphasia (SPA) Pilot Trial. Front Psychol 2021; 12:624952. [PMID: 34149511 PMCID: PMC8209260 DOI: 10.3389/fpsyg.2021.624952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Raff Calitri
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Mary Carter
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Chris Code
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Ruth Lamont
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Sarah Dean
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Mark Tarrant
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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Occupational Physicians' Perspectives on Determinants of Employee Participation in a Randomized Controlled Musculoskeletal Health Promotion Measure: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207445. [PMID: 33066098 PMCID: PMC7650758 DOI: 10.3390/ijerph17207445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians' experiences with employee participation in a randomized controlled workplace measure for musculoskeletal disorders (MSDs) in Germany. We conducted eight semi-structured telephone interviews with occupational physicians. Interviews were transcribed verbatim and analyzed using a combination of conventional and directed content analysis. Findings were mapped based on Andersen's behavioral model of health services use, resulting in four categories and 10 subcategories. (a) Contextual factors of the measure comprised impacts of the healthcare system and company environment, (b) individual factors of measure participation comprised demographic, social, belief, and MSD need characteristics, (c) health behavior during the measure included OPs' communication, employees' personal practices and measure participation, and (d) outcomes of participation included health status, satisfaction, and dissatisfaction with the measure. Findings imply occupational physicians' and employees' views should be investigated on a broader scale. Researchers should use present statements for the development of intervention studies, while political and managerial authorities can improve organizational conditions of prevention based on these findings.
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Morgan K, Rahman M, Moore G. Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales From 2008 to 2017: A Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3942. [PMID: 32498367 PMCID: PMC7313463 DOI: 10.3390/ijerph17113942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/16/2023]
Abstract
Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health.
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Affiliation(s)
- Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Muhammad Rahman
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK;
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
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