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Dimitriadis T, Mudarris MA, Veldhuijzen DS, Evers AW, Magee WL, Schaefer RS. Music therapy with adults in the subacute phase after stroke: A study protocol. Contemp Clin Trials Commun 2024; 41:101340. [PMID: 39188414 PMCID: PMC11345398 DOI: 10.1016/j.conctc.2024.101340] [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: 04/03/2024] [Revised: 06/07/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
Stroke is a highly disabling condition, for which music therapy is regularly used in rehabilitation. One possible mechanism for the effects of music therapy is the motivational aspect of music, for example regarding treatment adherence based on improved mood. In this study, changes in motivation related to Neurologic Music Therapy (NMT) techniques during rehabilitation in the subacute phase after stroke will be investigated. Using a randomised within-subjects cross-over design, the effects of two NMT techniques and related motivational indices will be investigated. Data will be collected at three timepoints: baseline (TP1), after being randomised into groups and receiving NMT or standard care (TP2), and then at a third time point after the cross-over and having received both conditions (TP3). This design allows to counteract order effects, time effects due to spontaneous and/or nonlinear recovery, as well as single-subject comparisons in a relatively heterogeneous sample. Twenty adult participants who have experienced a supratentorial ischaemic or haemorrhagic stroke and are experiencing upper-limb impairments and/or cognitive deficits will be included. Behavioural measures of motor function, cognition, and quality of life will be collected, along with self-reported indices of overall motivation. The study outcomes will have implications for the understanding of the underlying mechanisms of music therapy in stroke recovery, more specifically regarding the relevance of motivational states in neurorehabilitation.
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Affiliation(s)
- Theo Dimitriadis
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
- Amstelring Rehabilitation Centre and Nursing Homes, Saaftingestraat 8, 1069BW, Amsterdam, the Netherlands
| | - Mohammed A. Mudarris
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
- University of Jeddah, College of Science and Arts at AlKamil, Department of Communication Skills, Jeddah, Saudi Arabia
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands
| | - Dieuwke S. Veldhuijzen
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands
- Medical Delta Healthy Society, Leiden University, Technical University Delft and Erasmus University Rotterdam, the Netherlands
| | - Wendy L. Magee
- Boyer College of Music and Dance, Temple University, Philadelphia, PA, USA
| | - Rebecca S. Schaefer
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands
- Medical Delta Healthy Society, Leiden University, Technical University Delft and Erasmus University Rotterdam, the Netherlands
- Academy of Creative and Performing Arts, Leiden University, the Netherlands
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Hohenschurz-Schmidt D, Cherkin D, Rice ASC, Dworkin RH, Turk DC, McDermott MP, Bair MJ, DeBar LL, Edwards RR, Evans SR, Farrar JT, Kerns RD, Rowbotham MC, Wasan AD, Cowan P, Ferguson M, Freeman R, Gewandter JS, Gilron I, Grol-Prokopczyk H, Iyengar S, Kamp C, Karp BI, Kleykamp BA, Loeser JD, Mackey S, Malamut R, McNicol E, Patel KV, Schmader K, Simon L, Steiner DJ, Veasley C, Vollert J. Methods for pragmatic randomized clinical trials of pain therapies: IMMPACT statement. Pain 2024; 165:2165-2183. [PMID: 38723171 PMCID: PMC11404339 DOI: 10.1097/j.pain.0000000000003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/08/2024] [Indexed: 09/18/2024]
Abstract
ABSTRACT Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
- Research Department, University College of Osteopathy, London, United Kingdom
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Matthew J Bair
- VA Center for Health Information and Communication, Regenstrief Institute, and Indiana University School of Medicine, Indianapolis, IN, United States
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Scott R Evans
- Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, MD, United States
| | - John T Farrar
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert D Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Michael C Rowbotham
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Ajay D Wasan
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative, University of Rochester, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, United States
| | | | - Cornelia Kamp
- Center for Health and Technology (CHeT), Clinical Materials Services Unit (CMSU), University of Rochester Medical Center, Rochester, NY, United States
| | - Barbara I Karp
- National Institutes of Health, Bethesda, MD, United States
| | - Bethea A Kleykamp
- University of Maryland, School of Medicine, Baltimore, MD, United States
| | - John D Loeser
- Departments of Neurological Surgery and Anesthesia and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Sean Mackey
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, Palo Alto, CA, United States
| | | | - Ewan McNicol
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, United States
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kenneth Schmader
- Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center, and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Lee Simon
- SDG, LLC, Cambridge, MA, United States
| | | | | | - Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Tew GA, Wiley L, Ward L, Hugill-Jones JG, Maturana CS, Fairhurst CM, Bell KJ, Bissell L, Booth A, Howsam J, Mount V, Rapley T, Ronaldson SJ, Rose F, Torgerson DJ, Yates D, Hewitt CE. Chair-based yoga programme for older adults with multimorbidity: RCT with embedded economic and process evaluations. Health Technol Assess 2024; 28:1-152. [PMID: 39259017 PMCID: PMC11417643 DOI: 10.3310/kpgn4216] [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] [Indexed: 09/12/2024] Open
Abstract
Background Older adults with multimorbidity experience impaired health-related quality of life and treatment burden. Yoga has the potential to improve several aspects of health and well-being. The British Wheel of Yoga's Gentle Years Yoga© programme was developed specifically for older adults, including those with chronic conditions. A pilot trial demonstrated feasibility of using Gentle Years Yoga in this population, but there was limited evidence of its effectiveness and cost-effectiveness. Objective To determine the effectiveness and cost-effectiveness of the Gentle Years Yoga programme in addition to usual care versus usual care alone in older adults with multimorbidity. Design Pragmatic, multisite, individually randomised controlled trial with embedded economic and process evaluations. Setting Participants were recruited from 15 general practices in England and Wales from July 2019 with final follow-up in October 2022. Participants Community-dwelling adults aged 65 years and over with multimorbidity, defined as two or more chronic health conditions from a predefined list. Interventions All participants continued with any usual care provided by primary, secondary, community and social services. The intervention group was offered a 12-week programme of Gentle Years Yoga. Main outcome measures The primary outcome and end point were health-related quality of life measured using the EuroQol-5 Dimensions, five-level version utility index score over 12 months. Secondary outcomes were health-related quality of life, depression, anxiety, loneliness, incidence of falls, adverse events and healthcare resource use. Results The mean age of the 454 randomised participants was 73.5 years; 60.6% were female, and participants had a median of three chronic conditions. The primary analysis included 422 participants (intervention, n = 227 of 240, 94.6%; usual care, n = 195 of 214, 91.1%). There was no statistically or clinically significant difference in the EuroQol-5 Dimensions, five-level version utility index score over 12 months: the predicted mean score for the intervention group was 0.729 (95% confidence interval 0.712 to 0.747) and for usual care it was 0.710 [95% confidence interval (CI) 0.691 to 0.729], with an adjusted mean difference of 0.020 favouring intervention (95% CI -0.006 to 0.045, p = 0.14). No statistically significant differences were observed in secondary outcomes, except for the pain items of the Patient-Reported Outcomes Measurement Information System-29. No serious, related adverse events were reported. The intervention cost £80.85 more per participant (95% CI £76.73 to £84.97) than usual care, generated an additional 0.0178 quality-adjusted life-years per participant (95% CI 0.0175 to 0.0180) and had a 79% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. The intervention was acceptable to participants, with seven courses delivered face to face and 12 online. Limitations Self-reported outcome data raise the potential for bias in an unblinded trial. The COVID-19 pandemic affected recruitment, follow-up and the mode of intervention delivery. Conclusions Although the Gentle Years Yoga programme was not associated with any statistically significant benefits in terms of health-related quality of life, mental health, loneliness or falls, the intervention was safe, acceptable to most participants and highly valued by some. The economic evaluation suggests that the intervention could be cost-effective. Future work Longer-term cost-effectiveness modelling and identifying subgroups of people who are most likely to benefit from this type of intervention. Trial registration This trial is registered as ISRCTN13567538. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/94/36) and is published in full in Health Technology Assessment; Vol. 28, No. 53. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Garry Alan Tew
- Institute for Health and Care Improvement, York St John University, York, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Laura Wiley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lesley Ward
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | | | | | | | - Kerry Jane Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Laura Bissell
- British Wheel of Yoga Qualifications (BWYQ), Sleaford, Lincs, UK
| | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Howsam
- British Wheel of Yoga Qualifications (BWYQ), Sleaford, Lincs, UK
| | | | - Tim Rapley
- Department of Social Work, Education and Community Well-being, Northumbria University, Newcastle-upon-Tyne, UK
| | | | - Fiona Rose
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - David Yates
- Department of Anaesthesia, York Hospitals NHS Foundation Trust, York, UK
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4
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Kendrick D, Lindley R, Blackburn L, Roadevin C, Thompson E, Andrews I, Anwar F, Brooks A, Carlton E, Crouch R, Day F, Fallon S, Farrin A, Graham L, Hoffman K, Howell R, Holmes J, James M, Jones T, Kellezi B, Kettlewell J, Morriss R, das Nair R, Richardson D, Smith M, Timmons S, Wright-Hughes A, Radford K. Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial. Trials 2024; 25:439. [PMID: 38956682 PMCID: PMC11221047 DOI: 10.1186/s13063-024-08183-w] [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: 06/01/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Moderately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma. METHODS ROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants' self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere. DISCUSSION This trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS. TRIAL REGISTRATION ISRCTN: 43115471. Registered 27/07/2021.
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Affiliation(s)
- Denise Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK.
| | - Rebecca Lindley
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Lauren Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Ellen Thompson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Isabel Andrews
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Fahim Anwar
- Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Edd Carlton
- North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, UK
| | - Florence Day
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steve Fallon
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Laura Graham
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Barts Health NHS Trust and Queen Mary University London, Blizard Institute, 4 Newark St, London, E1 2AT, UK
| | - Rebekah Howell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Trevor Jones
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Blerina Kellezi
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Jade Kettlewell
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Richard Morriss
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | | | - Davina Richardson
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Matthew Smith
- Academic Department of Rehabilitation Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, NG8 1BB, UK
| | | | - Kathryn Radford
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
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Crocker TF, Jordão M, Lam N, Ramiz R, Mirza L, Patel I, Ellwood A, Patetsini E, Ensor J, Forster A, Clegg A, Gladman J. Development of the Community-based complex Interventions to sustain Independence in Older People (CII-OP) typology: a qualitative synthesis of interventions in randomised controlled trials. Age Ageing 2024; 53:afae102. [PMID: 38796315 PMCID: PMC11127769 DOI: 10.1093/ageing/afae102] [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: 06/29/2023] [Indexed: 05/28/2024] Open
Abstract
INTRODUCTION Community-based services to sustain independence for older people have varying configurations. A typology of these interventions would improve service provision and research by providing conceptual clarity and enabling the identification of effective configurations. We aimed to produce such a typology. METHOD We developed our typology by qualitatively synthesising community-based complex interventions to sustain independence in older people, evaluated in randomised controlled trials (RCTs), in four stages: (i) systematically identifying relevant RCTs; (ii) extracting descriptions of interventions (including control) using the Template for Intervention Description and Replication; (iii) generating categories of key intervention features and (iv) grouping the interventions based on these categories. PROSPERO registration: CRD42019162195. RESULTS Our search identified 129 RCTs involving 266 intervention arms. The Community-based complex Interventions to sustain Independence in Older People (CII-OP) typology comprises 14 action components and 5 tailoring components. Action components include procedures for treating patients or otherwise intended to directly improve their outcomes; regular examples include formal homecare; physical exercise; health education; activities of daily living training; providing aids and adaptations and nutritional support. Tailoring components involve a process that may result in care planning, with multiple action components being planned, recommended or prescribed. Multifactorial action from care planning was the most common tailoring component. It involves individualised, multidomain assessment and management, as in comprehensive geriatric assessment. Sixty-three different intervention types (combinations) were identified. CONCLUSIONS Our typology provides an empirical basis for service planning and evidence synthesis. We recommend better reporting about organisational aspects of interventions and usual care.
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Affiliation(s)
- Thomas Frederick Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Magda Jordão
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ridha Ramiz
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lubena Mirza
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ismail Patel
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Alison Ellwood
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Eleftheria Patetsini
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Joie Ensor
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Gladman
- Centre for Rehabilitation and Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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6
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Jones G, Bailey L, Beeken RJ, Brady S, Cooper C, Copeland RJ, Crosland S, Dawson S, Faires M, Gilbody S, Haynes H, Hill A, Hillison E, Horspool M, Lee E, Li J, Machaczek KK, Parrott S, Quirk H, Stubbs B, Tew GA, Traviss-Turner G, Turton E, Walker L, Walters S, Weich S, Wildbore E, Peckham E. Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2024; 10:32. [PMID: 38368380 PMCID: PMC10873949 DOI: 10.1186/s40814-024-01460-0] [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: 06/05/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. METHOD This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. DISCUSSION This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. TRIAL REGISTRATION ISRCTN: ISRCTN83877229. Registered on 09.09.2022.
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Affiliation(s)
- Gareth Jones
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK.
- Sport and Physical Activity Research Centre, Health and Wellbeing Department, Sheffield Hallam University, Sheffield, UK.
| | - Laura Bailey
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Samantha Brady
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sam Dawson
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Matthew Faires
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Holly Haynes
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Emily Hillison
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Michelle Horspool
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Ellen Lee
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Katarzyna K Machaczek
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TU, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Helen Quirk
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, WC2R 2LS, UK
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, YO31 7EX, UK
| | | | - Emily Turton
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Lauren Walker
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Ellie Wildbore
- Sheffield Health and Social Care NHS Foundation Trust, Distington House, Atlas Way, Sheffield, S4 7QQ, UK
| | - Emily Peckham
- School of Medical and Health Sciences, Bangor University, Gwynedd, LL57 2DG, UK
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Turner KM, Huntley A, Yardley T, Dawson S, Dawson S. Defining usual care comparators when designing pragmatic trials of complex health interventions: a methodology review. Trials 2024; 25:117. [PMID: 38342896 PMCID: PMC10860249 DOI: 10.1186/s13063-024-07956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Pragmatic trials evaluating complex health interventions often compare them to usual care. This comparator should resemble care as provided in everyday practice. However, usual care can differ for the same condition, between patients and practitioners, across clinical sites and over time. Heterogeneity within a usual care arm can raise methodological and ethical issues. To address these it may be necessary to standardise what usual care entails, although doing so may compromise a trial's external validity. Currently, there is no guidance detailing how researchers should decide the content of their usual care comparators. We conducted a methodology review to summarise current thinking about what should inform this decision. METHODS MEDLINE, Embase, CINAHL and PsycINFO were searched from inception to January 2022. Articles and book chapters that discussed how to identify or develop usual care comparators were included. Experts in the field were also contacted. Reference lists and forward citation searches of included articles were screened. Data were analysed using a narrative synthesis approach. RESULTS One thousand nine hundred thirty records were identified, 1611 titles and abstracts screened, 112 full texts screened, and 16 articles included in the review. Results indicated that the content of a usual care comparator should be informed by the aims of the trial, existing care practices, clinical guidelines, and characteristics of the target population. Its content should also be driven by the trial's requirements to protect participants, inform practice, and be methodologically robust, efficient, feasible and acceptable to stakeholders. When deciding the content of usual care, researchers will need to gather information about these drivers, balance tensions that might occur when responding to different trial objectives, and decide how usual care will be described and monitored in the trial. DISCUSSION When deciding the content of a usual care arm, researchers need to understand the context in which a trial will be implemented and what the trial needs to achieve to address its aim and remain ethical. This is a complex decision-making process and trade-offs might need to be made. It also requires research and engagement with stakeholders, and therefore time and funding during the trial's design phase. TRIAL REGISTRATION PROSPERO CRD42022307324.
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Affiliation(s)
- Katrina M Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Alyson Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Heaven A, Bower P, Day F, Farrin A, Fernadez C, Foster M, Foy R, Hawkins R, Hulme C, Humphrey S, Lawton R, Parker C, Thompson E, West R, Clegg A. PeRsOnaliSed care Planning for oldER people with frailty (PROSPER): protocol for a randomised controlled trial. Trials 2024; 25:8. [PMID: 38167481 PMCID: PMC10759371 DOI: 10.1186/s13063-023-07857-1] [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: 10/27/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Frailty is common in older age and is characterised by loss of biological reserves across multiple organ systems. These changes associated with frailty mean older people can be vulnerable to sudden, dramatic changes in health because of relatively small problems. Older people with frailty are at increased risk of adverse outcomes including disability, hospitalisation, and care home admission, with associated reduction in quality of life and increased NHS and social care costs. Personalised Care Planning offers an anticipatory, preventative approach to supporting older adults to live independently for longer, but it has not been robustly evaluated in a population of older adults with frailty. METHODS Following an initial feasibility study, this multi-centre, individually randomised controlled trial aims to establish whether personalised care planning for older people improves health-related quality of life. It will recruit 1337 participants from general practices across Yorkshire and Humber and Mid-Mersey in the North of England. Eligible patients will be aged 65 and over with an electronic frailty index score of 0.21 or above, living in their own homes, without severe cognitive impairment and not in receipt of end-of-life care. Following confirmation of eligibility, informed consent and baseline data collection, participants will be individually randomised to the PeRsOnaliSed care Planning for oldER people with frailty (PROSPER) intervention or usual care in a 2.6:1 allocation ratio. Participants will not be blinded to allocation, but data collection and analysis will be blinded. The intervention will be delivered over 12 weeks by a Personal Independence Co-ordinator worker based within a voluntary sector organisation, Age UK. The primary outcomes are health-related quality of life, measured using both the physical and mental components of the Short-Form 12 Item Health Questionnaire at 12 months after randomisation. Secondary outcomes comprise activities of daily living, self-management capabilities and loneliness, admission to care homes, hospitalisations, and health and social care resource use at 12 months post randomisation. Parallel cost-effectiveness and process evaluations will be conducted alongside the trial. DISCUSSION The PROSPER study will evaluate the effectiveness and cost-effectiveness of a personalised care planning approach for older people with frailty and inform the process of its implementation. TRIAL REGISTRATION ISRCTN16123291 . Registered on 28 August 2020.
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Affiliation(s)
- Anne Heaven
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
| | - Peter Bower
- NIHR Older People and Frailty Policy Research Unit, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, University of Manchester, M13 9PL, Manchester, UK
| | - Florence Day
- Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Catherine Fernadez
- Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Marilyn Foster
- PPI Representative, c/o Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Rebecca Hawkins
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Claire Hulme
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, EX1 2LU, UK
| | - Sara Humphrey
- OPMH & Dementia at Yorkshire and Humber Clinical Network, Rotherham, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Catriona Parker
- Cancer Clinical Trial Centre, Weston Park Cancer Centre, Whitham Road, Sheffield, S10 2SJ, UK
| | - Ellen Thompson
- Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Robert West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
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Seinsche J, de Bruin ED, Saibene E, Rizzo F, Carpinella I, Ferrarin M, Ifanger S, Moza S, Giannouli E. Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49377. [PMID: 37943591 PMCID: PMC10667977 DOI: 10.2196/49377] [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: 05/30/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. OBJECTIVE The aim of this study is to test the feasibility and effectiveness of this novel training system. METHODS A total of 180 older adults from Switzerland, Italy, and Cyprus aged ≥60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. RESULTS Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. CONCLUSIONS Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49377.
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Affiliation(s)
- Julia Seinsche
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Enrico Saibene
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Francesco Rizzo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Ilaria Carpinella
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Ferrarin
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Sarina Ifanger
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | | | - Eleftheria Giannouli
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Lawton R, Murray J, Baxter R, Richardson G, Cockayne S, Baird K, Mandefield L, Brealey S, O'Hara J, Foy R, Sheard L, Cracknell A, Breckin E, Hewitt C. Evaluating an intervention to improve the safety and experience of transitions from hospital to home for older people (Your Care Needs You): a protocol for a cluster randomised controlled trial and process evaluation. Trials 2023; 24:671. [PMID: 37838678 PMCID: PMC10576890 DOI: 10.1186/s13063-023-07716-z] [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: 07/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Older patients often experience safety issues when transitioning from hospital to home. The 'Your Care Needs You' (YCNY) intervention aims to support older people to 'know more' and 'do more' whilst in hospital so that they are better prepared for managing at home. METHODS A multi-centre cluster randomised controlled trial (cRCT) will evaluate the effectiveness and cost-effectiveness of the YCNY intervention. Forty acute hospital wards (clusters) in England from varying medical specialities will be randomised to deliver YCNY or care-as-usual on a 1:1 basis. The primary outcome will be unplanned hospital readmission rates within 30 days of discharge. This will be extracted from routinely collected data of at least 5440 patients (aged 75 years and older) discharged to their own homes during the 4- to 5-month YCNY intervention period. A nested cohort of up to 1000 patients will be recruited to the study to collect secondary outcomes via follow-up questionnaires at 5-, 30- and 90-day post-discharge. These will include measures of patient experience of transitions, patient-reported safety events, quality of life and healthcare resource use. Unplanned hospital readmission rates at 60 and 90 days of discharge will be collected from routine data. A process evaluation (primarily interviews and observations with patients, carers and staff) will be conducted to understand the implementation of the intervention and the contextual factors that shape this, as well as the intervention's underlying mechanisms of action. Fidelity of intervention delivery will also be assessed across all intervention wards. DISCUSSION This study will establish the effectiveness and cost-effectiveness of the YCNY intervention which aims to improve patient safety and experience for older people during transitions of care. The process evaluation will generate insights about how the YCNY intervention was implemented, what elements of the intervention work and for whom, and how to optimise its implementation so that it can be delivered with high fidelity in routine service contexts. TRIAL REGISTRATION UK Clinical Research Network Portfolio: 44559; ISTCRN: ISRCTN17062524. Registered on 11/02/2020.
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Affiliation(s)
- Rebecca Lawton
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK.
- School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
| | - Ruth Baxter
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | | | | | - Jane O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Alison Cracknell
- Leeds Centre for Older People's Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edmund Breckin
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
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van der Meulen AI, Neis EPJG, de Nijs EJM, Coenegracht BJEG, Stoppelenburg A, van den Beuken-van Everdingen MHJ, van der Linden YM. Dry mouth in patients with a life-limiting condition or frailty: a study protocol for two intervention studies and a nested qualitative sub-study (the Dry mOuth Project, DROP). BMC Palliat Care 2023; 22:120. [PMID: 37612654 PMCID: PMC10463805 DOI: 10.1186/s12904-023-01242-0] [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: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite its prevalent and impactful nature, dry mouth remains an underexposed and undertreated symptom in patients with a life-limiting condition or frailty. The main contributing factors are a lack of awareness and knowledge amongst both healthcare professionals and patients, and a scarcity of effective, evidence-based interventions. In the DRy mOuth Project (DROP), we address these factors by investigating both a non-pharmacological and a pharmacological intervention: a nurse-led patient education program and locally applied pilocarpine. METHODS This intervention-based research project consists of two parallel studies. The non-pharmacological study is a cluster non-randomized controlled trial in 228 palliative nursing home and hospital patients, investigating the effect of structured use of guidelines and of patient education on dry mouth symptoms. This intervention, a nurse-led patient education program (the Mouth Education Program, MEP), will be compared to care as usual, the control. The pharmacological study is a double-blind placebo-controlled randomized trial that examines the effect of locally applied pilocarpine drops in 120 patients with dry mouth symptoms. Both studies use the same mixed-methods study design, in which the primary outcome is the clinical response to the intervention at 4 weeks, as measured by a dry mouth severity score (numeric rating scale from 0 to 10). Other outcomes, as measured by questionnaires over a 12-week follow-up period, include durability of the effect, impact on quality of life and, adherence and acceptability of the intervention. In addition, the feasibility and cost-effectiveness are evaluated by means of questionnaires and focus groups with healthcare professionals, and interviews with patients. DISCUSSION This study investigates the effectiveness and feasibility of two interventions for dry mouth symptoms in patients with life-limiting conditions or frailty. Due to the large-scale and mixed-method nature of the study, this study will also improve our understanding of dry mouth and its relating factors and of the patients' and healthcare professionals' experiences with symptoms, care and guidelines of dry mouth, including any perceived barriers and facilitators. TRIAL REGISTRATION NCT05964959 & NCT05506137.
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Affiliation(s)
| | - Evelien P J G Neis
- Center of Expertise in Palliative Care, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ellen J M de Nijs
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Arianne Stoppelenburg
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | | | - Yvette M van der Linden
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
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Bourmaud A, Fianu A, Kervan C, Verga-Gérard A, Fournel I, Dumas A, Mancini J, Alla F, Omorou A, Giraudeau B. [French version of The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, in a French law context]. Rev Epidemiol Sante Publique 2023; 71:101847. [PMID: 37167813 DOI: 10.1016/j.respe.2023.101847] [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: 04/07/2022] [Revised: 01/06/2023] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION There is growing evidence on the ethical challenges raised by cluster randomized trials. This specificity is not reflected in the legal texts regulating research, which creates difficulties for researchers implementing these experimental designs. The Ottawa Statement (Weijer et al. 2012) aims to provide detailed guidance on the ethical design, conduct and assessment of cluster trials. More broadly aims to help research stakeholders and decision-makers to make informed ethical decisions regarding the particularity of these experimental designs. It seems that this international statement, written in English, is not sufficiently accessible to all of the French professionals involved in health research. The aim of this article is to provide these professionals with a contextualized and illustrated French translation of the "Ottawa statement". METHOD . The "complex design" working group of the RECaP network (Research in Clinical Epidemiology and Public Health), carried out this work. A first version was discussed by the authors in several meetings. It was completed by contextual explanations and examples of French studies currently conducted by the authors. The final version was obtained by consensus and validated by the group. RESULTS . This work reports 15 recommendations grouped into 7 key questions: How to justify cluster design? How to submit an article to an ethics committee? How to identify research participants? How and when to obtain informed consent? Who are the gatekeepers? How to assess benefits and harm? How to protect vulnerable participants? Each of these recommendations is specific to cluster trials. The recommendations are explained and detailed through concrete examples. CONCLUSION Without interfering with current French laws, this work provides a framework for the organization, conduct and ethical assessment of cluster randomized trials in France. In the present-day context, it is essential that all concerned groups can base their decisions on recommendations in line with the elementary principles of health research ethics.
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Affiliation(s)
- A Bourmaud
- Unité d'épidémiologie clinique, CIC-EC 1426, Hôpital Universitaire Robert Debré, AP-HP, Paris et Université Paris-Cité, Paris, France.
| | - A Fianu
- Inserm CIC1410, CHU Réunion, Saint-Pierre, France/CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - C Kervan
- Equipe MeRISP, Inserm UMR U1219, Bordeaux Population Health Research Center (BPH), Université de Bordeaux, Bordeaux, France
| | - A Verga-Gérard
- CIC-EC 1433, Nancy, Inserm ; RECaP/ F-CRIN, Nancy, France
| | - I Fournel
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, F21000 Dijon, France
| | - A Dumas
- Université Paris-Cité, ECEVE UMR 1123, Inserm, Paris, France
| | - J Mancini
- Aix Marseille Université, AP-HM, Inserm, IRD, ISSPAM, SESSTIM, BioSTIC, Marseille, France
| | - F Alla
- Université de Bordeaux, Inserm U1218, Bordeaux 33000, France; Prevention Department, Centre hospitalier universitaire de Bordeaux, France
| | - A Omorou
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Epidémiologie clinique, F-54000 Nancy, France
| | - B Giraudeau
- Université de Tours, Université de Nantes, Inserm, SPHERE U1246, Tours, France; INSERM CIC1415, CHRU de Tours, Tours, France
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Airagnes G, Valter R, Ducoutumany G, Vansteene C, Trabut JB, Gorwood P, Dubertret C, Matta J, Charles-Nelson A, Limosin F. Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial. Alcohol Alcohol 2023; 58:329-335. [PMID: 37012631 DOI: 10.1093/alcalc/agad021] [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: 11/07/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE Alcohol withdrawal syndrome (AWS) is a frequent and potentially life-threatening condition experienced in alcohol use disorder. Since hypomagnesemia is involved in AWS's severity, we conducted a multicenter double-blind randomized placebo-controlled trial to examine the efficacy of oral magnesium supplementation as an adjuvant therapy of AWS. MATERIAL AND METHODS Inpatients were recruited in six different centers if they had a baseline score higher than eight on the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). The experimental treatment was magnesium lactate dehydrate, administrated three times per day providing a total of 426.6 mg per day and up to 15 days. The primary endpoint was the significant between-group difference of the CIWA-Ar total score change from baseline to 3 days later. The treatment group and baseline score were introduced as covariables in an analysis of covariance. RESULTS A total of 98 inpatients were included {71.4% of men; mean age of 49.1 years [standard deviation (SD): 10.3]}. In the intention-to-treat population, the mean reduction of the CIWA-Ar score in the experimental group between baseline and 3 days later was 10.1 (SD: 5.2), whereas it was 9.2 (SD: 3.9) in the control group. The absolute difference of the adjusted mean in the experimental group compared with the control group was -0.69 (SD: 0.72), which did not correspond to a significant between-group difference (P = 0.34). Per-protocol analysis and sensitivity analyses also supported this result. Supplementary analyses found no significant difference regarding benzodiazepine consumption, magnesium blood concentration, and satisfaction to care. CONCLUSIONS The present study does not support the rationale of systematic oral magnesium supplementation in patients with AWS.
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Affiliation(s)
- Guillaume Airagnes
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- INSERM UMS011, Population-based Epidemiological Cohorts, Hôpital Paul Brousse Bât. 15/16, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France
| | - Rémi Valter
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - Géraldine Ducoutumany
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - Clément Vansteene
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France
| | - Jean-Baptiste Trabut
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Hôpital Emile ROUX, Department of Addictology, 1 Avenue de Verdun, 94450 Limeil-Brévannes, France
| | - Philip Gorwood
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
| | - Caroline Dubertret
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, University Hospital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France
| | - Joane Matta
- INSERM UMS011, Population-based Epidemiological Cohorts, Hôpital Paul Brousse Bât. 15/16, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France
| | - Anais Charles-Nelson
- INSERM, Centre d'Investigation Clinique 1418 Épidémiologie Clinique, AP-HP, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, 20 rue Leblanc, 75015 Paris, France
| | - Frédéric Limosin
- Department of Psychiatry and Addictology, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
- Faculté de Santé, UFR de Médecine, Université Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 1 rue Cabanis, 75014 Paris, France
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14
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Petersson EL, Forsén E, Björkelund C, Hammarbäck L, Hessman E, Weineland S, Svenningsson I. Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review. J Affect Disord 2023; 326:1-10. [PMID: 36708952 DOI: 10.1016/j.jad.2023.01.076] [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: 07/06/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care. METHOD A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022. RESULTS The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU. LIMITATIONS The limitations were that only studies published in English were included. CONCLUSIONS The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.
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Affiliation(s)
- E-L Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - E Forsén
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - C Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - L Hammarbäck
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - E Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - S Weineland
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - I Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
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15
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Arienti C, Buraschi R, Pollet J, Lazzarini SG, Cordani C, Negrini S, Gobbo M. A systematic review opens the black box of "usual care" in stroke rehabilitation control groups and finds a black hole. Eur J Phys Rehabil Med 2022; 58:520-529. [PMID: 35634889 PMCID: PMC9980563 DOI: 10.23736/s1973-9087.22.07413-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/05/2022] [Accepted: 05/25/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In experimental trials, new methods are tested against the "best" or "usual" care. To appraise control group (CG) interventions provided as "usual care," we focused on stroke as a leading cause of disability demanding rehabilitation as a complex intervention. EVIDENCE ACQUISITION For this methodological appraisal, we conducted a systematic review of RCTs without timespan limitation. The PICO included stroke survivors, rehabilitation, control group intervention, lower limb function. To assess the risk of bias, we used the Cochrane risk of bias tool (RoB). We identified the terminology describing the CG Program (CGP), performed a knowledge synthesis and conducted a frequency analysis of provided interventions. EVIDENCE SYNTHESIS We included 155 publications. 13.6% of the articles did not describe the CG, and 11.6% indicated only the professionals involved. In the remaining 116 studies, three studies provided an intervention according to specific guidelines, 106 different "usual care" CGPs were detected, with nine proposed twice and two between four and five times. The most adopted terminology to state "usual care" was "conventional physiotherapy." CONCLUSIONS This study shows that usual care in CG does not actually exist, as both specific terminology and consistency within CGP contents are missing. Reporting guidelines should give better assistance on this issue. These results should be verified in other fields.
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Affiliation(s)
| | | | - Joel Pollet
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | | | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, La Statale University, Milan, Italy
| | - Massimiliano Gobbo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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16
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Barais M, Costa M, Montalvo C, Rannou V, Vaillant-Roussel H, Costa D, Cadier S, Pereira B. Talking about premature ejaculation in primary care: the GET UP cluster randomised controlled trial. BJGP Open 2022; 6:BJGPO.2021.0168. [PMID: 34862162 PMCID: PMC9447320 DOI: 10.3399/bjgpo.2021.0168] [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: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Premature ejaculation (PE) is the most common sexual dysfunction in males. A previous qualitative study identified six communication strategies described by GPs to tackle this topic during consultations. AIM To determine whether these six strategies are more effective than usual care for promoting discussion about PE between patients and their GPs. DESIGN AND SETTING Cluster randomised controlled trial, stratified in four French regions, with an intervention group (GPs who received a training session on the six communication strategies) and a control group (routine medical care). Participants were males aged 18-80 years consulting for a sexual, urogenital, or psychological reason. METHOD The efficacy of the training session in communication skills, compared with usual care, was evaluated by determining the percentage of patients who discussed PE with their GP (primary outcome). The percentage of enrolled patients with PE was calculated using a cut-off score >9 of the premature ejaculation diagnostic tool (PEDT) completed by the enrolled patients at Week 4 after the consultation. The quality-of-life changes were evaluated as the SF-12 scale score difference between baseline and Week 4 post-consultation. RESULTS In total, 130 patients were included by 32 GPs (n = 16 in the intervention and n = 16 in the control group). The percentage of patients who discussed PE was higher in the intervention group than in the control group (42.0% versus 4.9%, absolute difference = 37.1%; 95% confidence intervals [CI] = 24% to 50%, P<0.001). CONCLUSION Training GPs in communication strategies about PE improves its detection.
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Affiliation(s)
- Marie Barais
- Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Marine Costa
- Department of General Practice, Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France
| | - Camille Montalvo
- Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Vincent Rannou
- Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Hélène Vaillant-Roussel
- Department of General Practice, Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France
- Department of Clinical Research and Innovation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - David Costa
- Département Universitaire de Médecine Générale, UFR Médecine Université de Montpellier-Nimes, Montpellier, France
| | - Sébastien Cadier
- Département de Médecine Générale, UFR Sciences Médicales, Université de Bordeaux, Bordeaux, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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17
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Proposing six criteria to improve reproducibility of “usual care” interventions in back pain trials: a systematic review. J Clin Epidemiol 2022; 149:227-235. [DOI: 10.1016/j.jclinepi.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
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18
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Lang AE. No need to shift course on smoking cessation treatments for patients with peripheral artery disease. J Vasc Surg 2022; 75:1791. [DOI: 10.1016/j.jvs.2021.12.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022]
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19
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Berinstein JA, Cohen-Mekelburg SA, Greenberg GM, Wray D, Berry SK, Saini SD, Fendrick AM, Adams MA, Waljee AK, Higgins PD. A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:1029-1038.e9. [PMID: 34461298 PMCID: PMC8882693 DOI: 10.1016/j.cgh.2021.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with substantial symptom burden, variability in clinical outcomes, and high direct costs. We sought to determine if a care coordination-based strategy was effective at improving patient symptom burden and reducing healthcare costs for patients with IBD in the top quintile of predicted healthcare utilization and costs. METHODS We performed a randomized controlled trial to evaluate the efficacy of a patient-tailored multicomponent care coordination intervention composed of proactive symptom monitoring and care coordinator-triggered algorithms. Enrolled patients with IBD were randomized to usual care or to our care coordination intervention over a 9-month period (April 2019 to January 2020). Primary outcomes included change in patient symptom scores throughout the intervention and IBD-related charges at 12 months. RESULTS Eligible IBD patients in the top quintile for predicted healthcare utilization and expenditures were identified. A total of 205 patients were enrolled and randomized to our intervention (n = 100) or to usual care (n = 105). Patients in the care coordinator arm demonstrated an improvement in symptoms scores compared with usual care (coefficient, -0.68, 95% confidence interval, -1.18 to -0.18; P = .008) without a significant difference in median annual IBD-related healthcare charges ($10,094 vs $9080; P = .322). CONCLUSIONS In this first randomized controlled trial of a patient-tailored care coordination intervention, composed of proactive symptom monitoring and care coordinator-triggered algorithms, we observed an improvement in patient symptom scores but not in healthcare charges. Care coordination programs may represent an effective value-based approach to improve symptoms scores without added direct costs in a subgroup of high-risk patients with IBD. (ClinicalTrials.gov, Number: NCT04796571).
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Affiliation(s)
- Jeffrey A. Berinstein
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Shirley A. Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Daniel Wray
- Twine Clinical Consulting, LLC Park City, UT, USA
| | - Sameer K. Berry
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Sameer D. Saini
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - A. Mark Fendrick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA,Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
| | - Megan A. Adams
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Peter D.R. Higgins
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
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20
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Checkley W, Hossen S, Rosa G, Thompson LM, McCracken JP, Diaz-Artiga A, Balakrishnan K, Simkovich SM, Underhill LJ, Nicolaou L, Hartinger SM, Davila-Roman VG, Kirby MA, Clasen TF, Rosenthal J, Peel JL. Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3790. [PMID: 35409475 PMCID: PMC8997769 DOI: 10.3390/ijerph19073790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
Objective: Household Air Pollution Intervention Network (HAPIN) investigators tested a complex, non-pharmacological intervention in four low- and middle-income countries as a strategy to mitigate household air pollution and improve health outcomes across the lifespan. Intervention households received a liquefied petroleum gas (LPG) stove, continuous fuel delivery and regular behavioral reinforcements for 18 months, whereas controls were asked to continue with usual cooking practices. While HAPIN was designed as an explanatory trial to test the efficacy of the intervention on four primary outcomes, it introduced several pragmatic aspects in its design and conduct that resemble real-life conditions. We surveyed HAPIN investigators and asked them to rank what aspects of the design and conduct they considered were more pragmatic than explanatory. Methods: We used the revised Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) to survey investigators on the degree of pragmatism in nine domains of trial design and conduct using a five-point Likert rank scale from very explanatory (1) to very pragmatic (5). We invited 103 investigators. Participants were given educational material on PRECIS-2, including presentations, papers and examples that described the use and implementation of PRECIS-2. Results: Thirty-five investigators (mean age 42 years, 51% female) participated in the survey. Overall, only 17% ranked all domains as very explanatory, with an average (±SD) rank of 3.2 ± 1.4 across domains. Fewer than 20% of investigators ranked eligibility, recruitment or setting as very explanatory. In contrast, ≥50% of investigators ranked the trial organization, delivery and adherence of the intervention and follow-up as very/rather explanatory whereas ≤17% ranked them as rather/very pragmatic. Finally, <25% of investigators ranked the relevance of outcomes to participants and analysis as very/rather explanatory whereas ≥50% ranked then as rather/very pragmatic. In-country partners were more likely to rank domains as pragmatic when compared to investigators working in central coordination (average rank 3.2 vs. 2.8, respectively; Wilcoxon rank-sum p < 0.001). Conclusion: HAPIN investigators did not consider their efficacy trial to be rather/very explanatory and reported that some aspects of the design and conduct were executed under real-world conditions; however, they also did not consider the trial to be overly pragmatic. Our analysis underscores the importance of using standardized tools such as PRECIS-2 to guide early discussions among investigators in the design of environmental health trials attempting to measure efficacy.
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London WC1E 7HT, UK;
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30332, USA;
| | - John P. McCracken
- Epidemiology and Biostatistics Department, University of Georgia, Athens, GA 30606, USA;
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai 600116, India;
| | - Suzanne M. Simkovich
- Division of Healthcare Delivery Research, Medstar Health Research Institute, Hyattsville, MD 20782, USA;
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington, DC 20007, USA
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Stella M. Hartinger
- Latin American Center of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Joshua Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA;
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21
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Darker C, Loudon K, O'Connell N, Castello S, Burke E, Vance J, Reynolds C, Buggy A, Dougall N, Williams P, Dobbie F, Bauld L, Hayes CB. An application of PRECIS-2 to evaluate trial design in a pilot cluster randomised controlled trial of a community-based smoking cessation intervention for women living in disadvantaged areas of Ireland. Pilot Feasibility Stud 2022; 8:19. [PMID: 35078530 PMCID: PMC8787878 DOI: 10.1186/s40814-022-00969-6] [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: 07/27/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "We Can Quit2" (WCQ2) was a pilot cluster randomised controlled trial with an embedded process evaluation assessing the feasibility and acceptability of 'We Can Quit' (WCQ, a peer-delivered community-based stop-smoking programme for women in disadvantaged communities. The control group comprised 'enhanced usual care' offered by the Irish Health Service Executive (HSE). The PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) is a tool to assess whether a trial design is more explanatory (working under ideal conditions) or pragmatic (working under 'real-world' conditions). The aim of this paper was to retrospectively evaluate the WCQ2 pilot trial using PRECIS-2 to inform the decision-making process on progression to a future definitive trial (DT). METHODS The WCQ2 trial protocol and HSE standard stop-smoking service were described across the nine PRECIS-2 domains: eligibility, recruitment, setting, organisation, flexibility-delivery, flexibility-adherence, follow-up and primary outcome. Team members scored the domains as pragmatic or explanatory for each arm in a half-day workshop. RESULTS Seven team members (practitioners and researchers) assessed the overall trial design as more explanatory than pragmatic. Important differences emerged between the two arms. WCQ targeted adult women from disadvantaged communities whereas HSE run a limited enhanced service for all quitters. Trial recruitment was challenging, intense efforts were needed as the trial proceeded. WCQ was delivered in a non-clinical community setting, HSE services in a clinical setting. WCQ organisation was co-designed with community partners and comprises peer-to-peer group support delivered by trained lay community facilitators, whereas HSE one-to-one support is delivered by Smoking Cessation Officers with a clinical background. Only WCQ allowed flexibility in delivery and adherence. Follow-up was more intensive in WCQ. Greater efforts to improve participant retention will be required in a future DT. CONCLUSIONS PRECIS-2 allowed the reflection of practitioners and researchers on similarities and differences between intervention and control arms. Results will inform the decision on progression to an effectiveness DT, which will require more a pragmatic and less explanatory design. This novel use of PRECIS-2 to retrospectively evaluate a complex community-based pilot trial in advance of a full DT will also support learning for those undertaking hybrid trials of implementation and effectiveness. TRIAL REGISTRATION This trial is registered with the ISRCTN registry ( No. 74721694 ).
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Affiliation(s)
- Catherine Darker
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nicola O'Connell
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stefania Castello
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emma Burke
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | - Aine Buggy
- Health Promotion and Improvement, Health Service Executive, Dublin, Ireland
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Pauline Williams
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Public and Patient Representative, Dublin, Ireland
| | - Fiona Dobbie
- Usher Institute and SPECTRUM Consortium, College of Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Catherine B Hayes
- Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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22
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Bergmann F, Gray R, Wachsmuth S, Höner O. Perceptual-Motor and Perceptual-Cognitive Skill Acquisition in Soccer: A Systematic Review on the Influence of Practice Design and Coaching Behavior. Front Psychol 2021; 12:772201. [PMID: 34925173 PMCID: PMC8675907 DOI: 10.3389/fpsyg.2021.772201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023] Open
Abstract
Facilitating players' skill acquisition is a major challenge within sport coaches' work which should be supported by evidence-based recommendations outlining the most effective practice and coaching methods. This systematic review aimed at accumulating empirical knowledge on the influence of practice design and coaching behavior on perceptual-motor and perceptual-cognitive skill acquisition in soccer. A systematic search was carried out according to the PRISMA guidelines across the databases SPORTDiscus, PsycInfo, MEDLINE, and Web of Science to identify soccer-specific intervention studies conducted in applied experimental settings (search date: 22nd November 2020). The systematic search yielded 8,295 distinct hits which underwent an independent screening process. Finally, 34 eligible articles, comprising of 35 individual studies, were identified and reviewed regarding their theoretical frameworks, methodological approaches and quality, as well as the interventions' effectiveness. These studies were classified into the following two groups: Eighteen studies investigated the theory-driven instructional approaches Differential Learning, Teaching Games for Understanding, and Non-linear Pedagogy. Another seventeen studies, most of them not grounded within a theoretical framework, examined specific aspects of practice task design or coaches' instructions. The Downs and Black checklist and the Template for Intervention Description and Replication were applied to assess the quality in reporting, risk of bias, and the quality of interventions' description. Based on these assessments, the included research was of moderate quality, however, with large differences across individual studies. The quantitative synthesis of results revealed empirical support for the effectiveness of coaching methodologies aiming at encouraging players' self-exploration within representative scenarios to promote technical and tactical skills. Nevertheless, "traditional" repetition-based approaches also achieved improvements with respect to players' technical outcomes, yet, their impact on match-play performance remains widely unexplored. In the light of the large methodological heterogeneity of the included studies (e.g., outcomes or control groups' practice activities), the presented results need to be interpreted by taking the respective intervention characteristics into account. Overall, the current evidence needs to be extended by theory-driven, high-quality studies within controlled experimental designs to allow more consolidated and evidence-based recommendations for coaches' work.
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Affiliation(s)
- Fynn Bergmann
- Institute of Sports Science, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Rob Gray
- Human Systems Engineering, Arizona State University, Mesa, AZ, United States
| | - Svenja Wachsmuth
- Institute of Sports Science, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Oliver Höner
- Institute of Sports Science, Eberhard Karls University Tübingen, Tübingen, Germany
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23
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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Lammers HA, Teunissen TAM, Akkermans RP, Wolfs PT, Lagro-Janssen ALM. The usefulness of uroflowmetry and ultrasound bladder scanning as diagnostic tools in primary care for new male patients with lower urinary tract symptoms; a cluster randomized controlled trial. Fam Pract 2021; 38:705-711. [PMID: 34173640 DOI: 10.1093/fampra/cmab044] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists. OBJECTIVE To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care. METHODS A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months. RESULTS Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5). CONCLUSIONS Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.
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Affiliation(s)
- Huub A Lammers
- Radboudumc, Department of Primary and Community Care / Gender & Women's Health, Nijmegen, the Netherlands
| | - Theodora A M Teunissen
- Radboudumc, Department of Primary and Community Care / Gender & Women's Health, Nijmegen, the Netherlands
| | - Reinier P Akkermans
- Radboudumc, Department of Primary and Community Care / Gender & Women's Health, Nijmegen, the Netherlands
| | - Pieter T Wolfs
- Radboudumc, Department of Primary and Community Care / Gender & Women's Health, Nijmegen, the Netherlands
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Affiliation(s)
- Christina Abdel Shaheed
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Fiona Blyth
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ann-Mason Furmage
- Disability Action Plan Steering Group, Sydney Local Health District, Sydney, Australia
- Consumer Advisory Council, the Clinical Council and the Disability Action Plan Working Group, Sydney Dental Hospital, Sydney, Australia
| | - Fiona Stanaway
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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26
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Prescott M, Lilley-Kelly A, Cundill B, Clarke D, Drake S, Farrin AJ, Forster A, Goodwin M, Goodwin VA, Hall AJ, Hartley S, Holland M, Hulme C, Nikolova S, Parker C, Wright P, Ziegler F, Clegg A. Home-based Extended Rehabilitation for Older people (HERO): study protocol for an individually randomised controlled multi-centre trial to determine the clinical and cost-effectiveness of a home-based exercise intervention for older people with frailty as extended rehabilitation following acute illness or injury, including embedded process evaluation. Trials 2021; 22:783. [PMID: 34749783 PMCID: PMC8576988 DOI: 10.1186/s13063-021-05778-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed ‘intermediate care’ services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People’s Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury. Methods A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation. Discussion This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated. Trial registration ISRCTN 13927531. Registered on April 19, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05778-5.
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Affiliation(s)
- Matthew Prescott
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.
| | - Amanda Lilley-Kelly
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Bonnie Cundill
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Science, University of Leeds, based at: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Sian Drake
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Science, University of Leeds, based at: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Madeline Goodwin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Victoria A Goodwin
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Abi J Hall
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Mike Holland
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Silviya Nikolova
- Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9JT, UK
| | - Catriona Parker
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Phil Wright
- Physiotherapy Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Friederike Ziegler
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Science, University of Leeds, based at: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
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Menichetti J, Lie HC, Mellblom AV, Brembo EA, Eide H, Gulbrandsen P, Heyn L, Saltveit KH, Strømme H, Sundling V, Turk E, Juvet LK. Tested communication strategies for providing information to patients in medical consultations: A scoping review and quality assessment of the literature. PATIENT EDUCATION AND COUNSELING 2021; 104:1891-1903. [PMID: 33516591 DOI: 10.1016/j.pec.2021.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To systematize the scientific knowledge of empirically tested strategies for verbally providing medical information in patient-physician consultations. METHODS A scoping review searching for terms related to physician, information, oral communication, and controlled study. Four pairs of reviewers screened articles. For each selected study, we assessed the quality and summarized aspects on participants, study, intervention, and outcomes. Information provision strategies were inductively classified by types and main categories. RESULTS After screening 9422 articles, 39 were included. The methodological quality was moderate. We identified four differently used categories of strategies for providing information: cognitive aid (n = 13), persuasive (n = 8), relationship- (n = 3), and objectivity-oriented strategies (n = 4); plus, one "mixed" category (n = 11). Strategies were rarely theoretically derived. CONCLUSIONS Current research of tested strategies for verbally providing medical information is marked by great heterogeneity in methods and outcomes, and lack of theory-driven approaches. The list of strategies could be used to analyse real life communication. PRACTICE IMPLICATIONS Findings may aid the harmonization of future efforts to develop empirically-based information provision strategies to be used in clinical and teaching settings.
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Affiliation(s)
- Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hanne C Lie
- Department of Behavioral Medicine, University of Oslo, Oslo, Norway.
| | - Anneli V Mellblom
- Department of Behavioral Medicine, University of Oslo, Oslo, Norway; Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.
| | - Espen Andreas Brembo
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Lena Heyn
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | | | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway.
| | - Vibeke Sundling
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway.
| | - Eva Turk
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia.
| | - Lene K Juvet
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway; Norvegian Institute of Public Health, Oslo, Norway.
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Cheung DST, Takemura N, Smith R, Yeung WF, Xu X, Ng AYM, Lee SF, Lin CC. Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis. Sleep Med 2021; 85:108-122. [PMID: 34303913 DOI: 10.1016/j.sleep.2021.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effects of qigong interventions on sleep disturbance-related symptom clusters for cancer patients and to explore the possible mediating role of fatigue and depression in affecting sleep. METHODS In this systematic review and meta-analysis, a systematic search was conducted through October 2020 by searching multiple English and Chinese databases. Inclusion was limited to randomized controlled trials that measured the effect of qigong on sleep and fatigue/depressive symptoms in cancer patients. Eleven studies involving 907 cancer patients were included in the systematic review, whereas the meta-analysis included ten studies with 851 cancer patients. RESULTS The most commonly investigated form of qigong was Taichi, and the intervention length ranged from 10 days to 6 months. All studies employed self-reported measurements. Overall, qigong significantly improved sleep (SMD = -1.28, 95% CI: -2.01, -0.55) and fatigue (SMD = -0.89, 95% CI: -1.59, -0.19) in cancer patients post-intervention, but not depressive symptoms (SMD = -0.69, 95% CI: -1.81, 0.42). Notably, the benefits on sleep and fatigue became non-significant after 3 months. Qigong's effect on sleep was significantly mediated by its effect on fatigue (β = 1.27, SE = 0.24, p = 0.002), but not depressive symptoms (β = 0.53, SE = 0.26, p = 0.106). CONCLUSIONS Qigong can be recommended for improving sleep disturbance-fatigue symptom clusters in the cancer population, while qigong's benefit on sleep is likely based on its effect on reducing fatigue. Future qigong studies should adopt more rigorous design and employ strategies to maintain longevity of intervention benefits.
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Affiliation(s)
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alina Yee Man Ng
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; School of Nursing, College of Nursing, Taipei Medical University, Taiwan; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Tew GA, Bissell L, Corbacho B, Fairhurst C, Howsam J, Hugill-Jones J, Maturana C, Paul SAS, Rapley T, Roche J, Rose F, Torgerson DJ, Ward L, Wiley L, Yates D, Hewitt C. Yoga for older adults with multimorbidity (the Gentle Years Yoga Trial): study protocol for a randomised controlled trial. Trials 2021; 22:269. [PMID: 33845869 PMCID: PMC8039798 DOI: 10.1186/s13063-021-05217-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimorbidity is common in older adults and associated with high levels of illness burden and healthcare expenditure. The evidence base for how to manage older adults with multimorbidity is weak. Yoga might be a useful intervention because it has the potential to improve health-related quality of life, physical functioning, and several medical conditions. The British Wheel of Yoga's Gentle Years Yoga© (GYY) programme was developed specifically for older adults, including those with chronic medical conditions. Data from a pilot trial suggested feasibility of using GYY in this population, but its effectiveness and cost-effectiveness remain uncertain. METHODS This is a multi-site, individually randomised, superiority trial with an embedded process evaluation and an economic analysis of cost-effectiveness. The trial will compare an experimental strategy of offering a 12-week GYY programme against a control strategy of no offer in community-dwelling adults aged 65 or over who have multimorbidity, defined as having two or more chronic conditions from a predefined list. The primary outcome is health-related quality of life measured using the EQ-5D-5L, the primary endpoint being the overall difference over 12 months. Both groups will continue to be able to access their usual care from primary, secondary, community, and social services. Participants, care providers, and yoga teachers will not be blinded to the allocated intervention. Outcome measures are primarily self-reported. The analysis will follow intention-to-treat principles. DISCUSSION This pragmatic randomised controlled trial will demonstrate if the GYY programme is an effective, cost-effective, and viable addition to the management of older adults with multimorbidity. TRIAL REGISTRATION ISRCTN ISRCTN13567538 . Registered on 18 March 2019.
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Affiliation(s)
- Garry A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK.
- York Trials Unit, Department of Health Sciences, University of York, York, UK.
| | - Laura Bissell
- British Wheel of Yoga Qualifications (BWYQ), Sleaford, Lincs, UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Howsam
- British Wheel of Yoga Qualifications (BWYQ), Sleaford, Lincs, UK
| | - Jess Hugill-Jones
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Camila Maturana
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Shirley-Anne S Paul
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-upon-Tyne, UK
| | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Fi Rose
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Laura Wiley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Yates
- Department of Anaesthesia, York Hospitals NHS Foundation Trust, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Casarin J, Cromi A, Sgobbi B, Di Siena A, Serati M, Bolis ME, Ghezzi F. Music Therapy for Preoperative Anxiety Reduction in Women Undergoing Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2021; 28:1618-1624.e1. [PMID: 33549732 DOI: 10.1016/j.jmig.2021.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To assess the superiority of a music therapy intervention (Music) vs usual care (Control) in reducing the preoperative anxiety of patients undergoing total laparoscopic hysterectomy (TLH) with nononcologic indications. DESIGN This was a 1:2 (Music vs Control) randomized controlled study. SETTING A teaching hospital. PATIENTS One hundred patients were available for the analysis: 30 and 70 in the Music and Control arms, respectively. INTERVENTIONS Perioperative music therapy pathway in patients undergoing TLH for benign disease. MEASUREMENTS AND MAIN RESULTS Anxiety was evaluated with the State-Trait Anxiety Inventory Y Form (STAI-Y) at different time points: at baseline and during preoperative, early postoperative, and late postoperative periods. Pathologic anxiety was defined as STAI-Y state >45. Postoperative pain was registered using the visual analog scale. Women in the Music arm experienced lower anxiety levels (median STAI-Y scores 38.0 vs 41.0; p = .002) during the preoperative period. STAI-Y scores did not vary significantly by intervention at each subsequent time point. A significant difference between the groups (Music vs Control) was found in the proportion of women with pathologic anxiety during the preoperative (16.7% vs 37.2%; p = .04) and early postoperative periods (0% vs 12.9%; p = .04), whereas no significant difference between the groups was registered during the late postoperative period (6.6% vs 7.1%; p = .93). Postoperative pain intensity did not significantly differ between the groups at 1, 3, and 6 hours after surgery. CONCLUSIONS Music therapy might be a viable complementary modality to usual surgical care in the gynecologic setting for its ability to significantly decrease preoperative anxiety in women undergoing TLH for benign conditions.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors).
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Barbara Sgobbi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Anna Di Siena
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Maria Elena Bolis
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
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Biesecker BB, Lillie SE, Amendola LM, Donohue KE, East KM, Foreman AKM, Gilmore MJ, Greve V, Liangolou B, O'Daniel JM, Odgis JA, Rego S, Rolf B, Scollon S, Suckiel SA, Zepp J, Joseph G. A review and definition of 'usual care' in genetic counseling trials to standardize use in research. J Genet Couns 2021; 30:42-50. [PMID: 33278053 PMCID: PMC7882019 DOI: 10.1002/jgc4.1363] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
The descriptor 'usual care' refers to standard or routine care. Yet, no formal definition exists. The need to define what constitutes usual care arises in clinical research. Often one arm in a trial represents usual care in comparison with a novel intervention. Accordingly, usual care in genetic counseling research appears predominantly in randomized controlled trials. Recent standards for reporting genetic counseling research call for standardization, but do not address usual care. We (1) inventoried all seven studies in the Clinical Sequencing Evidence-Generating Consortium (CSER) about how genetic counseling was conceptualized, conducted, and whether a usual care arm was involved; (2) conducted a review of published randomized control trials in genetic counseling, comparing how researchers describe usual care groups; and (3) reviewed existing professionally endorsed definitions and practice descriptions of genetic counseling. We found wide variation in the content and delivery of usual care. Descriptions frequently detailed the content of usual care, most often noting assessment of genetic risk factors, collecting family histories, and offering testing. A minority included addressing psychological concerns or the risks versus benefits of testing. Descriptions of how care was delivered were vague except for mode and type of clinician, which varied. This significant variation, beyond differences expected among subspecialties, reduces the validity and generalizability of genetic counseling research. Ideally, research reflects clinical practice so that evidence generated can be used to improve clinical outcomes. To address this objective, we propose a definition of usual care in genetic counseling research that merges common elements from the National Society of Genetic Counselors' practice definition, the Reciprocal Engagement Model, and the Accreditation Council for Genetic Counselors' practice-based competencies. Promoting consistent execution of usual care in the design of genetic counseling trials can lead to more consistency in representing clinical care and facilitate the generation of evidence to improve it.
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Affiliation(s)
- Barbara B Biesecker
- Genomics, Bioinformatics and Translation, RTI International, Washington, DC, USA
| | - Sarah E Lillie
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Laura M Amendola
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Katherine E Donohue
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Veronica Greve
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | | | - Jacqueline A Odgis
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shannon Rego
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bradley Rolf
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sabrina A Suckiel
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamilyn Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
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Brown SM, Peltan I, Kumar N, Leither L, Webb BJ, Starr N, Grissom CK, Buckel WR, Srivastava R, Butler AM, Groat D, Haaland B, Ying J, Harris E, Johnson S, Paine R, Greene T. Hydroxychloroquine vs. Azithromycin for Hospitalized Patients with COVID-19 (HAHPS): Results of a Randomized, Active Comparator Trial. Ann Am Thorac Soc 2020; 18:590-597. [PMID: 33166179 PMCID: PMC8009003 DOI: 10.1513/annalsats.202008-940oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
RATIONALE The COVID-19 pandemic struck an immunologically naïve, globally interconnected population. In the face of a new infectious agent causing acute respiratory failure for which there were no known effective therapies, rapid, often pragmatic trials were necessary to evaluate potential treatments, frequently starting with medications that are already marketed for other indications. Early in the pandemic, hydroxychloroquine and azithromycin were two such candidates. OBJECTIVE Assess the relative efficacy of hydroxychloroquine and azithromycin among hospitalized patients with COVID-19. METHODS We performed a randomized clinical trial of hydroxychloroquine vs. azithromycin among hospitalized patients with COVID-19. Treatment was 5 days of study medication. The primary endpoint was the COVID Ordinal Outcomes scale at day 14. Secondary endpoints included hospital-, ICU-, and ventilator-free days at day 28. The trial was stopped early after enrollment of 85 patients when a separate clinical trial concluded that a clinically important effect of hydroxychloroquine over placebo was definitively excluded. Comparisons were made a priori using a proportional odds model from a Bayesian perspective. RESULTS We enrolled 85 patients at 13 hospitals over 11 weeks. Adherence to study medication was high. The estimated odds ratio for less favorable status on the ordinal scale for hydroxychloroquine vs. azithromycin from the primary analysis was 1.07, with a 95% credible interval from 0.63 to 1.83 with a posterior probability of 60% that hydroxychloroquine was worse than azithryomycin. Secondary outcomes displayed a similar, slight preference for azithromycin over hydroxychloroquine. QTc prolongation was rare and did not differ between groups. The twenty safety outcomes were similar between arms with the possible exception of post-randomization onset acute kidney injury, which was more common with hydroxychloroquine (15% vs. 0%). Patients in the hydroxychloroquine arm received remdesivir more often than in the azithromycin arm (19% vs. 2%). There was no apparent association between remdesivir use and acute kidney injury. CONCLUSIONS While early termination limits the precision of our results, we found no suggestion of substantial efficacy for hydroxychloroquine over azithromycin. Acute kidney injury may be more common with hydroxychloroquine than azithromycin, although this may be due to the play of chance. Differential use of remdesivir may have biased our results in favor of hydroxychloroquine. Our results are consistent with conclusions from other trials that hydroxychloroquine cannot be recommended for inpatients with COVID-19; azithromycin may merit additional investigation. CLINICAL TRIAL REGISTRATION This trial was prospectively registered (NCT04329832) before enrollment of the first patient.
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Affiliation(s)
- Samuel M Brown
- Intermountain Medical Center, Center for Humanizing Critical Care, Murray, Utah, United States;
| | - Ithan Peltan
- Intermountain Medical Center, 98078, Division of Pulmonary & Critical Care Medicine, Murray, Utah, United States
- University of Utah School of Medicine, 12348, Division of Pulmonary & Critical Care Medicine, Salt Lake City, Utah, United States
| | - Naresh Kumar
- Intermountain Medical Center, Office of Research, Murray, Utah, United States
| | - Lindsay Leither
- Intermountain Medical Center, 98078, Murray, Utah, United States
| | - Brandon J Webb
- Intermountain Medical Center, Division of Clinical Epidemiology and Infectious Diseases, Murray, Utah, United States
| | - Nathan Starr
- Intermountain Medical Center, Internal Medicine, Murray, Utah, United States
| | - Colin K Grissom
- Intermountain Medical Center, Critical Care Medicine, Murray, Utah, United States
| | - Whitney R Buckel
- Intermountain Medical Center, Pharmacy, Murray, Utah, United States
| | - Rajendu Srivastava
- Intermountain Medical Center, 98078, Office of Research, Murray, Utah, United States
| | - Allison M Butler
- Intermountain Healthcare, Statistical Data Center, Salt Lake City, Utah, United States
| | - Danielle Groat
- Intermountain Medical Center, Center for Humanizing Critical Care, Murray, Utah, United States
| | - Benjamin Haaland
- University of Utah, Biostatistics, Salt Lake City, Utah, United States
| | - Jian Ying
- University of Utah, Biostatistics, Salt Lake City, Utah, United States
| | - Estelle Harris
- University of Utah School of Medicine, 12348, Division of Pulmonary & Critical Care Medicine, Salt Lake City, Utah, United States
| | - Stacy Johnson
- University of Utah School of Medicine, 12348, Internal Medicine, Salt Lake City, Utah, United States
| | - Robert Paine
- University of Utah, Salt Lake City, Utah, United States
| | - Tom Greene
- University of Utah School of Medicine, 12348, Study Design and Biostatistics Center and Division of Epidemiology, Salt Lake City, Utah, United States
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Barnish MS, Barran SM. A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson's disease. BMC Neurol 2020; 20:371. [PMID: 33038925 PMCID: PMC7547481 DOI: 10.1186/s12883-020-01938-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status. METHODS Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists. RESULTS Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains. CONCLUSIONS This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.
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Affiliation(s)
- Maxwell S. Barnish
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Susannah M. Barran
- Children and Young People’s Speech and Language Therapy, Evelina London Community Children’s Services, Mary Sheridan Health Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Heaven A, Bower P, Cundill B, Farrin A, Foster M, Foy R, Hartley S, Hawkins R, Hulme C, Humphrey S, Lawton R, Parker C, Pendleton N, West R, Young J, Clegg A. Study protocol for a cluster randomised controlled feasibility trial evaluating personalised care planning for older people with frailty: PROSPER V2 27/11/18. Pilot Feasibility Stud 2020; 6:56. [PMID: 32355566 PMCID: PMC7187486 DOI: 10.1186/s40814-020-00598-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Frailty is characterised by increased vulnerability to falls, disability, hospitalisation and care home admission. However, it is relatively reversible in the early stages. Older people living with frailty often have multiple health and social issues which are difficult to address but could benefit from proactive, person-centred care. Personalised care planning aims to improve outcomes through better self-management, care coordination and access to community resources. Methods This feasibility cluster randomised controlled trial aims to recruit 400 participants from 11 general practice clusters across Bradford and Leeds in the north of England. Eligible patients will be aged over 65 with an electronic frailty index score of 0.21 (identified via their electronic health record), living in their own homes, without severe cognitive impairment and not in receipt of end of life care. After screening for eligible patients, a restricted 1:1 cluster-level randomisation will be used to allocate practices to the PROSPER intervention, which will be delivered over 12 weeks by a personal independence co-ordinator worker, or usual care. Following initial consent, participants will complete a baseline questionnaire in their own home including measures of health-related quality of life, activities of daily living, depression and health and social care resource use. Follow-up will be at six and 12 months. Feasibility outcomes relate to progression criteria based around recruitment, intervention delivery, retention and follow-up. An embedded process evaluation will contribute to iterative intervention optimisation and logic model development by examining staff training, intervention implementation and contextual factors influencing delivery and uptake of the intervention. Discussion Whilst personalised care planning can improve outcomes in long-term conditions, implementation in routine settings is poor. We will evaluate the feasibility of conducting a cluster randomised controlled trial of personalised care planning in a community population based on frailty status. Key objectives will be to test fidelity of trial design, gather data to refine sample size calculation for the planned definitive trial, optimise data collection processes and optimise the intervention including training and delivery. Trial registration ISRCTN12363970 – 08/11/18.
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Affiliation(s)
- Anne Heaven
- 1Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Peter Bower
- 2NIHR Older People and Frailty Policy Research Unit, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Bonnie Cundill
- 3Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - Amanda Farrin
- 3Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - Marilyn Foster
- 1Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Robbie Foy
- 4Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Suzanne Hartley
- 3Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - Rebecca Hawkins
- 1Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Claire Hulme
- 5Health Economics Group, Institute of Health Research, University of Exeter, Exeter, LU EX1 2 UK
| | - Sara Humphrey
- Speciality Clinical Lead Older People Bradford District & Craven CCGs Scorex House West, 1 Bolton Rd, Bradford, BD1 4AS UK
| | - Rebecca Lawton
- 7School of Psychology, University of Leeds, Leeds, LS2 9JT UK
| | - Catriona Parker
- 3Leeds Institute of Clinical Trials Research (LICTR), Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - Neil Pendleton
- 8University of Manchester, Salford Royal Hospitals NHS Trust, Stott Lane, Salford, Greater Manchester M6 8HD UK
| | - Robert West
- 4Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - John Young
- 1Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
| | - Andrew Clegg
- 1Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ UK
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Abstract
PURPOSE OF REVIEW The aim of this review is to describe the use of usual care arms in randomized trials. RECENT FINDINGS Randomization of patients to an experimental or a control arm remains paramount for the estimation of average causal effects. Selection of the control arm is as important as the definition of the intervention, and it might include a placebo control, specific standards of care, protocolized usual care, or unrestricted clinical practice. Usual care control arms may enhance generalizability, clinician acceptability of the protocol, patient recruitment, and ensure community equipoise, while at the same time introducing significant variability in the care delivered in the control group. This effect may reduce the difference in treatments delivered between the two groups and lead to a negative result or the requirement for a larger sample size. Moreover, usual care control groups can be subject to changes in clinician behavior induced by the trial itself, or by secular trends in time. SUMMARY Usual care control arms may enhance generalizability while introducing significant limitations. Potential solutions include the use of pretrial surveys to evaluate the extent to which a protocolized control arm reflects the current standard of care and the implementation of adaptive trials.
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Young HM, Miyamoto S, Tang-Feldman Y, Dharmar M, Balsbaugh T, Greenwood D. Defining Usual Care in Clinical Trials. Res Gerontol Nurs 2019; 13:125-129. [PMID: 31834414 DOI: 10.3928/19404921-20191127-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022]
Abstract
Pragmatic trials occur within the complexity of real-world care delivery, and when effective, contribute to more rapid translation into practice because of their greater generalizability. Research with older adults is complex when participants have chronic conditions and multiple comorbidities. Often pragmatic trials introduce a novel intervention and try to determine whether it offers a benefit beyond the usual or routine care provided. Researchers commonly focus attention on describing the intervention, yet the comparator condition of usual or routine care can be anything but standard, reducing the effect size of the intervention and introducing threats to the overall validity of the study. The current article describes clinical trial guidelines, then illustrates the complexity of characterizing usual care for interventions addressing type 2 diabetes. The authors provide recommendations for improving description of usual care and discuss implications for gerontological nursing research. [Research in Gerontological Nursing, 13(3), 125-129.].
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Laporte C, Lambert C, Pereira B, Blanc O, Authier N, Balayssac D, Brousse G, Vorilhon P. Cannabis users: Screen systematically, treat individually. A descriptive study of participants in a randomized trial in primary care. PLoS One 2019; 14:e0224867. [PMID: 31790425 PMCID: PMC6886842 DOI: 10.1371/journal.pone.0224867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of the present study was to describe the profiles of a sample of young cannabis users not seeking care, for use in general practice in France. Methods In this cross-sectional study, baseline data were used from a previous clinical randomized trial, in which a brief intervention was tested. The participants were 262 cannabis users aged 15 to 25 years who smoked at least one joint per month. Assessment was undertaken both by the GP and via an anonymous self-reporting questionnaire. All statistical analyses were performed using Stata software and R. We used multiple correspondence analysis to determine the profiles of users. Results Among the 262 patients, 46.2% were daily users (more than 30 joints per month), 25.6% were regular users (from 10 to 29 joints per month), and 28.2% were recent users (fewer than 10 joints per month). The higher the frequency of use, the greater the incidence of unaccompanied use, daily use and week use (p from <0.001 to 0.01). The motivations of daily users were mostly self-treatment and habit (p <0.05). The cannabis abuse screening trial score revealed risky use for 87.5% of daily users and 34.4% for recent users. Factorial analysis identified 5 profiles according to age, risk, and motive for use. The reasons for consultation were equally distributed among users regardless of their level of use or their profile (p > 0.05). Conclusions The results provide support for the practice of asking young patients systematically about their cannabis use, allowing GPs to identify users who require medical care. GPs should consider the differences between participants according to their profile in order to determine the appropriate type of care. Trial registration Clinicaltrials.gov NCT01433692.
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Affiliation(s)
- Catherine Laporte
- Département de Médecine Générale, Equipe d’Accueil 7280, Unité de Formation et de Recherche de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
| | - Céline Lambert
- Délégation à la recherche clinique et à l’innovation, Centre Hospitalier Universitaire Clermont-Ferrand,Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la recherche clinique et à l’innovation, Centre Hospitalier Universitaire Clermont-Ferrand,Clermont-Ferrand, France
| | - Olivier Blanc
- Equipe d’Accueil 7280, Unité de Formation et de Recherche de Médicine, Université Clermont Auvergne; Service de Psychiatrie B et d’addictologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Authier
- Inserm, Neuro-Dol, Université Clermont Auvergne; Service de Pharmacologie Médicale, Centres Addictovigilance / Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - David Balayssac
- Inserm U1107, NEURO-DOL, Unité de Formation et de Recherche de Pharmacie, Université Clermont Auvergne; Laboratoire de Toxicologie, Délégation à la recherche clinique et à l’innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Georges Brousse
- Equipe d’Accueil 7280, Unité de Formation et de Recherche de Médicine, Université Clermont Auvergne; Service de Psychiatrie B et d’addictologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Vorilhon
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, France
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Owolabi MO, Gebregziabher M, Akinyemi RO, Akinyemi JO, Akpa O, Olaniyan O, Salako BL, Arulogun O, Tagge R, Uvere E, Fakunle A, Ovbiagele B. Randomized Trial of an Intervention to Improve Blood Pressure Control in Stroke Survivors. Circ Cardiovasc Qual Outcomes 2019; 12:e005904. [PMID: 31805787 PMCID: PMC7139215 DOI: 10.1161/circoutcomes.119.005904] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We conducted the first-of-its kind randomized stroke trial in Africa to test whether a THRIVES (Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke) intervention improved blood pressure (BP) control among patients with stroke. METHODS AND RESULTS Intervention comprised a patient global risk factor control report card, personalized phone text-messaging, and educational video. Four hundred patients recruited from 4 distinct medical facilities in Nigeria, aged ≥18 years with stroke-onset within one-year, were randomized to THRIVES intervention and control group. The control group also received text messages, and both groups received modest financial incentives. The primary outcome was mean change in systolic BP (SBP) at 12 months. There were 36.5% females, 72.3% with ischemic stroke; mean age was 57.2±11.7 years; 93.5% had hypertension and mean SBP was 138.33 (23.64) mm Hg. At 12 months, there was no significant difference in SBP reduction from baseline in the THRIVES versus control group (2.32 versus 2.01 mm Hg, P=0.82). In an exploratory analysis of subjects with baseline BP >140/90 mm Hg (n=168), THRIVES showed a significant mean SBP (diastolic BP) decrease of 11.7 (7.0) mm Hg while control group showed a significant mean SBP (diastolic BP) decrease of 11.2 (7.9) mm Hg at 12 months. CONCLUSIONS THRIVES intervention did not significantly reduce SBP compared with controls. However, there was similar significant decrease in mean BP in both treatment arms in the subgroup with baseline hypertension. As text-messaging and a modest financial incentive were the common elements between both treatment arms, further research is required to establish whether these measures alone can improve BP control among stroke survivors. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01900756.
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Affiliation(s)
- Mayowa O Owolabi
- Department of Medicine, University College Hospital and University of Ibadan, Nigeria and Center for Genomic and Precision Medicine, College of Medicine (M.O.O., R.O.A.), University of Ibadan, Nigeria
- Blossom Specialist Medical Center, First Center for Neurorehabilitation, Ibadan, Nigeria (M.O.O., E.U.)
| | - Mulugeta Gebregziabher
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences (M.G.), Medical University of South Carolina
| | - Rufus O Akinyemi
- Department of Medicine, University College Hospital and University of Ibadan, Nigeria and Center for Genomic and Precision Medicine, College of Medicine (M.O.O., R.O.A.), University of Ibadan, Nigeria
- Department of Medicine, Federal Medical Center, and Sacred Heart Hospital, Abeokuta, Nigeria (R.O.A.)
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics (J.O.A., O. Akpa), University of Ibadan, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics (J.O.A., O. Akpa), University of Ibadan, Nigeria
| | | | - Babatunde L Salako
- Department of Medicine (B.L.S., E.U., A.F.), University of Ibadan, Nigeria
| | - Oyedunni Arulogun
- Department of Health Promotion and Education (O. Arulogun), University of Ibadan, Nigeria
| | - Raelle Tagge
- Department of Neurosciences (R.T.), Medical University of South Carolina
| | - Ezinne Uvere
- Department of Medicine (B.L.S., E.U., A.F.), University of Ibadan, Nigeria
- Blossom Specialist Medical Center, First Center for Neurorehabilitation, Ibadan, Nigeria (M.O.O., E.U.)
| | - Adekunle Fakunle
- Department of Medicine (B.L.S., E.U., A.F.), University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco (B.O.)
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Pawson R. The "pragmatic trial": An essentially contested concept? J Eval Clin Pract 2019; 25:943-954. [PMID: 31313412 DOI: 10.1111/jep.13216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
For over 50 years, clinical research methodology has wrestled with the problem of the lack of correspondence between tests of treatments and applications of treatments. The former comprise of trials featuring scrupulous control of patient eligibility, treatment compliance, clinician expertise, follow-up intensity, and so on. In applying a validated treatment, the practitioner has to confront considerable real-world variation in potential patients and in implementation regimes. The remedy, going by the name of "pragmatic trials," is to conduct clinical trials in conditions corresponding more closely to everyday practice. This solution has proved easier to utter than to execute, and the paper reviews the extensive literature on pragmatic trials, seeking to assess whether it has terminated in clarity or contestation.
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Affiliation(s)
- Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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40
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Clare A, Camic PM. Live and recorded group music interventions with active participation for people with dementias: a systematic review. Arts Health 2019; 12:197-220. [PMID: 31583964 DOI: 10.1080/17533015.2019.1675732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: This literature review examined the existing evidence base for the impact of both live and recorded music interventions involving active participation in a dementia population. Methodology: PsycINFO, Medline, CINAHL, Web of Science, PubMed and Cochrane Library were searched and 15 studies met inclusion criteria. Results: There was a positive impact on behavioural and psychological symptoms, quality of life, communication and some aspects of cognitive function; methodological limitations, however, make it difficult to offer firm conclusions. Interventions using recorded music resulted in more consistent positive behavioural and psychological outcomes, whereas interventions using live music reported a benefit to communication and relationships. Conclusions: Although live and recorded music showed benefits, and should be considered in dementia care, the use of different outcome measures made definitive comparisons problematic. In order to better understand mechanisms of change, one future research area should explore how group music interventions affect communication by more closely assessing processes during live and recorded music.
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Affiliation(s)
- Amy Clare
- Salomons Institute for Applied Psychology, Canterbury Christ Church University , Tunbridge Wells, UK
| | - Paul M Camic
- Salomons Institute for Applied Psychology, Canterbury Christ Church University , Tunbridge Wells, UK.,Dementia Research Centre, Queen Square Institute of Neurology, University College London , London, UK
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Domingues L, Pimentel-Santos FM, Cruz EB, Sousa AC, Santos A, Cordovil A, Correia A, Torres LS, Silva A, Branco PS, Branco JC. Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clin Rehabil 2019; 33:1908-1918. [PMID: 31549519 DOI: 10.1177/0269215519876675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). DESIGN Randomized controlled trial. SETTING Outpatient care units. SUBJECTS Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. INTERVENTIONS Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. MAIN MEASURES The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. RESULTS Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25-P75): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25-P75): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. CONCLUSION This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.
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Affiliation(s)
- Lucia Domingues
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Manuel Pimentel-Santos
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde - Instituto Politecnico de Setúbal, Setúbal, Portugal
| | - Ana Cristina Sousa
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Santos
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Cordovil
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Anabela Correia
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Laura Sa Torres
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Antonio Silva
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Soares Branco
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Jaime Cunha Branco
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
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Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, Swaby L, Edwardson C, Carey ME, Davies MJ, Dickens CM, Doherty Y, French P, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Siddiqi N, Wright S, Waller G, Gaughran F, Barnett J, Northern A. Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 2019; 22:1-160. [PMID: 30499443 DOI: 10.3310/hta22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - David Saxon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tiyi A Morris
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katharine Barnard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Lizzie Swaby
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Marian E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,Psychological Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn E Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Sridevi Kalidindi
- Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Richard Laugharne
- Research and Innovation, Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | | | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Stephen Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Glenn Waller
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK.,Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Psychosis Unit and Research and Development Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janette Barnett
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
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43
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A systematic review of cognitive behavioral therapy for insomnia implemented in primary care and community settings. Sleep Med Rev 2019; 44:23-36. [DOI: 10.1016/j.smrv.2018.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 10/14/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022]
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Barais M, Vaillant Roussel H, Costa D, Derriennic J, Pereira B, Cadier S. Premature ejaculation in primary care: communication strategies versus usual care for male patients consulting for a sexual, urogenital or psychological reason - GET UP: study protocol for a cluster randomised controlled trial. Trials 2018; 19:622. [PMID: 30419940 PMCID: PMC6233366 DOI: 10.1186/s13063-018-2947-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Premature ejaculation (PE) is the most common sexual dysfunction among men. According to patients, the general practitioner (GP) is the appropriate professional with whom to discuss this issue. However, few patients receive the medical help needed because GPs find it difficult to talk to their patients about sex. A previous qualitative study provided six strategies described by GPs who had tackled the topic during consultation. A pilot study showed that using one of these strategies after a training course led to an increase in the rate of consultations where the topic was raised: an increase from 6.6 to 30.8%. The aim of this study is to compare whether training in communication skills with these six strategies is more effective than usual care on the incidence of patients bringing up the topic of PE with their GP. METHODS A cluster randomised controlled trial, stratified over four areas comparing an intervention group, which will receive the six strategies training session, and a control group, which ensures routine medical care. The primary outcome is to investigate the efficacy of a training in communication skills directed towards this pathology, compared with usual care procedures, on the incidence of patients bringing up the topic of PE with their GP. The secondary objective relates to the variation in the quality of life of patients after having recently addressed the topic of PE. Quality of life will be evaluated using the SF-12 health scale, with scoring filled in by the patient immediately after the consultation and 4 weeks later. The patients suffering from PE will be identified if their score is higher than 9 on the Premature Ejaculation Diagnostic Tool filled in 4 weeks after the consultation. The number of patients necessary to highlight a significant difference between the two groups from 5 to 20% is 101. Therefore, a total of 600 patients is expected, 300 in each arm (40 GPs, 15 patients per GP; risk α = 5%; power = 90%; intra-cluster correlation coefficient ρ = 0.2; Hawthorne effect = 15%; lost-to-follow-up rates for GPs = 10% and for patients = 20%). DISCUSSION The implication for practice is the improvement in the quality of patient-centred care within a topic area which encompasses almost 30% of male sex-related complaints. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02378779 . Registered on 3 February 2015.
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Affiliation(s)
- Marie Barais
- EA 7479 SPURBO, Department of General Practice, Université de Bretagne Occidentale, 22 avenue Camille Desmoulins, 29238, Brest, France.
| | - Hélène Vaillant Roussel
- UPU, ACCePPT, Department of General Practice, Faculty of Medicine, Clermont Auvergne University, 28 place Henri Dunant, 63001, Clermont-Ferrand, France
| | - David Costa
- Département Universitaire de Médecine Générale - UFR Médecine Université de Montpellier-Nimes, 2 rue École de Médecine CS 59001, 34060, Montpellier cedex 2, France
| | - Jérémy Derriennic
- EA 7479 SPURBO, Department of General Practice, Université de Bretagne Occidentale, 22 avenue Camille Desmoulins, 29238, Brest, France
| | - Bruno Pereira
- Biostatistics unit, Clinical Research and Innovation Department, Clermont-Ferrand University Hospital, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Sébastien Cadier
- Département de Médecine Générale, UFR Sciences Médicales, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux cedex, France
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45
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Robling M, Cannings-John R, Channon S, Hood K, Moody G, Poole R, Sanders J. What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting. BMJ Open 2018; 8:e020152. [PMID: 29730623 PMCID: PMC5942429 DOI: 10.1136/bmjopen-2017-020152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/16/2018] [Accepted: 03/15/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. DESIGN Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits. SETTING 18 partnerships of local authority and healthcare organisations in England. OUTCOMES Descriptive framework of services. Rates of service usage reported by trial participants. RESULTS 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30-63 universal services per site and 22-67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor. CONCLUSIONS The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential. TRIAL REGISTRATION NUMBER ISRCTN23019866.
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Affiliation(s)
| | | | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Gwen Moody
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ria Poole
- School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Correia LCL, Correia VCA, Souza TMB, Cerqueira AMS, Alexandre FKB, Garcia G, Ferreira FRM, Lopes FOA. Inconsistency prevents the valuable synergism of explanatory and pragmatic trails. J Evid Based Med 2018; 11:105-111. [PMID: 29878580 DOI: 10.1111/jebm.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/15/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess review articles on pragmatic trials in order to describe how authors define the aim of this type of study, how comprehensive methodological topics are covered, and which topics are most valued by authors. METHODS Review articles were selected from Medline Database, based on the expression "pragmatic trial" in the titles. Five trained medical students evaluated the articles, based on a list of 15 self-explanatory methodological topics. Each article was evaluated regarding topics covered. Baseline statements on the aim of pragmatic trials were derived. RESULTS Among 22 articles identified, there was general agreement that the aim of a pragmatic trial is to evaluate if the intervention works under real-world conditions. The mean number of methodological topics addressed by each article was 7.6 ± 3.1. Only one article covered all 15 topics, three articles (14%) responded to at least 75% of topics and 13 articles (59%) mentioned at least 50% of the topics. The relative frequency each of the 15 topics was cited by articles had a mean of 50% ± 25%. No topic was addressed by all articles, only three (20%) were addressed by more than 75% of articles. CONCLUSIONS There is agreement on the different aims of explanatory and pragmatic trials. But there is a large variation on methodological topics used to define a pragmatic trial, which led to inconsistency in defining the typical methodology of a pragmatic trial.
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Affiliation(s)
- Luis C L Correia
- Medical and Public Health School of Bahia, Salvador, Brazil
- Hospital São Rafael, Salvador, Brazil
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47
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Zuidgeest MG, Welsing PM, van Thiel GJ, Ciaglia A, Alfonso-Cristancho R, Eckert L, Eijkemans MJ, Egger M. Series: Pragmatic trials and real world evidence: Paper 5. Usual care and real life comparators. J Clin Epidemiol 2017; 90:92-98. [DOI: 10.1016/j.jclinepi.2017.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 05/11/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
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Drew BT, Conaghan PG, Smith TO, Selfe J, Redmond AC. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord 2017; 18:338. [PMID: 28778218 PMCID: PMC5545020 DOI: 10.1186/s12891-017-1698-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted treatment, matched according to specific clinical criteria e.g. hip muscle weakness, may result in better outcomes for people with patellofemoral pain (PFP). However, to ensure the success of future trials, a number of questions on the feasibility of a targeted treatment need clarification. The aim of the study was to explore the feasibility of matched treatment (MT) compared to usual care (UC) management for a subgroup of people with PFP determined to have hip weakness and to explore the mechanism of effect for hip strengthening. METHODS In a pragmatic, randomised controlled feasibility study, 24 participants with PFP (58% female; mean age 29 years) were randomly allocated to receive either MT aimed specifically at hip strengthening, or UC over an eight-week period. The primary outcomes were feasibility outcomes, which included rates of adherence, attrition, eligibility, missing data and treatment efficacy. Secondary outcomes focused on the mechanistic outcomes of the intervention, which included hip kinematics. RESULTS Conversion to consent (100%), missing data (0%), attrition rate (8%) and adherence to both treatment and appointments (>90%) were deemed successful endpoints. The analysis of treatment efficacy showed that the MT group reported a greater improvement for the Global Rating of Change Scale (62% vs. 9%) and the Anterior Knee Pain Scale (-5.23 vs. 1.18) but no between-group differences for either average or worst pain. Mechanistic outcomes showed a greatest reduction in peak hip internal rotation angle for the MT group (13.1% vs. -2.7%). CONCLUSION This feasibility study indicates that a definitive randomised controlled trial investigating a targeted treatment approach is achievable. Findings suggest the mechanism of effect of hip strengthening may be to influence kinematic changes in hip function in the transverse plane. TRIAL REGISTRATION This study was registered retrospectively. ISRCTN74560952 . Registration date: 2017-02-06.
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Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
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49
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van Gelder VA, Scherpbier-de Haan ND, van Berkel S, Akkermans RP, de Grauw IS, Adang EM, Assendelft PJ, de Grauw WJC, Biermans MCJ, Wetzels JFM. Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial. Fam Pract 2017; 34:430-436. [PMID: 28158576 DOI: 10.1093/fampra/cmw131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. OBJECTIVE This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. METHODS Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients. RESULTS The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. CONCLUSION The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.
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Affiliation(s)
- Vincent A van Gelder
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Saskia van Berkel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge S de Grauw
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddy M Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pim J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim J C de Grauw
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack F M Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
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50
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Turner KM, Percival J, Kessler D, Donovan J. Exploring patients' treatment journeys following randomisation in mental health trials to improve future trial conduct: a synthesis of multiple qualitative data sets. Trials 2017; 18:279. [PMID: 28619121 PMCID: PMC5472926 DOI: 10.1186/s13063-017-2030-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The way in which pragmatic trials are designed suggests that there are differences between the experiences of participants randomised to usual care and intervention arms. These potential differences relate not only to which treatment participants receive but also how they access and engage with their allocated treatment. Such differences could affect trial results. The aim of this study was to assess whether such differences exist and, if they do, to consider their implications for the design of future trials. METHODS Interview transcripts were sampled from data sets gathered during three qualitative studies, all of which had been nested within large, primary care depression trials. Each study had explored trial participants' views and experiences of treatments received following randomisation. Transcripts from 37 participants were purposefully sampled, 20 of which were from interviews held with individuals allocated to receive usual GP care. Data were analysed thematically. RESULTS There was evidence of differences between trial arms across all three data sets. Intervention participants were willing and able to engage with the treatment to which they had been allocated. Randomisation had led to them embarking upon a clear treatment pathway and receiving care in a context where they felt comfortable discussing their mental health and had sufficient time to do so. Intervention participants also had continuity with and confidence in the practitioners they saw. A few usual-care participants talked about having continuity with and confidence in their GPs. However, most of the usual-care participants reported a reluctance to consult GPs about mental health, difficulties in securing treatment appointments, and little or no changes in care following randomisation. Additionally, most reported a lack of continuity of care and a lack confidence in the treatment available to them. CONCLUSIONS There are important differences between usual-care and intervention arms that go beyond treatment received, and they relate to how participants experience accessing and engaging with their allocated care. As these differences could affect trial results, researchers may want to measure or reduce them in order to fully appreciate or control for the range of factors that might affect treatment outcomes.
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Affiliation(s)
- Katrina M. Turner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John Percival
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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