1
|
Bertram W, Penfold C, Glynn J, Johnson E, Burston A, Rayment D, Howells N, White S, Wylde V, Gooberman-Hill R, Blom A, Whale K. REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement - feasibility study for a randomised controlled trial. BMJ Open 2024; 14:e078785. [PMID: 38508646 PMCID: PMC10961562 DOI: 10.1136/bmjopen-2023-078785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement. DESIGN Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study. SETTING Two National Health Service (NHS) secondary care hospitals in England and Wales. PARTICIPANTS Preoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0-28 on the Sleep Condition Indicator questionnaire. INTERVENTION The REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals. OUTCOME MEASURES The primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients. RESULTS Screening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable. CONCLUSIONS This feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible. TRIAL REGISTRATION NUMBER ISRCTN14233189.
Collapse
Affiliation(s)
- Wendy Bertram
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Chris Penfold
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | - Joel Glynn
- University of Bristol Medical School, Bristol, UK
| | - Emma Johnson
- University of Bristol Medical School, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | | | | | - Simon White
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Rachael Gooberman-Hill
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University of Bristol Medical School, Bristol, UK
| | | | - Katie Whale
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| |
Collapse
|
2
|
Jameson C, Haq Z, Kosar Z, Musse S, Watson G, Bertram W, Hurley-Wallace A, Whale K, Wylde V. Musculoskeletal research priorities of people of South Asian, Black, African or Caribbean heritage in the United Kingdom. Musculoskeletal Care 2023. [PMID: 38013406 DOI: 10.1002/msc.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Catherine Jameson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Zehra Haq
- Dhek Bhal, Wellspring Settlement, Bristol, UK
| | - Zahra Kosar
- My Friday Coffee Morning - Barton Hill, University of Bristol Micro Campus, Bristol, UK
| | - Samira Musse
- My Friday Coffee Morning - Barton Hill, University of Bristol Micro Campus, Bristol, UK
| | - Gloria Watson
- Malcolm X Elders, Malcolm X Community Centre, Bristol, UK
| | - Wendy Bertram
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anna Hurley-Wallace
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Katie Whale
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| |
Collapse
|
3
|
Beswick AD, Wylde V, Bertram W, Whale K. The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis. Sleep Med 2023; 107:243-267. [PMID: 37257367 DOI: 10.1016/j.sleep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sleep disturbance is common in hospital. The hospital environment can have a negative impact on sleep quality, through factors such as noise, light, temperature, and nursing care disruptions. Poor sleep can lead to delays in recovery, wound healing, and increase risk of post-operative infection. METHODS We conducted a systematic review evaluating the effectiveness of non-pharmacological sleep interventions for improving inpatient sleep. The primary outcome was sleep quality, the secondary outcome was length of hospital stay, the harm outcome was adverse events. MEDLINE, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception to 17th February 2022. Meta-analysis was conducted using a fixed effects model, with narrative synthesis for studies with no useable data. Risk of bias was assessed with the Cochrane tool. RESULTS 76 studies identified with 5375 people randomised comparing 85 interventions. Interventions focused on physical sleep aids (n = 26), relaxation (n = 25), manual therapy (n = 12), music (n = 9), psychological therapy (n = 5), light therapy (n = 3), sleep protocols (n = 2), milk and honey (n = 1), exercise (n = 1), and nursing care (n = 1). In meta-analysis, medium to large improvements in sleep quality were noted for sleep aids, relaxation, music, and manual therapies. Results were generally consistent in studies at lower risk of bias. Length of hospital stay and adverse events were reported for some studies, with benefit in some trials but this was not consistent across all interventions. CONCLUSIONS Physical sleep aids, relaxation, manual therapy and music interventions have a strong evidence base for improving inpatient sleep quality. Research is needed to evaluate how to optimise interventions into routine care.
Collapse
Affiliation(s)
- A D Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
| | - V Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - W Bertram
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
| |
Collapse
|
4
|
Patel R, Judge A, Johansen A, Marques EMR, Griffin J, Bradshaw M, Drew S, Whale K, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study. Age Ageing 2022; 51:6679179. [PMID: 36041740 PMCID: PMC9427326 DOI: 10.1093/ageing/afac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/23/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Despite established standards and guidelines, substantial variation remains in the delivery of hip fracture care across the United Kingdom. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the months following hip fracture. METHODS We examined a national record-linkage cohort of 178,757 patients aged ≥60 years who sustained a hip fracture in England and Wales in 2016-19. Patient-level hospital admissions datasets, National Hip Fracture Database and mortality data were linked to metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality and emergency 30-day readmission. RESULTS Across hospitals mean LOS ranged from 12 to 41.9 days, mean 30-day mortality from 3.7 to 10.4% and mean readmission rates from 3.7 to 30.3%, overall means were 21.4 days, 7.3% and 15.3%, respectively. In all, 22 organisational factors were independently associated with LOS; e.g. a hospital's ability to mobilise >90% of patients promptly after surgery predicted a 2-day shorter LOS (95% confidence interval [CI]: 1.2-2.6). Ten organisational factors were independently associated with 30-day mortality; e.g. discussion of patient experience feedback at clinical governance meetings and provision of prompt surgery to >80% of patients were each associated with 10% lower mortality (95%CI: 5-15%). Nine organisational factors were independently associated with readmissions; e.g. readmissions were 17% lower if hospitals reported how soon community therapy would start after discharge (95%CI: 9-24%). CONCLUSIONS Receipt of hip fracture care should be reliable and equitable across the country. We have identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture.
Collapse
Affiliation(s)
- Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Antony Johansen
- Division of Population Medicine, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK,National Hip Fracture Database, Royal College of Physicians, London, UK
| | - Elsa M R Marques
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Jill Griffin
- Clinical & Operations Directorate, Royal Osteoporosis Society, Bath, UK
| | - Marianne Bradshaw
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Tim Chesser
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Xavier L Griffin
- Barts Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Celia L Gregson
- Address correspondence to: Celia L. Gregson, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. Tel: +44 7815102351.
| |
Collapse
|
5
|
Whale K, Gooberman-Hill R. Development of a novel intervention to improve sleep and pain in patients undergoing total knee replacement. Trials 2022; 23:625. [PMID: 35918742 PMCID: PMC9344446 DOI: 10.1186/s13063-022-06584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Up to 20% of patients experience long-term pain and dissatisfaction after total knee replacement, with a negative impact on their quality of life. New approaches are needed to reduce the proportion of people to go on to experience chronic post-surgical pain. Sleep and pain are bidirectionally linked with poor sleep linked to greater pain. Interventions to improve sleep among people undergoing knee replacement offer a promising avenue. Health beliefs and barriers to engagement were explored using behaviour change theory. This study followed stages 1–4 of the Medical Research Council’s guidance for complex intervention development to develop a novel intervention aimed at improving sleep in pre-operative knee replacement patients. Methods Pre-operative focus groups and post-operative telephone interviews were conducted with knee replacement patients. Before surgery, focus groups explored sleep experiences and views about existing sleep interventions (cognitive behavioural therapy for insomnia, exercise, relaxation, mindfulness, sleep hygiene) and barriers to engagement. After surgery, telephone interviews explored any changes in sleep and views about intervention appropriateness. Data were audio-recorded, transcribed, anonymised, and analysed using framework analysis. Results Overall, 23 patients took part, 17 patients attended pre-operative focus groups, seven took part in a post-operative telephone interview, and one took part in a focus group and interview. Key sleep issues identified were problems getting to sleep, frequent waking during the night, and problems getting back to sleep after night waking. The main reason for these issues was knee pain and discomfort and a busy mind. Participants felt that the sleep interventions were generally acceptable with no general preference for one intervention over the others. Views of delivery mode varied in relation to digital move and group or one-to-one approaches. Conclusion Existing sleep interventions were found to be acceptable to knee replacement patients. Key barriers to engagement related to participants’ health beliefs. Addressing beliefs about the relationship between sleep and pain and enhancing understanding of the bidirectional/cyclical relationship could benefit engagement and motivation. Individuals may also require support to break the fear and avoidance cycle of pain and coping. A future intervention should ensure that patients’ preferences for sleep interventions and delivery mode can be accommodated in a real-world context.
Collapse
Affiliation(s)
- K Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. .,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
| | - R Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| |
Collapse
|
6
|
Drew S, Fox F, Gregson CL, Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bradshaw M, Whale K, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gooberman-Hill R. 995 MULTIPLE ORGANISATIONAL FACTORS IMPROVE MULTI-DISCIPLINARY CARE DELIVERY TO PATIENTS WITH HIP FRACTURES: A QUALITATIVE STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services.
Method
Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway.
Results
We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the ‘right’ skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, ‘joined-up’ IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial.
Conclusion
Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services.
Collapse
Affiliation(s)
| | | | | | | | | | - A Johansen
- Cardiff University and University Hospital of Wales
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bhimjiyani A, Bradshaw M, Whale K, Drew, Gooberman-Hill R, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. 946 MULTIPLE ORGANISATIONAL FACTORS ARE ASSOCIATED WITH ADVERSE PATIENT OUTCOMES POST HIP FRACTURE IN HOSPITALS IN ENGLAND & WALES. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Older adults who sustain a hip fracture require complex multidisciplinary care, which can challenge organisational structures within hospitals. Despite standards and guidelines, substantial variation remains in hip fracture care delivery across the UK. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the post injury period.
Method
A cohort of 178,757 patients aged 60+ years in England and Wales (2016–19) who sustained a hip fracture was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality data were linked to metrics from 18 hospital-level organisational audits/reports/series. Multilevel models determined the organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality, and emergency 30-day readmission.
Results
Overall LOS was mean 21 days (standard deviation, 20); 13,126 (7.3%) died within 30-days; and 25,239 (15.3%) were readmitted. 25 organisational factors independently predicted LOS: for example, a hospital’s ability to promptly mobilise ≥90% of patients was associated with a 2-day (95%CI:1.3–2.7) shorter LOS, and hospitals where all patients received orthogeriatric assessment within 72 hours of admission had mean 1.5-day (95%CI:0.6–2.3) shorter LOS. Ten organisational factors independently predicted 30-day mortality: providing prompt surgery (≤36 hours from admission) to >80% patients was associated with the same 10% reduction in mortality (95%CI:4–15%), as was discussion of ‘patient experience’ feedback at clinical governance meetings (95%CI:5–15%). Nine organisational factors independently predicted readmission: knowledge of time from discharge to start of community therapy was associated with 17% (95%CI:9–24%) lower readmission rates. Organisational delivery of clinical governance, surgery, and physiotherapy were associated with all outcomes.
Conclusion
Multiple, potentially modifiable, organisational factors are associated with important patient outcomes post-hip fracture. These factors, if causal, indicate auditable components of hospital care where interventions can be targeted to reduce variability in hip fracture care delivery, to improve patient outcomes.
Collapse
Affiliation(s)
| | | | - A Johansen
- Cardiff University and University Hospital of Wales
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Whale K, Gooberman‐Hill R. The importance of sleep for people with chronic pain: current insights and evidence. JBMR Plus 2022; 6:e10658. [PMID: 35866153 PMCID: PMC9289983 DOI: 10.1002/jbm4.10658] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Katie Whale
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
| | - Rachael Gooberman‐Hill
- Bristol Medical School University of Bristol
- National Institute for Health Research Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol UK
| |
Collapse
|
9
|
Whale K, Dennis J, Wylde V, Beswick A, Gooberman-Hill R. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:440. [PMID: 35546397 PMCID: PMC9092772 DOI: 10.1186/s12891-022-05318-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/24/2022] [Indexed: 02/25/2023] Open
Abstract
Objective About two thirds of people with chronic pain report problems sleeping. We aimed to evaluate the effectiveness of non-pharmacological sleep interventions for improving sleep in people with chronic pain. Design We conducted a systematic review of non-pharmacological and non-invasive interventions to improve sleep quality or duration for adults with chronic non-cancer pain evaluated in a randomised controlled trial. Our primary outcome of interest was sleep; secondary outcomes included pain, health-related quality of life, and psychological wellbeing. We searched the Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL from inception to April 2020. After screening, two reviewers evaluated articles and extracted data. Meta-analysis was conducted using a random effects model. Risk of bias was assessed with the Cochrane tool. Results We included 42 trials involving 3346 people randomised to 94 groups, of which 56 received an intervention targeting sleep. 10 studies were of fair and 32 of good methodological quality. Overall risk of bias was judged to be low in 11, high in 10 and unclear in 21 studies. In 9 studies with 385 people randomised, cognitive behavioural therapy for insomnia showed benefit post-treatment compared with controls for improved sleep quality, standardised mean difference − 1.23 (95%CI -1.76, − 0.70; p < 0.00001). The effect size was only slightly reduced in meta-analysis of 3 studies at low risk of bias. The difference between groups was lower at 3 and 6 months after treatment but still favoured cognitive behavioural therapy for insomnia. Pain, anxiety and depression were reduced post-treatment, but evidence of longer term benefit was lacking. There was no evidence that sleep hygiene interventions were effective in improving sleep and there was some evidence in comparative studies to suggest that cognitive behavioural therapy for insomnia was more effective than sleep hygiene. Numerous other interventions were evaluated in small numbers of studies, but evidence was insufficient to draw conclusions about effectiveness. Conclusions Cognitive behavioural therapy for insomnia is an effective treatment to improve sleep for people with chronic pain, but further high-quality primary research is required to explore combined CBT content that will ensure additional improvements to pain, quality of life and psychological health and longer-term maintenance of benefits. Primary research is also needed to evaluate the effectiveness of interventions for which insufficient evidence exists. Trial registration PROSPERO registration number: CRD42019093799. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05318-5.
Collapse
Affiliation(s)
- Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. .,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
10
|
Bradshaw E, Whale K, Burston A, Wylde V, Gooberman-Hill R. Value, transparency, and inclusion: A values-based study of patient involvement in musculoskeletal research. PLoS One 2021; 16:e0260617. [PMID: 34852018 PMCID: PMC8635367 DOI: 10.1371/journal.pone.0260617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patient and public involvement work (PPI) is essential to good research practice. Existing research indicates that PPI offers benefits to research design, conduct, communication, and implementation of findings. Understanding how PPI works and its value helps to provide information about best practice and highlight areas for further development. This study used a values-based approach to reporting PPI at a Research Unit focused on musculoskeletal conditions within a UK medical school. Methods The study was conducted between October 2019 and January 2020 using Gradinger’s value system framework as a theoretical basis. The framework comprises three value systems each containing five clusters. All PPI members and researchers who had attended PPI groups were invited to participate. Participants completed a structured questionnaire based on the value system framework; PPI members also provided further information through telephone interviews. Data were deductively analysed using a framework approach with data mapped onto value systems. Results Twelve PPI members and 17 researchers took part. Views about PPI activity mapped onto all three value systems. PPI members felt empowered to provide their views, and that their opinions were valued by researchers. It was important to PPI members that they were able to ‘give back’ and to do something positive with their experiences. Researchers would have liked the groups to be more representative of the wider population, patients highlighted that groups could include more younger members. Researchers recognised the value of PPI, and the study highlighted areas where researchers members might benefit from further awareness. Conclusions Three areas for development were identified: (i) facilitating researcher engagement in training about the value and importance of PPI in research; (ii) support for researchers to reflect on the role that PPI plays in transparency of healthcare research; (iii) work to further explore and address aspects of diversity and inclusion in PPI.
Collapse
Affiliation(s)
- E. Bradshaw
- University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - K. Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - A. Burston
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - V. Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - R. Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| |
Collapse
|
11
|
Whale K, Beasant L, Wright AJ, Yardley L, Wallace LM, Moody L, Joinson C. A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp. JMIR Pediatr Parent 2021; 4:e26212. [PMID: 34779780 PMCID: PMC8663506 DOI: 10.2196/26212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. OBJECTIVE This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. METHODS URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. RESULTS Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. CONCLUSIONS The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.
Collapse
Affiliation(s)
- Katie Whale
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anne J Wright
- Evelina London Children's Hospital, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Lucy Yardley
- School of Psychological Sciences, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Louise M Wallace
- Faculty of Wellbeing, Education, and Language Studies, The Open University, Milton Keynes, United Kingdom
| | - Louise Moody
- Centre for Arts, Memory, and Communities, Faculty of Arts and Humanities, Coventry University, Coventry, United Kingdom
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
12
|
Patel R, Drew S, Johansen A, Chesser T, Javaid MK, Griffin XL, Jones T, Griffin J, Bradshaw M, Whale K, Barbosa EC, Marques EMR, Ben-Shlomo Y, Gooberman-Hill R, Judge A, Gregson CL. REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study. BMJ Open 2021; 11:e049763. [PMID: 34011603 PMCID: PMC8137248 DOI: 10.1136/bmjopen-2021-049763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients' outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care. METHODS AND ANALYSIS Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016-2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an 'Implementation Toolkit' to inform and improve commissioning and delivery of hip fracture services. ETHICS AND DISSEMINATION This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.
Collapse
Affiliation(s)
- Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Antony Johansen
- Division of Population Medicine, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
- National Hip Fracture Database, Royal College of Physicians, London, UK
| | - Tim Chesser
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Division of Orthopaedics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tim Jones
- Clinical & Operations Directorate, Royal Osteoporosis Society, Bath, UK
| | - Jill Griffin
- Clinical & Operations Directorate, Royal Osteoporosis Society, Bath, UK
| | - Marianne Bradshaw
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Estela Capelas Barbosa
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elsa M R Marques
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
13
|
Pearson J, Whale K, Walsh NE, Derham S, Russell J, Cramp F. Fibromyalgia Self‐Management: Mapping the behaviour change techniques used in a practice‐based programme. Musculoskeletal Care 2020; 18:372-382. [PMID: 32452615 DOI: 10.1002/msc.1470] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jennifer Pearson
- Centre for Health and Clinical Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
- Brownsword Therapy CentreRoyal United Hospital Bath Bath UK
| | - Katie Whale
- National Institute for Health Research Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of Bristol UK
| | - Nicola E Walsh
- Centre for Health and Clinical Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Sandi Derham
- Brownsword Therapy CentreRoyal United Hospital Bath Bath UK
| | - Julie Russell
- Brownsword Therapy CentreRoyal United Hospital Bath Bath UK
| | - Fiona Cramp
- Centre for Health and Clinical Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| |
Collapse
|
14
|
Whale K, Wylde V, Beswick A, Rathbone J, Vedhara K, Gooberman-Hill R. Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review. BMJ Open 2019; 9:e029742. [PMID: 31806606 PMCID: PMC6924731 DOI: 10.1136/bmjopen-2019-029742] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR). DESIGN Medline, Embase, and PsycINFO were searched from inception to up to 9 May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short-term and long-term postoperative pain after TKR were included. Screening, data extraction, and assessment of methodological quality were performed in duplicate by two reviewers. The primary effectiveness outcome was postoperative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological well-being. Reporting standards were assessed using the Template for Intervention Description and Replication (TIDieR) checklist for intervention reporting. RESULTS 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study), progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive-behavioural therapy (two studies), and a postoperative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. CONCLUSION Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute postoperative pain and chronic postoperative pain would be of benefit. PROSPERO REGISTRATION NUMBER CRD42018095100.
Collapse
Affiliation(s)
- Katie Whale
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vikki Wylde
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Rathbone
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachael Gooberman-Hill
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
15
|
Whale K, Ingram JC, George S, Spickett-Jones F, Sack A, Young AE. Exploring the acceptability of using low-friction bedding for patients with burns: Qualitative results from the SILKIE study. Burns 2018; 44:1251-1258. [PMID: 29753452 DOI: 10.1016/j.burns.2018.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Skin grafts following deep burns are needed to ensure healing. Grafts that fail and require re-grafting cause significant distress to patients and additional costs for the NHS. Shearing, which leads to graft loss, may be reduced through the use of low-friction bedding. A feasibility study was conducted to assess proof of concept for the use of low-friction bedding for patients with burns. Patient, parent and staff views on the acceptability of this material were explored through semi-structured interviews. METHOD Patient views were gathered through telephone interviews (n=17; 11 adult patients and 6 parents of child patients). One patient completed the questionnaire in written form because of hearing difficulties. Staff views were gathered at two time points: at the start of the study through open-ended questionnaires (n=20) and at the end of the study through focus group (n=12) and telephone interviews (n=3). Data were analysed using framework analysis. RESULTS Three themes were identified describing both patient and staff views of the sheets: Slippery feel of the sheets; leaking wounds and sheet changes; and movement and friction. Overall patients' views of the sheets were positive; they were comfortable to use the sheets and experienced reduced pain and itching. However, issues related to the slipperiness were highlighted. Staff views were largely negative because of difficulty in use, lack of absorbency, and increased workload. CONCLUSION The use of low-friction bedding is acceptable to patients undergoing a skin graft following a burn injury; however, problems related to sliding down the bed and soiling of sheets need addressing. Staff were supportive of the concept of low-friction bedding; however, they reported significant challenges in day-to-day use of sheets. Low-friction bedding presents a promising alternative to standard cotton sheets for patients with burns and those at risk of pressure sores; however, further work is needed to address current challenges in use.
Collapse
Affiliation(s)
- K Whale
- Centre for Child and Adolescent Health, Bristol Medical School, Population Health Sciences, University of Bristol, United Kingdom.
| | - J C Ingram
- Centre for Child and Adolescent Health, Bristol Medical School, Population Health Sciences, University of Bristol, United Kingdom
| | - S George
- Bristol Royal Children's Hospital, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - F Spickett-Jones
- Bristol Royal Children's Hospital, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - A Sack
- Southmead Hospital Bristol, North Bristol NHS Trust, United Kingdom
| | - A E Young
- Bristol Royal Children's Hospital, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| |
Collapse
|
16
|
Avery KNL, Chalmers KA, Brookes ST, Blencowe NS, Coulman K, Whale K, Metcalfe C, Blazeby JM. Development of a Core Outcome Set for Clinical Effectiveness Trials in Esophageal Cancer Resection Surgery. Ann Surg 2018; 267:700-710. [PMID: 28288055 PMCID: PMC5865486 DOI: 10.1097/sla.0000000000002204] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Development of a core outcome set (COS) for clinical effectiveness trials in esophageal cancer resection surgery. BACKGROUND Inconsistency and heterogeneity in outcome reporting after esophageal cancer resection surgery hampers comparison of trial results and undermines evidence synthesis. COSs provide an evidence-based approach to these challenges. METHODS A long list of clinical and patient-reported outcomes was identified and categorized into outcome domains. Domains were operationalized into a questionnaire and patients and health professionals rated the importance of items from 1 (not important) to 9 (extremely important) in 2 Delphi survey rounds. Retained items were discussed at a consensus meeting and a final COS proposed. Professionals were surveyed to request endorsement of the COS. RESULTS A total of 68 outcome domains were identified and operationalized into a questionnaire; 116 (91%) of consenting patients and 72 (77%) of health professionals completed round 1. Round 2 response rates remained high (87% patients, 93% professionals). Rounds 1 and 2 prioritized 43 and 19 items, respectively. Retained items were discussed at a patient consensus meeting and a final 10-item COS proposed, endorsed by 61/67 (91%) professionals and including: overall survival; in-hospital mortality; inoperability; need for another operation; respiratory complications; conduit necrosis and anastomotic leak; severe nutritional problems; ability to eat/drink; problems with acid indigestion or heartburn; and overall quality of life. CONCLUSIONS The COS is recommended for all pragmatic clinical effectiveness trials in esophageal cancer resection surgery. Further work is needed to delineate the definitions and parameters and explore best methods for measuring the individual outcomes.
Collapse
Affiliation(s)
- Kerry N. L. Avery
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Katy A. Chalmers
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Sara T. Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Natalie S. Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Karen Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Katie Whale
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Chris Metcalfe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, United Kingdom
| | - Jane M. Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
17
|
Pearson J, Whale K, Walsh N, Derham S, Russell J, Cramp F. 279 Mapping the behaviour change techniques used in a practice-based fibromyalgia self-management programme: a qualitative study. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer Pearson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| | - Katie Whale
- School of Clinical Sciences, University of Bristol, Bristol, UNITED KINGDOM
| | - Nicola Walsh
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| | - Sandi Derham
- Rheumatology Therapy Outpatient Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UNITED KINGDOM
| | - Julie Russell
- Rheumatology Therapy Outpatient Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UNITED KINGDOM
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| |
Collapse
|
18
|
Whale K, Cramer H, Joinson C. Left behind and left out: The impact of the school environment on young people with continence problems. Br J Health Psychol 2017; 23:253-277. [PMID: 29228510 PMCID: PMC5900927 DOI: 10.1111/bjhp.12284] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/27/2017] [Indexed: 11/30/2022]
Abstract
Objectives To explore the impact of the secondary school environment on young people with continence problems. Design In‐depth qualitative semi‐structured interviews. Methods We interviewed 20 young people aged 11–19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis. Results We generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning. Conclusion Disclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self‐management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential. Statement of Contribution What is already known on this subject? Continence problems are among the most common paediatric health problems Self‐management of continence problems requires a structured schedule of fluid intake and bladder emptying Inadequate toilet facilities and restricted access make it difficult for young people to manage their incontinence
What does this study add? Improvement is needed in teacher understanding of the needs of young people with continence problems Young people are reluctant to disclose continence problems due to perceived stigma and fear of social isolation Young people with continence problems may be at increased risk of academic underachievement
Collapse
Affiliation(s)
- Katie Whale
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | - Carol Joinson
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| |
Collapse
|
19
|
Whale K, Cramer H, Wright A, Sanders C, Joinson C. 'What does that mean?': a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK. BMJ Open 2017; 7:e015544. [PMID: 29042374 PMCID: PMC5652505 DOI: 10.1136/bmjopen-2016-015544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/14/2017] [Accepted: 07/27/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To explore the clinical care experiences of young people with continence problems. DESIGN In-depth semistructured qualitative interviews were conducted by Skype and telephone, with the addition of art-based participatory research techniques. Transcripts were analysed using inductive thematic analysis. SETTING Primary and secondary care in the UK. PARTICIPANTS We interviewed 20 participants (9 females, 11 males) aged 11-20 years. There were six participants with bedwetting alone, five with daytime wetting alone, five with combined (day and night) wetting and four with soiling. RESULTS We identified four themes: appointment experiences, treatment experiences, engagement with treatment and internalisation and externalisation of the continence problem. Patient-focused appointments using age-appropriate language were highly desirable. Continuity of care was highlighted as an important aspect of positive clinical experiences; however, this was found to be rare with many participants seeing a different person on each visit. Participants had tried a wide range of treatments for their continence problems with varying degrees of success. Relapse and treatment failure were common. Experiencing relapse was distressing and diminished participants' belief in the success of future treatments and undermined adherence. Participants would be seen to adopt two opposing coping strategies for dealing with their continence problem- internalisation and externalisation. CONCLUSION Incontinence in young people is challenging to manage. Young people may need to try a range of treatments before their symptoms improve. Due to challenges in treatment, there is an increased risk of poor adherence. During patient-focused appointments, clinicians should work to build rapport with patients and use age-appropriate language. Involving young people in their own care decisions is important. The way in which young people understand their continence problem can influence their coping strategies and adherence to treatment regimes.
Collapse
Affiliation(s)
- Katie Whale
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Anne Wright
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Carol Joinson
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
20
|
Coulman KD, Howes N, Hopkins J, Whale K, Chalmers K, Brookes S, Nicholson A, Savovic J, Ferguson Y, Owen-Smith A, Blazeby J, Blazeby J, Welbourn R, Byrne J, Donovan J, Reeves BC, Wordsworth S, Andrews R, Thompson JL, Mazza G, Rogers CA. A Comparison of Health Professionals' and Patients' Views of the Importance of Outcomes of Bariatric Surgery. Obes Surg 2016; 26:2738-2746. [PMID: 27138600 PMCID: PMC5069338 DOI: 10.1007/s11695-016-2186-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will include measures of benefit and risk. It is possible that stakeholders involved with surgery value these outcomes differently, although this has not previously been explored. This study aimed to investigate and compare how professionals and patients prioritise outcomes of bariatric surgery. METHODS Systematic reviews and qualitative interviews created an exhaustive list of outcomes. This informed the development of a 130-item questionnaire, structured in four sections (complications of surgery; clinical effectiveness; signs, symptoms, and other measures; quality of life). Health professionals and patients rated the importance of each item on a 1-9 scale. Items rated 8-9 by at least 70 % of the participants were considered prioritised. Items prioritised in each section were compared between professionals and patients and interrater agreement assessed using kappa statistics (ĸ). RESULTS One hundred sixty-eight out of four hundred fifty-nine professionals (36.6 %) and 90/465 patients (19.4 %) completed the questionnaire. Professionals and patients prioritised 18 and 25 items, respectively, with 10 overlapping items and 23 discordant items (ĸ 0.363). Examples of items prioritised by both included 'diabetes' and 'leakage from bowel joins'. Examples of discordant items included 're-admission rates' (professionals only) and 'excess skin' (patients only). Poor agreement was seen in the 'quality of life' section (0 overlapping items, 8 discordant, ĸ -0.036). CONCLUSIONS Although there was some overlap of outcomes prioritised by professionals and patients, there were important differences. We recommend that the views of all relevant health professionals and patients are considered when deciding on outcomes to evaluate bariatric surgery.
Collapse
Affiliation(s)
- Karen D Coulman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Noah Howes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Department of Upper GI and Bariatric Surgery, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, TA1 5DA, UK
| | - James Hopkins
- Department of Upper GI and Bariatric Surgery, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, TA1 5DA, UK
| | - Katie Whale
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Katy Chalmers
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sara Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Alex Nicholson
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jelena Savovic
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- The National Institute For Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Yasmin Ferguson
- Department of Upper GI and Bariatric Surgery, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, TA1 5DA, UK
| | - Amanda Owen-Smith
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mercieca-Bebber RL, Perreca A, King M, Macann A, Whale K, Soldati S, Jacobs M, Efficace F. Patient-reported outcomes in head and neck and thyroid cancer randomised controlled trials: A systematic review of completeness of reporting and impact on interpretation. Eur J Cancer 2016; 56:144-161. [DOI: 10.1016/j.ejca.2015.12.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 01/09/2023]
|
22
|
Coulman K, Brookes S, Chalmers K, Hopkins J, Howes N, Nicholson A, Owen-Smith A, Whale K, Blazeby J. Choosing outcomes for a core outcome set: does provision of feedback between delphi survey rounds help prioritise items? Trials 2015. [PMCID: PMC4660293 DOI: 10.1186/1745-6215-16-s2-p57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
23
|
Avery K, Chalmers K, Whale K, Blencowe N, Macefield R, Brookes S, Metcalfe C, Blazeby J. The importance of stakeholder selection in core outcome set development: how surveying different health professionals may influence outcome selection. Trials 2015. [PMCID: PMC4659317 DOI: 10.1186/1745-6215-16-s2-p47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
24
|
Efficace F, Fayers P, Pusic A, Cemal Y, Yanagawa J, Jacobs M, la Sala A, Cafaro V, Whale K, Rees J, Blazeby J. Quality of patient-reported outcome reporting across cancer randomized controlled trials according to the CONSORT patient-reported outcome extension: A pooled analysis of 557 trials. Cancer 2015; 121:3335-42. [PMID: 26079197 DOI: 10.1002/cncr.29489] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/01/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The main objectives of this study were to identify the number of randomized controlled trials (RCTs) including a patient-reported outcome (PRO) endpoint across a wide range of cancer specialties and to evaluate the completeness of PRO reporting according to the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. METHODS RCTs with a PRO endpoint that had been performed across several cancer specialties and published between 2004 and 2013 were considered. Studies were evaluated on the basis of previously defined criteria, including the CONSORT PRO extension and the Cochrane Collaboration's tool for assessing the risk of bias of RCTs. Analyses were also conducted by the type of PRO endpoint (primary vs secondary) and by the cancer disease site. RESULTS A total of 56,696 potentially eligible records were scrutinized, and 557 RCTs with a PRO evaluation, enrolling 254,677 patients overall, were identified. PROs were most frequently used in RCTs of breast (n = 123), lung (n = 85), and colorectal cancer (n = 66). Overall, PROs were secondary endpoints in 421 RCTs (76%). Four of 6 evaluated CONSORT PRO items were documented in less than 50% of the RCTs. The level of reporting was higher in RCTs with a PRO as a primary endpoint. The presence of a supplementary report was the only statistically significant factor associated with greater completeness of reporting for both RCTs with PROs as primary endpoints (β = .19, P = .001) and RCTs with PROs as secondary endpoints (β = .30, P < .001). CONCLUSIONS Implementation of the CONSORT PRO extension is equally important across all cancer specialties. Its use can also contribute to revealing the robust PRO design of some studies, which might be obscured by poor outcome reporting.
Collapse
Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy
| | - Peter Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrea Pusic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yeliz Cemal
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jane Yanagawa
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Andrea la Sala
- Laboratory of Molecular and Cellular Immunology, Scientific Hospitalization and Care Institution San Raffaele Pisana, Rome, Italy
| | - Valentina Cafaro
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy
| | - Katie Whale
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan Rees
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jane Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | |
Collapse
|
25
|
Rees JR, Whale K, Fish D, Fayers P, Cafaro V, Pusic A, Blazeby JM, Efficace F. Patient-reported outcomes in randomised controlled trials of colorectal cancer: an analysis determining the availability of robust data to inform clinical decision-making. J Cancer Res Clin Oncol 2015; 141:2181-92. [PMID: 25910987 DOI: 10.1007/s00432-015-1970-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/10/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Randomised controlled trials (RCTs) are the most robust study design measuring outcomes of colorectal cancer (CRC) treatments, but to influence clinical practice trial design and reporting of patient-reported outcomes (PROs) must be of high quality. Objectives of this study were as follows: to examine the quality of PRO reporting in RCTs of CRC treatment; to assess the availability of robust data to inform clinical decision-making; and to investigate whether quality of reporting improved over time. METHODS A systematic review from January 2004-February 2012 identified RCTs of CRC treatment describing PROs. Relevant abstracts were screened and manuscripts obtained. Methodological quality was assessed using International Society for Quality of Life Research-patient-reported outcome reporting standards. Changes in reporting quality over time were established by comparison with previous data, and risk of bias was assessed with the Cochrane risk of bias tool. RESULTS Sixty-six RCTs were identified, seven studies (10 %) reported survival benefit favouring the experimental treatment, 35 trials (53 %) identified differences in PROs between treatment groups, and the clinical significance of these differences was discussed in 19 studies (29 %). The most commonly reported treatment type was chemotherapy (n = 45; 68 %). Improvements over time in key methodological issues including the documentation of missing data and the discussion of the clinical significance of PROs were found. Thirteen trials (20 %) had high-quality reporting. CONCLUSIONS Whilst improvements in PRO quality reporting over time were found, several recent studies still fail to robustly inform clinical practice. Quality of PRO reporting must continue to improve to maximise the clinical impact of PRO findings.
Collapse
Affiliation(s)
- Jonathan R Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Katie Whale
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Daniel Fish
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Peter Fayers
- Institute of Applied Health Sciences, University of Aberdeen Medical School, Aberdeen, Scotland, UK
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science, Trondheim, Norway
| | - Valentina Cafaro
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Central Office, Rome, Italy
| | - Andrea Pusic
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Central Office, Rome, Italy
| |
Collapse
|
26
|
Hopkins J, Howes N, Chalmers K, Whale K, Savovic J, Coulman K, Nicholson A, Byrne J, Whistance R, Welbourn R, Andrews R, Blazeby J. What are important outcomes of bariatric surgery? An in-depth analysis to inform the development of a core outcome set and a comparison between the views of surgeons and other health professionals (the BARIACT study). Lancet 2015; 385 Suppl 1:S43. [PMID: 26312865 DOI: 10.1016/s0140-6736(15)60358-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Outcome reporting in bariatric surgery needs uniformity. A core outcome set is an agreed minimum set of outcomes reported in all studies of a particular condition, but members of the bariatric multidisciplinary team might value outcomes differently. The aim of this study was to summarise existing outcome reporting in bariatric surgery, to inform the development of a core outcome set, and to compare outcomes selected as important by type of health professional. METHODS Outcomes reported in randomised controlled trials (RCTs) and large non-randomised studies, identified by a systematic review, were listed verbatim. Frequency of outcome reporting and uniformity of definition were assessed. A questionnaire to rate the importance of each outcome was completed by members of the bariatric multidisciplinary team. Responses to each item were scored as 1 (not essential) to 9 (absolutely essential). We ranked outcomes according to percentage deemed important (7-9) and according to respondents by type of health professional. FINDINGS We identified 1088 individual outcomes from 90 studies (39 RCTs), grouped them into health domains, and presented them as a questionnaire with 131 items to 489 multidisciplinary team members. Most outcomes (n=920, 85%) were reported only once. The largest outcome domain was surgical complications, and 432 outcomes (42%) corresponded to an adverse event. Only a quarter of outcomes (n=461) were defined, and were often contradictory. For questionnaire responders (n=164, response rate 33·5%), most were surgeons (n=80, 48·8%), followed by dietitians (n=31, 18·9%), nurses (n=24, 14·6%), physicians (n=12, 7·3%), and others (n=16, 9·9%). Improvement in diabetes was the top outcome for all health professionals. Seven of the surgeon's top ten outcomes were adverse events, compared with three for other health professionals. Groups valued a measure of weight differently (third vs 15th for other health professionals and surgeons, respectively). INTERPRETATION This study shows that the assessment of bariatric surgery focuses largely on adverse events and resolution of comorbidity, but that reporting is inconsistent and ill-defined. Substantial variation between the views of surgeons and those of other health professionals was evident. The next step is to provide feedback to participants and to survey their views again before a final consensus meeting to produce a core outcome set for the Benefits and Adverse events in BARIAtric surgery Clinical Trials (BARIACT) as a solution to this problem. FUNDING National Institute for Health Research (NIHR), and the NIHR Health Technology Assessment programme. This work was also undertaken with the support of the MRC ConDuCT-II Hub (Collaboration and innovation for Difficult and Complex randomised controlled Trials In Invasive procedures, MR/K025643/1).
Collapse
|
27
|
Hopkins JC, Howes N, Chalmers K, Savovic J, Whale K, Coulman KD, Welbourn R, Whistance RN, Andrews RC, Byrne JP, Mahon D, Blazeby JM. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Obes Rev 2015; 16:88-106. [PMID: 25442513 DOI: 10.1111/obr.12240] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 12/19/2022]
Abstract
Outcome reporting in bariatric surgery needs a core outcome set (COS), an agreed minimum set of outcomes reported in all studies of a particular condition. The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS. Outcomes reported in randomized controlled trials (RCTs) and large non-randomized studies identified by a systematic review were listed verbatim and categorized into domains, scrutinizing the frequency of outcome reporting and uniformity of definitions. Ninety studies (39 RCTs) identified 1,088 separate outcomes, grouped into nine domains with most (n = 920, 85%) reported only once. The largest outcome domain was 'surgical complications', and overall, 42% of outcomes corresponded to a theme of 'adverse events'. Only a quarter of outcomes were defined, and where provided definitions, which were often contradictory. Percentage of excess weight loss was the main study outcome in 49 studies, but nearly 40% of weight loss outcomes were heterogeneous, thus not comparable. Outcomes of diverse bariatric operations focus largely on adverse events. Reporting is inconsistent and ill-defined, limiting interpretation and comparison of published studies. Thus, we propose and are developing a COS for the surgical treatment of severe and complex obesity.
Collapse
Affiliation(s)
- J C Hopkins
- University Surgery Unit, University Hospitals Southampton, Southampton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Efficace F, Rees J, Fayers P, Pusic A, Taphoorn M, Greimel E, Reijneveld J, Whale K, Blazeby J. Overcoming barriers to the implementation of patient-reported outcomes in cancer clinical trials: the PROMOTION Registry. Health Qual Life Outcomes 2014; 12:86. [PMID: 24902767 PMCID: PMC4064101 DOI: 10.1186/1477-7525-12-86] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/31/2014] [Indexed: 12/25/2022] Open
Abstract
Every cancer treatment, irrespective of its clinical effectiveness, has an impact on patients’ quality of life (QoL). Even recently developed targeted therapies might have side effects and significantly impact patients’ QoL. Thus, understanding the advantages and disadvantages of different treatments from the patient’s standpoint has become a must in clinical research and is highly valued by major stakeholders. Thousands of cancer patients are enrolled into randomized controlled trials (RCTs) each year and many complete patient-reported outcome (PRO) instruments to obtain patient-centered information as part of the assessment of the overall effectiveness of the new therapy. Some of these RCTs have generated high quality PRO evidence forming the basis for approval (or support to approval) of drugs by the US Food and Drug Administration. However, a consistent strategy to determine the quality of patient centered evidence presented in RCTs has until recently been lacking. One of the fundamental questions when including PROs in clinical research revolves around methodological robustness and consistency of outcome reporting. Cancer patients, physicians and healthcare system stakeholders need to rely on solid information to make the best possible choice regarding treatment. Therefore generating high-quality findings from PRO assessment in cancer trials is of paramount importance. In an effort to improve quality of PRO assessment and reporting in the near future, the Patient-Reported Outcome Measurements Over Time In ONcology (PROMOTION) Registry was developed. The scope of this Registry is to identify, track, analyse, and store information on all cancer RCTs that have included PROs, and assess the quality of their PRO assessments.
Collapse
Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Via Benevento, 6, 00161 Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Whale K, Gillison FB, Smith PC. ‘Are you still on that stupid diet?’: Women’s experiences of societal pressure and support regarding weight loss, and attitudes towards health policy intervention. J Health Psychol 2013; 19:1536-46. [DOI: 10.1177/1359105313495072] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study investigated how people’s attitudes and motivations towards losing weight are influenced by societal pressures surrounding weight loss, their interaction with the obesogenic environment and individuals’ attitudes and motivations towards weight. Semi-structured qualitative interviews were conducted with 10 women currently attending commercial weight-loss programmes. Participants experienced conflicting messages regarding weight norms, with the media portraying powerful social norms relating to thinness and beauty, and changes to the food environment and interactions with family and friends commonly undermining weight-loss activities and promoting increased consumption. Providing social and environmental support for the behaviours needed to produce weight loss may need to be a primary focus for obesity policy.
Collapse
Affiliation(s)
- Katie Whale
- University of Bath, UK
- University of Bristol, UK
| | | | | |
Collapse
|
30
|
Taylor R, Whale K, Raines M. The heavy eye phenomenon: orthoptic and ophthalmic characteristics. Ger J Ophthalmol 1995; 4:252-5. [PMID: 7492939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A series is presented of nine patients who demonstrate the heavy eye phenomenon. Illustrations of these patients show the salient features of the phenomenon, including hypotropia, exotropia and pseudoproptosis. The condition is summarized and the pathogenesis of the eye and lid positions are discussed. The indications for surgery and some examples with results are shown. The correct diagnosis may prevent unnecessary investigation of pseudoproptosis and pseudo third-nerve palsy.
Collapse
Affiliation(s)
- R Taylor
- Birmingham and Midland Eye Hospital, UK
| | | | | |
Collapse
|
31
|
Abstract
BACKGROUND AND DESIGN Although the association between streptococcal infection and guttate psoriasis is well known, to date there has been little information on whether only limited groups and/or serotypes of beta-hemolytic streptococci are involved. One hundred eleven patients with a sudden onset or deterioration of psoriasis were investigated for evidence of streptococcal infection. Of these patients, 34 had acute guttate psoriasis, 30 had a guttate flare of chronic psoriasis, 37 had chronic plaque psoriasis, and 10 had other types of psoriasis. RESULTS Serologic evidence of recent streptococcal infection was present in 19 (58%) of 33 patients with acute guttate psoriasis compared with seven (26%) of 27 patients with guttate exacerbations of chronic psoriasis. Streptococcus pyogenes was isolated from 19 (17%) of all 111 patients (9 [26%] of 34 with acute guttate psoriasis, four [13%] of 30 with guttate exacerbations of chronic psoriasis, and five [14%] of 37 patients with chronic psoriasis) compared with seven (7%) of 101 of a control population of patients being seen for treatment of viral warts. Other beta-hemolytic streptococci were found with equal frequency in the study and control populations. Thirteen isolates of 10 different streptococcal serotypes were obtained from the 64 patients with guttate psoriasis. These serotypes were similar in distribution and prevalence to those present in the local community. CONCLUSIONS This study confirms the strong association between prior infection with S pyogenes and guttate psoriasis but suggests that the ability to trigger guttate psoriasis is not serotype specific.
Collapse
Affiliation(s)
- N R Telfer
- Skin Hospital, Salford, Manchester, United Kingdom
| | | | | | | |
Collapse
|
32
|
|
33
|
Salh B, Fegan C, Hussain A, Jaulim A, Whale K, Webb A. Pulmonary infection with Nocardia caviae in a patient with diabetes mellitus and liver cirrhosis. Thorax 1988; 43:933-4. [PMID: 3222767 PMCID: PMC461569 DOI: 10.1136/thx.43.11.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The first reported case of pulmonary infection with Nocardia caviae in Britain occurred in a 67 year old woman, in whom diabetes mellitus and liver cirrhosis probably contributed to impaired cell mediated immunity. She was successfully treated with gentamicin 60 mg eight hourly and sulphadimidine 500 mg six hourly for six months and then with sulphadimidine 2 g/day for a further three months. When Nocardia caviae is isolated from the sputum of a patient with chronic respiratory infection and fever, effective treatment should be started promptly.
Collapse
Affiliation(s)
- B Salh
- Department of Chest Diseases, Monsall Hospital, Manchester
| | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Mandal B, Flegg P, Dunbar E, Whale K, Brennand J. Ciprofloxacin in enteric fever. Chemioterapia 1987; 6:492-3. [PMID: 3151350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- B Mandal
- Regional Department of Infectious Diseases and Tropical Medicine, University of Manchester School of Medicine, Monsall Hospital, England
| | | | | | | | | |
Collapse
|
36
|
|
37
|
Watson B, Ellis M, Mandal B, Dunbar E, Whale K, Brennand J. A comparison of the clinico-pathological features with stool pathogens in patients hospitalised with the symptom of diarrhoea. Scand J Infect Dis 1986; 18:553-9. [PMID: 3810049 DOI: 10.3109/00365548609021662] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The clinico-pathological features of 515 adult patients admitted to a major Regional Infectious Diseases Unit in United Kingdom with the symptom complex of diarrhoea were compared to the pathogens detected in their stool specimens. Routine clinical examination supported by basic pathological and laboratory investigations identified 138 (28%) in whom the cause of diarrhoea was extragastrointestinal or non-infectious gastrointestinal. Of the 351 patients (72%) with infectious gastroenteritis 72 (21%) had campylobacter, 59 (17%) had salmonella (22% bacteraemic) and 16 (5%) shigella. Clostridium difficile toxin accounted for a further 15 (4%)--antibiotics had been the antecedent cause in only one half of these. Routine microscopical examination of the faeces for red and white cells distinguished many with "culture positive" diarrhoea from those with "culture negative" infectious diarrhoea. Although there are no clinico-pathological features which are unique to a particular pathogen and unequivocally suggest a particular pathogen, certain features did tend to present more often in association with particular microorganisms, and this knowledge may suggest a bacterial diagnosis whilst awaiting the definitive results of stool microbiology. These features include prior antimicrobial therapy with positive sigmoidoscopical/histological features: Cl. difficile; protracted diarrhoea in elderly severely dehydrated patients: salmonellosis; foreign travel in males with bloody diarrhoea: shigellosis; abdominal pain in younger patients with a small degree of vomiting: campylobacteriosis. Early diagnosis may then prove useful in rationalizing initial therapy, particularly the appropriate use of antimicrobials.
Collapse
|
38
|
Affiliation(s)
- K Whale
- Department of Microbiology, North Manchester General Hospital, Crumpsall, Manchester M86RB
| |
Collapse
|
39
|
Mandal BK, Ellis ME, Dunbar EM, Whale K. Double-blind placebo-controlled trial of erythromycin in the treatment of clinical campylobacter infection. J Antimicrob Chemother 1984; 13:619-23. [PMID: 6381461 DOI: 10.1093/jac/13.6.619] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In a double-blind placebo-controlled trial in patients hospitalized with campylobacter infection, erythromycin lessened pain and curtailed the carriage state but otherwise did not alter the natural course of the illness, which proved to be a short-lived, self-limiting one, even in this selected group of hospitalized patients; the majority had become asymptomatic by the time of the bacteriological diagnosis. The rarity of bacteraemia is highlighted by the study.
Collapse
|
40
|
Chalmers RJ, Ead RD, Whale K, Ive FA. Guttate psoriasis, glomerulonephritis and streptococcal infection. Arch Dermatol 1983; 119:956. [PMID: 6360052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
41
|
Whale K. Dr Whale replies as follows. Clin Mol Pathol 1983. [DOI: 10.1136/jcp.36.8.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
42
|
|
43
|
|
44
|
Affiliation(s)
- K Whale
- Department of Microbiology North Manchester General Hospital, Crumpsall, Manchester M8 6RB
| |
Collapse
|
45
|
|
46
|
Gallagher P, Cade D, Whale K, Schofield PF. Does infection cause anastomotic dehiscence? J R Coll Surg Edinb 1982; 27:90-92. [PMID: 7086725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
47
|
Whale K, Jones DM. Stomach as reservoir for respiratory pathogens. Lancet 1979; 1:38. [PMID: 83478 DOI: 10.1016/s0140-6736(79)90472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|