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Scragg J, Morris E, Wane S, Noreik M, Jerome D, Yu LM, Galal U, Dyson P, Tan GD, Fox R, Breeze P, Thomas C, Jebb SA, Aveyard P. Dietary approaches to the management of type 2 diabetes (DIAMOND) in primary care: A protocol for a cluster randomised trial. Contemp Clin Trials 2023; 129:107199. [PMID: 37094737 DOI: 10.1016/j.cct.2023.107199] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION There is strong evidence that type 2 diabetes (T2D) remission can be achieved by adopting a low-energy diet achieved through total dietary replacement products. There is promising evidence that low-carbohydrate diets can achieve remission of T2D. The Dietary Approaches to the Management of type 2 Diabetes (DIAMOND) programme combines both approaches in a behaviourally informed low-energy, low-carbohydrate diet for people with T2D, delivered by nurses in primary care. This trial compares the effectiveness of the DIAMOND programme to usual care in inducing remission of T2D and in reducing risk of cardiovascular disease. METHODS AND ANALYSIS We aim to recruit 508 people in 56 practices with T2D diagnosed within 6 years, who are demographically representative of the UK population. We will allocate general practices, based on ethnicity and socioeconomic status, to provide usual care for diabetes or offer the DIAMOND programme. Participants in practices offering DIAMOND will see the nurse seven times over 6 months. At baseline, 6 months, and 1 year we will measure weight, blood pressure, HbA1c, lipid profile and risk of fatty liver disease. The primary outcome is diabetes remission at 1 year, defined as HbA1c < 48 mmol/mol and off glucose-lowering medication for at least 6 months. Thereafter, we will assess whether people resume treatment for diabetes and the incidence of microvascular and macrovascular disease through the National Diabetes Audit. Data will be analysed using mixed-effects generalised linear models. This study has been approved by the National Health Service Health Research Authority Research Ethics Committee (Ref: 22/EM/0074). TRIAL REGISTRATION NUMBER ISRCTN46961767.
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Affiliation(s)
- Jadine Scragg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sarah Wane
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Michaela Noreik
- Hochschule Niederrhein, Fachbereich Oecotrophologie, University of Applied Sciences, UK
| | - Derek Jerome
- PPI representative, the DIAMOND study, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Primary Care- Clinical trials unit, University of Oxford, Oxford, UK
| | - Ushma Galal
- Primary Care- Clinical trials unit, University of Oxford, Oxford, UK
| | - Pamela Dyson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Garry D Tan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Pickering K, Wane S, Speake H, Crank H, Anderson A, Cain H, Copeland R, Lee D, Gray J, McNally R, Hargreaves J, Cohen J, Northgraves M, Wilson C, Saxton J. Abstract PS8-26: The new normal; adjusting to remote ways of providing bespoke weight management support to breast cancer survivors during the COVID-19 global pandemic. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps8-26] [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: 11/16/2022]
Abstract
Abstract
PurposeNEWDAY-ABC (North England Women’s Diet and ActivitY After Breast Cancer) trial is a bespoke weight management and behaviour change intervention for women treated for early-stage estrogen-receptor positive breast cancer (BC) with a body mass index (BMI) of ≥25 kg/m2. Many women are overweight or report further weight gain during and after BC-treatment. Due to the complex nature of weight management, NEWDAY-ABC was co-designed with BC-survivors and health care professionals (HCPs) prior to the COVID-19 outbreak. However, because of the COVID-19 pandemic, refinements had to be made to the intervention to enable remote (virtual) delivery options, allowing the trial to proceed while adhering to government social distancing and shielding guidance.
MethodsPrior to the COVID-19 outbreak, initial focus groups (FG) were conducted with n=16 BC-survivors and n=21 HCPs. Framework analysis was used to categorise what BC-survivors want from a weight management intervention. Participants (n=9) subsequently attended a two-stage successive interactive co-design workshop. Workshop 1 explored: i) techniques to motivate change; ii) approaches to overcome challenges to intervention adherence; iii) core components of the intervention. Workshop 2 explored: i) language and graphics used for the support and educational materials; ii) delivery mechanisms; iii) refinement of workshop 1 ideas.
Results / findingsCo-design revealed the intervention should address: i) self-confidence and self-esteem; ii) reassurance of safe physical activity (PA) and dietary guidance for BC-survivors; iii) knowledge about what happens to the body after treatment. In terms of intervention delivery: i) self-monitoring of weight should be optional; ii) content should be as visual as possible iii) emotional needs are as important to address as PA and dietary recommendations; iv) one-to-one facilitator support is as important as group peer-support.
To integrate all these elements, the NEWDAY-ABC intervention included face-to-face group support sessions. However, due to the COVID-19 pandemic, remote delivery options had to be embedded into the intervention design to enable this support to be provided via means that are accessible to all eligible participants, whilst adhering to the guidance on social distancing and shielding of vulnerable populations.
Key considerations include:•Participant and session leader’s ability to access and engage with remote delivery•Creating a peer supportive environment remotely•Remote platform security•Effectiveness of remote delivery in achieving clinically meaningful weight loss
ConclusionsThe COVID-19 pandemic has forced cancer care to quickly adapt to ways of providing remote support to meet the needs of cancer patients and survivors. While this presents many challenges, including issues of accessibility, privacy and accessing peer support, use of virtual delivery platforms and new technologies means that BC-survivors can still access this bespoke weight management intervention during an extended period of post-pandemic social distancing. The effectiveness of the NEWDAY-ABC intervention in providing the required level of peer support, guidance and self-confidence needed for clinically meaningful weight loss with virtual delivery options will be tested in a randomised controlled trial.
Citation Format: Katie Pickering, Sarah Wane, Helen Speake, Helen Crank, Annie Anderson, Henry Cain, Rob Copeland, Daniela Lee, Joanne Gray, Richard McNally, Jackie Hargreaves, Judith Cohen, Matthew Northgraves, Caroline Wilson, John Saxton. The new normal; adjusting to remote ways of providing bespoke weight management support to breast cancer survivors during the COVID-19 global pandemic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-26.
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Affiliation(s)
| | - Sarah Wane
- 2Northumbria University, Newcastle, United Kingdom
| | - Helen Speake
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | - Helen Crank
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | | | - Henry Cain
- 4Newcastle Upon Tyne NHS Trust, Newcastle, United Kingdom
| | - Rob Copeland
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | - Daniela Lee
- 4Newcastle Upon Tyne NHS Trust, Newcastle, United Kingdom
| | - Joanne Gray
- 2Northumbria University, Newcastle, United Kingdom
| | | | | | - Judith Cohen
- 7Hull Clinical Trials Unit, Hull, United Kingdom
| | | | - Caroline Wilson
- 8University of Sheffield, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - John Saxton
- 2Northumbria University, Newcastle, United Kingdom
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Maxwell M, Berry K, Wane S, Hagen S, McClurg D, Duncan E, Abhyankar P, Elders A, Best C, Wilkinson J, Mason H, Fenocchi L, Calveley E, Guerrero K, Tincello D. Pelvic floor muscle training for women with pelvic organ prolapse: the PROPEL realist evaluation. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Pelvic organ prolapse is estimated to affect 41–50% of women aged > 40 years. A multicentre randomised controlled trial of individualised pelvic floor muscle training found that pelvic floor muscle training was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. Provision of pelvic floor muscle training for prolapse has continued to vary across the UK, with limited availability of specialist physiotherapists to deliver it.
Objectives
This project aimed to study the implementation and outcomes of different models of delivery to increase the service provision of pelvic floor muscle training, and to follow up treatment outcomes for the original trial participants.
Design
A realist evaluation of pelvic floor muscle training implementation conducted within three full case study sites and two partial case study sites; an observational prospective cohort study comparing patient-reported outcomes pre and post intervention in all five sites; and a long-term follow-up study linking previous trial participants to routine NHS hospital data.
Setting
The setting for the realist evaluation was pelvic floor muscle training service delivery models in three NHS sites. The setting for the patient-reported outcome measures study was pelvic floor muscle training services in five NHS sites.
Methods
Realist evaluation qualitative data were collected at four time points in three case study sites to understand the implementation models, uptake, adherence and impact. Interviews involved service managers/leads, consultants, staff delivering pelvic floor muscle training and women receiving pelvic floor muscle training.
Main outcomes measures
Patient-reported outcomes were collected at baseline and at 6 and 12 months across five sites, including the Pelvic Organ Prolapse Symptom Score, health-related quality of life (measured using the EuroQol-5 Dimensions, five-level version, questionnaire), prolapse severity (measured using the Pelvic Organ Prolapse Quantification System), urinary incontinence (measured using International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form) and need for further treatment.
Results
A total of 102 women were recruited to the patient-reported outcome measures cohort study (target, n = 120), and 65 women had matched baseline and 6-month Pelvic Organ Prolapse Symptom Scores. The mean Pelvic Organ Prolapse Symptom Score was 10.18 (standard deviation 5.63) at baseline and 6.98 (standard deviation 5.23) at 6 months, representing a statistically significant and clinically meaningful difference. There was no statistically significant difference between the outcomes obtained from delivery by specialist physiotherapists and the outcomes obtained from delivery by other health-care professionals (mean change in Pelvic Organ Prolapse Symptom Score: –3.95 vs. –2.81, respectively). Services delivered using higher-band physiotherapists only were more costly than services delivered using other staff mixes. The effect of the original pelvic floor muscle training intervention, over a post-intervention period of > 10 years, was a reduction in the odds of any treatment during follow-up (odds ratio 0.61, 95% confidence interval 0.37 to 0.99). The realist evaluation revealed stark differences in implementation. The site with a specialist physiotherapy service resisted change because of perceived threats to the specialist role and concerns about care quality. Pelvic floor muscle training delivery by other health-care staff was easier when there was a lack of any existing specialist service; staff had prior training and interest in pelvic health; staff had support, autonomy, time and resources to deliver pelvic floor muscle training as part of their core role; and surrounding services supported a flow of pelvic floor muscle training referrals.
Limitations
The number of available matched pre and post outcomes for women and the lack of Pelvic Organ Prolapse Quantification System examinations were limitations of this study.
Conclusions
It is possible to train different staff to effectively deliver pelvic floor muscle training to women. Women’s self-reported outcomes significantly improved across all service models. Training should be adequately tailored to differential skill mix needs.
Future work
Future work should include further implementation of pelvic floor muscle training and should include pre- and post-outcome data collection using the Pelvic Organ Prolapse Symptom Score.
Study registration
This study is registered as Research Registry 4919.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Karen Berry
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Sarah Wane
- Department of Sport, Exercise and Rehabilitation, University of Northumbria, Newcastle upon Tyne, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Purva Abhyankar
- Division of Health Sciences, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Catherine Best
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Joyce Wilkinson
- Division of Health Sciences, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Linda Fenocchi
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Karen Guerrero
- Department of Urogynaecology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Douglas Tincello
- Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
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Abhyankar P, Wilkinson J, Berry K, Wane S, Uny I, Aitchison P, Duncan E, Calveley E, Mason H, Guerrero K, Tincello D, McClurg D, Elders A, Hagen S, Maxwell M. Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delivery models. BMC Health Serv Res 2020; 20:910. [PMID: 32998714 PMCID: PMC7528592 DOI: 10.1186/s12913-020-05748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 01/29/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pelvic Floor Muscle Training (PFMT) has been shown to be effective for pelvic organ prolapse in women, but its implementation in routine practice is challenging due to lack of adequate specialist staff. It is important to know if PFMT can be delivered by different staff skill mixes, what barriers and facilitators operate in different contexts, what strategies enable successful implementation and what are the underlying mechanisms of their action. PROPEL intervention was designed to maximise the delivery of effective PFMT in the UK NHS using different staff skill mixes. We conducted a realist evaluation (RE) of this implementation to understand what works, for whom, in what circumstances and why. METHODS Informed by the Realist and RE-AIM frameworks, the study used a longitudinal, qualitative, multiple case study design. The study took place in five, purposively selected, diverse NHS sites across the UK and proceeded in three phases to identify, test and refine a theory of change. Data collection took place at 4 time points over an 18 month implementation period using focus groups and semi-structured interviews with a range of stakeholders including service leads/managers, senior practitioners, newly trained staff and women receiving care in the new service models. Data were analysed using thematic framework approach adapted to identify Context, Mechanism and Outcome (CMO) configurations of the RE. RESULTS A heightened awareness of the service need among staff and management was a mechanism for change, particularly in areas where there was a shortage of skilled staff. In contrast, the most established specialist physiotherapist-delivered PFMT service activated feelings of role protection and compromised quality, which restricted the reach of PFMT through alternative models. Staff with some level of prior knowledge in women's health and adequate organisational support were more comfortable and confident in new role. Implementation was seamless when PFMT delivery was incorporated in newly trained staff's role and core work. CONCLUSION Roll-out of PFMT delivery through different staff skill mixes is possible when it is undertaken by clinicians with an interest in women's health, and carefully implemented ensuring adequate levels of training and ongoing support from specialists, multi-disciplinary teams and management.
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Affiliation(s)
- Purva Abhyankar
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK.
| | - Joyce Wilkinson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Karen Berry
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - Sarah Wane
- Department of Sport, Exercise and Rehabilitation, University of Northumbria, Sutherland Building, Newcastle-upon-Tyne, NE1 8ST, UK
| | - Isabelle Uny
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - Patricia Aitchison
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Karen Guerrero
- Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Douglas Tincello
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 RRH, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling Innovation Park, Stirling, FK9 4NF, UK
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Abhyankar P, Uny I, Semple K, Wane S, Hagen S, Wilkinson J, Guerrero K, Tincello D, Duncan E, Calveley E, Elders A, McClurg D, Maxwell M. Women's experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC Womens Health 2019; 19:45. [PMID: 30876415 PMCID: PMC6419797 DOI: 10.1186/s12905-019-0741-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/08/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pelvic organ prolapse is a common urogenital condition affecting 41-50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women's needs, throughout their patient journey. This study explored women's experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. METHODS Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women's experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. RESULTS Three themes emerged relating to women's experiences of a) Evaluating what is normal b) Hobson's choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals' preferences which were subtly reflected through the framing of the offer. Women's embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women's preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. CONCLUSIONS As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them.
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Affiliation(s)
| | | | - Karen Semple
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Suzanne Hagen
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | - Edward Duncan
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Eileen Calveley
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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Maxwell M, Semple K, Wane S, Elders A, Duncan E, Abhyankar P, Wilkinson J, Tincello D, Calveley E, MacFarlane M, McClurg D, Guerrero K, Mason H, Hagen S. PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol. BMC Health Serv Res 2017; 17:843. [PMID: 29273048 PMCID: PMC5741940 DOI: 10.1186/s12913-017-2795-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/16/2017] [Accepted: 12/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background Pelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments. Methods A Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis. Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery. Discussion Study of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term.
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Affiliation(s)
- Margaret Maxwell
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Karen Semple
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Sarah Wane
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK.
| | | | - Edward Duncan
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Purva Abhyankar
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Joyce Wilkinson
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Mary MacFarlane
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
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Affiliation(s)
- Sarah Wane
- School of Human Movement Studies, University of Queensland, Brisbane, Australia
| | | | - Wendy Brown
- School of Human Movement Studies, University of Queensland, Brisbane, Australia
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Wane S, Brown W, van Uffelen J. Determinants of weight gain in young women: A review of the literature. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.304] [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: 10/19/2022]
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Aymar M, Robaux O, Wane S. Central-field calculations of photoionisation cross sections of excited states of Rb and Sr+and analysis of photoionisation cross sections of excited alkali atoms using quantum defect theory. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0022-3700/17/6/013] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kane PA, Ayad M, Hane A, Wane S. [Specific desensitization, basic treatment of asthma. Our experience in Dakar apropos of 56 cases]. Dakar Med 1980; 25:51-58. [PMID: 7460738] [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]
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