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Salvador-Carulla L, Woods C, de Miquel C, Lukersmith S. Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist. Heliyon 2024; 10:e29930. [PMID: 38726201 PMCID: PMC11078766 DOI: 10.1016/j.heliyon.2024.e29930] [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: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Background Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.
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Affiliation(s)
| | | | - Carlota de Miquel
- University of Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Spain
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Raggi A, Bernard RM, Toppo C, Sabariego C, Salvador Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Olaya B, Antunes Lima R, Gutiérrez-Marín D, Vorstenbosch E, Curatoli C, Cacciatore M. The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study. J Med Internet Res 2024; 26:e48504. [PMID: 38488846 PMCID: PMC10980995 DOI: 10.2196/48504] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
| | - Luis Salvador Carulla
- Health Research Institute, University of Canberra, Canberra, Australia
- Healthcare Information Systems (CTS553), University of Cadiz, Cadiz, Spain
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Canberra, Australia
| | | | | | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Desirée Gutiérrez-Marín
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ellen Vorstenbosch
- Swiss Paraplegic Research, Nottwil, Switzerland
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Chiara Curatoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martina Cacciatore
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Lukersmith S, Salvador-Carulla L, Chung Y, Du W, Sarkissian A, Millington M. A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools-What Works, for Whom, and under What Circumstances? Int J Environ Res Public Health 2023; 20:4362. [PMID: 36901374 PMCID: PMC10002263 DOI: 10.3390/ijerph20054362] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person's characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person's recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.
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Affiliation(s)
- Sue Lukersmith
- Health Research Institute, University of Canberra, Canberra 2617, Australia
- Lukersmith & Associates, Sydney 2777, Australia
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra 2617, Australia
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia
| | - Younjin Chung
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia
| | - Wei Du
- School of Public Health, Southeast University, Nanjing 211189, China
| | - Anoush Sarkissian
- Lukersmith & Associates, Sydney 2777, Australia
- Wellbeing Rehab, Sydney 2112, Australia
| | - Michael Millington
- Centre for Disability Studies, University of Sydney, Sydney 2006, Australia
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McRae P, Kobel C, Lukersmith S, Simpson G. What Does It Take to Get Somebody back to Work after Severe Acquired Brain Injury? Service Actions within the Vocational Intervention Program (VIP 2.0). IJERPH 2022; 19:ijerph19159548. [PMID: 35954914 PMCID: PMC9368610 DOI: 10.3390/ijerph19159548] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022]
Abstract
Little is known about service actions delivered in the complex intervention of vocational rehabilitation (VR) for people with severe acquired brain injury (ABI). Scale-up of the Vocational Intervention Program (VIP) across the 12 Community teams of the NSW Brain Injury Rehabilitation Program provided an opportunity to analyse the intensity and profile of actions delivered in providing VR programs. Seventy-two participants with severe TBI were supported in returning to either pre-injury employment (FastTrack, FT, n = 27) or new employment (NewTrack, NT, n = 50), delivered by two types of VR providers (Disability Employment Service DES; private providers). VR providers documented their service actions in hours and minutes, using the Case Management Taxonomy, adapted to VR. The NT pathway required significantly higher levels of intervention in comparison to FT (25 h, five minutes vs. 35 h, 30 min, p = 0.048, W = 446). Case coordination was the most frequent service action overall (41.7% of total time for FT, 42.3% for NT). DES providers recorded significantly greater amounts of time undertaking engagement, assessment and planning, and emotional/motivational support actions compared to private providers. Overall duration of the programs were a median of 46 weeks (NT) and 36 weeks (FT), respectively. This study helps illuminate the profile of VR interventions for people with severe TBI.
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Affiliation(s)
- Philippa McRae
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW 2065, Australia
| | - Conrad Kobel
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia;
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia;
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Sydney, NSW 2065, Australia
- Correspondence:
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Bernard RM, Toppo C, Raggi A, de Mul M, de Miquel C, Pugliese MT, van der Feltz-Cornelis CM, Ortiz-Tallo A, Salvador-Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Staszewska K, Sabariego C. Strategies for Implementing Occupational eMental Health Interventions: Scoping Review. J Med Internet Res 2022; 24:e34479. [PMID: 35648457 PMCID: PMC9201704 DOI: 10.2196/34479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. OBJECTIVE The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. METHODS A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. RESULTS A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. CONCLUSIONS This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.
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Affiliation(s)
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Maria Teresa Pugliese
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Ana Ortiz-Tallo
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sue Lukersmith
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Kaja Staszewska
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Center for Rehabilitation in Global Health Systems, World Health Organization Collaborating Center, University of Lucerne, Lucerne, Switzerland
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Salvador-Carulla L, Fernandez A, Sarma H, Mendoza J, Wands M, Gandre C, Chevreul K, Lukersmith S. Impact of Ed-LinQ: A Public Policy Strategy to Facilitate Engagement between Schools and the Mental Health Care System in Queensland, Australia. Int J Environ Res Public Health 2021; 18:ijerph18157924. [PMID: 34360229 PMCID: PMC8345643 DOI: 10.3390/ijerph18157924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Ed-LinQ is a mental health policy initiative to enhance the early detection and treatment of children with mental illness by improving the liaison between schools and health services in Queensland, Australia. We measured its impact from policy to practice to inform further program developments and public strategies. We followed a mixed quantitative/qualitative approach. The Adoption Impact Ladder (AIL) was used to analyse the adoption of this initiative by end-users (decision makers both in the health and education sectors) and the penetration of the initiative in the school sector. Survey respondents included representatives of schools (n = 186) and mental health providers (n = 78). In total, 63% of the school representative respondents were at least aware of the existence of the Ed-LinQ initiative, 74% were satisfied with the initiative and 28% of the respondent schools adopted the initiative to a significant extent. Adoption was higher in urban districts and in the health sector. The overall level of penetration in the school sector of Queensland was low (3%). The qualitative analysis indicated an improvement in the referral and communication processes between schools and the health sectors and the importance of funding in the implementation of the initiative. Mapping of existing programs is needed to assess the implementation of a new one as well as the design of different implementation strategies for urban and rural areas. Assessing the adoption of health policy strategies and their penetration in a target audience is critical to understand their proportional impacts across a defined ecosystem and constitutes a necessary preliminary step for the evaluation of their quality and efficiency.
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Affiliation(s)
- Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
| | - Ana Fernandez
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Agencia de Salut Publica, 08023 Barcelona, Spain
| | - Haribondhu Sarma
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
| | - John Mendoza
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Marion Wands
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Coralie Gandre
- IRDES, Institut de Recherche et Documentation en Économie de La Santé, 75019 Paris, France;
| | | | - Sue Lukersmith
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Correspondence:
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Wieringa S, Dreesens D, Forland F, Hulshof C, Lukersmith S, Macbeth F, Shaw B, van Vliet A, Zuiderent-Jerak T. Different knowledge, different styles of reasoning: a challenge for guideline development. BMJ Evid Based Med 2018; 23:87-91. [PMID: 29615396 PMCID: PMC5969373 DOI: 10.1136/bmjebm-2017-110844] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Sietse Wieringa
- Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Continuing Education, University of Oxford, Oxford, UK
| | - Dunja Dreesens
- School CAPHRI, department of General Practice, Maastricht University, Maastricht, The Netherlands
- Knowledge Institute of Medical Specialists, Utrecht, The Netherlands
| | - Frode Forland
- Division for Infectious Diseases and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Carel Hulshof
- Coronel Institute of Occupational Health, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Sue Lukersmith
- Research School of Population Health, Australian National University, Australia
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Beth Shaw
- National Institute for Health and Care Excellence, London, UK
| | - Arlène van Vliet
- Leiden University Medical Center/Dutch Working Party on Infection Prevention, Leiden, The Netherlands
| | - Teun Zuiderent-Jerak
- Department of Thematic Studies - Technology and social change, Linköping University, Linkoping, Sweden
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Sullivan WF, Heng J, Salvador-Carulla L, Lukersmith S, Casson I. Comment aborder les soins primares aux adultes ayant des déficiences intellectuelles et développementales. Can Fam Physician 2018; 64:S12-S14. [PMID: 29650739 PMCID: PMC5906786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- William F Sullivan
- Professeur agrégé au Département de médecine familiale et communautaire de l'Université de Toronto, en Ontario, médecin membre du personnel aux Services médicaux du Surrey Place Centre et à l'Unité de pratique familiale de l'Hôpital St Michael's et directeur du Programme des soins primaires pour déficiences développementales au Surrey Place Centre.
| | - John Heng
- Professeur adjoint au Département de philosophie et au Département des études interdisciplinaires au Collège King's University à London, en Ontario
| | - Luis Salvador-Carulla
- Professeur et directeur du Centre de recherche sur la santé mentale à la Faculté de recherche sur la santé de la population de l'Université nationale de l'Australie à Canberra
| | - Sue Lukersmith
- Associée de recherche au Centre de recherche et de politiques sur les déficiences de l'Université de Sydney, en Australie
| | - Ian Casson
- Professeur agrégé au Département de médecine familiale de l'Université Queen's à Kingston, en Ontario
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Sullivan WF, Heng J, Salvador-Carulla L, Lukersmith S, Casson I. Approaches to primary care of adults with intellectual and developmental disabilities: Importance of frameworks for guidelines. Can Fam Physician 2018; 64:S5-S7. [PMID: 29650737 PMCID: PMC5906778] [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: 06/08/2023]
Affiliation(s)
- William F Sullivan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario, a staff physician in Medical Services at Surrey Place Centre and the Family Practice Unit at St Michael's Hospital, and Director of the Developmental Disabilities Primary Care Program at Surrey Place Centre.
| | - John Heng
- Assistant Professor in the Department of Philosophy and the Department of Interdisciplinary Studies at King's University College in London, Ont
| | - Luis Salvador-Carulla
- Professor in and Head of the Centre for Mental Health Research at the Research School of Population Health at Australian National University in Canberra
| | - Sue Lukersmith
- Research affiliate in the Centre for Disability Research and Policy at the University of Sydney in Australia
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
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Salvador-Carulla L, Lukersmith S, Sullivan W. From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health. Epidemiol Psychiatr Sci 2017; 26:105-114. [PMID: 28290273 PMCID: PMC6998697 DOI: 10.1017/s2045796016000767] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as 'Greek temple' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.
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Affiliation(s)
- L. Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - S. Lukersmith
- Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - W. Sullivan
- Department of Family & Community Medicine, Medical Services, Surrey Place Centre, St. Michael's Hospital, Toronto, Canada
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Lukersmith S, Hopman K, Vine K, Krahe L, McColl A. A new framing approach in guideline development to manage different sources of knowledge. J Eval Clin Pract 2017; 23:66-72. [PMID: 27198591 DOI: 10.1111/jep.12566] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
RATIONALE Contemporary guideline methodology struggles to consider context and information from different sources of knowledge besides quantitative research. Return to work programmes involve multiple components and stakeholders. If the guideline is to be relevant and practical for a complex intervention such as return to work, it is essential to use broad sources of knowledge. AIMS AND OBJECTIVE This paper reports on a new method in guideline development to manage different sources of knowledge. METHODS The method used framing for the return-to-work guidance within the Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The development involved was a multi-disciplinary working party of experts including consumers. The researchers considered a broad range of research, expert (practice and experience) knowledge, the individual's and workplace contexts, and used framing with the International Classification of Functioning, Disability and Health. Following a systematic database search on four clinical questions, there were seven stages of knowledge management to extract, unpack, map and pack information to the ICF domains framework. Companion graded recommendations were developed. RESULTS The results include practical examples, user and consumer guides, flow charts and six graded or consensus recommendations on best practice for return to work intervention. CONCLUSIONS Our findings suggest using framing in guideline methodology with internationally accepted frames such as the ICF is a reliable and transparent framework to manage different sources of knowledge. Future research might examine other examples and methods for managing complexity and using different sources of knowledge in guideline development.
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Affiliation(s)
| | | | - Kristina Vine
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Lee Krahe
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Alexander McColl
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
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Fernandez A, Sturmberg J, Lukersmith S, Madden R, Torkfar G, Colagiuri R, Salvador-Carulla L. Evidence-based medicine: is it a bridge too far? Health Res Policy Syst 2015; 13:66. [PMID: 26546273 PMCID: PMC4636779 DOI: 10.1186/s12961-015-0057-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/29/2015] [Indexed: 01/28/2023] Open
Abstract
AIMS This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. RESULTS The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context. CONCLUSION EBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.
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Affiliation(s)
- Ana Fernandez
- Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Joachim Sturmberg
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
| | - Sue Lukersmith
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Rosamond Madden
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Ghazal Torkfar
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Ruth Colagiuri
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy-Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
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Lukersmith S, Fernandez A, Millington M, Salvador-Carulla L. The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language. Disabil Health J 2015; 9:272-80. [PMID: 26616541 DOI: 10.1016/j.dhjo.2015.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 03/21/2015] [Revised: 07/08/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. OBJECTIVE To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. METHODS The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. RESULTS The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. CONCLUSIONS The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation.
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Affiliation(s)
- Sue Lukersmith
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia; Lifetime Care & Support Authority, Australia.
| | - Ana Fernandez
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, University of Sydney, Australia
| | - Michael Millington
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, University of Sydney, Australia
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Madden RH, Glozier N, Fortune N, Dyson M, Gilroy J, Bundy A, Llewellyn G, Salvador-Carulla L, Lukersmith S, Mpofu E, Madden R. In search of an integrative measure of functioning. Int J Environ Res Public Health 2015; 12:5815-32. [PMID: 26016438 PMCID: PMC4483673 DOI: 10.3390/ijerph120605815] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/26/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
Abstract
International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF) based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF). An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health.
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Affiliation(s)
- Rosamond H. Madden
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-293-519-115; Fax: +61-293-519-128
| | - Nick Glozier
- Brain & Mind Research Institute, Sydney Medical School, University of Sydney, 94 Mallett St., Camperdown, NSW 2050, Australia; E-Mail:
| | - Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- National Centre for Classification in Health, University of Sydney, P.O. Box 170, NSW 1826, Australia
| | - Maree Dyson
- Dyson Consulting Group, 450 Chapel Street, South Yarra, VIC 3141, Australia; E-Mail:
| | - John Gilroy
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Anita Bundy
- Faculty of Health Sciences, University of Sydney, East Street, Lidcombe 2141, Australia; E-Mails: (A.B.); (E.M.)
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- Brain & Mind Research Institute, Sydney Medical School, University of Sydney, 94 Mallett St., Camperdown, NSW 2050, Australia; E-Mail:
| | - Sue Lukersmith
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Elias Mpofu
- Faculty of Health Sciences, University of Sydney, East Street, Lidcombe 2141, Australia; E-Mails: (A.B.); (E.M.)
| | - Richard Madden
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- National Centre for Classification in Health, University of Sydney, P.O. Box 170, NSW 1826, Australia
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Salvador-Carulla L, Fernandez A, Madden R, Lukersmith S, Colagiuri R, Torkfar G, Sturmberg J. Framing of scientific knowledge as a new category of health care research. J Eval Clin Pract 2014; 20:1045-55. [PMID: 25421111 DOI: 10.1111/jep.12286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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] [Accepted: 09/24/2014] [Indexed: 12/25/2022]
Abstract
RATIONALE The new area of health system research requires a revision of the taxonomy of scientific knowledge that may facilitate a better understanding and representation of complex health phenomena in research discovery, corroboration and implementation. METHOD A position paper by an expert group following and iterative approach. RESULTS 'Scientific evidence' should be differentiated from 'elicited knowledge' of experts and users, and this latter typology should be described beyond the traditional qualitative framework. Within this context 'framing of scientific knowledge' (FSK) is defined as a group of studies of prior expert knowledge specifically aimed at generating formal scientific frames. To be distinguished from other unstructured frames, FSK must be explicit, standardized, based on the available evidence, agreed by a group of experts and subdued to the principles of commensurability, transparency for corroboration and transferability that characterize scientific research. A preliminary typology of scientific framing studies is presented. This typology includes, among others, health declarations, position papers, expert-based clinical guides, conceptual maps, classifications, expert-driven health atlases and expert-driven studies of costs and burden of illness. CONCLUSIONS This grouping of expert-based studies constitutes a different kind of scientific knowledge and should be clearly differentiated from 'evidence' gathered from experimental and observational studies in health system research.
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Affiliation(s)
- Luis Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Research Institute, Centre for Disability Research Policy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Sturmberg JP, O'Halloran D, Colagiuri R, Fernandez A, Lukersmith S, Torkfar G, Salvador-Carulla L. Health care frames - from Virchow to Obama and beyond: the changing frames in health care and their implications for patient care. J Eval Clin Pract 2014; 20:1036-44. [PMID: 25312686 DOI: 10.1111/jep.12266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Accepted: 08/25/2014] [Indexed: 01/20/2023]
Abstract
RATIONALE, AIMS, OBJECTIVES AND METHODS Framing allows us to highlight some aspects of an issue, thereby bringing them to the forefront of our thinking, talking and acting. As a consequence, framing also distracts our attention away from other issues. Over time, health care has used various frames to explain its activities. This paper traces the emergence of various health care frames since the 1850s to better understand how we reached current ways of thinking and practicing. RESULTS AND CONCLUSIONS The succession of the most prominent frames can be summarized as: medicine as a social science; the germ theory of disease; health care as a battleground (or the war metaphor); managing health care resources (or the market metaphor); Health for All (the social justice model); evidence-based medicine; and Obama Care. The focus of these frames is causal, instrumental, political/economic or social in nature. All remain relevant; however, recycling individual past frames in response to current problems will not achieve the outcomes we seek. Placing the individual and his/her needs at the centre (the attractor for the health system) of our thinking, as emphasized by the World Health Organization's International Classification of Function framework and the European Society of Person Centered Health Care, may provide the frame to refocus health and health care as interdependent experiences across individual, community and societal domains. Shifting beyond the entrenched instrumental and economic thinking will be challenging but necessary for the sake of patients, health professionals, society and the economy.
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van Dulmen SA, Lukersmith S, Muxlow J, Santa Mina E, Nijhuis-van der Sanden MWG, van der Wees PJ. Supporting a person-centred approach in clinical guidelines. A position paper of the Allied Health Community - Guidelines International Network (G-I-N). Health Expect 2013; 18:1543-58. [PMID: 24118821 DOI: 10.1111/hex.12144] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A person-centred approach in the context of health services delivery implies a biopsychosocial model focusing on all factors that influence the person's health and functioning. Those wishing to monitor change should consider this perspective when they develop and use guidelines to stimulate active consideration of the person's needs, preferences and participation in goal setting, intervention selection and the use of appropriate outcome measures. OBJECTIVE To develop a position paper that promotes a person-centred approach in guideline development and implementation. DESIGN, SETTING AND PARTICIPANTS We used three narrative discussion formats to collect data for achieving consensus: a nominal group technique for the Allied Health Steering Group, an Internet discussion board and a workshop at the annual G-I-N conference. We analysed the data for relevant themes to draft recommendations. RESULTS We built the position paper on the values of the biopsychosocial model. Four key themes for enhancing a person-centred approach in clinical guidelines emerged: (i) use a joint definition of health-related quality of life as an essential component of intervention goals, (ii) incorporate the International Classification of Functioning, Disability and Health (ICF) as a framework for considering all domains related to health, (iii) adopt a shared decision-making method, and (iv) incorporate patient-reported health outcome measures. The position statement includes 14 recommendations for guideline developers, implementers and users. CONCLUSION This position paper describes essential elements for incorporating a person-centred approach in clinical guidelines. The consensus process provided information about barriers and facilitators that might help us develop strategies for implementing person-centred care.
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Affiliation(s)
- Simone A van Dulmen
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | | | | | - Elaine Santa Mina
- Daphne Cockwell School of Nursing, Ryerson University Toronto, Toronto, ON, Canada
| | | | - Philip J van der Wees
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
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Madden RH, Dune T, Lukersmith S, Hartley S, Kuipers P, Gargett A, Llewellyn G. The relevance of the International Classification of Functioning, Disability and Health (ICF) in monitoring and evaluating Community-based Rehabilitation (CBR). Disabil Rehabil 2013; 36:826-37. [DOI: 10.3109/09638288.2013.821182] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lukersmith S, Radbron L, Hopman K. Development of clinical guidelines for the prescription of a seated wheelchair or mobility scooter for people with traumatic brain injury or spinal cord injury. Aust Occup Ther J 2013; 60:378-86. [PMID: 24299477 DOI: 10.1111/1440-1630.12077] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Providing a wheelchair or scooter is a complex therapy intervention aimed at enhancing the person's functioning. The research and experience has shown that a wheelchair which is poorly matched to the individual, adversely affects potential activities and participation, lifestyle goals, health status and can be costly. The development of an evidence-based clinical guideline will provide a synthesis of the evidence and recommendations for best practice. METHODS The guidelines were developed using a rigorous methodology of systematic search for primary studies, critical appraisal and synthesis of the evidence using an adaptation of the National Health and Medical Research Council recommendation grades in conjunction with a multidisciplinary working party. RESULTS Seventy-six recommendations were developed from 44 clinical questions related to goals, assessment and review, capacity and performance, upper limb capacity and injury risk, wheelchair features, propulsion, training, transport and maintenance. Resources were developed to support the use of the guidelines. Only examples of recommendations are provided here. The complete guidelines and technical report should be downloaded from http://www.lifetimecare.nsw.gov.au/Brain_Injury.aspx. CONCLUSION The guidelines provide appraisal and synthesis of the literature and recommendations for best practice on the prescription of a wheelchair or scooter for adults with spinal cord injury and/or traumatic brain injury. The guidelines are intended to reduce the potential for poor wheelchair prescription, inform and guide practice to enhance outcomes. Through judicious application of the available research, these guidelines provide best practice recommendations for prescribing the most appropriate wheelchair for a person with a traumatic brain injury/spinal cord injury.
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Affiliation(s)
- Sue Lukersmith
- Service Development & Review, Lifetime Care & Support Authority, Sydney, New South Wales, Australia; Lukersmith & Associates, Woodford, New South Wales, Australia
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Lukersmith S, Hartley S, Kuipers P, Madden R, Llewellyn G, Dune T. Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disabil Rehabil 2013; 35:1941-53. [PMID: 23574396 DOI: 10.3109/09638288.2013.770078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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]
Abstract
PURPOSE To identify and analyse tools and methods that have been reported in the literature for the monitoring and evaluation of community-based rehabilitation (CBR) programmes. METHOD A literature review and descriptive analysis were carried out to scope CBR monitoring and evaluation methods and tools. A search was conducted using PubMed and Google Scholar databases, hand searches and reference lists. Reports were retrieved, screened and information was extracted and analysed against research questions. RESULTS There were 34 reports which met the inclusion criteria. Analysis of the 34 reports showed that most reports used demographic and programme data. A range of methods were used: interviews, focus groups and questionnaires being the most common. Apart from this, no common standardised procedures or tools were identified and there was not a standard approach to the inclusion of people with disabilities or other CBR stakeholders. CONCLUSIONS The findings suggest that there would be value in creating resources such as guidelines, common processes and checklists for monitoring and evaluation of CBR, to facilitate efficient and comparable practices and more comparable data. This needs to be done in partnership with people with disabilities, CBR providers, partners and researchers to ensure that all stakeholders' needs are understood and met. Implications for Rehabilitation While there is broad scope and complexity of CBR programmes, there needs to be consistency and a valid approach in the monitoring and evaluation methods and tools used by CBR programmes. The principles of CBR and CRPD require that monitoring and evaluation involve people with disabilities, CBR managers and staff not only as informants but also in the design and execution of monitoring and evaluation activities. The consistent use of appropriate and valid monitoring and evaluation methods and tools will contribute to developing a stronger evidence base on the efficacy and effectiveness of CBR.
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Affiliation(s)
- Sue Lukersmith
- Australian ICF Disability & Rehabilitation Research Program (AIDARRP), Centre for Disability Research and Policy, University of Sydney , Sydney , Australia
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Lukersmith S, Burgess-Limerick R. The perceived importance and the presence of creative potential in the health professional's work environment. Ergonomics 2013; 56:922-934. [PMID: 23550803 DOI: 10.1080/00140139.2013.779033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The value of creative employees to an organisation's growth and innovative development, productivity, quality and sustainability is well established. This study examined the perceived relationship between creativity and work environment factors of 361 practicing health professionals, and whether these factors were present (realised) in their work environment. Job design (challenges, team work, task rotation, autonomy) and leadership (coaching supervisor, time for thinking, creative goals, recognition and incentives for creative ideas and results) were perceived as the most important factors for stimulating creativity. There was room for improvement of these in the work environment. Many aspects of the physical work environment were less important. Public health sector employers and organisations should adopt sustainable strategies which target the important work environment factors to support employee creativity and so enhance service quality, productivity, performance and growth. Implications of the results for ergonomists and workplace managers are discussed with a participatory ergonomics approach recommended. PRACTITIONER SUMMARY Creative employees are important to an organisation's innovation, productivity and sustainability. The survey identified health professionals perceive a need to improve job design and leadership factors at work to enhance and support employee creativity. There are implications for organisations and ergonomists to investigate the creative potential of work environments.
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Affiliation(s)
- Sue Lukersmith
- Lukersmith & Associates, Sydney, New South Wales, Australia.
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McCluskey A, Lukersmith S. A proposed curriculum and strategies for improving occupational therapists' report writing, court performance and expert opinion on work capacity. Aust Occup Ther J 2008; 55:144-5. [PMID: 20887449 DOI: 10.1111/j.1440-1630.2008.752_2.x] [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: 11/27/2022]
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Lovarini M, Lukersmith S. HIGHER RETURN-TO-WORK RATES CAN BE ACHIEVED FOR WORKERS WITH MUSCULOSKELETAL PAIN WHO HAVE A MEDIUM OR POOR PROGNOSIS FOR RETURN TO WORK IF THEY RECEIVE LIGHT OR EXTENSIVE MULTIDISCIPLINARY TREATMENTS, RESPECTIVELY. Aust Occup Ther J 2004. [DOI: 10.1111/j.1440-1630.2004.00427.x] [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: 11/29/2022]
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