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Perry MA, Jones B, Devan H, Neill A, Piper A, Ingham T. Non-invasive ventilation for people with neuromuscular disorders in Australia and New Zealand: a qualitative study of clinician perspectives. Med J Aust 2023; 219:270-274. [PMID: 37449654 DOI: 10.5694/mja2.52036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non-invasive ventilation guidelines, and their perspectives on delivering quality non-invasive ventilation services to people with neuromuscular disorders. DESIGN, SETTING, PARTICIPANTS Qualitative study; semi-structured focus groups and individual interviews with Australian and New Zealand clinicians who provide non-invasive ventilation services to people with neuromuscular disorders, recruited from participants at a 2017 sleep medicine conference. Interviews were conducted during 1 October 2017 - 31 May 2018. MAIN OUTCOME MEASURES Major themes identified by an iterative, semantic, and inductive analysis. RESULTS A total of 28 participants attended the four focus group sessions and five individual interviews; fourteen each from New Zealand and Australia, seventeen women and eleven men, eighteen physicians and ten other clinicians. Two major themes were identified: decision making for current practice, and resource constraints. Participants noted variable use of clinical guidelines and limited training to meet the needs of people with neuromuscular disorders who require non-invasive ventilation. They described a lack of dedicated funding, unstructured care pathways, equipment supply levels that do not meet need, low staff-to-patient ratios and staff shortages, and the inability to deliver quality multidisciplinary care. The need for clinical guidelines and service specifications was highlighted as requisite for reducing variation in clinical care. CONCLUSIONS Systemic factors influence the needs-based provision of non-invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non-invasive ventilation care.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | | | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - Alister Neill
- University of Otago, Wellington, New Zealand
- Capital and Coast District Health Board, Newtown, New Zealand
| | - Amanda Piper
- The University of Sydney Central Clinical School, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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Perry MA, Jones B, Jenkins M, Devan H, Neill A, Ingham T. Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand. Int J Environ Res Public Health 2023; 20:4758. [PMID: 36981666 PMCID: PMC10048586 DOI: 10.3390/ijerph20064758] [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] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Non-invasive ventilation (NIV) is a critical therapy for many patients with neuromuscular disorders (NMD), supporting those with respiratory failure to achieve adequate respiration and improve their quality of life. The aim of this study was to explore the experiences of access to, consent, uptake, maintenance and safe use of non-invasive ventilation by people with NMD. Semi-structured individual interviews were conducted with 11 people with NMD, each using NIV for more than 12 months. A critical realism ontological paradigm with contextualism epistemology guided the Reflexive Thematic Analysis. An Equity of Health Care Framework underpinned the analysis. Three themes were interpreted: Uptake and informed consent for NIV therapy; Practicalities of NIV; and Patient-clinician relationships. We identified issues at the system, organization and health professional levels. Conclusions: We recommend the development of national service specifications with clear standards and dedicated funding for patients with NMD and call on the New Zealand Ministry of Health to proactively investigate and monitor the variations in service delivery identified. The specific areas of concern for patients with NMD suggest the need for NMD-related NIV research and service provision responsive to the distinct needs of this population.
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Affiliation(s)
- Meredith A. Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
| | - Matthew Jenkins
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Alister Neill
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Department of Respiratory Medicine, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington 6140, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
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Burns F, Calder A, Devan H. Experiences of individuals with multiple sclerosis and stroke using transcutaneous foot drop electrical stimulators: a systematic review and meta-synthesis of qualitative studies. Disabil Rehabil 2022:1-10. [PMID: 35609240 DOI: 10.1080/09638288.2022.2076936] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the end users' experiences of foot drop electrical stimulator use for people with neurological conditions. MATERIALS AND METHODS Electronic databases MEDLINE, EMBASE, CINAHL, Scopus, and Google Scholar were searched in March 2022. Included articles were quality assessed using the Critical Appraisal Skills Programme (CASP) checklist. A thematic synthesis approach was used to synthesise the review findings and establish analytical themes. A Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence of analytical themes. RESULTS Seven qualitative studies were included with 67 participants with stroke and multiple sclerosis. The outcomes to foot drop stimulator use were enhanced walking ability, independence, confidence, and social participation. Main barriers to use were device aesthetics, usability challenges, trustworthiness of device in complex environments, and cost of the device. A conceptual model was created illustrating the barriers and outcomes in managing foot drop. CONCLUSIONS We recommend that the outcomes to continued use of foot drop electrical stimulators are carefully considered against the barriers. Our conceptual model may be useful to guide clinical conversations around the possible use of FES for managing foot drop in people with multiple sclerosis and stroke.Implications for rehabilitationThe key outcomes to foot drop electrical stimulator use were enhanced walking ability, improved independence and confidence, and enhanced social participation.The main barriers to foot drop electrical stimulator use were device aesthetics, usability challenges, trustworthiness of device in complex environments, and cost of the device.We created a conceptual model that may be useful to guide clinical conversations around the possible use of FES for managing foot drop in people with multiple sclerosis and stroke.
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Affiliation(s)
- Felicity Burns
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Allyson Calder
- School of Physiotherapy, University of Otago, Christchurch, New Zealand
| | - Hemakumar Devan
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand
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Perry MA, Devan H, Davies C, Hempel D, Ingham T, Jones B, Reid S, Saipe B, Hale L. iSelf-Help: a co-designed, culturally appropriate, online pain management programme in Aotearoa. Res Involv Engagem 2022; 8:6. [PMID: 35193704 PMCID: PMC8862515 DOI: 10.1186/s40900-022-00339-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa. AIMS To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain. METHODS A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cultural appropriateness of iSelf-help, three focus groups (n = 15) were held with Māori (the Indigenous population of Aotearoa) living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). All contents were finalised by iterative discussion among the PAR team and consultation with Māori stakeholders. The preliminary version of iSelf-help was pilot tested with the PAR group participants and Māori community members living with persistent pain and their feedback was included. The iterative co-design process occurred over a period of nine months. RESULTS The finalised version of iSelf-help included a total of 130 resources organised in to 12 content relevant online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations explaining main concepts, patient stories, written content to accompany visual content, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. A dedicated module of videos demonstrating cardiovascular and strengthening exercises of varying intensity was also included. CONCLUSIONS This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. The next step is to evaluate the clinical and cost-effectiveness of iSelf-help compared to in-person delivered pain management programme.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, Aotearoa, New Zealand.
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, Aotearoa, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma and Research Trust, Wellington, New Zealand
| | - Dagmar Hempel
- Wellington Pain Management Service, Capital & Coast District Health Board, Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Susan Reid
- Health Literacy New Zealand, Auckland, New Zealand
| | - Barbara Saipe
- Wellington Pain Management Service, Capital & Coast District Health Board, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Fernandes LG, Devan H, Fioratti I, Kamper SJ, Williams CM, Saragiotto BT. At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain. Pain 2022; 163:e165-e181. [PMID: 34433776 DOI: 10.1097/j.pain.0000000000002364] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app-based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) "at my own pace, space, and place" and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.
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Affiliation(s)
- Lívia G Fernandes
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade São Paulo (UNICID), São Paulo, Brazil
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Iuri Fioratti
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade São Paulo (UNICID), São Paulo, Brazil
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Nepean Hospital, Penrith NSW, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Camperdown, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Bruno T Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade São Paulo (UNICID), São Paulo, Brazil
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Camperdown, Australia
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Areli E, Godfrey HK, Perry MA, Hempel D, Saipe B, Grainger R, Hale L, Devan H. 'I think there is nothing . . . that is really comprehensive': healthcare professionals' views on recommending online resources for pain self-management. Br J Pain 2021; 15:429-440. [PMID: 34840791 DOI: 10.1177/2049463720978264] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives To explore healthcare professionals' views on, and attitudes, towards recommending online resources for persistent pain self-management. Methods This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach. Results The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption. Conclusion Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a 'blended model' where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed 'trustworthy online resources' that provide evidence-based, updated information that is personalised to clients' health literacy and cultural beliefs. Practice implications Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.
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Affiliation(s)
- E Areli
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - H K Godfrey
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand.,Centre for Science in Society, Victoria University of Wellington, Wellington, New Zealand
| | - M A Perry
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand
| | - D Hempel
- Pain Management Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - B Saipe
- Pain Management Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - R Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - L Hale
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - H Devan
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand
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Lim WS, Sharma S, Devan H. Physiotherapists’ attitudes towards and challenges of working in a referral-based practice setting – a systematic scoping review. European Journal of Physiotherapy 2021. [DOI: 10.1080/21679169.2020.1739748] [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: 10/24/2022]
Affiliation(s)
- Wil Son Lim
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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Devan H, Elphick-laveta T, Lynch M, MacDonell K, Marshall D, Tuhi L, Grainger R. “Power of Storytelling”: A Content Analysis of Chronic Pain Narratives on YouTube. Can J Pain 2021. [DOI: 10.1080/24740527.2021.1929117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Maxwell Lynch
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Katie MacDonell
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - David Marshall
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leah Tuhi
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Devan H, Jones B, Davies C, Perry M, Hale L, Grainger R, Ingham T. Are we just dishing out pills constantly to mask their pain? Kaiāwhina Māori health workers' perspectives on pain management for Māori. N Z Med J 2021; 134:19-29. [PMID: 34695073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To explore kaiāwhina (Māori community health workers) perspectives on supporting whānau Māori with chronic pain, and to understand their views on the use of online resources for pain management. METHOD A Māori-centred, qualitative design using focus groups as the primary data collection method. Analysis using the general inductive approach. RESULTS Thirteen kaiāwhina working in the Greater Wellington region took part in the focus groups. Four key themes were identified: (1) treatment of chronic pain in primary health relies exclusively on medication, (2) health literacy approaches to pain management are urgently required, (3) Māori have significant unmet need for culturally responsive pain management, and (4) the availability of, and referral practices to, specialist pain services are inadequate for Māori communities. CONCLUSION Current chronic pain management was predominantly biomedical, and educational strategies lack health literacy approaches. Primary health services exclude traditional Māori methods of treating chronic pain and do not focus on whānau wellbeing. The lack of referral for Māori to specialist services highlights the existing health inequities for Māori. Developing new initiatives (both in-person and online) to address chronic pain management for Māori must be Māori-led and co-designed with whānau to result in holistic solutions for Māori.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma and Research Trust, Wellington, New Zealand
| | - Meredith Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
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Sampath KK, Darlow B, Tumilty S, Shillito W, Hanses M, Devan H, Thomson OP. Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain - a mixed methods systematic review. BMC Health Serv Res 2021; 21:695. [PMID: 34266436 PMCID: PMC8281672 DOI: 10.1186/s12913-021-06720-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.
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Affiliation(s)
- Kesava Kovanur Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology, 51, Akoranga Road, Hamilton, New Zealand.
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand.
- School of Public Health, University of Technology Sydney, Sydney, Australia.
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Warwick Shillito
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Melissa Hanses
- Department of Health Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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Devan H, Perry MA, Yaghoubi M, Hale L. "A coalition of the willing": experiences of co-designing an online pain management programme (iSelf-help) for people with persistent pain. Res Involv Engagem 2021; 7:28. [PMID: 33975653 PMCID: PMC8112221 DOI: 10.1186/s40900-021-00275-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Participatory approaches to developing health interventions with end-users are recommended to improve uptake and use. We aimed to explore the experiences of co-designing an online-delivered pain management programme (iSelf-help) for people with persistent pain. METHODS A modified participatory action research (PAR) framework was used to co-design contents and delivery of iSelf-help. The PAR team included: (1) a patient advisory group consisting of people living with persistent pain (n = 8), (2) pain management service clinicians (n = 2), (3) health researchers (n = 3), (4) digital health experts (n = 2), (5) a health literacy expert, and (6) two Māori health researchers and our community partner who led the cultural appropriateness of iSelf-help for Māori (the Indigenous population of New Zealand). The iSelf-help co-design processes and activities of the 'PAR' team is reported in another paper. In this paper, all PAR team members were invited to share their experiences of the co-design process. Individual interviews were held with 12 PAR team members. Interview transcripts were analysed using the General Inductive Approach. RESULTS Five common themes were identified from the interviews: (1) Shared understanding and values of the co-design process, (2) Mismatched expectations with content creation, (3) Flexibility to share power and decision making, (4) Common thread of knowledge, and (5) Shared determination. Sustaining these themes was an overarching theme of "A coalition of the willing". CONCLUSIONS PAR team members valued the shared determination and responsibility to co-design iSelf-help. They also acknowledged the complexities and challenges during the process related to mismatched expectations, power sharing and establishing a common thread of knowledge. Successful co-design requires a shared commitment and responsibility as a coalition to meet the aspirations of end-users, within the boundaries of time and budget.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Mostafa Yaghoubi
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin, New Zealand
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Hale L, Devan H, Davies C, Dean SG, Dowell A, Grainger R, Gray AR, Hempel D, Ingham T, Jones B, Leung W, Mills J, Saipe B, Shipton E, Perry M. Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain-protocol for a non-inferiority randomised controlled trial (iSelf-help trial). BMJ Open 2021; 11:e046376. [PMID: 33542046 PMCID: PMC7868244 DOI: 10.1136/bmjopen-2020-046376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Persistent non-cancer pain affects one in five adults and is more common in Māori-the Indigenous population of New Zealand (NZ), adults over 65 years, and people living in areas of high deprivation. Despite the evidence supporting multidisciplinary pain management programmes (PMPs), access to PMPs is poor due to long waiting lists. Although online-delivered PMPs enhance access, none have been codesigned with patients or compared with group-based, in-person PMPs. This non-inferiority trial aims to evaluate the clinical and cost-effectiveness of a cocreated, culturally appropriate, online-delivered PMP (iSelf-help) compared with in-person PMP in reducing pain-related disability. METHODS AND ANALYSIS Mixed-methods, using a modified participatory action research (PAR) framework, involving three phases. Phase I involved cocreation and cultural appropriateness of iSelf-help by PAR team members. Phase II: The proposed iSelf-help trial is a pragmatic, multicentred, assessor-blinded, two-arm, parallel group, non-inferiority randomised controlled trial. Adults (n=180, age ≥18 years) with persistent non-cancer pain eligible for a PMP will be recruited and block randomised (with equal probabilities) to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help participants will participate in two 60-minute video-conferencing sessions weekly for 12 weeks with access to cocreated resources via smartphone application and a password-protected website. The control participants will receive group-based, in-person delivered PMP. Primary outcome is pain-related disability assessed via modified Roland Morris Disability Questionnaire at 6 months post intervention. Secondary outcomes include anxiety, depression, stress, pain severity, quality of life, acceptance, self-efficacy, catastrophising and fear avoidance. Data will be collected at baseline, after the 12-week intervention, and at 3 and 6 months post intervention. We will conduct economic analyses and mixed-method process evaluations (Phase IIA). ETHICS AND DISSEMINATION The Health and Disability Ethics Committee approved the study protocol (HDEC18/CEN/162). Phase III involves dissemination of findings guided by the PAR team as outcomes become apparent. TRIAL REGISTRATION NUMBER ACTRN 12619000771156.
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Affiliation(s)
- Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma and Research Trust, Wellington, New Zealand
| | - Sarah Gerard Dean
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Andrew R Gray
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jessica Mills
- Burwood Pain Management Service, Canterbury District Health Board (CDHB), Christchurch, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Edward Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Meredith Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
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13
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Aikman K, Burtt L, Ronde OD, Lim DKW, Stratton P, Wong MH, Grainger R, Devan H. Mass media campaigns for chronic pain: a scoping review to inform design of future campaigns. Physical Therapy Reviews 2020. [DOI: 10.1080/10833196.2020.1832711] [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: 10/23/2022]
Affiliation(s)
- Kelda Aikman
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Lyndie Burtt
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Olivia de Ronde
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Dave K. W. Lim
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Paige Stratton
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Man Hon Wong
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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14
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Karos K, McParland JL, Bunzli S, Devan H, Hirsh A, Kapos FP, Keogh E, Moore D, Tracy LM, Ashton-James CE. The social threats of COVID-19 for people with chronic pain. Pain 2020; 161:2229-2235. [PMID: 32694381 PMCID: PMC7382418 DOI: 10.1097/j.pain.0000000000002004] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Kai Karos
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Group on Experimental Health Psychology, Department for Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Joanna L McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Adam Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, IN, United States
| | - Flavia P Kapos
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Edmund Keogh
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - David Moore
- Department of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Claire E Ashton-James
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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15
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Grainger R, Devan H, Sangelaji B, Hay-Smith J. Issues in reporting of systematic review methods in health app-focused reviews: A scoping review. Health Informatics J 2020; 26:2930-2945. [PMID: 32914696 DOI: 10.1177/1460458220952917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
No guidelines exist for the conduct and reporting of manuscripts with systematic searches of app stores for, and then appraisal of, mobile health apps ('health app-focused reviews'). We undertook a scoping review including a systematic literature search for health app-focused reviews describing systematic app store searches and app appraisal, for apps designed for patients or clinicians. We created a data extraction template which adapted data elements from the PRISMA guidelines for systematic literature reviews to data elements operationalised for health app-focused reviews. We extracted the data from included health app-focused reviews to describe: (1) which elements of the adapted 'usual' methods of systematic review are used; (2) methods of app appraisal; and (3) reporting of clinical efficacy and recommendations for app use. From 2798 records, the 26 included health app-focused reviews showed incomplete or unclear reporting of review protocol registration; use of reporting guidelines; processes of screening apps; data extraction; and appraisal tools. Reporting of clinical efficacy of apps or recommendations for app use were infrequent. The reporting of methods in health app-focused reviews is variable and could be improved by developing a consensus reporting standard for health app-focused reviews.
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Affiliation(s)
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherpay, University of Otago, Wellington, New Zealand
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16
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Regan R, Sampath KK, Devan H, Arumugam A. Effectiveness of physiotherapy interventions on disease-specific and generic outcomes for individuals with cardiovascular diseases in India – a systematic review and Meta-analysis. Physical Therapy Reviews 2020. [DOI: 10.1080/10833196.2020.1792204] [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: 10/23/2022]
Affiliation(s)
- Raja Regan
- PSG College of Physiotherapy, Coimbatore, Tamil Nadu, India
| | - Kesava Kovanur Sampath
- Department of Allied Health and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Adjunct Faculty, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Adjunct Faculty, Department of Physiotherapy, Binawan University, Jakarta, Indonesia
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17
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Fernandes LG, Devan H, Kamper SJ, Williams CM, Saragiotto BT. Enablers and barriers of people with chronic musculoskeletal pain for engaging in telehealth interventions: protocol for a qualitative systematic review and meta-synthesis. Syst Rev 2020; 9:122. [PMID: 32475341 PMCID: PMC7262761 DOI: 10.1186/s13643-020-01390-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain represents an enormous burden in society. Best-practice care for chronic musculoskeletal pain suggests adoption of self-management strategies. Telehealth interventions (e.g., videoconferencing) are a promising approach to promote self-management and have the potential to overcome geographical barriers between patient and care providers. Understanding patient perspectives will inform and identify practical challenges towards applying the self-management strategies delivered via telehealth to everyday lives. The aim of this study is to synthesize the perceptions of individuals with musculoskeletal pain with regards to enablers and barriers to engaging in telehealth interventions for chronic musculoskeletal pain self-management. METHODS A systematic review of qualitative studies will be performed based on searches of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases. Screening of identified titles will be conducted by two independent investigators. Data extraction will retrieve detailed qualitative information from selected articles. The critical appraisal skills program (CASP) checklist will be used for critical appraisal of included studies, and the level of confidence in the findings will be assessed using the confidence in the evidence from reviews of qualitative research (GRADE-CERQual). A thematic synthesis approach will be used to derive analytical themes. DISCUSSION This review will systematically identify, synthesize, and present enablers and barriers reported by people with musculoskeletal pain to engage in telehealth interventions. The review will provide information required to support the design and improvement of telehealth services. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019136148.
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Affiliation(s)
- Lívia G. Fernandes
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade São Paulo (UNICID), São Paulo, Brazil
- Centre for Pain, Health, and Lifestyle (CPHL), New Lambton Heights, Australia
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Steven J. Kamper
- Centre for Pain, Health, and Lifestyle (CPHL), New Lambton Heights, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australia Institute for Musculoskeletal Health, Sydney, Australia
| | - Christopher M. Williams
- Centre for Pain, Health, and Lifestyle (CPHL), New Lambton Heights, Australia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Bruno T. Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade São Paulo (UNICID), São Paulo, Brazil
- Centre for Pain, Health, and Lifestyle (CPHL), New Lambton Heights, Australia
- Australia Institute for Musculoskeletal Health, Sydney, Australia
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18
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Kovanur Sampath K, Darlow B, Tumilty S, Shillito W, Hanses M, Devan H, Thomson OP. Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – A mixed methods systematic review protocol. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Devan H, Young J, Avery C, Elder L, Khasyanova Y, Manning D, Scrimgeour M, Grainger R. Media representation of chronic pain in Aotearoa New Zealand-a content analysis of news media. N Z Med J 2020; 133:92-110. [PMID: 31945046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To analyse how the New Zealand news media has reported on chronic pain and identify whether this publicly available information is reflective of best practice. METHODS A content analysis of news media published between January 2015 and June 2019, with a primary focus on chronic pain was undertaken. The Factiva, EBSCO and ProQuest databases, alongside popular New Zealand news websites were searched. RESULTS Two hundred and forty news articles were included; the overarching themes identified in content analysis were (1) the lived experience and the impact of chronic pain (n=119/240), (2) pain management strategies with information on pharmacological (ie, opioids and medicinal cannabis) (n=107/240) and non-pharmacological strategies (eg) psychological therapies (36/240), physical activity (34/240), pain education (34/240), (3) the systemic issues influencing chronic pain healthcare pathways (n=79/240). CONCLUSION Living with chronic pain is predominantly represented as a struggle, with a lesser focus on the ability to successfully self-manage and live a meaningful life. The limited emphasis on each of the non-pharmacological strategies suggest that the reports failed to communicate that these strategies should be a key component of self-managing chronic pain. New Zealand healthcare providers and researchers can collaboratively work with the media to provide evidence-based information on both non-pharmacological and pharmacological pain management strategies.
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Affiliation(s)
- Hemakumar Devan
- Postdoctoral Fellow, Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington
| | - Jessica Young
- Research Fellow, School of Health, Victoria University of Wellington, Wellington
| | - Ceonne Avery
- Bachelor of Physiotherapy Student, School of Physiotherapy, University of Otago, Wellington
| | - Liv Elder
- Bachelor of Physiotherapy Student, School of Physiotherapy, University of Otago, Wellington
| | - Yulia Khasyanova
- Bachelor of Physiotherapy Student, School of Physiotherapy, University of Otago, Wellington
| | - Dominic Manning
- Bachelor of Physiotherapy Student, School of Physiotherapy, University of Otago, Wellington
| | - Morghan Scrimgeour
- Bachelor of Physiotherapy Student, School of Physiotherapy, University of Otago, Wellington
| | - Rebecca Grainger
- Associate Professor, Department of Medicine, University of Otago, Wellington
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20
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Annear A, Sole G, Devan H. Corrigendum to "What are the current practices of sports physiotherapists in integrating psychological strategies during athletes' return-to-play rehabilitation? Mixed methods systematic review" [Physical Therapy in Sport 38 (2019) 96-105]. Phys Ther Sport 2019; 41:94-96. [PMID: 31790942 DOI: 10.1016/j.ptsp.2019.11.009] [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]
Affiliation(s)
- Andrew Annear
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; High Performance Sport, New Zealand.
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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21
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Farrell G, Watson L, Devan H. Current evidence for nonpharmacological interventions and criteria for surgical management of persistent acromioclavicular joint osteoarthritis: A systematic review. Shoulder Elbow 2019; 11:395-410. [PMID: 32269599 PMCID: PMC7094063 DOI: 10.1177/1758573219840673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/28/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary aim of this systematic review was to investigate the individual/combined effectiveness of nonpharmacological interventions in individuals with persistent acromioclavicular joint osteoarthritis. The secondary aims were to investigate the comparative effectiveness of nonpharmacological versus surgical interventions, and to identify the criteria used for defining failure of conservative interventions in individuals who require surgery for persistent acromioclavicular joint osteoarthritis. METHOD Major electronic databases were searched from inception until October 2018. Studies involving adults aged 16 years and older, diagnosed clinically and radiologically with isolated acromioclavicular joint osteoarthritis for at least three months or more were included. Studies must explicitly state the type and duration of conservative interventions. Methodological risk of bias was assessed using the Modified Downs and Black checklist. RESULTS Ten surgical intervention studies were included for final synthesis. No studies investigated the effectiveness of nonpharmacological interventions or compared them with surgical interventions. Common nonpharmacological interventions trialed from the 10 included studies were activity modification (n = 8) and physiotherapy (n = 4). Four to six months was the most often reported timeframe defining failure of conservative management (range 3-12 months). CONCLUSIONS Currently, there is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis.
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Affiliation(s)
- Gerard Farrell
- School of Physiotherapy, Dunedin, New
Zealand,Gerard Farrell, Gippsland Physiotherapy
Group, 150 Commercial Road, Morwell, Victoria, Australia.
| | - Lyn Watson
- Melbourne Shoulder Group, Victoria,
Australia
| | - Hemakumar Devan
- School of Physiotherapy, Centre for
Health, Activity, and Rehabilitation Research, University of Otago, Wellington, New
Zealand
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22
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Devan H, Perry MA, van Hattem A, Thurlow G, Shepherd S, Muchemwa C, Grainger R. Do pain management websites foster self-management support for people with persistent pain? A scoping review. Patient Educ Couns 2019; 102:1590-1601. [PMID: 30981410 DOI: 10.1016/j.pec.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/10/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality. METHODS Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification. RESULTS Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites. CONCLUSIONS The review identified 27 contemporary pain management websites that could be used for self-management skills training. PRACTICE IMPLICATIONS Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Greg Thurlow
- School of Physiotherapy, University of Otago, New Zealand
| | - Sam Shepherd
- School of Physiotherapy, University of Otago, New Zealand
| | - Carol Muchemwa
- School of Physiotherapy, University of Otago, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Devan H, Godfrey HK, Perry MA, Hempel D, Saipe B, Hale L, Grainger R. Current practices of health care providers in recommending online resources for chronic pain self-management. J Pain Res 2019; 12:2457-2472. [PMID: 31496788 PMCID: PMC6698079 DOI: 10.2147/jpr.s206539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/25/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose Online health resources (websites, apps and social media) may be an adjunct to provide self-management support for people with persistent or chronic pain. Endorsement of online health resources by health care providers is crucial for uptake by end-users. The aim of this study was to investigate the current practices of New Zealand (NZ) health care providers in recommending online resources for persistent pain management, and to identify what factors predict health care providers’ recommendations and to explore the common concerns. Methods An online survey of NZ health care providers (ie, chiropractors, general practitioners, nurses, occupational therapists, osteopaths, physiotherapists, psychologists, specialist consultants, and social workers) involved in the management of persistent pain was conducted. The recruitment strategy was tailored to each occupation via occupation-specific professional organizations, and by approaching multidisciplinary professional organizations. Results Data from 213 health care providers were used in the final analysis. Most of the health care providers were physiotherapists (n=71), followed by chiropractors (n=39) and general practitioners (n=31). Fifty three percent (111/210) of health care providers reported currently recommending online resources. A multivariate logistic regression model showed that specialist interest in treating pain (OR=3.84; 95% CI: 1.66, 8.87; P=0.002), and level of confidence in recommending online resources (OR=1.05; CI: 1.04, 1.07; P<0.001), positively influenced recommending online resources. The majority of the health care providers (65%, 138/213) were concerned about the safety issues related to the risk of patients misinterpreting online information and to the lack of evidence-based information. Conclusion Half of the health care providers surveyed reported recommending online resources, which may suggest limited confidence in recommending, or knowledge of, existing online resources for persistent pain management. Ongoing education for health care providers on evidence-based online resources is required to recommend online resources as a self-management support tool for people with persistent pain.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Hazel K Godfrey
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.,School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Annear A, Sole G, Devan H. What are the current practices of sports physiotherapists in integrating psychological strategies during athletes' return-to-play rehabilitation? Mixed methods systematic review. Phys Ther Sport 2019; 38:96-105. [PMID: 31077961 DOI: 10.1016/j.ptsp.2019.04.018] [Citation(s) in RCA: 9] [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: 01/08/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The primary aim was to identify the current practices of sports physiotherapists in implementing psychological strategies during athletes' return-to-play rehabilitation and, secondly, to explore their attitudes and challenges to do so. METHODS An electronic search of the PubMed, CINAHL, Scopus, Medline, Google Scholar, Cochrane Library, AMED, and PsycINFO databases was performed. Studies were considered eligible if they explored physiotherapists' implementation of psychological strategies during athletic rehabilitation. Methodological quality of included studies was assessed using the Guidelines for Critical Review Form. Data were synthesised using thematic analysis. RESULTS AND CONCLUSIONS Eleven studies involving 1440 sports physiotherapists were included: six were quantitative, three were qualitative, and two were mixed-method studies. Most sports physiotherapists recognised the importance of implementing psychological strategies during athletes' rehabilitation but were unsure whether it is within their scope. Common psychological strategies implemented included goal setting and encouraging positive self-thoughts. Barriers to implementing psychological strategies include lack of knowledge and training at undergraduate level, lack of postgraduate psychology courses available, and perceived stigma from athletes toward seeking psychological support. Strategies for sports physiotherapists to incorporate psychological strategies during athletes' return-to-play rehabilitation could include targeted professional development opportunities to gain confidence in implementing psychological strategies.
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Affiliation(s)
- Andrew Annear
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; High Performance Sport, New Zealand.
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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Devan H, Farmery D, Peebles L, Grainger R. Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e13080. [PMID: 30747715 PMCID: PMC6390192 DOI: 10.2196/13080] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Background Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality. Methods A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Devin Farmery
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Saitta M, Devan H, Boland P, Perry MA. Park-based physical activity interventions for persons with disabilities: A mixed-methods systematic review. Disabil Health J 2018; 12:11-23. [PMID: 30100214 DOI: 10.1016/j.dhjo.2018.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/11/2017] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Park-based physical activity (PA) interventions improve health in the general population, but it is unknown if the evidence can be translated to persons with disabilities. OBJECTIVES To conduct a mixed-methods systematic synthesis of the evidence for park-based physical activity interventions for persons with disabilities and secondarily, to consider the health benefits across the lifespan (children and adolescents, young, middle, and older adults). METHODS All major electronic databases were searched from inception until 30th November 2016. Studies were eligible if the PA intervention was conducted in an urban park environment with people reporting a disability (e.g. physical, psychological and developmental impairments) and health outcomes were evaluated with biopsychosocial measures. Methodological quality was assessed using Crowes Critical Appraisal Tool (CCAT) and key findings extracted. RESULTS Six quantitative and four qualitative papers, comprising of 446 participants (age range seven to ninety-one years), were included for qualitative synthesis; five in children/adolescents, none in adults, and five in older adults. There was limited, low level, preliminary evidence for short-term improvements in physical, psychological, and social health outcomes in children and older adults with disabilities as well as improvements in disability-related impairments. When accessible, parks fostered societal inclusion. CONCLUSIONS Health benefits from park use in persons with disabilities were identified. Parks may provide an alternative environment for rehabilitation and management of disabilities. Further randomized controlled trials evaluating the long-term effectiveness of park-based interventions is necessary to corroborate our findings. Legislative commitment ensuring urban parks are accessible may mitigate some health disparities in persons with disabilities.
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Affiliation(s)
- Miles Saitta
- School of Physiotherapy, University of Otago, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Pauline Boland
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand.
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Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2018; 98:381-397. [PMID: 29669089 DOI: 10.1093/ptj/pzy029] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 02/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain. PURPOSE The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self-management strategies for people in everyday life after completion of a pain self-management intervention. DATA SOURCES Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. STUDY SELECTION Study selection included qualitative and mixed-method studies that explored the perceptions of individuals with chronic pain after completion of a self-management intervention. DATA EXTRACTION A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. DATA SYNTHESIS Thirty-three studies with 512 participants were included. Enablers to self-management included self-discovery-the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self-management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self-management included difficulty with sustaining motivation for pain self-management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. LIMITATIONS This review only included interventions that involved at least 4 self-management skills; thus, informative studies may have been missed. The follow-up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low- and middle-income countries could not be located. CONCLUSIONS The sustained effort to self-manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person-centered care via shared decision making and guided problem solving is essential to facilitating ongoing self-management.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB)
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
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Perry MA, Devan H, Fitzgerald H, Han K, Liu LT, Rouse J. Accessibility and usability of parks and playgrounds. Disabil Health J 2017; 11:221-229. [PMID: 28918095 DOI: 10.1016/j.dhjo.2017.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/21/2016] [Revised: 08/09/2017] [Accepted: 08/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Public parks and playgrounds are an environment for leisure activity, which all generations can enjoy at low or no financial cost. Evaluating the accessibility and usability of parks and playgrounds is crucial because their design, environment (natural and built) and safety could restrict participation of persons with disabilities. OBJECTIVE To evaluate the accessibility and usability of 21 public parks and playgrounds in three metropolitan cities of New Zealand. Secondary aims were to compare the accessibility and usability by park type (destination or neighborhood) and deprivation level (high and low). METHODS Twenty-one parks were evaluated. A stratified random sampling was used to select 18 parks (six from each city). Three additional parks were purposely selected (one from each city) at the request of each respective city council. The parks and playgrounds were evaluated using a customized tool. Data were analyzed using descriptive statistics. RESULTS None of the parks we evaluated met the national standards and/or international guidelines for park and playground design. We identified potential accessibility and usability issues with car parking spaces, path surfaces and play equipment as well as lack of lighting and fencing. The presence of amenities (e.g. toilets and drinking fountains) was more common in destination parks. Fewer parks in areas of higher deprivation had accessible car parking spaces and main paths wider than 1.5 m. CONCLUSION Our evaluation identified potential design, environmental and safety barriers to park and playground based participation for persons with disabilities across the lifespan. A larger, more comprehensive evaluation of parks and playgrounds is required.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand.
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Harry Fitzgerald
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Karen Han
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Li-Ting Liu
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Jack Rouse
- School of Physiotherapy, University of Otago, Wellington, New Zealand
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Hoermann S, Ferreira Dos Santos L, Morkisch N, Jettkowski K, Sillis M, Devan H, Kanagasabai PS, Schmidt H, Krüger J, Dohle C, Regenbrecht H, Hale L, Cutfield NJ. Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy. Disabil Rehabil 2017; 39:1503-1514. [PMID: 28478736 DOI: 10.1080/09638288.2017.1291765] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. METHOD We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. RESULTS The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. CONCLUSIONS Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.
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Affiliation(s)
- Simon Hoermann
- a Department of Medicine (DSM) , University of Otago , Dunedin , New Zealand.,b Department of Information Science , University of Otago , Dunedin , New Zealand.,i School of Electrical & Information Engineering , The University of Sydney , Sydney , Australia
| | - Luara Ferreira Dos Santos
- c Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Industrial Automation Technology , Technische Universität Berlin , Berlin , Germany
| | - Nadine Morkisch
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Katrin Jettkowski
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Moran Sillis
- f MEDIAN Klinik Berlin-Kladow , Berlin , Germany.,g Department of Sport Medicine & Sport Orthopaedics , University of Potsdam , Potsdam , Germany
| | - Hemakumar Devan
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Parimala S Kanagasabai
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Henning Schmidt
- d Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Automation Technology , Fraunhofer IPK , Berlin , Germany
| | - Jörg Krüger
- c Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Industrial Automation Technology , Technische Universität Berlin , Berlin , Germany.,d Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Automation Technology , Fraunhofer IPK , Berlin , Germany
| | - Christian Dohle
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Holger Regenbrecht
- b Department of Information Science , University of Otago , Dunedin , New Zealand
| | - Leigh Hale
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Nicholas J Cutfield
- a Department of Medicine (DSM) , University of Otago , Dunedin , New Zealand
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Devan H, Hendrick P, Hale L, Carman A, Dillon MP, Ribeiro DC. Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey. PM R 2017; 9:949-959. [DOI: 10.1016/j.pmrj.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/02/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Affiliation(s)
- Meredith Perry
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Sarah Dean
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
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Devan H, Carman A, Hendrick P, Hale L, Ribeiro DC. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review. ACTA ACUST UNITED AC 2016; 52:1-19. [PMID: 26186283 DOI: 10.1682/jrrd.2014.05.0135] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/10/2014] [Indexed: 11/05/2022]
Abstract
Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Johnson G, Godlwana L, Jayakaran P, Devan H, Drum S. Integrating evidence into lower limb prosthetic rehabilitation in today's world. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.009] [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: 10/23/2022]
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Devan H, Carman AB, Hendrick PA, Ribeiro DC, Hale LA. Perceptions of low back pain in people with lower limb amputation: a focus group study. Disabil Rehabil 2014; 37:873-83. [DOI: 10.3109/09638288.2014.946158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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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Devan H, Hendrick P, Ribeiro DC, A Hale L, Carman A. Asymmetrical movements of the lumbopelvic region: Is this a potential mechanism for low back pain in people with lower limb amputation? Med Hypotheses 2014; 82:77-85. [DOI: 10.1016/j.mehy.2013.11.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/10/2013] [Indexed: 11/16/2022]
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Devan H, Tumilty S, Smith C. Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey. ACTA ACUST UNITED AC 2012; 49:1457-66. [DOI: 10.1682/jrrd.2011.09.0155] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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