ORCID Profile
0000-0001-8896-0978
Current Organisations
Mid North Coast Local Health District
,
University of Sydney
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Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2017
Abstract: Study Design Longitudinal cohort study. Background Spinal pain is responsible for a huge personal and societal burden, but its etiology remains unclear. Deficits in motor control have been associated with spinal pain in adults, and delayed motor development is associated with a range of health problems and risks in children. Objective To assess whether there is an independent relationship between the age at which infants first sit and walk without support and spinal pain at 11 years of age. Methods Data from the Danish National Birth Cohort were analyzed, using the age at which children first sat and first walked without support as predictors. Parents reported the predictors when the children were 6 months and 18 months of age, and also provided information in response to a comprehensive list of covariates, including child sex, birth weight, and cognitive development socioeconomic indicators and parental health variables. Outcomes were measured at 11 years of age using the Young Spine Questionnaire, which assesses the presence and intensity of spinal pain. Data were analyzed using multivariable logistic regression models to estimate determinants of neck, thoracic, lumbar, and multisite pain. Results The analyses included data from approximately 23 000 children and their parents. There were no consistent independent associations between the age at first sitting or walking and spinal pain at the age of 11. Odds ratios were between 0.95 and 1.00 for the various pain sites. Conclusion The age at which a child first sits or walks without support does not influence the likelihood that he or she will experience spinal pain in later childhood. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2017 (10):763-768. doi:10.2519/jospt.2017.7484.
Publisher: Wiley
Date: 06-05-2015
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: BMJ
Date: 03-2016
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BERH.2017.04.003
Abstract: Emerging data suggest that back pain in adolescents is responsible for a substantial disability burden and consumes considerable healthcare services. Of further concern is the fact that back pain during this period of life may have health implications in adulthood. Given this, understanding the epidemiology and clinical evidence base relevant to clinicians and researchers in the field of musculoskeletal health is crucial. This chapter provides an overview and synthesis of systematic reviews that address important questions related to back pain in children and adolescents.
Publisher: Wiley
Date: 11-03-2019
DOI: 10.1002/HPJA.238
Abstract: School-based nutrition policies can have a positive effect on the school food environment. The primary aim of this study was to assess the primary school adherence to a mandatory state-wide healthy canteen policy 12 months after an effective multi-strategic implementation intervention concluded. Primary schools were randomised to (a) a 12-14 months multi-strategic intervention or (b) no-intervention (control). The intervention aimed to improve implementation of a state-wide canteen policy by encouraging schools to remove unhealthy food and beverages (classified as ''red'' or ''banned'') from canteen menus and replace with healthy items (classified as ''green''). No implementation support was provided to either group by the research team between the 12 and 24 months data collection period. Seventy schools participated, of which 56 schools were assessed at 24-month follow-up. Intervention schools were less likely to have a menu which contained ''red/banned'' items at 24-month follow-up (RR = 2.28 95% CI: 1.18-4.40 P = 0.01). Intervention schools, however, were not more likely than controls to have a menu which contained >50% ''green'' items at 24-month follow-up (RR = 1.29 95% CI: 0.98-1.70 P = 0.10). Intervention schools were more likely to adhere to both policy components (no red/banned items and >50% green items on the menu) than control schools (RR = 2.61 95% CI: 1.29-5.29 P = 0.006). Among intervention schools that were fully adherent to the policy following implementation support (12-month post baseline), all were also adherent at the 24-month follow-up. The intervention was effective in achieving long-term school adherence to a state-wide canteen policy at 24-month follow-up. SO WHAT?: The findings suggest that sustained improvements in implementation of school nutrition policies is possible following a period (12 months) of comprehensive implementation support.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.BERH.2017.04.001
Abstract: In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BERH.2017.04.002
Abstract: Guidelines for low back pain (LBP) often recommend the use of self-management such as unsupervised exercise, booklets, and online education. Another potentially useful way for patients to self-manage LBP is by using smartphone applications (apps). However, to date, there has been no rigorous evaluation of LBP apps and no guidance for consumers on how to select high-quality, evidence-based apps. This chapter reviews smartphone apps for the self-management of LBP and evaluates their content quality and whether they recommend evidence-based interventions. This chapter shows that generally app developers are selecting interventions that are endorsed by guidelines, although their quality is low. There are many apps available for the self-management of LBP, but their effectiveness in improving patient outcomes has not been rigorously assessed. App developers need to work closely with healthcare professionals, researchers, and patients to ensure app content is accurate, evidence based, and engaging.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-10-2021
DOI: 10.1097/J.PAIN.0000000000002506
Abstract: We conducted a complier average causal effect (CACE) analyses for 2 pragmatic randomised controlled trials. We aimed to assess the effectiveness of telephone-based lifestyle weight loss interventions compared with usual care among compliers. Participants from 2 trials with low back pain (n = 160) and knee osteoarthritis (n = 120) with a body mass index ≥27 kg/m 2 were included. We defined adherence to the telephone-based lifestyle weight loss program as completing 60% (6 from 10) of telephone health coaching calls. The primary outcomes for CACE analyses were pain intensity (0-10 Numerical Rating Scale) and disability (Roland Morris Disability Questionnaire for low back pain and Western Ontario and McMaster Universities Osteoarthritis Index for knee osteoarthritis). Secondary outcomes were weight, physical activity, and diet. We used an instrumental variable approach to estimate CACE in compliers. From the intervention groups of the trials, 29% of those with low back pain (n = 23/80) and 34% of those with knee osteoarthritis (n = 20/60) complied. Complier average causal effect estimates showed potentially clinically meaningful effects, but with low certainty because of wide confidence intervals, for pain intensity (−1.4 95% confidence interval, −3.1, 0.4) and small but also uncertain effects for disability (−2.1 95% confidence interval, −8.6, 4.5) among compliers in the low back pain trial intervention compared with control but not in the knee osteoarthritis trial. Our findings showed that compliers of a telephone-based weight loss intervention in the low back pain trial generally had improved outcomes however, there were inconsistent effects in compliers from the knee osteoarthritis trial. Complier average causal effect estimates were larger than intention-to-treat results but must be considered with caution.
Publisher: Wiley
Date: 05-11-2022
DOI: 10.1002/EJP.1878
Abstract: Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests the stronger influence of psychological rather than other factors. We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalizing and externalizing symptoms) were converted to age‐standardized scores and dichotomized according to t‐scores ( =high distress). Life‐time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33 95% CI 1.01–1.76), but not spinal pain with greater impact (OR 1.22 95% 0.83–1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders. Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. Our findings provide evidence that psychological distress early in life is an independent risk factor for spinal pain with impact during adolescence. As psychological distress during childhood is potentially modifiable, it may be a promising target for research on the prevention of consequential spinal pain in adolescence. Identifying and addressing psychological distress in children may be an important component of best practice to reduce consequential spinal pain in adolescents.
Publisher: Oxford University Press (OUP)
Date: 2014
DOI: 10.2522/PTJ.20130217
Abstract: The Pain Self-Efficacy Questionnaire (PSEQ) is used by physical therapists in clinical practice and in research. However, current understanding of the PSEQ's measurement properties is incomplete, and investigators cannot be confident that it provides unbiased information on patient self-efficacy. The aims of this study were: (1) to investigate the scale properties of the PSEQ using Rasch analysis and (2) to determine whether age, sex, pain intensity, pain duration, and pain-related disability bias function of the PSEQ. This was a retrospective study data were obtained from 3 existing studies. Data were combined from more than 600 patients with low back pain of varying duration. Rasch analysis was used to evaluate targeting, category ordering, unidimensionality, person fit, internal consistency, and item bias. There was evidence of adequate category ordering, unidimensionality, and internal consistency of the PSEQ. Importantly, there was no evidence of item bias. The PSEQ did not adequately target the s le instead, it targeted people with lower self-efficacy than this population. Item 7 was hardest for participants to endorse, showing excessive positive misfit to the Rasch model. Response strings of misfitting persons revealed older participants and those reporting high levels of disability. The in idual items of the PSEQ can be validly summed to provide a score of self-efficacy that is robust to age, sex, pain intensity, pain duration, and disability. Although item 7 is the most problematic, it may provide important clinical information and requires further investigation before its exclusion. Although the PSEQ is commonly used with people with low back pain, of whom the s le in this study was representative, the results suggest it targets patients with lower self-efficacy than that observed in the current s le.
Publisher: JMIR Publications Inc.
Date: 15-03-2013
DOI: 10.2196/JMIR.2083
Publisher: Springer Science and Business Media LLC
Date: 11-02-2016
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2017-019151
Abstract: The primary aim for this review is to determine the effectiveness of strategies to improve the implementation of policies, practices or programmes in sporting organisations. The secondary aims are to describe the cost or cost-effectiveness and adverse effects of such strategies and to examine the effects of those implementation strategies on in idual’s diet, physical activity, obesity, alcohol use or tobacco use. We conducted searches of academic databases (eg, MEDLINE, EMBASE and CENTRAL), trial registers and hand searches of selected journals. Studies were included if they were conducted at a sporting venue described a strategy to improve implementation of policies, practices or programmes focusing on one or more health risks (diet, physical inactivity, obesity, alcohol or tobacco use), and included a parallel control group. Two authors independently screened citations and extracted data. The results of included studies were synthesised narratively. Of the 5926 citations screened three studies met the inclusion criteria. Two studies were randomised controlled trials. Two studies sought to improve the implementation of nutrition-related policy and practices and one study sought to improve implementation of alcohol-related policy and practices. Each study reported improvement in at least one measure of policy or practice implementation. Two studies reported in idual-level outcomes and found a reduction in excessive alcohol consumption and an increase in purchase of fruits and vegetables at the sports club ground. Two studies assessed club revenue as a potential adverse effect, neither reported significant between-group differences on these measures. There is a sparse evidence base regarding the effectiveness of strategies to improve the implementation of policies, practices or programmes targeting chronic disease risk factors in sporting clubs. While all studies reported some improvements in implementation, for some multistrategic implementation strategies it is difficult to determine the extent to which such effects are generalisable. CRD42016039490.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.MATH.2013.08.007
Abstract: Survival analysis is a statistical approach used to study time to an event of interest. The approach is highly applicable to the manual therapy discipline, yet is rarely used. This masterclass aims to present a simple overview of survival analysis aimed at both clinicians and researchers in the manual therapy field. Specifically the masterclass aims to 1) describe situations where survival analysis is appropriate to use 2) describe unique characteristics of survival data including censoring of participants 3) describe analysis methods for survival data including log rank test and Cox regression 4) describe the interpretation of results from survival analyses including survival plots and hazard ratios.
Publisher: American Medical Association (AMA)
Date: 21-09-2021
Publisher: BMJ
Date: 25-09-2014
DOI: 10.1136/BJSPORTS-2014-F7095REP
Abstract: What are the best red flags to indicate the possibility of fracture or malignancy in patients presenting with low back pain in primary, secondary, or tertiary care? Older age, prolonged corticosteroid use, severe trauma, and presence of a contusion or abrasion increase the likelihood of spinal fracture (likelihood was higher with multiple red flags) a history of malignancy increases the likelihood of spinal malignancy.
Publisher: BMJ
Date: 03-03-2014
Publisher: Oxford University Press (OUP)
Date: 16-12-2014
DOI: 10.1093/HER/CYU068
Abstract: Despite significant investment in many countries, the extent of schools' adoption of obesity prevention policies and practices has not been widely reported. The aims of this article are to describe Australian schools' adoption of healthy eating and physical activity policies and practices over an 8-year period and to determine if their adoption varies according to schools' size, geographic or socio-economic location. Between 2006 and 2013, a representative randomly selected cohort of primary schools (n = 476) in New South Wales, Australia, participated in four telephone interviews. Repeated measures logistic regression analyses using a Generalised Estimating Equation (GEE) framework were undertaken to assess change over time. The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed to ensure the intended benefits of government investment are achieved.
Publisher: Wiley
Date: 09-06-2018
Publisher: Wiley
Date: 14-11-2018
Publisher: Wiley
Date: 27-02-2023
Publisher: Springer Science and Business Media LLC
Date: 12-03-2018
Publisher: Springer Science and Business Media LLC
Date: 31-05-2020
DOI: 10.1186/S13643-020-01390-X
Abstract: 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 in iduals with musculoskeletal pain with regards to enablers and barriers to engaging in telehealth interventions for chronic musculoskeletal pain self-management. 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. 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. PROSPERO CRD42019136148
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2018-022560
Abstract: The present review aimed to assess the quality, content and evidence of efficacy of universally delivered (to all pupils aged 5–16 years), school-based, mental health interventions designed to promote mental health/well-being and resilience, using a validated outcome measure and provided within the UK in order to inform UK schools-based well-being implementation. A systematic review of published literature set within UK mainstream school settings. Embase, CINAHL, MEDLINE, PsycINFO, PsychArticles, ASSIA and Psychological and Behavioural Sciences published between 2000 and April 2016. Published in English universal interventions that aimed to improve mental health/emotional well-being in a mainstream school environment school pupils were the direct recipients of the intervention pre-post design utilised allowing comparison using a validated outcome measure. 12 studies were identified including RCTs and non-controlled pre-post designs (5 primary school based, 7 secondary school based). A narrative synthesis was applied with study quality check. 1 Effectiveness of school-based universal interventions was found to be neutral or small with more positive effects found for poorer quality studies and those based in primary schools (pupils aged 9–12 years). Studies varied widely in their use of measures and study design. Only four studies were rated ‘excellent’ quality. Methodological issues such as small s le size, varying course fidelity and lack of randomisation reduced overall study quality. Where there were several positive outcomes, effect sizes were small, and methodological issues rendered many results to be interpreted with caution. Overall, results suggested a trend whereby higher quality studies reported less positive effects. The only study that conducted a health economic analysis suggested the intervention was not cost-effective. The current evidence suggests there are neutral to small effects of universal, school-based interventions in the UK that aim to promote emotional or mental well-being or the prevention of mental health difficulties. Robust, long-term methodologies need to be pursued ensuring adequate recording of fidelity, the use of validated measures sensitive to mechanisms of change, reporting of those lost to follow-up and any adverse effects. Further high-quality and large-scale research is required across the UK in order to robustly test any long-term benefits for pupils or on the wider educational or health system.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2021
DOI: 10.1186/S13063-021-05591-0
Abstract: This paper describes the statistical analysis plan for a randomised controlled trial of a Healthy Lifestyle Program (HeLP) for low back pain targeting multiple health risks and behaviours, weight, physical activity, diet and smoking, to improve disability. We describe the methods for the main analyses and economic analysis of the trial. The trial is a two-arm pragmatic randomised controlled trial comparing the effect of the HeLP intervention to usual care on low back pain disability at 26 weeks. A total of 346 adults with low back pain were recruited from the Newcastle and Hunter region between September 2017 and November 2019 and randomised to either HeLP or usual care. HeLP is a 6-month intervention with participant outcomes measured at weeks 6, 12, 26 and 52 post randomisation. This statistical analysis plan describes data integrity, handling and preparation of data for analyses and methods for analyses. The primary endpoint for the trial is disability at 26 weeks using the 24-item self-report Roland Morris Disability Questionnaire. The primary analysis will follow the intention-to-treat principle using linear mixed regression models. The statistical analysis plan for this trial was produced to reduce outcome reporting bias arising from knowledge of the study findings. Any deviations will be described and justified in the final report. Australian New Zealand Clinical Trials Registry ACTRN12617001288314 . Registered on 6 September 2017.
Publisher: Springer Science and Business Media LLC
Date: 25-09-2018
Publisher: Wiley
Date: 20-01-2017
DOI: 10.1002/EJP.976
Abstract: There is substantial variability in the prognosis of acute low back pain (LBP). The ability to identify the probability of in idual patients recovering by key time points would be valuable in making informed decisions about the amount and type of treatment to provide. Predicting recovery based on presentation 1-week after initially seeking care is clinically important and may be more accurate than predictions made at initial presentation. The aim of this study was to predict the probability of recovery at 1-week, 1-month and 3-months after 1-week review in patients who still have LBP 1-week after initially seeking care. The study s le comprised 1070 patients with acute LBP, with a pain score of ≥2 1-week after initially seeking care. The primary outcome measure was days to recovery from pain. Ten potential prognostic factors were considered for inclusion in a multivariable Cox regression model. The final model included duration of current episode, number of previous episodes, depressive symptoms, intensity of pain at 1-week, and change in pain over the first week after seeking care. Depending on values of the predictor variables, the probability of recovery at 1-week, 1-month and 3-months after 1-week review ranged from 4% to 59%, 19% to 91% and 30% to 97%, respectively. The model had good discrimination (C = 0.758) and calibration. This study found that a model based on five easily collected variables could predict the probability of recovery at key time points in people who still have LBP 1-week after seeking care. A clinical prediction model based on five easily collected variables was able to predict the likelihood of recovery from an episode of acute LBP at three key time points. The model had good discrimination (C = 0.758) and calibration.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-11-2019
Publisher: Cold Spring Harbor Laboratory
Date: 02-03-2018
DOI: 10.1101/274605
Abstract: During adolescence, prevalence of pain and health risk factors such as smoking, alcohol use, and poor mental health rise sharply. While these risk factors and mental health are accepted public health concerns, the same is not true for pain. The aim of this study was to describe the relationship between back pain and health risk factors in adolescents. Cross-sectional data from the Healthy Schools Healthy Futures study, and the Australian Child Wellbeing Project was used. The mean age of participants was 14-15 years. Children were stratified according to the frequency they experienced back pain over the past 6 months. Within each strata, the proportion of children that reported drinking alcohol or smoking in the past month and the proportion that experienced feelings of anxiety or depression was reported. Test-for-trend analyses assessed whether increasing frequency of pain was associated with health risk factors. Data from approximately 2,500 and 3,900 children in the two studies was analysed. Larger proportions of children smoked or drank alcohol within each strata of increasing pain frequency. The trend with report of anxiety and depression was less clear, although there was a marked difference between the children that reported pain ‘rarely or never’, and those that experienced back pain more frequently. Two large, independent s les show Australian adolescents that experience back pain more frequently are also more likely to smoke, drink alcohol and report feelings of anxiety and depression. Pain appears to be part of the picture of general health risk in adolescents. The prevalence of back pain rises steeply during the adolescent years, and is responsible for considerable personal impact in a substantial minority. During this time, indicators of adverse health risk such as smoking, alcohol use, anxiety and depression also increase in prevalence. Pain and lifestyle-related health risk factors can have ongoing consequences that stretch into adulthood. This study shows a close relationship between increasing pain frequency, and tendency to engage in health risk behaviours and experience indicators of poor mental health in adolescents. This study shows that pain may be an important consideration in understanding the general health, and health risk in adolescents.
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/AJR.12854
Abstract: To describe the context of low back pain (LBP) presentations to emergency departments (EDs) by remoteness areas, hospital delineation level and staffing portfolios. A retrospective observational study using routinely captured ED and admission data over a 5‐year period (July 2014–June 2019). Thirty seven EDs across a large health district in NSW, Australia, covering major cities, inner regional areas and outer regional areas. Emergency department (ED) presentations with a principal or secondary diagnosis of LBP based on ICD‐10 code (M54.5). ED presentation and associated admission measures, including presentation rate, referral source, time in ED, re‐presentation rate, admission details and cost to the health system. There were 26 509 ED presentations for LBP across the 5 years. Time spent in ED was 206 min for EDs in major cities, 146 min for inner regional EDs and 89 min for outer regional EDs. Re‐presentation rates were 6% in major cities, 8.8% in inner regional EDs and 11.8% in outer regional EDs. Admission rates were 20.4%, 15.8% and 18.8%, respectively. This study describes LBP presentations across 37 EDs, highlighting the potential burden these presentations place on hospitals. LBP presentations appear to follow different pathways depending on the ED remoteness area, delineation level and staff portfolio.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.CCT.2011.04.013
Abstract: Internet based Cognitive Behavioural Therapy (iCBT) represents a significant development in the way psychological interventions are delivered. Studies tend to recruit via common media channels leading to criticisms of biased s le sizes and limited generalisability to primary care settings. To evaluate the use of a prevalence recruitment strategy within primary care to recruit into an RCT examining a free to use iCBT intervention. Fully randomised controlled trial (RCT), utilising a prevalence based recruitment strategy, comparing the iCBT intervention with telephone support provided by NHS Direct Health Advisors with treatment-as-usual (TAU) control. Recruitment rates were low with only 7 participants recruited over 8 months. Overall only 14% of expected study invitations were sent, with only 1% undertaking the consent and initial screening process. Key differences with successful prevalence recruitment strategies highlight four main issues to consider when recruiting participants from primary care into iCBT studies--lack of equipoise, a need for an assertive approach, coding of depression in GP databases and help seeking behaviour in depression which can all act as potential contributors to failure to recruit. However other non-primary care recruitment methods, such as the use of media channels, which are already shown to be effective in non-primary care settings should be considered if these methods more accurately target the population who would be willing to adopt iCBT more generally.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-03-2018
DOI: 10.1097/J.PAIN.0000000000001198
Abstract: We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain ( months in duration) and body mass index ≥27 kg/m 2 and kg/m 2 were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval −8.0 to 21.0 P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.
Publisher: Wiley
Date: 04-10-2016
Publisher: John Wiley & Sons, Ltd
Date: 30-07-2015
Publisher: Elsevier BV
Date: 06-2023
Publisher: BMJ
Date: 03-10-2017
Publisher: Springer Science and Business Media LLC
Date: 12-2018
DOI: 10.1186/S12967-018-1736-8
Abstract: Cell-based therapies have shown promise for the treatment of knee osteoarthritis (OA). The current study compared exercise therapy to autologous bone marrow concentrate (BMC) and platelet products for knee OA treatment. Patients with symptomatic knee OA (N = 48) were randomized into either an exercise therapy control group or treatment group with injection of autologous BMC and platelet products. Patients in the control group could crossover to BMC treatment after 3 months. Clinical outcomes were documented at baseline and at 6-weeks, 3, 6, 12 and 24 months, including the Knee Society Score (KSS), Pain Visual Analogue Scale, Short Form-12 Scales (SF-12), and Lower Extremity Activity Scale (LEAS). All patients in the exercise group crossed over to receive BMC treatment after 3 months (N = 22 crossover). At 3 months, KSS-knee, SF-12 Physical, and LEAS improved significantly in the crossover group compared to exercise, similar to significant improvements on KSS-knee and LEAS for the treatment group (N = 26) compared to exercise group at 3 months. After BMC treatment, patients’ clinical outcome scores (except SF-12 Mental Health), were significantly improved through the 2-year follow-up compared to baseline. No serious adverse events were reported. The use of image-guided percutaneous BMC with platelet products yielded better results than exercise therapy as an effective alternative therapy for patients with symptomatic moderate to moderate-severe osteoarthritis of the knee. Trial registration NCT02034032. t2/show/NCT02034032 . Registered 13 January 2014
Publisher: American Academy of Pediatrics (AAP)
Date: 22-07-2022
Abstract: Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to “growing pain(s)” or “growth pain(s)” in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-06-2019
DOI: 10.1097/J.PAIN.0000000000001639
Abstract: Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61 father OR = 1.59] both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.
Publisher: BMJ
Date: 25-02-2015
Publisher: BMJ
Date: 07-2022
DOI: 10.1136/BMJOPEN-2022-063250
Abstract: Social media provide promising contemporary platforms for sharing public health information with a broad audience. Before implementation, testing social media c aigns that are intended to engage audiences and initiate behaviour change is necessary. This trial aims to investigate the effectiveness of a public health c aign to increase people’s confidence in becoming more active despite low back pain in comparison with no intervention. This is an online randomised controlled trial with two intervention groups and one control group in a 1:1:1 allocation. People over 18 years of age and fluent in English will be recruited via social media advertising. We developed a social media-based public health c aign to support recommendations for managing low back pain. The interventions are two videos. Participants in the control group will be asked questions about low back pain but will not view either video intervention. The primary outcome will be item 10 of the Pain Self-Efficacy Questionnaire, which asks participants to rate how confident they would feel to gradually become more active despite pain ranging from 0 (not at all confident) to 6 (completely confident). This outcome will be measured immediately in all participant groups. We will compare group mean of the three arms of the trial using univariate analyses of variance. This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry. We obtained ethical approval from our institutions Human Research Ethics Committee before data collection. We will publish the results in a peer-reviewed medical journal and on institution websites. Australian New Zealand Clinical Trials Registry (ACTRN12622000466741).
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2017
Abstract: Musculoskeletal conditions are responsible for a significant disability burden, and recent data show that this is also the case for children and adolescents. Importantly, though, musculoskeletal conditions rarely occur in isolation they often coexist with other health issues. There is potentially great benefit of an approach to research and practice that considers musculoskeletal pain in children and adolescents from a broader perspective. Considering the role of musculoskeletal pain in the broader picture of child and adolescent health offers new perspectives for researchers and clinicians in the public health and clinical fields. J Orthop Sports Phys Ther 2017 (10):699-701. doi:10.2519/jospt.2017.0108.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2017
Abstract: There are substantial gaps in our understanding of musculoskeletal pain in children and adolescents. While there are challenges to performing research in this space, the prevalence, burden, and lack of available evidence to inform clinical practice mean that overcoming these challenges is important. The editors see the collection of work in this special issue as a step in the right direction. J Orthop Sports Phys Ther 2017 (10):702-704. doi:10.2519/jospt.2017.0109.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2010
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-071489
Abstract: To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions. We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting. Australian primary care. Registered physiotherapists who are members of a practice-based research network (n=31). The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application. High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the in idual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.
Publisher: BMJ
Date: 14-08-2013
Publisher: Cold Spring Harbor Laboratory
Date: 06-04-2018
DOI: 10.1101/296285
Abstract: We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Eligible patients with chronic low back pain (n=160) were randomised to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight, and body mass index. Costs included intervention costs, healthcare utilisation costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Mean total costs were lower in the intervention group than the control group (-$614 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292 95%CI: -872 to -33), medication costs (-$30 95%CI: -65 to -4) and absenteeism costs (-$1000 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e. 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2017
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Wiley
Date: 29-10-2019
Publisher: Wiley
Date: 04-12-2018
DOI: 10.1002/EJP.1334
Abstract: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Mean total costs were lower in the intervention group than the control group (-$614 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292 95%CI: -872 to -33), medication costs (-$30 95%CI: -65 to -4) and absenteeism costs (-$1,000 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings. This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.
Publisher: Center for Open Science
Date: 20-04-2020
Abstract: ObjectiveMediation analysis is a widely used quantitative method for investigating how interventions and exposures in randomised controlled trials and observational studies have an effect on healthcare outcomes. This study aimed to assess the importance of items that should be considered in a consensus meeting aimed at developing a guideline for reporting mediation analyses. Study Design and SettingA Delphi panel of international experts were asked to rate the importance of a list of items for inclusion in a guideline for reporting mediation analyses. Thresholds for disagreement and consensus on importance for inclusion were specified a priori. We used the Research ANd Development/University of California Los Angeles appropriateness method to quantitatively assess the importance for inclusion and panel agreement. ResultsNineteen expert panellists (10 female) from seven countries agreed to participate. All panellists contributed to all three rounds conducted between 10/06/2019 and 06/11/2019. The panel reached consensus on 34 unique reporting items for study design, analytic procedures and effect estimates, with 3 items rated ‘optional’. Panellists added one extra item and provided 60 qualitative comments for item refinement and prioritisation. ConclusionThis Delphi study used a rigorous consensus process to reach consensus on 34 reporting items for studies that use mediation analysis. These results will inform a consensus meeting that will consolidate a core set of recommended items for reporting mediation analyses.
Publisher: Public Library of Science (PLoS)
Date: 11-01-2013
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AMEPRE.2015.02.002
Abstract: Schools represent a valuable setting for interventions to improve children's diets, as they offer structured opportunities for ongoing intervention. Modifications to the school food environment can increase purchasing of healthier foods and improve children's diets. This study examines the availability of healthy food and drinks, implementation of pricing and promotion strategies in Australian primary school canteens, and whether these varied by school characteristics. In 2012 and 2013, canteen managers of primary schools in the Hunter New England region of New South Wales reported via telephone interview the pricing and promotion strategies implemented in their canteens to encourage healthier food and drink purchases. A standardized audit of canteen menus was performed to assess the availability of healthy options. Data were analyzed in 2014. Overall, 203 (79%) canteen managers completed the telephone interview and 170 provided menus. Twenty-nine percent of schools had menus that primarily consisted of healthier food and drinks, and 11% did not sell unhealthy foods. Less than half reported including only healthy foods in meal deals (25%), labeling menus (43%), and having a comprehensive canteen policy (22%). A significantly larger proportion of schools in high socioeconomic areas (OR=3.0) and large schools (OR=4.4) had primarily healthy options on their menus. School size and being a Government school were significantly associated with implementation of some pricing and promotion strategies. There is a need to monitor canteen environments to inform policy development and research. Future implementation research to improve the food environments of disadvantaged schools in particular is warranted.
Publisher: SAGE Publications
Date: 27-02-2019
Abstract: To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs) which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.JCLINEPI.2021.05.020
Abstract: To assess the reporting quality of exercise interventions from clinical trials of low back pain (LBP). We conducted a systematic review to assess the reporting quality of randomised controlled trials (RCTs) that investigated the effectiveness of exercise interventions for patients with LBP. Five online databases and Clinical Trial Registries were searched (October 2018). We included RCTs that reported interventions for LBP, containing at least 50% exercise. The Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) reporting checklists were then used to assess quality of reporting. 582 trials were eligible for inclusion. Due to the large number of eligible studies, 100 studies were randomly selected for data extraction and coding with the TIDieR and CERT checklists. The random s le was representative of the 582 eligible trials. The overall completeness of reporting (median (IQR)) of TIDieR items was 59.2% (45.5%-72.7%) and CERT was 33.3% (22.2%-52.6%). We found poor overall reporting with both checklists, which has not improved over time or since the introduction of the checklists. More dedicated work is required to address poor reporting of exercise interventions in clinical trials.
Publisher: Wiley
Date: 22-09-2021
Abstract: To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED (ii) barriers and enablers they face when providing care to patients with LBP and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary‐level public hospital in New South Wales, Australia, using focus groups and in idual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. Twenty‐one clinicians participated (two in idual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient‐, clinician‐ and service‐level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow‐up options post‐discharge and improved communication between ED and primary care. We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient‐, clinician‐ and service‐level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow‐up options, access to resources and an ‘LBP pathway’ to support decision making.
Publisher: Center for Open Science
Date: 13-10-2017
Abstract: Studies investigating causal mechanisms are becoming increasingly common.Despite growing numbers of publications and trialist embedding mechanismevaluations into randomised controlled trials and observational studies, the reporting accuracy and consistency of mechanism studies is suboptimal. The heterogeneity in the reporting of mechanism evaluations stifles systematic reviews, complicates meta-analyses, and limits transparency and replication. The aim of this initiative is to develop a reporting guideline for mechanism evaluations (mediation analyses). We also plan to develop an accompanying explanation and elaboration (E& E) paper. This project is the first initiative to address the issue of poor reporting quality of mechanism evaluations and has been registered on the “Enhancing the QUAlity and Transparency of health Research” (EQUATOR) network.This initiative is being conducted in accordance with the Guidance for Developers ofHealth Research Reporting Guidelines. This draft report provides an update on theprogress of the project summarising achievements to date and future work.Currently, multiple phases of the overall program are running in parallel, with eachphase informing the subsequent.
Publisher: JMIR Publications Inc.
Date: 11-05-2020
DOI: 10.2196/17203
Abstract: People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Pharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25 total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5 90th percentile compared with similar systems), with acceptance rated as good to excellent. A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study s le limits the generalizability of the findings but offers important insights to inform the next stage of system development.
Publisher: Elsevier BV
Date: 11-2014
Publisher: BMJ
Date: 03-05-2012
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3327356
Publisher: Springer Science and Business Media LLC
Date: 21-09-2018
DOI: 10.1007/S00586-016-4781-0
Abstract: To report health care costs and the factors associated with such costs in people with acute low back pain receiving guideline-recommended first line care. This is a secondary analysis of a trial which found no difference in clinical outcomes. Participants with acute low back pain received reassurance and advice, and either paracetamol (taken regularly or as needed) or placebo for up to 4 weeks and followed up for 12 weeks. Data on health service utilisation were collected by self-report. A health sector perspective was adopted to report all direct costs incurred (in 2015 AUD, 1 AUD = 0.53 Euro). Costs were reported for the entire study cohort and for each group. Various baseline clinical, demographic, work-related and socioeconomic factors were investigated for their association with increased costs using generalised linear models. The mean cost per participant was AUD167.74 (SD = 427.24) for the entire cohort (n = 1365). Most of these costs were incurred in primary care through visits to a general practitioner or physiotherapist. Compared to the placebo group, there was an increase in cost when paracetamol was taken. Multivariate analysis showed that disability, symptom duration and compensation were associated with costs. Receiving compensation was associated with a twofold increase compared to not receiving compensation. Taking paracetamol as part of first line care for acute low back pain increased the economic burden. Higher disability, longer symptom duration and receiving compensation were independently associated with increased health care costs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/ACM.0000000000002497
Abstract: Despite the more than $32 billion the National Institutes of Health has invested annually, evidence-based health care services are not reliably implemented, sustained, or distributed in health care delivery organizations, resulting in suboptimal care and patient harm. New organizational approaches and frameworks that reflect the complex nature of health care systems are needed to achieve this goal. To guide the implementation of evidence-based health care services at their institution, the authors used a number of behavioral theories and frameworks to develop the Agile Implementation (AI) Playbook, which was finalized in 2015. The AI Playbook leverages these theories in an integrated approach to selecting an evidence-based health care service to meet a specific opportunity, rapidly implementing the service, evaluating its fidelity and impact, and sustaining and scaling up the service across health care delivery organizations. The AI Playbook includes an interconnected eight-step cycle: (1) identify opportunities (2) identify evidence-based health care services (3) develop evaluation and termination plans (4) assemble a team to develop a minimally viable service (5) perform implementation sprints (6) monitor implementation performance (7) monitor whole system performance and (8) develop a minimally standardized operating procedure. The AI Playbook has helped to improve care and clinical outcomes for intensive care unit survivors and is being used to train clinicians and scientists in AI to be quality improvement advisors. The authors plan to continue disseminating the details of the AI Playbook and illustrating how health care delivery organizations can successfully leverage it.
Publisher: Wiley
Date: 28-04-2201
DOI: 10.1002/ART.38329
Abstract: Recent research suggests that sleep quality and pain intensity are intimately linked. Although sleep problems are common in patients with low back pain, the effect of sleep quality on the levels of pain intensity is currently unknown. The aim of this study was to investigate the effect of sleep quality on subsequent pain intensity in patients with recent-onset low back pain. Data on 1,246 patients with acute low back pain were included in the analysis. Sleep quality was assessed using the sleep quality item of the Pittsburgh Sleep Quality Index, scored on a 0-3-point scale, where 0 = very good sleep quality and 3 = very bad sleep quality. Pain intensity was assessed on a numerical rating scale (range 0-10). A generalized estimating equation (GEE) analysis modeled with an exchangeable correlation structure was used to examine the relationship between sleep quality and pain intensity. The model further controlled for symptoms of depression and prognostic factors for low back pain. The GEE analysis demonstrated a large effect of poor sleep on subsequent pain intensity, such that for every 1-point decrease in sleep quality (based on a 0-3-point scale), pain intensity (based on a 0-10-point scale) increased by 2.08 points (95% confidence interval 1.99-2.16). This effect was independent of depression and common prognostic factors for low back pain. Sleep quality is strongly related to subsequent pain intensity in patients with acute low back pain. Future research is needed to determine whether targeting sleep improvement contributes to pain reduction.
Publisher: Wiley
Date: 26-11-2014
DOI: 10.1002/J.1532-2149.2013.00427.X
Abstract: Magnetic resonance imaging (MRI) has the potential to identify pathology responsible for low back pain (LBP). However, the importance of findings on MRI remains controversial. We aimed to systematically review whether MRI findings of the lumbar spine predict future LBP in different s les with and without LBP. MEDLINE, CINAHL and EMBASE databases were searched. Included were prospective cohort studies investigating the relationship between baseline MRI abnormalities of the lumbar spine and clinically important LBP outcome at follow-up. We excluded cohorts with specific diseases as the cause of their LBP. Associations between MRI findings and LBP pain outcomes were extracted from eligible studies. A total of 12 studies met the inclusion criteria. Six studies presented data on participants with current LBP one included a s le with no current LBP, three included a s le with no history of LBP and two included mixed s les. Due to small s le size, poor overall quality and the heterogeneity between studies in terms of participants, MRI findings and clinical outcomes investigated, it was not possible to pool findings. No consistent associations between MRI findings and outcomes were identified. Single studies reported significant associations for Modic changes type 1 with pain, disc degeneration with disability in s les with current LBP and disc herniation with pain in a mixed s le. The limited number, heterogeneity and overall quality of the studies do not permit definite conclusions on the association of MRI findings of the lumbar spine with future LBP (PROSPERO: CRD42012002342).
Publisher: Springer Science and Business Media LLC
Date: 16-06-2011
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.APMR.2017.05.029
Abstract: To describe the magnitude of patient-reported nonadherence with guideline-recommended care for acute low back pain. Secondary analysis of data from participants enrolled in the Paracetamol for Acute Low Back Pain study trial, a randomized controlled trial evaluating the effectiveness of paracetamol for acute low back pain. Primary care, general practitioner. Data from participants with acute low back pain (N=1643). Guideline-recommended care, including reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also, advice against additional treatments and referral for imaging. Proportion of nonadherence with guideline-recommended care. Nonadherence was defined as (1) failure to consume the advised paracetamol dose, or (2) receipt of additional health care, tests, or medication during the trial treatment period (4wk). Multivariable logistic regression analysis was performed to determine the factors associated with nonadherence. In the first week of treatment, 39.7% of participants were classified as nonadherent. Over the 4-week treatment period, 70.0% were nonadherent, and 57.5% did not complete the advised paracetamol regimen. Higher perceived risk of persistent pain, lower level of disability, and not claiming workers' compensation were associated with nonadherence, with odds ratios ranging from .46 to 1.05. Adherence to guideline-recommended care for acute low back pain was poor. Most participants do not complete the advised paracetamol regimen. Higher perceived risk of persistence of complaints, lower baseline disability, and participants not claiming workers' compensation were independently associated with nonadherence.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2012
Abstract: NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.
Publisher: American Medical Association (AMA)
Date: 08-02-2010
DOI: 10.1001/ARCHINTERNMED.2009.507
Abstract: Acute low back pain (LBP) is primarily managed in general practice. We aimed to describe the usual care provided by general practitioners (GPs) and to compare this with recommendations of best practice in international evidence-based guidelines for the management of acute LBP. Care provided in 3533 patient visits to GPs for a new episode of LBP was mapped to key recommendations in treatment guidelines. The proportion of patient encounters in which care arranged by a GP aligned with these key recommendations was determined for the period 2005 through 2008 and separately for the period before the release of the local guideline in 2004 (2001-2004). Although guidelines discourage the use of imaging, over one-quarter of patients were referred for imaging. Guidelines recommend that initial care should focus on advice and simple analgesics, yet only 20.5% and 17.7% of patients received these treatments, respectively. Instead, the analgesics provided were typically nonsteroidal anti-inflammatory drugs (37.4%) and opioids (19.6%). This pattern of care was the same in the periods before and after the release of the local guideline. The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time. The unendorsed care may contribute to the high costs of managing LBP, and some aspects of the care provided carry a higher risk of adverse effects.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2020
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JOCA.2018.01.003
Abstract: To determine the effectiveness of telephone-based weight loss support in reducing the intensity of knee pain in patients with knee osteoarthritis, who are overweight or obese, compared to usual care. We conducted a parallel randomised controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary referral hospital in NSW, Australia. Patients with knee osteoarthritis, classified as overweight or obese [body mass index (BMI) between ≥27 kg/m Between May 19 and June 30 2015, 120 patients were randomly assigned to the intervention (59 analysed, one post-randomisation exclusion) or usual care (60 analysed). We found no statistically significant between group differences in pain intensity [area under the curve (AUC), mean difference 5.4, 95%CI: -13.7 to 24.5, P = 0.58] or weight change at 6 months (self-reported mean difference -0.4, 95%CI: -2.6 to 1.8, P = 0.74). Among patients with knee osteoarthritis who are overweight, telephone-based weight loss support, provided using an existing 6-month weight management and healthy lifestyle service did not reduce knee pain intensity or weight, compared with usual care. ACTRN12615000490572.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Springer Science and Business Media LLC
Date: 24-01-2023
DOI: 10.1186/S12913-022-08887-2
Abstract: Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research. This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies. A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a ‘deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research’. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement. A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity. The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.
Publisher: Therapeutic Guidelines Limited
Date: 10-2011
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2017
Abstract: Study Design Cross-sectional study. Background Adolescents with musculoskeletal pain are thought to be at greater risk of modifiable health risk behaviors, but little is known about these behaviors in adolescents with problematic pain. Objective To describe the prevalence of substance use (tobacco smoking, alcohol consumption, and illicit drugs) and poor mental health in adolescents with problematic musculoskeletal pain, compared to those without such pain. Methods Data on self-reported pain, substance use, and poor mental health were collected from 1831 year 9 students (age range, 14-16 years). Participants were considered to have problematic pain if they reported experiencing pain at least monthly over a 6-month period that also required medication or impacted 1 or more of the following: school or work, daily activities, and leisure or sporting activities. Results Almost half (46%) of the participants experienced problematic pain. Adolescents with problematic pain, compared to those without pain, reported higher substance use and poorer mental health: tobacco smoking in the last 4 weeks, 12% versus 7% (odds ratio [OR] = 1.76 95% confidence interval [CI]: 1.25, 2.28) alcohol consumption in the last 4 weeks, 30% versus 20% (OR = 1.68 95% CI: 1.34, 2.11) illicit drug use, 13% versus 6% (OR = 2.18 95% CI: 1.55, 3.07) lower Mental Health Inventory scores (β = -11.43 standard error [SE], 0.96 P<.05), indicating poorer mental health and higher Strengths and Difficulties Questionnaire total scores (β = 3.67 SE, 0.29 P<.05), indicating greater difficulties. Conclusion Adolescents with problematic pain report higher smoking, alcohol use, and use of illicit drugs and poorer mental health than adolescents without problematic pain. The experience of problematic pain could be an important consideration for substance use and chronic disease prevention. This trial is registered with the Australian New Zealand Clinical Trials Registry (reference number ACTRN12611000606987). J Orthop Sports Phys Ther 2017 (10):705-711. doi:10.2519/jospt.2017.7441.
Publisher: BMJ
Date: 11-12-2013
DOI: 10.1136/BMJ.F7095
Publisher: Wiley
Date: 24-06-2020
Publisher: Springer Science and Business Media LLC
Date: 11-01-2017
Publisher: Springer Science and Business Media LLC
Date: 03-11-2016
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.JCLINEPI.2013.08.007
Abstract: Expenditure on research has grown substantially however, a major challenge for conducting successful clinical research is the efficient recruitment of participants. We investigated factors influencing the rate at which general practitioners (GPs) recruit participants to a randomized controlled trial. We used data on 363 GPs recruiting participants for a randomized controlled trial of low back pain. Multivariate negative binomial regression was used to determine associations of characteristics of the GP and study operational aspects with the recruitment rate. GPs recruited 1,195 participants at a rate of 0.013 participants/day. GPs located in a high socioeconomic area recruited at half the rate as those located in a low socioeconomic area [incident rate ratio (IRR), 0.52 95% confidence interval (CI): 0.37, 0.74]. A follow-up within 2 weeks of training the GP and a higher number of face-to-face visits were operational procedures associated with a higher rate of recruitment (IRR, 2.15 95% CI: 1.58, 2.94 and IRR, 1.17 95% CI: 1.11, 1.24, respectively). Other contacts made with a GP were not associated with recruitment. The results suggested that the type of operational procedures used in clinical trial recruitment strategies are important aspects to consider. The ability to predict which GPs will recruit based on GP characteristics seems limited.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2016
DOI: 10.1007/S00586-016-4461-0
Abstract: To determine whether emotional distress reported at the initial consultation affects subsequent healthcare use either directly or indirectly via moderating the influence of symptoms. Longitudinal observational study of 2891 participants consulting primary care for low back pain. Negative binomial regression models were constructed to estimate independent effects of emotional distress on healthcare use. Potential confounders were identified using directed acyclic graphs. After the initial consultation, participants had a mean (SD) of one (1.2) visit for back pain over 3 months, and nine (14) visits for back pain over 12 months. Higher reports of anxiety during the initial consultation led to increased short-term healthcare use (IRR 1.06, 95 % CI 1.01-1.11) and higher reports of depression led to increased long-term healthcare use (IRR 1.04, 95 % CI 1.02-1.07). The effect sizes suggest that a patient with a high anxiety score (8/10) would consult 50 % more frequently over 3 months, and a person with a high depression score (8/10) would consult 30 % more frequently over 12 months, compared to a patient with equivalent pain and disability and no reported anxiety or depression. Emotional distress in the acute stage of low back pain increased subsequent consultation rates. Interventions that target emotional distress during the initial consultation are likely to reduce costly and potentially inappropriate future healthcare use for patients with non-specific low back pain.
Publisher: Wiley
Date: 20-07-2022
Publisher: FapUNIFESP (SciELO)
Date: 06-2016
Publisher: Oxford University Press (OUP)
Date: 28-03-2017
DOI: 10.1093/HER/CYX038
Abstract: Implementation of vegetable and fruit programs in schools is less than optimal. This study aimed to identify, using a theoretical framework, factors associated with implementation of a school vegetable and fruit program that provides a time in class for children to consume a piece of vegetable or fruit they have brought from home. Three hundred and three randomly selected school principals across the state of New South Wales, Australia responded to a 25-min telephone survey. Principals were asked if their school had implemented a vegetable and fruit program, and which of 12 factors from Damschroder's consolidated framework for implementation research had facilitated or impeded implementation. Multiple logistic regression models examined the association between such factors and program implementation. Seventy-eight percent of schools had a vegetable and fruit program. Schools were significantly more likely to implement the program if the principal believed that: the program was effective (OR = 2.97 P < 0.02) they had sufficient resources to implement the program (OR = 4.22 P < 0.0001) the program would not be difficult to implement (OR = 10.16 P< 0.0001) and that the program was as important as other school priorities (OR = 2.45 P < 0.02). Realizing the intended benefits of vegetable and fruit programs requires widespread implementation by schools. Consideration of principal beliefs about the program effectiveness, resources, difficultly and relative importance in program implementation strategies appear key to increasing program implementation.
Publisher: Informa UK Limited
Date: 2019
Publisher: Cold Spring Harbor Laboratory
Date: 21-03-2018
DOI: 10.1101/284588
Abstract: Telephone-based support offers a promising option to provide widely accessible and cost-effective weight loss care to the people with knee osteoarthritis who are overweight. While telephone-based interventions targeting weight loss are used routinely in the general populations, the cost-effectiveness of referring patients with knee osteoarthritis to these is unknown. The aim of this study was to assess the cost-effectiveness of referral to a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese, compared to usual care. We randomised 120 patients with knee osteoarthritis to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. The primary outcome of the study was quality-adjusted life years (QALYs). Secondary outcomes included pain intensity, disability, weight, and body mass index (BMI). Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. The primary cost-effectiveness analysis was performed from the societal perspective. Mean cost differences between groups (intervention minus control) were, $454 (95%CI: −2735 to 4206) for healthcare costs, $-36, (95%CI: −73 to 2) for medication costs, and $-13 (95%CI: −225 to 235) for absenteeism costs. The total mean difference in societal costs was $1022 (95%CI: −2201 to 4771). For all outcomes, the probability of the intervention being cost-effective compared with usual care was less than 0.33 at all willingness-to-pay values. From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis for QALYs, pain intensity, disability, weight, and BMI.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
DOI: 10.1097/BOT.0000000000000578
Abstract: To evaluate the ionizing radiation dose received by the eyes of orthopaedic surgeons during various orthopaedic procedures. Secondary objective was to compare the ionizing radiation dose received between differing experience level. Prospective comparative study between January 2013 and May 2014. Westmead Hospital, a Level 1 Trauma Centre for Greater Western Sydney. A total of 26 surgeons volunteered to participate within the study. Experience level, procedure performed, fluoroscopy time, dose area product, total air kerma, and eye dose received was recorded. Participants were evaluated on procedure and experience level. Radiation dose received at eye level by the primary surgeon during an orthopaedic procedure. Data from a total of 131 cases was recorded and included for analysis. The mean radiation dose detected at the eye level of the primary surgeon was 0.02 mSv (SD = 0.05 mSv) per procedure. Radiation at eye level was only detected in 31 of the 131 cases. The highest registered dose for a single procedure was 0.31 mSv. Femoral nails and pelvic fixation procedures had a significantly higher mean dose received than other procedure groups (0.04 mSv (SD = 0.07 mSv) and 0.04 mSv (SD = 0.06 mSv), respectively). Comparing the eye doses received by orthopaedic consultants and trainees, there was no significant difference between the 2 groups. The risk of harmful levels of radiation exposure at eye level to orthopaedic surgeons is low. This risk is greatest during insertion of femoral intramedullary nails and pelvic fixation, and it is recommended that in these situations, surgeons take all reasonable precautions to minimize radiation dose. The orthopaedic trainees in this study were not subjected to higher doses of radiation than their consultant trainers. On the basis of these results, most of the orthopaedic surgeons remain well below the yearly radiation dose of 20 mSv as recommended by the International Commission on Radiological Protection.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 19-12-2016
Publisher: Wiley
Date: 02-02-2020
Publisher: Wiley
Date: 19-03-2014
DOI: 10.1002/J.1532-2149.2014.00467.X
Abstract: Clinical prediction rules can assist clinicians to identify patients with low back pain (LBP) who are likely to recover quickly with minimal treatment however, there is a paucity of validated instruments to assist with this task. We performed a pre-planned external validation study to assess the generalizability of a simple 3-item clinical prediction rule developed to estimate the probability of recovery from acute LBP at certain time points. The accuracy of the rule (calibration and discrimination) was determined in a s le of 956 participants enrolled in a randomized controlled trial. The calibration of the rule was reasonable in the new s le with predictions of recovery typically within 5-10% of observed recovery. Discriminative performance of the rule was poor to moderate and similar to that found in the development s le. The results suggest that the rule can be used to provide accurate information about expected recovery from acute LBP, within the first few weeks of patients presenting to primary care. Impact analysis to determine if the rule influences clinical behaviours and patient outcomes is required.
Publisher: JMIR Publications Inc.
Date: 30-04-2015
DOI: 10.2196/JMIR.3639
Publisher: Cold Spring Harbor Laboratory
Date: 26-03-2018
DOI: 10.1101/286757
Abstract: We assessed the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis (OA), who are overweight or obese. We conducted causal mediation analyses of aggregated data from two RCTs which included 160 patients with chronic low back pain, and 120 patients with knee OA. Participants were randomised via one central randomisation schedule, to the intervention, or usual care. The intervention consisted of brief advice and referral to a 6-month telephone-based healthy lifestyle coaching service. Participants in the back pain trial were also offered a single physiotherapy consultation. The hypothesised primary mediator was self-reported weight, and alternative mediators were diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). Data were analysed using causal mediation analyses with sensitivity analyses for sequential ignorability. All mediation models were specified a priori . The intervention had no effect on pain intensity, disability or physical QoL. The intervention significantly improved mental QoL, however, the intervention effect was not channelled via the selected mediators. The intervention did not reduce weight, or the alternative mediators (diet, physical activity, pain beliefs), and these mediators were not associated with the outcomes (with one exception poor diet was associated with lower mental QoL). The sensitivity analyses showed that our estimates were stable across all possible levels of residual confounding. Our findings show that the intervention did not cause a meaningful change in the hypothesised mediators, and these mediators were not associated with patient outcomes.
Publisher: Oxford University Press (OUP)
Date: 09-2019
Abstract: During adolescence, prevalence of pain and health risk factors such as smoking, alcohol use and poor mental health all rise sharply. The aim of this study was to describe the relationship between back pain and health risk factors in adolescents. Cross-sectional data from the Healthy Schools Healthy Futures study, and the Australian Child Wellbeing Project was used, mean age: 14–15 years. Children were stratified according to back pain frequency. Within each strata, the proportion of children that reported drinking alcohol or smoking or that experienced feelings of anxiety or depression was reported. Test-for-trend analyses assessed whether increasing frequency of pain was associated with health risk factors. Data was collected from ~2500 and 3900 children. Larger proportions of children smoked or drank alcohol within each strata of increasing pain frequency. The trend with anxiety and depression was less clear, although there was a marked difference between the children that reported no pain, and pain more frequently. Two large, independent s les show adolescents that experience back pain more frequently are also more likely to smoke, drink alcohol and report feelings of anxiety and depression. Pain appears to be part of the picture of general health risk in adolescents.
Publisher: BMJ
Date: 05-04-2012
Publisher: Public Library of Science (PLoS)
Date: 17-05-2016
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BERH.2017.05.002
Abstract: The evidence base regarding treatment for back pain does not align with clinical practice. Currently there is relatively little evidence to guide health decision-makers on how to improve the use, uptake or adoption of evidence-based recommended practice for low back pain. Improving the design, conduct and reporting of strategies to improve the implementation of back pain care will help address this important evidence-practice gap. In this paper, we.
Publisher: Wiley
Date: 31-01-2013
Publisher: BMJ
Date: 07-07-2021
DOI: 10.1136/BMJ.N1446
Abstract: To investigate the efficacy, acceptability, and safety of muscle relaxants for low back pain. Systematic review and meta-analysis of randomised controlled trials. Medline, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and WHO ICTRP from inception to 23 February 2021. Randomised controlled trials of muscle relaxants compared with placebo, usual care, waiting list, or no treatment in adults (≥18 years) reporting non-specific low back pain. Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty of the evidence using the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development and Evaluations, respectively. Random effects meta-analytical models through restricted maximum likelihood estimation were used to estimate pooled effects and corresponding 95% confidence intervals. Outcomes included pain intensity (measured on a 0-100 point scale), disability (0-100 point scale), acceptability (discontinuation of the drug for any reason during treatment), and safety (adverse events, serious adverse events, and number of participants who withdrew from the trial because of an adverse event). 49 trials were included in the review, of which 31, s ling 6505 participants, were quantitatively analysed. For acute low back pain, very low certainty evidence showed that at two weeks or less non-benzodiazepine antispasmodics were associated with a reduction in pain intensity compared with control (mean difference −7.7, 95% confidence interval−12.1 to−3.3) but not a reduction in disability (−3.3, −7.3 to 0.7). Low and very low certainty evidence showed that non-benzodiazepine antispasmodics might increase the risk of an adverse event (relative risk 1.6, 1.2 to 2.0) and might have little to no effect on acceptability (0.8, 0.6 to 1.1) compared with control for acute low back pain, respectively. The number of trials investigating other muscle relaxants and different durations of low back pain were small and the certainty of evidence was reduced because most trials were at high risk of bias. Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty. PROSPERO CRD42019126820 and Open Science Framework osf.io/mu2f5/ .
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 26-05-2023
DOI: 10.1186/S12961-023-00983-X
Abstract: The disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians’ motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction. We describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians’ motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas. Through formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group ( n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes. Clinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-06-2021
DOI: 10.1097/J.PAIN.0000000000002364
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.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2020
DOI: 10.1186/S12874-020-0915-5
Abstract: There are a growing number of studies using mediation analysis to understand the mechanisms of health interventions and exposures. Recent work has shown that the reporting of these studies is heterogenous and incomplete. This problem stifles clinical application, reproducibility, and evidence synthesis. This paper describes the processes and methods that will be used to develop a guideline for reporting studies of mediation analyses (AGReMA). AGReMA will be developed over five overlapping stages. Stage one will comprise a systematic review to examine relevant evidence on the quality of reporting in published studies that use mediation analysis. In the second stage we will consult a group of methodologists and applied researchers by using a Delphi process to identify items that should be considered for inclusion in AGReMA. The third stage will involve a consensus meeting to consolidate and prioritise key items to be included in AGReMA. The fourth stage will involve the production of AGReMA and an accompanying explanation and elaboration document. In the final stage we will disseminate the AGReMA statement via journals, conferences, and professional meetings across multiple disciplines. The development and implementation of AGReMA will improve the standardization, transparency, and completeness in the reporting of studies that use mediation analysis to understand the mechanisms of health interventions and exposures.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2017
Abstract: Synopsis Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants, children, and adolescents with and without cognitive impairment can be particularly challenging to clinicians for a number of reasons, including factors related to the consultation (eg, heterogeneous patient population, time constraints), the clinician (eg, awareness/knowledge of available pain scales), standardized assessment scales (eg, availability, psychometric properties, and application of each scale), the patient (eg, developmental stage, ability to communicate), and the context in which the interaction took place (eg, familiarity with the setting and physiological and psychological state). As a result, pain is frequently not assessed or measured during the consultation and, in many instances, underestimated and undertreated in this population. The purpose of this article is to provide clinicians with an overview of scales that may be used to measure pain in infants, children, and adolescents. Specifically, the paper reviews the various approaches to measure pain intensity identifies factors that can influence the pain experience, expression, and assessment in infants, children, and adolescents provides age-appropriate suggestions for measuring pain intensity in patients with and without cognitive impairment and identifies ways to assess the impact of pain using multidimensional pain scales. J Orthop Sports Phys Ther 2017 (10):712-730. doi:10.2519/jospt.2017.7469.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2017
Publisher: Cold Spring Harbor Laboratory
Date: 12-06-2021
DOI: 10.1101/2021.06.09.21258450
Abstract: To better understand the characteristics of, and requirements for, lay summaries by reviewing journals, global health organisations, professional medical associations and multi-disciplinary organisations, consumer advocacy groups and funding bodies. Using a scoping review methodology, we searched the websites of each identified data source to determine if they require, suggest, or refer to lay summaries. Two reviewers extracted lay summary writing instructions from eligible data sources from Australia, USA, UK, Canada and New Zealand. Data sources were linked to the top 10 non-communicable diseases. Using an inductive approach, we identified characteristics of lay summaries and lay summary writing instructions and extracted data on these characteristics. These characteristics are lay summary formats, audience, requirements, authorship and labels, and elements of lay summary writing instructions (e.g. word count/length). We also noted who was expected to write the lay summaries, whether they were mandatory or optional, and the terms used for to denote them. The websites of 526 data sources were searched. Of these, 124 published or mentioned lay summaries and 108 provided writing instructions. For lay summaries, most were in journals, written by the author of the published paper, and only half were mandatory. Thirty-three distinct labels for a lay summary were identified, the most common being “graphical abstract”, “highlights” and “key points”. From the lay summary writing instructions, the most common elements for written lay summaries referred to: structure (86%), content (80%) and word count/length (74%). The least common elements were readability (3%), use of jargon, acronyms and abbreviations (24%), and wording (29%). The target audience was unclear in 68 of 108 (63.0%) of lay summary instructions. Although we identified over 100 sources provided instructions for writing lay summaries, very few provided instructions related to readability, use of jargon, acronyms and abbreviations, and wording. Some instructions provided structured formats via subheadings or questions to guide content, but not all. Only half mandated the use of lay summaries. For lay summaries to be effective, writing instructions should consider the intended audience, ideally incorporating consumer input into their development. Presently, lay summaries are likely to be inaccessible to many consumers, written at a high reading level, with jargon, acronyms and abbreviations. Ideally, all research articles will have an accompanying lay summary. Mandatory lay summaries, however, are of limited value without clear and thorough instructions to guide authors. Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research study. We conducted a scoping review using methods outlined in the PRISMA extension for scoping reviews and information in the Joanna Briggs Institute Reviewers’ Manual for scoping reviews. A protocol for this study was completed prior to data analysis and is on Open Science Framework.
Publisher: Wiley
Date: 29-09-2016
DOI: 10.1071/HE16056
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3514702
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JMPT.2014.10.016
Abstract: The purpose of this study was to identify factors that influence recruitment of patients to an observational study of low back pain (LBP). From 1147 primary care (first health contact) clinicians initially contacted, 138 (physiotherapists and chiropractors) agreed to participate in a large observational study of LBP and were the focus of the current study. Data were collected pertaining to clinicians' characteristics, operational factors, and the number of patients recruited. The association of a variety of clinician characteristics and operational factors with recruitment rate was determined using a multivariate negative binomial regression analysis. From October 2011 to November 2012, 1585 patients were screened by 138 study clinicians with 951 eligible patients entering the observational study. Clinicians who were members of their professional association had a recruitment rate less than half that of those who were nonmembers (P < .0001). Clinicians who were trained by telephone had a recruitment rate 4.01 times higher than those trained face to face (P < .0001). Similarly, clinicians who referred a larger number of ineligible participants had a slightly higher recruitment rate with an incident rate ratio of 1.04 per ineligible patient (P < .0001). Other clinicians' characteristics and operational factors were not associated with recruitment. This study provides evidence that it is feasible to recruit participants from primary care practices to a simple observational study of LBP. Factors identified as influencing recruitment were professional association (negative association), training by telephone, and referring a higher number of ineligible participants.
Publisher: Springer Science and Business Media LLC
Date: 21-11-2022
DOI: 10.1186/S12913-022-08741-5
Abstract: Physiotherapists deliver evidence-based guideline recommended treatments only half of the time to patients with musculoskeletal conditions. Physiotherapists’ behaviour in clinical practice are influenced by many cognitive, social, and environmental factors including time and financial pressures. Many initiatives aimed at improving physiotherapists’ uptake of evidence-based care have failed to appreciate the context involved in clinical decisions and clinical practice. Therefore, we aimed to describe: i) opinions toward evidence ii) how evidence is accessed iii) factors influencing evidence access iv) factors influencing evidence application, for physiotherapists working in regional areas. We used a mixed-methods study with online survey and focus groups. We included registered physiotherapists in the survey and physiotherapists practising in regional New South Wales in the focus groups. Quantitative and qualitative data were used to inform all research objectives. We used eight domains of the Transtheoretical Domains Framework to design survey questions. We analysed quantitative and qualitative data in parallel, then integrated both sources through by developing a matrix while considering the Transtheoretical Domains Framework domains to generate themes. Fifty-seven physiotherapists participated in the study (survey only n = 41 focus group only n = 8 both survey and focus group n = 8). Participants reported that evidence was important, but they also considered patient expectations, colleagues’ treatment choices, and business demands in clinical decision making. Physiotherapists reported they access evidence on average 30 minutes or less per week. Competing demands like business administration tasks are barriers to accessing evidence. Participants reported that patient expectations were a major barrier to applying evidence in practice. Environmental and systemic factors, like funding structures or incentives for evidence-based care, and social factors, like lacking or having a culture of accountability and mentorship, were reported as both barriers and enablers to evidence application. This study provides context to physiotherapists’ opinion, access, and application of evidence in clinical practice. Physiotherapists’ provision of evidence-based care may be improved by enhancing structural support from workplaces to access and apply evidence and exploring discrepancies between physiotherapists’ perceptions of patient expectations and actual patient expectations.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2022
Abstract: To assess the effectiveness of patient education with "myths and facts" versus "facts only" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP). Randomized Study Within A Trial. One hundred fifty-two participants with chronic LBP were included. Participants allocated to the "facts only" group received an information sheet with 6 LBP facts, whereas those allocated to the "myths and facts" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet. There was no evidence of a difference in the proportion of participants with a correct recall between the "myths and facts" and "facts only" groups (odds ratio = 0.98 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3 95% CI: -4.56, -0.04). We found no overall difference in the recall of back pain information for patients provided with "myths and facts" compared with that for patients provided with "facts only" and a slight reduction in fear-avoidance beliefs for physical activity using "myths and facts" compared with that using "facts only," but the meaningfulness of this result is uncertain.
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-029290
Abstract: Low back pain is one of the most common and burdensome chronic conditions worldwide. Lifestyle factors, such as excess weight, physical inactivity, poor diet and smoking, are linked to low back pain chronicity and disability. There are few high-quality randomised controlled trials that investigate the effects of targeting lifestyle risk factors in people with chronic low back pain. The aim of this study is to determine the effectiveness of a Healthy Lifestyle Program (HeLP) for low back pain targeting weight, physical activity, diet and smoking to reduce disability in patients with chronic low back pain compared with usual care. This is a randomised controlled trial, with participants stratified by body mass index, allocated 1:1 to the HeLP intervention or usual physiotherapy care. HeLP involves three main components: (1) clinical consultations with a physiotherapist and dietitian (2) educational resources and (3) telephone-based health coaching support for lifestyle risk factors. The primary outcome is disability (Roland Morris Disability Questionnaire) at 26 weeks. Secondary outcomes include pain intensity, weight, quality of life and smoking status. Data will be collected at baseline, and at weeks 6, 12, 26 and 52. Patients with chronic low back pain who have at least one health risk factor (are overweight or obese, are smokers and have inadequate physical activity or fruit and vegetable consumption) will be recruited from primary or secondary care, or the community. Primary outcome data will be analysed by intention to treat using linear mixed-effects regression models. We will conduct three supplementary analyses: causal mediation analysis, complier average causal effects analysis and economic analysis. This study was approved by the Hunter New England Research Ethics Committee (Approval No 17/02/15/4.05), and the University of Newcastle Human Research Ethics Committee (Ref No H-2017-0222). Outcomes of this trial and supplementary analyses will be disseminated through publications in peer-reviewed journals and conference presentations. ACTRN12617001288314.
Publisher: Wiley
Date: 14-10-2020
DOI: 10.1002/MSC.1520
Abstract: Social deprivation is broadly defined as the restriction of access an in idual has to social or cultural interactions due to poverty, discrimination or other disadvantages. While social deprivation is a widely acknowledged determinant of outcome in musculoskeletal conditions, it remains unclear how this is considered in the conduct and interpretation of musculoskeletal trials. To determine the frequently to which measures of social deprivation are reported in trials recruiting people with musculoskeletal diseases. We conducted a Pubmed search of randomised controlled trials published between 01 January 2019 and 01 June 2020. We included full‐text papers of trials recruiting people with musculoskeletal diseases, irrespective of intervention type or origin. We extracted data relating to trial characteristics, setting, trial design, funding source and musculoskeletal disease. We extracted data on any reported social deprivation index or measure of social deprivation based on internationally adopted indicators. We analysed data descriptively to summarise the reporting of each social deprivation index and measure of social deprivation within trials. From 2133 potentially eligible citations, 402 were eligible. Mean age of participants was 51.7 years 63% were female. Trials most frequently recruited people with spinal pain (24.6%) or osteoarthritis (10.0%). Two trials (0.5%) reported social deprivation indices/scores. When assessed by discrete measures of social deprivation, 164 trials (40.8%) reported one or more social deprivation measures. The most commonly reported measures were morbidity (20.2%), employment status (17.7%) and educational attainment (15.5%). Race (6.7%), ethnicity (6.2%) and annual salary (1.3%) were infrequently reported. One trial (0.3%) presented subgroup results by social deprivation measures. Social deprivation is inconsistently reported in musculoskeletal trials. Trialists should report baseline measures of social deprivation in trial reports and aid generalisability to target population, and to examine whether social deprivation might modify treatment effects of interventions for musculoskeletal conditions.
Publisher: BMJ
Date: 26-08-2020
DOI: 10.1136/BMJEBM-2020-111406
Abstract: Mediation analysis is a widely used quantitative method for investigating how interventions and exposures in randomised controlled trials and observational studies have an effect on healthcare outcomes. This study aimed to assess the importance of items that should be considered in a consensus meeting aimed at developing a guideline for reporting mediation analyses. International online Delphi study. International experts in the development and application of mediation analysis. The Delphi panel were asked to rate the importance of a list of items for inclusion in a guideline for reporting mediation analyses. Thresholds for disagreement and consensus on importance for inclusion were specified a priori. We used the Research ANd Development/University of California Los Angeles appropriateness method to quantitatively assess the importance for inclusion and panel agreement. Nineteen expert panellists (10 female) from seven countries agreed to participate. All panellists contributed to all three rounds conducted between 10 June 2019 and 6 November 2019. The panel reached consensus on 34 unique reporting items for study design, analytic procedures and effect estimates, with three items rated ‘optional’. Panellists added one extra item and provided 60 qualitative comments for item refinement and prioritisation. This Delphi study used a rigorous consensus process to reach consensus on 34 reporting items for studies that use mediation analysis. These results will inform a consensus meeting that will consolidate a core set of recommended items for reporting mediation analyses.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JCLINEPI.2019.03.005
Abstract: The objective of this study was to investigate whether systematic reviews of mediation studies identify limitations in reporting quality and methodological conduct. We conducted an overview of systematic reviews. We searched four databases (MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and PubMed) to identify systematic reviews of studies that used mediation analysis to investigate mechanisms of health care interventions or exposures in clinical populations between 2007 and 2017. Two reviewers independently screened titles and abstracts. Summary data on the characteristics, reporting quality, and methodological conduct of the studies included in the systematic reviews were extracted independently by two reviewers. The protocol was prospectively registered on PROSPERO (CRD42017059834). Fifty-four systematic reviews were included, representing 11 health care fields, 26 health conditions, and 2008 mediation studies. Eighteen of fifty-four systematic reviews (33%) explicitly stated that the reporting of primary studies was suboptimal. Of these, 14/18 (78%) reviews noted incomplete reporting of effect sizes and precision estimates from mediation analyses. Twenty-nine of fifty-four systematic reviews (54%) identified limitations in the methodological conduct of primary studies. The reporting and methodological conduct of studies investigating mechanisms in health care seems to be suboptimal. Guidance is needed to improve the quality, completeness, and transparency of mediation studies.
Publisher: BMJ
Date: 06-2015
Publisher: BMJ
Date: 17-04-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-08-2019
DOI: 10.1097/J.PAIN.0000000000001685
Abstract: In 2014, the Paracetamol for Acute Low Back Pain (PACE) trial demonstrated that paracetamol had no effect compared with placebo in acute low back pain (LBP). However, noncompliance was a potential limitation of this trial. The aim of this study was to investigate the efficacy of paracetamol in acute LBP among compliers. Using in idual participant data from the PACE trial (ACTN12609000966291), complier average causal effect (CACE), intention-to-treat, and per protocol estimates were calculated for pain intensity (primary), disability, global rating of symptom change, and function (all secondary) after 2 weeks of follow-up. Compliance was defined as intake of an average of at least 4 of the prescribed 6 tablets of regular paracetamol per day (2660 mg in total) during the first 2 weeks after enrolment. Exploratory analyses using alternative time points and definitions of compliance were conducted. Mean between-group differences in pain intensity on a 0 to 10 scale using the primary time point and definition of compliance were not clinically relevant (propensity-weighted CACE 0.07 [−0.37 to 0.50] P = 0.76 joint modelling CACE 0.23 [−0.16 to 0.62] P = 0.24 intention-to-treat 0.11 [−0.20 to 0.42] P = 0.49 per protocol 0.29 [−0.07 to 0.65] P = 0.12) results for secondary outcomes and for exploratory analyses were similar. Paracetamol is ineffective for acute LBP even for patients who comply with treatment. This reinforces the notion that management of acute LBP should focus on providing patients advice and reassurance without the addition of paracetamol.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Publisher: Springer Science and Business Media LLC
Date: 19-11-2013
Abstract: Depression is a mental health condition which affects millions of people each year, with worldwide rates increasing. Cognitive behavioral therapy (CBT) is recommended in the National Institute for Health and Clinical Excellence (NICE) guidelines for the treatment of depression. However, waiting lists can cause delays for face-to-face therapy. Also a proportion of people decline to present for help through the health service – the so-called treatment gap. Self-referral to CBT using community-based group interventions delivered by a voluntary sector organization may serve to resolve this problem. The aim of this randomized controlled trial (RCT) is to determine the efficacy of such a guided CBT self-help course, the ‘Living Life to the Full’ (LLTTF) classes delivered by the charity Action on Depression (AOD). The primary outcome is level of depression at 6 months assessed using the patient health questionnaire-9 (PHQ9) depression scale. Secondary measures include levels of anxiety and social functioning. Participants with symptoms of low mood will be recruited from the community through newspaper adverts and also via the AOD website. Participants will receive either immediate or delayed access to guided CBT self-help classes - the eight session LLTTF course. The primary endpoint will be at 6 months at which point the delayed group will be offered the intervention. Levels of depression, anxiety and social functioning will be assessed and an economic analysis will be carried out. This RCT will test whether the LLTTF intervention is effective and/or cost-effective. If the LLTTF community-based classes are found to be cost effective, they may be helpful as both an intervention for those already seeking care in the health service, as well as those seeking help outside that setting, widening access to psychological therapy. Current Controlled Trials ISRCTN86292664
Publisher: Wiley
Date: 25-04-2016
DOI: 10.1002/OBY.21459
Abstract: This review aimed to examine the impact of interventions involving an explicit sleep component on child body mass index (BMI), diet, and physical activity. A systematic search was undertaken in six databases to identify randomized controlled trials examining the impact of interventions with a sleep component on child BMI, dietary intake, and/or physical activity. A random effects meta-analysis was conducted assessing the impact of included interventions on child BMI. Of the eight included trials, three enforced a sleep protocol and five targeted sleep as part of multicomponent behavioral interventions either exclusively or together with nutrition and physical activity. Meta-analysis of three studies found that multicomponent behavioral interventions involving a sleep component were not significantly effective in changing child BMI (n = 360,-0.04 kg/m(2) [-0.18, 0.11], I(2) = 0%) however, only one study included in the meta-analysis successfully changed sleep duration in children. There were some reported improvements to adolescent diet, and only one trial examined the impact on child physical activity, where a significant effect was observed. Findings from the included studies suggest that where improvements in child sleep duration were achieved, a positive impact on child BMI, nutrition, and physical activity was also observed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Wiley
Date: 13-07-2023
Publisher: Wiley
Date: 17-05-2017
Publisher: Springer Science and Business Media LLC
Date: 02-09-2020
DOI: 10.1186/S13643-020-01453-Z
Abstract: Maternal behaviours in pregnancy associated with adverse pregnancy, birth and health outcomes include tobacco smoking, poor nutrition, alcohol consumption and low physical activity, collectively referred to as the SNAP risk factors. Due to the high prevalence, co-occurrence and possible interactive health effects of such health behaviours in pregnancy, antenatal interventions that support pregnant women to improve multiple SNAP behaviours have a greater potential impact on the health outcomes of women and their children than interventions addressing single behaviours. The objective of this review is to determine the effectiveness of interventions delivered as part of antenatal care that aim to improve multiple SNAP behaviours among pregnant women. Seven electronic databases will be searched for potentially eligible studies. Eligible studies will include those where pregnant women are attending antenatal care. Studies that examine the effect of an intervention that addresses multiple SNAP behaviours (≥ 2 behaviours) during pregnancy and are delivered or instigated through antenatal care in a healthcare service will be included. Systematic reviews of randomised controlled trials (RCTs), RCTs, cluster RCTs, stepped-wedge RCTs and non-randomised control trials will be eligible. Studies that include a no-intervention control, wait-list control group, standard/usual care, or another active single behavioural intervention (e.g. addressing one behaviour only) will be considered. Two independent reviewers will conduct study screening, data extraction and risk of bias assessment. Discrepancies will be resolved by consensus or a third reviewer if required. A random effects model will be used to synthesise the results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarising effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form. The review will synthesise the evidence on the effect of interventions that address multiple SNAP behaviours in antenatal care and will help researchers, policy-makers and health services to develop and deliver best practice integrated models of antenatal care that have the potential to impact on both the short- and long-term health outcomes for women and their children. PROSPERO CRD42018095315
Publisher: IOP Publishing
Date: 2011
Publisher: BMJ
Date: 2013
Publisher: BMJ
Date: 18-01-2021
DOI: 10.1136/BMJ.M3721
Publisher: JMIR Publications Inc.
Date: 26-11-2019
Abstract: eople with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. his study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. harmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25 total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5 90th percentile compared with similar systems), with acceptance rated as good to excellent. novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study s le limits the generalizability of the findings but offers important insights to inform the next stage of system development.
Publisher: JMIR Publications Inc.
Date: 02-04-2014
DOI: 10.2196/RESPROT.3071
Publisher: MDPI AG
Date: 15-06-2023
Abstract: The Australian National Preventive Health Strategy 2021–2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex concept 1: primary and/or secondary prevention interventions concept 2: full economic evaluation context: local public health services as the provider of concept 1. The search identified 472 articles 26 were included. Focus health areas included mental health (n = 3 reviews), obesity (n = 1), type 2 diabetes (n = 3), dental caries (n = 2), public health (n = 4), chronic disease (n = 5), sexual health (n = 1), immunisation (n = 1), smoking cessation (n = 3), reducing alcohol (n = 1), and fractures (n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2014
Publisher: Springer Science and Business Media LLC
Date: 15-09-2021
DOI: 10.1186/S13063-021-05566-1
Abstract: There is a lack of high-quality evidence underpinning many contemporary clinical practice guidelines embedded in the healthcare systems, leading to treatment uncertainty and practice variation in most medical disciplines. Comparative effectiveness trials (CETs) represent a erse range of research that focuses on optimising health outcomes by comparing currently approved interventions to generate high-quality evidence to inform decision makers. Yet, despite their ability to produce real-world evidence that addresses the key priorities of patients and health systems, many implementation challenges exist within the healthcare environment. This manuscript aims to highlight common barriers to conducting CETs and describes potential solutions to normalise their conduct as part of a learning healthcare system.
Publisher: Wiley
Date: 29-08-2022
Publisher: BMJ
Date: 06-2017
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.YPMED.2018.11.014
Abstract: Implementation of interventions in community organisations such as schools, childcare centres, and sporting clubs are recommended to target a range of modifiable risks of non-communicable diseases. Poor implementation, however, is common and has contributed to the failure of non-communicable disease interventions globally. This study aimed to characterise experimental research regarding strategies to improve implementation of chronic disease prevention programs in community settings. The review used data collected in three comprehensive systematic reviews undertaken between August 2015 and July 2017. Randomised controlled trials, including cluster design, and non-randomised trials with a parallel control group were included. The data were extracted to describe trial characteristics, implementation strategies employed, implementation outcomes and study quality. Of the 40 implementation trials included in the study, unhealthy diet was the most common risk factor targeted (n = 20). The most commonly reported implementation strategies were educational meetings (n = 38, 95%), educational materials (n = 36, 90%) and educational outreach visits (n = 29, 73%). Few trials were conducted 'at-scale' (n = 8, 20%) or reported adverse effects (n = 5, 13%). The reporting of implementation related outcomes intervention adoption (n = 13, 33%) appropriateness (n = 11, 28%) acceptability (n = 8, 20%) feasibility (n = 8, 20%) cost (n = 3, 8%) and sustainability (n = 2, 5%) was limited. For the majority of trials, risk of bias was high for blinding of study personnel articipants and outcome assessors. Testing of strategies to improve implementation of non-communicable disease prevention strategies in community settings, delivered 'at-scale', utilising implementation frameworks, including a comprehensive range of implementation outcomes should be priority areas for future research in implementation science.
Publisher: Wiley
Date: 29-11-2017
Publisher: Springer Science and Business Media LLC
Date: 08-03-2023
DOI: 10.1186/S12889-023-15329-Z
Abstract: Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. We pre-registered the study on Open Science Framework osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. We identified 8618 unique records, 96 met our criteria for inclusion – involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09–0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05–0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p 0.001) 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.
Publisher: BMJ
Date: 20-11-2013
Publisher: PeerJ
Date: 30-10-2018
DOI: 10.7717/PEERJ.5846
Abstract: Osteoarthritis and spinal pain are common and burdensome conditions however, the majority of patients with these conditions do not receive care that is consistent with clinical practice guidelines. Telehealth models of care have the potential to improve care for osteoarthritis and spinal pain patients. The aim of this review was to assess the effectiveness of verbal real-time telehealth interventions, including telephone-based and videoconferencing interventions to reduce pain intensity and disability in patients with osteoarthritis of the knee or hip and spinal pain (back or neck pain). We searched seven electronic databases from inception to May 2018. Randomised controlled trials (RCTs), cluster-RCTs, and non-randomised controlled trials were included. Two review authors independently extracted data for each included study. Primary outcomes were pain intensity and disability. We conducted primary meta-analyses combining all conditions with similar interventions and comparators. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. We used the Cochrane Risk of Bias tool to assess risk of bias, and GRADE to evaluate the quality of evidence. We included 23 studies with 56 trial arms and 4,994 participants. All studies utilised telephone-based interventions. Only two studies used a telephone only approach and the remainder included educational materials and/or face-to-face components. We found no studies utilising videoconferencing. Meta-analysis showed telephone-based interventions (with educational materials) for osteoarthritis and spinal pain improved pain intensity ( n = 5 trials, n = 1,357 participants, SMD −0.27, 95% CI [−0.53, −0.01], Tau 2 = 0.06, I 2 = 74% moderate-quality evidence) and disability ( n = 7 trials, n = 1,537 participants, SMD −0.21, 95% CI [−0.40, −0.02], Tau 2 = 0.03, I 2 = 56% moderate-quality evidence) compared to usual care. Meta-analyses found telephone with face-to-face interventions does not improve pain and disability compared to usual care or face-to-face care alone. We are moderately confident that telephone-based interventions reduce pain intensity and disability in patients with osteoarthritis and spinal pain compared to usual care, but telephone plus face-to-face interventions are no more effective than usual care or face-to-face interventions alone.
No related grants have been discovered for Christopher Williams.