ORCID Profile
0000-0001-5210-8548
Current Organisation
Bond University
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Publisher: Wiley
Date: 09-2013
Abstract: When working with in iduals following stroke or traumatic brain injury, an important role of the occupational therapist is to assess the impact of cognitive impairment on their ability to engage in occupations and resume important life roles. The aim of this study was to survey therapists' reasons for selection of and challenges with using various cognitive assessment approaches, across the continuum of care, when working with in iduals following stroke and traumatic brain injury. A cross-sectional survey, completed via post or online, with responses from 209 Australian occupational therapists was conducted. Participants included clinicians working in acute, inpatient rehabilitation and community settings. Occupational performance-based assessments were ranked as the most important assessment method, with 69% of participants reporting using these assessments for more than 75% of their clients with cognitive impairment. Participants identified the lack of quantitative data provided by these assessments as a frequent challenge. The identification of cognitive deficits was the highest ranked reason for using cognitive screens and batteries. Challenges identified with using cognitive screens and batteries included difficulty linking assessment results to occupational performance, and difficulty using results to generate intervention strategies. The majority of participants reported using a combined approach to assessment, and used screens and batteries to support findings of occupational performance-based assessments. Targeted efforts to further incorporate standardised occupational performance-based methods into clinical practice, research, and ongoing professional development is required to enhance occupational therapy services when working with in iduals with cognitive impairment.
Publisher: Informa UK Limited
Date: 13-04-2022
DOI: 10.1080/09638288.2021.1910737
Abstract: The context of implementation plays an important role in the delivery of optimal treatments in stroke recovery and rehabilitation. Considering that stroke systems of care vary widely across the globe, the goal of the present paper is to compare healthcare providers' priority of key areas in translating stroke research to clinical practice among High Income Countries, Upper Middle- and Lower Middle-Income Countries (HICs, UMICs, LMICs). We also aimed to compare perceptions regarding the key areas' feasibility of implementation, and formulate recommendations specific to each socioeconomic region. Data related to recommendations for knowledge translation in stroke, from a primary survey from the second Stroke Recovery and Rehabilitation Roundtable were segregated based on socioeconomic region. Frequency distribution was used to compare the key areas for practice change and examine the perceived feasibility of implementation of the same across HIC, UMIC and LMICs. A total of 632 responses from healthcare providers across 28 countries were received. Interdisciplinary care and access to services were high priorities across the three groups. Transitions in Care and Intensity of Practice were high priority areas in HICs, whereas Clinical Practice Guidelines were a high priority in LMICs. Interventions specific to clinical discipline, screening and assessment were among the most feasible areas in HICs, whereas Intensity of practice and Clinical Practice Guidelines were perceived as most feasible to implement in LMICs. We have identified healthcare providers' priorities for addressing international practice change across socioeconomic regions. By focusing on the most feasible key areas, we can aid the channeling of appropriate resources to bridge the disparities in stroke outcomes across HICs, UMICs and LMICs.IMPLICATIONS FOR REHABILITATIONIt is pertinent to examine the differences in priorities of stroke rehabilitation professionals and the feasibility of implementing evidence-based practice across socioeconomic regions.There is an urgent necessity for the development of clinical practice guidelines for stroke rehabilitation in Low-Middle Income Countries, taking into consideration the cultural, economic and geographical constraints.In upper-middle income countries, encouraging family support and timely screening and assessment for aphasia, cognition and depression appear to be the low hanging fruits to enhance quality of life after stroke.Innovative ways to increase intensity of practice and channelling of resources to improve transitions in care may prove to be the most beneficial in advancing stroke rehabilitation in high income countries.
Publisher: Mark Allen Group
Date: 07-2004
DOI: 10.12968/IJTR.2004.11.7.13357
Abstract: This study aimed to determine current practice in the provision of written information to 57 stroke patients and their carers. It also explored their informational needs while in hospital and 6months later and examined the suitability of the written materials received, comparing readability levels to participants' general reading ability. While in hospital, 22.8% of patients and 41.7% of carers received written information, yet 91.2% of patients and 100% of carers wanted information. More than half of the participants wanted information on preventing strokes, causes and risk factors of stroke, recovery, what a stroke is, stroke-related medications and sources of further information. At 6months after stroke, 75.5% of patients and all carers wanted further information. The mean SMOG readability level of the written materials received was equivalent to a grade 11 level of education, compared to the patients' mean reading ability, which was equivalent to a 7th–8th grade reading level. The authors conclude that stroke patients and their carers want substantially more information than they are receiving, both while in hospital and 6months later. The majority of written information that is distributed to these people is unsuitable in terms of readability levels and other factors.
Publisher: Public Library of Science (PLoS)
Date: 29-03-2012
Publisher: SAGE Publications
Date: 07-2017
Abstract: Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n = 182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
Publisher: Elsevier BV
Date: 06-2021
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJOPEN-2020-037820
Abstract: Overuse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain. A qualitative evidence synthesis using a thematic analysis. We searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method. We included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence) patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence) and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients’ expectations (12 studies, moderate confidence). Clinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention. CRD42017076047.
Publisher: John Wiley & Sons, Ltd
Date: 08-10-2013
Publisher: CMA Joule Inc.
Date: 17-11-2015
DOI: 10.1503/CMAJ.140848
Publisher: Elsevier BV
Date: 2023
Publisher: FapUNIFESP (SciELO)
Date: 19-12-2015
DOI: 10.1590/1516-3180.2013.8040011
Abstract: CONTEXT AND OBJECTIVE: The current paradigm of science is to accumulate as much research data as possible, with less thought given to navigation or synthesis of the resulting mass, which h ers locating and using the research. The aim here was to describe the number of randomized controlled trials (RCTs) and systematic reviews (SRs) focusing on exercise, and their journal sources, that have been indexed in PubMed over time. DESIGN AND SETTING: Descriptive study conducted at Bond University, Australia. METHOD: To find RCTs, a search was conducted in PubMed Clinical Queries, using the category "Therapy" and the Medical Subject Headings (MeSH) term "Exercise". To find SRs, a search was conducted in PubMed Clinical Queries, using the category "Therapy", the MeSH term "Exercise" and various methodological filters. RESULTS: Up until 2011, 9,354 RCTs about exercise were published in 1,250 journals and 1,262 SRs in 513 journals. Journals in the area of Sports Science published the greatest number of RCTs and journals categorized as belonging to "Other health professions" area (for ex le nursing or psychology) published the greatest number of SRs. The Cochrane Database of Systematic Reviews was the principal source for SRs, with 9.8% of the total, while the Journal of Strength and Conditioning Research and Medicine & Science in Sports & Exercise published 4.4% and 5.0% of the RCTs, respectively. CONCLUSIONS: The rapid growth and resulting scatter of RCTs and SRs on exercise presents challenges for locating and using this research. Solutions for this issue need to be considered.
Publisher: Springer Science and Business Media LLC
Date: 06-10-2018
Publisher: Oxford University Press (OUP)
Date: 14-03-2007
Abstract: The ideal method of providing stroke patients with information has not been established. To evaluate the effectiveness of providing stroke patients with computer-generated tailored written information. Randomised controlled trial with blinded assessor. Acute stroke unit. 138 stroke patients. Patients were randomised to receive either computer-generated tailored written information about stroke or generic written information while in hospital. Three months following discharge, a blinded assessor evaluated the outcomes of knowledge about stroke, self-efficacy (Self-Efficacy to Perform Self-Management Behaviours Scale), anxiety and depression (Hospital Anxiety and Depression (HAD) Scale), perceived health status (COOP charts), satisfaction with content and presentation of the written information received (separate 10-point visual analogue scale for content and presentation), and desire for additional information. Complete data were obtained for 133 (96.4%) patients. Patients in the intervention group were significantly more satisfied with the content (difference on a 10-point visual analogue scale was 1, 95% confidence interval 0.4 to 1.7, P = 0.003) and presentation (difference on a 10-point visual analogue scale was 1.2, 95% confidence interval 0.6 to 1.9, P < 0.001). Significantly, fewer patients in the intervention group desired additional information about stroke at follow-up than patients in the control group (4.5% versus 32.8% P < 0.001). Anxiety change scores improved slightly more in favour of the control group (1.4 difference on the HAD subscale, 95% confidence interval 0.2 to 2.8, P = 0.03). No significant differences between the groups were observed for any of the other outcome measures. Providing stroke patients with computer-generated tailored written information improved satisfaction with the information that was received and was more effective in meeting patients' informational needs than non-tailored information, but had no effect on knowledge about stroke, self-efficacy, depression, or perceived health status.
Publisher: Elsevier BV
Date: 06-2020
Publisher: BMJ
Date: 30-07-2018
DOI: 10.1136/BMJ.K3229
Publisher: Informa UK Limited
Date: 12-2011
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2023-072553
Abstract: To develop and user-test a patient decision aid portraying the benefits and harms of non-surgical management and surgery for Achilles tendon ruptures. Mixed methods. A draft decision aid was developed using guidance from a multidisciplinary steering group and existing patient decision aids. Participants were recruited through social media. People who have previously sustained an Achilles tendon rupture and health professionals who manage these patients. Semi-structured interviews and questionnaires were used to gather feedback on the decision aid from health professionals and patients who had previously suffered an Achilles tendon rupture. The feedback was used to redraft the decision aid and assess acceptability. An iterative cycle of interviews, redrafting according to feedback and further interviews was used. Interviews were analysed using reflexive thematic analysis. Questionnaire data were analysed descriptively. We interviewed 18 health professionals (13 physiotherapists, 3 orthopaedic surgeons, 1 chiropractor, 1 sports medicine physician) and 15 patients who had suffered an Achilles tendon rupture (median time since rupture was 12 months). Most health professionals and patients rated the aid’s acceptability as good-excellent. Interviews showcased agreement among health professionals and patients on most aspects of the decision aid: introduction, treatment options, comparing benefits and harms, questions to ask health professionals and formatting. However, health professionals had differing views on details about Achilles tendon retraction distance, factors that modify the risk of harms, treatment protocols and evidence on benefits and harms. Our patient decision aid is an acceptable tool to both patients and health professionals, and our study highlights the views of key stakeholders on important information to consider when developing a patient decision aid for Achilles tendon rupture management. A randomised controlled trial evaluating the impact of this tool on the decision-making of people considering Achilles tendon surgery is warranted.
Publisher: Wiley
Date: 03-2006
Publisher: Springer Science and Business Media LLC
Date: 02-11-2015
Publisher: SAGE Publications
Date: 29-10-2019
Abstract: Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.
Publisher: Informa UK Limited
Date: 06-2013
DOI: 10.2147/CIA.S45891
Publisher: Elsevier BV
Date: 04-2016
Publisher: Oxford University Press (OUP)
Date: 10-07-2023
DOI: 10.1093/HER/CYAD029
Abstract: Making informed health decisions requires knowledge and skills in appraising health claims, and teaching adolescents these skills may prepare them for future decision-making. This cluster randomized trial evaluated the effectiveness of an educational intervention on students’ ability to identify and appraise health claims. Nine Australian high schools (4 control and 5 intervention) were recruited, comprising 974 students (382 control and 592 intervention) in Grades 7–10. Intervention impact was evaluated through baseline and follow-up evaluation. Follow-up mean scores on questions (maximum score of 25) from the Claim Evaluation Tools database (primary outcome) showed minimal between-group difference (intervention versus control: 14.4 versus 13.6 difference 0.8, 95% confidence interval [CI] −1.6 to 3.1 P = 0.52). Change scores were only slightly higher in the intervention group (difference 1.2 [95% CI −0.7 to 3.1 P = 0.21]). Between-group differences for secondary outcomes were also minimal. Most intervention group students ‘trusted’ and ‘liked’ the programme and found the content ‘easy’ and ‘helpful’. Most teacher feedback was positive, some noting challenges of covering content in allocated time and maintaining student engagement. It is unlikely that the assessed educational intervention had a large effect. Future research priorities are suggested.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 14-01-2015
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 2020
Abstract: While advances in assessment and management of musculoskeletal conditions have improved care for many people, there have been other, less beneficial developments in the provision of care for people with musculoskeletal pain conditions, one of which is the worrying tendency to provide too much medicine. Too much medicine occurs when the provision of either investigation or intervention (or both) is unjustifiably excessive. Another concern in musculoskeletal health care is medicalizing normality-when a normal human function or condition is labeled as abnormal. In this Viewpoint, the authors argue that medicalizing normality creates health concerns where none exist, while too much medicine involves provision of care where benefits do not outweigh harms, and wastes precious health care resources. The authors (1) list 2 common ex les of too much medicine, and 2 ex les of medicalizing normality, relevant to physical therapy practice (2) outline the drivers of too much medicine and medicalizing normality and (3) make suggestions for change.
Publisher: Wiley
Date: 10-2009
DOI: 10.1111/J.1440-1630.2008.00764.X
Abstract: Cognitive impairment is a common and often debilitating consequence of stroke. The current practice patterns of Australian occupational therapists who work in this area are not clearly known. The aim of this study was to investigate the theoretical approaches, assessments, interventions and research evidence used by Australian occupational therapists who work with patients who have cognitive impairment poststroke. A self-administered, purpose-designed online survey was used. Survey responses were received from 102 occupational therapists. The client-centred approach was the most commonly used theoretical approach, with 81.3% and 72% using it often or all of the time with inpatients and outpatients, respectively. Assessments that were most frequently used were the Mini Mental State Examination (63.7% of participants), the Lowenstein Occupational Therapy Cognitive Assessment (45.1%), the Functional Independence Measure (57.8%, and the Assessment of Living Skills and Resources (10.0%). Interventions involving functional activities were used more frequently than compensatory techniques, such as diaries, alarms, or other electronic devices, and paper and pencil remedial exercises. Few (16%) participants used computer programs specifically designed for cognitive rehabilitation. Although 60.8% of the participants reported using research literature when making decisions about interventions, a higher percentage reported relying on their past experience (88.3%) and colleagues' opinions (77.4%). This study provides an insight into the current practices of Australian occupational therapists who work with people who have cognitive impairment after stroke. Client-centredness is emphasised in current practice however, the use of research evidence to inform practice appears to be limited.
Publisher: BMJ
Date: 2013
Publisher: Oxford University Press (OUP)
Date: 17-09-2013
DOI: 10.1093/HER/CYT091
Abstract: The objectives of this study were to describe the sources of falls prevention information provided to older adults during and after hospitalization, identify and explore reasons why discussion about falls prevention may not take place. Six participant groups were interviewed using semi-structured interviews or focus groups: (i) older patients (n = 16) (ii) caregivers (n = 8) (iii) allied health and nursing professionals (n = 33) (iv) doctors from acute wards (n = 8) (v) doctors from subacute wards (n = 10) and (vi) general practitioners (n = 9). Participants were recruited from three Australian hospitals that provided acute and subacute in-patient services to the older adults. General practitioners were recruited from the community of Melbourne. Findings showed provision of falls prevention information was dependent on setting of the ward and which health professionals the older adult encountered during and after hospitalization. Medical practitioners were reactive in providing information, whereas older adults and their caregivers were passive in seeking falls prevention information. Several barriers in information provision and information seeking were identified. There is great potential to improve the consistency of falls prevention information provision to older adults during hospitalization and in preparation for discharge to assist with prevention of falls in this high risk period.
Publisher: BMJ
Date: 16-05-2017
DOI: 10.1136/BMJ.J2234
Publisher: American Medical Association (AMA)
Date: 09-2022
DOI: 10.1001/JAMAONCOL.2022.2867
Abstract: Emerging policies drafted by the pharmaceutical industry indicate that they will transparently share clinical trial data. These data offer an unparalleled opportunity to advance evidence-based medicine and support decision-making. To evaluate the eligibility of independent, qualified researchers to access in idual participant data (IPD) from oncology trials that supported US Food and Drug Administration (FDA) approval of new anticancer medicines within the past 10 years. In this quality improvement study, a cross-sectional analysis was performed of pivotal clinical trials whose results supported FDA-approved anticancer medicines between January 1, 2011, and June 30, 2021. These trials’ results were identified from product labels. Eligibility for IPD sharing was confirmed by identification of a public listing of the trial as eligible for sharing or by receipt of a positive response from the sponsor to a standardized inquiry. The main outcome was frequency of IPD sharing eligibility. Reasons for data sharing ineligibility were requested and collated, and company-, drug-, and trial-level subgroups were evaluated and presented using χ 2 tests and forest plots. During the 10-year period examined, 115 anticancer medicines were approved by the FDA on the basis of evidence from 304 pharmaceutical industry–sponsored trials. Of these trials, 136 (45%) were eligible for IPD sharing and 168 (55%) were not. Data sharing rates differed substantially among industry sponsors, with the most common reason for not sharing trial IPD being that the collection of long-term follow-up data was still ongoing (89 of 168 trials [53%]). Of the top 10 anticancer medicines by global sales, nivolumab, pembrolizumab, and pomalidomide had the lowest eligibility rates for data sharing (& % of trials). There has been a substantial increase in IPD sharing for industry-sponsored oncology trials over the past 5 years. However, this quality improvement study found that more than 50% of queried trials for FDA-approved anticancer medicines were ineligible for IPD sharing. Data accessibility would be substantially improved if, at the time of FDA registration of a medicine, all data that support the registration were made available.
Publisher: Wiley
Date: 06-2012
Publisher: Oxford University Press (OUP)
Date: 17-05-2011
Abstract: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies to utilize in the post-discharge period. The study was part of a prospective cohort study, nested within a larger, randomized controlled trial. Participants (n = 333) were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with current reported research evidence for falls prevention interventions. Participants' strategies (n = 629) were classified into 7 categories: behavioral, support while mobilizing, approach to movement, physical environment, visual, medical, and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only 2.9% of participants suggested engaging in exercises. Falls prevention was most often conceptualized by participants as requiring 1 (35.4%) or 2 (40.8%) strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviors. Results demonstrate that older patients have low levels of knowledge about appropriate falls prevention strategies that could be used after discharge in spite of their increased falls risk during this period. Findings suggest that health care workers should design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 11-2016
DOI: 10.3138/PTC.68.4.GEF
Publisher: SAGE Publications
Date: 10-2007
DOI: 10.1177/030802260707001003
Abstract: The aim of this study was to determine the overall quantity and quality of randomised controlled trials and the quantity of systematic reviews relevant to occupational therapy practice. The content of OTseeker ( www.otseeker.com ) was surveyed in June 2006. There were 3401 randomised controlled trials and 939 systematic reviews in OTseeker (total = 4340), published mostly in non-occupational therapy journals. The diagnostic areas of stroke (n = 458) and back or neck conditions/injuries (n = 391), and the intervention categories of exercise (n = 1262) and consumer education (n = 1098), were the most frequently listed. Although the quantity of evidence available about the effectiveness of occupational therapy interventions is rapidly increasing, some areas require greater research effort. Occupational therapists also need to search more broadly than occupational therapy journals for research to support clinical decision making.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 11-2016
DOI: 10.3138/PTC.68.4.GEE
Publisher: Wiley
Date: 16-08-2005
DOI: 10.1111/J.1471-1842.2005.00597.X
Abstract: Online databases can support the implementation of evidence-based practice by providing easy access to research. OTseeker (www.otseeker.com), an electronic evidence database, was introduced in 2003 to assist occupational therapists to locate and interpret research. This study explored Australian occupational therapists' use and perceptions of OTseeker and its impact on their knowledge and practice. A postal survey questionnaire was distributed to two s les: (i) a proportionate random s le of 400 occupational therapists from all states and territories of Australia, and (ii) a random s le of occupational therapists working in 95 facilities in two Australian states (Queensland and New South Wales). The questionnaire was completed by 213 participants. While most participants (85.9%) had heard of OTseeker, only 103 (56.6%) had accessed it, with lack of time being the main reason for non-use. Of the 103 participants who had accessed OTseeker, 68.9% had done so infrequently, 63.1% agreed that it had increased their knowledge and 13.6% had changed their practice after accessing information on OTseeker. Despite OTseeker being developed to provide occupational therapists with easy access to research, lack of time was the main reason why over half of the participants in this study had not accessed it. This exploratory research suggests, however, that there is potential for the database to influence occupational therapists' knowledge and practice about treatment efficacy through access to the research literature.
Publisher: Informa UK Limited
Date: 10-2011
DOI: 10.1310/TSR1805-481
Abstract: Behavior change is an important component of secondary stroke prevention. The transtheoretical model, which describes behavior change as occurring through a series of stages, may be a useful way of assessing patients' readiness to change behavior. The model has been successfully applied to other chronic conditions and argues that people progressing "forward" through the stages are more likely to successfully change their behavior. The aim of this study was to describe stroke patients' readiness to change behaviors for stroke-related risk factors using this model, in the absence of a behavior modification intervention. Patients (n = 27) from an acute stroke ward of a major metropolitan hospital in Brisbane, Australia, were interviewed prior to and at 3 months following hospital discharge regarding their awareness of stroke risk factors and their readiness to change stroke risk-related behaviors. At both points in time, 30% of patients could not spontaneously nominate one or more stroke risk factors. Despite a trend of "forward" progression in stages of change between the 2 interviews for behaviors relating to hypertension, heart disease, and high cholesterol, there were no statistically significant changes over time for any of the behaviors. Patients' readiness to change stroke risk-related behaviors differed for each risk factor. Acknowledging that patients' readiness to change may differ for each risk factor may promote more effective facilitation of stroke secondary prevention behaviors.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2012
DOI: 10.1038/NG0612-732C
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.PHYSIO.2016.03.001
Abstract: Incomplete descriptions of interventions are a common problem in reports of randomised controlled trials. To date no study has evaluated the completeness of the descriptions of physiotherapy interventions. To evaluate the completeness of the descriptions of physiotherapy interventions in a random s le of reports of randomised controlled trials (RCTs). A random s le of 200 reports of RCTs from the PEDro database. We included full text papers, written in English, and reporting trials with two arms. We included trials evaluating any type of physiotherapy interventions and subdisciplines. The methodological quality was evaluated using the PEDro scale and completeness of intervention description using the Template for Intervention Description and Replication (TIDieR) checklist. The proportion and 95% confidence interval were calculated for intervention and control groups, and used to present the relationship between completeness and methodological quality, and subdisciplines. Completeness of intervention reporting in physiotherapy RCTs was poor. For intervention groups, 46 (23%) trials did not describe at least half of the items. Reporting was worse for control groups, 149 (75%) trials described less than half of the items. There was no clear difference in the completeness across subdisciplines or methodological quality. Our s le were restricted to trials published in English in 2013. Descriptions of interventions in physiotherapy RCTs are typically incomplete. Authors and journals should aim for more complete descriptions of interventions in physiotherapy trials.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-026735
Abstract: To explore patients’ or parents of child patients’ understanding of antibiotic resistance and aspects of resistance such as resistance reversibility and its spread among those in close proximity, along with how this may influence attitudes towards antibiotic use for acute respiratory infections (ARIs). Qualitative semistructured interview study using convenience s ling and thematic analysis by two researchers independently. General practices in Gold Coast, Australia. 32 patients or parents of child patients presenting to general practice with an ARI. Five themes emerged: (1) antibiotic use is seen as the main cause of antibiotic resistance, but what it is that becomes resistant is poorly understood (2) resistance is perceived as a future ‘big problem’ for the community, with little appreciation of the in idual impact of or contribution to it (3) poor awareness that resistance can spread between family members but concern that it can (4) low awareness that resistance can decay with time and variable impact of this knowledge on attitudes towards future antibiotic use and (5) antibiotics are perceived as sometimes necessary, with some awareness and consideration of their harms. Patients’ or parents of child patients’ understanding of antibiotic resistance and aspects of it was poor. Targeting misunderstandings about resistance in public health messages and clinical consultations should be considered as part of a strategy to improve knowledge about it, which may encourage more consideration about antibiotic use for illnesses such as ARIs.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1310/TSR1401-88
Abstract: Inadequacies in the provision of written education materials to stroke patients and their carers have been reported. In this study, 20 stroke team health professionals were surveyed regarding their use of and perspectives on written education materials. Seventy percent of participants provided materials to 25% or fewer stroke patients and 90% believed that patients and carers are only occasionally or rarely provided with sufficient written information. Health professionals were uncertain which team members provided written information and identified the need to improve the quality of materials used. Stroke teams should implement a system that facilitates the routine provision of quality written materials to patients and carers, communication among team members, and documentation and verbal reinforcement of the information provided.
Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-024551
Abstract: To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3–4 chronic kidney disease (CKD). Mixed-methods process evaluation embedded in a randomised controlled trial. People with stage 3–4 CKD (estimated glomerular filtration rate [eGFR]15–60 mL/min/1.73 m 2 ). Participants were recruited from three hospitals in Australia and completed the intervention in ambulatory community settings. The intervention group received one telephone call per fortnight and 2–8 tailored text messages for 3 months, and then 4–12 tailored text messages for 3 months without telephone calls. The control group received usual care for 3 months then non-tailored education-only text messages for 3 months. Feasibility (recruitment, non-participation and retention rates, intervention fidelity and participant adherence) and acceptability (questionnaire and semistructured interviews). Descriptive statistics and qualitative content analysis. Overall, 80/230 (35%) eligible patients who were approached consented to participate (mean±SD age 61.5±12.6 years). Retention was 93% and 98% in the intervention and control groups, respectively, and 96% of all planned intervention calls were completed. All participants in the intervention arm identified the tailored text messages as useful in supporting dietary self-management. In the control group, 27 (69%) reported the non-tailored text messages were useful in supporting change. Intervention group participants reported that the telehealth programme delivery methods were practical and able to be integrated into their lifestyle. Participants viewed the intervention as an acceptable, personalised alternative to face-face clinic consultations, and were satisfied with the frequency of contact. This telehealth-delivered dietary coaching programme is an acceptable intervention which appears feasible for supporting dietary self-management in stage 3–4 CKD. A larger-scale randomised controlled trial is needed to evaluate the efficacy of the coaching programme on clinical and patient-reported outcomes. ACTRN12616001212448 Results.
Publisher: American Medical Association (AMA)
Date: 03-2017
DOI: 10.1001/JAMAINTERNMED.2016.8254
Abstract: Inaccurate clinician expectations of the benefits and harms of interventions can profoundly influence decision making and may be contributing to increasing intervention overuse. To systematically review all studies that have quantitatively assessed clinicians' expectations of the benefits and/or harms of any treatment, test, or screening test. A comprehensive search strategy of 4 databases (MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO) from the start years to March 17-20, 2015, with no language or study type restriction, was performed. Searches were also conducted on cited references of the included studies, and experts and study authors were contacted. Two researchers independently evaluated methodologic quality and extracted participants' estimates of benefit and harms and authors' contemporaneous estimates. Of the 8166 records screened, 48 articles (13 011 clinicians) were eligible. Twenty studies focused on treatment, 20 on medical imaging, and 8 on screening. Of the 48 studies, 30 (67%) assessed only harm expectations, 9 (20%) evaluated only benefit expectations, and 6 (13%) assessed both benefit and harm expectations. Among the studies comparing benefit expectations with a correct answer (total of 28 outcomes), most participants provided correct estimation for only 3 outcomes (11%). Of the studies comparing expectations of harm with a correct answer (total of 69 outcomes), a majority of participants correctly estimated harm for 9 outcomes (13%). Where overestimation or underestimation data were provided, most participants overestimated benefit for 7 (32%) and underestimated benefit for 2 (9%) of the 22 outcomes, and underestimated harm for 20 (34%) and overestimated harm for 3 (5%) of the 58 outcomes. Clinicians rarely had accurate expectations of benefits or harms, with inaccuracies in both directions. However, clinicians more often underestimated rather than overestimated harms and overestimated rather than underestimated benefits. Inaccurate perceptions about the benefits and harms of interventions are likely to result in suboptimal clinical management choices.
Publisher: SAGE Publications
Date: 12-04-2016
Abstract: Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers h er our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research biomarkers of recovery intervention development, monitoring and reporting and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
Publisher: BMJ
Date: 30-08-2020
DOI: 10.1136/BMJEBM-2019-111220
Abstract: Shared decision-making (SDM) has emerged as a key skill to assist clinicians in applying evidence-based practice (EBP). We aimed to develop and pilot a new approach to teaching EBP, which focuses on teaching knowledge and skills about SDM and pre-appraised evidence. We designed a half-day workshop, informed by an international consensus on EBP core competencies and invited practicing clinicians to participate. Skills in SDM and communicating evidence were assessed by audio-recording consultations between clinicians and standardised patients (immediately pre-workshop and post-workshop). These were rated by two independent assessors using the OPTION (Observing Patient Involvement, 0 to 100 points) and ACEPP (Assessing Communication about Evidence and Patient Preferences, 0 to 5 points) tools. Participants also completed a feedback questionnaire (9 Likert scale and four open-ended questions). Fourteen clinicians participated. Skills in SDM and communicating research evidence improved from pre-workshop to post-workshop (mean increase in OPTION score=5.5, 95% CI 1.0 to 9.9 increase in ACEPP score=0.5, 95% CI 0.02 to 1.06). Participant feedback was positive, with most indicating ‘agree’ or ‘strongly agree’ to the questions. A contemporary approach to teaching clinicians EBP, with a focus on SDM and pre-appraised evidence, was feasible, perceived as useful, and showed modest improvements in skills. Results should be interpreted cautiously because of the small study size and pre-post design.
Publisher: BMJ
Date: 10-09-2013
DOI: 10.1136/BMJ.F3755
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA12.11870
Publisher: Wiley
Date: 04-2013
Publisher: AMPCo
Date: 08-2013
DOI: 10.5694/MJA13.10551
Publisher: CMA Joule Inc.
Date: 14-03-2016
DOI: 10.1503/CMAJ.150684
Publisher: Elsevier BV
Date: 03-2015
Publisher: BMJ
Date: 28-04-2022
DOI: 10.1136/BMJ.O1055
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To explore construct(s) (ability, capability, actual performance, and/or perceived difficulty) of activities of daily living measures that have been used in randomized controlled trials. Three databases (Medline, CINAHL, and OTSeeker) were searched. A questionnaire was sent to the author of each eligible study requesting information about the activities of daily living construct(s) that were adopted in his/her study. A total of 106 studies, which altogether used 17 different activities of daily living measures, were found. Among these, only 12 studies specified in the paper the activities of daily living construct assessed 7 studies assessed "ability" and 5 assessed "actual performance". Only 20% of the randomized controlled trials authors reported the mode of administration in the paper. Authors of 34 studies replied to our questionnaire. The most commonly used activities of daily living measures (i.e. the Barthel Index (either the 0-20 or 0-100 scoring version) and the Functional Independence Measure) were employed for assessing various constructs of activities of daily living, with inconsistency between the studies. In stroke randomized controlled trials that measured activities of daily living as an outcome, the measures were used for assessing various construct(s) of activities of daily living (including ability, capability, actual performance, and/or perceived difficulty). This could h er data interpretation, meta-analysis, and the translation of evidence into clinical practice.
Publisher: BMJ
Date: 16-05-2018
DOI: 10.1136/BMJ.K1079
Publisher: Wiley
Date: 16-09-2015
DOI: 10.1111/JAR.12127
Abstract: The Internet is a frequently accessed source of information for parents of a child with autism. To help parents make informed decisions about treatment options, websites should contain accurate information. This study aimed to evaluate the quality of information in a s le of autism-relevant websites. Autism-related keywords were entered into three widely used search engines in April 2013 and the 20 most frequently appearing sites identified. Website quality was rated, by two independent raters, using the DISCERN tool. Websites were also coded according to the type of references/sources provided to support the intervention content presented. The mean DISCERN score was 46.5 (range 23-67.5), of a possible 80. Information about treatment risks and no treatment as an option was rarely described. Only six (30%) websites provided research references when describing intervention options. Many websites did not meet criteria for quality health information and failed to cite evidence supporting described interventions. Implications of these findings are discussed.
Publisher: American Speech Language Hearing Association
Date: 17-05-2017
DOI: 10.1044/2016_AJSLP-16-0035
Abstract: To evaluate the completeness of intervention descriptions in recent randomized controlled trials of speech-language pathology treatments. A consecutive s le of entries on the speechBITE database yielded 129 articles and 162 interventions. Interventions were rated using the Template for Intervention Description and Replication (TIDieR) checklist. Rating occurred at 3 stages: interventions as published in the primary article, secondary locations referred to by the article (e.g., protocol papers, websites), and contact with corresponding authors. No interventions were completely described in primary publications or after analyzing information from secondary locations. After information was added from correspondence with authors, a total of 28% of interventions was rated as complete. The intervention elements with the most information missing in the primary publications were tailoring and modification of interventions (in 25% and 13% of articles, respectively) and intervention materials and where they could be accessed (18%). Elements that were adequately described in most articles were intervention names (in 100% of articles) rationale (96%) and details of the frequency, session duration, and length of interventions (69%). Clinicians and researchers are restricted in the usability of evidence from speech-language pathology randomized trials because of poor reporting of elements essential to the replication of interventions.
Publisher: American Medical Association (AMA)
Date: 28-03-2011
DOI: 10.1001/ARCHINTERNMED.2010.444
Abstract: Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent them. This study was a 3-group randomized trial to evaluate the efficacy of 2 forms of multimedia patient education compared with usual care for the prevention of in-hospital falls. Older hospital patients (n = 1206) admitted to a mixture of acute (orthopedic, respiratory, and medical) and subacute (geriatric and neurorehabilitation) hospital wards at 2 Australian hospitals were recruited between January 2008 and April 2009. The interventions were a multimedia patient education program based on the health-belief model combined with trained health professional follow-up (complete program), multi-media patient education materials alone (materials only), and usual care (control). Falls data were collected by blinded research assistants by reviewing hospital incident reports, hand searching medical records, and conducting weekly patient interviews. Rates of falls per 1000 patient-days did not differ significantly between groups (control, 9.27 materials only, 8.61 and complete program, 7.63). However, there was a significant interaction between the intervention and presence of cognitive impairment. Falls were less frequent among cognitively intact patients in the complete program group (4.01 per 1000 patient-days) than among cognitively intact patients in the materials-only group (8.18 per 1000 patient-days) (adjusted hazard ratio, 0.51 95% confidence interval, 0.28-0.93]) and control group (8.72 per 1000 patient-days) (adjusted hazard ratio, 0.43 95% confidence interval, 0.24-0.78). Multimedia patient education with trained health professional follow-up reduced falls among patients with intact cognitive function admitted to a range of hospital wards. Trial Registration anzctr.org.au Identifier: ACTRN12608000015347.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2016
Publisher: BMJ
Date: 06-2019
Publisher: Wiley
Date: 22-07-2026
Publisher: Informa UK Limited
Date: 27-08-2020
DOI: 10.1080/09638288.2020.1807619
Abstract: Translation of findings from stroke trials into clinical practice remains low. Little is known about planned translation activities from the perspective of trialists who generate the evidence. This study aims to investigate perceptions of Australian stroke clinical trialists' about implementation of their findings into practice, and what translation activities they embedded into trial protocols. A descriptive cohort design and electronic survey was conducted. Three databases were searched to identify Australian stroke rehabilitation trials published between 2007 and 2017. Corresponding authors of the included trials were invited to complete an anonymous online survey about implementation of their trial intervention. Fifty-one trialists were invited to participate and 38 completed the survey (74% response rate). The majority (79%) considered their trial results to be clinically significant and 68% had pre-planned knowledge translation activities. The most common planned translation activities were publication (89%), conference presentation (87%), and feedback of results to target audiences (58%). Mixed opinions were evident regarding
Publisher: BMJ
Date: 30-03-2021
DOI: 10.1136/BMJ.N725
Publisher: AOTA Press
Date: 09-2006
Abstract: BACKGROUND. A strategic and prioritized approach to occupational therapy research is needed, particularly given the limited research funding available. Comparing occupational therapists’ information needs with the research evidence available can potentially inform research debate within the profession. This study aimed to identify research topics most often sought by users of the OTseeker database and to compare these with the quantity of topics available in the database. METHOD. A random s le of keyword search terms submitted to OTseeker (n = 4,500) was coded according to diagnostic and intervention categories, and compared with the amount of research contained in OTseeker in 2004. RESULTS. Most frequently sought topics were relevant to the diagnostic categories of pediatric conditions (19%), neurology and neuromuscular disorders (17%), and mental health (17%). Most frequently sought intervention topics included modes of service delivery, sensory interventions, and physical modalities. Although many frequently sought topics had a correspondingly high volume of research in OTseeker, a few areas had very little content (e.g., fine motor skill acquisition, autistic spectrum disorder). This information is offered to inform discussions about research priorities and resource allocation for research within occupational therapy.
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-023560
Abstract: Treatment fidelity is a complex, multifaceted evaluative process which refers to whether a studied intervention was delivered as intended. Monitoring and enhancing fidelity is one recommendation of the TiDIER (Template for Intervention Description and Replication) checklist, as fidelity can inform interpretation and conclusions drawn about treatment effects. Despite the methodological and translational benefits, fidelity strategies have been used inconsistently within health behaviour intervention studies in particular, within aphasia intervention studies, reporting of fidelity remains relatively rare. This paper describes the development of a fidelity protocol for the Action Success Knowledge (ASK) study, a current cluster randomised trial investigating an early mood intervention for people with aphasia (a language disability caused by stroke). A novel fidelity protocol and tool was developed to monitor and enhance fidelity within the two arms (experimental treatment and attention control) of the ASK study. The ASK fidelity protocol was developed based on the National Institutes of Health Behaviour Change Consortium fidelity framework. The study protocol was approved by the Darling Downs Hospital and Health Service Human Research Ethics Committee in Queensland, Australia under the National Mutual Acceptance scheme of multicentre human research projects. Specific ethics approval was obtained for those participating sites who were not under the National Mutual Agreement at the time of application. The monitoring and ongoing conduct of the research project is in line with requirements under the National Mutual Acceptance. On completion of the trial, findings from the fidelity reviews will be disseminated via publications and conference presentations. ACTRN12614000979651.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2017
Publisher: Public Library of Science (PLoS)
Date: 29-03-2021
Publisher: Informa UK Limited
Date: 03-04-2017
Publisher: EDP Sciences
Date: 22-05-2012
DOI: 10.1051/TPE/2012003
Publisher: AMPCo
Date: 06-2013
DOI: 10.5694/MJA12.11576
Publisher: Center for Open Science
Date: 14-09-2020
Abstract: Background: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did and what they found. Over the last decade, there have been many advances in systematic review methodology and terminology, which have necessitated an update to the guideline.Objectives: To develop the PRISMA 2020 statement for reporting systematic reviews.Methods: We reviewed 60 documents with reporting guidance for systematic reviews to generate suggested modifications to the PRISMA 2009 statement. We sought feedback on the suggested modifications through an online survey of 110 systematic review methodologists and journal editors. The results of the review and survey were discussed at a 21-member in-person meeting. Following the meeting, drafts of the PRISMA 2020 checklist, abstract checklist, explanation and elaboration and flow diagram were generated and refined iteratively based on feedback from co-authors and a convenience s le of 15 systematic reviewers.Results: In this statement paper, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews. The checklist includes new reporting guidance that reflects advances in methods to identify, select, appraise and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. The PRISMA 2020 statement replaces the 2009 statement.Conclusions: The PRISMA 2020 statement is intended to facilitate transparent, complete and accurate reporting of systematic reviews. Improved reporting should benefit users of reviews, including guideline developers, policy makers, health care providers, patients and other stakeholders. In order to achieve this, we encourage authors, editors and peer-reviewers to adopt the guideline.
Publisher: BMJ
Date: 29-03-2021
DOI: 10.1136/BMJ.N160
Publisher: JMIR Publications Inc.
Date: 06-2020
DOI: 10.2196/16497
Abstract: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs.
Publisher: Springer Science and Business Media LLC
Date: 13-06-2017
Publisher: Public Library of Science (PLoS)
Date: 24-07-2017
Publisher: BMJ
Date: 22-06-2017
DOI: 10.1136/BMJ.J2782
Publisher: SAGE Publications
Date: 07-2021
DOI: 10.1177/0272989X211021397
Abstract: The objective of this International Patient Decision Aids Standard (IPDAS) review is to update and synthesize theoretical and empirical evidence on how balanced information can be presented and measured in patient decision aids (PtDAs). A multidisciplinary team conducted a scoping review using 2 search strategies in multiple electronic databases evaluating the ways investigators defined and measured the balance of information provided about options in PtDAs. The first strategy combined a search informed by the Cochrane Review of the Effectiveness of Decision Aids with a search on balanced information. The second strategy repeated the search published in the 2013 IPDAS update on balanced presentation. Of 2450 unique citations reviewed, the full text of 168 articles was screened for eligibility. Sixty-four articles were included in the review, of which 13 provided definitions of balanced presentation, 8 evaluated mechanisms that may introduce bias, and 42 quantitatively measured balanced with methods consistent with the IPDAS criteria in PtDAs. The revised definition of balanced information is, “Objective, complete, salient, transparent, evidence-informed, and unbiased presentation of text and visual information about the condition and all relevant options (with important elements including the features, benefits, harms and procedures of those options) in a way that does not favor one option over another and enables in iduals to focus attention on important elements and process this information.” Developers can increase the balance of information in PtDAs by informing their structure and design elements using the IPDAS checklist. We suggest that new PtDA components pertaining to balance be evaluated for cognitive bias with experimental methods as well by objectively evaluating patients’ and content experts’ beliefs from multiple perspectives.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2009
Abstract: Accidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences for older patients, including serious physical injury and reduced quality of life, and are also a source of substantial cost to health systems worldwide. There have been a limited number of randomised controlled trials, mainly using multifactorial interventions, aiming to prevent older people falling whilst inpatients. Trials to date have produced conflicting results and recent meta-analyses highlight that there is still insufficient evidence to clearly identify which interventions may reduce the rate of falls, and falls related injuries, in this population. A prospective randomised controlled trial (n = 1206) is being conducted at two hospitals in Australia. Patients are eligible to be included in the trial if they are over 60 years of age and they, or their family or guardian, give written consent. Participants are randomised into three groups. The control group continues to receive usual care. Both intervention groups receive a specifically designed patient education intervention on minimising falls in addition to usual care. The education is delivered by Digital Video Disc (DVD) and written workbook and aims to promote falls prevention activities by participants. One of the intervention groups also receives follow up education training visits by a health professional. Blinded assessors conduct baseline and discharge assessments and follow up participants for 6 months after discharge. The primary outcome measure is falls by participants in hospital. Secondary outcome measures include falls at home after discharge, knowledge of falls prevention strategies and motivation to engage in falls prevention activities after discharge. All analyses will be based on intention to treat principle. This trial will examine the effect of a single intervention (specifically designed patient education) on rates of falls in older patients in hospital and after discharge. The results will provide robust recommendations for clinicians and researchers about the role of patient education in this population. The study has the potential to identify a new intervention that may reduce rates of falls in older hospital patients and could be readily duplicated and applied in a wide range of clinical settings. ACTRN12608000015347
Publisher: Informa UK Limited
Date: 11-2011
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.PEC.2022.05.005
Abstract: To evaluate the effects of a patient decision aid for people considering shoulder surgery. Participants with shoulder pain considering shoulder surgery (n = 425) were recruited online and randomised to (i) a decision aid outlining the benefits and harms of shoulder surgery and non-surgical options (then randomised to a side-by-side vs. top-and-bottom display of options) and (ii) general information about shoulder pain from the NHS. Outcomes included treatment intention (primary), knowledge, attitudes, informed choice, and decisional conflict. Linear and logistic regression models were used to evaluate between-groups differences in outcomes. 409 participants (96%) had post-intervention data. Mean age was 41.3 years, 44.2% were female. There was no between-group difference in post-intervention treatment intention (MD -0.2, 95% CI: -3.3 to 2.8) and likelihood of intending to have shoulder surgery (OR 0.7, 95% CI: 0.3-1.5). The decision aid slightly improved knowledge (MD 4.4, 95% CI: 0.2-8.6), but not any other secondary outcomes. The display of options did not influence any outcome. In this online trial, a co-designed patient decision aid had no effect on treatment intention, attitudes, informed choice, and decisional conflict, but a small effect on improving knowledge. Research is needed to understand reasons for the lack of anticipated effects. Australia New Zealand Clinical Trials Registry (ACTRN12621000992808).
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019470
Abstract: Little is known about how to reduce unnecessary imaging for low back pain. Understanding clinician, patient and general public beliefs about imaging is critical to developing strategies to reduce overuse. To synthesise qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain. We will perform a qualitative evidence synthesis of relevant qualitative research exploring clinician, patient and general public beliefs about diagnostic imaging for low back pain. Exclusions will be studies not using qualitative methods and studies not published in English. Studies will be identified using sensitive search strategies in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Two reviewers will independently apply inclusion and exclusion criteria, extract data, and use the Critical Appraisal Skills Programme quality assessment tool to assess the quality of included studies. To synthesise the data we will use a narrative synthesis approach that involves developing a theoretical model, conducting a preliminary synthesis, exploring relations in the data, and providing a structured summary. We will code the data using NVivo. At least two reviewers will independently apply the thematic framework to extracted data. Confidence in synthesis findings will be evaluated using the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool. Ethical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal. CRD42017076047 .
Publisher: The Royal Australian College of General Practitioners
Date: 02-2022
Publisher: University of Rijeka, Faculty of Medicine
Date: 12-2010
DOI: 10.21860/MEDFLUM2021_264903
Abstract: Uvod: Preporučene smjernice za izvještavanje u sustavnim pregledima i metaanalizama (engl. Preferred Reporting Items for Systematic reviews and Meta-Analyses, PRISMA) prvi su put objavljene 2009. godine kako bi autorima sustavnih pregleda omogućile transparentno izvještavanje o predmetu istraživanja, korištenim metodama i dobivenim rezultatima. Tijekom posljednjeg desetljeća postignut je značajan napredak u metodologiji i terminologiji sustavnih pregleda, što je rezultiralo potrebom za nadopunjavanjem i prilagođavanjem postojećih smjernica. Svrha rada: Predstaviti ažurirane smjernice PRISMA 2020. za izvještavanje u sustavnim pregledima. Metode: Pregledali smo 60 dokumenata sa smjernicama za izvještavanje u sustavnim pregledima s ciljem obuhvaćanja predloženih izmjena smjernica PRISMA iz 2009. godine. Tražili smo povratne informacije o predloženim izmjenama pomoću internetske ankete provedene među 110 urednika časopisa i metodologa sustavnih pregleda. O rezultatima anketa i pregleda raspravljalo se na sastanku na kojem je sudjelovao 21 član. Nakon sastanka, temeljem povratnih informacija koautora i prigodnog uzorka od 15 recenzenata sustavnih pregleda, generirali smo koncept za kontrolni popis PRISMA 2020., sažetak kontrolnog popisa, razradu i objašnjenje te dijagram toka. Rezultati: U ovom radu predstavljamo kontrolni popis za smjernice PRISMA 2020. sastavljene od 27 stavki, odnosno prošireni kontrolni popis s detaljnim preporukama za izvještavanje pojedine stavke, sažetak kontrolnog popisa PRISMA 2020. te revidirane dijagrame toka za izvorne i ažurirane preglede. Kontrolni popis uključuje nove smjernice za izvještavanje koje sadrže ažurirane metode identifikacije, odabira, procjene i sinteze istraživanja. Struktura i prikaz stavaka su izmijenjeni kako bi se olakšala njihova provedba. Smjernice PRISMA 2020. zamjenjuju smjernice iz 2009. godine. Zaključak: Svrha smjernica PRISMA 2020. je olakšati transparentnost, cjelovitost i točnost izvještavanja u sustavnim pregledima. Poboljšano izvještavanje koristit će autorima sustavnih pregleda, autorima smjernica, kreatorima politike, zdravstvenim radnicima, pacijentima i drugim korisnicima. U svrhu postizanja navedenih ciljeva potičemo autore, urednike i recenzente da usvoje predstavljene smjernice.
Publisher: Georg Thieme Verlag KG
Date: 29-01-2016
Abstract: Nur wenn Interventionsbeschreibungen vollständig veröffentlicht sind, können Kliniker und Patienten Interventionen, die sich als nützlich erwiesen haben, verlässlich umsetzen und andere Forscher die Studienergebnisse replizieren oder darauf aufbauen. Die Qualität von Interventionsbeschreibungen in wissenschaftlichen Publikationen ist bemerkenswert gering. Um die Vollständigkeit der Berichterstattung und damit die Replizierbarkeit von Interventionen zu verbessern, entwickelte eine internationale Gruppe von Experten und Interessensvertretern die Checkliste zur Interventionsbeschreibung und Replikation (TIDieR). Der Prozess beinhaltete eine Literaturrecherche zu relevanten Checklisten und wissenschaftlichen Untersuchungen, eine Delphi-Umfrage mit internationalen Experten zur Steuerung der Item-Auswahl und eine Expertenkonferenz. Die daraus resultierende 12-Item-TIDieR Checkliste (Bezeichnung, Warum, Was (Materialien), Was (Verfahren), Wer intervenierte, Wie, Wo, Wann und Wieviel, Anpassungen, Modifikationen, Wie gut (geplante Durchführungskontrolle), Wie gut (tatsächliche Durchführung)) ist eine Erweiterung des CONSORT 2010 Statements (Item 5) und des SPIRIT 2013 Statements (Item 11). Während der Fokus der Checkliste auf klinischen Studien liegt, kann die erweiterte Anleitung bei allen evaluativen Studiendesigns herangezogen werden. Dieser Artikel präsentiert die TIDieR Checkliste und Anleitung mit Erklärung und Erläuterung jedes einzelnen Items sowie Beispielen guter Berichterstattung. Die TIDieR Checkliste und Anleitung sollen das Berichten von Interventionen verbessern und Autoren eine Hilfe bieten, die Berichterstattung ihrer Interventionen zu strukturieren, Gutachtern und Herausgebern, die Beschreibungen zu beurteilen und Lesern, die Informationen zu nutzen.
Publisher: SAGE Publications
Date: 20-08-2021
Publisher: AOTA Press
Date: 11-2003
Abstract: This clinical scenario illustrates how OTseeker can be used by occupational therapists to locate research that may inform clinical decisions. Beyond the clinical arena, this database also has potential to greatly enhance the ability of researchers to perform systematic reviews of RCTs and eventually, development of clinical guidelines. In conclusion, OTseeker is a new Web-based database that provides fast access to evidence of therapeutic effectiveness for clinicians, academics, and students, as well as consumers and providers of occupational therapy services. OTseeker will be able to be used by clinicians to guide dinical practice, by researchers to perform systematic reviews of RCTs, by students, and by consortiums of stakeholders to develop evidence-based guidelines for occupational therapy practice.
Publisher: Cold Spring Harbor Laboratory
Date: 24-07-2020
DOI: 10.1101/2020.07.22.20160432
Abstract: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs), and assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI), or influenza events. Systematic review of randomised trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI, or laboratory-confirmed influenza or related consequences. Searches were conducted in CENTRAL, PubMed, Embase, CINAHL and trial registries (April 2020) and data extraction completed by independent pairs of reviewers. Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (Risk Ratio (RR) 1.23, 95%CI 0.78-1.93) six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95%CI 0.71-0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose-response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared to the soap group two found no significant difference between the intervention arms. Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission, however direct and indirect evidence suggest sanitiser might be more effective in practice.
Publisher: Informa UK Limited
Date: 23-02-2009
Publisher: Wiley
Date: 05-05-2017
DOI: 10.1111/HEX.12562
Publisher: Georg Thieme Verlag KG
Date: 09-09-2016
Publisher: SAGE Publications
Date: 25-07-2017
Publisher: Elsevier BV
Date: 2024
Publisher: Wiley
Date: 09-2016
DOI: 10.1111/NEP.12888
Publisher: Informa UK Limited
Date: 09-2012
DOI: 10.1310/TSR1905-417
Abstract: Written materials are frequently used to provide education to stroke patients and their carers. However, poor quality materials are a barrier to effective information provision. A quick and reliable method of evaluating material quality is needed. This study evaluated the interrater reliability of the Suitability Assessment of Materials (SAM) checklist in a s le of written stroke education materials. Two independent raters evaluated the materials (n = 25) using the SAM, and ratings were analyzed to reveal total percentage agreements and weighted kappa values for in idual items and overall SAM rating. The majority of the in idual SAM items had high interrater reliability, with 17 of the 22 items achieving substantial, almost perfect, or perfect weighted kappa value scores. The overall SAM rating achieved a weighted kappa value of 0.60, with a percentage total agreement of 96%. Health care professionals should evaluate the content and design characteristics of written education materials before using them with patients. A tool such as the SAM checklist can be used however, raters should exercise caution when interpreting results from items with more subjective scoring criteria. Refinements to the scoring criteria for these items are recommended. The value of the SAM is that it can be used to identify specific elements that should be modified before education materials are provided to patients.
Publisher: Springer Science and Business Media LLC
Date: 02-06-2022
DOI: 10.1186/S12874-022-01640-7
Abstract: Recent international health events have led to an increased proliferation of remotely delivered health interventions. Even with the pandemic seemingly coming under control, the experiences of the past year have fueled a growth in ideas and technology for increasing the scope of remote care delivery. Unfortunately, clinicians and health systems will have difficulty with the adoption and implementation of these interventions if ongoing and future clinical trials fail to report necessary details about execution, platforms, and infrastructure related to these interventions. The purpose was to develop guidance for reporting of telehealth interventions. A working group from the US Pain Management Collaboratory developed guidance for complete reporting of telehealth interventions. The process went through 5-step process from conception to final checklist development with input for many stakeholders, to include all 11 primary investigators with trials in the Collaboratory. An extension focused on unique considerations relevant to telehealth interventions was developed for the Template for the Intervention Description and Replication (TIDieR) checklist. The Telehealth Intervention guideline encourages use of the Template for the Intervention Description and Replication (TIDieR) checklist as a valuable tool (TIDieR-Telehealth) to improve the quality of research through a reporting guide of relevant interventions that will help maximize reproducibility and implementation.
Publisher: Wiley
Date: 05-03-0018
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-029724
Abstract: Interaction of conditions and treatments, complicated care needs and substantial treatment burden make patient–physician encounters involving multimorbid older patients highly complex. To optimally integrate patients’ preferences, define and prioritise realistic treatment goals and in idualise care, a patient-centred approach is recommended. However, the preferences of older patients, who are especially vulnerable and frequently multimorbid, have not been systematically investigated with regard to their health status. The purpose of this evidence map is to explore current research addressing health-related preferences of older patients with multimorbidity, and to identify the knowledge clusters and research gaps. To identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library from their inception. We will check reference lists of relevant articles and carry out cited reference research (forward citation tracking). Two independent reviewers will screen titles and abstracts, check full texts for eligibility and extract the data. Any disagreement will be resolved and consensus reached with the help of a third reviewer. We will include both qualitative and quantitative studies, and address preferences from the patients’ perspectives in a multimorbid population of 60 years or older. There will be no restrictions on the publication language. Data extraction tables will present study and patient characteristics, aim of study, methods used to identify preferences and outcomes (ie, type of preferences). We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe clusters and gaps. Due to the nature of the proposed evidence map, ethics approval will not be required. Results from our research will be disseminated by means of specifically prepared materials for patients, at relevant (inter)national conferences and via publication in peer-reviewed journals.
Publisher: Cold Spring Harbor Laboratory
Date: 29-07-2020
DOI: 10.1101/2020.07.27.20163204
Abstract: Public cooperation to practice preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. An online cross-sectional survey conducted May 8 to May 11 2020. A national s le of 1500 Australian adults with representative quotas for age and gender provided by online panel provider. Proportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions. Of the 1802 potential participants contacted, 289 were excluded, 13 declined, and 1500 participated in the survey (response rate 83%). Most participants correctly identified “washing your hands regularly with soap and water” (92%) and “staying at least 1.5m away from others” (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them contracting COVID-19. Views about face masks were ided. Only 66% of participants correctly identified that “regular use of antibiotics” would not prevent COVID-19. Most participants (90%) identified “fever, fatigue and cough” as indicators of COVID-19. However, 42% of participants thought that being unable to “hold your breath for 10 seconds without coughing” was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%), and the Australian Government COVID-19 information app (31%). Public messaging about hand hygiene and physical distancing to prevent transmission appear to have been effective. However, there are clear, identified barriers for many in iduals that have the potential to impede uptake or maintenance of these behaviours in the long-term. Currently these non-drug interventions are our only effective strategy to combat this pandemic. Ensuring ongoing adherence to is critical. The current strategies to prevent the transmission of COVID-19 are behavioural (hand hygiene, physical distancing, quarantining and testing if symptomatic) and rely on the public knowledge and subsequent practice of these strategies. Previous research has demonstrated a good level of public knowledge of COVID-19 symptoms and preventive behaviours but a wide variation in practicing the recommended behaviours. Although knowledge can facilitate behaviour change, knowledge alone is insufficient to reliably change behaviour to the widespread extent require to combat health crises. Participants reveal confusion about whether wearing masks will reduce transmission, apprehension about attending health services, and perceptions that antibiotics and alternative remedies (such as essential oils) prevent transmission. Analysis of why participants hold these beliefs revealed two dominant themes: an incomplete or inaccurate understanding of how COVID-19 is transmitted, and the belief that the behaviours were unnecessary. This study underlines the necessity to not only target public messaging at effective preventative behaviours, but enhance behaviour change by clearly explaining why each behaviour is important.
Publisher: Elsevier BV
Date: 12-2016
Abstract: The long-term management of chronic disease requires the adoption of complex dietary recommendations, which can be facilitated by regular coaching to support behavioral changes. Telehealth interventions can overcome patient-centered barriers to accessing face-to-face programs and provide feasible delivery methods, accessible regardless of geographic location. This systematic review assessed the effectiveness of telehealth dietary interventions at facilitating dietary change in chronic disease. A structured systematic search was conducted for all randomized controlled trials evaluating multifactorial dietary interventions in adults with chronic disease that provided diet education in an intervention longer than 4 wk. Meta-analyses that used the random-effects model were performed on diet quality, dietary adherence, fruit and vegetables, sodium intake, energy, and dietary fat intake. A total of 25 studies were included, involving 7384 participants. The telehealth dietary intervention was effective at improving diet quality [standardized mean difference (SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and vegetable intake [mean difference (MD) 1.04 servings/d (95% CI: 0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake [SMD: -0.39 (-0.58, -0.20), P = 0.0001]. Single nutrients (total fat and energy consumption) were not improved by telehealth intervention however, after a telehealth intervention, important clinical outcomes were improved, such as systolic blood pressure [MD: -2.97 mm Hg (95% CI: -5.72, -0.22 mm Hg), P = 0.05], total cholesterol [MD: -0.08 mmol/L (95% CI: -0.16, -0.00 mmol/L), P = 0.04], triglycerides [MD: -0.10 mmol/L (95% CI: -0.19, -0.01 mmol/L), P = 0.04], weight [MD: -0.80 kg (95% CI: -1.61, 0 kg), P = 0.05], and waist circumference [MD: -2.08 cm (95% CI: -3.97, -0.20 cm), P = 0.03]. Telehealth-delivered dietary interventions targeting whole foods and/or dietary patterns can improve diet quality, fruit and vegetable intake, and dietary sodium intake. When applicable, they should be incorporated into health care services for people with chronic conditions. This review was registered at www.crd.york.ac.uk/PROSPERO/ as CRD42015026398.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.PEC.2009.03.009
Abstract: This study evaluated the educational practices of staff working in acute stroke wards in Australian hospitals, including the coordination and methods of patient education provision, post-discharge education and support services available, and the education and support services that health professionals would like to provide. Health professionals who worked in acute stroke wards in Australian hospitals were surveyed about the stroke education practices of staff in their ward. Thirty-four hospitals returned a completed questionnaire via email or fax. Verbal communication and written materials were the most frequently used methods of information provision. Twenty-three (67.6%) wards developed their own written education materials, five (14.7%) offered group education programs, and 19 (55.9%) offered education or support after discharge. Fourteen (41.2%) wards had a particular staff member responsible for coordinating the provision of education to patients and one (2.9%) ward had a written policy on stroke education. The majority (70.6%) of participants would like to be able to provide more education/support services. The educational practices of the Australian hospitals surveyed were variable, with improvements needed in the coordination and documentation of patient education and the available follow-up services. Health professionals need to be aware of the importance of education in the care of patients following stroke. Patients' informational needs, while in hospital and after discharge, may be better met if staff in acute stroke wards had improved communication and coordination practices and ensured that stroke education was appropriately documented and supported by policy.
Publisher: Wiley
Date: 30-09-2019
DOI: 10.1111/ECI.13169
Publisher: Springer Science and Business Media LLC
Date: 22-05-2013
Abstract: Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by in idual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service. Australia and New Zealand Clinical Trials Register: ACTRN12608000015347 .
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.PEC.2018.09.017
Abstract: We explored the relationship between patient-perceived shared decision making (SDM) and three domains of health literacy (HL) in patients with breast cancer. In this cross-sectional study, we prospectively recruited a convenience s le of 511 breast cancer patients from 3 hospitals in Taiwan. Patients completed questionnaires about HL and perceived SDM in a recent consultation. Sequential regressions, controlling for International Classification of Functioning, Disability and Health (ICF)-related factors) were conducted. Interactions of each HL domain with age or education were also assessed for the relationship with perceived SDM. Higher scores in the HL domains of healthcare and disease prevention, but lower scores in the health promotion domain, were significantly associated with a higher perceived level of SDM after controlling for ICF-related factors (R Each HL domain was significantly associated with perceived SDM after controlling for the ICF-related factors and across different age- and education-stratifications. Clinicians should be cognizant of patients' HL levels and incorporate HL best practices into consultations and interactions with patients with breast cancer to facilitate SDM.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Annals of Family Medicine
Date: 11-2019
DOI: 10.1370/AFM.2445
Publisher: Springer Science and Business Media LLC
Date: 12-2022
DOI: 10.1186/S12879-022-07887-1
Abstract: Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it’s reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care. A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations. We identified 82 guidelines, covering 114 eligible infections . Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24). Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making. Systematic review registration CRD42021247048
Publisher: Springer Science and Business Media LLC
Date: 02-05-2018
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-067624
Abstract: To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public. Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p .016 to allow for three-primary comparisons. Two Australian s les were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed. In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where ‘wait and see’ is a legitimate option. Comprehension of information (scored 0–6). Decision intention, presentation satisfaction and preferences. In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI −0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (−0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (−0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (−0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between −1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B). Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information. Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.PEC.2005.06.020
Abstract: This study (a) evaluated the reading ability of patients following stroke and their carers and the reading level and content and design characteristics of the written information provided to them, (b) explored the influence of sociodemographic and clinical characteristics on patients' reading ability, and (c) described an education package that provides well-designed information tailored to patients' and carers' informational needs. Fifty-seven patients and 12 carers were interviewed about their informational needs in an acute stroke unit. Their reading ability was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The written information provided to them in the acute stroke unit was analysed using the SMOG readability formula and the Suitability Assessment of Materials (SAM). Thirteen (22.8%) patients and 5 (41.7%) carers had received written stroke information. The mean reading level of materials analysed was 11th grade while patients read at a mean of 7-8th grade. Most materials (89%) scored as only adequate in content and design. Patients with combined aphasia read significantly lower (4-6th grade) than other patients (p=0.001). Only a small proportion of patients and carers received written materials about stroke and the readability level and content and design characteristics of most materials required improvement. When developing and distributing written materials about stroke, health professionals should consider the reading ability and informational needs of the recipients, and the reading level and content and design characteristics of the written materials. A computer system can be used to generate written materials tailored to the informational needs and literacy skills of patients and carers.
Publisher: SAGE Publications
Date: 05-2364
DOI: 10.4276/030802212X13336366278130
Abstract: A self-management approach to upper limb management following stroke has received little attention in the literature. The aim of the study was to investigate the impact of occupational therapists' and physiotherapists' standard practice on clients' and carers' self-management of upper limb recovery. Fifteen clients, 7 carers, 11 occupational therapists and 7 physiotherapists were recruited. Therapists described five self-administered tasks they expected clients and carers were doing, using the Goal Attainment Scale (GAS). For each task, clients' and carers' performances were then evaluated using the GAS and their self-efficacy was rated on a 10-point Likert scale. A survey questionnaire investigated their perceptions of the training provided, with respect to a self-management approach. At least a quarter of the self-administered tasks related to upper limb activity, strengthening and secondary prevention were performed below therapists' expectations. In contrast, mean self-efficacy ratings across these tasks were high (clients = 7.8–9.5, carers = 8.5–8.9). Seventy per cent of the self-management training strategies listed in the survey questionnaire were considered missing by more than 40% of carers. There is a need for therapy resources that enhance the content and delivery of self-management training related to upper limb management following stroke, particularly for carers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
DOI: 10.1161/STROKEAHA.120.032496
Abstract: Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines (2) inadequate conceptualization of dose, which is multidimensional and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain in idual sessions and episodes that can be active (time on task) or inactive (time off task), and each in idual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.
Publisher: Royal College of General Practitioners
Date: 09-12-2021
Abstract: Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use has not been established, which h ers informed decision making about antibiotic use. To determine the natural history of non-bullous impetigo. Systematic review. The authors searched PubMed up to January 2020, as well as reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials, or in single-group prognostic studies that did not use antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who had either symptom resolution, symptom improvement, or failed to improve at any timepoint. Adverse event data were also extracted. Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as ‘failure to improve’ ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. Although some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory, and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.
Publisher: Wiley
Date: 18-01-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Informa UK Limited
Date: 07-10-2000
Publisher: John Wiley & Sons, Ltd
Date: 25-06-2013
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-026701
Abstract: Information included in a patient decision aid (PDA) can significantly influence patients’ decisions and is, therefore, expected to be evidence-based and rigorously selected and summarised. PDA developers have not yet agreed on a standardised process for the selection and summarisation of the supporting evidence. We intend to generate consensus on a process (and related steps and criteria) for selecting and summarising evidence for PDAs using a modified Delphi survey. We will develop an evidence summarisation process specific to PDA development by using a consensus-based Delphi approach, surveying international experts and stakeholders with two to three rounds. To increase generalisability and acceptability, we will distribute the survey to the following stakeholder groups: PDA developers, researchers with expertise in shared decision making, PDA development and evidence summarisation, members of the International Patient Decision Aids Standards (IPDAS) collaboration, policy makers with expertise in PDA certification and patient stakeholder groups. For each criterion, if at least 80% of survey participants rank the criterion as most important/least important, we will consider that consensus has been achieved. It is critical for PDAs to have accurate and trustworthy evidence-based information about the risks and benefits of health treatments and tests, as these decision aids help patients make important choices. We want to generate consensus on an approach for selecting and summarising the evidence included in PDAs, which can be widely implemented by PDA developers. Dartmouth College’s Committee for the Protection of Human Subjects approved this protocol. We will publish our results in a peer reviewed journal.
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2007
Publisher: Wiley
Date: 29-09-2011
DOI: 10.1111/J.1440-1630.2011.00954.X
Abstract: Networking, together with knowledge acquisition and resource sharing, are key components of occupational therapists' professional development. To enhance the connectedness and clinical support available to occupational therapists, OT AUSTRALIA Queensland developed an online community of practice (CoP). No research regarding the use of online CoPs by occupational therapists has been conducted. This study aimed to explore occupational therapists' perceptions of the benefits of, barriers to, and reasons for using or not using the online CoP. Two focus groups were conducted, one with therapists who had used the CoP (n = 5) and the other with therapists who had not used it (n = 9). Participant responses to focus group questions informed the development of a survey asking therapists about their use of the CoP, its benefits and reasons for using/not using it, which was sent via email to all OT AUSTRALIA Queensland members. Motivation to use the CoP, technology, workload management impacts, potential benefits and time considerations emerged as themes from the focus groups. Of the 55 survey respondents, 58.2% were aware of the CoP but only 32.7% had accessed it. Potential benefits of the CoP identified by participants included time efficiency, structural flexibility, networking capabilities and mentoring opportunities. Reasons for not accessing and/or participating in the CoP included access difficulties, usability difficulties, personal communication preferences and perceived irrelevance of available information. The findings of this study suggest that the CoP is still in the early stages of development however, it has the potential to be further embraced by therapists if further promotion, training and minor usability modifications are undertaken.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.ARCHGER.2014.09.009
Abstract: Depression is common in older people and symptoms of depression are known to substantially increase during hospitalization. There is little known about predictors of depressive symptoms in older adults or impact of common interventions during hospitalization. This study aimed to describe the magnitude of depressive symptoms, shift of depressive symptoms and the impact of the symptoms of depression among older hospital patients during hospital admission and identify whether exposure to falls prevention education affected symptoms of depression. Participants (n=1206) were older adults admitted within two Australian hospitals, the majority of participants completed the Geriatric Depression Scale - Short Form (GDS) at admission (n=1168). Participants' mean age was 74.7 (±SD 11) years and 47% (n=551) were male. At admission 53% (619 out of 1168) of participants had symptoms of clinical depression and symptoms remained at the same level at discharge for 55% (543 out of 987). Those exposed to the low intensity education program had higher GDS scores at discharge than those in the control group (low intensity vs control n=652, adjusted regression coefficient (95% CI)=0.24 (0.02, 0.45), p=0.03). The only factor other than admission level of depression that affected depressive symptoms change was if the participant was worried about falling. Older patients frequently present with symptoms of clinical depression on admission to hospital. Future research should consider these factors, whether these are modifiable and whether treatment may influence outcomes.
Publisher: SAGE Publications
Date: 16-06-2015
DOI: 10.1111/IJS.12524
Abstract: Evidence-based interventions cannot be provided unless there is a clear understanding of what the intervention is. Many published randomized trials, systematic reviews, and guidelines contain incomplete intervention descriptions. For non-pharmacological interventions, such as stroke rehabilitation, the reporting is particularly poor. Contributors to this problem include lack of attention to this issue and awareness of what constitutes a complete intervention description by authors, reviewers, journals, and editors. Part of the solution is for authors to follow guidance about how to describe interventions, such as the Template for Intervention Description and Replication statement. Improving stroke interventions reporting will remove one of the current barriers to evidence-based care.
Publisher: Springer Science and Business Media LLC
Date: 25-02-2016
Publisher: Wiley
Date: 26-10-2022
DOI: 10.5694/MJA2.51755
Publisher: American Medical Association (AMA)
Date: 10-2014
Publisher: JMIR Publications Inc.
Date: 07-2020
DOI: 10.2196/17249
Abstract: Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. This systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. A search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. This project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. Nursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. PRR1-10.2196/17249
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 25-11-2017
Publisher: SAGE Publications
Date: 10-2018
Publisher: BMJ
Date: 17-11-2015
Publisher: JMIR Publications Inc.
Date: 15-06-2017
Abstract: elehealth-delivered dietary interventions are effective for chronic disease management and are an emerging area of clinical practice. However, to apply interventions from the research setting in clinical practice, health professionals need details of each intervention component. he aim of this study was to evaluate the completeness of intervention reporting in published dietary chronic disease management trials that used telehealth delivery methods. ligible randomized controlled trial publications were identified through a systematic review. The completeness of reporting of experimental and comparison interventions was assessed by two independent assessors using the Template for Intervention Description and Replication (TIDieR) checklist that consists of 12 items including intervention rationale, materials used, procedures, providers, delivery mode, location, when and how much intervention delivered, intervention tailoring, intervention modifications, and fidelity. Where reporting was incomplete, further information was sought from additional published material and through email correspondence with trial authors. ithin the 37 eligible trials, there were 49 experimental interventions and 37 comparison interventions. One trial reported every TIDieR item for their experimental intervention. No publications reported every item for the comparison intervention. For the experimental interventions, the most commonly reported items were location (96%), mode of delivery (98%), and rationale for the essential intervention elements (96%). Least reported items for experimental interventions were modifications (2%) and intervention material descriptions (39%) and where to access them (20%). Of the 37 authors, 14 responded with further information, and 8 could not be contacted. any details of the experimental and comparison interventions in telehealth-delivered dietary chronic disease management trials are incompletely reported. This prevents accurate interpretation of trial results and implementation of effective interventions in clinical practice.
Publisher: CSIRO Publishing
Date: 31-01-2019
DOI: 10.1071/AH18138
Abstract: The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The Theoretical Domains Framework, COM-B (‘capability’, ‘opportunity’, motivation’ and ‘behaviour’) Model and Behaviour Change Wheel were used to conduct a theoretical analysis of the barriers and identify potential interventions to increase the uptake of SDM. This was supplemented by a purposive review of articles about current international efforts to facilitate SDM. From the theoretical analysis, 9 of the 14 theoretical domains were considered relevant to implementing SDM in the NSW Health context. Multi-faceted interventions including education, training, enablement, modelling, incentivisation, persuasion and environmental restructuring were identified as potential ways to increase SDM. The review of international articles identified communication and marketing, patient and public involvement, research, training, legislation, patient decision aids, service provision, clinical ch ions, financial incentives and policy as interventions being used to increase the uptake of SDM internationally. Based on current perceptions about barriers for SDM implementation in NSW Health, initial efforts should focus on workforce skills development, motivation, communication and marketing, service provision and creating receptive work environments. Investments into facilitating SDM will require an ongoing commitment to enhancing patient experience, evidence translation and reducing unwarranted variations in care. What is known about the topic? Shared decision making is considered an important strategy for reducing unwarranted variation in health care and promoting person-centred care. Despite a growing evidence base, uptake in Australia has been slow. What does this paper add? A description of the theoretical methods and results used to identify potential implementation interventions to increase the uptake of shared decision making clinical practice in New South Wales Health, Australia. What are the implications for practitioners? Learnings from this present case study may be relevant to other organisations wanting to support a culture of shared decision making and meet the National Safety and Quality Healthcare Standards in Australia.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-054032
Abstract: To develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery. Mixed-methods study outlining the development of a patient decision aid. We assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors’ collaboration network. People with shoulder pain and health professionals who manage people with shoulder pain. We interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively. We interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited ergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms). This decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people’s intentions to undergo shoulder surgery and facilitates informed treatment choices is underway. Trial registration number ACTRN12621000992808
Publisher: Wiley
Date: 30-11-2005
DOI: 10.1111/J.1365-2753.2005.00574.X
Abstract: 'OTseeker' is an online database of randomized controlled trials (RCTs) and systematic reviews relevant to occupational therapy. RCTs are critically appraised and rated for quality using the 'PEDro' scale. We aimed to investigate the inter-rater reliability of the PEDro scale before and after revising rating guidelines. In study 1, five raters scored 100 RCTs using the original PEDro scale guidelines. In study 2, two raters scored 40 different RCTs using revised guidelines. All RCTs were randomly selected from the OTseeker database. Reliability was calculated using Kappa and intraclass correlation coefficients [ICC (model 2,1)]. Inter-rater reliability was 'good to excellent' in the first study (Kappas >or= 0.53 ICCs >or= 0.71). After revising the rating guidelines, the reliability levels were equivalent or higher to those previously obtained (Kappas >or= 0.53 ICCs >or= 0.89), except for the item, 'groups similar at baseline', which still had moderate reliability (Kappa = 0.53). In study 2, two PEDro scale items, which had their definitions revised, 'less than 15% dropout' and 'point measures and variability', showed higher reliability. In both studies, the PEDro items with the lowest reliability were 'groups similar at baseline' (Kappas = 0.53), 'less than 15% dropout' (Kappas <or= 0.68) and 'point measures and variability data' (Kappas <or= 0.68). The PEDro scale is a reliable instrument for rating the quality of RCTs. Revised rating guidelines are provided for scale items that are difficult to rate, and helped to improve inter-rater reliability.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2016
Publisher: Wiley
Date: 02-2017
Publisher: Wiley
Date: 12-2013
Publisher: FapUNIFESP (SciELO)
Date: 06-2016
Publisher: Public Library of Science (PLoS)
Date: 05-07-2012
Publisher: Springer Science and Business Media LLC
Date: 07-07-2015
Publisher: Springer Science and Business Media LLC
Date: 28-07-2021
DOI: 10.1186/S12910-021-00667-7
Abstract: Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to “unlearn” what we thought was true. Complexity further increases if unconfirmed findings have been used to inform guidelines. To help achieve a balance between early access to research findings and its negative consequences, we formulated five recommendations: (a) consensus should be sought on a term clearer than ‘pre-print’, such as ‘Unrefereed manuscript’, “Manuscript awaiting peer review” or ‘’Non-reviewed manuscript” (b) Caveats about unrefereed manuscripts should be prominent on their first page, and each page should include a red watermark stating ‘Caution—Not Peer Reviewed’ (c) pre-print authors should certify that their manuscript will be submitted to a peer-review journal, and should regularly update the manuscript status (d) high level consultations should be convened, to formulate clear principles and policies for the publication and dissemination of non-peer reviewed research results (e) in the longer term, an international initiative to certify servers that comply with good practices could be envisaged.
Publisher: Wiley
Date: 11-05-2010
DOI: 10.1111/J.1471-1842.2010.00877.X
Abstract: Research is essential for evidence-based practice yet many health professionals do not have enough time to find research. Studies relevant to occupational therapists can be particularly difficult to find. Most search engines are broad and return a large number of irrelevant articles. Occupational Therapy Systematic Evaluation of Evidence (OTseeker) is an occupational therapy database available at www.otseeker.com. Developed by Australian occupational therapists, the resource aims to increase access to research and support clinical decision making. This discipline-specific database contains pre-appraised information from a variety of sources and decreases the time required to locate best evidence. The aims of this paper are to: (i) describe how health librarians can use OTseeker to help allied health students, researchers and practitioners, particularly in occupational therapy, to find quality evidence (ii) provide a teaching resource for health librarians based around the OTseeker evidence database and (iii) highlight new features contained on the OTseeker database. A case study is provided which focuses on searching for evidence on the effectiveness of upper limb rehabilitation after stroke using OTseeker. This paper may increase the knowledge, skills and competencies of health librarians, helping them to access evidence-based databases, and educate other professionals.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2021
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.1310/TSR1702-99
Abstract: Cognitive impairment is a frequent consequence of stroke and can impact the ability of people who have had a stroke to perform everyday activities. There are a number of intervention strategies that various health professionals may use when working with people who have cognitive impairment post stroke. The purpose of this systematic review was to determine whether interventions for people with cognitive impairment after a stroke improve their functional performance of basic and/or instrumental activities of daily living (ADL). Searches were performed in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. Studies were eligible for inclusion if they were a randomised controlled trial or quasi-randomised controlled trial that evaluated an intervention that focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment and measured functional ability, either basic or instrumental ADL, as either a primary or secondary outcome measure. Four studies, involving a total of 376 participants, were included in this review. There was no statistically significant difference between groups on basic ADL performance in any of the four studies or on instrumental ADL in the one study that measured this. There were not an adequate number of high quality trials to be able to make recommendations that support or refute the use of specific cognitive retraining interventions to improve functional outcomes following a stroke. More research is required before conclusions can be made about the effect of cognitive interventions on functional outcomes post stroke.
Publisher: Wiley
Date: 08-09-2010
Publisher: Springer Science and Business Media LLC
Date: 02-02-2021
Publisher: John Wiley & Sons, Ltd
Date: 13-01-2014
Publisher: Oxford University Press (OUP)
Date: 07-2016
Publisher: Royal College of General Practitioners
Date: 21-09-2020
Abstract: Although uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established this h ers informed decision making about antibiotic use. To determine the natural history of uncomplicated UTI in adults. Systematic review. PubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted. Three randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36% up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant. Although some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.
Publisher: Informa UK Limited
Date: 17-06-2011
DOI: 10.3109/17549507.2011.560396
Abstract: People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation s ling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.ZEFQ.2022.04.002
Abstract: Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.
Publisher: Wiley
Date: 07-07-2018
DOI: 10.1111/FAF.12232
Publisher: Springer Science and Business Media LLC
Date: 23-10-2023
Publisher: Springer Science and Business Media LLC
Date: 15-04-2012
DOI: 10.1038/NG.2245
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.1310/TSR1702-119
Abstract: Telephone interviews may be a cost-effective alternative to administering stroke outcome measures for people who are living in the community following a stroke, but there is a lack of research that has compared the different modes of administering outcome measures. The aim of this study was to determine whether telephone administration of selected stroke outcome measures resulted in significantly different results to face-to-face administration of the same outcome measures. Nineteen participants who were taking part in a randomised controlled trial (RCT) evaluating the effectiveness of a postdischarge education and support package for stroke patients and their carers were recruited for this study. Participants had the RCT follow-up outcome measures, at 3 months post discharge, administered by both telephone and face-to-face. Participants were randomised to receive either the telephone or face-to-face administration first and a period of 2 weeks separated the two administrations. Outcome measures were the Knowledge of Stroke Questionnaire, a stroke self-efficacy questionnaire, Hospital Anxiety and Depression Scale, Stroke and Aphasia Quality of Life Scale, and the Caregiver Strain Index. There were no significant differences between scores obtained on any of the outcome measures that were administered by telephone and face-to-face (P > .05). The telephone can be used to administer the outcome measures that were evaluated in this study to stroke patients and carers. These findings may be of benefit to stroke researchers and clinicians who wish to incorporate the use of telephone measures into the follow-up care of stroke patients and their carers.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2012
DOI: 10.1038/NG.2247
Publisher: The Haworth Press
Date: 09-2001
Publisher: Center for Open Science
Date: 14-09-2020
Abstract: The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and elaboration paper for PRISMA 2020, where we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present exemplars from published reviews. We hope that changes to the content and structure of PRISMA 2020 will facilitate uptake of the guideline and lead to more transparent, complete and accurate reporting of systematic reviews.
Publisher: Wiley
Date: 23-07-2019
Abstract: Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. To investigate occupational and physiotherapists' perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed-method study was conducted. Using an online survey and semi-structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free-text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. Forty-six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. Therapists identified that both motivators and barriers to implementing best-practice upper limb rehabilitation occur largely at the levels of the in idual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.
Publisher: Wiley
Date: 02-11-2009
Publisher: BMJ
Date: 07-03-2014
DOI: 10.1136/BMJ.G1687
Abstract: Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and ex les of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
Publisher: JMIR Publications Inc.
Date: 04-10-2019
Abstract: vidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. his study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. f 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Health app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs.
Publisher: Wiley
Date: 29-03-2010
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.PEC.2010.07.007
Abstract: To identify the preferences of patients with stroke and their carers for format and delivery style, of different categories of stroke information, and whether these preferences changed over time. A semi-structured questionnaire, designed to explore preferences for four topic categories was administered to 34 acute stroke unit patients and 18 carers prior to discharge and again, 3 months after discharge to 27 of these patients and 16 of these carers. Overall format preferences were a combination of face-to-face, written and telephone for both patients and carers prior to discharge. This combination continued for carers following discharge, while patients preferred face-to-face, written and alternative formats of online and audiovisual at this time. Patients and carers most frequently preferred delivery styles appeared to be a mix of active and passive delivery styles, across all topics. Access to a telephone hotline was a popular delivery style. Patient and carer preferences varied, supporting the need to offer a variety of formats and delivery styles at each point of contact. By focusing on specific formats and delivery styles for different topics, health professionals may maximise the access to, and relevance of, stroke information for patients and their carers.
Publisher: Elsevier BV
Date: 07-0012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
Publisher: Mark Allen Group
Date: 09-2004
DOI: 10.12968/IJTR.2004.11.9.19586
Abstract: Where is the evidence that occupational therapy intervention can make a difference? In short, it may be found somewhere among thousands of articles, spread over hundreds of journals. It is not surprising that surveys show that a major difficulty facing occupational therapists implementing evidence-based practice is the limited time they have to locate relevant research (Humphris et al, 2000 Bennett et al, 2003).
Publisher: Informa UK Limited
Date: 04-08-2016
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-043421
Abstract: Public cooperation to practise preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. An online cross-sectional survey. A national s le of 1500 Australian adults with representative quotas for age and gender provided by an online panel provider. Proportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions. Of the 1802 potential participants contacted, 289 did not qualify, 13 declined and 1500 participated in the survey (response rate 83%). Most participants correctly identified ‘washing your hands regularly with soap and water’ (92%) and ‘staying at least 1.5 m away from others’ (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them from contracting COVID-19. Views about face masks were ided. Only 66% of participants correctly identified that ‘regular use of antibiotics’ would not prevent COVID-19. Most participants (90%) identified ‘fever, fatigue and cough’ as indicators of COVID-19. However, 42% of participants thought that being unable to ‘hold your breath for 10 s without coughing’ was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%) and the Australian Government COVID-19 information app (31%). Public messaging about hand hygiene and physical distancing to prevent transmission appears to have been effective. However, there are clear, identified barriers for many in iduals that have the potential to impede uptake or maintenance of these behaviours in the long term. We need to develop public health messages that harness these barriers to improve future cooperation. Ensuring adherence to these interventions is critical.
Publisher: SAGE Publications
Date: 10-2017
Abstract: Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/J.IJMEDINF.2006.02.005
Abstract: Online evidence databases can provide access to high quality evidence at the point of care, making evidence-based practice more achievable. A discipline-specific online bibliographic database called OTseeker (www.otseeker.com) was designed for use by occupational therapists. The database is free, and contains citations and abstracts of systematic reviews, and critically appraised randomized controlled trials relevant to occupational therapy. The aim of this study was to investigate search practices of database users, their views on its functionality, and the reported impact, if any, on their practice from using OTseeker. An online survey, placed on the database website for 30 days. Potential participants were users of OTseeker during a 30-day period. A total of 498 people who had used the database more than once from over 40 countries completed the survey. Three hundred and nine (62%) participants believed that OTseeker had improved their ability to locate research about the effectiveness of occupational therapy interventions, and 92 (19%) agreed that the information in the database had contributed to a change in practice. Those reporting no practice changes agreed that use of OTseeker had improved their knowledge generally (n=189 38%), confirmed their practice (n=75 15%), or revealed that there was insufficient research relevant to their search topic (n=92 19%). Features of the database which helped respondents locate research evidence included: having discipline-specific content, providing critical appraisal ratings for randomized controlled trials, and presenting search results ranked for methodological quality. This study confirms the value of a discipline-specific, online database for helping occupational therapists locate high quality research evidence. Information located on databases such as OTseeker can help change or confirm practice, and improve knowledge.
Publisher: Informa UK Limited
Date: 07-2008
DOI: 10.1310/TSR1504-341
Abstract: To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the quality of the randomised controlled trials (RCTs), and the types of interventions and outcome measures used. A survey of stroke-related content in the OTseeker database was conducted in 2007. The year of publication and intervention categories used in each stroke-related RCT and systematic review (SR) were recorded. The internal validity of RCTs using the PEDro scale (partitioned) and the outcome measures used were also recorded. Of the 4,369 articles indexed on OTseeker, 452 (10.3%) related to stroke were conducted between 1979 and 2006. The five most frequently studied intervention categories were movement training (43.2%), models of service delivery (31.2%), physical modalities/orthotics/splinting (30.1%), exercise/stretching/strength training (19.5%), and skill acquisition/training (9.3%). Random allocation (96.1%) was the most frequently satisfied internal validity criterion and therapist blinding (3.1%) was least often satisfied. The five most frequently used outcome measurement categories were basic and extended activities of daily living (70.1%), hand and upper limb function (56.1%), walking/gait (44.1%), movement/motor function (32.7%), and quality of life/general overall health (27.9%). The stroke-related content on OTseeker is useful for allied health professionals. This study highlights a need for better definitions of interventions and consensus about the best outcome measures. Few interventions or outcome measures were participation focused.
Publisher: Elsevier BV
Date: 10-2013
Publisher: SAGE Publications
Date: 21-08-2012
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJOPEN-2019-034485
Abstract: To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Evidence map (systematic review variant). MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded from inception to April 2018. Studies reporting primary research on health-related preferences of older patients (mean age ≥60 years) with multimorbidity (≥2 chronic/acute conditions). Two independent reviewers assessed studies for eligibility, extracted data and clustered the studies using MAXQDA-18 content analysis software. The 152 included studies (62% from North America, 28% from Europe) comprised 57 093 patients overall (range 9–9105). All used an observational design except for one interventional study: 63 (41%) were qualitative (59 cross-sectional, 4 longitudinal), 85 (57%) quantitative (63 cross-sectional, 22 longitudinal) and 3 (2%) used mixed methods. The setting was specialised care in 85 (56%) and primary care in 54 (36%) studies. We identified seven clusters of studies on preferences: end-of-life care (n=51, 34%), self-management (n=34, 22%), treatment (n=32, 21%), involvement in shared decision making (n=25, 17%), health outcome prioritisation/goal setting (n=19, 13%), healthcare service (n=12, 8%) and screening/diagnostic testing (n=1, 1%). Terminology (eg, preferences, views and perspectives) and concepts (eg, trade-offs, decision regret, goal setting) used to describe health-related preferences varied substantially between studies. Our study provides the first evidence map on the preferences of older patients with multimorbidity. Included studies were mostly conducted in developed countries and covered a broad range of issues. Evidence on patient preferences concerning decision-making on screening and diagnostic testing was scarce. Differences in employed terminology, decision-making components and concepts, as well as the sparsity of intervention studies, are challenges for future research into evidence-based decision support seeking to elicit the preferences of older patients with multimorbidity and help them construct preferences. Open Science Framework (OSF): DOI 10.17605/OSF.IO/MCRWQ.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Informa UK Limited
Date: 07-03-2020
Publisher: BMJ
Date: 20-07-2017
DOI: 10.1136/BMJ.J2998
Publisher: SAGE Publications
Date: 04-03-2021
Abstract: Patients and clinicians expect the information in patient decision aids to be based on the best available research evidence. The objectives of this International Patient Decision Aid Standards (IPDAS) review were to 1) check the currency of, and where needed, update evidence for the domain of “basing the information in decision aids on comprehensive, critically appraised, and up-to-date syntheses of the evidence” 2) analyze the evidence characteristics of decision aids and 3) propose updates to relevant IPDAS criteria. We searched MEDLINE and PubMed to inform updates of this domain’s definitions, justifications, and components. We also searched 5 sources to identify all publicly available decision aids ( N = 471). Two assessors independently extracted each aid’s evidence characteristics. Minor updates to the definitions and theoretical justifications of this IPDAS domain are provided and changes to relevant IPDAS criteria proposed. Nearly all aids (97%) provided a year of creation/update, but most (81%) did not report an explicit update or expiration policy. No scientific references were cited in 33% of aids. Of the 314 that cited at least 1 reference, 39% cited at least 1 guideline, 44% cited at least 1 systematic review, and 23% cited at least 1 randomized trial. In 35%, it was unclear what statement in the aid the citations referred to. Only 14% reported any of the processes used to find and decide on evidence inclusion. Only 14% reported the evidence quality. Many emerging issues and future research areas were identified. Although many emerging issues need to be addressed, this IPDAS domain is validated and criteria refined. High-quality patient decision aids should be based on comprehensive and up-to-date syntheses of critically appraised evidence.
Publisher: Informa UK Limited
Date: 05-12-2012
DOI: 10.3109/17549507.2011.631583
Abstract: The objectives of this study were to obtain the preferences of people with aphasia for the design of stroke and aphasia printed education materials (PEMs) and to compare these preferences with recommendations in the literature for developing written information for other populations. A face-to-face quantitative questionnaire was completed with 40 adults with aphasia post-stroke. The questionnaire explored preferences for: (1) the representation of numbers, (2) font size and type, (3) line spacing, (4) document length, and (5) graphic type. Most preferences (62.4%, n = 146) were for numbers expressed as figures rather than words. The largest proportion of participants selected 14 point (28.2%, n = 11) and Verdana ref (33.3%, n = 13) as the easiest font size and type to read, and a preference for 1.5 line spacing (41.0%, n = 16) was identified. Preference for document length was not related to the participant's reading ability or aphasia severity. Most participants (95.0%, n = 38) considered graphics to be helpful, with photographs more frequently reported as a helpful graphic type. The identified preferences support many of the formatting recommendations found within the literature. This research provides guiding principles for developing PEMs in preferred formats for people with aphasia.
Publisher: Wiley
Date: 20-12-2018
Abstract: Scientific conferences provide a forum for clinicians, educators, students and researchers to share research findings. To be selected to present at a scientific conference, authors must submit a short abstract which is then rated on its scientific quality and professional merit and is accepted or rejected based on these ratings. Previous research has indicated that inter-rater variability can have a substantial impact on abstract selection decisions. For their 2015 conference, the Occupational Therapy Australia National Conference introduced a system to identify and adjust for inter-rater variability in the abstract ranking and selection process. Ratings for 1340 abstracts submitted for the 2015 and 2017 conferences were analysed using many-faceted Rasch analysis to identify and adjust for inter-rater variability. Analyses of the construct validity of the abstract rating instrument and rater consistency were completed. To quantify the influence of inter-rater variability of abstract selection decisions, comparisons were made between decisions made using Rasch-calibrated measure scores and decisions that would have been made based purely on raw average scores derived from the abstract ratings. Construct validity and measurement properties of the abstract rating tool were good to excellent (item fit MnSq scores ranged from 0.8 to 1.2 item reliability index = 1.0). Most raters (24 of 27, 89%) were consistent in their use of the rating instrument. When comparing abstract allocations under the two conditions, 25% of abstracts (n = 341) would have been allocated differently if inter-rater variability was not accounted for. This study demonstrates that, even with a strong abstract rating instrument and a small rater pool, inter-rater variability still exerts a substantial influence on abstract selection decisions. It is recommended that all occupational therapy conferences internationally, and scientific conferences more generally, adopt systems to identify and adjust for the impact of inter-rater variability in abstract selection processes.
Publisher: BMJ
Date: 29-03-2021
DOI: 10.1136/BMJ.N71
Publisher: SAGE Publications
Date: 05-05-2019
DOI: 10.1177/17474930231176718
Abstract: Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and in idual participant level. A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version–10 at screening. Each arm received manualized intervention over 6–8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire–21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (β = –2.74, 95% confidence interval (CI) = –4.76 to –0.73, p = 0.008). In idual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.
Publisher: American Medical Association (AMA)
Date: 22-06-2018
DOI: 10.1001/JAMANETWORKOPEN.2018.0281
Abstract: Evidence-based practice (EBP) is necessary for improving the quality of health care as well as patient outcomes. Evidence-based practice is commonly integrated into the curricula of undergraduate, postgraduate, and continuing professional development health programs. There is, however, inconsistency in the curriculum content of EBP teaching and learning programs. A standardized set of minimum core competencies in EBP that health professionals should meet has the potential to standardize and improve education in EBP. To develop a consensus set of core competencies for health professionals in EBP. For this modified Delphi survey study, a set of EBP core competencies that should be covered in EBP teaching and learning programs was developed in 4 stages: (1) generation of an initial set of relevant EBP competencies derived from a systematic review of EBP education studies for health professionals (2) a 2-round, web-based Delphi survey of health professionals, selected using purposive s ling, to prioritize and gain consensus on the most essential EBP core competencies (3) consensus meetings, both face-to-face and via video conference, to finalize the consensus on the most essential core competencies and (4) feedback and endorsement from EBP experts. From an earlier systematic review of 83 EBP educational intervention studies, 86 unique EBP competencies were identified. In a Delphi survey of 234 participants representing a range of health professionals (physicians, nurses, and allied health professionals) who registered interest (88 [61.1%] women mean [SD] age, 45.2 [10.2] years), 184 (78.6%) participated in round 1 and 144 (61.5%) in round 2. Consensus was reached on 68 EBP core competencies. The final set of EBP core competencies were grouped into the main EBP domains. For each key competency, a description of the level of detail or delivery was identified. A consensus-based, contemporary set of EBP core competencies has been identified that may inform curriculum development of entry-level EBP teaching and learning programs for health professionals and benchmark standards for EBP teaching.
Publisher: SAGE Publications
Date: 11-2014
DOI: 10.1111/IJS.12374_25
Publisher: Springer Science and Business Media LLC
Date: 19-03-2022
DOI: 10.1186/S12961-022-00833-2
Abstract: The COVID-19 pandemic has led to an increased interest in communication with the public regarding vaccination. Our recent Cochrane qualitative evidence synthesis points to several factors that could influence the implementation and success of healthcare worker communication with older adults about vaccination. However, it is often difficult to assess whether factors identified as potentially important in qualitative studies have been considered in randomized trials because of poor trial reporting. We therefore decided to use our qualitative evidence synthesis findings to encourage better reporting of vaccination communication interventions in trials by developing an elaboration of the TIDieR (Template for Intervention Description and Replication) checklist for intervention reporting. We examined the findings from our Cochrane qualitative evidence synthesis on healthcare workers’ perceptions of and experiences with communicating about vaccination with adults over the age of 50 years. We identified factors that could influence the implementation and uptake, and thereby the effectiveness, of vaccination communication interventions. We then drafted a list of the information elements we would need from trial reports to assess whether these factors had been considered in the development of the interventions evaluated in these trials. Finally, we compared our list of information elements to the TIDieR checklist items. We were able to align all of our information elements with the TIDieR items. However, for several of the TIDieR items, we developed a more detailed description to ensure that relevant information would be captured sufficiently in trial reports. We developed elaborations for the following TIDieR items: “Why” (item 2), “What—materials” (item 3), “Who provided” (item 5), “How” (item 6), “Where” (item 7) and “Tailoring” (item 9). Both qualitative research and trials of intervention effectiveness are critical to furthering our understanding of what works, where, for whom and through which mechanisms. However, a key ingredient for developing this understanding is adequate reporting of intervention design, content and implementation in randomized trials. We hope that this elaboration of the TIDier checklist will improve reporting of interventions in trials focused on vaccine communication with older adults, and thereby enhance the usability of this research for developing future communication strategies.
Publisher: BMJ
Date: 17-05-2012
DOI: 10.1136/BMJ.E3223
Publisher: Springer Science and Business Media LLC
Date: 25-08-2021
DOI: 10.1186/S12911-021-01612-9
Abstract: Understanding prognostic information can help patients know what may happen to their health over time and make informed decisions. However, communicating prognostic information well can be challenging. To conduct a systematic review to identify and synthesize research that has evaluated visual presentations that communicate quantitative prognostic information to patients or the public. MEDLINE, EMBASE, CINAHL, PsycINFO , ERIC and the Cochrane Central Register of Controlled Trials (CENTRAL) (from inception to December 2020), and forward and backward citation search. Two authors independently screened search results and assessed eligibility. To be eligible, studies required a quantitative design and comparison of at least one visual presentation with another presentation of quantitative prognostic information. The primary outcome was comprehension of the presented information. Secondary outcomes were preferences for or satisfaction with the presentations viewed, and behavioral intentions. Two authors independently assessed risk of bias and extracted data. Eleven studies (all randomized trials) were identified. We grouped studies according to the presentation type evaluated. Bar graph versus pictograph (3 studies): no difference in comprehension between the groups. Survival vs mortality curves (2 studies): no difference in one study higher comprehension in survival curve group in another study. Tabular format versus pictograph (4 studies): 2 studies reported similar comprehension between groups 2 found higher comprehension in pictograph groups. Tabular versus free text (3 studies): 2 studies found no difference between groups 1 found higher comprehension in a tabular group. Heterogeneity in the visual presentations and outcome measures, precluding meta-analysis. No visual presentation appears to be consistently superior to communicate quantitative prognostic information.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1053/J.JRN.2017.07.008
Abstract: People with chronic kidney disease (CKD) contend with complex dietary recommendations. The challenge in practice is for clinicians to provide in idualized support with the frequency and consistency required to sustain dietary changes. This study aimed to describe the experiences of patients with managing dietary recommendations, including their perspectives on the potential to use telehealth to support dietary management in CKD. Focus group study. Twenty-one adult patients with CKD (nondialysis) and 3 caregivers (total N = 24) purposively s led to achieve erse demographic and clinical characteristics, from two nephrology units in Queensland, Australia. Five focus groups were conducted, audio recorded, and transcribed. Transcripts were analyzed using thematic analysis drawing on the principles of grounded theory. Themes aligned with the research question. We identified five themes: exasperating stagnancy (patronized by redundant advice, confused and unprepared for dietary change, inevitability of failure, and barriers to accessing dietetic services) supporting and sustaining change (receiving regular feedback, incremental and comprehendible modification, practical guidance on food, flexibility in monitoring schedule, and valuing peer advice) fostering ownership (seeking kidney diet information, enacting behavior change, making reminders, and tracking progress against targets) motivators and positive learning instruction (relying on reassurance, positive reinforcement, focusing on allowable foods, and involving family) threats and ambiguities of risk (sugar as the culprit, ubiquity of salt, illegible food labeling, avoiding processed foods, and questioning credibility of sources). Patients with CKD desire a preventative approach to CKD progression and maintaining their health, however, are stymied by dietary restrictions and a lack of reliable dietetic advice. Easy-to-use telehealth options have the potential to overcome the shortcomings in current health service delivery which may be limiting factors to providing these approaches. They provide patients with pragmatic tools, comprehensible and consistent information which fosters ownership and self-monitoring.
Publisher: AOTA Press
Date: 05-2013
Abstract: OBJECTIVE. We sought to identify and describe the number, topics, and publishing trends of systematic reviews relevant to occupational therapy indexed in the OTseeker database. METHOD. We performed a cross-sectional survey of the systematic reviews contained in OTseeker in December 2011. RESULTS. Of the 1,940 systematic reviews indexed in OTseeker, only 53 (2.7%) were published in occupational therapy journals. The most common diagnostic categories were stroke (n = 195, 10.1%) and affective disorders (n = 204, 10.5%). The most common intervention categories were consumer education (n = 644, 33.2%) and psychosocial techniques (n = 571, 29.4%). Only 390 (20.1%) of the 1,940 systematic reviews specifically involved occupational therapy. CONCLUSION. Occupational therapists need to search broadly to locate relevant systematic reviews or, alternatively, to use databases such as OTseeker. Clarity about the involvement of occupational therapy in reports of future research will improve the ability to identify occupational therapy research for all stakeholders. Finally, occupational therapy practitioners need to read systematic reviews critically to determine whether review conclusions are justified.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2013
DOI: 10.1038/NG0613-713A
Publisher: SAGE Publications
Date: 30-09-2019
Abstract: Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.
Publisher: Elsevier BV
Date: 08-2016
Publisher: Wiley
Date: 22-05-2016
Publisher: SAGE Publications
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 27-11-2018
Publisher: JMIR Publications Inc.
Date: 11-12-2017
DOI: 10.2196/JMIR.8193
Publisher: JMIR Publications Inc.
Date: 29-11-2019
Abstract: ral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. his systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. his project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. ursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. RR1-10.2196/17249
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1002/CHP.21263
Abstract: Abstract ranking processes for scientific conferences are essential but controversial. This study examined the validity of a structured abstract rating instrument, evaluated interrater variability, and modeled the impact of interrater variability on abstract ranking decisions. Additionally, we examined whether a more efficient rating process (abstracts rated by two rather than three raters) supported valid abstract rankings. Data were 4016 sets of abstract ratings from the 2011 and 2013 national scientific conferences for a health discipline. Many-faceted Rasch analysis procedures were used to examine validity of the abstract rating instrument and to identify and adjust for the presence of interrater variability. The two-rater simulation was created by the deletion of one set of ratings for each abstract in the 2013 data set. The abstract rating instrument demonstrated sound measurement properties. Although each rater applied the rating criteria consistently (intrarater reliability), there was significant variability between raters. Adjusting for interrater variability changed the final presentation format for approximately 10-20% of abstracts. The two-rater simulation demonstrated that abstract rankings derived through this process were valid, although the impact of interrater variability was more substantial. Interrater variability exerts a small but important influence on overall abstract acceptance outcome. The use of many-faceted Rasch analysis allows for this variability to be adjusted for. Additionally, Rasch processes allow for more efficient abstract ranking by reducing the need for multiple raters.
Publisher: Oxford University Press (OUP)
Date: 09-07-2011
Abstract: This study aimed to determine (i) risk factors for postdischarge falls and (ii) the effect of inpatient falls prevention education on rates of falls after discharge. Participants (n = 343) were a prospective cohort nested within a randomized controlled trial (n = 1,206) of falls prevention patient education in hospital compared with usual care. Participants were followed up for 6 months after discharge and falls recorded via a falls diary and monthly telephone calls. Potential falls risk factors were assessed at point of discharge and at 6 months postdischarge using a telephone survey. There were 276 falls among 138 (40.2%) participants in the 6 months following discharge (4.52/1,000 person days) of which 150 were injurious falls (2.46/1,000 person days). Pairwise comparisons found no significant differences between groups in rates of falls after adjustment for confounding variables. Independent risk factors for all falls outcomes were male gender, history of falls prior to hospital admission, fall during hospital admission, depressed mood at discharge, using a walking aid at discharge, and receiving assistance with activities of daily living at 6 months following discharge. Receiving assistance with activities of daily living significantly reduced the risk of falls and injurious falls for high risk patients. Older patients are at increased risk of falls and falls injuries following discharge. Education that effectively reduced inpatient falls appears to have no ongoing protective effect after discharge. Independent risk factors for falls in this population differ from both hospital and general community settings.
Publisher: FapUNIFESP (SciELO)
Date: 07-2022
Publisher: CMA Joule Inc.
Date: 29-07-2018
DOI: 10.1503/CMAJ.171400
Publisher: Elsevier BV
Date: 06-2021
Publisher: JMIR Publications Inc.
Date: 30-07-2020
DOI: 10.2196/17447
Abstract: The ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners and their patients view the possibility of prescribing mobile health (mHealth) apps as a nondrug intervention. This study aimed to determine barriers and facilitators to prescribing mHealth apps in Australian general practice from the perspective of general practitioners and their patients. We conducted semistructured interviews in Australian general practice settings with purposively s led general practitioners and patients. The audio-recorded interviews were transcribed, coded, and thematically analyzed by two researchers. Interview participants included 20 general practitioners and 15 adult patients. General practitioners’ perceived barriers to prescribing apps included a generational difference in the digital propensity for providers and patients lack of knowledge of prescribable apps and trustworthy sources to access them the time commitment required of providers and patients to learn and use the apps and concerns about privacy, safety, and trustworthiness of health apps. General practitioners perceived facilitators as trustworthy sources to access prescribable apps and information, and younger generation and widespread smartphone ownership. For patients, the main barriers were older age and usability of mHealth apps. Patients were not concerned about privacy and data safety issues regarding health app use. Facilitators for patients included the ubiquity of smartphones and apps, especially for the younger generation and recommendation of apps by doctors. We identified evidence of effectiveness as an independent theme from both the provider and patient perspectives. mHealth app prescription appears to be feasible in general practice. The barriers and facilitators identified by the providers and patients overlapped, though privacy was of less concern to patients. The involvement of health professionals and patients is vital for the successful integration of effective, evidence-based mHealth apps with clinical practice.
Publisher: Annals of Family Medicine
Date: 2022
DOI: 10.1370/AFM.2755
Publisher: American Medical Association (AMA)
Date: 08-2017
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-018791
Abstract: Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations. Systematic review. Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high ( %) across all domains of AGREE-II highest rated domains were ‘scope and purpose’ (85.1, SD 18.3) and ‘clarity’ (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines. Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality. CRD42016026936 .
Publisher: Wiley
Date: 05-05-2006
Publisher: Wiley
Date: 24-09-2012
Publisher: Informa UK Limited
Date: 04-2001
Publisher: Public Library of Science (PLoS)
Date: 13-03-2018
Publisher: Springer Science and Business Media LLC
Date: 04-03-2017
DOI: 10.1007/S40271-017-0223-2
Abstract: Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p < 0.01], and had higher total knowledge [mean difference (MD) 2.8, 95% CI 2.2-3.5, p < 0.01], conceptual knowledge (MD 0.7, 95% CI 0.4-1.1, p < 0.01) and numerical knowledge (MD 2.1, 95% CI 1.6-2.5, p < 0.01). Between-group differences in attitudes or intention to use antibiotics were not significant. Most intervention group participants found the information understandable and liked the aids' format and features. The decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.
Publisher: Informa UK Limited
Date: 03-2014
DOI: 10.1310/TSR21S1-S52
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2019-029540
Abstract: Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation to overuse or underuse of tests or treatments. The aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services. We will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group. No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2015
Publisher: BMJ
Date: 09-03-2022
DOI: 10.1136/BMJ.O533
Publisher: Informa UK Limited
Date: 09-2012
DOI: 10.2147/IJGM.S36557
Publisher: Springer Science and Business Media LLC
Date: 31-01-2014
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2019-034696
Abstract: Mobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists. This pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources) (2) the enhanced intervention package compared with no intervention (6-month waiting list control group) and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, in idualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other. Ethical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers. ACTRN12618001983291.
Publisher: Wiley
Date: 13-07-2007
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOQ-2020-000954
Abstract: Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists and physiotherapists, and explore effect on patient upper limb outcomes. This was a non-randomised clustered feasibility study of occupational and physiotherapy rehabilitation services (n=3 inpatient and n=3 outpatient services). Services were allocated to one of three groups: (group A) facilitator-mediated implementation package, (group B) self-directed implementation package or (group C) usual care (control) we recruited n=1 inpatient and n=1 outpatient service per group. Outcomes of feasibility, adherence to guidelines (medical file audits) and patient upper limb impairment (Fugl-Meyer Upper Extremity Assessment), activity (Box and Block Test) and practice (minutes/week) were collected at baseline and after 3 months of intervention. 29 therapists (8 in group A, 13 in groups B and 8 in group C) and 55 patients participated. Both the facilitator-mediated and the self-directed implementation packages were feasible to deliver in the rehabilitation setting. Therapists in group A improved with respect to guideline adherence (medical file audits median within-group proportion difference of 0.29 (95% CI 0.22 to 0.36, p .0001) preintervention to postintervention). No significant within-group differences from baseline to postintervention were found in group B or group C, and no between-group differences were found for upper limb outcomes. A facilitator-mediated package was acceptable to therapists working in stroke rehabilitation, and feasibility data suggest increased guideline uptake following implementation. An adequately powered study is planned to understand how to support therapists to provide evidence-based upper limb rehabilitation after stroke. Australian New Zealand Clinical Trials Registry (ACTRN12619000596101).
Publisher: Springer Science and Business Media LLC
Date: 06-03-2019
Publisher: Wiley
Date: 07-05-2010
DOI: 10.1111/J.1532-5415.2010.02856.X
Abstract: To compare three different methods of falls reporting and examine the characteristics of the data missing from the hospital incident reporting system. Fourteen-month prospective observational study nested within a randomized controlled trial. Rehabilitation, stroke, medical, surgical, and orthopedic wards in Perth and Brisbane, Australia. Fallers (n=153) who were part of a larger trial (1,206 participants, mean age 75.1 + or - 11.0). Three falls events reporting measures: participants' self-report of fall events, fall events reported in participants' case notes, and falls events reported through the hospital reporting systems. The three reporting systems identified 245 falls events in total. Participants' case notes captured 226 (92.2%) falls events, hospital incident reporting systems captured 185 (75.5%) falls events, and participant self-report captured 147 (60.2%) falls events. Falls events were significantly less likely to be recorded in hospital reporting systems when a participant sustained a subsequent fall, (P=.01) or when the fall occurred in the morning shift (P=.01) or afternoon shift (P=.01). Falls data missing from hospital incident report systems are not missing completely at random and therefore will introduce bias in some analyses if the factor investigated is related to whether the data is missing. Multimodal approaches to collecting falls data are preferable to relying on a single source alone.
Publisher: BMJ
Date: 24-06-2020
DOI: 10.1136/BMJEBM-2019-111210
Abstract: Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their erse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information service using established and inductive coding systems. We analysed 126 clinical questions submitted by 53 Australian GPs over a 1.5-year period. Questions were coded using the International Classification of Primary Care (ICPC-2 PLUS) and Ely and colleagues’ generic questions taxonomy by two independent coders. Inductive qualitative content analysis was also used to identify perceived knowledge gaps. Treatment (71%), diagnosis (15%) and epidemiology (9%) were the most common categories of questions. Using the ICPC-2 classification, questions were most commonly coded to the endocrine/metabolic and nutritional chapter heading, followed by general and unspecified, digestive and musculoskeletal. Seventy per cent of all questions related to the need to stay up-to-date with the evidence, or be informed about new tests or treatments (including complementary and alternative therapies). These findings suggest that current guideline formats for common clinical problems may not meet the knowledge demands of GPs and there is gap in access to evidence updates on new tests, treatments and complementary and alternative therapies. Better systems for ‘pulling’ real-time questions from GPs could better inform the ‘push’ of more relevant and timely evidence for use in the clinical encounter.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/PY22258
Publisher: Springer Science and Business Media LLC
Date: 14-01-2014
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JCLINEPI.2019.11.010
Abstract: The aim of the study was to generate a comprehensive bank of systematic review (SR) reporting items to inform an update of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2009 statement. We searched the Enhancing the QUAlity and Transparency Of health Research Network library in May 2019 to identify all reporting guidelines for SRs that were published after 2009, regardless of the scope of the guideline. We also conducted a selective review of four guidance manuals for SRs, three tools for assessing the risk of bias in SRs, six meta-research studies evaluating the reporting quality of SRs using a tailored checklist, and five reporting guidelines for other study designs. One author screened and selected sources for inclusion, extracted reporting guidance from sources, and mapped guidance against the PRISMA 2009 checklist items. We included 60 sources providing guidance on reporting of SRs and meta-analyses. From these, we collated a list of 221 unique reporting items. Items were categorized into title (four items), abstract (10 items), introduction (12 items), methods (111 items), results (61 items), discussion (12 items), funding and conflicts of interest (four items), administrative information (three items), and data availability (four items). This exercise generated 175 reporting items that could be added to the guidance in the PRISMA 2009 statement. Generation of a comprehensive item bank through review and mapping of the literature facilitates identification of missing items and those needing modification, which may not otherwise be identified by the guideline development team or from other activities commonly used to develop reporting guidelines.
Publisher: Wiley
Date: 20-11-2008
DOI: 10.1111/J.1440-1630.2007.00693.X
Abstract: Occupational therapy is an important component of neurological rehabilitation. Clients in rural areas have fewer opportunities to receive rehabilitation than those in metropolitan areas. Telehealth is a potential method of closing these gaps in service delivery, although research into telehealth applications for neurological rehabilitation is extremely limited. To assist in the development of appropriate telehealth applications, this study aimed to identify the nature of occupational therapy services for neurological rehabilitation in areas of Queensland other than the capital city of Brisbane, the barriers to service delivery, and the current uses of various information and communication technologies among occupational therapists. A self-administered questionnaire was sent to occupational therapists working in adult neurological rehabilitation in all areas of Queensland other than the capital city of Brisbane. Contact details were obtained from OT AUSTRALIA Queensland. Responses were received from 39 eligible participants. The client's home was the most frequent setting in which participants saw clients. Home visits and modifications, equipment prescription, client/family education, and activities of daily living assessment and retraining were the most common interventions provided by participants. Frequently identified barriers to service provision included travelling distance to clients, large workloads and limited resources. Telephone, email, fax, the Internet and videoconferencing were available in most workplaces. Few participants used the Internet or videoconferencing for purposes other than continuing professional development. Home-based assessment and intervention appear to be frequent components of occupational therapy practice among therapists working in neurological rehabilitation. The use of telehealth to provide direct home-based client services is currently limited, but should be explored as a possible solution to overcome some of the identified barriers to occupational therapy service provision for clients with neurological conditions in rural and remote areas.
Publisher: Wiley
Date: 30-11-2011
DOI: 10.1111/J.1365-2753.2010.01602.X
Abstract: To evaluate the effectiveness of a semester-long multi-professional university course teaching evidence-based practice principles to allied health students in terms of changes in attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice. This was a pre-post study of allied health students who completed a multi-professional university course that taught evidence-based practice skills and concepts. The course was run over a 13-week period (2 hours per week) and utilized didactic lectures, tutorial and workshop formats, and a hands-on database searching session. Participants completed a questionnaire which assessed their attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice on the first and last day of the course. Ninety-one students participated in the study however, complete data sets were available for only 59 participants. Attitudes towards evidence-based practice did not significantly improve however, attitudes were already positive prior to undertaking the course. There was a statistically significant improvement in confidence with a mean increase of 9.02 [score range 6-30, 95% confidence interval (CI) 8.21, 9.82]. Perceived knowledge improved with a statistically significant mean increase of 14.15 (score range 5-25, 95% CI 12.55, 15.75) and there was a statistically significant mean increase in actual knowledge of 3.56 (score range 0-10, 95% CI 2.83, 4.29). Teaching evidence-based practice skills and concepts to allied health students within a multi-professional university curriculum improved confidence and perceived and actual knowledge regarding evidence-based practice. Further research is needed to determine if these changes result in long-term behaviour change once students graduate, and to consider optimal methods for multi- and interprofessional delivery of evidence-based practice training.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-046175
Abstract: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events. Systematic review and meta-analysis. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020. We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences. Two review authors independently screened the titles and abstracts for inclusion and extracted data. Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93) six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose–response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms. Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission however, direct and indirect evidence suggest sanitiser might be more effective in practice.
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.1310/TSR1702-69
Abstract: Education is a key component of post stroke care, but patients and carers often report dissatisfaction with information provided. A small number of studies have reported challenges surrounding the provision of information to this population, but patients' perspectives have not been explored in detail. The aim of this study was to identify patients' and carers' perceived barriers to accessing and understanding information about stroke. Interviews were conducted with patients and their carers prior to and 3 months following discharge from an acute stroke unit. Transcripts were analysed using qualitative content analysis. The three categories of barriers were identified: (1) limited availability and suitability of information, (2) barriers in the hospital environment, and (3) patient and carer barriers. Three themes were also identified, namely, (1) who is responsible, (2) communication, and (3) not knowing. These results have clinical implications for the way in which health professionals coordinate and present stroke information to patients and carers. Addressing these barriers may enhance patients' and carers' access to, understanding of, and satisfaction with information about stroke.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.APMR.2011.04.009
Abstract: To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge. A prospective observational study using qualitative and quantitative evaluation. Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital. Participants (N=343) were older patients (mean age ± SD, 79.4 ± 8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge. Not applicable. Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey. Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61 95% confidence interval [CI], .48-.78 P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93 95% CI, 1.03-3.59 P=.04), and if they lived with a partner (OR=1.97 95% CI, 1.18-3.28 P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery. Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.
Publisher: MDPI AG
Date: 29-12-2021
DOI: 10.3390/JCM10010091
Abstract: Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2016
Abstract: The TIDieR (template for intervention description and replication) checklist and guide were developed to improve the reporting of interventions in any evaluative study, including randomized trials. The checklist contains 12 items and was developed as an extension to the CONSORT 2010 and SPIRIT 2013 statements to provide further guidance for authors on the key information to include in trial reports. Incomplete reporting of interventions in physical therapy studies is an important problem, and we endorse the use of the TIDieR checklist as a potential solution. J Orthop Sports Phys Ther 2016 (6):402-404. doi:10.2519/jospt.2016.0108.
Publisher: SAGE Publications
Date: 03-2008
Abstract: Summary We evaluated the feasibility and accuracy of conducting occupational therapy home visits using the Internet. Studies were conducted at the homes of 40 patients who were scheduled to undergo a total hip or knee replacement: home visits were conducted, on the same day, by both a face-to-face therapist and an online therapist. The online therapist conducted the visit via a low-speed, dial-up Internet connection using a specially developed telerehabilitation system. This system combines real-time videoconferencing (320 x 240 pixel resolution) with a suite of calibrated assessment tools which the operator can use to measure real-scale angular displacement/velocity and linear distances during the videoconference. Both therapists completed a home environment questionnaire, assessed patients' transfer ability and measured the heights of six objects ieces of furniture. For the questionnaire items which related to variables in the home environment, the mean percentage exact agreement was 98.9% (SD 2.6 range 90–100), while there was 100% agreement on the items related to transfers. The mean absolute difference in measured heights between the two therapists ranged from 0.1–3.3 cm. The results suggest that conducting pre-admission orthopaedic occupational therapy home visits via the Internet is both feasible and accurate.
Publisher: The Royal Australian College of General Practitioners
Date: 12-2018
Publisher: Public Library of Science (PLoS)
Date: 13-03-2019
Publisher: Elsevier BV
Date: 11-2015
Publisher: SAGE Publications
Date: 03-2004
DOI: 10.1177/030802260406700303
Abstract: This study explored the extent, source and format of the information received by stroke rehabilitation patients and their perceptions of the quality of that information. Additionally, the readability levels of the written materials received were assessed. Fifteen patients were interviewed approximately 1.8 months post-inpatient rehabilitation. Occupational therapists were the principal sources of information about returning home, equipment/ assistive devices, activities/exercise after stroke and the physical effects of stroke. The patients wanted additional information on the following topics that occupational therapists can address: treatments after stroke, the causes of stroke, risk factors/future prevention, stroke support groups, what to expect in rehabilitation and emotional problems/ difficulties during recovery. Most information was verbal. Although 70% of the patients felt that they had not received enough information and 87% identified gaps in what they had received, the information was considered relevant to their needs, easy to read/understand and helpful in coping with lifestyle changes. Two-thirds had received written information, written at an average grade 12 equivalent this was a level too high for educating lay people about health. The implications for occupational therapists are that general information may be being provided at the expense of the information of most importance to the patients. Occupational therapists should assess and address patients' informational needs and identify the patients' preferred formats for receiving the information. The assessment of readability is also useful.
Publisher: American Medical Association (AMA)
Date: 09-2017
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.ZEFQ.2017.05.011
Abstract: Shared decision making (SDM) is now firmly established within national clinical standards for accrediting hospitals, day procedure services, public dental services and medical education in Australia, with plans to align general practice, aged care and disability service. Implementation of these standards and training of health professionals is a key challenge for the Australian health sector at this time. Consumer involvement in health research, policy and clinical service governance has also increased, with a major focus on encouraging patients to ask questions during their clinical care. Tools to support shared decision making are increasingly used but there is a need for more systemic approaches to their development, cultural adaptation and implementation. Sustainable solutions to ensure tools are kept up-to-date with the best available evidence will be important for the future.
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJOPEN-2020-038682
Abstract: End-of-life care is an essential task performed by most healthcare providers and often involves decision-making about how and where patients want to receive care. To provide decision support to healthcare professionals and patients in this difficult situation, we will systematically review a knowledge cluster of the end-of-life care preferences of older patients with multimorbidity that we previously identified using an evidence map. We will systematically search for studies reporting end-of-life care preferences of older patients (mean age ≥60) with multimorbidity (≥2 chronic conditions) in MEDLINE, CINAHL, PsycINFO, Social Sciences Citation Index, Social Sciences Citation Index Expanded, PSYNDEX and The Cochrane Library from inception to September 2019. We will include all primary studies that use quantitative, qualitative and mixed methodologies, irrespective of publication date and language. Two independent reviewers will assess eligibility, extract data and describe evidence in terms of study opulation characteristics, preference assessment method and end-of-life care elements that matter to patients (eg, life-sustaining treatments). Risk of bias/applicability of results will be independently assessed by two reviewers using the Mixed-Methods Appraisal Tool. Using a convergent integrated approach on qualitative/quantitative studies, we will synthesise information narratively and, wherever possible, quantitatively. Due to the nature of the proposed systematic review, ethics approval is not required. Results from our research will be disseminated at relevant (inter-)national conferences and via publication in peer-reviewed journals. Synthesising evidence on end-of-life care preferences of older patients with multimorbidity will improve shared decision-making and satisfaction in this final period of life. CRD42020151862.
Publisher: Springer Science and Business Media LLC
Date: 08-2018
Publisher: SAGE Publications
Date: 12-2007
DOI: 10.1258/135763307783064377
Abstract: An Internet-based goniometer has recently been developed which can be used for the remote quantification of joint range of motion (ROM). We evaluated the validity and intra- and inter-rater reliability of this goniometer for the measurement of upper limb ROM in 10 people who had had a stroke. The movements on which the device was evaluated were shoulder flexion, shoulder abduction, elbow flexion, wrist flexion, wrist extension, forearm supination and forearm pronation. Measurements performed using the Internet-based goniometer were compared with measurements made using the most widely accepted clinical joint ROM measurement tool, the universal goniometer. The Internet-based goniometer was found to be a valid tool for the measurement of upper limb ROM, with the disagreement between the two measurement tools ranging from 1.1–2.4°. The Internet-based goniometer was also shown to possess a high level of intra- and inter-rater reliability (all intra class correlation coefficients .93). The results suggest that therapists can confidently use the Internet-based goniometer to measure the upper limb ROM in people who have had a stroke.
Publisher: Ubiquity Press, Ltd.
Date: 12-08-2022
DOI: 10.5334/GH.1142
Publisher: Elsevier BV
Date: 2022
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.1310/TSR1702-79
Abstract: Written health information can be better comprehended by people with aphasia if it is provided in an aphasia-friendly format. However, before pursuing research in the area of text-formatting for people with aphasia, it must be determined whether people with aphasia consider it helpful to receive health information in the written media. This study, therefore, aimed to determine the following: whether people with aphasia consider it important to receive written stroke and aphasia information when people with aphasia prefer to receive this information and what their preferences are for health information media. Surveys were administered in a face-to-face interview with 40 adults with aphasia. Participants were purposefully selected using maximum variation s ling for a variety of variables including aphasia severity, reading ability, and time post stroke. Participants thought it important to receive written information about both stroke and aphasia. They considered it helpful to receive written information at several stages post stroke, particularly from 1 month onwards. The largest proportion (97%) of participants identified 6 months post stroke as the most helpful time to receive this information. Written information was the most preferred media at participants' present time post stroke (M = 39 months range, 2-178 months). Videos/DVDs were the most preferred media during the 6 months immediately following the stroke. Despite reading and language difficulties, participants considered written information to be important, hence people with aphasia should receive written information about both stroke and aphasia. This information should be easily accessible throughout the continuum of care.
Publisher: Wiley
Date: 12-2003
Publisher: Wiley
Date: 15-05-2021
DOI: 10.1111/HEX.13244
Abstract: Patient decision aids (PDAs) should provide evidence‐based information so patients can make informed decisions. Yet, PDA developers do not have an agreed‐upon process to select, synthesize and present evidence in PDAs. To reach the consensus on an evidence summarization process for PDAs. A two‐round modified Delphi survey. A group of international experts in PDA development invited developers, scientific networks, patient groups and listservs to complete Delphi surveys. We emailed participants the study description and a link to the online survey. Participants were asked to rate each potential criterion (omit, possible, desirable, essential) and provide qualitative feedback. Criteria in each round were retained if rated by % of participants as desirable or essential. If two or more participants suggested rewording, reordering or merging, the steering group considered the suggestion. Following two Delphi survey rounds, the evidence summarization process included defining the decision, reporting the processes and policies of the evidence summarization process, assembling the editorial team and managing (collect, manage, report) their conflicts of interest, conducting a systematic search, selecting and appraising the evidence, presenting the harms and benefits in plain language, and describing the method of seeking external review and the plan for updating the evidence (search, selection and appraisal of new evidence). A multidisciplinary stakeholder group reached consensus on an evidence summarization process to guide the creation of high‐quality PDAs. A patient partner was part of the steering group and involved in the development of the Delphi survey.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
DOI: 10.1161/CIRCOUTCOMES.114.001381
Abstract: Complete reporting of all components of complex interventions is essential for translation of research evidence into clinical practice. Previous work has highlighted deficiencies in the reporting of nonpharmacological interventions however, the reporting quality of exercise-based interventions for coronary heart disease has not been examined. A systematic search strategy was used to identify randomized controlled trials of exercise-based cardiac rehabilitation published until December 2013. Fifty-seven trials were included, reporting on 74 interventions. Intervention description completeness was assessed using the Template for Intervention Description and Replication checklist. Missing intervention details were then sought from additional published material and also by emailing corresponding authors. Only 6 interventions (8%) sufficiently described all required items within the main publication this increased to 11 (15%) after searching for additional published material and 32 (43%) after contacting trial authors. Although location/setting and duration were consistently well reported in publications, complete descriptions of the exercise schedule, as well as details about its tailoring and progression, were missing for over half of interventions (complete for 42% and 36% of interventions, respectively). Although some authors (25/61) were able to provide missing intervention details when contacted, others could not be located (20) or did not respond (16). Inadequate reporting of cardiac rehabilitation interventions is a substantial problem, with essential information frequently missing, and for almost half of all interventions, unobtainable after publication. A conscientious effort to address this problem could facilitate an improvement in the quality of cardiac rehabilitation delivered in clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2023
DOI: 10.1186/S13063-023-07215-1
Abstract: Reporting of intervention research has been inadequate for many years. The development and promotion of freely available checklists aims to address this problem by providing researchers with a list of items that require reporting to enable study interpretation and replication. In this commentary, we present evidence from a recent systematic review of 51 randomised controlled trials published 2015–2020 that inadequate intervention reporting remains a widespread issue and that checklists are not being used to describe all intervention components. In 2022, we assessed the submission guidelines of 33 journals that published articles included in our review and found that just one at the time encouraged the use of reporting checklists for all intervention components. To drive progress, we contacted the editors of the other 32 journals and requested that they update their submission guidelines in response. We conclude by highlighting the waste associated with current practices and encourage journals from all fields to urgently review their submission guidelines. Only through collective action can we build an evidence base that is fit for purpose.
Publisher: American Medical Association (AMA)
Date: 02-2015
DOI: 10.1001/JAMAINTERNMED.2014.6016
Abstract: Unrealistic patient expectations of the benefits and harms of interventions can influence decision making and may be contributing to increasing intervention uptake and health care costs. To systematically review all studies that have quantitatively assessed patients' expectations of the benefits and/or harms of any treatment, test, or screening test. A comprehensive search strategy was used in 4 databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO) up to June 2013, with no language or study type restriction. We also ran cited reference searches of included studies and contacted experts and study authors. Two researchers independently evaluated methodological quality and extracted participants' estimates of benefit and harms and authors' contemporaneous estimates. Of the 15,343 records screened, 36 articles (from 35 studies) involving a total of 27,323 patients were eligible. Fourteen studies focused on a screen, 15 on treatment, 3 a test, and 3 on treatment and screening. More studies assessed only benefit expectations (22 [63%]) than benefit and harm expectations (10 [29%]) or only harm (3 [8%]). Fifty-four outcomes (across 32 studies) assessed benefit expectations: of the 34 outcomes with overestimation data available, the majority of participants overestimated benefit for 22 (65%) of them. For 17 benefit expectation outcomes, we could not calculate the proportion of participants who overestimated or underestimated, although for 15 (88%) of these, study authors concluded that participants overestimated benefits. Expectations of harm were assessed by 27 outcomes (across 13 studies): underestimation data were available for 15 outcomes and the majority of participants underestimated harm for 10 (67%) of these. A correct estimation by at least 50% of participants only occurred for 2 outcomes about benefit expectations and 2 outcomes about harm expectations. The majority of participants overestimated intervention benefit and underestimated harm. Clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.
Publisher: Wiley
Date: 29-11-2015
DOI: 10.1111/HEX.12026
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-02-2020
DOI: 10.2215/CJN.12341019
Abstract: The dietary self-management of CKD is challenging. Telehealth interventions may provide an effective delivery method to facilitate sustained dietary change. This pilot, randomized, controlled trial evaluated secondary and exploratory outcomes after a dietitian-led telehealth coaching intervention to improve diet quality in people with stage 3–4 CKD. The intervention group received phone calls every 2 weeks for 3 months (with concurrent, tailored text messages for 3 months), followed by 3 months of tailored text messages without telephone coaching, to encourage a diet consistent with CKD guidelines. The control group received usual care for 3 months, followed by nontailored, educational text messages for 3 months. Eighty participants (64% male), aged 62±12 years, were randomized to the intervention or control group. Telehealth coaching was safe, with no adverse events or changes to serum biochemistry at any time point. At 3 months, the telehealth intervention, compared with the control, had no detectable effect on overall diet quality on the Alternative Health Eating Index (3.2 points, 95% confidence interval, −1.3 to 7.7), nor at 6 months (0.5 points, 95% confidence interval, −4.6 to 5.5). There was no change in clinic BP at any time point in any group. There were significant improvements in several exploratory diet and clinical outcomes, including core food group consumption, vegetable servings, fiber intake, and body weight. Telehealth coaching was safe, but appeared to have no effect on the Alternative Healthy Eating Index or clinic BP. There were clinically significant changes in several exploratory diet and clinical outcomes, which require further investigation. Evaluation of In idualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD (ENTICE-CKD), ACTRN12616001212448.
Publisher: AMPCo
Date: 07-2014
DOI: 10.5694/MJA14.00002
Abstract: Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation improving patient knowledge, risk perception accuracy and patient-clinician communication and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are h ering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.
Publisher: BMJ
Date: 22-09-2021
DOI: 10.1136/BMJEBM-2020-111521
Abstract: To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties. Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication. Online and open to all specialties and levels of clinical experience, including students. The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study. The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK’s National Health Service e-learning platform. Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool total score range 10–50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked. Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants’ mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p .0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p .0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions. This online, free e-learning course was successful in increasing participants’ confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians’ numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.
Publisher: Wiley
Date: 29-07-2009
DOI: 10.1111/J.1532-5415.2009.02346.X
Abstract: To compare the effectiveness of a digital video disc (DVD) with that of a written workbook delivering falls prevention education to older hospital patients on self-perceived risk of falls, perception of falls epidemiology, knowledge of prevention strategies, and motivation and confidence to engage in self-protective strategies. To compare the effect of receiving either education approach versus no education on patients' perception of falls epidemiology. Randomized trial (DVD vs workbook) with additional quasi-experimental control group. Geriatric, medical, and orthopedic wards in Perth and Brisbane, Australia. One hundred (n=51 DVD, n=49 workbook) hospital inpatients aged 60 and older receiving an intervention (mean age 75.3+/-10.1) and 122 in the control group (mean age 79.3+/-8.3). Participants randomly assigned to receive identical educational material on falls prevention delivered on a DVD or in a workbook. Control group received usual care. Custom-designed survey addressing elements of the Health Belief Model of health behavior change. Participants randomized to DVD delivery had a higher self-perceived risk of falling (P=.04) and higher levels of confidence (P=.03) and motivation (P=.04) to engage in self-protective strategies than participants who received the workbook. A higher proportion of participants who received either form of the education provided "desired" responses than of control group participants across all knowledge items (P<.001). Delivery of falls prevention education on a DVD compared to a written workbook is more likely to achieve important changes in parameters likely to affect successful uptake of falls prevention messages in the hospital setting.
Publisher: Informa UK Limited
Date: 04-0001
DOI: 10.1310/TSR1504-295
Abstract: Information provision is an integral part of poststroke care, and there is a need to identify how to provide it most effectively. Intervention details, such as content, delivery style, format, and timing, are infrequently reported in the literature. This project describes in detail the provision of information to clients with stroke and their carers by community services in Brisbane, Australia, and compares these to current recommendations in the literature. Fifty-seven metropolitan-based community services were surveyed regarding the content, delivery style, format, and timing of information available to clients with stroke and their carers, using a telephone-administered questionnaire designed for this study. Services provided information using a range of formats and delivery styles. The most frequently provided topics were information on services and benefits available and practical management strategies. Less than 75% of services provided written information to most of their clients and/or carers. Less than 40% of services considered client and carer input when designing written information materials. Community services surveyed in this study demonstrated congruency with some, but not all, of the current content, format, and delivery style recommendations in the literature. Areas for improvement are discussed.
Publisher: Wiley
Date: 02-11-2018
DOI: 10.1111/MEDU.13410
Abstract: Complete reporting of intervention details in trials of evidence-based practice (EBP) educational interventions is essential to enable clinical educators to translate research evidence about interventions that have been shown to be effective into practice. In turn, this will improve the quality of EBP education. This study was designed to examine the completeness of reporting of EBP educational interventions in published studies and to assess whether missing details of educational interventions could be retrieved by searching additional sources and contacting study authors. A systematic review of controlled trials that had evaluated EBP educational interventions was conducted using a citation analysis technique. Forward and backward citations of the index articles were tracked until March 2016. The TIDieR (template for intervention description and replication) checklist was used to assess the completeness of intervention reporting. Missing details were sought from: (i) the original publication (ii) additional publicly available sources, and (iii) the study authors. Eighty-three articles were included 45 (54%) were randomised controlled trials (RCTs) and 38 (46%) were non-RCTs. The majority of trials (n = 62, 75%) involved medical professionals. None of the studies completely reported all of the main items of the educational intervention within the original publication or in additional sources. However, details became complete for 17 (20%) interventions after contact with the respective authors. The item most frequently missing was 'intervention materials', which was missing in 80 (96%) of the original publications, in additional sources for 77 (93%) interventions, and in 59 (71%) studies after contact with the authors. Authors of 69 studies were contacted 33 provided the details requested. The reporting of EBP educational interventions is incomplete and remained so for the majority of studies, even after study authors had been contacted for missing information. Collaborative efforts involving authors and editors are required to improve the completeness of reporting of EBP educational interventions.
Publisher: Wiley
Date: 20-11-2020
Publisher: Springer Science and Business Media LLC
Date: 17-09-2014
Publisher: Annals of Family Medicine
Date: 03-2017
DOI: 10.1370/AFM.2040
Publisher: Wiley
Date: 11-03-2004
Publisher: Wiley
Date: 22-10-2016
DOI: 10.1111/CCH.12296
Abstract: When a child is diagnosed with autism, parents are faced with the task of choosing from many different intervention options. To find information about the options available, parents turn to a number of different sources. This study explores parents' (n = 23) intervention decision-making processes and information preferences following the diagnosis of ASD for their child. Qualitative thematic analysis of verbatim transcripts from interviews and focus groups involving parents of children with an autism diagnosis was undertaken. Analysis of the results revealed that there are concurrent emotional and pragmatic intervention 'journeys' undertaken by parents post diagnosis, which encompass the primary themes of: (1) information sources used, (2) parents' information preferences and (3) factors influencing intervention decision making. Parents described a journey from the point of diagnosis that involved seeking information on ASD interventions from multiple sources, with the Internet being the primary source. They were overwhelmed by the sheer volume of information available, and their preferences for information varied according to their stage in the journey post diagnosis. Parents had a 'trial and error' approach to choosing ASD interventions, with confidence increasing as they became more familiar with their child's condition, and had opportunities to explore numerous information sources about their child's diagnosis. While confidence increased over time, consideration of the effectiveness or evidence supporting interventions remained largely absent throughout the journey. This study highlights the need for parents of children with ASD to be supported to make informed intervention decisions, particularly with consideration for research evidence.
Publisher: Wiley
Date: 30-08-2018
DOI: 10.1111/NEP.13441
Publisher: Research Square Platform LLC
Date: 13-10-2023
Publisher: JMIR Publications Inc.
Date: 12-12-2019
Abstract: he ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners and their patients view the possibility of prescribing mobile health (mHealth) apps as a nondrug intervention. his study aimed to determine barriers and facilitators to prescribing mHealth apps in Australian general practice from the perspective of general practitioners and their patients. e conducted semistructured interviews in Australian general practice settings with purposively s led general practitioners and patients. The audio-recorded interviews were transcribed, coded, and thematically analyzed by two researchers. nterview participants included 20 general practitioners and 15 adult patients. General practitioners’ perceived barriers to prescribing apps included a generational difference in the digital propensity for providers and patients lack of knowledge of prescribable apps and trustworthy sources to access them the time commitment required of providers and patients to learn and use the apps and concerns about privacy, safety, and trustworthiness of health apps. General practitioners perceived facilitators as trustworthy sources to access prescribable apps and information, and younger generation and widespread smartphone ownership. For patients, the main barriers were older age and usability of mHealth apps. Patients were not concerned about privacy and data safety issues regarding health app use. Facilitators for patients included the ubiquity of smartphones and apps, especially for the younger generation and recommendation of apps by doctors. We identified evidence of effectiveness as an independent theme from both the provider and patient perspectives. Health app prescription appears to be feasible in general practice. The barriers and facilitators identified by the providers and patients overlapped, though privacy was of less concern to patients. The involvement of health professionals and patients is vital for the successful integration of effective, evidence-based mHealth apps with clinical practice. >
Publisher: AMPCo
Date: 23-10-2017
DOI: 10.5694/MJA17.00574
Abstract: In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for in idual GPs), interventions that GPs can in idually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs' access to near-patient diagnostic testing, and public awareness c aigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.
Publisher: Journal of Rehabilitation Research & Development
Date: 2013
DOI: 10.1682/JRRD.2012.08.0148
Abstract: Telerehabilitation may be an alternative service delivery model for people with Parkinson disease (PD) who live in areas where traditional rehabilitation services are not readily accessible. The aim of this study was to determine the accuracy and reliability of performing remote physical assessments of people with PD via telerehabilitation when compared with traditional face-to-face assessments. Twelve subjects were simultaneously examined by a face-to-face investigator and a remote investigator via the eHAB telerehabilitation system. The outcome measures evaluated included the timed stance test, Timed "Up and Go" test, step test, steps in 360 degree turn, Berg Balance Scale, and lateral and functional reach tests. Limits of agreements intervals and weighted kappa statistics demonstrated the telerehabilitation assessments to be accurate within clinically acceptable limits. A high level of inter- and intrarater reliability was demonstrated across all telerehabilitation assessments. This study indicates that it is possible to assess the physical ability of people with PD via telerehabilitation systems and provides support for the further development of telerehabilitation applications for patients with neurological disorders.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2018
Publisher: Informa UK Limited
Date: 03-2200
Publisher: American Association for Cancer Research (AACR)
Date: 10-2011
DOI: 10.1158/1055-9965.EPI-11-0496
Abstract: Backgrounds: Multiple polymorphisms affecting smoking behavior have been identified through genome-wide association studies. Circulating levels of the nicotine metabolite cotinine is a marker of recent smoking exposure. Hence, genetic variants influencing smoking behavior are expected to be associated with cotinine levels. Methods: We conducted an analysis in a lung cancer case–control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. We investigated the effects of single-nucleotide polymorphisms (SNP) previously associated with smoking behavior on (i) circulating cotinine and (ii) lung cancer risk. A total of 894 cases and 1,805 controls were analyzed for cotinine and genotyped for 10 polymorphisms on 7p14, 8p11, 10q23, 15q25, and 19q13. Results: Two variants in the nicotinic acetylcholine receptor subunit genes CHRNA5 and CHRNA3 on 15q25, rs16969968 and rs578776, were associated with cotinine (P = 0.001 and 0.03, respectively) in current smokers and with lung cancer risk (P & 0.001 and P = 0.001, respectively). Two 19q13 variants, rs7937 and rs4105144, were associated with increased cotinine (P = 0.003 and P & 0.001, respectively) but decreased lung cancer risk (P = 0.01 for both, after adjusting for cotinine). Variants in 7p14, 8p11, and 10q23 were not associated with cotinine or lung cancer risk. Conclusions: 15q25 and 19q13 SNPs were associated with circulating cotinine. The directions of association for 15q25 variants with cotinine were in accordance with that expected of lung cancer risk, whereas SNPs on 19q13 displayed contrasting associations of cotinine and lung cancer that require further investigation. Impact: This study is the largest to date investigating the effects of polymorphisms affecting smoking behavior on lung cancer risk using circulating cotinine measures as proxies for recent smoking behavior. Cancer Epidemiol Biomarkers Prev 20(10) 2250–61. ©2011 AACR.
Publisher: Public Library of Science (PLoS)
Date: 21-09-2020
Publisher: Royal College of General Practitioners
Date: 29-09-2020
DOI: 10.3399/BJGPOPEN20X101082
Abstract: The management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence. To compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs. A scoping review of the literature was performed using comprehensive search strategies. PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published studies from inception until 17 April 2019. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion. Two groups of researchers independently screened articles for inclusion, extracted data, and assessed the quality of included studies. A total of 108 eligible studies were identified: 80 on ARI, eight on UTI, and 20 on SSTI. The quality of studies varied with unclear risk of bias (RoB) prevalent in many domains. There was a gradual improvement in the quality of trials investigating ARIs over time, which could not be assessed in SSTI and UTI studies. This review highlights a sparsity of trials assessing the effectiveness of antibiotics in people with UTIs and SSTIs, compared to trials targeting ARIs. This gap in the evidence needs to be addressed by conducting further high quality trials on the effects of antibiotics in patients with UTI and SSTI.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Oxford University Press
Date: 28-07-2016
Publisher: Elsevier BV
Date: 09-2021
Publisher: Center for Open Science
Date: 14-09-0018
Abstract: Objectives: To describe the processes used to update the PRISMA 2009 statement for reporting systematic reviews, present results of a survey conducted to inform the update, summarise decisions made at the PRISMA update meeting, and describe and justify changes made to the guideline.Methods: We reviewed 60 documents with reporting guidance for systematic reviews to generate suggested modifications to the PRISMA 2009 statement. We invited 220 systematic review methodologists and journal editors to complete a survey about the suggested modifications. The results of these projects were discussed at a 21-member in-person meeting. Following the meeting, we drafted the PRISMA 2020 statement and refined it based on feedback from co-authors and a convenience s le of 15 systematic reviewers. Results: The review of 60 documents revealed that all topics addressed by the PRISMA 2009 statement could be modified. Of the 110 survey respondents, more than 66% recommended keeping six of the original checklist items as they were and modifying 15 of them using wording suggested by us. Attendees at the in-person meeting supported the revised wording for several items but suggested rewording for most to enhance clarity, and further refinements were made over six drafts of the guideline. Conclusions: The PRISMA 2020 statement consists of updated reporting guidance for systematic reviews. We hope that providing this detailed description of the development process will enhance the acceptance and uptake of the guideline and assist those developing and updating future reporting guidelines.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2013
Publisher: SAGE Publications
Date: 08-2017
Abstract: Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers h er our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research biomarkers of recovery intervention development, monitoring and reporting and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
Publisher: Elsevier BV
Date: 11-2004
DOI: 10.1016/J.IJMEDINF.2004.07.001
Abstract: The aim of this project was to design and evaluate a system that would produce tailored information for stroke patients and their carers, customised according to their informational needs, and facilitate communication between the patient and health professional. A human factors development approach was used to develop a computer system, which dynamically compiles stroke education booklets for patients and carers. Patients and carers are able to select the topics about which they wish to receive information, the amount of information they want, and the font size of the printed booklet. The system is designed so that the health professional interacts with it, thereby providing opportunities for communication between the health professional and patient/carer at a number of points in time. Preliminary evaluation of the system by health professionals, patients and carers was positive. A randomised controlled trial that examines the effect of the system on patient and carer outcomes is underway.
Publisher: SAGE Publications
Date: 02-2004
DOI: 10.1177/030802260406700204
Abstract: Occupational therapists prescribe assistive equipment to increase clients' independence in self-care activities. This study examined clients' use of assistive equipment post-discharge and explored the factors that might have influenced use. The participants were 127 clients (mean age 78.7 years, 62.2% men) who were issued one or more items of assistive equipment while inpatients at a metropolitan hospital. At approximately 10 weeks post-discharge, the participants completed a postal questionnaire. Of the 407 items of equipment prescribed, 363 (89.2%) were used, with three types of equipment (bathboards, hand-held shower hoses and stair rails) having 100% use. The participants who lived alone were more likely to use toileting equipment and shower chairs than the participants who did not live alone (p .05). The long-handled equipment had the lowest usage rates. For unused equipment, 16.5% was not used because it was no longer needed and 9.3% because the participants reported that they had never really needed it. Overall, 91.3% of the participants reported that they had received adequate training in the use of the equipment. Although most of the participants used prescribed assistive equipment, recommendations based on a client-centred approach to the prescription process are made to increase clients' use of equipment further.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.RIDD.2016.09.018
Abstract: Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions. When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions.
Publisher: Georg Thieme Verlag KG
Date: 03-2016
Publisher: Public Library of Science (PLoS)
Date: 30-01-2019
Publisher: Informa UK Limited
Date: 02-03-2015
Publisher: Oxford University Press (OUP)
Date: 28-03-2014
Publisher: Public Library of Science (PLoS)
Date: 20-05-2021
DOI: 10.1371/JOURNAL.PONE.0251347
Abstract: To assess Australian physiotherapists’ knowledge about, attitudes towards, and self-reported use of shared decision making, as well as perceived barriers to its implementation in practice. Physiotherapists registered for a national Australian physiotherapy conference were invited via email and the conference app to complete a self-administered online questionnaire about shared decision making, including: a) knowledge, b) attitude to and reported approach in practice, c) behaviours used, d) barriers, e) previous training and future training interest. Responses were analysed descriptively and open-ended questions synthesised narratively. 372 physiotherapists (71% female, mean age 45 years, mean experience 23 years) completed the survey. Respondents had a good level of knowledge on most questions, with correct responses ranging from 39.5% to 98.5% of participants, and a generally positive attitude towards shared decision making, believing it useful to most practice areas. Sixty percent indicated they make decisions with their patients and there was general agreement between how decisions should be made and how they are actually made. The behaviour with the lowest reported occurrence was explaining the relevant research evidence about the benefits and harms of the options. The main perceived barriers were patient knowledge and confidence, consequent fewer physiotherapy sessions, and time constraints. Most (79%) were keen to learn more about shared decision making. Shared decision making is of growing importance to all health professions and rarely studied in physical therapy. This s le of Australian physiotherapists had a generally positive attitude to shared decision making and learning more about it. Opportunities for providing such skills training at the undergraduate level and in continuing professional development should be explored. This training should ensure that the communicating evidence component of shared decision making is addressed as well as debunking myths about perceived barriers to its implementation.
No related grants have been discovered for Tammy Hoffmann.