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Bourne AM, Johnston RV, Cyril S, Briggs AM, Clavisi O, Duque G, Harris IA, Hill C, Hiller C, Kamper SJ, Latimer J, Lawson A, Lin CWC, Maher C, Perriman D, Richards BL, Smitham P, Taylor WJ, Whittle S, Buchbinder R. Scoping review of priority setting of research topics for musculoskeletal conditions. BMJ Open 2018; 8:e023962. [PMID: 30559158 PMCID: PMC6303563 DOI: 10.1136/bmjopen-2018-023962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified. DESIGN Scoping review. SETTING AND POPULATION Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included. METHODS AND ANALYSIS We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted. RESULTS Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities. CONCLUSIONS While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value. PROSPERO REGISTRATION NUMBER CRD42017059250.
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Affiliation(s)
- Allison M Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renea V Johnston
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheila Cyril
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Hill
- Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Claire Hiller
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Latimer
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Christopher Maher
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, Australian Capital Territory, Australia
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bethan L Richards
- Rheumatology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Sam Whittle
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Roblin DW, Zelman D, Plummer S, Robinson BE, Lou Y, Edmonds SW, Wolinsky FD, Saag KG, Cram P. Evaluation of a "Just-in-Time" Nurse Consultation on Bone Health: A Pilot Randomized Controlled Trial. Perm J 2017; 21:16-112. [PMID: 28746019 DOI: 10.7812/tpp/16-112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Evidence is inconclusive whether a nurse consultation can improve osteoporosis-related patient outcomes. OBJECTIVE To evaluate whether a nurse consultation immediately after dual-energy x-ray absorptiometry (DXA) produced better osteoporosis-related outcomes than a simple intervention to activate adults in good bone health practices or usual care. DESIGN Pilot randomized controlled trial, conducted within the larger Patient Activation After DXA Result Notification (PAADRN) trial (NCT01507662). After DXA, consenting adults age 50 years or older were randomly assigned to 3 groups: nurse consultation, PAADRN intervention (mailed letter with individualized fracture risk and an educational brochure), or usual care (control). Nurse consultation included reviewing DXA results, counseling on bone health, and ordering needed follow-up tests or physician referrals. MAIN OUTCOME MEASURES Change from baseline to 52 weeks in participant-reported osteoporosis-related pharmacotherapy, lifestyle, activation and self-efficacy, and osteoporosis care satisfaction. RESULTS Nurse consultation participants (n = 104) reported 52-week improvements in strengthening and weight-bearing exercise (p = 0.09), calcium intake (p < 0.01), osteoporosis knowledge (p = 0.04), activation (p < 0.01), dietary self-efficacy (p = 0.06), and osteoporosis care satisfaction (p < 0.01). Compared with PAADRN intervention participants (n = 39), nurse consultation participants had improved dietary self-efficacy (p = 0.07) and osteoporosis care satisfaction (p = 0.05). No significant improvements in osteoporosis-related outcomes were achieved vs PAADRN controls (n = 70). CONCLUSION "Just-in-time" nurse consultation yielded a few improvements over 52 weeks in osteoporosis-related outcomes; however, most changes were not different from those obtained through the lower-cost PAADRN intervention or usual care.
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Affiliation(s)
- Douglas W Roblin
- Professor of Health Management and Policy at Georgia State University School of Public Health and a Consulting Senior Research Scientist at the Center for Clinical and Outcomes Research in Atlanta.
| | - David Zelman
- At the time of this study was a Rheumatologist with The Southeast Permanente Medical Group, Inc, in Atlanta, GA.
| | - Sally Plummer
- At the time of this study was a Consulting Nurse Educator at the Center for Clinical and Outcomes Research in Atlanta, GA.
| | - Brandi E Robinson
- Senior Project Manager at the Center for Clinical and Outcomes Research in Atlanta, GA.
| | - Yiyue Lou
- Biostatistician in the College of Public Health at the University of Iowa in Iowa City.
| | - Stephanie W Edmonds
- Graduate Research Assistant in Internal Medicine and a Doctoral Candidate in the College of Nursing at the University of Iowa in Iowa City.
| | - Fredric D Wolinsky
- The John W Colloton Chair in the College of Public Health at the University of Iowa in Iowa City.
| | - Kenneth G Saag
- Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.
| | - Peter Cram
- Professor of Internal Medicine in the Division of General Internal Medicine at the University of Toronto and the Director of General Internal Medicine at the University Health Network and Mount Sinai Hospital in Ontario, Canada.
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Senay A, Delisle J, Raynauld JP, Morin SN, Fernandes JC. Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program. Osteoporos Int 2016; 27:1569-1576. [PMID: 26602915 PMCID: PMC4791513 DOI: 10.1007/s00198-015-3413-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/06/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses' actions for 525 fragility fracture patients, showing that their management is efficient and safe. INTRODUCTION A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians' and nurses' clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS. METHODS Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment. RESULTS Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians' decisions were the same in >96 %, and Gwet AC11 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed. CONCLUSIONS High agreement between nurses' and physicians' clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.
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Affiliation(s)
- A Senay
- Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada.
| | - J Delisle
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada
| | - J P Raynauld
- Hôpital Notre-Dame of the Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montreal, QC, H2L 4M1, Canada
- Institut de Rhumatologie de Montréal, 1551 rue Ontario Est, Montreal, QC, H2L 1S6, Canada
| | - S N Morin
- Department of Medicine, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - J C Fernandes
- Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada
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Pavon JM, Sanders LL, Sloane R, Colón-Emeric C. Sensitivity of osteoporosis screening guidelines for eventual hip fracture in older male veterans. BONEKEY REPORTS 2014; 3:530. [PMID: 24876931 DOI: 10.1038/bonekey.2014.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/30/2014] [Indexed: 11/09/2022]
Abstract
This study sought to determine whether guideline-recommended clinical criteria to select men for osteoporosis screening provide significantly better sensitivity than the osteoporotic screening tool (OST) among men who later went on to have a hip fracture, and whether the sensitivity differs by race. This retrospective observational study uses data from the Department of Veterans Affairs Austin Automation Center. We identified 825 male veterans with hip fractures from 2007 to 2009. Clinical risk factors used as screening selection criteria were abstracted from five accepted guidelines. Outpatient encounters were examined for each subject to determine whether they would have met screening selection criteria for each guideline in the 5 years before their hip fracture event. Sensitivities for each guideline were compared with the OST, using McNemar's exact test. Sensitivities of Veterans Affairs Health Service Research and Development Services (VA HSR&D) and National Osteoporosis Foundation (NOF) guidelines were 77% and 82%, respectively, and were significantly better than the OST sensitivity of 72% (P<0.05). Sensitivities of American College of Physicians (ACP; 68%), VA Secretary's Letters (45%) and Center for Medicare and Medicaid Services (13%) were significantly worse than the OST sensitivity (P<0.001). The sensitivities of the VA HSR&D, ACP and NOF were significantly higher in Whites compared with non-Whites (76% vs 65%, P<0.01; 70% vs 58%, P<0.01; and 84% vs 70%, P<0.001, respectively). Only VA HSR&D and NOF clinical screening criteria are more sensitive than OST in identifying veterans who subsequently experience hip fractures, and these sensitivities vary by race.
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Affiliation(s)
- Juliessa M Pavon
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA ; Durham VAMC GRECC, Durham VA Medical Center , Durham, NC, USA
| | - Linda L Sanders
- Division of General Internal Medicine, Duke University Medical Center, Duke University , Durham, NC, USA
| | - Richard Sloane
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA
| | - Cathleen Colón-Emeric
- Division of Geriatrics, Duke University Medical Center, Duke University , Durham, NC, USA ; Durham VAMC GRECC, Durham VA Medical Center , Durham, NC, USA
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Kilgore ML, Outman R, Locher JL, Allison JJ, Mudano A, Kitchin B, Saag KG, Curtis JR. Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial. Osteoporos Int 2013; 24:2555-60. [PMID: 23536256 PMCID: PMC4089895 DOI: 10.1007/s00198-013-2340-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
SUMMARY We conducted a cluster randomized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care. The trial did not find a significant difference in medication use in the intervention arm. INTRODUCTION This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures. METHODS We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide home health agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications. A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre-post design. RESULTS There were 11 offices randomized to each of the treatment and control arms; these offices treated 337 and 330 eligible patients, respectively. Among the offices in the intervention arm, the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 %, compared with 15.7 % in the usual care arm (difference in proportions 3.4 %, 95 % CI, -2.6 to 9.5 %). The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward, a nonsignificant difference. CONCLUSIONS The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients.
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Affiliation(s)
- Meredith L. Kilgore
- University of Alabama at Birmingham (UAB), Department of Health Care Organization & Policy, 1665 University Blvd, RPHB 330, Birmingham, AL
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Laliberté MC, Perreault S, Damestoy N, Lalonde L. The role of community pharmacists in the prevention and management of osteoporosis and the risk of falls: results of a cross-sectional study and qualitative interviews. Osteoporos Int 2013; 24:1803-15. [PMID: 23070479 DOI: 10.1007/s00198-012-2171-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/30/2012] [Indexed: 01/06/2023]
Abstract
UNLABELLED In a mailed survey and qualitative interviews, it was observed that community pharmacists and public health authorities believe that pharmacists should play a significant role in the prevention and management of osteoporosis and the risk of falls. However, pharmacists acknowledge a wide gap between their ideal and actual levels of involvement. INTRODUCTION The aim of this study was to explore perceptions of community pharmacists and public health authorities regarding the role of pharmacists in providing services in relation to osteoporosis and risk of falls and the barriers to providing them. METHODS Using a modified five-step version of Dillman's tailored design method, a questionnaire was mailed to a random sample of 1,250 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. A similar questionnaire was sent to public health officers in these regions. Additionally, telephone interviews were conducted with regional and ministry level public health officers. RESULTS Of the 1,250 pharmacists contacted, 28 were ineligible. In all, 571 of 1,222 (46.7 %) eligible community pharmacists and all the public health officers returned the questionnaire. Six public health officers (five regional and one at ministry level) were interviewed. Most pharmacists believed they should be involved in screening for osteoporosis (46.6 %) and risk of falls (50.3 %); however, fewer reported actually being involved in such services (17.4 % and 19.2 %, respectively). In their view, the main barriers to providing these services in current practice were lack of time (78.8 %), lack of clinical tools (65.4 %), and lack of coordination with other healthcare professionals (54.5 %). Public health authorities also thought community pharmacists should play a significant role in providing osteoporosis and fall risk services. However, few community pharmacist-mediated activities are in place in the participating regions. CONCLUSIONS Although community pharmacists and public health authorities believe pharmacists should play a significant role with regard to osteoporosis and the risk of falls, they acknowledge a wide gap between the ideal and actual levels of pharmacist involvement.
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Affiliation(s)
- M-C Laliberté
- Faculty of Pharmacy, Université de Montréal, Quebec, Canada
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