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Kucksdorf JJ, Bartley J, Rhon DI, Young JL. Reproducibility of Exercise Interventions in Randomized Controlled Trials for the Treatment of Rotator Cuff-Related Shoulder Pain: A Systematic Review. Arch Phys Med Rehabil 2024; 105:770-780. [PMID: 37741486 DOI: 10.1016/j.apmr.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE To determine the reproducibility of exercise therapy interventions in randomized controlled trials for rotator cuff-related shoulder pain (RCRSP). DATA SOURCES Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and SPORTDiscus from studies published from database inception to April 23, 2022. STUDY SELECTION Randomized controlled trials studying the use of exercise therapy for RCRSP. DATA EXTRACTION Two reviewers extracted exercise reporting details from all studies using the Template for Intervention Description and Replication (TIDieR) and the modified Consensus on Exercise Reporting Template (CERT). The same 2 reviewers assessed risk of bias of all studies using Cochrane Risk of Bias Tool version 2.0. DATA SYNTHESIS For 104 studies meeting inclusion criteria, the average number of items reported on the TIDieR was 5.27 (SD 2.50, range 1-12 out of 12) and 5.09 (SD 4.01, range 0-16 out of 16) on the CERT. Improved reporting over time was seen on both the TIDieR and CERT dating back to 1993 and through April 23, 2022. When comparing groups of studies published before and after the TIDieR (2014) and CERT (2016) were established, a statistically significant increase in median scores was noted on the TIDieR (P=.02) but not the CERT (P=.31). Quality of exercise therapy reporting was highest in studies with "low risk" of bias, and lowest in studies with "high risk" of bias on the RoB-2. CONCLUSION Overall exercise reporting in trials for RCRSP is incomplete despite the development of the TIDieR and CERT checklists. This has implications for translating evidence into practice.
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Affiliation(s)
- Joseph J Kucksdorf
- Bellin College, Green Bay, WI; Sports Medicine and Orthopedics, Bellin Health, Green Bay, WI.
| | - Jason Bartley
- Bellin College, Green Bay, WI; Multicare Health System, Tacoma, WA; Augustana University, Sioux Falls, SD
| | - Daniel I Rhon
- Bellin College, Green Bay, WI; Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Ruppar TM. Enhancing Rigor: Reporting Detailed Intervention Descriptions. West J Nurs Res 2024; 46:67. [PMID: 38183284 DOI: 10.1177/01939459231222072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
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Martin CL, Austin RR, Alexander S, Britt-Lalich M, Lee K, Monsen KA. Discovering Patterns in the Corpus of Omaha System Evidence-Based Guidelines: A Descriptive Visualization Analysis. Comput Inform Nurs 2024; 42:1-10. [PMID: 38194509 DOI: 10.1097/cin.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Christie L Martin
- Author Affiliations: School of Nursing, University of Minnesota (Drs Martin, Austin, and Monsen, and Ms Britt-Lalich), Minneapolis; College of Nursing, The University of Alabama in Huntsville (Dr Alexander); and University of Missouri (Dr Lee), Columbia
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Allen MJ, Carter HE, Cyarto E, Meyer C, Dwyer T, Oprescu F, Aitken C, Farrington A, Shield C, Rowland J, Lee XJ, Graves N, Parkinson L, Harvey G. From pilot to a multi-site trial: refining the Early Detection of Deterioration in Elderly Residents (EDDIE +) intervention. BMC Geriatr 2023; 23:811. [PMID: 38057722 PMCID: PMC10698876 DOI: 10.1186/s12877-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Early Detection of Deterioration in Elderly Residents (EDDIE +) is a multi-modal intervention focused on empowering nursing and personal care workers to identify and proactively manage deterioration of residents living in residential aged care (RAC) homes. Building on successful pilot trials conducted between 2014 and 2017, the intervention was refined for implementation in a stepped-wedge cluster randomised trial in 12 RAC homes from March 2021 to May 2022. We report the process used to transition from a small-scale pilot intervention to a multi-site intervention, detailing the intervention to enable future replication. METHODS The EDDIE + intervention used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide the intervention development and refinement process. We conducted an environmental scan; multi-level context assessments; convened an intervention working group (IWG) to develop the program logic, conducted a sustainability assessment and deconstructed the intervention components into fixed and adaptable elements; and subsequently refined the intervention for trial. RESULTS The original EDDIE pilot intervention included four components: nurse and personal care worker education; decision support tools; diagnostic equipment; and facilitation and clinical support. Deconstructing the intervention into core components and what could be flexibly tailored to context was essential for refining the intervention and informing future implementation across multiple sites. Intervention elements considered unsustainable were updated and refined to enable their scalability. Refinements included: an enhanced educational component with a greater focus on personal care workers and interactive learning; decision support tools that were based on updated evidence; equipment that aligned with recipient needs and available organisational support; and updated facilitation model with local and external facilitation. CONCLUSION By using the i-PARIHS framework in the scale-up process, the EDDIE + intervention was tailored to fit the needs of intended recipients and contexts, enabling flexibility for local adaptation. The process of transitioning from a pilot to larger scale implementation in practice is vastly underreported yet vital for better development and implementation of multi-component interventions across multiple sites. We provide an example using an implementation framework and show it can be advantageous to researchers and health practitioners from pilot stage to refinement, through to larger scale implementation. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
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Affiliation(s)
- Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Trudy Dwyer
- Central Queensland University, Norman Gardens, Australia
| | - Florin Oprescu
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Christopher Aitken
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Carla Shield
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jeffrey Rowland
- Faculty of Medicine, University of Queensland, Herston, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Xing J Lee
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Lynne Parkinson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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McMahon SK, Macheledt K, Choma EA, Lewis BA, Guan W, Wyman JF, Rothman AJ. Rethinking how and when to report descriptions of behavior change content within interventions: a case study of an ongoing physical activity trial (ready steady 3.0). Transl Behav Med 2023; 13:368-379. [PMID: 36757385 PMCID: PMC10255763 DOI: 10.1093/tbm/ibac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Specifications of what and how much health behavior change (BC) content within research interventions are needed to advance BC science, its implementation, and dissemination. We analyzed the types and dosages of the smallest potentially active BC ingredients and associated behavioral prescriptions intended to be delivered in an ongoing physical activity optimization trial for older adults (Ready Steady 3.0 [RS3]). We defined BC types as behavior change techniques (BCT) and behavioral prescriptions. Our protocol integrated the BCT Taxonomy coding procedures with BCT roles (primary or secondary) and, when relevant, linkages to behavioral prescriptions. Primary BCTs targeted theoretical mechanisms of action, whereas secondary BCTs supported primary BCT delivery. Behavioral prescriptions represented what participants were encouraged to do with each primary BCT in RS3 (ascertain, practice, implement). We assessed dosage parameters of duration, frequency, and amount in each BCT and prescription. Results provided a catalog of in-depth, multidimensional content specifications with 12 primary BCTs, each supported by 2-7 secondary BCTs, with dosages ranging from 2 to 8 weeks, 1 to 8 contacts, and 5 to 451 minutes. Minutes spent on behavioral prescriptions varied: ascertain (1 to 41), practice (5 to 315), and implement (0 to 38). Results can be organized and summarized in varied ways (e.g., by content component) to strengthen future assessments of RS3 fidelity and intervention refinement. Results highlight potential benefits of this early, integrated approach to analyzing BC content and frames questions about how such information might be incorporated and disseminated with reporting research outcomes.
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Affiliation(s)
| | - Kait Macheledt
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Elizabeth A Choma
- DPT Doctor of Physical Therapy Program, Whitworth University, Spokane, WA, USA
| | | | - Weihua Guan
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Hacke C, Schreiber J, Weisser B. Application of the Templates TIDieR and CERT Reveal Incomplete Reporting and Poor Replicability of Exercise Interventions for Type 2 Diabetes Mellitus. Curr Diabetes Rev 2022; 18:e250821195838. [PMID: 34433402 DOI: 10.2174/1871525719666210825150957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exercise is strongly recommended for the management of type 2 diabetes mellitus (T2DM). However, incomplete intervention reporting in clinical trials limits the replication of exercise protocols. As previously demonstrated by us for exercise and hypertension, the reporting quality might also be insufficient in studies with respect to T2DM and exercise. OBJECTIVE The aim of the study was to assess the completeness of exercise intervention reporting in randomized controlled trials (RCTs) for T2DM. METHODS Two independent reviewers applied the Consensus on Exercise Reporting Template (CERT) and the template for intervention description and replication (TIDieR) to 23 exercise trials obtained from the most recent and frequently cited meta-analysis in current guidelines. The completeness of reporting was evaluated, focusing on the F.I.T.T. components (frequency, intensity, time, type). Interrater agreement and associations with publication year and journal impact factor were examined. RESULTS Mean CERT score was 11/19 (range 5-17), and 8/12 (range 4-12) for TIDieR. F.I.T.T. components were almost completely described, whereas overall completeness of exercise reporting was 60% and 68% (CERT and TIDieR). Replication of each exercise of the respective program was not possible in 52% of interventions. The majority of items had shown excellent agreement. No associations with publication year or impact factor were found. CONCLUSION Exercise interventions were not found to be sufficiently reported in RCTs that currently guide clinical practice in T2DM. Replication in further studies or clinical practice is limited due to poor exercise description. We suggest the use of more specific CERT for reporting results of exercise interventions. Further refinement for internal diseases is needed to better describe exercise interventions.
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Affiliation(s)
- Claudia Hacke
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Janika Schreiber
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Burkhard Weisser
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University Kiel, Kiel, Germany
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Emond T, Guillaumie L, de Montigny F. Using a logic model to develop an intervention for improving miscarriage care in the emergency department. EVALUATION AND PROGRAM PLANNING 2021; 85:101910. [PMID: 33561757 DOI: 10.1016/j.evalprogplan.2021.101910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/04/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
Miscarriage is the most common pregnancy-related complication and is frequently treated at the emergency department (ED). Parents have expressed dissatisfaction with the care they received at the ED and few interventions have been developed for improving miscarriage care. When planning an intervention, it is crucial to develop a program theory specifying what must be done for an intervention to achieve its objectives. The purpose of this paper is to describe the logic model process for developing an intervention intended to improve parents' miscarriage experience at the ED. The six steps of W. K. Kellogg Foundation (2004) theory logic model were used to 1) describe the problem; 2) conduct a needs assessment; and to identify 3) expected results, 4) influential factors, 5) intervention strategies, and 6) assumptions related to change strategies. A community-based participatory approach was used. It included two planning groups: parents who had visited the ED for a miscarriage (N = 9) and health professionals (N = 8). The theory logic model provided a rigorous framework for intervention development based on theories, scientific evidence, and the experiences of parents and health professionals. Detailed description of the intervention should facilitate its implementation, evaluation, and replication for other health problems.
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Affiliation(s)
- Tina Emond
- Faculty of Nursing, Université Laval, 1050, avenue de la Médecine, Local 3645, Québec, Québec, G1V 0A6, Canada.
| | - Laurence Guillaumie
- Faculty of Nursing, Université Laval, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, Local 3443, Québec, Québec, G1V 0A6, Canada.
| | - Francine de Montigny
- Faculty of Nursing, University du Québec en Outaouais, C.P. 1250, succ. Hull, Gatineau, Quebec, J8X 3X7, Canada.
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Progovac AM, Tepper MC, Stephen Leff H, Cortés DE, (Cohen) Colts A, Ault-Brutus A, Hou SSY, Lu F, Banbury S, Sunder D, Cook BL. Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211043791. [PMID: 37089996 PMCID: PMC9978621 DOI: 10.1177/26334895211043791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees' transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6-7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6-7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.
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Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - Miriam C Tepper
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - H. Stephen Leff
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | | | - Andrea Ault-Brutus
- Office of Health Equity, Nassau County Department of
Health, Mineola, NY, USA
| | - Sherry S-Y Hou
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Frederick Lu
- Boston University School of
Medicine, Boston, MA, USA
| | - Sara Banbury
- University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, USA
| | | | - Benjamin L Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
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Odgers-Jewell K, Ball LE, Reidlinger DP, Isenring EA, Thomas R, Kelly JT. Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting. Diabet Med 2020; 37:768-778. [PMID: 31646673 DOI: 10.1111/dme.14158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
AIMS To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes. METHODS A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors. RESULTS Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%). CONCLUSIONS Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.
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Affiliation(s)
- K Odgers-Jewell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - L E Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - D P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - E A Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - R Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - J T Kelly
- School of Public Health, University of Queensland, Brisbane, Australia
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The Consensus on Exercise Reporting Template (CERT) applied to exercise interventions in musculoskeletal trials demonstrated good rater agreement and incomplete reporting. J Clin Epidemiol 2018; 103:120-130. [PMID: 30055247 DOI: 10.1016/j.jclinepi.2018.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/03/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine inter-rater agreement and utility of the Consensus on Exercise Reporting Template (CERT) for evaluating reporting of musculoskeletal exercise trials. STUDY DESIGN AND SETTING Two independent reviewers applied the CERT to a random sample of 20 exercise trials published 2010 to 2015 identified from searches of PEDro, CENTRAL, and PubMed. Reviewers recorded whether each item criterion was met and detailed missing data, and appraisal time percent agreement and the Prevalence and Bias Adjusted Kappa (PABAK) statistic were used to measure inter-rater agreement. RESULTS The trials included a range of musculoskeletal conditions (back/neck pain, hip/knee osteoarthritis, tendinopathies). For percent agreement, inter-rater agreement was high (13 items ≥80%) and for PABAK substantial (nine items: 0.61-0.80) and excellent (three items: 0.81-1.0). Agreement was lower for starting level decision rule (percent agreement: 55%, PABAK 0.30); tailoring of exercise (%A: 65%, PABAK 0.40 [95% CI: 0.00 to 0.80]); exercise equipment (percent agreement: 70%, PABAK 0.30); and motivation strategies (percent agreement: 70%, PABAK 0.40). Sixty percent of descriptions were missing information for ≥50% of CERT items. Mean appraisal time was 30 minutes, and the majority of interventions required access to other published papers. CONCLUSIONS The CERT has good inter-rater agreement and can comprehensively evaluate reporting of exercise interventions. Most trials do not adequately report intervention details, and information can be difficult to obtain. Incomplete reporting of effective exercise programs may be remedied by using the CERT when constructing, submitting, reviewing, and publishing articles.
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Candy B, Vickerstaff V, Jones L, King M. Description of complex interventions: analysis of changes in reporting in randomised trials since 2002. Trials 2018; 19:110. [PMID: 29467013 PMCID: PMC5822627 DOI: 10.1186/s13063-018-2503-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background Inadequate description of non-pharmacological complex interventions in trial publications means that they cannot be replicated or assessed for generalisability. There are published guidelines on how to describe an intervention, such as those from the CONSORT Group. However, there have been few evaluations of whether intervention reporting is improving. Methods We aimed to assess whether descriptions of multicomponent, non-pharmacological interventions evaluated in randomised trials are improving. To do so, we chose trials of educational and psychotherapeutic interventions to promote adherence to therapy, and compared those published between 2002 and 2007 (Time-1) with those between 2010 and 2015 (Time-2). These time periods were chosen to concord with the publication in 2008 of the CONSORT extension statement of reporting guidelines for non-pharmacological treatment which included items on intervention description. We assessed 19 items, based on the CONSORT Statement and the more recent Template for Intervention Description and Replication Checklist (TIDieR). Two reviewers independently extracted data. We created a quality score of the eight items we considered key information for replication and assessment of generalisability (setting, provider, recipient, comparator, intervention intensity, how it was conducted, existence of a manual or protocol, and detail of whether there was an assessment of fidelity). Score per item was ‘1’ if reported adequately and ‘0’ if not. Results Of the eligible trials, 42 were published in Time-1 and 134 published in Time-2. The trials included were published in 112 peer-reviewed journals, 52 of these journals currently require authors to follow the CONSORT Statements, while only one recommended adherence to the TIDieR. Most items of CONSORT and TIDieR were reported by more than half of the trials at both time points. Few trials reported fidelity. A large proportion of the trials did not report the existence of a manual or protocol, or what the comparator group received. We found no statistically significant improvement in the eight-item quality score (Time-1: mean 5.71 (standard deviation (SD) 1.09), Time-2: 5.87 (SD 1.28), p = 0.49). Conclusions We found no overall evidence that reporting the specifics of multicomponent, non-pharmacological interventions is improving. Details to replicate interventions remain lacking, impairing best implementation or meaningful further research. Editorial endorsement of reporting checklists needs to be more extensive.
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Affiliation(s)
- Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Crespo-Gonzalez C, Fernandez-Llimos F, Rotta I, Correr CJ, Benrimoj SI, Garcia-Cardenas V. Characterization of pharmacists' interventions in asthma management: A systematic review. J Am Pharm Assoc (2003) 2018; 58:210-219. [PMID: 29439927 DOI: 10.1016/j.japh.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/13/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the "amount of program delivered," and core components of the intervention provided by pharmacists in asthma management. DATA SOURCES A literature search was conducted in December 2016 using PubMed. STUDY SELECTION A 2-stage approach was used. At the first stage, systematic reviews of pharmacists' interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. DATA EXTRACTION The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions' core components. RESULTS Thirty-one studies were included. In most of the studies, the pharmacist-patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists' interventions were the provision of drug information and patient counseling (n = 27). Pharmacists' interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. CONCLUSION Pharmacists' interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists' interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their implementation in practice. (Registration number CRD42016029181.).
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Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework. Int J Nurs Stud 2017; 79:86-93. [PMID: 29220738 DOI: 10.1016/j.ijnurstu.2017.12.001] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/17/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years there has been much emphasis on 'research waste' caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial. OBJECTIVE We therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practice METHODS: Based on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design. RESULTS A comprehensive iterative approach is presented by combining the elements of the MRC Framework development phase with essential elements from existing guidance including: problem identification, the systematic identification of evidence, identification or development of theory, determination of needs, the examination of current practice and context, modelling the process and expected outcomes leading to final element: the intervention design. All elements are drawn from existing models to provide intervention developers with a greater chance of producing an intervention that is well adopted, effective and fitted to the context. CONCLUSION This comprehensive approach of developing interventions will strengthen the internal and external validity, minimize research waste and add value to health care research. In complex interventions in health care research, flaws in the development process immediately impact the chances of success. Knowledge regarding the causal mechanisms and interactions within the intended clinical context is needed to develop interventions that fit daily practice and are beneficial for the end-user.
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Lor M, Backonja U, Lauver DR. How Could Nurse Researchers Apply Theory to Generate Knowledge More Efficiently? J Nurs Scholarsh 2017; 49:580-589. [PMID: 28654713 PMCID: PMC6754730 DOI: 10.1111/jnu.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reports of nursing research often do not provide adequate information about whether, and how, researchers applied theory when conducting their studies. Unfortunately, the lack of adequate application and explication of theory in research impedes development of knowledge to guide nursing practice. OBJECTIVES To clarify and exemplify how to apply theory in research. METHODS First we describe how researchers can apply theory in phases of research. Then we share examples of how three research teams applied one theory to these phases of research in three different studies of preventive behaviors. CONCLUSIONS Nurse researchers can review and refine ways in which they apply theory in guiding research and writing publications. Scholars can appreciate how one theory can guide researchers in building knowledge about a given condition such as preventive behaviors. Clinicians and researchers can collaborate to apply and examine the usefulness of theory. CLINICAL RELEVANCE If nurses had improved understanding of theory-guided research, they could better assess, select, and apply theory-guided interventions in their practices.
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Affiliation(s)
- Maichou Lor
- University Services Program Associate, University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Uba Backonja
- Assistant Professor, University of Washington Tacoma, Nursing and Healthcare Leadership, Tacoma, WA, and Adjunct Assistant Professor, University of Washington School of Medicine, Department of Biomedical Informatics & Medical Education, Seattle, WA, USA
| | - Diane R Lauver
- Professor, University of Wisconsin-Madison School of Nursing, Madison, WI, USA
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Kovach CR. RGN's Commitment to Moving Intervention Science Forward: Specifying Targets, Mechanisms of Action, and Outcomes. Res Gerontol Nurs 2017; 10:55-56. [PMID: 28339002 DOI: 10.3928/19404921-20170315-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement. Br J Sports Med 2016; 50:1428-1437. [DOI: 10.1136/bjsports-2016-096651] [Citation(s) in RCA: 324] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/31/2022]
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Bleijenberg N, Ten Dam VH, Drubbel I, Numans ME, de Wit NJ, Schuurmans MJ. Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People. Worldviews Evid Based Nurs 2016; 13:75-84. [PMID: 26873373 DOI: 10.1111/wvn.12151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fidelity is critical to successful translation of evidence-based interventions into practice. AIMS To assess treatment delivery, dose and content of nursing care delivered within the nurse-led care program, and to explore if the delivery may have influenced the trial results. METHODS A mixed-methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. RESULTS A total of 835 older persons were included in the nurse-led care program. The mean age was 75 years, 64% were female and 53.5% were living alone. The most frequent self-reported conditions were loneliness (60.8%) and cognitive problems (59.4%). One-third of the patients with a geriatric condition received an additional assessment (e.g., Mini-Mental State Examination), and the majority of these patients received at least one nurse intervention (>85%). Most nursing care was delivered to patients at risk of falling and to those with urinary incontinence. Patients with nutrition problems seldom received nursing interventions. The nurses explained that differences in type and dose were influenced by the preference of the patient, the type of geriatric problem, and the time required to apply a nurse intervention. LINKING EVIDENCE TO ACTION All intervention components were delivered; however, differences were observed in the type and dose of nursing care delivered across geriatric conditions. The findings better explain the treatment fidelity and suggest that there is room for improvement that may result in more beneficial patient outcomes.
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Affiliation(s)
- Nienke Bleijenberg
- Assistant Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valerie H Ten Dam
- General Practitioner, geriatrics specialist, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Drubbel
- Physician, general practitioner trainee, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mattijs E Numans
- Professor of General Practice, Department Public Health and Primary Care of the Leiden University Medical Center, The Netherlands
| | - Niek J de Wit
- Professor of General Practice, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Professor of Nursing Science, Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Conn VS. Sins of Omission. West J Nurs Res 2016; 38:1240-2. [PMID: 27655082 DOI: 10.1177/0193945916650387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Self-management interventions: Proposal and validation of a new operational definition. J Clin Epidemiol 2016; 80:34-42. [PMID: 27531245 DOI: 10.1016/j.jclinepi.2016.08.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/29/2016] [Accepted: 08/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Systematic reviews on complex interventions like self-management interventions often do not explicitly state an operational definition of the intervention studied, which may impact the review's conclusions. This study aimed to propose an operational definition of self-management interventions and determine its discriminative performance compared with other operational definitions. STUDY DESIGN AND SETTING Systematic review of definitions of self-management interventions and consensus meetings with self-management research experts and practitioners. RESULTS Self-management interventions were defined as interventions that aim to equip patients with skills to actively participate and take responsibility in the management of their chronic condition in order to function optimally through at least knowledge acquisition and a combination of at least two of the following: stimulation of independent sign/symptom monitoring, medication management, enhancing problem-solving and decision-making skills for medical treatment management, and changing their physical activity, dietary, and/or smoking behavior. This definition substantially reduced the number of selected studies (255 of 750). In two preliminary expert meetings (n = 6), the proposed definition was identifiable for self-management research experts and practitioners (80% and 60% agreement, respectively). CONCLUSION Future systematic reviews must carefully consider the operational definition of the intervention studied because the definition influences the selection of studies on which conclusions and recommendations for clinical practice are based.
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Jonkman NH, Schuurmans MJ, Groenwold RHH, Hoes AW, Trappenburg JCA. Identifying components of self-management interventions that improve health-related quality of life in chronically ill patients: Systematic review and meta-regression analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:1087-1098. [PMID: 26856778 DOI: 10.1016/j.pec.2016.01.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To quantify diversity in components of self-management interventions and explore which components are associated with improvement in health-related quality of life (HRQoL) in patients with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), or type 2 diabetes mellitus (T2DM). METHODS Systematic literature search was conducted from January 1985 through June 2013. Included studies were randomised trials in patients with CHF, COPD, or T2DM, comparing self-management interventions with usual care, and reporting data on disease-specific HRQoL. Data were analysed with weighted random effects linear regression models. RESULTS 47 trials were included, representing 10,596 patients. Self-management interventions showed great diversity in mode, content, intensity, and duration. Although self-management interventions overall improved HRQoL at 6 and 12 months, meta-regression showed counterintuitive negative effects of standardised training of interventionists (SMD=-0.16, 95% CI: -0.31 to -0.01) and peer interaction (SMD=-0.23, 95% CI: -0.39 to 0.06) on HRQoL at 6 months. CONCLUSION Self-management interventions improve HRQoL at 6 and 12 months, but interventions evaluated are highly heterogeneous. No components were identified that favourably affected HRQoL. Standardised training and peer interaction negatively influenced HRQoL, but the underlying mechanism remains unclear. PRACTICE IMPLICATIONS Future research should address process evaluations and study response to self-management on the level of individual patients.
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Affiliation(s)
- Nini H Jonkman
- Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands.
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, HP Str. 6.131, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, HP Str. 6.131, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands
| | - Jaap C A Trappenburg
- Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands
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What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis. J Card Fail 2016; 22:861-871. [PMID: 27374838 DOI: 10.1016/j.cardfail.2016.06.422] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/22/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. METHODS AND RESULTS Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97-0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96-0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92-0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. CONCLUSION No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.
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Jonkman NH, Westland H, Trappenburg JC, Groenwold RH, Bischoff EW, Bourbeau J, Bucknall CE, Coultas D, Effing TW, Epton M, Gallefoss F, Garcia-Aymerich J, Lloyd SM, Monninkhof EM, Nguyen HQ, van der Palen J, Rice KL, Sedeno M, Taylor SJ, Troosters T, Zwar NA, Hoes AW, Schuurmans MJ. Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis. Eur Respir J 2016; 48:55-68. [DOI: 10.1183/13993003.01860-2015] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/16/2016] [Indexed: 11/05/2022]
Abstract
It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective.Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. Individual patient data were requested for meta-analysis by generalised mixed effects models.14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97–0.99; risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92–0.99; RR after 12 months follow-up 0.98, 95% CI 0.96–1.00).Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes.
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Lokker C, McKibbon KA, Colquhoun H, Hempel S. A scoping review of classification schemes of interventions to promote and integrate evidence into practice in healthcare. Implement Sci 2015; 10:27. [PMID: 25885047 PMCID: PMC4352247 DOI: 10.1186/s13012-015-0220-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 02/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many models and frameworks are currently used to classify or describe knowledge translation interventions to promote and integrate evidence into practice in healthcare. METHODS We performed a scoping review of intervention classifications in public health, clinical medicine, nursing, policy, behaviour science, improvement science and psychology research published to May 2013 by searching MEDLINE, PsycINFO, CINAHL and the grey literature. We used five stages to map the literature: identifying the research question; identifying relevant literature; study selection; charting the data; collating, summarizing, and reporting results. RESULTS We identified 51 diverse classification schemes, including 23 taxonomies, 15 frameworks, 8 intervention lists, 3 models and 2 other formats. Most documents were public health based, 55% included a literature or document review, and 33% were theory based. CONCLUSIONS This scoping review provides an overview of schemes used to classify interventions which can be used for evaluation, comparison and validation of existing and emerging models. The collated taxonomies can guide authors in describing interventions; adequate descriptions of interventions will advance the science of knowledge translation in healthcare.
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Affiliation(s)
- Cynthia Lokker
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University, CRL Building, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada.
| | - K Ann McKibbon
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University, CRL Building, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada.
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1 V7, Canada.
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, m4339, Santa Monica, 90407, CA, USA.
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Abell B, Glasziou P, Hoffmann T. Reporting and Replicating Trials of Exercise-Based Cardiac Rehabilitation. Circ Cardiovasc Qual Outcomes 2015; 8:187-94. [DOI: 10.1161/circoutcomes.114.001381] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bridget Abell
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
| | - Paul Glasziou
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
| | - Tammy Hoffmann
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
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Ruppar TM, Delgado JM, Temple J. Medication adherence interventions for heart failure patients: A meta-analysis. Eur J Cardiovasc Nurs 2015; 14:395-404. [DOI: 10.1177/1474515115571213] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/15/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Todd M Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, USA
| | - Janet M Delgado
- Sinclair School of Nursing, University of Missouri, Columbia, USA
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Dijkers MP. Reporting on interventions: issues and guidelines for rehabilitation researchers. Arch Phys Med Rehabil 2015; 96:1170-80. [PMID: 25660003 DOI: 10.1016/j.apmr.2015.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/23/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Observers commonly note the poor reporting of research, including rehabilitation research. The Consolidated Standards of Reporting Trials (CONSORT) checklist (supplemented by the CONSORT extension for nonpharmacologic interventions) has been published for improving the reporting of intervention research. However, the items on these checklists are considered to be inadequate to guide authors as to which information to include when reporting on the intervention(s) studied, and the Template for Intervention Description and Replication, Journal Article Reporting Standards, and the checklist of the Western Journal of Nursing Research are recommended to rehabilitation researchers. The Rehabilitation Treatment Taxonomy framework is recommended as a conceptual scheme to assist authors in thinking through the linkages between intervention ingredients, targets of treatment, and the mechanisms of action linking these 2 areas. Recommendations are made for prospective authors and journal editors who desire to see improved reporting of rehabilitation interventions.
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Affiliation(s)
- Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Conn VS, Chan K, Banks J, Ruppar TM, Scharff J. Cultural relevance of physical activity intervention research with underrepresented populations. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2015; 34:391-414. [PMID: 25228486 DOI: 10.2190/iq.34.4.g] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article describes cultural relevance in physical activity intervention research with underrepresented populations. Seventy-one extant studies which tested interventions to increase physical activity among underrepresented adults were included. Verbatim descriptions of efforts to enhance cultural relevance of study designs and interventions were extracted and then content analyzed. We found strategies to enhance cultural relevance of interventions as soliciting input from population members, linking intervention content with values, addressing language and literacy challenges, incorporating population media figures, using culturally relevant forms of physical activity, and addressing specific population linked barriers to activity. Methodological approaches included specialized recruitment and study locations, culturally relevant measures, underrepresented personnel, and cost-awareness study procedures to prevent fiscal barriers to participation. Most reported activities were surface matching. Existing research neither compared the effectiveness of cultural relevance approaches to standardized interventions nor addressed economic, education, geographic, or cultural heterogeneity among groups.
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A quality evaluation of nursing intervention studies in Mainland China: From 1979 to 2012. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jonkman NH, Westland H, Trappenburg JCA, Groenwold RHH, Effing-Tijdhof TW, Troosters T, van der Palen J, Bourbeau J, Jaarsma T, Hoes AW, Schuurmans MJ. Towards tailoring of self-management for patients with chronic heart failure or chronic obstructive pulmonary disease: a protocol for an individual patient data meta-analysis. BMJ Open 2014; 4:e005220. [PMID: 24860002 PMCID: PMC4039847 DOI: 10.1136/bmjopen-2014-005220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Self-management interventions in patients with chronic conditions have received increasing attention over the past few years, yet the meta-analyses encountered considerable heterogeneity in results. This suggests that the effectiveness of self-management interventions must be assessed in the context of which components are responsible for eliciting the effect and in which subgroups of patients the intervention works best. The aim of the present study is to identify condition-transcending determinants of success of self-management interventions in two parallel individual patient data meta-analyses of self-management trials in patients with congestive heart failure (CHF) and in patients with chronic obstructive pulmonary disease (COPD). METHODS AND ANALYSIS Investigators of 53 randomised trials (32 in CHF and 21 in COPD) will be requested to share their de-identified individual patient data. Data will be analysed using random effects models, taking clustering within studies into account. Effect modification by age, sex, disease severity, symptom status, comorbid conditions and level of education will be assessed. Sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION The de-identified individual patient data are used only for the purpose for which they were originally collected and for which ethical approval has been obtained by the original investigators. Knowledge on the effective ingredients of self-management programmes and identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised self-management interventions for patients with CHF and COPD as well as with other chronic diseases. TRIAL REGISTRATION NUMBER PROSPERO CRD42013004698.
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Affiliation(s)
- Nini H Jonkman
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heleen Westland
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap C A Trappenburg
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tanja W Effing-Tijdhof
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Jean Bourbeau
- Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
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Using a content analysis to identify study eligibility criteria concepts in cancer nursing research. Comput Inform Nurs 2014; 32:333-42. [PMID: 24814997 DOI: 10.1097/cin.0000000000000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aims of this study were to (1) identify and categorize study eligibility criteria concepts used in cancer nursing randomized controlled trials and (2) determine the extent to which a previously identified set of study eligibility criteria, based primarily on medical randomized controlled trials, were represented in cancer nursing randomized controlled trials. A total of 145 articles of cancer nursing randomized controlled trials indexed in PubMed or Cumulative Index to Nursing and Allied Health Literature and published in English from 1986 to 2010 were screened, and 114 were eligible. Directed content analysis was conducted until data saturation was achieved. Forty-three concepts categorized into eight domains were extracted from 49 articles published in 27 different journals. Most of the concepts identified were related to health status, treatment, and demographics domains. Although many concepts matched to the previously identified study eligibility concepts based on medical research, new concepts may need to be added to fully represent cancer nursing research. This study provides a solid foundation for future study of mapping the concepts to existing standardized terminologies to identify which systems can be adopted. Nursing researchers can use these eligibility criteria concepts as a guideline in structuring the eligibility criteria for their studies.
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Conn VS, Koopman RJ, Ruppar TM, Phillips LJ, Mehr DR, Hafdahl AR. Insulin Sensitivity Following Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults. J Prim Care Community Health 2014; 5:211-22. [PMID: 24474665 DOI: 10.1177/2150131913520328] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Although exercise can improve insulin sensitivity, no adequate synthesis exists of exercise intervention studies with regard to their effect on insulin sensitivity. This comprehensive meta-analysis synthesized the insulin sensitivity outcomes of supervised exercise interventions. METHOD Extensive literature searching located published and unpublished intervention studies that measured insulin sensitivity outcomes. Eligible studies tested supervised exercise interventions among healthy adults. Primary study characteristics and results were coded. Random-effects meta-analyses of standardized mean differences included moderator analyses. RESULTS Data were synthesized across 2509 subjects (115 samples, 78 reports). The overall mean effect size for 2-group postintervention comparisons was 0.38 (95% confidence interval [CI] = 0.25-0.51, I (2) = 0%) and for 2-group pre-post comparisons was 0.43 (95% CI = 0.30-0.56, I (2) = 52%; higher mean insulin sensitivity for treatment than control subjects). The postintervention mean of 0.38 is consistent with treatment subjects ending studies with a mean fasting insulin of 6.8 mU/L if control participants' mean fasting insulin were 7.9 mU/L. Exploratory moderator analyses did not document different insulin sensitivity effect sizes across intervention characteristics or sample attributes. CONCLUSION This study documented that exercise is a valuable primary care and community health strategy for healthy adults to improve insulin sensitivity and lower the risk for diabetes conferred by insulin resistance.
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Hoffmann T, English T, Glasziou P. Reporting of interventions in randomised trials: an audit of journal instructions to authors. Trials 2014; 15:20. [PMID: 24422788 PMCID: PMC3896798 DOI: 10.1186/1745-6215-15-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/23/2013] [Indexed: 11/10/2022] Open
Abstract
Background A complete description of the intervention in a published trial report is necessary for readers to be able to use the intervention, yet the completeness of intervention descriptions in trials is very poor. Low awareness of the issue by authors, reviewers, and editors is part of the cause and providing specific instructions about intervention reporting to authors and encouraging full sharing of intervention materials is important. We assessed the extent to which: 1) journals’ Instructions to Authors provide instructions about how interventions that have been evaluated in a randomised controlled trial (RCT) should be reported in the paper; and 2) journals offer the option of authors providing online supplementary materials. Methods We examined the web-based Instructions to Authors of 106 journals (the six leading general medical journals, 50 randomly selected journals from the National Library of Medicine’s Core Clinical Journals, and 50 randomly selected journals from the remainder of the journal collection indexed by PubMed). To be eligible, each journal must have published at least one randomised trial involving human participants each year from 2008 to 2012. We extracted all information related to the reporting of interventions, reporting of randomised trials in general, and online supplementary materials. Results Of the 106 journals’ Instructions to Authors, only 15 (14%) specifically mentioned the reporting of interventions and most of these provided non-specific advice such as ‘describe essential features’. Just over half (62, 58%) of the journals mentioned the Consolidated Standards of Reporting Trials (CONSORT) statement in their author instructions. Seventy-eight (74%) of the journals’ instructions mentioned the option of providing supplementary content online as part of the paper; however, only four of these journals explicitly encouraged or mandated use of this option for providing intervention information or materials. Conclusions Most journals’ Instructions to Authors do not provide any specific instructions regarding reporting of interventions or encourage authors to provide online supplementary materials to enhance intervention reporting. Journals can help to improve the problem of incomplete intervention reporting by providing specific instructions to authors and peer reviewers about intervention reporting and requiring full intervention descriptions to be provided.
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Affiliation(s)
- Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences Medicine, Bond University, 4229 Queensland, Australia.
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Chase JAD. Physical activity interventions among older adults: a literature review. Res Theory Nurs Pract 2013; 27:53-80. [PMID: 23923347 DOI: 10.1891/1541-6577.27.1.53] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Physical activity (PA) is important in the management of chronic illness among older adults worldwide. Researchers have conducted several intervention studies to increase PA behavior in this population. This review of the past 12 years of relevant PA intervention research among adults aged 60 years and older systematically summarized research findings, identified characteristics of successful interventions, and proposed areas of future research. There were 20 studies reviewed for this article, most employing a combination of cognitive-behavioral intervention design. Cognitive-based only and combination interventions were more successful in changing PA behavior; however, behavioral-based interventions demonstrated more long-term changes in PA behavior. Among theory-based interventions, self-efficacy was the most commonly operationalized construct. Findings from this review may inform future primary research to promote PA behavior among older adults, as well as gerontological clinical practice.
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Affiliation(s)
- Jo-Ana D Chase
- University of Missouri, Sinclair School of Nursing, USA.
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Bleijenberg N, ten Dam VH, Drubbel I, Numans ME, de Wit NJ, Schuurmans MJ. Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care. J Nurs Scholarsh 2013; 45:230-7. [PMID: 23530956 DOI: 10.1111/jnu.12023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in detail the development process of the U-CARE program to allow its replication. METHODS The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a theoretical guide for the design of the U-CARE program. An extended stepwise multimethod procedure was used to develop U-CARE. A team of researchers, general practitioners, registered practice nurses, experts, and an independent panel of older persons was involved in the development process to increase its feasibility in clinical practice. A systematic review of the literature and of relevant guidelines, combined with clinical practice experience and expert opinion, was used for the development of the intervention. FINDINGS Based on predefined potentially effective guiding components, the U-CARE program comprises three steps: a frailty assessment, a comprehensive geriatric assessment at home followed by a tailor-made care plan, and multiple follow-up visits. Evidence-based care plans were developed for 11 geriatric conditions. The feasibility in clinical practice was tested and approved by experienced registered practice nurses. CONCLUSIONS Using the MRC Framework, a detailed description of the development process of the innovative U-CARE program is provided, which is often missing in reports of complex intervention trials. Based on our feasibility-pilot study, the general practitioners and the registered practice nurses indicated that the U-CARE intervention is feasible in clinical practice. CLINICAL RELEVANCES The U-CARE program consists of promising components and has the potential to improve the care of older patients.
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Affiliation(s)
- Nienke Bleijenberg
- Rho Chi at Large, Nurse, Nursing Scientist, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Conn VS, Ruppar TM, Phillips LJ, Chase JAD. Using meta-analyses for comparative effectiveness research. Nurs Outlook 2012; 60:182-90. [PMID: 22789450 DOI: 10.1016/j.outlook.2012.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
Abstract
Comparative effectiveness research seeks to identify the most effective interventions for particular patient populations. Meta-analysis is an especially valuable form of comparative effectiveness research because it emphasizes the magnitude of intervention effects rather than relying on tests of statistical significance among primary studies. Overall effects can be calculated for diverse clinical and patient-centered variables to determine the outcome patterns. Moderator analyses compare intervention characteristics among primary studies by determining whether effect sizes vary among studies with different intervention characteristics. Intervention effectiveness can be linked to patient characteristics to provide evidence for patient-centered care. Moderator analyses often answer questions never posed by primary studies because neither multiple intervention characteristics nor populations are compared in single primary studies. Thus, meta-analyses provide unique contributions to knowledge. Although meta-analysis is a powerful comparative effectiveness strategy, methodological challenges and limitations in primary research must be acknowledged to interpret findings.
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Affiliation(s)
- Vicki S Conn
- Meta-Analysis Research Center, School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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Conn VS. Unpacking the black box: countering the problem of inadequate intervention descriptions in research reports. West J Nurs Res 2012; 34:427-33. [PMID: 22547207 DOI: 10.1177/0193945911434627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Improving Medication Adherence: Moving from Intention and Motivation to a Personal Systems Approach. Nurs Clin North Am 2011; 46:271-81, v. [DOI: 10.1016/j.cnur.2011.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Conn VS, Groves PS. Protecting the power of interventions through proper reporting. Nurs Outlook 2011; 59:318-25. [PMID: 21840555 DOI: 10.1016/j.outlook.2011.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 06/16/2011] [Accepted: 06/27/2011] [Indexed: 12/17/2022]
Abstract
Authors, reviewers, and journal editors are responsible for ensuring that standards of research reporting include detailed descriptions of interventions. The impact of nursing intervention research is much reduced when interventions are poorly described. Nursing research reports often fail to detail descriptions of interventions sufficiently to move future research forward, apply new knowledge in practice, and refine theories. To address this deficit, the authors constructed detailed guidelines for reporting interventions. Based on a review of health care literature, these guidelines include a discussion of theoretical, participant, interventionist, content, and delivery intervention elements with rationale for their inclusion. Suggestions for presenting this information in limited journal space are also presented.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, Columbia, USA.
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Leeman J, Chang YK, Lee EJ, Voils CI, Crandell J, Sandelowski M. Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence. J Adv Nurs 2010; 66:1915-30. [PMID: 20707822 DOI: 10.1111/j.1365-2648.2010.05360.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy. BACKGROUND Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings. DATA SOURCES Sixty-one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty-two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity. REVIEW METHODS An adaptation of Pawson's realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed. RESULTS The final explanatory model suggests that individuals with HIV will be more likely to enroll in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one-to-one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand-alone interventions. CONCLUSION The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, USA.
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Conn VS, Algase DL, Rawl SM, Zerwic JJ, Wyman JF. Publishing pilot intervention work. West J Nurs Res 2010; 32:994-1010. [PMID: 20702685 DOI: 10.1177/0193945910367229] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pilot intervention studies can be viewed as rehearsals for subsequent full-scale trials. They can help investigators fine-tune later larger studies as well as explore issues related to project management and budget. Pilot studies permit testing of sampling strategies, participant recruitment, intervention content, delivery methods, data collection, and analysis. They also allow researchers to experience the more practical aspects of implementing a study, such as determining the number of study staff members needed to handle recruitment and data collection or identifying special equipment needs. Because pilot study findings may be generalizable, publication is encouraged as long as the preliminary nature of the work is clearly indicated in both the abstract and the article. The present article provides an overview of the types of information that can be gleaned from pilot intervention studies that are suitable for publication.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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Wanted: Less Time and More Space! J Nurs Scholarsh 2009. [DOI: 10.1111/j.1547-5069.2009.01299_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boren SA, Wakefield BJ, Gunlock TL, Wakefield DS. Heart failure self-management education: a systematic review of the evidence. INT J EVID-BASED HEA 2009; 7:159-68. [DOI: 10.1111/j.1744-1609.2009.00134.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fealy G, McCarron M, O'Neill D, McCallion P, Clarke M, Small V, O'Driscoll A, Cullen A. Effectiveness of gerontologically informed nursing assessment and referral interventions for older persons attending the emergency department: systematic review. J Adv Nurs 2009; 65:934-5. [PMID: 19399966 DOI: 10.1111/j.1365-2648.2009.04961.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of a literature review conducted to analyse data from published studies reporting nursing interventions targeted at older attendees of emergency departments (EDs), and to provide a critical appraisal of the evidence concerning their effectiveness. BACKGROUND Attendance at hospital EDs by older persons presents opportunities for targeted interventions to address actual and potential problems associated with or in addition to the presenting problem. The evidence concerning the effectiveness of such interventions is mixed. DATA SOURCES Studies were retrieved from a systematic search of published works indexed in CINAHL, MEDLINE (PubMed), Science Direct and the Cochrane Central Register of Controlled Trials (CENTRAL). METHODS A systematic review of effectiveness was conducted using the Cochrane Effective Practice and Organisation of Care guidelines and a narrative synthesis approach for data handling and presentation. The review period was 1992 to 31 August 2008. RESULTS Nursing assessment and referral interventions have demonstrated effectiveness in reducing service use and improving physical function, but have failed to demonstrate statistically significant effects on predicted patient and/or health systems outcomes. CONCLUSION The evidence of the effectiveness of gerontologically informed nursing assessment and referral interventions in EDs must be accepted with caution, as not all studies demonstrated effectiveness in predicted patient and/or health systems outcomes, and the testing of complex social interventions in randomized clinical trials is inherently problematic. Further evidence of the effectiveness of nursing interventions is required, and such evidence might be usefully demonstrated using pragmatic, as opposed to explanatory, trials.
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Affiliation(s)
- Gerard Fealy
- School of Nursing, Midwifery & HealthSystems, University College Dublin, Ireland.
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De Bleser L, Matteson M, Dobbels F, Russell C, De Geest S. Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int 2009; 22:780-97. [PMID: 19386076 DOI: 10.1111/j.1432-2277.2009.00881.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Reports of interventions to improve adherence to medical regimens in solid organ transplant recipients are scarce. A systematic review identified 12 intervention studies. These studies focused on renal, heart, and liver transplant recipients. Five reports used randomized controlled trial (RCT) designs. Sample sizes varied between 18 and 110 subjects. The interventions are difficult to evaluate and categorize because of brief descriptions of intervention details. Of the 12 studies identified in this review, only five studies found a statistically significant improvement in at least one medication-adherence outcome with the intervention. In general, most included a combination of patient-focused cognitive/educational, counseling/behavioral, and psychologic/affective dimensions. Eight studies intervened at the healthcare provider, healthcare setting or healthcare system level, but showed a limited improvement in adherence. No single intervention proved to be superior at increasing medication-adherence in organ transplantation, but a combination of interventions in a team approach for the chronic disease management of organ transplant patients may be effective in a long-term perspective. In conclusion, finding the most effective combination of interventions to enhance adherence is vital. Utilizing an RCT design and adhering to the CONSORT guidelines can lead to higher quality studies and possibly more effective intervention studies to enhance medication-adherence.
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Affiliation(s)
- Leentje De Bleser
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, Belgium
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Hallberg IR. Moving nursing research forward towards a stronger impact on health care practice? Int J Nurs Stud 2009; 46:407-12. [DOI: 10.1016/j.ijnurstu.2009.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC, Byock IR, Hull JG, Li Z, McKinstry E, Seville JL, Ahles TA. The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions. Palliat Support Care 2009; 7:75-86. [PMID: 19619377 PMCID: PMC3685415 DOI: 10.1017/s1478951509000108] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is a paucity of randomized controlled trials (RCTs) to evaluate models of palliative care. Although interventions vary, all have faced a variety of methodological challenges including adequate recruitment, missing data, and contamination of the control group. We describe the ENABLE II intervention, methods, and sample baseline characteristics to increase intervention and methodological transparency, and to describe our solutions to selected methodological issues. METHODS Half of the participants recruited from our rural U.S. comprehensive cancer center and affiliated clinics were randomly assigned to a phone-based, nurse-led educational, care coordination palliative care intervention model. Intervention services were provided to half of the participants weekly for the first month and then monthly until death, including bereavement follow-up call to the caregiver. The other half of the participants were assigned to care as usual. Symptoms, quality of life, mood, and functional status were assessed every 3 months until death. RESULTS Baseline data of 279 participants were similar to normative samples. Solutions to methodological challenges of recruitment, missing data, and "usual care" control group contamination are described. SIGNIFICANCE OF RESULTS It is feasible to overcome many of the methodological challenges to conducting a rigorous palliative care RCT.
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Affiliation(s)
- Marie Bakitas
- Department of Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
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Ramírez-García P. Intervention Mapping: un protocolo útil para el desarrollo e implantación de intervenciones en enfermería. ENFERMERIA CLINICA 2008. [DOI: 10.1016/s1130-8621(08)72200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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