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Aubrey B, Fulcher ML, Reid D. Defining the role of sport and exercise physicians: the experience of different referrer types in New Zealand. BMJ Open Sport Exerc Med 2024; 10:e001968. [PMID: 38685918 PMCID: PMC11057259 DOI: 10.1136/bmjsem-2024-001968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
The aim of this study was to analyse the reasons health professionals refer to sport and exercise physicians (SEPs) and to define what service gap the specialty fills. This was a qualitative study design using thematic analysis. Online focus group interviews consisting of 4-6 participants in each group were conducted separately with physiotherapists, emergency clinicians, general practitioners and orthopaedic surgeons practising in New Zealand. Thematic analysis of the focus group interviews was then used for the identification of common themes around referral tendencies towards SEPs. Three primary themes were identified relating to referrals towards SEPs: (1) role utilisation of SEPs, (2) collaboration and (3) accessibility. SEPs are viewed as experts in the assessment, investigation and diagnosis of musculoskeletal (MSK) conditions, including some which might traditionally be viewed as surgical diagnoses. Some confusion or lack of understanding exists regarding the range of conditions that SEPs can treat and manage, with some referrers assuming that SEPs only treat sport-related injuries. SEPs are often used alongside other specialist practitioners in the management of patients with MSK conditions. This requires collaboration with other health professionals who also treat MSK conditions to ensure the best patient outcome. A common feeling towards SEPs is they are easily accessible compared with other potential health providers who may also treat MSK conditions such as orthopaedic surgeons and general practitioners, and that SEPs provide sound management plans and access to investigations such as MRI, in a timely fashion.
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Affiliation(s)
- Brendon Aubrey
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Mark L Fulcher
- Axis Sports Medicine, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Duncan Reid
- Department of Physiotherapy, AUT, Auckland, New Zealand
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Ooi JJY, Hutchinson R, Harris GA. Confusion among doctors regarding sports and exercise medicine as a specialty: an Australian multidisciplinary, cross-sectional survey. BMJ Open 2023; 13:e072979. [PMID: 37748847 PMCID: PMC10533687 DOI: 10.1136/bmjopen-2023-072979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This cross-sectional study aims to characterise the understanding and attitudes medical practitioners have towards sports and exercise medicine (SEM). By identifying knowledge gaps, misunderstandings and barriers to SEM referral, interventions may be suggested to improve the integration of SEM within a multidisciplinary approach to healthcare. DESIGN A survey was constructed with a multidisciplinary expert panel. Refinement and consensus were achieved through a modified Delphi method. Both quantitative and qualitative data were analysed and intergroup comparisons made using χ2 test of independence and post-hoc paired comparisons. SETTING The questionnaire was distributed across Australian public and private health sectors, in community and hospital-based settings. PARTICIPANTS Australian medical doctors practising in specialties likely to intersect with SEM were invited; including general practice, orthopaedics, emergency, rheumatology and anaesthetics/pain. Invitation was uncapped with no reportable response rate. A total of 120 complete responses were collected RESULTS: The minority (42.5%) of respondents understood the role and scope of sports and exercise physicians. SEM was poorly recognised and comprehended, with the most common misconception being that SEM is solely for elite athletes and performance. Few (20%) doctors were familiar with referral pathways to SEM services. Lack of awareness, clear scope and public presence were seen as major barriers. There was near unanimous (92.5%) agreement that 'exercise is medicine'. A strong majority felt SEM would be valuable to collaborate with more in their current practice (63.3%) and as a part of the Australian public health system (82.5%). There were some significant differences among subgroups, including that junior doctors were more likely to express confusion about SEM. CONCLUSIONS Among non-SEM doctors, there is significant lack of clarity regarding the role of SEM and its optimal integration. Interdisciplinary education and addressing misconceptions may improve the contribution of SEM to community healthcare.
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Affiliation(s)
| | - Robin Hutchinson
- Novar Musculoskeletal Research Institute, Ballarat, Victoria, Australia
| | - Gregory A Harris
- Ballarat Orthopaedics & Sports Medicine, Ballarat, Victoria, Australia
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Woodhead G, Sivaramakrishnan D, Baker G. Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom. Syst Rev 2023; 12:104. [PMID: 37355661 PMCID: PMC10290366 DOI: 10.1186/s13643-023-02245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions. METHODS A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion. RESULTS In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance. CONCLUSION This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.
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Affiliation(s)
- Gemma Woodhead
- Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Sciences, University of Edinburgh, Scotland, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, Moray House School of Education & Sport, University of Edinburgh, Scotland, UK.
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Vishnubala D, Iqbal A, Marino KR, Salman D, Pringle A, Nykjaer C, Bazira P, Finn G. Creating a Sport and Exercise Medicine Masters syllabus for doctors: a Delphi study. BMJ Open Sport Exerc Med 2022; 8:e001252. [PMID: 35516072 PMCID: PMC8995950 DOI: 10.1136/bmjsem-2021-001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Sport and Exercise Medicine (SEM) Masters curricula vary. This Delphi study is aimed to create a consensus curriculum for doctors undertaking SEM Masters courses. Methods A modified Delphi survey was used. An expert panel was established of individuals deemed to have adequate knowledge of the field. The research group developed the initial draft of the curriculum by collating and reviewing previously published UK-based postgraduate SEM-related curricula. There were two phases. In phase 1 the expert group either accepted, rejected or modified each learning objective (LO). During phase 2 the expert group were asked to accept or reject each LO that did not get accepted outright previously. The research group analysed the levels of agreements and the comments given by the expert panel after each phase. Results The expert panel consisted of 45 individuals, with 35 completing phase 2 (78% retention rate). Of the 136 LOs initially collated: 71 (52%) were accepted outright, 60 (44%) were altered in some way and reincluded in phase 2, and 5 (4%) were removed after phase 1. The research group added 2 (1%) new LOs on reflection over comments made by the expert panel. The final curriculum contained 133 LOs, divided into 11 subthemes. Conclusions The findings will better inform educators when developing SEM Masters curricula and inform students what they should look for when considering an SEM Masters. This consensus curriculum is an important step in standardising postgraduate SEM education.
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Affiliation(s)
- Dane Vishnubala
- Hull York Medical School, Hull, UK.,University of Leeds, Leeds, UK.,School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - David Salman
- School of Public Health/MSk lab, Imperial College Hospital, London, UK
| | - Andy Pringle
- Sport Outdoor and Exercise Science, University of Derby, Derby, UK
| | - Camilla Nykjaer
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
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Vishnubala D, Marino KR, Pratten MK, Pringle A, Griffin SA, Finn G, Bazira P, Edwards K. Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study. BMJ Open Sport Exerc Med 2020; 6:e000888. [PMID: 33262891 PMCID: PMC7672496 DOI: 10.1136/bmjsem-2020-000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS. METHODS Semi-structured interviews were undertaken to collect data from identified 'stakeholders'. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data. RESULTS N=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality. CONCLUSION The management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent 'unique selling points' of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.
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Affiliation(s)
- Dane Vishnubala
- Hull York Medical School, York, UK
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | | | | | - Andy Pringle
- School of Human Sciences, University of Derby, Derby, UK
| | | | | | | | - Kimberley Edwards
- Centre for Sports Medicine, Queens Medical Centre Nottingham, Nottingham, UK
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Tzortziou Brown V, Underwood M, Westwood OM, Morrissey D. Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study. BMJ Open 2019; 9:e024710. [PMID: 30782916 PMCID: PMC6398779 DOI: 10.1136/bmjopen-2018-024710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To assess whether a quality improvement-based approach to referral management can result in better musculoskeletal care within general practice. DESIGN Prospective cohort study using mixed methodology including random-effects meta-analysis and interrupted time series. SETTING AND PARTICIPANTS 36 general practices in East London. INTERVENTION Informed by the results of a Cochrane review on educational interventions to improve general practitioners' (GPs) musculoskeletal care, we developed a multifaceted intervention, underpinned by quality improvement and behavioural change theories. It combined locally agreed clinical pathways, feedback on referral rates, clinical audit and peer review. MAIN OUTCOME MEASURES Referral letter content, pathway adherence, referral rates, inter-practice variability and patient experience were evaluated before and after the intervention. RESULTS Referral letter content on suspected diagnosis and prior management improved from a pooled preintervention proportion of 59% (95% CI 53% to 65%) and 67% (95% CI 61% to 73%), respectively, to 77% (95% CI 70% to 84%) and 81% (95% CI 74% to 88%). Pathway adherence improved from a pooled preintervention percentage of 42% (95% CI 35% to 48%) to 66% (95% CI 57% to 76%). The effect was greater across all quality outcomes for practices with baseline performance below or equal to the pooled baseline performance. There were reductions in the variability and rates of orthopaedic referrals at 6, 12 and 18 months (referral rate relative effect 32% (95% CI 14% to 48%), 30% (95% CI 7% to 53%) and 30% (95% CI 0% to 59%), respectively). Patient rating of how well GPs explained the musculoskeletal condition improved by 29% (95% CI 14% to 43%) and patient perception on the usefulness of the GP appointment improved by 24% (95% CI 9% to 38%). CONCLUSIONS A quality improvement-based approach to referral management which values GPs' professionalism can result in improvements across a range of outcomes including referral quality, patient experience, referral rates and variability.
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Affiliation(s)
- Victoria Tzortziou Brown
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Warwick University, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Olwyn M Westwood
- CHLS Central Office, Brunel University London, London, Uxbridge, United Kingdom
| | - Dylan Morrissey
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Pullen E, Malcolm D, Wheeler P. How effective is the integration of sport and exercise medicine in the English National Health Service for sport related injury treatment and health management? J Sports Med Phys Fitness 2018; 59:481-488. [PMID: 29877672 DOI: 10.23736/s0022-4707.18.08389-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Regular participation in sport, exercise and physical activity (PA) is associated with positive health outcomes and form a mainstay of British public health policies. However, regular participation in sport and exercise can result in sport related injury (SRI) which, in turn, is a key cause of exercise cessation. The integration of Sport and Exercise Medicine (SEM) in the English National Health Service (NHS) aims to provide a specialist service for public populations and thus reduce the impact of SRI on exercise cessation and associated negative health outcomes. More broadly it aims to both support PA health promotion policies and improve healthcare organisations efficiencies through providing the most condition-appropriate treatment. METHODS This qualitative interview study examines patients' (N.=19) experiences of accessing and receiving SEM treatment within the English NHS. RESULTS The research demonstrates that referral pathways into SEM were often prolonged, characterised by multiple general practitioner (GP) visits and referrals into other musculoskeletal services, demonstrating an inefficient use of healthcare resources. Prolonged pathways fostered only limited recovery back to previous PA levels and other negative health behaviours, yet on accessing the SEM clinic, patients experienced progressive rehabilitation back into sport and exercise participation. CONCLUSIONS This study highlights the importance of more fully integrating SEM services into public healthcare as a way of improving the organisational capacity of healthcare in treating SRI and ensuring that citizens comply with state interventions which orchestrate health management through raising PA levels across the population.
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Affiliation(s)
- Emma Pullen
- Faculty of Management, Bournemouth University, Bournemouth, UK -
| | - Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick Wheeler
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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