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Hee SW, Patel S, Sandhu H, Matharu MS, Underwood M. Does pain self-efficacy predict, moderate or mediate outcomes in people with chronic headache; an exploratory analysis of the CHESS trial. J Headache Pain 2024; 25:77. [PMID: 38745132 PMCID: PMC11094916 DOI: 10.1186/s10194-024-01768-5] [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] [Received: 01/19/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Chronic headache disorders are disabling. The CHESS trial studied the effects of a short non-pharmacological intervention of education with self-management support for people affected by migraine and/or tension type headache for at least 15 days per month for at least three months. There were no statistically significant effects on the Headache Impact Test-6 (HIT-6) at 12-months. However, we observed improvement in pain self-efficacy questionnaire (PSEQ) and short-term HIT-6. We explored the impact of the CHESS intervention on PSEQ, and subsequently, on the HIT-6 and chronic headache quality of life questionnaire (CH-QLQ) at four, eighth and 12 months. METHODS We included all 736 participants from the CHESS trial. We used simple linear regression models to explore the change of HIT-6 and CH-QLQ with treatment and PSEQ at baseline (predictor analysis), and the interaction between treatment and baseline PSEQ (moderator analysis). We considered the change of PSEQ from baseline to four months as a mediator in the mediation analysis. RESULTS Baseline PSEQ neither predicted nor moderated outcomes. The prediction effect on change of HIT-6 from baseline to 12 months was 0.01 (95% CI, -0.03 to 0.04) and the interaction (moderation) effect was -0.07 (95% CI, -0.15 to 0.002). However, the change of PSEQ from baseline to 4-month mediated the HIT-6 (baseline to 8-, and 12-month) and all components of CH-QLQ (baseline to 8-, and 12-month). The CHESS intervention improved the mediated variable, PSEQ, by 2.34 (95% CI, 0.484 to 4.187) units and this corresponds to an increase of 0.21 (95% CI, 0.03 to 0.45) units in HIT-6 at 12-months. The largest mediated effect was observed on the CH-QLQ Emotional Function, an increase of 1.12 (95% CI, 0.22 to 2.20). CONCLUSIONS PSEQ was not an effective predictor of outcome. However, change of short-term PSEQ mediated all outcomes, albeit minimally. Future behavioural therapy for chronic headache may need to consider how to achieve larger, and more sustained increases level of self-efficacy than that achieved within the CHESS trial. TRIAL REGISTRATION ISRCTN79708100.
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Affiliation(s)
- Siew Wan Hee
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK.
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK.
| | - Shilpa Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
| | - Harbinder Sandhu
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
| | - Manjit S Matharu
- Queen Square Institute of Neurology, University College London, Queen Square, WC1N 3BG, London, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
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Dione MN, Donelle L, Smye V, Befus D. Self-management Experience of Nurses Living with Migraine: A Qualitative Study. Can J Nurs Res 2024; 56:38-48. [PMID: 37700606 DOI: 10.1177/08445621231199652] [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] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Migraine is a neurobiological condition characterized by a constellation of unpredictable symptoms and is the second cause of disability worldwide. Migraine is prevalent among nurses. However, literature exploring nurses' experience of living with migraine is scarce which has important individual and systems implications for health and wellness and patient safety. Self-management is essential in chronic disease management as the patient engages in various strategies to be able to live with their condition. PURPOSE This study explored the experiences of living and working with migraine among female nurses in Ontario, with particular attention to their priorities and strategies for self-management. METHODS Interpretive description methodology was employed to guide this study and informed a thematic analysis approach to examine the self-management experiences of nurses living with migraine. RESULTS Nurses engaged in various self-management strategies including pharmacological and non-pharmacological strategies and highlighted the role of technology in migraine self-management. Participants described experiences of living with migraine as an invisible condition including feelings of not being understood, stigmatization, and the absence of formal support at the workplace. CONCLUSION The implications of these findings support the incorporation of a critical approach to relational engagement that is person-centred including nonjudgemental, strength-based care as a practice approach when caring for persons living with migraines and the need to include experiential learning in educational curriculums as a strategy to reduce stigma against migraines.
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Affiliation(s)
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Ellard DR, Nichols VP, Griffiths FE, Underwood M, Taylor SJC. Chronic Headache Education and Self-Management Study (CHESS): a process evaluation. BMC Neurol 2023; 23:8. [PMID: 36609224 PMCID: PMC9823254 DOI: 10.1186/s12883-022-02792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention. METHODS The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised. RESULTS The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected 'dose'of the intervention was delivered to participants and intervention fidelity was high. Attendance ("dose received") fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised. CONCLUSIONS From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time. TRIAL REGISTRATION ISRCTN79708100 .
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Affiliation(s)
- David R. Ellard
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK ,grid.412570.50000 0004 0400 5079University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Vivien P. Nichols
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Frances E. Griffiths
- grid.7372.10000 0000 8809 1613Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Martin Underwood
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK ,grid.412570.50000 0004 0400 5079University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Stephanie J. C. Taylor
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB UK
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Nkhata LA, Brink Y, Ernstzen D, Tsegaye D, Louw Q. Nurses’ beliefs about back pain, their coping strategies and participant activation for self-management. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1622. [PMCID: PMC9634942 DOI: 10.4102/sajp.v78i1.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 07/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Back pain affects nurses’ physical, social and emotional well-being, as they encounter difficulties in executing their social and occupational duties. Objectives Our study investigated the impact of a cross-cultural back pain campaign on nurses’ beliefs about back pain; activating the participants to self-manage; coping strategies; sick leave claimed; and frequency of doctor visits. Method A single sample pre- and post-test design was used. The intervention was a 12-week educational campaign based on evidence-based back pain messages. Primary outcomes were measured by their beliefs about back pain and their activation to self-manage. Analyses were conducted using SPSS version 27.0 software, and significant differences from before and after the campaign were analysed using the Chi-square test at a 0.05 significance level. Results There were no significant differences in the age, gender and work hours of the nurses who participated before and after the campaign, except for their professional work settings (< 0.05). All secondary outcomes improved significantly after the campaign, and outcomes on beliefs about back pain showed significantly positive changes in six of the 14 items, while all questions pertaining to patient activation improved significantly. Conclusion The 12-week back pain campaign, based on contextualised, evidence-based back pain messages for Zambian nurses, motivated the participants to self-manage their back pain. However, not all beliefs about back pain changed positively after the campaign. Clinical implications The findings of this back pain education campaign show promise as a strategy to improve knowledge, behaviours and beliefs about back pain in African settings.
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Affiliation(s)
- Loveness A. Nkhata
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa,Department of Physiotherapy, Faculty of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Yolandi Brink
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dawn Ernstzen
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Diribsa Tsegaye
- Department of Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa,Department of Biostatistics, Faculty of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Quinnette Louw
- Department of Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Bentivegna E, Luciani M, Ferrari V, Galastri S, Baldari F, Scarso F, Lamberti PA, Martelletti P. Recently approved and emerging drug options for migraine prophylaxis. Expert Opin Pharmacother 2022; 23:1325-1335. [PMID: 35850597 DOI: 10.1080/14656566.2022.2102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Migraine occupies the first position regarding to the disability caused in female working population (15-49 years). Research in the field of prophylaxis of this pathology has made enormous strides in recent years. AREAS COVERED In this narrative review we retrace the most important scientific evidence regarding recently approved and emerging drug for prophylactic treatment of migraine. The purpose of this article is in fact to evaluate currently approved or emerging pharmacological agents for migraine prophylaxis. This review is based on literature published in peer review journal obtained through PubMed, Cochrane library, Clinicaltrials.gov and US FDA. EXPERT OPINION : Monoclonal antibodies (mAbs) that target the calcitonin gene-related peptide signalling pathway (CGRP) have marked an innovation in prophylactic migraine therapy. The combination of Onabotulinumtoxin-A (OBTA) and mAbs appears to be an effective, but costly, therapeutic option for resistant cases. New classes of molecules like gepants and ditans seem to give exceptional results. In addition, new prophylactic drugs are emerging with several targets: the pituitary adenylate cyclase-activating polypeptide (PACAP), ion channels, several receptors coupled to G proteins, orexin, and glutamate. All these therapies will implement and improve migraine management, as well as personalized medicine for each patient.
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Affiliation(s)
- Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | - Valeria Ferrari
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Silvia Galastri
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Francesco Baldari
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Francesco Scarso
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Piera A Lamberti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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Oliveira Gonçalves AS, Laumeier I, Hofacker MD, Raffaelli B, Burow P, Dahlem MA, Heintz S, Jürgens TP, Naegel S, Rimmele F, Scholler S, Kurth T, Reuter U, Neeb L. Study Design and Protocol of a Randomized Controlled Trial of the Efficacy of a Smartphone-Based Therapy of Migraine (SMARTGEM). Front Neurol 2022; 13:912288. [PMID: 35785344 PMCID: PMC9243352 DOI: 10.3389/fneur.2022.912288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Digitalization and electronic health (eHealth) offer new treatment approaches for patients with migraine. Current smartphone applications (apps) for migraine patients include a wide spectrum of functions ranging from digital headache diaries to app-based headache treatment by, among others, analysis of the possible triggers, behavioral therapy approaches and prophylactic non-drug treatment methods with relaxation therapy or endurance sport. Additional possibilities arise through the use of modern, location-independent communication methods, such as online consultations. However, there is currently insufficient evidence regarding the benefits and/or risks of these electronic tools for patients. To date, only few randomized controlled trials have assessed eHealth applications. Methods SMARTGEM is a randomized controlled trial assessing whether the provision of a new digital integrated form of care consisting of the migraine app M-sense in combination with a communication platform (with online consultations and medically moderated patient forum) leads to a reduction in headache frequency in migraine patients, improving quality of life, reducing medical costs and work absenteeism (DRKS-ID: DRKS00016328). Discussion SMARTGEM constitutes a new integrated approach for migraine treatment, which aims to offer an effective, location-independent, time-saving and cost-saving treatment. The design of the study is an example of how to gather high quality evidence in eHealth. Results are expected to provide insightful information on the efficacy of the use of electronic health technology in improving the quality of life in patients suffering from migraine and reducing resource consumption.
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Affiliation(s)
- Ana Sofia Oliveira Gonçalves
- Institute of Public Health, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- *Correspondence: Ana Sofia Oliveira Gonçalves
| | - Inga Laumeier
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Bianca Raffaelli
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Philipp Burow
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | | | - Simon Heintz
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | | | - Steffen Naegel
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | - Florian Rimmele
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Tobias Kurth
- Institute of Public Health, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Lars Neeb
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
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Nichols V, Pearce G, Ellard DR, Evans S, Haywood K, Norman C, Potter R, Sandhu H, Stewart K, Underwood M, Patel S. Patient and public involvement in a UK National Institute for Health Research Programme Grant for Applied Research: experiences from the Chronic Headache Education and Self-management Study (CHESS). Prim Health Care Res Dev 2021; 22:e72. [PMID: 34796815 PMCID: PMC8628557 DOI: 10.1017/s1463423621000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) plays a crucial role in ensuring research is carried out in conjunction with the people that it will impact upon. In this article, we present our experiences and reflections from working collaboratively with patients and public through the lifetime of an National Institute for Health Research (NIHR) programme grant; the Chronic Headache Education and Self-management Study (CHESS) which took place between 2015 and 2020. PPI OVER THE COURSE OF CHESS We worked closely with three leading UK migraine charities and a lay advisory group throughout the programme. We followed NIHR standards and used the Guidance for Reporting Involvement of Patients and the Public checklist. We consulted our PPI contacts using a variety of methods depending on the phase of the study and the nature of the request. This included emails, discussions, and face-to-face contact.PPI members contributed throughout the study in the programme development, in the grant application, ethics documentation, and trial oversight. During the feasibility study; in supporting the development of a classification interview for chronic headache by participating in a headache classification conference, assessing the relevance, and acceptability of patient-reported outcome measures by helping to analyse cognitive interview data, and testing the smartphone application making suggestions on how best to present the summary of data collected for participants. Due to PPI contribution, the content and duration of the study intervention were adapted and a Delphi study with consensus meeting developed a core outcome set for migraine studies. CONCLUSIONS The involvement of the public and patients in CHESS has allowed us to shape its overall design, intervention development, and establish a core outcome set for future migraine studies. We have reflected on many learning points for the future application of PPI.
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Affiliation(s)
- Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Gemma Pearce
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Chloe Norman
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kimberley Stewart
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- University Hospitals of Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- University Hospitals of Coventry and Warwickshire, Coventry, CV2 2DX, UK
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Helmerson B, Sundholm A, Hedborg K, Waldenlind E, Kierkegaard M, Remahl AIMN. A pilot study of the feasibility of a Swedish multimodal group intervention for severe migraine—The migraine patient school. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211020447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate a multidisciplinary group intervention, the migraine patient school (MPS), for patients with severe, mostly chronic migraine. Method: A 13-week group intervention program including seven sessions of patient education, practical body awareness and relaxation exercises, and home assignments was performed in small groups with 5–11 participants. Four groups were consecutively included from spring 2014 to fall 2015. Headache diaries and standardized and study-specific questionnaires were used for evaluation at baseline before MPS (pre-interventional phase), and at follow-up. Results: Twenty-four of 30 included patients completed the study, i.e. attended ≥ four sessions. Most participants found it rewarding to participate in the MPS and easy to take part in, understand and complete home assignments. Validated standardized questionnaires delivered before, and after (follow-up) MPS showed that the impact on life (HIT-6) and avoidance behavior (PIPS-A) were significantly improved whereas quality of life (MSQL), anxiety and depression (HAD) and perceived stress (PSS-14) did not show a statistically significant change. Conclusion: The Migraine patient school with a multimodal educational and behavioral group intervention program was feasible to perform and seem to benefit patients with severe (high-frequency or chronic) migraine.
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Affiliation(s)
- Birgitta Helmerson
- Women’s Health and Allied Health Professionals Theme Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sundholm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Hedborg
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Kierkegaard
- Women’s Health and Allied Health Professionals Theme Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Stockholm Health Services, Region Stockholm, Stockholm, Sweden
| | - A Ingela M Nilsson Remahl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Educational Processes for Health and Disease Self-Management in Public Health: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126448. [PMID: 34203594 PMCID: PMC8296271 DOI: 10.3390/ijerph18126448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
This study systematically reviewed processes and educational programs for self-management of health and diseases that are the subject of public health attention. This systematic review of the literature (SRL) is relevant to recognizing the characteristics of the educational processes in self-managing chronic diseases in contexts where technology did not play a significant role. Following the PRISMA protocol, the authors independently reviewed full-text articles from several databases using the following criteria: (1) intervention studies evaluating the effects of self-management health programs; (2) educational process of disease self-management; (3) studies that included at least one control group, and (4) peer-reviewed studies. In addition, the Scottish Intercollegiate Guideline Network measurement tool was used to assess the risk of bias in each trial. In the final sample, 38 articles were included. The findings regarding health education methods of self-care, using community-based care and technological tools, are considered fundamental. Among the conclusions, the relevance of the pedagogy that health education processes demand improvement in post-pandemic program effectiveness stands out.
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Nkhata LA, Brink Y, Ernstzen D, Louw QA. Nurses back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain. J Adv Nurs 2021; 77:3772-3783. [PMID: 34009680 DOI: 10.1111/jan.14890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 12/26/2022]
Abstract
AIMS To determine the back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain amongst nurses working in peri-urban district healthcare centres. DESIGN A descriptive cross-sectional study design. METHODS Data were collected between February and March 2020 using a self-administered questionnaire. Descriptive data analysis was done in Stata version 20.0. Back pain beliefs, participant activation and coping strategies were presented using relative frequencies and percentages. Odds ratios at 5% significance level were used to test association of factors for participant activation for self-management of back pain. RESULTS Majority of the participants had experienced back pain which lasted 3 days for half of the participants. Further, pain medication was commonly used to cope with back pain. In addition, age, gender and work-setting were significantly associated with participant activation for self-management of back pain. CONCLUSION Participants' coping strategies for back pain were linked to the conveyed back pain beliefs which demonstrate that participants believed in rest and lengthy periods of time off work for back pain. However, participants acknowledged that taking an active role in determining one's health and function is vital. This highlights the importance of self-management support for health behaviour change amongst nurses. IMPACT The study addressed back pain beliefs, coping strategies and participant activation for self-management of back pain amongst nurses in peri-urban healthcare centres. Majority of the participants experienced back pain which lasted 3 days. Pain medication was commonly used to cope with back pain. Age, gender and work-setting were significantly associated with participant activation for self-management of back pain. Although this study was conducted in Zambia, outcomes from this study may be of benefit to nurses in similar settings. Further, the research provides insight to the international body of knowledge on the process and appropriateness of international research in resource-constrained settings.
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Affiliation(s)
- Loveness A Nkhata
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Physiotherapy, School of Health Sciences, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Yolandi Brink
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dawn Ernstzen
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bertz PE. Occipital neuralgia: What NPs need to know. Nurse Pract 2020; 45:12-16. [PMID: 33093390 DOI: 10.1097/01.npr.0000718500.46346.2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Patrick E Bertz
- Patrick E. Bertz is a family NP at Womack Army Medical Center-Intrepid Spirit TBI Clinic, Fort Bragg, N.C
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Donisi V, Mazzi MA, Gandolfi M, Deledda G, Marchioretto F, Battista S, Poli S, Giansante M, Geccherle E, Perlini C, Smania N, Del Piccolo L. Exploring Emotional Distress, Psychological Traits and Attitudes in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylaxis versus Withdrawal Treatment. Toxins (Basel) 2020; 12:E577. [PMID: 32911799 PMCID: PMC7551686 DOI: 10.3390/toxins12090577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
This explorative cross-sectional study aims at exploring emotional distress, psychological profiles, and the attitude towards receiving psychological support in eighty-seven patients with chronic migraine (CM) undergoing OnabotulinumtoxinA prophylactic treatment (OBT-A, n = 40) or withdrawal treatment (WT, n = 47). The outcomes were explored through a specific battery of questionnaires. 25% of patients undergoing OBT-A and almost half of the patients undergoing WT reported psychological distress of at least moderate-severe level, respectively. Coping strategies, self-efficacy, and perceived social support were similar in the two groups. Patients undergoing OBT-A presented lower psychological inflexibility than patients undergoing WT. Predictors of higher psychological distress were low perceived social support by friends, low self-efficacy, and higher avoidance strategies. In both groups, most of the patients evaluated receiving psychological support to be useful (79%). The potential beneficial effects of OBT-A on the severity of symptoms and psychological distress might further support its role in the multidisciplinary management of patients with CM. Identifying patients with psychological vulnerabilities who may benefit from psychological support is relevant in patients with CM.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Giuseppe Deledda
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Fabio Marchioretto
- Neurological Unit, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2, 17100 Savona, Italy;
| | - Sara Poli
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
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Patel S, Achana F, Carnes D, Eldridge S, Ellard DR, Griffiths F, Haywood K, Hee SW, Mistry D, Mistry H, Nichols VP, Petrou S, Pincus T, Potter R, Sandhu HK, Stewart K, Taylor S, Underwood M, Matharu M. Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS). BMJ Open 2020; 10:e033520. [PMID: 32284387 PMCID: PMC7200026 DOI: 10.1136/bmjopen-2019-033520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic headaches are poorly diagnosed and managed and can be exacerbated by medication overuse. There is insufficient evidence on the non-pharmacological approaches to helping people living with chronic headaches. METHODS AND ANALYSIS Chronic Headache Education and Self-management Study is a pragmatic randomised controlled trial to test the effectiveness and cost-effectiveness of a self-management education support programme on top of usual care for patients with chronic headaches against a control of usual care and relaxation. The intervention is a 2-day group course based on education, personal reflection and a cognitive behavioural approach, plus a nurse-led one-to-one consultation and follow-up over 8 weeks. We aim to recruit 689 participants (356 to the intervention arm and 333 to the control) from primary care and self-referral in London and the Midlands. The trial is powered to show a difference of 2.0 points on the Headache Impact Test, a patient-reported outcome measure at 12 months post randomisation. Secondary outcomes include health related quality of life, self-efficacy, social activation and engagement, anxiety and depression and healthcare utilisation. Outcomes are being measured at 4, 8 and 12 months. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION This trial will provide data on effectiveness and cost-effectiveness of a self-management support programme for chronic headaches. The results will inform commissioning of services and clinical practice. North West - Greater Manchester East Research Ethics Committee have approved the trial. The current protocol version is 3.6 date 7 March 2019. TRIAL REGISTRATION NUMBER ISRCTN79708100.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - David R Ellard
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Kirstie Haywood
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Medical School, Warwick Evidence, University of Warwick, Coventry, UK
| | - Vivien P Nichols
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Rachel Potter
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Kimberley Stewart
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Manjit Matharu
- University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Nichols VP, Ellard DR, Griffiths FE, Underwood M, Taylor SJC, Patel S. The CHESS trial: protocol for the process evaluation of a randomised trial of an education and self-management intervention for people with chronic headache. Trials 2019; 20:323. [PMID: 31164158 PMCID: PMC6549347 DOI: 10.1186/s13063-019-3372-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Process evaluation is increasingly common alongside complex randomised controlled trials (RCTs). This evaluation helps in understanding the mechanisms of impact and how the study processes were executed, and it includes any contextual factors which may have implications for the trial results and any future implementation. This process evaluation is for the Chronic Headache Education and Self-management Study (CHESS) RCT, which is evaluating an education and self-management group behavioural intervention for people with chronic headache. Chronic headache is defined as headaches which are present for 15 or more days per month. The most common types are chronic migraine and chronic tension type and medication overuse headaches. Methods We will use a mixed methods approach. Quantitative data will be taken from routine trial data which will help us to assess the reach of the study; i.e. did we reach those whom we expected and from where? Intervention attendance (dose received) and attrition and qualitative data will augment our understanding about reasons why people may not wish to take part in or failed to attend sessions. Interviews with intervention facilitators and trial participants will gain different perspectives on taking part in the trial. Fidelity will be assessed through listening to audio recordings for adherence to course content and competence of the facilitation of a sample of sessions. Discussion Our process evaluation will allow us to gain insight into how the trial was delivered, the obstacles and enablers encountered and the possible reasons why the interventions may or may not be effective. Trial registration ISRCTN79708100. Registered on 16 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3372-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vivien P Nichols
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Frances E Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Stephanie J C Taylor
- Complex Intervention and Social Practice in Health Care unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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White K, Potter R, Patel S, Nichols VP, Haywood KL, Hee SW, Mistry D, Carnes D, Taylor SJC, Underwood M, Matharu MS. Chronic Headache Education and Self-management Study (CHESS) - a mixed method feasibility study to inform the design of a randomised controlled trial. BMC Med Res Methodol 2019; 19:30. [PMID: 30744571 PMCID: PMC6371558 DOI: 10.1186/s12874-019-0672-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/31/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-management support programmes are effective in a range of chronic conditions however there is limited evidence for their use in the treatment of chronic headaches. The aim of this study was to test the feasibility of four key aspects of a planned, future evaluative trial of a new education and self-management intervention for people with chronic headache: 1) recruiting people with chronic headache from primary care; 2) a telephone interview for the classification of chronic headaches; 3) the education and self-management intervention itself; and 4) the most appropriate patient reported outcomes (PROMS). METHODS Participants were identified and recruited from general practices in the West Midlands of the UK. We developed a nurse-led chronic headache classification interview and assessed agreement with an interview with headache specialists. We developed and tested a group based education and self-management intervention to assess training and delivery receipt using observation, facilitator, and participant feedback. We explored the acceptability and relevance of PROMs using postal questionnaires, interviews and a smartphone app. RESULTS Fourteen practices took part in the study and participant recruitment equated to 1.0/1000 registered patients. Challenges to recruitment were identified. We did 107 paired headache classification interviews. The level of agreement between nurse and doctor interviews was very good. We piloted the intervention in four groups with 18 participants. Qualitative feedback from participants and facilitators helped refine the intervention including shortening the overall intervention and increasing the facilitator training time. Participants completed 131 baseline questionnaires, measurement data quality, reliability and validity for headache-specific and generic measures was acceptable. CONCLUSION This study indicated that recruiting people with chronic headache from primary care is feasible but challenging, our headache classification interview is fit for purpose, our study intervention is viable, and that our choice of outcome measures is acceptable to participants in a future randomised controlled trial (RCT). TRIAL REGISTRATION ISRCTN, ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100.
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Affiliation(s)
- Kimberley White
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Vivien P. Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Kirstie L. Haywood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Dawn Carnes
- Faculty of Health, University of Applied Sciences, Fribourg, Western Switzerland Switzerland
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Manjit S. Matharu
- Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - on behalf of the CHESS team
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
- Faculty of Health, University of Applied Sciences, Fribourg, Western Switzerland Switzerland
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
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