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Rebbeck T, Bandong AN, Leaver A, Ritchie C, Armfield N, Arora M, Cameron ID, Connelly LB, Daniell R, Gillett M, Ingram R, Jagnoor J, Kenardy J, Mitchell G, Refshauge K, Scotti Requena S, Robins S, Sterling M. Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial. Pain 2023; 164:2216-2227. [PMID: 37318019 DOI: 10.1097/j.pain.0000000000002940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/24/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Current pathways of care for whiplash follow a "stepped care model," result in modest treatment outcomes and fail to offer efficient management solutions. This study aimed to evaluate the effectiveness of a risk-stratified clinical pathway of care (CPC) compared with usual care (UC) in people with acute whiplash. We conducted a multicentre, 2-arm, parallel, randomised, controlled trial in primary care in Australia. Participants with acute whiplash (n = 216) were stratified for risk of a poor outcome (low vs medium/high risk) and randomised using concealed allocation to either the CPC or UC. In the CPC group, low-risk participants received guideline-based advice and exercise supported by an online resource, and medium-risk/high-risk participants were referred to a whiplash specialist who assessed modifiable risk factors and then determined further care. The UC group received care from their primary healthcare provider who had no knowledge of risk status. Primary outcomes were neck disability index (NDI) and Global Rating of Change (GRC) at 3 months. Analysis blinded to group used intention-to-treat and linear mixed models. There was no difference between the groups for the NDI (mean difference [MD] [95% confidence interval (CI)] -2.34 [-7.44 to 2.76]) or GRC (MD 95% CI 0.08 [-0.55 to 0.70]) at 3 months. Baseline risk category did not modify the effect of treatment. No adverse events were reported. Risk-stratified care for acute whiplash did not improve patient outcomes, and implementation of this CPC in its current form is not recommended.
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Affiliation(s)
- Trudy Rebbeck
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aila Nica Bandong
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Physical Therapy, The University of the Philippines, Manila, Philippines
| | - Andrew Leaver
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Armfield
- RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Luke B Connelly
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia
- Departimento di Sociologia e Diritto Dell'Economia Bologna, Emilia-Romagna, Italy
| | - Roy Daniell
- Belconnen Physiotherapy Clinic, Canberra, Australia
| | - Mark Gillett
- Emergency Department, Royal North Shore Hospital, Sydney, Australia
| | - Rodney Ingram
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, School of Population Health, University of New South Wales, New South Wales, Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, Queensland, Brisbane, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, School of Medicine, University of Queensland Brisbane, Australia
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Simone Scotti Requena
- RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Sarah Robins
- RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
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Macpherson S, Rebbeck TR, Coates S, Evans K. Referral practices of recent graduate and experienced physiotherapists working in Australian primary care for people with musculoskeletal conditions. Musculoskelet Sci Pract 2023; 64:102745. [PMID: 36924580 DOI: 10.1016/j.msksp.2023.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND People with musculoskeletal conditions often seek care from physiotherapists. Some, particularly those at risk of poor outcomes, may benefit from referral to physiotherapists with expertise in managing musculoskeletal conditions and/or multidisciplinary care. Understanding referral practices of physiotherapists, and how experience influences those practices, may assist in implementing optimal care pathways in primary care. AIMS Explore (i) current referral practices of recent graduate and experienced physiotherapists who manage musculoskeletal conditions; (ii) opinions about referral to specialist physiotherapists for people at risk of poor outcomes. METHODS This qualitative study consisted of 23 semi-structured interviews with recent graduate (n = 9) and experienced physiotherapists (n = 14) working in primary care. Perspectives of participants' current referral practices (to whom, when and why they are referred) and referral to specialist physiotherapists were sought. Interviews were recorded and transcribed verbatim prior to analysis. RESULTS Referral practices for both groups were influenced by specific diagnoses, complexity of presentations, confidence, self-awareness, the clinical environment and system-related factors. Experienced physiotherapists were more confident and specific in their referrals and had established trusted networks compared with new graduates. Early referral to specialist physiotherapists was more likely when therapists were co-located. Barriers to early referral were lack of awareness, health system factors and impact on the patient (e.g., financial, time, continuity of care). CONCLUSION Understanding factors influencing referral decisions may improve both intra- and interprofessional care for people with musculoskeletal conditions. Referral of people at risk of poor outcomes to specialist physiotherapists may be improved by greater intraprofessional awareness and clarity of roles.
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Affiliation(s)
- S Macpherson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - T R Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - S Coates
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; School of Allied Health, Australian Catholic University, Sydney, New South Wales, Australia
| | - K Evans
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Healthia Limited, Brisbane, Queensland, Australia.
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Rahayuwati L, Nurhidayah I, Ekawati R, Agustina HS, Suhenda D, Rosmawati D, Amelia V. Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia. Int J Environ Res Public Health 2023; 20:2303. [PMID: 36767669 PMCID: PMC9915049 DOI: 10.3390/ijerph20032303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. PURPOSE This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. METHOD This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. RESULT The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. CONCLUSION Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.
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Affiliation(s)
- Laili Rahayuwati
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Ikeu Nurhidayah
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Rindang Ekawati
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Habsyah Saparidah Agustina
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Dadang Suhenda
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Dean Rosmawati
- National Population and Family Planning Board, Jakarta 13650, Indonesia
| | - Vira Amelia
- Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
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Boyle EM, Fary RE, Lee S, Mikhailov A, Evans K, Rebbeck T, Beales DJ. Patient perspectives of care pathways for people with low back pain: A qualitative study. Musculoskelet Sci Pract 2022; 62:102657. [PMID: 36058010 DOI: 10.1016/j.msksp.2022.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low back pain (LBP) care pathways aim to enhance health outcomes through patient-clinician mutual decision-making and care coordination. However, challenges to successful translation into practice include patients' understanding, expectation, and acceptance of treatment and management strategies for LBP. This study explored patients' perspectives and/or experience of care pathways and their involvement in decision-making in primary care. METHODS A qualitative descriptive design was adopted. Semi-structured interviews were conducted with 14 participants with LBP recruited from the community. Inductive thematic analysis of the qualitative data was conducted within the design framework to enable a systematic comparison of experiences across participants and within individual cases. RESULTS Five themes described participant perspectives and understanding of care pathways: i) care pathways can guide decision-making; ii) familiarity with no and/or stepped care pathway, but preference for matched or blend of care pathways; iii) engaging in shared decision-making; iv) patient-related barriers to implementation; v) patient-related facilitators to implementation. CONCLUSIONS Participants felt that existing care pathways did not meet their needs when pain persisted. Participants preferred matched or hybrid care pathways and suggested that implementation of such pathways should focus on addressing an individual's needs. Adopting a holistic approach, and clarity in shared decision-making, were deemed crucial for effective implementation of LBP pathways in practice. Consumer (patient) engagement in the design of LBP care pathways is recommended.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Samantha Lee
- Department of Allied Health, SingHealth Polyclinics, Singapore
| | - Anton Mikhailov
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Healthia Limited, Brisbane, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Stone DB, Rebbeck T, Ward EC, Elliott JE. Features and impact of dysphagia, dysphonia and laryngeal hypersensitivity in whiplash associated disorder - a qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35867954 DOI: 10.1080/09638288.2022.2098395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Investigation into dysphagia, dysphonia and laryngeal hypersensitivity after whiplash is limited, offering minimal insight into specific features and impact. This study aimed to explore these symptoms. MATERIALS AND METHODS A qualitative interpretive description design was used. Eleven participants with chronic Whiplash Associated Disorder and self-reported swallowing, voice and/or throat-related problems completed baseline symptom questionnaires and were offered a videofluroscopic swallow study to investigate baseline swallowing biomechanics. Semi-structured interviews were conducted to explore features of swallowing, voice and laryngeal sensory complaints and analysed using thematic analysis. RESULTS There were high baseline levels of self-reported neck, pain- and throat-related disability and psychological distress. There was no evidence of baseline deficits in swallow biomechanics. Thematic analysis revealed 5 themes: (1) A range of features of dysphagia and dysphonia exist after whiplash with varied clinical course; (2) Activity and participation in swallow and voice activities have changed; (3) There are psychological and emotional impacts; (4) Features of laryngeal hypersensitivity co-exist and (5) There are barriers to management. CONCLUSIONS Swallow, voice and laryngeal sensory problems after whiplash were described, with impacts on quality of life and barriers to management. These insights broaden understanding of post-whiplash sequalae, indicating the need for better detection.Implications for rehabilitationDysphagia, dysphonia and laryngeal hypersensitivity are under-recognised consequences of whiplash.Individuals presenting with dysphagia, dysphonia and laryngeal sensory symptoms after whiplash experience significant implications to wellbeing, activity and participation.Improved understanding of these symptoms may facilitate better detection and subsequent referral to speech-language pathology.Greater understanding into the functional and psychosocial implications of these symptoms may guide more effective post-whiplash assessments and informed rehabilitation.
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Affiliation(s)
- Danielle B Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Speech Pathology Department, Royal North Shore Hospital, St. Leonards, Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, Australia
| | - James E Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Waluya JG, Rahayuwati L, Lukman M. Supportive–educative nursing intervention on knowledge, attitude and physical activity intensity of survivors of breast cancer. Work 2022; 71:1137-1144. [DOI: 10.3233/wor-205165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The high incidence of and death by breast cancer show that breast cancer requires serious treatment. Studies revealed that the physical activity of survivors of breast cancer significantly reduced after a diagnosis of breast cancer. OBJECTIVE: This study aimed to examine the effect of supportive–educative nursing intervention (SENI) on the knowledge, attitudes and behaviour of survivors of breast cancer towards the intensity of physical activity. METHODS: The study population included patients with breast cancer living in a palliative shelter of a referral hospital. Data were obtained from 61 respondents (intervention group, n = 30; control group, n = 31). The study used a pre-test and post-test design with a control group (quasi-experiment with control). RESULTS: SENI showed a significant effect on the knowledge (p = 0.000) and attitude (p = 0.000) of the participants towards physical activity. SENI did not demonstrate a significant effect on increasing the intensity of physical activity (p = 0.413). CONCLUSIONS: Descriptively, the intensity of physical activity showed a tendency to increase in the intervention group, but no significant effect was noted. Palliative shelters in community can hold programmes that may increase the physical activity of survivors.
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Affiliation(s)
| | - Laili Rahayuwati
- Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Mamat Lukman
- Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
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Kang K, Evans K, Simic M, Ferreira P, Bandong AN, Coates S, Beales D, Rebbeck T. Impact of an interactive workshop on specialist physiotherapists' practice when implementing a new clinical care pathway for people with musculoskeletal conditions. Musculoskelet Sci Pract 2022; 57:102466. [PMID: 34742051 DOI: 10.1016/j.msksp.2021.102466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A new pathway of care proposes early comprehensive assessment and targeted management by specialist musculoskeletal clinicians for people with musculoskeletal conditions at risk of poor outcomes. Adoption of this care pathway is likely to be influenced by beliefs and behaviours of specialist musculoskeletal clinicians. OBJECTIVE To evaluate the effect of an interactive educational workshop about the proposed clinical care pathway on knowledge, beliefs and practice of specialist musculoskeletal physiotherapists. DESIGN Mixed methods. METHODS Fifty specialist musculoskeletal physiotherapists participated in a 2-day interactive educational workshop. Knowledge, beliefs and clinical practice behaviours were assessed immediately before the workshop and 3 months' later using surveys. RESULTS Knowledge about key guideline messages improved and were maintained at follow-up. Most participants agreed to provide more targeted interventions to patients at risk of poor outcome (92%, 95% CI: 81%-98%) and utilise prognostic screening tools (84%, 95% CI: 71 to 93). However, only 56% (95% CI: 39%-68%) of participants believed implementing a shared care pathway was easy. At follow-up, participants' beliefs were more aligned with the proposed care pathway (i.e., shared care: 83%, 95% CI: 68%-93%). With respect to clinical practice, there were 16% more referrals back to the primary physiotherapist at 3 months than before the workshop. Barriers (practitioner, patient and system factors) to implementation of the care pathway were discussed. CONCLUSION An interactive educational workshop influenced specialist musculoskeletal physiotherapists' knowledge, beliefs and clinical practice, but barriers need to be overcome to facilitate widespread implementation.
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Affiliation(s)
- Kwangil Kang
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia.
| | - Kerrie Evans
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia; Healthia Limited, Brisbane, Australia
| | - Milena Simic
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia
| | - Paulo Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia
| | - Aila Nica Bandong
- University of the Philippines, College of Allied Medical Professions, Manila, Philippines
| | - Sonia Coates
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia
| | - Darren Beales
- Curtin University, School of Physiotherapy and Exercise Science, Western Australia, Australia
| | - Trudy Rebbeck
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Sydney, Australia
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Nikles J, Keijzers G, Mitchell G, Farrell SF, Perez S, Schug S, Ware RS, McLean SA, Connelly LB, Sterling M. Pregabalin vs placebo to prevent chronic pain after whiplash injury in at-risk individuals: results of a feasibility study for a large randomised controlled trial. Pain 2022; 163:e274-e284. [PMID: 34108431 DOI: 10.1097/j.pain.0000000000002362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT There are few effective treatments for acute whiplash-associated disorders (WADs). Early features of central sensitisation predict poor recovery. The effect of pregabalin on central sensitisation might prevent chronic pain after acute whiplash injury. This double blind, placebo-controlled randomised controlled trial examined feasibility and potential effectiveness of pregabalin compared with placebo for people with acute WAD. Twenty-four participants with acute WAD (<48 hours) and at risk of poor recovery (pain ≥5/10) were recruited from hospital emergency departments in Queensland, Australia, and randomly assigned by concealed allocation to either pregabalin (n = 10) or placebo (n = 14). Pregabalin was commenced at 75 mg bd, titrated to 300 mg bd for 4 weeks, and then weaned over 1 week. Participants were assessed at 5 weeks and 3, 6, and 12 months. Feasibility issues included recruitment difficulties and greater attrition in the placebo group. For the primary clinical outcome of neck pain intensity, attrition at 5 weeks was pregabalin: 10% and placebo: 36% and at 12 months was pregabalin: 10% and placebo: 43%. Pregabalin may be more effective than placebo for the primary clinical outcome of neck pain intensity at 3 months (mean difference: -4.0 [95% confidence interval -6.2 to -1.7]) on an 11-point Numerical Rating Scale. Effects were maintained at 6 months but not 12 months. There were no serious adverse events. Minor adverse events were more common in the pregabalin group. A definitive large randomised controlled trial of pregabalin for acute whiplash injury is warranted. Feasibility issues would need to be addressed with modifications to the protocol.
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Affiliation(s)
- Jane Nikles
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, the University of Queensland, Herston, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Geoffrey Mitchell
- Faculty of Medicine, the University of Queensland, Herston, Australia
| | - Scott F Farrell
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, the University of Queensland, Herston, Australia
| | - Siegfried Perez
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Stephan Schug
- Medical School, the University of Western Australia, Perth, Australia
| | - Robert S Ware
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, United States
| | - Luke B Connelly
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, the University of Queensland, Herston, Australia
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
- Dipartimento di Sociologia e Diritto Dell'Economia, University of Bologna, Bologna, Italy
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, the University of Queensland, Herston, Australia
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Rebbeck T, Evans K, Ferreira P, Beales D, Sterling M, Bennell KL, Cameron I, Nicholas M, Ritchie C, Jull G, Treleaven J, Trevena L, Refshauge K, Connelly L, Foster N, Black D, Hodges P, Ferreira M, Shaw TJ, Simic M. Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial). BMJ Open 2021; 11:e057705. [PMID: 37039086 PMCID: PMC8718479 DOI: 10.1136/bmjopen-2021-057705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Musculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a novel clinical PAthway of CarE programme (PACE programme), where care is provided based on people’s risk of poor outcome. Methods and analysis Multicentre randomised controlled trial. 716 people with MSK conditions (low back pain, neck pain or knee osteoarthritis) will be recruited in primary care. They will be stratified for risk of a poor outcome (low risk/high risk) using the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMSPQ) then randomised to usual care (n=358) or the PACE programme (n=358). Participants at low risk in the PACE programme will receive up to 3 sessions of guideline based care from their primary healthcare professional (HCP) supported by a custom designed website (mypainhub.com). Those at high risk will be referred to an allied health MSK specialist who will conduct a comprehensive patient-centred assessment then liaise with the primary HCP to determine further care. Primary outcome (SF 12-item PCS) and secondary outcomes (eg, pain self-efficacy, psychological health) will be collected at baseline, 3, 6 and 12 months. Cost-effectiveness will be measured as cost per quality-adjusted life-year gained. Health economic analysis will include direct and indirect costs. Analyses will be conducted on an intention-to-treat basis. Primary and secondary outcomes will be analysed independently, using generalised linear models. Qualitative and mixed-methods studies embedded within the trial will evaluate patient experience, health professional practice and interprofessional collaboration. Ethics and dissemination Ethics approval has been received from the following Human Research Ethics Committees: The University of Sydney (2018/926), The University of Queensland (2019000700/2018/926), University of Melbourne (1954239), Curtin University (HRE2019-0263) and Northern Sydney Local Health District (2019/ETH03632). Dissemination of findings will occur via peer-reviewed publications, conference presentations and social media. Trial registration number ACTRN12619000871145.
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Affiliation(s)
- Trudy Rebbeck
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, New South Wales, Australia, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Kerrie Evans
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Healthia Limited, Brisbane, Queensland, Australia
| | - Paulo Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, The University of Queensland, Brisbane, Queensland, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian Cameron
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, The University of Queensland, Brisbane, Queensland, Australia
| | - Gwen Jull
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Julia Treleaven
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Lyndal Trevena
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathryn Refshauge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Luke Connelly
- Department of Sociology and Business Law, The University of Queensland, Centre for the Business and Economics of Health, The University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Surgical, Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Deborah Black
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Hodges
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Manuela Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia
| | - Tim J Shaw
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Milena Simic
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Sterling M, Rebbeck T, Connelly LB, Leaver A, Ritchie C, Bandong A, Mackey M, Cameron ID, Mitchell G, Arora M, Armfield NR. A randomised controlled trial of implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): Statistical analysis plan. Braz J Phys Ther 2021; 25:471-480. [PMID: 34119443 DOI: 10.1016/j.bjpt.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. METHODS We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. DISCUSSION This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial.
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Affiliation(s)
- Michele Sterling
- RECOVER Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Australia.
| | - Trudy Rebbeck
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Luke B Connelly
- Centre for Business and Economics of Health, The University of Queensland, Australia; and Faculty of Economics and Statistics, The University of Bologna, Italy
| | - Andrew Leaver
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Australia
| | - Aila Bandong
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, New South Wales, Australia; College of Allied Medical Professions, The University of the Philippines Manila, Philippines
| | - Martin Mackey
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, New South Wales, Australia; Faculty of Medicine and Health, Sydney Medical School - Northern, The University of Sydney, New South Wales, Australia
| | - Geoffrey Mitchell
- Discipline of General Practice, School of Medicine, University of Queensland, Queensland, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, New South Wales, Australia; Faculty of Medicine and Health, Sydney Medical School - Northern, The University of Sydney, New South Wales, Australia
| | - Nigel R Armfield
- RECOVER Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Australia
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Sterling M, Ritchie C, Rebbeck T, Cameron ID, Griffin A, Jagnoor J, Nicholas M, Nguyen H, Warren J. Comparison of the Accuracy of WhipPredict to That of a Modified Version of the Short-Form Örebro Musculoskeletal Pain Screening Questionnaire to Predict Poor Recovery After Whiplash Injury. J Orthop Sports Phys Ther 2021; 51:207-15. [PMID: 33607916 DOI: 10.2519/jospt.2021.9987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the accuracy of a whiplash-specific risk screening tool (WhipPredict) with that of the modified generic short-form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPSQ) for predicting poor recovery in patients following whiplash injury. STUDY DESIGN Inception cohort study. METHODS Two hundred two participants with acute whiplash completed the WhipPredict and modified SF-ÖMPSQ at baseline. Poor recovery was measured at 6 and 12 months using the Neck Disability Index (greater than 10%), numeric pain-rating scale (greater than 3/10), global perceived recovery (less than +4), and inability to return to preinjury work level. Accuracy statistics were calculated to predict poor recovery. RESULTS Seventy-one percent (n = 143) of participants completed the 6-month assessment and 56% (n = 113) completed the 12-month assessment. At baseline, agreement between the WhipPredict and modified SF-ÖMPSQ was fair (prevalence-adjusted and bias-adjusted κ = 0.26; 95% confidence interval: 0.12, 0.39). Depending on the outcome, 20% to 72% of people had not recovered at 6 months and 12% to 71% had not recovered at 12 months. At 6 and 12 months, the WhipPredict tool showed high sensitivity (88%-96%) and low specificity (all outcomes less than 31%) on all 4 separate outcomes. The modified SF-ÖMPSQ showed moderate sensitivity (67%-75%) for the Neck Disability Index, numeric pain-rating scale, and global perceived recovery, high sensitivity for return to work (81%-90%), and moderate specificity (54%-77%) for all 4 outcomes. CONCLUSION Both tools showed acceptable accuracy in predicting poor recovery. The WhipPredict tool is recommended to correctly identify patients who will not recover but may falsely classify those who recover well. Using the modified SF-ÖMPSQ will result in fewer patients falsely categorized as being at risk of poor recovery and may result in some people being undertreated. J Orthop Sports Phys Ther 2021;51(5):207-215. Epub 19 Feb 2021. doi:10.2519/jospt.2021.9987.
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Beales D, Mitchell T, Moloney N, Rabey M, Ng W, Rebbeck T. Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal clinicians. Musculoskelet Sci Pract 2021; 51:102221. [PMID: 32972875 DOI: 10.1016/j.msksp.2020.102221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Research on musculoskeletal disorders indicates that pain sensitivity can be an important consideration for musculoskeletal clinicians in the holistic view of a patient presentation. However, diversity in research findings in this field can make this a difficult concept for clinicians to navigate. Limited integration of the concept of pain sensitivity into clinical practice for musculoskeletal clinicians has been noted. PURPOSE The purpose of this masterclass is to provide a framework for the consideration of pain sensitivity as a contributing factor in the presentation of people with musculoskeletal pain. It provides pragmatic synthesis of the literature related to pain sensitivity through a lens of how this information can inform clinical practice for musculoskeletal clinicians. Guidance is provided in a 'how to' format for integration of this knowledge into the clinical encounter to facilitate personalised care. IMPLICATIONS The relationship of pain sensitivity with pain and disability is not clear or linear. The real importance of pain sensitivity in a clinical presentation may be: (1) the potential for pain sensitivity to modify the effect of common treatments utilised by musculoskeletal clinicians, or (2) the effect of pain sensitivity on the prognosis/course of a disorder. Screening tools and subjective features have been highlighted to indicate when physical assessment of pain sensitivity should be prioritised in the physical examination. A pragmatic blueprint for specific assessment related to pain sensitivity has been outlined. A framework for integrating assessment findings into clinical reasoning to formulate management plans for the pain sensitive patient is provided.
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Nguyen H, Rebbeck T, Kifley A, Jagnoor J, Dinh M, Shetty A, Nicholas M, Cameron ID. Positive recovery for low-risk injuries screened by the short form - Örebro musculoskeletal pain screening questionnaire following road traffic injury: evidence from an inception cohort study in New South Wales, Australia. BMC Musculoskelet Disord 2019; 20:531. [PMID: 31722704 DOI: 10.1186/s12891-019-2881-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk of poor recovery for people with musculoskeletal injuries after road traffic crash is not available. This study aimed to examine differences in recovery, return to work and health related quality of life between low and high-risk of poor recovery people with musculoskeletal injuries stratified by the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (SF-OMPSQ). Methods In an inception cohort study, participants with non-fracture musculoskeletal injury with the main site being the neck, lower back or lower limb were stratified into low (score ≤ 50) and high (score > 50) risk of poor recovery using the SF-OMPSQ score at baseline. We assessed the proportion of fully recovered participants (Global Perceived Effect scale ≥4), the proportion returning to work and changes in short form 12-item (SF-12) scores between baseline and 6-month follow-up in low and high-risk groups. Modified Poisson regression was used to estimate the adjusted risk ratio (RR) of being recovered and return to work in the low and high-risk groups. Paired t-test was used to compare changes in SF-12 physical and mental component summary scales, and chi-square test was used to assess the significance of the risk ratio of fully recovered between low and high-risk groups. Results The study included 498 participants (166 with neck, 78 with lower back and 254 with lower limb injuries). The proportion of being recovered was significantly higher in the low than the high-risk groups (Adjusted risk ratio: 2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low-risk group returned to work (91.0%) than the high-risk group (54.6%). People at low-risk had higher SF-12 scores at baseline and 6-month follow-up than those at high-risk. There were no differences between injury types for recovery and return to work at 6 months. Conclusion The SF-OMPSQ could be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after road traffic injury, who would have a higher or lower likelihood of recovering or returning fully to pre-injury work. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Registered 09 August 2013.
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14
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Griffin A, Jagnoor J, Arora M, Cameron ID, Kifley A, Sterling M, Kenardy J, Rebbeck T. Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study. BMC Health Serv Res 2019; 19:806. [PMID: 31694622 PMCID: PMC6836463 DOI: 10.1186/s12913-019-4623-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/10/2019] [Indexed: 01/09/2023] Open
Abstract
Background Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury. Methods Participants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ≤4/50 and global perceived effect of ≥4/5. Results Two-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18–1.62). EBC was not significantly associated with recovery. Conclusions Guideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.
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Affiliation(s)
- Alexandra Griffin
- Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW, Australia. .,John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia.
| | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia.,The George Institute for Global Health, The University of Sydney, Level 5, 1 King St, Newtown, NSW, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia
| | - Michele Sterling
- NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland, Brisbane, QLD, Australia.,Recover Injury Research Centre, The University of Queensland, Level 7, UQ Oral Health Centre, Herston, QLD, Australia
| | - Justin Kenardy
- Recover Injury Research Centre, The University of Queensland, Level 7, UQ Oral Health Centre, Herston, QLD, Australia
| | - Trudy Rebbeck
- Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW, Australia.,John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia
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Rebbeck T, Evans K, Elliott JM. Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management. J Orthop Sports Phys Ther 2019; 49:819-28. [PMID: 31610758 DOI: 10.2519/jospt.2019.8946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, raising suspicion of coexisting postconcussion syndrome. All cases were referred for specialist physical therapy. Characteristics consistent with poor recovery in both whiplash and postconcussion syndrome were confirmed, and multidisciplinary management, drawing from both whiplash and concussion guidelines, was implemented. All patients reported improvement in activities of daily living after tailored management addressing both neck and head injury-related factors, suggesting that these conditions were not mutually exclusive. Self-reported outcomes included reductions in neck disability and postconcussion symptoms of between 20% and 40%. It may be appropriate for whiplash and concussion guidelines to be amalgamated, enhanced, and mutually recognized on a patient-by-patient basis. Primary health care professionals might consider minimum screening to identify postconcussion syndrome in patients following motor vehicle collision by administering questionnaires and assessing cranial nerve function, balance, and cognition. Management should then incorporate principles from both whiplash and concussion guidelines and harmonize with available imaging guidelines for suspected spine and head trauma. J Orthop Sports Phys Ther 2019;49(11):819-828. doi:10.2519/jospt.2019.8946.
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Bandong AN, Mackey M, Leaver A, Ingram R, Sterling M, Ritchie C, Kelly J, Rebbeck T. An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation. JMIR Form Res 2019; 3:e12216. [PMID: 31452515 PMCID: PMC6732967 DOI: 10.2196/12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.
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Affiliation(s)
- Aila Nica Bandong
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Physical Therapy, College of Allied Medical Professions, The University of the Philippines, Manila, Philippines
| | - Martin Mackey
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Andrew Leaver
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Rodney Ingram
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Carrie Ritchie
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Joan Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Trudy Rebbeck
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Kolling Institute, John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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Sterling M, de Zoete RMJ, Coppieters I, Farrell SF. Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain. J Clin Med 2019; 8:E1219. [PMID: 31443149 DOI: 10.3390/jcm8081219] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Abstract
Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other relevant studies for the effects of rehabilitation approaches for chronic neck pain. Rehabilitation was defined as the aim to restore a person to health or normal life through training and therapy and as such, passive interventions applied in isolation were not considered. The results of this review found that the strongest treatment effects to date are those associated with exercise. Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term. The evidence was of moderate quality at best, indicating that future research will likely change these conclusions. Lower quality evidence and smaller effects were found for other exercise approaches. Other treatments, including education/advice and psychological treatment, showed only very small to small effects, based on low to moderate quality evidence. The review also provided suggestions for promising future directions for clinical practice and research.
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Kelly J, Ritchie C, Sterling M. Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury. Musculoskelet Sci Pract 2019; 39:73-79. [PMID: 30522090 DOI: 10.1016/j.msksp.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/06/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND A prognostic clinical prediction rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The clinical utility of this tool is unknown. OBJECTIVES To investigate: 1) the level of agreement between physiotherapist- and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification. DESIGN Pragmatic, observational. METHOD 38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n = 24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups. RESULTS Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n = 11/38), which was less than what is expected by chance (K = -0.03; 95%CI -0.17 to 0.12). Physiotherapists most frequently considered range of movement (n = 23/38, 61%), a premorbid pain condition (n = 14/38, 37%), response to initial physiotherapy treatment (n = 12/38, 32%), and pain intensity (n = 12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ2(2) = 2.69, p = 0.26). CONCLUSIONS Physiotherapists should consider incorporating the whiplash CPR into current assessment processes to enhance accuracy in prognostic decision-making.
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Affiliation(s)
- Joan Kelly
- Menzies Health Institute Queensland, Griffith University, G05, 3.20E Parklands Drive, Southport, 4222, Australia.
| | - Carrie Ritchie
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Level 7 Oral Health Centre, 288 Herston Road, Herston, Queensland, 4006, Australia.
| | - Michele Sterling
- Menzies Health Institute Queensland, Griffith University, G05, 3.20E Parklands Drive, Southport, 4222, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Level 7 Oral Health Centre, 288 Herston Road, Herston, Queensland, 4006, Australia.
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Shabaninejad H, Alidoost S, Delgoshaei B. Identifying and classifying indicators affected by performing clinical pathways in hospitals: a scoping review. INT J EVID-BASED HEA 2018; 16:3-24. [PMID: 29176429 DOI: 10.1097/XEB.0000000000000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. METHODS We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. RESULTS Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. CONCLUSION Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. WHAT IS KNOWN ABOUT THE TOPIC?: WHAT DOES THIS ARTICLE ADD?
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Bandong AN, Leaver A, Mackey M, Sterling M, Kelly J, Ritchie C, Rebbeck T. Referral to specialist physiotherapists in the management of whiplash associated disorders: Perspectives of healthcare practitioners. Musculoskelet Sci Pract 2018; 34:14-26. [PMID: 29220703 DOI: 10.1016/j.msksp.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/11/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. specialist physiotherapists) of people who are not recovering. This recommendation is a key component of a proposed clinical pathway of care for WAD. OBJECTIVE To explore healthcare practitioners' opinions about referral to specialist physiotherapists of people with WAD at high risk of non-recovery. DESIGN Qualitative descriptive study. METHODS Six focus groups were conducted among primary care allied-health practitioners (n = 16) and specialist physiotherapists (n = 12) in New South Wales and Queensland, Australia. Discussions were audio recorded and transcribed for thematic analysis. RESULTS Ten themes were generated from analysis. Practitioners appeared to have good knowledge of indicators for referral; however, referrals were often made to the medical practitioner, less commonly to specialist physiotherapists. There was general support for referral to specialist physiotherapists, which was deemed as a viable alternative for people who are not recovering. Practitioners, however, had differing views about the attributes of a specialist physiotherapist and referral timeframe. A number of factors have been identified to influence the referral process and practitioners expressed specific expectations of the desired outcomes of referral as well as considerations for specialist management approaches. There was strong support for a collaborative approach in management that involved the referring practitioner. CONCLUSION Results support the feasibility of referral to specialist physiotherapists despite limited uptake in practice and recognised barriers to referral. These findings have implications for further study and adopting strategies to facilitate effective implementation and translation of the proposed pathway into primary care practice.
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Affiliation(s)
- Aila Nica Bandong
- The University of Sydney, Faculty of Health Sciences, New South Wales, Australia; University of the Philippines, College of Allied Medical Professions, Manila, Philippines.
| | - Andrew Leaver
- The University of Sydney, Faculty of Health Sciences, New South Wales, Australia
| | - Martin Mackey
- The University of Sydney, Faculty of Health Sciences, New South Wales, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Joan Kelly
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Carrie Ritchie
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Trudy Rebbeck
- The University of Sydney, Faculty of Health Sciences, New South Wales, Australia
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Lee JA, Ha IH, Choi TY, Choi J, Jun JH, Kang BK, Lee MS. Evaluating the clinical application of a leaflet for clinical practice guideline in patients with lumbar herniated intervertebral discs: Randomized controlled trial. Medicine (Baltimore) 2017; 96:e9406. [PMID: 29390557 PMCID: PMC5758259 DOI: 10.1097/md.0000000000009406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aims to demonstrate the effectiveness of using clinical practice guideline (CPG) leaflets as a communication tool between doctors and patients. We evaluated the leaflets as a communication tool in the treatment of lumbar herniated intervertebral discs (HIVDs) in terms of patient and physician satisfaction and ease of treatment. METHODS This study is a 2-parallel-arm, assessor-blinded, randomized controlled trial at Jaseng Hospital, Seoul, South Korea. We evaluated efficacy through a comparison of satisfaction and clinical outcomes in randomly allocated groups of HIVD lumbar patients visiting Jaseng Hospital of Korean Medicine. We used leaflets on the basis of Korean medicine CPG recommendations as an intervention. The intervention group received treatment and diagnosis using the leaflet, and the control group received the typical intervention, which was provided without the leaflet. RESULTS The levels of patient satisfaction with and understanding of the doctors' explanation was 92% in the leaflet group and 64% in the nonleaflet group, which showed that, compared with patient satisfaction in the nonleaflet group, patient satisfaction was considerably higher by 28% in the leaflet group. In addition, the level of the reliability with treatment was 92% in the leaflet group and 64% in the control group. However, there were no significant differences in statistical analyses. The level of doctors' satisfaction with communicating with patients using the leaflet was 100% in the leaflet group. Given this satisfaction, the ease of persuasion of treatment was highest (84%) and followed the improvement in the patient's understanding of the treatment (16%) in the leaflet group. In addition, in the nonleaflet user group, almost all doctors thought that having a leaflet would be a more effective treatment. CONCLUSION Although this study failed to show significant differences between the intervention and control groups, the leaflet, which included CPG information in the treatment of HIVD patients, was an effective communication tool between patients and doctors. However, further studies with larger samples should be conducted to investigate the effectiveness of the communication tool based on the CPG. TRIAL REGISTRATION NUMBER Clinical Research Information Service: KCT0001762.
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Affiliation(s)
- Ju Ah Lee
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon
- Department of Korean Internal Medicine, College of Korean Medicine, Gachon University, South Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Tae-Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Jiae Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Ji Hee Jun
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Byoung-Kab Kang
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
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Kelly J, Sterling M, Rebbeck T, Bandong AN, Leaver A, Mackey M, Ritchie C. Health practitioners' perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia. BMJ Open 2017; 7:e015916. [PMID: 28801412 PMCID: PMC5629683 DOI: 10.1136/bmjopen-2017-015916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate health practitioners' understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR. DESIGN Qualitative study using six semistructured focus groups. SETTING Primary and secondary care in New South Wales and Queensland, Australia. PARTICIPANTS Physiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders. METHODS Focus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. RESULTS Health practitioners' understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability ('whether I agree with it') and implementation ('how I'll use it') when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients. CONCLUSIONS Education on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR.
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Affiliation(s)
- Joan Kelly
- Recover Injury Research Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Gold Coast, Australia
| | - Michele Sterling
- Recover Injury Research Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Gold Coast, Australia
| | - Trudy Rebbeck
- NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Gold Coast, Australia
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Aila Nica Bandong
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
- College of Allied Medical Professions, University of the Philippines, Manila, Philippines
| | - Andrew Leaver
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Martin Mackey
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Carrie Ritchie
- Recover Injury Research Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Gold Coast, Australia
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Abstract
Synopsis The majority of people with whiplash-associated disorder do not have neurological deficit or fracture and are therefore largely managed with nonsurgical interventions such as exercise, patient education, and behavioral-based interventions. To date, clinical guidelines, systematic reviews, and the results of high-quality randomized controlled trials recommend exercise and patient education as the primary interventions for people in both acute and chronic stages after injury. However, the relatively weak evidence and small effect sizes in individual trials have led authors of some systematic reviews to reach equivocal recommendations for either exercise or patient education, and led policy makers and funders to question whether the more expensive intervention (exercise) should be funded at all. Physical therapists, one of the most commonly consulted professionals treating individuals with whiplash-associated disorder, need to look beyond the evidence for insights as to what role patient education and exercise should play in the future management of whiplash. This clinical commentary therefore will review the evidence for exercise, patient education, and behavioral-based interventions for whiplash and provide clinical insight as to the future role that exercise and patient education should play in the management of this complex condition. Possible subgroups of patients who may best respond to exercise will be explored using stratification based on impairments, treatment response, and risk/prognostic factors. J Orthop Sports Phys Ther 2017;47(7):481-491. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7138.
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Elbers NA, Chase R, Craig A, Guy L, Harris IA, Middleton JW, Nicholas MK, Rebbeck T, Walsh J, Willcock S, Lockwood K, Cameron ID. Health care professionals' attitudes towards evidence-based medicine in the workers' compensation setting: a cohort study. BMC Med Inform Decis Mak 2017; 17:64. [PMID: 28532470 PMCID: PMC5440905 DOI: 10.1186/s12911-017-0460-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers' compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers' compensation setting. METHODS The study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers' compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators' clinical networks and the workers' compensation government regulator's website. RESULTS Participants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers' compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management. CONCLUSIONS Overall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers' compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers' compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.
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Affiliation(s)
- Nieke A. Elbers
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Robin Chase
- Tyrrell Consulting, Adelaide, South Australia Australia
| | - Ashley Craig
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Lyn Guy
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Ian A. Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - James W. Middleton
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Michael K. Nicholas
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Trudy Rebbeck
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - John Walsh
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Simon Willcock
- Macquarie University Hospital and Health Sciences Centre, Sydney, Australia
| | - Keri Lockwood
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
| | - Ian D Cameron
- Sydney Medical School Northern, University of Sydney; Northern Sydney Local Health District, St Leonards, Australia
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