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Stevenson K, Hadley-Barrows T, Evans N, Campbell L, Southam J, Chudyk A, Ellington D, Jeeves B, Jenson C, Kleberg S, Birkinshaw H, Mair F, Dziedzic K, Peat G, Jordan KP, Yu D, Bailey J, Braybooke A, Mallen CD, Hill JC. The SelfSTarT intervention for low back pain patients presenting to first contact physiotherapists: A mixed methods service evaluation. Musculoskeletal Care 2024; 22:e1876. [PMID: 38511963 DOI: 10.1002/msc.1876] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Globally, back pain is the leading cause of years of disability. In the United Kingdom, over 20 million people live with musculoskeletal (MSK) pain, with low back pain being one of the most common causes. National strategies promote self-management and the use of digital technologies to empower populations. AIMS To evaluate the uptake and impact of providing the SelfSTart approach (STarT Back and SelfBACK App) when delivered by a First Contact Physiotherapist (FCP) to people presenting with low back pain in primary care. METHODS Patients presenting with a new episode of low back pain underwent routine assessment and completion of a STarT Back questionnaire. Patients with low/medium scores were offered the SelfBACK App. A control population was provided by the MIDAS-GP study. Patient Experience, outcome measures, healthcare utilisation and retention were captured through the app and clinical systems (EMIS). Interviews with five FCPs explored the experiences of using the SelfSTart approach. RESULTS SelfSTarT was taken up by almost half (48%) of those to whom it was offered. Compared to MIDAS-GP, users were more likely to be younger, male, in work, and with higher health literacy. SelfSTarT users reported significant improved experiences relating to receiving an agreed care plan and receiving sufficient information. There were no significant differences in treatments offered. FCPs were positive about the app and felt it had value but wanted feedback on patient progress. They recognised that a digital solution would not be suitable for all. CONCLUSION This approach offers an opportunity to empower and support self-management, using robustly evaluated digital technology.
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Affiliation(s)
- K Stevenson
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
- Midlands Partnership University Foundation NHS Trust, Haywood Hospital, Keele, Staffordshire, UK
| | - T Hadley-Barrows
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Evans
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - L Campbell
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - J Southam
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - A Chudyk
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - D Ellington
- Midlands Partnership University Foundation NHS Trust, Haywood Hospital, Keele, Staffordshire, UK
| | - B Jeeves
- Midlands Partnership University Foundation NHS Trust, Haywood Hospital, Keele, Staffordshire, UK
| | - C Jenson
- SelfBack Company, Odense, Denmark
| | | | - H Birkinshaw
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - F Mair
- Glasgow University, Glasgow, UK
| | - K Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - G Peat
- Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK
| | - K P Jordan
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - D Yu
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - J Bailey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - A Braybooke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - C D Mallen
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - Jonathan C Hill
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
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Curran E, Palmer VJ, Ellis KA, Chong TWH, Rego T, Cox KL, Anstey KJ, Westphal A, Moorhead R, Southam J, Lai R, You E, Lautenschlager NT. Physical Activity for Cognitive Health: A Model for Intervention Design for People Experiencing Cognitive Concerns and Symptoms of Depression or Anxiety. J Alzheimers Dis 2023:JAD221216. [PMID: 37334591 PMCID: PMC10357152 DOI: 10.3233/jad-221216] [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: 06/20/2023]
Abstract
BACKGROUND People experiencing cognitive concerns and symptoms of depression or anxiety are at risk for Alzheimer's disease and dementia. We know physical activity can benefit cognition but understanding how to best support engagement is an ongoing challenge. Evidence-based conceptual models of factors underpinning physical activity engagement in target populations can inform intervention tailoring to address this challenge. OBJECTIVE This study (part of a pragmatic physical activity implementation trial) aimed to develop a specified model of physical activity engagement in people experiencing depressive or anxiety symptoms and cognitive concerns, to enable optimized dementia risk reduction intervention tailoring. METHODS We employed a qualitative design, triangulating data from three sources: semi-structured individual interviews with people experiencing cognitive concerns and mild to moderate depressive or anxiety symptoms; review of published evidence; and the Capability, Opportunity and Motivation system of behavior, an existing behavioral science model. Findings were integrated to develop a contextualized model of mechanisms of action for optimizing engagement. RESULTS Twenty-one participants were interviewed, and 24 relevant papers included. Convergent and complementary themes extended understanding of intervention needs. Findings highlighted emotional regulation, capacities to enact intentions despite barriers, and confidence in existing skills as areas of population-specific need that have not previously been emphasized. The final model provides specificity, directionality, and linked approaches for intervention tailoring. CONCLUSION This study demonstrated that people experiencing cognitive concerns and symptoms of depression or anxiety require different interventions to improve physical activity engagement. The novel model can enable more precise intervention tailoring, and, ultimately, benefits for a key at-risk population.
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Affiliation(s)
- Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Victoria J Palmer
- ALIVE National Centre for Mental Health Research Translation, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
- Primary Care Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
- St Vincent's Hospital Melbourne, St George's Campus, Melbourne, Australia
| | - Thomas Rego
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Kay L Cox
- Medical School, The University of Western Australia, Perth, Australia
| | - Kaarin J Anstey
- University of New South Wales Ageing Futures Institute, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Alissa Westphal
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Moorhead
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rhoda Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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Chong TWH, Curran E, Southam J, Cox KL, Bryant C, Goh AMY, You E, Ellis KA, Lautenschlager NT. Factors Influencing Long-Term Physical Activity Maintenance: A Qualitative Evaluation of a Physical Activity Program for Inactive Older Adults at Risk of Cognitive Decline: The INDIGO Follow-Up Study. J Alzheimers Dis 2022; 89:1025-1037. [PMID: 35964180 DOI: 10.3233/jad-220202] [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: 11/15/2022]
Abstract
BACKGROUND Physical inactivity is a modifiable risk factor for dementia, but there remains a research translation gap in effective physical activity (PA) implementation, particularly in the longer-term. The INDIGO trial investigated the effectiveness of a six-month PA intervention for inactive older adults at risk of cognitive decline with subjective cognitive decline or mild cognitive impairment. OBJECTIVE This follow-up study aimed to collect feedback from INDIGO participants about their experience of involvement in the trial, including barriers and enablers to longer-term maintenance of PA. METHODS A qualitative study using semi-structured individual interviews was conducted and transcripts analyzed thematically. All INDIGO trial completers were invited, with 29 participating (follow-up period 27-66 months post-baseline). RESULTS At long-term follow-up, participants described INDIGO trial participation as beneficial. The theme of "Motivation" (subthemes: structure and accountability, knowledge and expected benefits, preferences and motivation, tools) followed by "Situation" (subthemes: environment and time, social aspects, aging and physical health) appeared to be critical to PA "Action". Most participants had a positive view of goal-setting and peer mentoring/support, but there was some polarization of opinion. Key factors to longer-term "Maintenance" of PA were self-efficacy and perceived benefits, habit formation, and for some participants, enjoyment. CONCLUSION PA interventions for older adults at risk of cognitive decline should include behavior change techniques tailored to the individual. Effective techniques should focus on "Motivation" (particularly structure and accountability) and "Situation" factors relevant to individuals with the aim of developing self-efficacy, habit formation, and enjoyment to increase the likelihood of longer-term PA maintenance.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Kay L Cox
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Anita M Y Goh
- National Ageing Research Institute, Parkville, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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Cox KL, Clare L, Cyarto EV, Ellis KA, Etherton-Beer C, Southam J, Ames D, Flicker L, Almeida OP, LoGiudice D, Liew D, Vlaskovsky P, Lautenschlager NT. A Randomized Controlled Trial on the Effects of a 6-Month Home-Based Physical Activity Program with Individual Goal-Setting and Volunteer Mentors on Physical Activity, Adherence, and Physical Fitness in Inactive Older Adults at Risk of Cognitive Decline: The INDIGO Study. J Alzheimers Dis 2021; 84:207-226. [PMID: 34511499 DOI: 10.3233/jad-210479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
BACKGROUND Increasing physical activity (PA) in those who have memory concerns requires innovative approaches. OBJECTIVE To compare in this randomized controlled trial (RCT) the effects on PA, adherence, and fitness of two approaches to deliver a 6-month home-based PA program in older, inactive individuals at risk of cognitive decline. METHODS Individuals (n = 52) aged 60-85 years, inactive with mild cognitive impairment or subjective cognitive decline were recruited from the community and memory clinics. Randomization was to 6 months of 150 min/week moderate intensity PA with either: goal-setting with mentor support; or education and peer contact. A subset of participants (n = 36) continued for a further 6 months. PA, moderate and vigorous PA, and secondary outcomes, fitness, goal performance/satisfaction and self-efficacy were assessed at baseline, 6 and 12 months. Modelling of primary and secondary outcomes was conducted with linear mixed models. RESULTS Participants were mean age (±sd) 70.1 (6.4) years. Six-month retention was 88.5%(n = 46). No significant between-group differences were observed for PA or fitness. Post-hoc combined group data showed a significant, moderate-large effect size increase in PA with time. PA increased by a mean 1,662 (943, 2383) steps/day (95%CI) and 1,320 (603, 2037) steps/day at 6 and 12 months (p < 0.001). Median (quartiles Q1-Q3) 6 and 6-12 month combined group adherence was 88.9 (74.4-95.7)%and 84.6 (73.9-95.4)%respectively. CONCLUSION In this target group, no differences were detected between groups both intervention strategies were highly effective in increasing PA and fitness.
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Affiliation(s)
- Kay L Cox
- Medical School, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University ofExeter, UK
| | - Elizabeth V Cyarto
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Bolton Clarke Research Institute, Brisbane, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Qld, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Christopher Etherton-Beer
- Medical School, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,St George's Hospital, Kew, Victoria, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Dina LoGiudice
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Philip Vlaskovsky
- Royal Perth Hospital Research Foundation Biostatistical Unit, Perth, Australia
| | - Nicola T Lautenschlager
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia.,Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,North Western Mental Health, Royal Melbourne Hospital, Melbourne, Australia
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Chong TW, Curran E, Ellis KA, Southam J, You E, Cox KL, Hill KD, Pond D, Dow B, Anstey KJ, Hosking D, Cyarto E, Lautenschlager NT. Physical activity for older Australians with mild cognitive impairment or subjective cognitive decline – A narrative review to support guideline development. J Sci Med Sport 2020; 23:913-920. [DOI: 10.1016/j.jsams.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/12/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
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