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Darlow B, Gray B. Censorship or inclusion? Proc Natl Acad Sci U S A 2024; 121:e2321261121. [PMID: 38739792 DOI: 10.1073/pnas.2321261121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6021, New Zealand
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6021, New Zealand
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Djurtoft C, Bruun MK, Riel H, Hoegh MS, Darlow B, Rathleff MS. How do we explain painful non-traumatic knee conditions to adolescents? A multiple-method study to develop credible explanations. Eur J Pain 2024; 28:659-672. [PMID: 37987218 DOI: 10.1002/ejp.2210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand "what's wrong with me". Our aim is to develop credible explanations about the condition for adolescents suffering from non-traumatic knee pain. METHODS This multiple-method study integrated findings from two systematic literature searches of qualitative and quantitative studies, an Argumentative Delphi with international experts (n = 16) and think-aloud interviews with adolescents (n = 16). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents' needs; we analysed feedback using thematic analysis. The explanations were tailored based on the adolescent end-users' input. RESULTS We screened 3239 titles/abstracts and included 16 papers exploring diagnostic uncertainty from adolescents' and parents' perspectives. Five themes were generated: (1) understanding causes and contributors to the pain experience, (2) feeling stigmatized for having an invisible condition, (3) having a name for pain, (4) controllability of pain, and (5) worried about something being missed. The Argumentative Delphi identified the following themes: (1) multidimensional perspective, (2) tailored to adolescents, (3) validation and reassurance, and (4) careful wording. Merging findings from the systematic search and the Delphi developed three essential domains to address in credible explanations: "What is non-traumatic knee pain and what does it mean?", "What is causing my knee pain?" and "How do I manage my knee pain?" CONCLUSIONS Six credible explanations for the six most common diagnoses of non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain. SIGNIFICANCE This study provides credible explanations for the six most common diagnoses of non-traumatic knee pain. Additionally, we identified three key domains that may need to be addressed to reduce diagnostic uncertainty in adolescents suffering from pain complaints. Based on our findings, we believe that clinicians will benefit from exploring adolescents' own perceptions of why they experience pain and perceived management strategies, as this information might capture important clinical information when managing these young individuals.
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Affiliation(s)
- C Djurtoft
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - M K Bruun
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - H Riel
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - M S Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - B Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Liew BXW, Darlow B. Exploring the complexity of commonly held attitudes and beliefs of low back pain-a network analysis. Front Med (Lausanne) 2024; 11:1327791. [PMID: 38327704 PMCID: PMC10847361 DOI: 10.3389/fmed.2024.1327791] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives The current study used a network analysis approach to explore the complexity of attitudes and beliefs held in people with and without low back pain (LBP). The study aimed to (1) quantify the adjusted associations between individual items of the Back Pain Attitudes Questionnaire (Back-PAQ), and (2) identify the items with the strongest connectivity within the network. Methods This is a secondary data analysis of a previously published survey using the Back-PAQ (n = 602). A nonparametric Spearman's rank correlation matrix was used as input to the network analysis. We estimated an unregularised graphical Gaussian model (GGM). Edges were added or removed in a stepwise manner until the extended Bayesian information criterion (EBIC) did not improve. We assessed three measures of centrality measures of betweenness, closeness, and strength. Results The two pairwise associations with the greatest magnitude of correlation were between Q30-Q31 [0.54 (95% CI 0.44 to 0.60)] and Q15-Q16 [0.52 (95% CI 0.43 to 0.61)]. These two relationships related to the association between items exploring the influence of attentional focus and expectations (Q30-Q31), and feelings and stress (Q15-Q16). The three items with the greatest average centrality values, were Q22, Q25, and Q10. These items reflect beliefs about damaging the back, exercise, and activity avoidance, respectively. Conclusion Beliefs about back damage, exercise, and activity avoidance are factors most connected to all other beliefs within the network. These three factors may represent candidate targets that clinicians can focus their counseling efforts on to manage unhelpful attitudes and beliefs in people experiencing LBP.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
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Darlow B, Brown M, Stanley J, Abbott JH, Briggs AM, Clark J, Frew G, Grainger R, Hood F, Hudson B, Keenan R, Marra C, McKinlay E, Pask A, Pierobon A, Simmonds S, Vincent L, Wilson R, Dean S. Reducing the burden of knee osteoarthritis through community pharmacy: Protocol for a randomised controlled trial of the Knee Care for Arthritis through Pharmacy Service. Musculoskeletal Care 2023; 21:1053-1067. [PMID: 37212721 DOI: 10.1002/msc.1785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/02/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Knee osteoarthritis (OA) negatively impacts the health outcomes and equity, social and employment participation, and socio-economic wellbeing of those affected. Little community-based support is offered to people with knee OA in Aotearoa New Zealand. Identifying Māori and non-Māori with knee OA in community pharmacy and providing co-ordinated, evidence- and community-based care may be a scalable, sustainable, equitable, effective and cost-effective approach to improve health and wellbeing. AIM Assess whether the Knee Care for Arthritis through Pharmacy Service (KneeCAPS) intervention improves knee-related physical function and pain (co-primary outcomes). Secondary aims assess impacts on health-related quality of life, employment participation, medication use, secondary health care utilisation, and relative effectiveness for Māori. METHODS AND ANALYSIS A pragmatic randomised controlled trial will compare the KneeCAPS intervention to the Pharmaceutical Society of New Zealand Arthritis Fact Sheet and usual care (active control) at 12 months for Māori and non-Māori who have knee OA. Participants will be recruited in community pharmacies. Knee-related physical function will be measured using the function subscale of the Short Form of the Western Ontario and McMaster Universities Osteoarthritis Index. Knee-related pain will be measured using an 11-point numeric pain rating scale. Primary outcome analyses will be conducted on an intention-to-treat basis using linear mixed models. Parallel within-trial health economic analysis and process evaluation will also be conducted. ETHICS AND TRIAL DISSEMINATION Ethical approval was obtained from the Central Health and Ethics Committee (2022-EXP-11725). The trial is registered with ANZCTR (ACTRN12622000469718). Findings will be submitted for publication and shared with participants.
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Affiliation(s)
- Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Melanie Brown
- University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- University of Otago Wellington, Wellington, New Zealand
| | | | | | - Jane Clark
- Consumer Research Partner, Wellington, New Zealand
| | - Gareth Frew
- Canterbury Community Pharmacy Group, Christchurch, New Zealand
| | | | - Fiona Hood
- University of Otago Wellington, Wellington, New Zealand
| | - Ben Hudson
- University of Otago Christchurch, Christchurch, New Zealand
| | - Rāwiri Keenan
- University of Otago Wellington, Wellington, New Zealand
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Haber T, Hinman RS, Dobson F, Vicenzino B, Darlow B, Kayll S, Hall M. Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross-sectional survey. Musculoskeletal Care 2023; 21:763-775. [PMID: 36864703 PMCID: PMC10947065 DOI: 10.1002/msc.1751] [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: 02/08/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Using a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George. METHODS We conducted a cross-sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open-text responses. RESULTS Two hundred and twenty physiotherapists completed the survey (39% response-rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety-six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (<15%). DISCUSSION About half of the physiotherapists that diagnosed George's hip pain made a diagnosis of hip OA, despite the case vignette including clinical criteria for a diagnosis of OA. Physiotherapists offered exercise and education, but many physiotherapists did not offer other clinically indicated and recommended treatments, such as weight loss and sleep advice.
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Affiliation(s)
- Travis Haber
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Fiona Dobson
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Bill Vicenzino
- School of Health and Rehabilitation SciencesUniversity of QueenslandSaint LuciaAustralia
| | - Ben Darlow
- Department of Primary Health Care and General PracticeUniversity of Otago WellingtonWellingtonNew Zealand
| | - Sam Kayll
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Michelle Hall
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
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Darlow B, Krägeloh C, Abbott JH, Bennell K, Briggs AM, Brown M, Clark J, Dean S, French S, Hinman RS, Lawford BJ, O'Brien D, Whittaker JL, Stanley J. The osteoarthritis knowledge scale. Musculoskeletal Care 2023; 21:516-526. [PMID: 36573463 DOI: 10.1002/msc.1727] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Accurate knowledge is central to effective self-care of osteoarthritis (OA). This study aimed to assess the measurement properties of the Osteoarthritis Knowledge Scale (OAKS) with versions for the hip and knee. METHODS Participants with hip OA (n = 144), knee OA (n = 327), and no OA (n = 735) were recruited. Rasch analysis was conducted to assess psychometric properties using data from all participants with hip OA and 144 randomly selected participants with either knee OA or no OA. Test-retest reliability and measurement error were estimated among those with hip (n = 51) and knee (n = 142) OA. RESULTS Four items from the draft scales were deleted following Rasch analysis. The final 11-item OAKS was unidimensional. Item functioning was not affected by gender, age, educational level, or scale version (hip or knee). Person separation index was 0.75. Test-retest intraclass correlation coefficient was 0.81 (95% CI 0.74, 0.86; hip version 0.66 [0.47, 0.79]; knee version 0.85 (0.79, 0.90)). Smallest detectable change was 9 points (scale range 11-55; hip OA version 11 points; knee OA version 8 points). CONCLUSION The OAKS is a psychometrically adequate, unidimensional measure of important OA knowledge that can be used in populations with and without hip and knee OA. Caution is needed when using with populations with only hip OA as test-retest reliability of the hip version did not surpass the acceptable range.
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Affiliation(s)
- Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Chris Krägeloh
- Auckland University of Technology, Auckland, New Zealand
| | | | - Kim Bennell
- University of Melbourne, Melbourne, Australia
| | | | - Melanie Brown
- University of Otago Wellington, Wellington, New Zealand
| | - Jane Clark
- Consumer Research Partner, Wellington, New Zealand
| | | | | | | | | | - Daniel O'Brien
- Auckland University of Technology, Auckland, New Zealand
| | | | - James Stanley
- University of Otago Wellington, Wellington, New Zealand
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Fourré A, Vanderstraeten R, Ris L, Bastiaens H, Michielsen J, Demoulin C, Darlow B, Roussel N. Management of Low Back Pain: Do Physiotherapists Know the Evidence-Based Guidelines? Int J Environ Res Public Health 2023; 20:ijerph20095611. [PMID: 37174131 PMCID: PMC10178177 DOI: 10.3390/ijerph20095611] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Clinical practice guidelines promote bio-psychosocial management of patients suffering from low back pain (LBP). The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists about a guideline-adherent approach to LBP and to assess the ability of physiotherapists to recognise signs of a specific LBP in a clinical vignette. METHODS Physiotherapists were recruited to participate in an online study. They were asked to indicate whether they were familiar with evidence-based guidelines and then to fill in the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), as well as questions related to two clinical vignettes. RESULTS In total, 527 physiotherapists participated in this study. Only 38% reported being familiar with guidelines for the management of LBP. Sixty-three percent of the physiotherapists gave guideline-inconsistent recommendations regarding work. Only half of the physiotherapists recognised the signs of a specific LBP. CONCLUSIONS The high proportion of physiotherapists unfamiliar with guidelines and demonstrating attitudes and beliefs not in line with evidence-based management of LBP is concerning. It is crucial to develop efficient strategies to enhance knowledge of guidelines among physiotherapists and increase their implementation in clinical practice.
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Affiliation(s)
- Antoine Fourré
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, 7000 Mons, Belgium
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, 2610 Antwerpen, Belgium
| | - Rob Vanderstraeten
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, 2610 Antwerpen, Belgium
| | - Laurence Ris
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, 7000 Mons, Belgium
| | - Hilde Bastiaens
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, 2610 Antwerpen, Belgium
| | - Jozef Michielsen
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, 2610 Antwerpen, Belgium
- Orthopedic Department, University Hospital, 2650 Antwerp, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, 4000 Liège, Belgium
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6021, New Zealand
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, 2610 Antwerpen, Belgium
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Wilson R, Pryymachenko Y, Abbott JH, Dean S, Stanley J, Garrett S, Mathieson F, Dowell A, Darlow B. A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: A Difference-in-Difference-in-Differences Analysis. Appl Health Econ Health Policy 2023; 21:253-262. [PMID: 36471226 PMCID: PMC9734860 DOI: 10.1007/s40258-022-00776-3] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Real-world adherence to clinical practice guidelines is often poor, resulting in sub-standard patient care and unnecessary healthcare costs. This study evaluates the effect of a guideline-implementation intervention for the management of low back pain (LBP) in general practice-the Fear Reduction Exercised Early (FREE) approach-on LBP-related injury insurance claims, healthcare utilisation, and costs of treatment. DESIGN Data were extracted from comprehensive nationwide New Zealand injury insurance claims records. Data were analysed using a 'triple-difference' (difference-in-difference-in-differences) method to isolate the causal effect of FREE training on LBP claims activity, comparing the difference in general practitioner (GP) LBP claims and associated activity before and after training with their non-musculoskeletal injury claims for the same periods (assumed to be unaffected by training), relative to the same comparisons for GPs not trained in the FREE approach. RESULTS Training GPs in the FREE approach resulted in significant reductions in the number of LBP injury claims lodged (- 19%, 95% CI -34 to -5), the use of physiotherapy (-30%, 95% CI - 42 to - 18) and imaging (- 27%, 95% CI - 46 to - 8%), and the healthcare costs (- 21%, 95% CI - 41 to - 1) of LBP injury. Changes in claims for earnings' compensation (- 10%, 95% CI - 34 to 13) were not significant. CONCLUSIONS A brief guideline-implementation intervention following best-practice LBP management and guideline-implementation strategies achieved significant reductions, persisting over at least 6 to18 months, in healthcare utilisation consistent with improved delivery of guideline-concordant care.
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Affiliation(s)
- Ross Wilson
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand.
| | - Yana Pryymachenko
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Sarah Dean
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Darlow B, Brown M, Hudson B, Frew G, Clark J, Vincent L, Grainger R, Marra C, McKinlay E, Abbott JH, Briggs AM. Knee osteoarthritis and the knowledgeable, trustworthy pharmacist: Patient and pharmacist perceptions of community pharmacy-based education and support. Musculoskeletal Care 2023; 21:3-15. [PMID: 35615979 DOI: 10.1002/msc.1660] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Osteoarthritis (OA) clinical guidelines recommend self-management education, but education is often not included in primary care consultations. OBJECTIVE To explore pharmacists' and patients' perceptions of a pharmacist-led model of service delivery for knee OA that was integrated within pharmacies' day-to-day workflow. METHODS Cross-sectional qualitative design using Thematic Analysis. Community pharmacies were recruited in New Zealand and Australia. Pharmacy patients were screened for knee OA and offered tailored explanations, self-management information and referral for further support. Pharmacist focus groups and patient 1:1 interviews explored perceptions of the service delivery model. RESULTS Nineteen pharmacists and 12 patients with knee OA participated. Pharmacist and patient data were analysed separately, with themes compared and contrasted to derive three meta-themes. Meta-theme 1: 'Welcome Engagement' included two pharmacist themes ('putting my broad skill set to use' and 'we're here and happy to help') and two patient themes ('information delivered well' and 'a welcome offer of help'). Meta-theme 2: 'The Knowledgeable and Trustworthy Pharmacist' included two pharmacist themes ('professional knowledge to help all sorts of patients' and 'managing time to help my patients') and one patient theme ('the accessible professional who I know and trust'). Meta-theme 3: 'The Opportunity for More Support' included one pharmacist theme ('this is not the end of the story') and one patient theme ('more help is available'). CONCLUSION Community pharmacists are well-positioned to provide information and support to people with knee OA. Pharmacists appreciate the opportunity to better use their skills and accessibility for OA care, and patients welcome this engagement.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Gareth Frew
- Canterbury Community Pharmacy Group, Christchurch, New Zealand
| | - Jane Clark
- Consumer Research Partner, Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Carlo Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - J Haxby Abbott
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Darlow B, Brown M, McKinlay E, Gray L, Purdie G, Pullon S. Influence of a rural interprofessional education placement on the rural health workforce: working in primary care, rural settings, and with Māori. J Prim Health Care 2023; 15:78-83. [PMID: 37000543 DOI: 10.1071/hc22136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/18/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Pre-registration interprofessional rural immersion programmes provide students with first-hand insight into challenges faced in rural clinical practice and can influence future practice intentions. The impact of short rural and hauora Māori interdisciplinary placements on early healthcare careers is unknown. Aim Explore whether a 5-week rural interprofessional education programme influenced graduates' choices to work in primary care, rurally, and with Māori patients. Methods We conducted a survey-based, non-randomised trial of graduates from eight healthcare disciplines who did (n = 132) and did not (n = 479) attend the Tairāwhiti interprofessional education rural programme with hauora Māori placements. Participants were surveyed at 1-, 2-, and 3-years' post-registration. Self-reported practice location and vocation were analysed with mixed-model logistic regression. Free-text comments were analysed with Template Analysis. Results We did not identify any measurable impact on rural or community workforce participation at 3-years' post-registration. Free-text analysis indicated that a short rural interprofessional immersion placement had long-term self-perceived impacts on desire and skills to work in rural locations, and on desire and ability to work with Māori and embrace Māori models of health. Discussion Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers. Three-years' post-graduation may be too early to determine whether rural placements help to address rural health workforce needs. Reports from rural placement participants of increased ability to care for people from rural backgrounds, even when encountered in a city, suggest that assessment of practice location may not adequately capture the benefits of rural placement programmes.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Gordon Purdie
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
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O'Keeffe M, Michaleff ZA, Harris IA, Buchbinder R, Ferreira GE, Zadro JR, Traeger AC, Thomas R, Belton J, Darlow B, Maher CG. Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis. Eur Spine J 2022; 31:3627-3639. [PMID: 36198841 DOI: 10.1007/s00586-022-07365-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/19/2022] [Accepted: 08/21/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. METHODS In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. RESULTS Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain. CONCLUSION Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia.
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | | | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
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12
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Darlow B, Brown M, McKinlay E, Gray L, Purdie G, Pullon S. Longitudinal impact of preregistration interprofessional education on the attitudes and skills of health professionals during their early careers: a non-randomised trial with 4-year outcomes. BMJ Open 2022; 12:e060066. [PMID: 35858731 PMCID: PMC9305815 DOI: 10.1136/bmjopen-2021-060066] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess whether a preregistration interprofessional education (IPE) programme changed attitudes towards teamwork and team skills during health professionals' final year of training and first 3 years of professional practice. DESIGN Prospective, longitudinal, non-randomised trial. SETTING Final year health professional training at three academic institutions in New Zealand. PARTICIPANTS Students from eight disciplines eligible to attend the IPE programme were recruited (617/730) prior to their final year of training. 130 participants attended the IPE programme; 115 intervention and 372 control participants were included in outcome analysis. INTERVENTION The 5-week Tairāwhiti IPE (TIPE) immersion programme during which students experience clinical placements in interdisciplinary teams, complete collaborative tasks and live together in shared accommodation. MAIN OUTCOME MEASURES Data were collected via five surveys at 12-month intervals, containing Attitudes Towards Healthcare Teams Scale (ATHCTS), Team Skills Scale (TSS) and free-text items. Mixed-model analysis of covariance, adjusting for baseline characteristics, compared scores between groups at each time point. Template analysis identified themes in free-text data. RESULTS Mean ATHCTS scores for TIPE participants were 1.4 (95% CI 0.6 to 2.3) points higher than non-TIPE participants (p=0.002); scores were 1.9 (95% CI 0.8 to 3.0) points higher at graduation and 1.1 (95% CI -0.1 to 2.4) points higher 3 years postgraduation. Mean TSS scores for TIPE participants were 1.7 (95% CI 0.0 to 3.3) points higher than non-TIPE participants (p=0.045); scores were 3.5 points (95% CI 1.5 to 5.5) higher at graduation and 1.3 (95%CI -0.8 to 3.5) points higher 3 years postgraduation. TIPE participants made substantially more free-text comments about benefits of interprofessional collaboration and perceived the TIPE programme had a meaningful influence on their readiness to work in teams and the way in which they performed their healthcare roles. CONCLUSIONS TIPE programme participation significantly improved attitudes towards healthcare teams and these changes were maintained over 4 years.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Gordon Purdie
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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13
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Darlow B, Brown M, Hudson B, Frew G, Clark J, Vincent L, Abbott J, Briggs AM, Grainger R, Marra C, McKinlay E, Stanley J. Feasibility of a randomised controlled trial of two types of written information for people with knee osteoarthritis. Osteoarthritis and Cartilage Open 2022; 4:100254. [DOI: 10.1016/j.ocarto.2022.100254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
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14
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Abbott JH, Keenan R, Billing-Bullen G, Pask A, O'Brien D, Hudson B, Darlow B. Guest Editorial: Most people waiting for osteoarthritis care never get it – it’s time to try a different approach. J Prim Health Care 2022; 14:93-95. [PMID: 35771699 DOI: 10.1071/hc22063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, New Zealand
| | - Rawiri Keenan
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
| | | | - Alison Pask
- Independent Dietitian, Wellington, New Zealand
| | - Daniel O'Brien
- Auckland University of Technology, Auckland, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago Christchurch, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
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15
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O'Keeffe M, Ferreira GE, Harris IA, Darlow B, Buchbinder R, Traeger AC, Zadro JR, Herbert RD, Thomas R, Belton J, Maher CG. Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment. Eur J Pain 2022; 26:1532-1545. [PMID: 35616226 PMCID: PMC9545091 DOI: 10.1002/ejp.1981] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
Background Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities. Methods Six‐arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels: ‘disc bulge’,‘degeneration’,‘arthritis’,‘lumbar sprain’,‘non‐specific LBP’, ‘episode of back pain’. The primary outcome was the belief about the need for imaging. Results A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. The need for imaging was rated lower with the labels ‘episode of back pain’ (4.2 [2.9]), ‘lumbar sprain’ (4.2 [2.9]) and ‘non‐specific LBP’ (4.4 [3.0]) compared to the labels ‘arthritis’ (6.0 [2.9]), ‘degeneration’ (5.7 [3.2]) and ‘disc bulge’ (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to ‘disc bulge’,‘degeneration’ and ‘arthritis’. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. Conclusions ‘Episode of back pain’,‘lumbar sprain’ and ‘non‐specific LBP’ reduced need for imaging, surgery and second opinion compared to ‘arthritis’,‘degeneration’ and ‘disc bulge’ amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care).
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia.,University of New South Wales, Randwick, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Joletta Belton
- Endless Possibilities Initiative, Fraser, Colorado, United States
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Australia
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16
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Tay HA, Özgül B, Darlow B, Sarı Z. Cross-cultural translation, validity, and reliability of the Turkish version of the Back Pain Attitudes Questionnaire. Musculoskelet Sci Pract 2022; 57:102472. [PMID: 34742050 DOI: 10.1016/j.msksp.2021.102472] [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: 06/08/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND As the Back Pain Attitudes Questionnaire (Back-PAQ), a validated instrument, could be performed to evaluate biopsychosocial dimensions of back pain, it has not been translated and adapted for Turkish population. OBJECTIVES It was aimed to translate and cross-culturally adapt the Back-PAQ (versions of 34-item, 20-item, and 10-item) into Turkish language and analyse the validity and reliability of the Back-PAQ-Turkish version (Back-PAQ-Tr). STUDY DESIGN Study of diagnostic accuracy/assessment scale. METHODS The translation and cross-cultural adaptation process were carried out in several steps according to international best-practice guidelines. 173 participants with back pain were recruited. Turkish version of the Tampa Scale of Kinesiophobia (TSK-Tr) and Fear Avoidance Beliefs Questionnaire (FABQ-Tr) were used to investigate the convergent validity. RESULTS Internal consistency of the Back-PAQ-Tr, Back-PAQ-Tr-20, and Back-PAQ-Tr-10 were 0.82, 0.78 and 0.68, respectively. Test-retest reliability was excellent for Back-PAQ-Tr (ICC = 0.95) and Back-PAQ-Tr-20 (ICC = 0.95), but weak for Back-PAQ-Tr-10 (ICC = 0.50). A weak correlation was found between all versions of Back-PAQ-Tr and TSK-Tr & FABQ-Tr, except for the moderate correlation between Back-PAQ-Tr-10 and TSK-Tr (r = -0.51) & the physical activity score of FABQ-Tr (r = -0.51). Back-PAQ-Tr, Back-PAQ-Tr-20, and Back-PAQ-Tr-10 accounted for 66.2%, 60.5%, and 78.2% of the variance in the data set, respectively. CONCLUSION The versions of 34-item and 20-item Back-PAQ-Tr are reliable and valid questionnaire to assess Turkish populations' attitudes and beliefs regarding back pain. Since the reliability of the 10-item version was determined to be quite low, we particularly recommend the use of the versions of Back-PAQ-Tr and Back-PAQ-Tr-20.
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Affiliation(s)
- Hilal Ata Tay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Marmara University, Turkey
| | - Bahar Özgül
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Turkey.
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Zübeyir Sarı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Turkey
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17
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McKinlay E, Banks D, Coleman K, Darlow B, Dungey G, Farr T, Fyfe R, Gray B, Kemp L, Mitchell M, Morris C, Myers J, Neser H, Perry M, Price R, Thompson W, Westenra B, Pullon S. Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic. J Prim Health Care 2021; 13:359-369. [PMID: 34937649 DOI: 10.1071/hc21070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/05/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND CONTEXT Globally, the coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for better interprofessional collaboration and teamwork. When disciplines have worked together to undertake testing, deliver care and administer vaccines, progress against COVID-19 has been made. Yet, teamwork has often not happened, wasting precious resources and stretching health-care workforces. Continuing to train health professionals during the pandemic is challenging, particularly delivering interprofessional education that often uses face-to-face delivery methods to optimise interactional learning. Yet, continuing to offer interprofessional education throughout the pandemic is critical to ensure a collaboration-ready health workforce. One example is continuing the established INVOLVE (Interprofessional Visits to Learn Interprofessional Values through Patient Experience) interprofessional education initiative. ASSESSMENT OF PROBLEM Educators have not always prioritised interprofessional education during the pandemic, despite its immediate and long-term benefits. The INVOLVE interprofessional education initiative, usually delivered face-to-face, was at risk of cancellation. RESULTS A quality improvement analysis of the strategies used to continue INVOLVE demonstrated that it is possible to deliver interprofessional education within the constraints of a pandemic by using innovative online and hybrid educational strategies. Educators and students demonstrated flexibility in responding to the sudden changes in teaching and learning modalities. STRATEGIES When pandemic alert levels change, interprofessional educators and administrators can now choose from a repertoire of teaching approaches. LESSONS Four key lessons have improved the performance and resilience of INVOLVE: hold the vision to continue interprofessional education; be nimble; use technology appropriately; and there will be silver linings and unexpected benefits to the changes.
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Affiliation(s)
- Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand; and Corresponding author.
| | | | | | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Gay Dungey
- Department of Radiation Therapy, University of Otago Wellington, New Zealand
| | - Tracy Farr
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Rebecca Fyfe
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Liz Kemp
- School of Physiotherapy, University of Otago Wellington, New Zealand
| | | | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago Wellington, Box 7343, Wellington, New Zealand
| | - Julia Myers
- Department of Medicine, University of Otago Wellington, New Zealand
| | | | - Meredith Perry
- School of Physiotherapy, University of Otago Wellington, New Zealand
| | - Rowena Price
- Acute Pain Management Service, Capital and Coast District Health Board, New Zealand
| | - Wendy Thompson
- Wellington Regional Hospital, Capital and Coast District Health Board, New Zealand
| | | | - Sue Pullon
- Centre for Interprofessional Education, University of Otago, New Zealand
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18
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Sampath KK, Darlow B, Tumilty S, Shillito W, Hanses M, Devan H, Thomson OP. Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain - a mixed methods systematic review. BMC Health Serv Res 2021; 21:695. [PMID: 34266436 PMCID: PMC8281672 DOI: 10.1186/s12913-021-06720-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.
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Affiliation(s)
- Kesava Kovanur Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology, 51, Akoranga Road, Hamilton, New Zealand.
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand.
- School of Public Health, University of Technology Sydney, Sydney, Australia.
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Warwick Shillito
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Melissa Hanses
- Department of Health Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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19
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Christe G, Nzamba J, Desarzens L, Leuba A, Darlow B, Pichonnaz C. Physiotherapists' attitudes and beliefs about low back pain influence their clinical decisions and advice. Musculoskelet Sci Pract 2021; 53:102382. [PMID: 33915318 DOI: 10.1016/j.msksp.2021.102382] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 10/07/2020] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Physiotherapists' biomedical orientation influences the implementation of evidenced-based care for low back pain (LBP) management. However, information on physiotherapists' own beliefs about their back and LBP and the influence of these on clinical decisions and advice is lacking. OBJECTIVES To identify attitudes and beliefs about LBP among physiotherapists and to analyse the association of these beliefs with physiotherapists' individual characteristics and clinical decisions and advice. DESIGN Cross-sectional survey. METHOD Attitudes and beliefs about LBP were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ) among French-speaking Swiss physiotherapists. Physiotherapists' clinical decisions and advice were assessed with a clinical vignette to determine their association with the Back-PAQ score. RESULTS The study included 288 physiotherapists. The mean Back-PAQ score (82.7; SD 17.2) indicated the presence of helpful beliefs in general, but unhelpful beliefs in relation to back protection and the special nature of LBP (nature of pain, impact, complexity) were frequently identified. Individual characteristics explained 17% of the Back-PAQ score. Unhelpful beliefs were associated with clinical decisions toward back protection and movement avoidance (r = - 0.47, p < 0.001). CONCLUSIONS While helpful beliefs and guidelines consistent decisions were generally identified, unhelpful beliefs about back protection and the special nature of LBP were frequently present among physiotherapists. These unhelpful beliefs were associated with less optimal clinical decisions. Educational approaches should challenge unhelpful beliefs and empower physiotherapists to provide explanations and management that increases patients' confidence in the back. Future research should investigate the effect of educational strategies on implementation of best practice for LBP management.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland; Swiss BioMotion Lab, Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.
| | - Jessica Nzamba
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Ludovic Desarzens
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Leuba
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland; Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
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20
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Kanaan SF, Khraise H, Almhdawi KA, Darlow B, Oteir AO, Mansour ZM. Arabic version of the Back Pain Attitudes Questionnaire: Translation, cross-cultural adaptation, and psychometric properties. J Back Musculoskelet Rehabil 2021; 34:59-67. [PMID: 32986654 DOI: 10.3233/bmr-191758] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Back Pain Attitudes Questionnaire (Back-PAQ) is a tool developed for the assessment of attitudes about back pain. However, this tool is not available in the Arabic language. The availability of the Arabic version of the questionnaire will enable clinicians and researchers in Arabic-speaking countries to assess patients' attitudes towards back pain. OBJECTIVE We aimed to translate and cross-culturally adapt the English version of the Back-PAQ into Arabic and study its psychometric properties. METHODS The translation and cross-cultural adaptation processes were performed according to published guidelines. The translated Arabic version was tested for face and content validity on 40 participants. The psychometric properties of the final Arabic version were tested on 110 participants. Participants completed the Arabic version of the Back-PAQ and Fear-Avoidance Beliefs Questionnaire (FABQ). A subgroup of 50 participants completed the questionnaire twice in a week interval to determine the Back-PAQ test-retest reliability. RESULTS The majority of participants found the questionnaire understandable and the questions relevant and appropriate for their back problem. There was a fair correlation between the Back-PAQ-Arabic and the FABQ physical activity scale (rho = 0.283, p= 0.001), and little to no correlation with total FABQ (rho = 0.186, p= 0.026) and education level (rho =-0.162, p= 0.045). The Arabic Back-PAQ-Arabic showed moderate internal consistency with Cronbach's α of 0.601, and excellent test-retest reliability (ICC2,1= 0.963). The Back-PAQ standard error of measurement was 3.57 and minimum detectable changes was 9.90. CONCLUSION The Arabic version of the Back-PAQ has adequate validity and reliability properties.
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Affiliation(s)
- Saddam F Kanaan
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hana'a Khraise
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khader A Almhdawi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Alaa O Oteir
- Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid M Mansour
- Department of Physical and Occupational Therapy, Hashemite University, Zarka, Jordan
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21
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Christe G, Darlow B, Pichonnaz C. Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training. Arch Physiother 2021; 11:13. [PMID: 33993879 PMCID: PMC8126429 DOI: 10.1186/s40945-021-00106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training. METHODS During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score. RESULTS The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001). CONCLUSIONS A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
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22
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Pullon S, Garrett S, Garnett A, Schwass ER, McKinlay E, Ashworth N, Darlow B. Five years on: Influences on early career health professionals from a rural interprofessional pre-registration immersion program. Aust J Rural Health 2021; 29:146-157. [PMID: 33793016 DOI: 10.1111/ajr.12705] [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] [Received: 08/20/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To ascertain former students' perceptions of and influences from a final-year pre-registration, rurally located, clinically based, 5 week interprofessional program on their subsequent work and career in the health professions. DESIGN Online survey delivered 5 years post-program (4 years post-graduation). SETTING The Tairāwhiti interprofessional education program was first undertaken in 2012/2013 by students from six health professional degree programs (dentistry, dietetics, medicine, nursing, pharmacy and physiotherapy) in the Tairāwhiti region, New Zealand. PARTICIPANTS Health professionals who attended the Tairāwhiti interprofessional education program in 2012/2013 as students were invited to participate; 70 of 86 (81%) responded in 2017/2018. RESULTS Five years on, most respondents (91%;64/70) were working as health professionals, with a fifth (23%;15/64) working overseas. Of those currently practising in New Zealand, 51% (24/47) were working in hospital practice and 49% (23/47) in the community, with 56% (27/48) working in metropolitan areas and 44% (21/48) in regional/rural locations. Of the 51 respondents who provided free-text comments about perceived influences of program participation, the majority described positive influences on their clinical practice as health professionals or their subsequent career choices. Five themes emerged from the free-text data: 'made me a better clinician'; 'made me consider rural/regional work'; 'collaborating for care'; 'choosing an area of practice to work in,' and 'little or no impact.' CONCLUSION This work reports positive influences on subsequent careers among respondents who had previously participated as final-year students in a rurally located IPE program, particularly with respect to interprofessional working, rural health, and contextual and cultural influences.
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Affiliation(s)
- Susan Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Amanda Garnett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Elizabeth Rose Schwass
- Department of Primary Health Care and General Practice Tairāwhiti, Tairāwhiti District Health Board, Gisborne, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Natasha Ashworth
- Department of Primary Health Care and General Practice Tairāwhiti, Tairāwhiti District Health Board, Gisborne, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Wang H, Stewart S, Darlow B, Horgan B, Hosie G, Clark J, Dalbeth N. Patient research partner involvement in rheumatology clinical trials: analysis of journal articles 2016-2020. Ann Rheum Dis 2021; 80:1095-1096. [PMID: 33648959 DOI: 10.1136/annrheumdis-2021-220138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Huixin Wang
- Department of Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Sarah Stewart
- Medicine, The University of Auckland, Auckland, New Zealand
| | - Ben Darlow
- Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Ben Horgan
- Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Graham Hosie
- Department of Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Jane Clark
- Department of Primary Healthcare and General Practice, University of Otago Faculty of Medicine, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
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Abstract
CONTEXT As psychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain, the 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument. OBJECTIVES To provide more detailed information about the psychometric properties of the Back-PAQ when used with participants from the general population and also to test the internal validity of the tool for use with General Practitioners (GPs). METHODS After applying partial-credit Rasch analysis with a sample of participants from the general population (n = 600), a replication analysis was conducted with a sample of GPs (n = 184). This approach permitted examination of sample-specific personal factors for differential item functioning. Subtests were used to differentiate between local dependency due to underlying dimensionality from local dependency due to method effects. RESULTS A unidimensional fit to the Rasch model was achieved after 14 misfitting items had been deleted. The final 20-item solution also fit with a sample of 184 GPs. In both cases, the Back-PAQ-20 demonstrated good reliability (PSI ≥ 0.80), with no evidence of differential item functioning by personal factors. CONCLUSION The ordinal-to-interval conversion algorithms presented here further enhance the precision of the scale and permit analysis of Back-PAQ-20 scores using parametric statistics. The present study provided evidence for valid and reliable assessment of the back pain recovery beliefs of both users as well as providers of health services.IMPLICATIONS FOR REHABILITATIONPsychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain.The 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument.The 20-item version of the Back Pain Attitudes Questionnaire (Back-PAQ) is shown here to have strong psychometric properties for administration with users and providers of health services.
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Affiliation(s)
- Chris Krägeloh
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - James Stanley
- University of Otago Wellington, Wellington, New Zealand
| | | | - Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
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Greer C, Adamson P, Harris S, Horwood J, Troughton R, Darlow B. Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Being born at very low birth weight (VLBW, <1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts.
Purpose
To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls.
Methods
The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight <1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained.
Results
VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different.
Conclusion
Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction.
Graph 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Greer
- Christchurch Hospital, Christchurch, New Zealand
| | - P Adamson
- University of Otago Christchurch, Christchurch, New Zealand
| | - S Harris
- University of Otago Christchurch, Christchurch, New Zealand
| | - J Horwood
- University of Otago Christchurch, Christchurch, New Zealand
| | - R Troughton
- University of Otago Christchurch, Christchurch, New Zealand
| | - B Darlow
- University of Otago Christchurch, Christchurch, New Zealand
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26
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Clode NJ, Darlow B, Rouse J, Perry M. What electronic information resources do physiotherapists prefer to use to support their CPD? Physiother Res Int 2020; 26:e1881. [PMID: 32964592 DOI: 10.1002/pri.1881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 08/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The way health professionals consume that informal professional education is changing. Physiotherapists are relying more on using electronic sources of information, including social media, to answer clinical questions. This study aims to identify the sources of electronic information physiotherapists in New Zealand use within their informal professional education. METHODS A cross-sectional survey of 203 physiotherapists and physiotherapy students was undertaken at the National Physiotherapy New Zealand Conference in 2018. RESULTS One hundred and seventy nine participated in the survey providing a response rate of 88%. Median engagement in electronic professional learning was 1-3 h per week (82/179, 47%). Search engines were the most frequently used resource for accessing professional learning (171/179, 98%). Electronic Journal articles and webinars were seen as the most useful electronic learning resources. Social media sites, such as Twitter and Facebook, were used less frequently. Just over half (94/179, 53%) of participants in the survey reported to regularly critically appraising information. CONCLUSION Physiotherapists in New Zealand embark on a significant amount of electronic professional learning. Electronic journal articles are seen as the most valuable resource. Critical appraisal of learning material was not always completed by physiotherapists when consuming informal professional education.
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Affiliation(s)
- Nicholas J Clode
- Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington, New Zealand
| | - Ben Darlow
- Department of, Primary Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Jack Rouse
- Queenstown Physiotherapy, Queenstown, New Zealand
| | - Meredith Perry
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
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27
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Darlow B, Brown M, Grainger R, Hudson B, Briggs AM, Haxby Abbott J, McKinlay E. Stakeholder views about a novel consumer health resource for knee osteoarthritis. Osteoarthritis and Cartilage Open 2020; 2:100058. [DOI: 10.1016/j.ocarto.2020.100058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/02/2020] [Indexed: 01/14/2023] Open
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28
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Author Response to Cibulka. Phys Ther 2020; 100:pzaa047. [PMID: 32242632 DOI: 10.1093/ptj/pzaa047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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29
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Kovanur Sampath K, Darlow B, Tumilty S, Shillito W, Hanses M, Devan H, Thomson OP. Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – A mixed methods systematic review protocol. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Greer C, Adamson P, Harris S, Horwood J, Troughton R, Darlow B. A002 Very Low Birth Weight is Associated With Reduced Right Ventricular Function Detected by Strain Imaging in Early Adulthood – Findings From a Prospective Cohort Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019; 99:1511-1519. [PMID: 31355883 DOI: 10.1093/ptj/pzz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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32
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McKinlay E, Brown M, Beckingsale L, Burrow M, Coleman K, Darlow B, Donovan S, Gorte T, Hilder J, Neser H, Perry M, Sutherland D, Wallace D, Waterworth C, Pullon S. Forming inter-institutional partnerships to offer pre-registration IPE: a focus group study. J Interprof Care 2019; 34:380-387. [PMID: 31750747 DOI: 10.1080/13561820.2019.1685476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/25/2022]
Abstract
Interprofessional education (IPE) programs for pre-registration health science students are largely offered within one institution including different schools or faculties. Sometimes in small or regional institutions where there are limited student numbers or few professional training programs, or where larger institutions do not offer particular professional programs, it may be necessary to partner with other institutions to offer IPE. This study sought to explore teacher perspectives of forming inter-institutional partnerships to deliver IPE, in particular, to identify the elements that influence the formation of partnerships. An interpretive descriptive approach was used to thematically analyze data from three focus groups with teachers (n = 21) working in three different partnerships to deliver IPE to students in Wellington, New Zealand. Two main themes were identified which enabled the development of a model of partnership, with a continuum of complexity depending on whether institutions were on the same page and whether the partnership formed to join an existing IPE program or to create a new IPE program. Forming inter-institution partnerships is a pragmatic solution to providing IPE with benefits to all taking part. Our work showed that time, effort, working with complexity, and ability to stay on the same page are necessary elements for building successful partnerships and all need to be taken into account when planning inter-institution partnerships.
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Affiliation(s)
- Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Louise Beckingsale
- Department of Human Nutrition, University of Otago, Christchurch, New Zealand
| | - Marla Burrow
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Karen Coleman
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Ben Darlow
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Sarah Donovan
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tom Gorte
- Clinical Nurse Educator, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Jo Hilder
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Hazel Neser
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Meredith Perry
- School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Debbie Wallace
- EVOLVE Programme Manager, Pharmaceutical Society, Wellington, New Zealand
| | | | - Sue Pullon
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
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33
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Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Wilson R, Mathieson F, Dowell A. The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: A pragmatic cluster-randomised controlled trial. PLoS Med 2019; 16:e1002897. [PMID: 31498799 PMCID: PMC6733445 DOI: 10.1371/journal.pmed.1002897] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Received: 03/25/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective and cost-effective primary care treatments for low back pain (LBP) are required to reduce the burden of the world's most disabling condition. This study aimed to compare the clinical effectiveness and cost-effectiveness of the Fear Reduction Exercised Early (FREE) approach to LBP (intervention) with usual general practitioner (GP) care (control). METHODS AND FINDINGS This pragmatic, cluster-randomised controlled trial with process evaluation and parallel economic evaluation was conducted in the Hutt Valley, New Zealand. Eight general practices were randomly assigned (stratified by practice size) with a 1:1 ratio to intervention (4 practices; 34 GPs) or control group (4 practices; 29 GPs). Adults presenting to these GPs with LBP as their primary complaint were recruited. GPs in the intervention practices were trained in the FREE approach, and patients presenting to these practices received care based on the FREE approach. The FREE approach restructures LBP consultations to prioritise early identification and management of barriers to recovery. GPs in control practices did not receive specific training for this study, and patients presenting to these practices received usual care. Between 23 September 2016 and 31 July 2017, 140 eligible patients presented to intervention practices (126 enrolled) and 110 eligible patients presented to control practices (100 enrolled). Patient mean age was 46.1 years (SD 14.4), and 46% were female. The duration of LBP was less than 6 weeks in 88% of patients. Primary outcome was change from baseline in patient participant Roland Morris Disability Questionnaire (RMDQ) score at 6 months. Secondary patient outcomes included pain, satisfaction, and psychosocial indices. GP outcomes included attitudes, knowledge, confidence, and GP LBP management behaviour. There was active and passive surveillance of potential harms. Patients and outcome assessors were blind to group assignment. Analysis followed intention-to-treat principles. A total of 122 (97%) patients from 32 GPs in the intervention group and 99 (99%) patients from 25 GPs in the control group were included in the primary outcome analysis. At 6 months, the groups did not significantly differ on the primary outcome (adjusted mean RMDQ score difference 0.57, 95% CI -0.64 to 1.78; p = 0.354) or secondary patient outcomes. The RMDQ difference met the predefined criterion to indicate noninferiority. One control group participant experienced an activity-related gluteal tear, with no other adverse events recorded. Intervention group GPs had improvements in attitudes, knowledge, and confidence compared with control group GPs. Intervention group GP LBP management behaviour became more guideline concordant than the control group. In cost-effectiveness, the intervention dominated control with lower costs and higher Quality-Adjusted Life Year (QALY) gains. Limitations of this study were that although adequately powered for primary outcome assessment, the study was not powered for evaluating some employment, healthcare use, and economic outcomes. It was also not possible for research nurses (responsible for patient recruitment) to be masked on group allocation for practices. CONCLUSIONS Findings from this study suggest that the FREE approach improves GP concordance with LBP guideline recommendations but does not improve patient recovery outcomes compared with usual care. The FREE approach may reduce unnecessary healthcare use and produce economic benefits. Work participation or health resource use should be considered for primary outcome assessment in future trials of undifferentiated LBP. TRIAL REGISTRATION ACTRN12616000888460.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
- * E-mail:
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Sarah Dean
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - J. Haxby Abbott
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ross Wilson
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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34
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McKinlay E, McDonald J, Darlow B, Perry M. Social networks of patients with multimorbidity: a qualitative study of patients' and supporters' views. J Prim Health Care 2019. [PMID: 29530227 DOI: 10.1071/hc16062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multimorbidity impacts on patients' health and wellbeing, but relationships experienced within social networks can support people to live well. AIM This study sought to elicit the views of New Zealanders with multimorbidity about their social networks and the views of their nominated supporters. METHODS Ten patients with multimorbidity and their nominated supporters each independently recorded their views of the patient's social network on a five-concentric-circle template, indicating supporting role and importance to each patient. Sets of patients' and nominated supporters' templates were compared followed by comparing matched pairs of patient-supporter templates. Nominated supporters' views about the patients' networks and why they were nominated were collated. RESULTS Three patients nominated family members as supporters and seven nominated health professionals. Nominated family members identified a greater range of supporters than nominated health professionals. Nominated family members perceived that they played an integral role, whereas health professionals were less comfortable viewing relationships with patients in this way. Family members were not surprised to be nominated as supporters, and some described a considerable burden of care. Health professionals described themselves as coordinators of support and having positive relationships with patients. DISCUSSION Patients with multimorbidity have rich and diverse social networks. They view partners, family and health professionals as providing significant support. Family members are more aware of their role and have a deeper understanding of other network members than health professionals. Further research is needed on the use of social networks in clinical practice to support the health and wellbeing of those with multimorbidity.
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Briggs AM, Hinman RS, Darlow B, Bennell KL, Leech M, Pizzari T, Greig AM, MacKay C, Bendrups A, Larmer PJ, Francis-Cracknell A, Houlding E, Desmond LA, Jordan JE, Minaee N, Slater H. Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study. ACR Open Rheumatol 2019; 1:219-235. [PMID: 31777798 PMCID: PMC6857979 DOI: 10.1002/acr2.1032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care. Methods Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high- and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses). Results A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data. Conclusion Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Rana S Hinman
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice University of Otago Wellington New Zealand
| | - Kim L Bennell
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Michelle Leech
- Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre La Trobe University Melbourne Australia
| | - Alison M Greig
- Department of Physical Therapy University of British Columbia Vancouver Canada
| | - Crystal MacKay
- Toronto Rehabilitation Institute University Health Network Toronto Canada
| | - Andrea Bendrups
- Department of Medicine (Royal Melbourne Hospital) University of Melbourne Melbourne Australia
| | - Peter J Larmer
- School of Clinical Sciences Auckland University of Technology Auckland New Zealand
| | | | - Elizabeth Houlding
- School of Physiotherapy and Exercise Science Curtin University Perth Australia.,Faculty of Science University of Ottawa Ottawa Canada
| | - Lucy A Desmond
- Department of Medicine Western Health Melbourne Australia
| | | | - Novia Minaee
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
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McKinlay E, McDonald J, Darlow B, Perry M. The social networks of New Zealand patients with multimorbidity and the work of those nominated as their 'significant supporters': An exploratory study. Health Soc Care Community 2019; 27:392-399. [PMID: 30175532 DOI: 10.1111/hsc.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.
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Affiliation(s)
| | - Janet McDonald
- Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Meredith Perry
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago Wellington, Wellington, New Zealand
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Swain N, Parr-Brownlie LC, Thompson BL, Darlow B, Mani R, Baxter D. Six things you need to know about pain. N Z Med J 2018; 131:5-8. [PMID: 30496161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Nicola Swain
- Department of Psychological Medicine, University of Otago, Dunedin
| | | | - Bronwyn Lennox Thompson
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch
| | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington
| | | | - David Baxter
- Centre for Health, Activity and Rehabilitation/Ageing Well, University of Otago, Dunedin
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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Meng D, O'Sullivan K, Darlow B, O'Sullivan PB, Ekås GR, Forster BB. MRI for degenerative meniscal lesions: cease and desist! A three-step action plan. Br J Sports Med 2018; 53:1139-1140. [PMID: 30108063 DOI: 10.1136/bjsports-2018-099663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Dylan Meng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Guri Ranum Ekås
- Division of Orthopaedic Surgery, Oslo University Hospital/University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | - Bruce B Forster
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Darlow B, Brown M, Thompson B, Hudson B, Grainger R, McKinlay E, Abbott JH. Living with osteoarthritis is a balancing act: an exploration of patients' beliefs about knee pain. BMC Rheumatol 2018; 2:15. [PMID: 30886966 PMCID: PMC6390552 DOI: 10.1186/s41927-018-0023-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 10/10/2017] [Accepted: 05/24/2018] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to explore the beliefs of people with knee osteoarthritis (OA) about the disease, and how these beliefs had formed and what impact these beliefs had on activity participation, health behaviour, and self-management. Methods Semi-structured interviews were conducted with 13 people with knee OA recruited from general practices, community physiotherapy clinics, and public advertisements in two provinces of New Zealand. Data were analysed using Interpretive Description. Results Two key themes emerged. 1) Knowledge: certainty and uncertainty described participants’ strong beliefs about anatomical changes in their knee. Participants’ beliefs in a biomechanical model of progressive joint degradation often appeared to originate within clinical encounters and from literal interpretation of the term ‘wear and tear’. These beliefs led to uncertainty regarding interpretation of daily symptoms and participants’ ability to influence the rate of decline and certainty that joint replacement surgery represented the only effective solution to fix the damaged knee. 2) Living with OA described broader perspectives of living with OA and the perceived need to balance competing values and risks when making decisions about activity participation, medication, attentional focus, accessing care, and making the most of today without sabotaging tomorrow. Misunderstandings about knee OA negatively impacted on activity participation, health behaviours, and self-management decisions. Conclusion Biomechanical models of OA reduced participant exploration of management options and underpinned a perceived need to balance competing values. Improved information provision to people with knee OA could help guide positive health behaviour and self-management decisions and ensure these decisions are grounded in current evidence. Electronic supplementary material The online version of this article (10.1186/s41927-018-0023-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Darlow
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - Melanie Brown
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - Bronwyn Thompson
- 2Department Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Ben Hudson
- 3Department of General Practice, University of Otago - Christchurch, Christchurch, New Zealand
| | - Rebecca Grainger
- 4Department of Medicine, University of Otago - Wellington, Wellington, New Zealand
| | - Eileen McKinlay
- 1Department of Primary Health Care and General Practice, University of Otago - Wellington, Wellington, New Zealand
| | - J Haxby Abbott
- 5Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Darlow B, McKinlay E, Gallagher P, Beckingsale L, Coleman K, Perry M, Pullon S. Building and expanding interprofessional teaching teams. J Prim Health Care 2018. [PMID: 29530185 DOI: 10.1071/hc16053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Interprofessional education (IPE) aims to prepare learners to work in collaborative health-care teams. The University of Otago, Wellington has piloted, developed and expanded an IPE programme since 2011. An interprofessional teaching team has developed alongside this programme. AIMS This study aimed to understand the development of a university-based interprofessional teaching team over a 4-year period and generate insights to aid the development of such teams elsewhere. METHODS Two semi-structured audio-recorded educator focus groups were conducted at key times in the development of the IPE programme in 2011 and 2014. The programme focused on long-term condition management and involved students from dietetics, medicine, physiotherapy and radiation therapy. Focus group transcripts were independently analysed by two researchers using Thematic Analysis to identify broad themes. Initial themes were compared, discussed and combined to form a thematic framework. The thematic framework was verified by the education team and subsequently updated and reorganised. RESULTS Three key themes emerged: (i) development as an interprofessional educator; (ii) developing a team; and (iii) risk and reward. Teaching in an interprofessional environment was initially daunting but confidence increased with experience. Team teaching highlighted educators' disciplinary roles and skill sets and exposed educators to different teaching approaches. Educators perceived they modelled team development processes to students through their own development as a team. Interprofessional teaching was challenging to organise but participation was rewarding. Programme expansion increased the risks and complexity, but also acted as a stimulus for development and energised the teaching team. DISCUSSION Interprofessional teaching is initially challenging but ultimately enriching. Interprofessional teaching skills take time to develop and perspectives of role change over time. Educator team development is aided by commitment, understanding, enthusiasm, leadership and trust.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Peter Gallagher
- Education Unit, University of Otago, Wellington, New Zealand
| | - Louise Beckingsale
- Department of Human Nutrition, University of Otago, Christchurch, NewZealand
| | - Karen Coleman
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Meredith Perry
- School of Physiotherapy, University of Otago, New Zealand
| | - Sue Pullon
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
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Darlow B, Brown M, Gallagher P, Gray L, McKinlay E, Purdie G, Wilson C, Pullon S. Longitudinal impact of interprofessional education on attitudes, skills and career trajectories: a protocol for a quasi-experimental study in New Zealand. BMJ Open 2018; 8:e018510. [PMID: 29358432 PMCID: PMC5781053 DOI: 10.1136/bmjopen-2017-018510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/28/2017] [Accepted: 11/16/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interprofessional practice is recognised as an important element of safe and effective healthcare. However, few studies exist that evaluate how preregistration education contributes to interprofessional competencies, and how these competencies develop throughout the early years of a health professional's career. This quasiexperimental study will gather longitudinal data during students' last year of preregistration training and their first 3 years of professional practice to evaluate the ongoing development of interprofessional competencies and the influence that preregistration education including an explicit interprofessional education (IPE) programme may have on these. METHODS AND ANALYSIS Participants are students and graduates from the disciplines of dentistry, dietetics, medicine, nursing, occupational therapy, oral health, pharmacy and physiotherapy recruited before their final year of study. A subset of these students attended a 5-week IPE immersion programme during their final year of training. All data will be collected via five written or electronic surveys completed at 12-month intervals. Each survey will contain the Attitudes Towards Health Care Teams Scale and the Team Skills Scale, as well as quantitative and free-text items to explore vocational satisfaction, career trajectories and influences on these. Students who attend the IPE programme will complete additional free-text items to explore the effects of this programme on their careers. Quantitative analysis will compare scores at each time point, adjusted for baseline scores, for graduates who did and did not participate in the IPE programme. Associations between satisfaction data and discipline, professional setting, location and IPE participation will also be examined. Template analysis will explore free-text themes related to influences on career choices including participation in preregistration IPE. ETHICS AND DISSEMINATION This study has received approval from the University of Otago Ethics Committee (D13/019). Results will be disseminated through peer-reviewed publications, conferences and stakeholder reports. Findings will inform future IPE developments and health workforce planning.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Peter Gallagher
- Education Unit, University of Otago, Wellington, New Zealand
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Gordon Purdie
- Biostatistical Group, Dean’s Department, University of Otago, Wellington, New Zealand
| | - Christine Wilson
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Darlow B, O'Sullivan PPB. Infographic: Managing non-traumatic back pain in sport. Br J Sports Med 2017; 53:146-147. [PMID: 29113974 DOI: 10.1136/bjsports-2017-098758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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O’Sullivan K, Grunau GL, Forster BB, O’Sullivan PP, Flynn T, Darlow B. I know what the imaging guidelines say, but... Br J Sports Med 2017; 53:267-268. [DOI: 10.1136/bjsports-2017-098194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/04/2022]
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Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Mathieson F, Dowell A. The Fear Reduction Exercised Early (FREE) approach to low back pain: study protocol for a randomised controlled trial. Trials 2017; 18:484. [PMID: 29041947 PMCID: PMC5646107 DOI: 10.1186/s13063-017-2225-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/17/2017] [Accepted: 09/29/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a major health issue associated with considerable health loss and societal costs. General practitioners (GPs) play an important role in the management of LBP; however, GP care has not been shown to be the most cost-effective approach unless exercise and behavioural counselling are added to usual care. The Fear Reduction Exercised Early (FREE) approach to LBP has been developed to assist GPs to manage LBP by empowering exploration and management of psychosocial barriers to recovery and provision of evidence-based care and information. The aim of the Low Back Pain in General Practice (LBPinGP) trial is to explore whether patients with LBP who receive care from GPs trained in the FREE approach have better outcomes than those who receive usual care. METHODS/DESIGN This is a cluster randomised controlled superiority trial comparing the FREE approach with usual care for LBP management with investigator-blinded assessment of outcomes. GPs will be recruited and then cluster randomised (in practice groups) to the intervention or control arm. Intervention arm GPs will receive training in the FREE approach, and control arm GPs will continue to practice as usual. Patients presenting to their GP with a primary complaint of LBP will be allocated on the basis of allocation of the GP they consult. We aim to recruit 60 GPs and 275 patients (assuming patients are recruited from 75% of GPs and an average of 5 patients per GP complete the study, accounting for 20% patient participant dropout). Patient participants and the trial statistician will be blind to group allocation throughout the study. Analyses will be undertaken on an intention-to-treat basis. The primary outcome will be back-related functional impairment 6 months post-initial LBP consultation (interim data at 2 weeks, 6 weeks and 3 months), measured with the Roland-Morris Disability Questionnaire. Secondary patient outcomes include pain, satisfaction, quality of life, days off from work and costs of care. Secondary GP outcomes include beliefs about pain and impairment, GP confidence, and actual and reported clinical behaviour. Health economic and process evaluations will be conducted. DISCUSSION In the LBPinGP trial, we will investigate providing an intervention during the first interaction a person with back pain has with their GP. Because the FREE approach is used within a normal GP consultation, if effective, it may be a cost-effective means of improving LBP care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000888460 . Registered on 6 July 2016.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago, Wellington, New Zealand
| | - Sarah Dean
- Medical School, University of Exeter, Exeter, UK
| | - J Haxby Abbott
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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O’Sullivan K, Darlow B, O’Sullivan P, Forster BB, Reiman MP, Weir A. Imaging for hip-related groin pain: don’t be hip-notised by the findings. Br J Sports Med 2017; 52:551-552. [DOI: 10.1136/bjsports-2017-097889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grunau GL, Darlow B, Flynn T, O’Sullivan K, O’Sullivan PB, Forster BB. Red flags or red herrings? Redefining the role of red flags in low back pain to reduce overimaging. Br J Sports Med 2017; 52:488-489. [DOI: 10.1136/bjsports-2017-097725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/04/2022]
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Dowell A, Darlow B, Macrae J, Stubbe M, Turner N, McBain L. Childhood respiratory illness presentation and service utilisation in primary care: a six-year cohort study in Wellington, New Zealand, using natural language processing (NLP) software. BMJ Open 2017; 7:e017146. [PMID: 28765137 PMCID: PMC5642764 DOI: 10.1136/bmjopen-2017-017146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify childhood respiratory tract-related illness presentation rates and service utilisation in primary care by interrogating free text and coded data from electronic medical records. DESIGN Retrospective cohort study. Data interrogation used a natural language processing software inference algorithm. SETTING 36 primary care practices in New Zealand. Data analysed from January 2008 to December 2013. PARTICIPANTS The records from 77 582 children enrolled were reviewed over a 6-year period to estimate the presentation of childhood respiratory illness and service utilisation. This cohort represents 268 919 person-years of data and over 650 000 unique consultations. MAIN OUTCOME MEASURE Childhood respiratory illness presentation rate to primary care practice, with description of seasonal and yearly variation. RESULTS Respiratory conditions constituted 46% of all child-general practitioner consultations with a stable year-on-year pattern of seasonal peaks. Upper respiratory tract infection was the most common respiratory category accounting for 21.0% of all childhood consultations, followed by otitis media (12.2%), wheeze-related illness (9.7%), throat infection (7.4%) and lower respiratory tract infection (4.4%). Almost 70% of children presented to their general practitioner with at least one respiratory condition in their first year of life; this reduced to approximately 25% for children aged 10-17. CONCLUSION This is the first study to assess the primary care incidence and service utilisation of childhood respiratory illness in a large primary care cohort by interrogating electronic medical record free text. The study identified the very high primary care workload related to childhood respiratory illness, especially during the first 2 years of life. These data can enable more effective planning of health service delivery. The findings and methodology have relevance to many countries, and the use of primary care 'big data' in this way can be applied to other health conditions.
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Affiliation(s)
- Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | | | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Nikki Turner
- Department of General Practice and Primary Health Care, University of Auckland, Wellington, New Zealand
| | - Lynn McBain
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Darlow B, Forster BB, O'Sullivan K, O'Sullivan P. It is time to stop causing harm with inappropriate imaging for low back pain. Br J Sports Med 2016; 51:414-415. [PMID: 27797737 DOI: 10.1136/bjsports-2016-096741] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Bruce B Forster
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kieran O'Sullivan
- University of Limerick, Ireland and Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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