1,720,984 research outputs found
‘A challenge to my professional identity’- resisting the shift from over-management to self-management for back pain within an implementation trial: a qualitative study
No full textObjective: the Enhanced Transtheoretical Model Intervention (ETMI) is based on behavioral models and focuses on guiding Chronic Low Back Pain (CLBP) patients to self-manage symptoms and engage in recreational physical activity. While there is promising evidence that ETMI benefits patients, it is unclear how challenging it might be to implement widely. This investigation focused on the perceptions of physiotherapists trained to deliver ETMI for CLBP. Design: a Qualitative study comprised of semi-structured interviews (July to November 2023). Interviews were audio-recorded, transcribed, coded, and analyzed thematically by two independent researchers. Setting: data were obtained as part of a large implementation study evaluating the uptake and impact of ETMI amongst physiotherapists in a large public healthcare setting. Participants: 22 physiotherapists trained to deliver the ETMI approach and chose to use it with at least one patient. Results: while physiotherapists acknowledged the evidence base behind ETMI and the clarity of the approach, they struggled to adapt it to routine delivery. Exploration of the reasons for this identified an overarching meta-theme, ‘A challenge to my professional identity’, and three main themes consisting of 1) interventions such as ETMI contradicted my training. 2) I am ambivalent/ do not accept evidence that contradicts my habitual practice, and 3) I am under-skilled in psychological and communication skills. Conclusion: this study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity. The shift from over-management by experts seeking cures to supporting self-management was not palatable to physiotherapists. The challenge of embracing a new professional identity must be addressed to enable a successful implementation of the approach. Contribution of the Paper: • This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity. • The shift from overdiagnosis (weak cores, bad postures, unstable back, or disc sliding) and over-management (specific exercises, modalities, or special techniques) by experts seeking cures to support self-management was not palatable to physiotherapists. • The findings could lead to a reevaluation of professional development programs for physiotherapists, with an emphasis on updating skills and knowledge to align with evidence-based practices, ultimately aiming to enhance the quality of care provided to patients.</p
Implementation of the Enhanced Transtheoretical Model Intervention (ETMI) for Low Back Pain patients in primary care: Study Protocol
No full textBackground: Self-management, an active life routine, and adherence to physical activity are effective in the management of low back pain (LBP). However, delivering effective education and reassurance to patients can be a difficult for practitioners. The enhanced transtheoretical model intervention (ETMI) has shown to be successful and cost effective. The intervention focuses on educating practitioners to reassure patients, empower them to increase physical activity, and improve their self-efficacy.Objectives: To assess whether ETMI can be implemented among primary care practitioners and to examine whether it reduces pain, disability, and fear avoidance as well as decreasing healthcare utilization. This protocol outlines the methodology for the implementation of ETMI through a hybrid implementation-effectiveness design.Methods: Two qualitative and mixed-method studies provided a basis for an implementation prospective cohort study. Discussions are followed by a prospective cohort study with pre-and post-intervention measures as well as descriptions retrieving economic and therapeutic outcome data from the Maccabi Healthcare Services (MHS) databases. In addition, a fourth qualitative study was conducted at the midpoint of the implementation to evaluate the process by measuring the perceptions and practice of practitioners. The intervention group was 220 primary care practitioners and their patients (~n=10,000) from the central district of MHS. The control data was provided by other care districts with similar socioeconomic makeup (~n=40,000).Conclusions: We evaluated the process and outcomes of the implementation of ETMI. We investigated the relationship between the care received (ETMI against treatment as usual) and healthcare utilization, costs, and patient-clinical outcomes
Implementation of a self-management approach (ETMI) for low back pain in a public healthcare system
No full textImportance: self-management is recommended first-line care for chronic low back pain (CLBP). However, implementation of structured self-management models in large public health maintenance organizations (HMO) remains scarce.Objective: to determine the feasibility of implementing the enhanced transtheoretical model intervention (ETMI) in a public HMO in Israel and to compare outcomes of patients who received ETMI-guided vs usual physiotherapy care.Design, setting, and participants: in this cohort study, all physiotherapists in 13 outpatient physiotherapy clinics in a public HMO were trained in ETMI in 2022. Data were extracted for all eligible patients aged 18 years and older with CLBP who attended an associated physiotherapy center between January 1, 2022, and July 31, 2023.Exposure: ETMI is a self-management approach focused on reassurance, addressing unhelpful beliefs, and encouraging recreational physical activity, delivered without passive treatments or prescribed exercises. ETMI trains physiotherapists to guide patients in managing their pain independently, helping them avoid future reliance on medical services, medication, or imaging when pain recurs.Main outcomes and measures: implementation outcomes were reach (physiotherapist uptake of ETMI), adoption (number of patients who received ETMI), and fidelity. Clinical outcomes were patient-reported function (0-100), pain (0-10) and fear-avoidance beliefs (0-100), assessed at baseline and discharge.Results: a total of 128 physiotherapists (mean [SD] age, 37.5 [9.3] years; 63 [49.2%] female) were invited to attend ETMI training, 109 (85.1%) attended, and 70 (64.0%) delivered the intervention at least once. Fidelity to ETMI-guided care was good. Of 4193 patients (mean [SD] age, 56.3 [16.7] years; 2454 [58.5%] female), 711 (17.0%) received ETMI-guided care. A total of 1624 patients (39.0%) had complete data and were included in the analysis. Compared with usual care, ETMI was associated with greater improvement in function scores (mean [SD] change, 12.0 [13.7] vs 15.7 [14.1]; adjusted mean difference (aMD), 3.3; 95% CI, 1.5 to 5.1), and fear-avoidance scores (-4.4 [22.7] vs -8.9 [23.8]; aMD, -4.3; 95% CI, -1.7 to -7.0) with no differences observed for pain scores (-1.7 [2.4] vs -2.0 [2.4]; aMD, -0.0; 95% CI, -0.3 to 0.3). ETMI patients had fewer sessions (mean [SD], 5.0 [4.2] vs 6.3 [4.5]; aMD, 1.3; 95% CI, 0.6 to 1.8; P < .001).Conclusions and relevance: in this cohort study, the implementation of ETMI was feasible and associated with better patient outcomes in fewer treatment sessions than usual care, although its reach was limited
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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