4 research outputs found
Correction: Study protocol: Improving patient choice in treating Low back pain (IMPACT - LBP): A randomised controlled trial of a decision support package for use in physical therapy
No full textThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.After publication of this protocol a change in study design was needed [1]. Due to changes in the service configuration in the host physiotherapy department individual randomisation as originally planned could not be implemented. It was necessary to change to cluster randomisation with the unit of randomisation being the treating physiotherapist. Potential participants are given outpatient appointments by booking staff unaware of the physiotherapist’s randomisation. Trial recruitment is also done blind to physiotherapist allocation. In this manner we have ensured allocation concealment prior to participants joining the study. Cluster randomised trials need to inflate their sample size to account for clustering. Typically primary care trials use an intra-cluster correlation coefficient (ICC) of 0.05 in this calculation [2]. Our past experience is that clustering effects by therapist in trials of this nature may be very small [3]. To account for this we developed a provisional revised sample size using an ICC of 0.05 and did an interim analysis of pooled data, just for ICC of the primary outcome, after the first 40 participants had completed the three month follow-up questionnaire. The ICC was close to zero, suggesting that using an ICC of 0.05 was too conservative. We therefore assumed an ICC of 0.01 to estimate the design effect due to clustering. Based on an average cluster size of nine this results in a revised final sample size of 158
Study protocol: Improving patient choice in treating low back pain (IMPACT - LBP): A randomised controlled trial of a decision support package for use in physical therapy
No full textCopyright @ 2011 Patel et al - This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a common and costly condition. There are several treatment options for people suffering from back pain, but there are few data on how to improve patients' treatment choices. This study will test the effects of a decision support package (DSP), designed to help patients seeking care for back pain to make better, more informed choices about their treatment within a physiotherapy department. The package will be designed to assist both therapist and patient.
Methods/Design: Firstly, in collaboration with physiotherapists, patients and experts in the field of decision support and decision aids, we will develop the DSP. The work will include: a literature and evidence review; secondary analysis of existing qualitative data; exploration of patients' perspectives through focus groups and exploration of experts' perspectives using a nominal group technique and a Delphi study.
Secondly, we will carry out a pilot single centre randomised controlled trial within NHS Coventry Community Physiotherapy. We will randomise physiotherapists to receive either training for the DSP or not. We will randomly allocate patients seeking treatment for non specific low back pain to either a physiotherapist trained in decision support or to receive usual care. Our primary outcome measure will be patient satisfaction with treatment at three month follow-up. We will also estimate the cost-effectiveness of the intervention, and assess the value of conducting further research.
Discussion: Informed shared decision-making should be an important part of any clinical consultation, particularly when there are several treatments, which potentially have moderate effects. The results of this pilot will help us determine the benefits of improving the decision-making process in clinical practice on patient satisfaction.This work is funded from the National Institute for Health Research (NIHR), Research for Patient Benefit (RfPB) Programme (Ref: PB-PG-0808-17039)
The design and development of a decision support package for low back pain
No full textArthritis Care & Research is published by Wiley
Periodicals, Inc. on behalf of the American College of Rheumatology.
This is an open access article under the terms of the Creative Commons
Attribution-NonCommercial-NoDerivs License, which permits use and
distribution in any medium, provided the original work is properly cited,
the use is non-commercial and no modifications or adaptations are made.Objective: To develop a decision support package for people with low back pain (LBP) referred for physiotherapy. Methods: A programme of exploratory work including, literature reviews, a Delphi study, a nominal group with physiotherapists, focus groups with patients' and secondary analysis of existing interview data. Results: We developed an information booklet describing the evidence-based treatment modalities available in a physiotherapy department. This includes data on likely benefits and risks and how the intervention is delivered. The booklet specifically addresses questions identified as important in our exploratory work. Space is provided for patients to note down the pros and cons of each treatment and what matters to them when choosing treatments. The patient is subsequently directed to a section that explores any gaps in knowledge, values, support and choice before finally clarifying if a treatment decision is possible. At this stage they are encouraged to note down any questions or concerns they have to be discussed at the first physiotherapy consultation. This overall package includes patient material in the form of a booklet, posted prior to their consultation, plus the enhanced consultation with the specially trained physiotherapist. Patients then receive their chosen treatment. In addition we developed a training package for physiotherapists that explains the content of the booklet and supports them in using informed shared decision making in their consultation. Conclusion: This package has the potential to improve effectiveness of treatments and patient satisfaction for LBP by facilitating patient choice and thus matching patients more effectively to different treatments. © 2013 American College of Rheumatology
Telephonic support to facilitate return to work: what works, how, and when? (Research report No 853)
No full textSummary
There is wide acceptance that a timely return to work for people with health problems is a desirable goal. Telephonic approaches have much to offer in supporting work participation for people with common musculoskeletal and mental health problems. When well designed and implemented, and with suitable governance, they compare favourably with face-to-face approaches.
Telephonic approaches are not a replacement for standard clinical healthcare: they are a complement. Telephonic contact has a dual role: to identify peoples’ needs, and then signpost them to the right intervention at the right time.
The evidence supporting telephonic approaches is generally robust, being based on a synthesis of academic, institutional, and best practice sources.
There are several key aspects of telephonic approaches that facilitate early return to work outcomes. They have optimal effect when used in combination:
• Assessment: identifies the client’s needs and their obstacles to return to work, which guide the return to work plan.
• Triage: allocates cases to the most appropriate rehabilitation pathway using a stepped-care model.
• Advice and information: fostering positive beliefs, setting expectations, and giving self-management advice.
• Case management: managing the client’s journey has cost benefits: telephonic approaches provide clear advantages through speed and ease of access, shorter waiting times, optimised referrals to face-to-face interventions, efficient use of resources.
A well-designed and delivered telephonic service can enable a substantial proportion of cases to entirely self-manage their health problem and work participation.
Provision should be made for a tiered component of the service that combines telephone and face-to-face contact in order to accommodate cases with more complex health problems or difficult obstacles to work participation.
The effectiveness of telephonic services in achieving positive work outcomes relies heavily on the training and skills of staff, and on the adoption of a strong work focus by all the key players, including support at the workplace.
There is robust evidence that, when properly implemented, telephonic case management approaches can speed return to work and reduce overall case costs. Telephonic intervention by appropriately trained professionals has been shown to be safe and acceptable to users
