Journal articles
Taylor WJ, Brown M, Levack W, McPherson K, Reed K, Dean SG, Weatherall M (In Press). A pilot cluster randomized controlled trial of structured goal-setting following stroke. Clinical Rehabilitation
Price LRS, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, Hillsdon M (In Press). Are we overestimating Physical Activity prevalence in children. Journal of Physical Activity and Health
Poltawski L, Allison R, Briscoe S, Freeman J, Kilbride C, Neal D, Turton A, Dean S (In Press). Assessing the impact of upper limb disability following stroke:. a qualitative enquiry using internet-based personal accounts of stroke survivors.
Disability and RehabilitationAbstract:
Assessing the impact of upper limb disability following stroke:. a qualitative enquiry using internet-based personal accounts of stroke survivors
Purpose
Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally-significant. impacts of upper limb disability following stroke.
Methods
Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke.
Results
Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily-accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias.
Conclusions
A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.
Abstract.
Price LRS, Wyatt K, Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M (In Press). Children’s compliance with wrist worn accelerometry within a cluster randomised controlled trial: Findings from the Healthy Lifestyles Programme (HeLP). Pediatric Exercise Science
Wyatt KM, Lloyd JJ, Green C, Hurst A, McHugh C, Logan S, Taylor R, Hillsdon M, Price L, Abraham C, et al (In Press). Cluster randomised controlled trial, economic and process evaluation to determine the effectiveness and cost effectiveness of a novel intervention (Healthy Lifestyles Programme, HeLP) to prevent obesity in school children. NIHR Public Health Research
Dean S, Poltawski L, Forster A, Taylor R, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd A, et al (In Press). Community-based Rehabilitation Training after stroke: protocol of a pilot randomised controlled trial (ReTrain). BMJ Open
Levack WMM, Weatherall M, Hay-Smith EJC, Dean SG, McPherson K, Siegert RJ (In Press). Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis. European Journal of Physical and Rehabilitation Medicine
Norris M, Poltawski L, Calitri RA, Shepherd A, Dean S (In Press). Hope and despair: a qualitative exploration of the experiences and impact of trial processes in a rehabilitation trial. Trials
Campbell JL (In Press). Identifying policies and strategies for GP retention in direct patient care in the United Kingdom: a RAND/UCLA Appropriateness Method Panel study. BMC Family Practice
Shepherd A, Pulsford R, Poltawski L, Forster A, Taylor R, Spencer A, Hollands L, James M, Allison R, Norris M, et al (In Press). Physical activity, sleep, and fatigue in community dwelling Stroke Survivors. Scientific Reports
Tarrant M, Carter M, Dean S, Taylor R, Warren F, Spencer A, Adamson J, Landa P, Code C, Calitri RA, et al (In Press). Singing for People with Aphasia (SPA): a Protocol for a Pilot Randomised Controlled Trial of a Group Singing Intervention to Improve Wellbeing. BMJ Open
Norris M, Poltawski L, Calitri RA, Shepherd A, Dean S (In Press). The acceptability and experience of a functional training programme (ReTrain) in community dwelling stroke survivors in South West England: a qualitative study. BMJ Open
Hay-Smith J, Bick D, Dean S, Salmon V, Terry R, Jones E, Edwards E, Frawley H, MacArthur C (2023). 225 ANTENATAL PELVIC FLOOR MUSCLE EXERCISE INTERVENTION TO REDUCE POSTNATAL URINARY INCONTINENCE: QUANTITATIVE RESULTS FROM a FEASIBILITY AND PILOT RANDOMISED CONTROLLED TRIAL. Continence, 7(BJOG. 122 7 2015).
Wilson R, Pryymachenko Y, Abbott JH, Dean S, Stanley J, Garrett S, Mathieson F, Dowell A, Darlow B (2023). 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,
21(2), 253-262.
Abstract:
A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: a Difference-in-Difference-in-Differences Analysis.
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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Watkins R, Swancutt D, Alexander M, Moghadam S, Perry S, Dean S, Sheaff R, Pinkney J, Tarrant M, Lloyd J, et al (2023). A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK.
Patient,
16(6), 625-640.
Abstract:
A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK.
BACKGROUND: Addressing the increasing prevalence of obesity is a global public health priority. Severe obesity (body mass index > 40) reduces life expectancy, due to its association with people developing complications (e.g. diabetes, cancer, cardiovascular disease), and greatly impairs quality of life. The National Health Service (NHS) in the UK provides specialist weight management services (SWMS) for people with severe obesity, but key uncertainties remain around patient access to and engagement with weight management services, as well as pathways beyond the service. METHODS: in this multiple methods study, using online forum data and semi-structured interviews, stakeholders' experiences of delivering and receiving SWMS were explored. Using the web search engine Google with keywords and web address (URL) identifiers, relevant public online platforms were sourced with snowball sampling and search strings used to identify threads related to people's experiences of accessing SWMS (n = 57). Interviews were conducted with 24 participants (nine patients, 15 staff), and data from all sources were analysed thematically using the framework approach. RESULTS: Six themes related to access to and engagement with SWMS emerged during data analysis: (1) making the first move, (2) uncertainty and confusion, (3) resource issues, (4) respect and understanding, (5) mode of delivery, and (6) desire for ongoing support. CONCLUSION: There is a mixed and varied picture of SWMS provision across the UK. The service offered is based on local clinical decision making and available resources, resulting in a range of patient experiences and perspectives. Whilst service capacity issues and patient anxiety were seen as barriers to accessing care, peer support and positive clinical and group interactions (connectedness between individuals) were considered to increase engagement.
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Lambert J, Taylor A, Streeter A, Greaves C, Ingram WM, Dean S, Jolly K, Mutrie N, Price L, Campbell J, et al (2023). Adding web-based support to exercise referral schemes improves symptoms of depression in people with elevated depressive symptoms: a secondary analysis of the e-coachER randomised controlled trial. Mental Health and Physical Activity, 25
Goldsmith G, Bollen JC, Salmon VE, Freeman JA, Dean SG (2023). Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol.
BMJ Open,
13(3), e062548-e062548.
Abstract:
Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol
IntroductionUsing tele-rehabilitation methods to deliver exercise, physical activity (PA) and behaviour change interventions for people with multiple sclerosis (pwMS) has increased in recent years, especially since the SARS-CoV-2 pandemic. This scoping review aims to provide an overview of the literature regarding adherence to therapeutic exercise and PA delivered via tele-rehabilitation for pwMS.Methods and analysisFrameworks described by Arksey and O’Malley and Levacet alunderpin the methods. The following databases will be searched from 1998 to the present: Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Health Management Information Consortium Database, ProQuest Dissertations and Theses Global, Pedro, Cochrane Central Register of Controlled Trials, US National Library of Medicine Registry of Clinical Trials, WHO International Clinical Trials Registry Platform portal and the Cochrane Database of Systematic Reviews. To identify papers not included in databases, relevant websites will be searched. Searches are planned for 2023. With the exception of study protocols, papers on any study design will be included. Papers reporting information regarding adherence in the context of prescribed therapeutic exercise and PA delivered via tele-rehabilitation for pwMS will be included. Information relating to adherence may comprise; methods of reporting adherence, adherence levels (eg, exercise diaries, pedometers), investigation of pwMS’ and therapists’ experiences of adherence or a discussion of adherence. Eligibility criteria and a custom data extraction form will be piloted on a sample of papers. Quality assessment of included studies will use Critical Appraisal Skills Programme checklists. Data analysis will involve categorisation, enabling findings relating to study characteristics and research questions to be presented in narrative and tabular format.Ethics and disseminationEthical approval was not required for this protocol. Findings will be submitted to a peer-reviewed journal and presented at conferences. Consultation with pwMS and clinicians will help to identify other dissemination methods.
Abstract.
McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS (2023). Home-based versus centre-based cardiac rehabilitation.
Cochrane Database Syst Rev,
10(10).
Abstract:
Home-based versus centre-based cardiac rehabilitation.
BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES: to compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS: We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Darlow B, Brown M, Stanley J, Abbott JH, Briggs AM, Clark J, Frew G, Grainger R, Hood F, Hudson B, et al (2023). 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 CareAbstract:
Reducing the burden of knee osteoarthritis through community pharmacy: Protocol for a randomised controlled trial of the Knee Care for Arthritis through Pharmacy Service.
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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Darlow B, Krägeloh C, Abbott JH, Bennell K, Briggs AM, Brown M, Clark J, Dean S, French S, Hinman RS, et al (2023). The osteoarthritis knowledge scale.
Musculoskeletal Care,
21(2), 516-526.
Abstract:
The osteoarthritis knowledge scale.
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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Hay-Smith EJC, Pearson M, Dean SG (2023). ‘Making Sense’ of Urinary Incontinence: a Qualitative Study Investigating Women’s Pelvic Floor Muscle Training Adherence.
New Zealand Journal of Physiotherapy,
51(1), 6-13.
Abstract:
‘Making Sense’ of Urinary Incontinence: a Qualitative Study Investigating Women’s Pelvic Floor Muscle Training Adherence
Urinary incontinence is common and disabling. Pelvic floor muscle training is recommended as first-line therapy for uncomplicated urinary incontinence. The effects of such behavioural therapies depend in part on adherence. We explored women’s experiences of incontinence treatment and training adherence in a longitudinal qualitative design. Six women (40–80 years) with stress, urgency or mixed urinary incontinence symptoms were interviewed twice; once at the start of treatment and again after discharge about 3 months later. Interviews were transcribed and analysed using principles of Interpretative Phenomenological Analysis. Experiences were represented by four themes: Past experiences and meanings of leakage; the supervised treatment period; going on and looking ahead; and the relationship with and experience of others. Variable adherence was explained by how women ‘made sense of it all’. Women with the least difficulty in making sense of their incontinence and in overcoming training inertia had the best self-reported outcomes. Conversely, variable adherence, poorer self-reported outcomes, and ambivalence about engaging in treatment were characteristic of women who struggled to make sense of their apparently intermittent or unpredictable condition. Helping women make sense of incontinence and overcome inertia and ambivalence could improve adherence, but this may be a prolonged process.
Abstract.
Dean S, Salmon V, Terry R, Hay-Smith J, Frawley H, Chapman S, Pearson M, Boddy K, Cockcroft E, Webb S, et al (2022). 14 TEACHING EFFECTIVE PELVIC FLOOR MUSCLE EXERCISES IN ANTENATAL CARE: DESIGN AND DEVELOPMENT OF a TRAINING PACKAGE FOR COMMUNITY MIDWIVES IN THE UNITED KINGDOM. Continence, 2, 1-2.
Stokes I, Warren F, Hay-Smith J, Elders A, Bugge C, Hagen S, Dean S (2022). 15 PELVIC FLOOR MUSCLE TRAINING ADHERENCE: EVALUATING WOMEN’S ADHERENCE TO HOME EXERCISE PRESCRIPTION IN a MULTICENTRE RANDOMISED CONTROLLED TRIAL. Continence, 2, 1-2.
Smith C, Salmon V, Jones E, Edwards E, Hay-Smith J, Frawley H, Webb S, Bick D, MacArthur C, Dean S, et al (2022). 16 TRAINING FOR MIDWIVES TO SUPPORT WOMEN TO DO THEIR EXERCISES DURING PREGNANCY. A MIXED METHOD EVALUATION OF THE MIDWIFE TRAINING DURING a FEASIBILITY AND PILOT RANDOMISED CONTROLLED TRIAL. Continence, 2, 1-2.
Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, et al (2022). A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol.
Pilot and Feasibility Studies,
8(1).
Abstract:
A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol
Abstract
. Background
. Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity.
.
. Methods
. This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted.
.
. Discussion
. This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients.
.
. Trial registration
. ISRCTN number 22088800.
.
Abstract.
Lambert J, Taylor A, Streeter A, Greaves C, Ingram WM, Dean S, Jolly K, Mutrie N, Taylor RS, Yardley L, et al (2022). A process evaluation, with mediation analysis, of a web-based intervention to augment primary care exercise referral schemes: the e-coachER randomised controlled trial.
Int J Behav Nutr Phys Act,
19(1).
Abstract:
A process evaluation, with mediation analysis, of a web-based intervention to augment primary care exercise referral schemes: the e-coachER randomised controlled trial.
BACKGROUND: the e-coachER trial aimed to determine whether adding web-based behavioural support to exercise referral schemes (ERS) increased long-term device-measured physical activity (PA) for patients with chronic conditions, compared to ERS alone, within a randomised controlled trial. This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention's logic model. METHODS: Four hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12 months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12 months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months. RESULTS: the internal reliability (Cronbach's alpha) for all multi-item scales was > 0.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, p = 0.001), confidence (1.28, 95% CI: 0.57 to 1.98, p
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Bick D, Bishop J, Coleman T, Dean S, Edwards E, Frawley H, Gkini E, Hay-Smith J, Hemming K, Jones E, et al (2022). Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial.
Pilot Feasibility Stud,
8(1).
Abstract:
Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial.
BACKGROUND: Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME. METHODS: the primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally. Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only. All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10-12 weeks postpartum (around 1400-1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter. Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands-Edgbaston Research Ethics Committee approved the study protocol. DISCUSSION: Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women's questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10-12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere. TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN10833250. Registered 09/03/2020.
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Hollands L, Calitri R, Warmoth K, Shepherd A, Allison R, Dean S, ReTrain Trial, team (2022). Assessing the fidelity of the independently getting up off the floor (IGO) technique as part of the ReTrain pilot feasibility randomised controlled trial for stroke survivors.
Disabil Rehabil,
44(25), 7829-7838.
Abstract:
Assessing the fidelity of the independently getting up off the floor (IGO) technique as part of the ReTrain pilot feasibility randomised controlled trial for stroke survivors.
PURPOSE: Hemiparesis and physical deconditioning following stroke lead to an increase in falls, which many individuals cannot get up from. Teaching stroke survivors to independently get off the floor (IGO) might mitigate long-lie complications. IGO was taught as part of a community-based, functional rehabilitation training programme (ReTrain). We explore the feasibility of teaching IGO and assess participant's level of mastery, adherence, and injury risk. MATERIALS AND METHODS: Videos of participants (n = 17) performing IGO at early, middle, and late stages of the ReTrain programme were compared to a manualised standard. A visual, qualitative analysis was used to assess technique mastery, adherence, and injury risk. RESULTS: Most participants (64%) achieved independent, safe practice of IGO. A good (73%) level of adherence to IGO and low incidence of risk of injury (6.8%) were observed. Deviations were made to accommodate for non-stroke related comorbidities. CONCLUSIONS: IGO was successfully and safely practised by stroke survivors including those with hemiparesis. Trainers should be aware of comorbidities that may impede completion of IGO and modify teaching to accommodate individual need. Further research should assess if IGO can be utilised by individuals who have other disabilities with unilateral impairments and whether IGO has physical, functional and economic benefit.Implications for rehabilitationFalls are common in stroke survivors, and many are unable to get up despite being uninjured, leading to long-lie complications or ambulance call-outs but non-conveyance to hospital.Teaching the independently getting up off the floor (IGO) technique to stroke survivors was possible for those with or without hemiparesis, and remained safe despite modifications to accommodate an individual's needs.Individual assessment is needed to check if a stroke survivor is suitable for learning IGO including, but not limited to, their ability to safely get to the floor and to temporarily stand (without support) at the end of the technique.
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Burns A, Donnelly B, Feyi-Waboso J, Shephard E, Calitri R, Tarrant M, Dean SG (2022). How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? a systematic review and thematic synthesis.
BMJ Open,
12(6), e060101-e060101.
Abstract:
How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? a systematic review and thematic synthesis
ObjectivesTo conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making.DesignSystematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed.SettingPrimary care.ResultseRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: ‘Novel risk’, ‘Risk refinement’, ‘Autonomy’, ‘Communication’, ‘Fear’ and ‘Mistrust’.ConclusioneRATs may improve the understanding and communication of risk in the primary care consultation. The themes of ‘Fear’ and ‘Mistrust’ could represent potential challenges with eRATs.Trial registration numberCRD219446.
Abstract.
Sims L, Hay-Smith J, Dean S (2022). Pelvic floor exercises and female stress urinary incontinence.
Br J Gen Pract,
72(717), 185-187.
Author URL.
Krägeloh C, Medvedev ON, Dean S, Stanley J, Dowell A, Darlow B (2022). Rasch analysis of the Back Pain Attitudes Questionnaire (Back-PAQ).
Disabil Rehabil,
44(13), 3228-3235.
Abstract:
Rasch analysis of the Back Pain Attitudes Questionnaire (Back-PAQ).
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.
Abstract.
Author URL.
Lamont RA, Calitri R, Mounce LTA, Hollands L, Dean SG, Code C, Sanders A, Tarrant M (2022). Shared social identity and perceived social support among stroke groups during the COVID‐19 pandemic: Relationship with psychosocial health.
Applied Psychology: Health and Well-Being,
15(1), 172-192.
Abstract:
Shared social identity and perceived social support among stroke groups during the COVID‐19 pandemic: Relationship with psychosocial health
AbstractCommunity‐based peer support groups for stroke survivors are common in the United Kingdom and aim to support rehabilitation. This study of 260 stroke survivors across 118 groups nationally used an online survey format, completed on average 3 months into the pandemic. Analysis of both quantitative and open‐ended responses provided insights into how stroke group members maintained contact during the COVID‐19 pandemic and how the group processes of shared social identity and perceived social support related to psychosocial outcomes (self‐esteem, well‐being and loneliness). Group members adapted to the pandemic early through telephone calls (61.6% of participants) and internet‐based contact (>70% of participants), although also showed a desire for greater contact with their groups. A stronger sense of shared social identity and perceptions of social support from the stroke groups were weakly associated with reductions in loneliness among members, and greater perceived social support was associated with higher self‐esteem. However, having poor health and living alone were more strongly associated with more negative psychosocial outcomes. The discussion considers how barriers to contact during pandemics can be managed, including access and use of online communication, limitations imposed by stroke‐related disability, and how the experience of feeling supported and social identification can be better nurtured within remote contexts.
Abstract.
Orr N, Yeo NL, Dean SG, White MP, Garside R (2021). "It Makes you Feel That you Are There": Exploring the Acceptability of Virtual Reality Nature Environments for People with Memory Loss.
Geriatrics (Basel),
6(1).
Abstract:
"It Makes you Feel That you Are There": Exploring the Acceptability of Virtual Reality Nature Environments for People with Memory Loss.
Aim: to report on the acceptability of virtual reality (VR) nature environments for people with memory loss at memory cafes, and explore the experiences and perceptions of carers and staff. Methods: a qualitative study was conducted between January and March 2019. Ten adults with memory loss, eight carers and six volunteer staff were recruited from two memory cafes, located in Cornwall, UK. There were 19 VR sessions which were audio recorded and all participants were interviewed at the end of the sessions. Framework analysis was used to identify patterns and themes in the data. Results: During the VR experience, participants were engaged to varying degrees, with engagement facilitated by the researcher, and in some cases, with the help of a carer. Participants responded positively to the nature scenes, finding them soothing and evoking memories. The VR experience was positive; many felt immersed in nature and saw it as an opportunity to 'go somewhere'. However, it was not always positive and for a few, it could be 'strange'. Participants reflected on their experience of the VR equipment, and volunteer staff and carers also shared their perceptions of VR for people with dementia in long-term care settings. Conclusions: the VR nature experience was an opportunity for people with memory loss to be immersed in nature and offered the potential to enhance their quality of life. Future work should build on lessons learned and continue to work with people with dementia in developing and implementing VR technology in long-term care settings.
Abstract.
Author URL.
Calitri R, Carter M, Code C, Lamont R, Dean S, Tarrant M (2021). Challenges of Recruiting Patients into Group-Based Stroke Rehabilitation Research: Reflections on Clinician Equipoise Within the Singing for People with Aphasia (SPA) Pilot Trial.
Front Psychol,
12 Author URL.
Hale L, Devan H, Davies C, Dean SG, Dowell A, Grainger R, Gray AR, Hempel D, Ingham T, Jones B, et al (2021). Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain-protocol for a non-inferiority randomised controlled trial (iSelf-help trial).
BMJ Open,
11(2).
Abstract:
Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain-protocol for a non-inferiority randomised controlled trial (iSelf-help trial).
INTRODUCTION: Persistent non-cancer pain affects one in five adults and is more common in Māori-the Indigenous population of New Zealand (NZ), adults over 65 years, and people living in areas of high deprivation. Despite the evidence supporting multidisciplinary pain management programmes (PMPs), access to PMPs is poor due to long waiting lists. Although online-delivered PMPs enhance access, none have been codesigned with patients or compared with group-based, in-person PMPs. This non-inferiority trial aims to evaluate the clinical and cost-effectiveness of a cocreated, culturally appropriate, online-delivered PMP (iSelf-help) compared with in-person PMP in reducing pain-related disability. METHODS AND ANALYSIS: Mixed-methods, using a modified participatory action research (PAR) framework, involving three phases. Phase I involved cocreation and cultural appropriateness of iSelf-help by PAR team members. Phase II: the proposed iSelf-help trial is a pragmatic, multicentred, assessor-blinded, two-arm, parallel group, non-inferiority randomised controlled trial. Adults (n=180, age ≥18 years) with persistent non-cancer pain eligible for a PMP will be recruited and block randomised (with equal probabilities) to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help participants will participate in two 60-minute video-conferencing sessions weekly for 12 weeks with access to cocreated resources via smartphone application and a password-protected website. The control participants will receive group-based, in-person delivered PMP. Primary outcome is pain-related disability assessed via modified Roland Morris Disability Questionnaire at 6 months post intervention. Secondary outcomes include anxiety, depression, stress, pain severity, quality of life, acceptance, self-efficacy, catastrophising and fear avoidance. Data will be collected at baseline, after the 12-week intervention, and at 3 and 6 months post intervention. We will conduct economic analyses and mixed-method process evaluations (Phase IIA). ETHICS AND DISSEMINATION: the Health and Disability Ethics Committee approved the study protocol (HDEC18/CEN/162). Phase III involves dissemination of findings guided by the PAR team as outcomes become apparent. TRIAL REGISTRATION NUMBER: ACTRN 12619000771156.
Abstract.
Author URL.
Gaboury I, Tousignant M, Corriveau H, Menear M, Le Dorze G, Rochefort C, Vachon B, Rochette A, Gosselin S, Michaud F, et al (2021). Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial.
JMIR Res Protoc,
10(10).
Abstract:
Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial.
BACKGROUND: Strong evidence supports beginning stroke rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE: the aim of this study is to assess the impact of a telerehabilitation platform on stroke patients' adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. METHODS: in this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). RESULTS: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32134.
Abstract.
Author URL.
Darlow B, Abbott H, Bennell K, Briggs AM, Brown M, Clark J, Dean S, French S, Hinman RS, Krägeloh C, et al (2021). Knowledge about osteoarthritis: Development of the Hip and Knee Osteoarthritis Knowledge Scales and protocol for testing their measurement properties. Osteoarthritis and Cartilage Open, 3(2).
Tarrant M, Lamont RA, Carter M, Dean SG, Spicer S, Sanders A, Calitri R (2021). Measurement of Shared Social Identity in Singing Groups for People with Aphasia.
Frontiers in Psychology,
12Abstract:
Measurement of Shared Social Identity in Singing Groups for People with Aphasia
Community groups are commonly used as a mode of delivery of interventions for promoting health and well-being. Research has demonstrated that developing a sense of shared social identity with other group members is a key mechanism through which the health benefits of group membership are realized. However, there is little understanding of how shared social identity emerges within these therapeutic settings. Understanding the emergence of shared social identity may help researchers optimize interventions and improve health outcomes. Group-based singing activities encourage coordination and a shared experience, and are a potential platform for the development of shared social identity. We use the “Singing for People with Aphasia” (SPA) group intervention to explore whether group cohesiveness, as a behavioral proxy for shared social identity, can be observed and tracked across the intervention. Video recordings of group sessions from three separate programmes were rated according to the degree of cohesiveness exhibited by the group. For all treatment groups, the final group session evidenced reliably higher levels of cohesiveness than the first session (t values ranged from 4.27 to 7.07; all p values < 0.003). As well as providing confidence in the design and fidelity of this group-based singing intervention in terms of its capacity to build shared social identity, this evaluation highlighted the value of observational methods for the analysis of shared social identity in the context of group-based singing interventions.
Abstract.
Tarrant M, Carter M, Dean S, Taylor R, Warren F, Spencer A, Landa P, Adamson J, Code C, Backhouse A, et al (2021). Singing for people with aphasia (SPA): Results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility.
BMJ OpenAbstract:
Singing for people with aphasia (SPA): Results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility
Objectives: Pilot feasibility randomised controlled trial (RCT) for the ‘Singing groups for People with Aphasia’ (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved.
Design: a two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation.
Setting: Three community-based cohorts in the South-West of England.
Participants: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control.
Intervention: the manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack.
Outcome measures: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews.
Results: of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, Control=21); 36 participants (SPA=17, Control=19) completed 3-month follow-up, 34 (SPA=18, Control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified.
Conclusions: the SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable.
Abstract.
Dean S, Campbell J, Price L, Taylor A, Taylor RS, Ingram W, Dean SG, Jolly K, Mutrie N, Lambert J, et al (2020). A randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial. BJSM
Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, Mutrie N, Lambert J, Yardley L, Greaves C, et al (2020). Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT.
Health Technology Assessment,
24(63), 1-106.
Abstract:
Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT
. Background
. There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity.
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. Objectives
. To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes.
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. Design
. A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control).
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. Setting
. Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow.
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. Participants
. There were 450 participants aged 16–74 years, with a body mass index of 30–40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users.
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. Intervention
. e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven ‘steps to health’. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme.
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. Primary outcome measure
. Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day.
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. Secondary outcomes
. Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation.
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.
. Results
. Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval –2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval –£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year.
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. Limitations
. A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation.
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. Future work
. The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions.
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. Conclusions
. Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model.
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. Trial registration
. Current Controlled Trials ISRCTN15644451.
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. Funding
. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.
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Abstract.
Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, McClurg D, Abdel-Fattah M, Agur W, Andreis F, et al (2020). Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT.
Health Technol Assess,
24(70), 1-144.
Abstract:
Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT.
BACKGROUND: Urinary incontinence affects one in three women worldwide. Pelvic floor muscle training is an effective treatment. Electromyography biofeedback (providing visual or auditory feedback of internal muscle movement) is an adjunct that may improve outcomes. OBJECTIVES: to determine the clinical effectiveness and cost-effectiveness of biofeedback-mediated intensive pelvic floor muscle training (biofeedback pelvic floor muscle training) compared with basic pelvic floor muscle training for treating female stress urinary incontinence or mixed urinary incontinence. DESIGN: a multicentre, parallel-group randomised controlled trial of the clinical effectiveness and cost-effectiveness of biofeedback pelvic floor muscle training compared with basic pelvic floor muscle training, with a mixed-methods process evaluation and a longitudinal qualitative case study. Group allocation was by web-based application, with minimisation by urinary incontinence type, centre, age and baseline urinary incontinence severity. Participants, therapy providers and researchers were not blinded to group allocation. Six-month pelvic floor muscle assessments were conducted by a blinded assessor. SETTING: This trial was set in UK community and outpatient care settings. PARTICIPANTS: Women aged ≥ 18 years, with new stress urinary incontinence or mixed urinary incontinence. The following women were excluded: those with urgency urinary incontinence alone, those who had received formal instruction in pelvic floor muscle training in the previous year, those unable to contract their pelvic floor muscles, those pregnant or
Abstract.
Author URL.
Hagen S, Elders A, Stratton S, Sergenson N, Bugge C, Dean S, Hay-Smith J, Kilonzo M, Dimitrova M, Abdel-Fattah M, et al (2020). Effectiveness of pelvic floor muscle training with and without electromyography biofeedback for female urinary incontinence: multicentre randomised controlled trial. BMJ: British Medical Journal
Salmon VE, Hay-Smith EJC, Jarvie R, Dean S, Terry R, Frawley H, Oborn E, Bayliss SE, Bick D, Davenport C, et al (2020). Implementing pelvic floor muscle training in women's childbearing years: a critical interpretive synthesis of individual, professional, and service issues.
Neurourol Urodyn,
39(2), 863-870.
Abstract:
Implementing pelvic floor muscle training in women's childbearing years: a critical interpretive synthesis of individual, professional, and service issues.
AIMS: Antenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations. METHODS: Critical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT. RESULTS: Fifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over-arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers. CONCLUSION: Numerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low-risk, low-cost, and proven strategies as part of women's reproductive health.
Abstract.
Author URL.
Yeo NL, Elliott LR, Bethel A, White MP, Dean SG, Garside R (2020). Indoor Nature Interventions for Health and Wellbeing of Older Adults in Residential Settings: a Systematic Review.
Gerontologist,
60(3), e184-e199.
Abstract:
Indoor Nature Interventions for Health and Wellbeing of Older Adults in Residential Settings: a Systematic Review.
BACKGROUND AND OBJECTIVES: Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. RESEARCH DESIGN AND METHODS: Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. RESULTS: of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. DISCUSSION AND IMPLICATIONS: There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.
Abstract.
Author URL.
Day J, Dean SG, Reed N, Hazell J, Lang I (2020). Knowledge needs and use in long‐term care homes for older people: a qualitative interview study of managers’ views. Health & Social Care in the Community, 30(2), 592-601.
Long H (2020). Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research. BMJ Open, 10
Yeo NL, White MP, Alcock I, Garside R, Dean SG, Smalley AJ, Gatersleben B (2020). What is the best way of delivering virtual nature for improving mood? an experimental comparison of high definition TV, 360° video, and computer generated virtual reality. Journal of Environmental Psychology, 72, 101500-101500.
Abel GA, Gomez-Cano M, Mustafee N, Smart A, Fletcher E, Salisbury C, Chilvers R, Dean SG, Richards SH, Warren F, et al (2020). Workforce predictive risk modelling: development of a model to identify general practices at risk of a supply-demand imbalance.
BMJ Open,
10(1).
Abstract:
Workforce predictive risk modelling: development of a model to identify general practices at risk of a supply-demand imbalance.
OBJECTIVE: This study aimed to develop a risk prediction model identifying general practices at risk of workforce supply-demand imbalance. DESIGN: This is a secondary analysis of routine data on general practice workforce, patient experience and registered populations (2012 to 2016), combined with a census of general practitioners' (GPs') career intentions (2016). SETTING/PARTICIPANTS: a hybrid approach was used to develop a model to predict workforce supply-demand imbalance based on practice factors using historical data (2012-2016) on all general practices in England (with over 1000 registered patients n=6398). The model was applied to current data (2016) to explore future risk for practices in South West England (n=368). PRIMARY OUTCOME MEASURE: the primary outcome was a practice being in a state of workforce supply-demand imbalance operationally defined as being in the lowest third nationally of access scores according to the General Practice Patient Survey and the highest third nationally according to list size per full-time equivalent GP (weighted to the demographic distribution of registered patients and adjusted for deprivation). RESULTS: Based on historical data, the predictive model had fair to good discriminatory ability to predict which practices faced supply-demand imbalance (area under receiver operating characteristic curve=0.755). Predictions using current data suggested that, on average, practices at highest risk of future supply-demand imbalance are currently characterised by having larger patient lists, employing more nurses, serving more deprived and younger populations, and having considerably worse patient experience ratings when compared with other practices. Incorporating findings from a survey of GP's career intentions made little difference to predictions of future supply-demand risk status when compared with expected future workforce projections based only on routinely available data on GPs' gender and age. CONCLUSIONS: it is possible to make reasonable predictions of an individual general practice's future risk of undersupply of GP workforce with respect to its patient population. However, the predictions are inherently limited by the data available.
Abstract.
Author URL.
Terry R, Jarvie R, Hay-Smith J, Salmon V, Pearson M, Boddy K, MacArthur C, Dean S (2020). “Are you doing your pelvic floor?” an ethnographic exploration of the interaction between women and midwives about pelvic floor muscle exercises (PFME) during pregnancy. Midwifery, 83, 102647-102647.
Hagen S, McClurg D, Bugge C, Hay-Smith J, Dean SG, Elders A, Glazener C, Abdel-Fattah M, Agur WI, Booth J, et al (2019). Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: Protocol for the OPAL randomised trial.
BMJ Open,
9(2).
Abstract:
Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: Protocol for the OPAL randomised trial
Introduction Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. Methods and analysis This multicentre randomised controlled trial will compare the effectiveness and cost-effectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. Ethics and dissemination Approval granted by the West of Scotland Research Ethics Committee 4 (16/LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. Trial registration number ISRCTN57746448; Pre-results.
Abstract.
Grant A, Dean S, Hay-Smith J, Hagen S, McClurg D, Taylor A, Kovandzic M, Bugge C (2019). Effectiveness and cost-effectiveness randomised controlled trial of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: Protocol for the OPAL (optimising pelvic floor exercises to achieve long-term benefits) trial mixed methods longitudinal qualitative case study and process evaluation.
BMJ Open,
9(2).
Abstract:
Effectiveness and cost-effectiveness randomised controlled trial of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: Protocol for the OPAL (optimising pelvic floor exercises to achieve long-term benefits) trial mixed methods longitudinal qualitative case study and process evaluation
Introduction Female urinary incontinence (UI) is common affecting up to 45% of women. Pelvic floor muscle training (PFMT) is the first-line treatment but there is uncertainty whether intensive PFMT is better than basic PFMT for long-term symptomatic improvement. It is also unclear which factors influence women's ability to perform PFMT long term and whether this has impacts on long-term outcomes. OPAL (optimising PFMT to achieve long-term benefits) trial examines the effectiveness and cost-effectiveness of basic PFMT versus biofeedback-mediated PFMT and this evaluation explores women's experiences of treatment and the factors which influence effectiveness. This will provide data aiding interpretation of the trial findings; make recommendations for optimising the treatment protocol; support implementation in practice; and address gaps in the literature around long-term adherence to PFMT for women with stress or mixed UI. Methods and analysis This evaluation comprises a longitudinal qualitative case study and process evaluation (PE). The case study aims to explore women's experiences of treatment and adherence and the PE will explore factors influencing intervention effectiveness. The case study has a two-tailed design and will recruit 40 women, 20 from each trial group; they will be interviewed four times over 2 years. Process data will be collected from women through questionnaires at four time-points, from health professionals through checklists and interviews and by sampling 100 audio recordings of appointments. Qualitative analysis will use case study methodology (qualitative study) and the framework technique (PE) and will interrogate for similarities and differences between the trial groups regarding barriers and facilitators to adherence. Process data analyses will examine fidelity, engagement and mediating factors using descriptive and interpretative statistics. Ethics and dissemination Approval from West of Scotland Research Ethics Committee 4 (16/LO/0990). Findings will be published in journals, disseminated at conferences and through the final report. Trial registration number ISRCTN57746448.
Abstract.
(2019). ICS 2019 Gothenburg Scientific Programme. Neurourology and Urodynamics, 38(S3).
Dean S, Poltawski L, Warmoth K, Goodwin V, Stiles V, Taylor R (2019). Independently Getting Off the floor (IGO): a feasibility study of teaching people with stroke to get up after a fall. International Journal of Therapy and Rehabilitation, 26
Campbell JL, Fletcher E, Abel G, Anderson R, Chilvers R, Dean SG, Richards SH, Sansom A, Terry R, Aylward A, et al (2019). Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study.
Health Services and Delivery Research,
7(14), 1-288.
Abstract:
Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study
BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) to identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) to consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Abstract.
Darlow B, Stanley J, Dean S, Haxby Abbott J, Garrett S, Wilson R, Mathieson F, Dowell A (2019). The fear reduction exercised early (free) approach to management of low back pain in general practice: a pragmatic cluster-randomised controlled trial.
PLoS Medicine,
16(9).
Abstract:
The fear reduction exercised early (free) approach to management of low back pain in general practice: a pragmatic cluster-randomised controlled trial
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.
Abstract.
Dean S, Poltawski L, Forster A, Taylor RS, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd AI, et al (2018). Community-based Rehabilitation Training after stroke: Results of a pilot randomised controlled trial (ReTrain) investigating acceptability and feasibility. BMJ Open
Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, et al (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial.
The Lancet Child and Adolescent Health,
2(1), 35-45.
Abstract:
Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial
Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades, scarce evidence exists for effective preventive strategies. We aimed to establish whether a school-based intervention for children aged 9–10 years would prevent excessive weight gain after 24 months. Methods This pragmatic cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a school-based obesity prevention intervention, was done in 32 schools in southwest England. All state-run primary and junior schools in Devon and Plymouth (UK) with enough pupils for at least one year-5 class were eligible. Schools were assigned (1:1) using a computer-generated sequence to either intervention or control, stratified by the number of year-5 classes (one vs more than one) and the proportion of children eligible for free school meals (
Abstract.
Ingram W, Webb D, Taylor RS, Anokye N, Yardley L, Jolly K, Mutrie N, Campbell JL, Dean SG, Greaves C, et al (2018). Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial.
BMJ Open,
8(9).
Abstract:
Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial.
INTRODUCTION: Physical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence.This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective. METHODS AND ANALYSIS: a multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK.The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months.We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36-39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions. ETHICS AND DISSEMINATION: Approved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals.Results will be disseminated to ERS services, primary healthcare providers and trial participants. TRIAL REGISTRATION NUMBER: ISRCTN15644451; Pre-results.
Abstract.
Author URL.
Sansom A, Terry R, Fletcher E, Salisbury C, Long L, Richards SH, Aylward A, Welsman J, Sims L, Campbell JL, et al (2018). Why do GPs leave direct patient care and what might help to retain them? a qualitative study of GPs in South West England.
BMJ Open,
8Abstract:
Why do GPs leave direct patient care and what might help to retain them? a qualitative study of GPs in South West England
Objective to identify factors influencing general practitioners’ (GPs’) decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role. Design Qualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care. Setting South West England, UK. Participants 41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles. Results Reasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs’ thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today’s National Health Service for this group of GPs. Conclusion Future policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs’ perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs’ concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care.
Abstract.
Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, Cowie A, Zawada A, Taylor RS (2017). Home-based versus centre-based cardiac rehabilitation.
Cochrane Database Syst Rev,
6(6).
Abstract:
Home-based versus centre-based cardiac rehabilitation.
BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. OBJECTIVES: to compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. MAIN RESULTS: We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = -0.13, 95% CI -0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health-related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home-based participants. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- and centre-based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in the included short-term trials can be confirmed in the longer term and need to consider adequately powered non-inferiority or equivalence study designs.
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Author URL.
Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, Wyatt KM (2017). Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation.
Int J Behav Nutr Phys Act,
14(1).
Abstract:
Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation.
BACKGROUND: the Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9-10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. This paper reports on both the quantitative and qualitative data regarding the implementation of the HeLP intervention in the definitive cluster randomised controlled trial, which was part of the wider process evaluation. METHODS: Mixed methods were used to collect data on intervention uptake, fidelity of delivery in terms of content and quality of delivery of the intervention, as well as school and child engagement with the programme. Data were collected using registers of attendance, observations and checklists, field notes, focus groups with children and semi-structured interviews with teachers. Qualitative data were analysed thematically and quantitative data were summarized using descriptive statistics. RESULTS: all 16 intervention schools received a complete or near complete programme (94-100%), which was delivered in the spirit in which it had been designed. of the 676 children in the intervention schools, over 90% of children participated in each phase of HeLP; 92% of children across the socio-economic spectrum were deemed to be engaged with HeLP and qualitative data revealed a high level of enjoyment by all children, particularly to the interactive drama workshops. Further evidence of child engagment with the programme was demonstrated by children's clear understanding of programme messages around marketing, moderation and food labelling. Thirteen of the intervention schools were deemed to be fully engaged with HeLP and qualitative data revealed a high level of teacher 'buy in', due to the programme's compatability with the National Curriculum, level of teacher support and use of innovative and creative delivery methods by external drama practitioners. CONCLUSION: Our trial shows that it is possible to successfully scale up complex school-based interventions, engage schools and children across the socio-economic spectrum and deliver an intervention as designed. As programme integrity was maintained throughout the HeLP trial, across all intervention schools, we can be confident that the trial findings are a true reflection of the effectiveness of the intervention, enabling policy recommendations to be made. TRIAL REGISTRATION: ISRCTN15811706.
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Author URL.
Frawley HC, Dean SG, Slade SC, Hay-Smith EJC (2017). Is Pelvic-Floor Muscle Training a Physical Therapy or a Behavioral Therapy? a Call to Name and Report the Physical, Cognitive, and Behavioral Elements.
PHYSICAL THERAPY,
97(4), 425-437.
Author URL.
Salmon VE, Hay-Smith EJC, Jarvie R, Dean S, Oborn E, Bayliss SE, Bick D, Davenport C, Ismail KM, MacArthur C, et al (2017). Opportunities, challenges and concerns for the implementation and uptake of pelvic floor muscle assessment and exercises during the childbearing years: protocol for a critical interpretive synthesis.
Syst Rev,
6(1).
Abstract:
Opportunities, challenges and concerns for the implementation and uptake of pelvic floor muscle assessment and exercises during the childbearing years: protocol for a critical interpretive synthesis.
BACKGROUND: Pregnancy and childbirth are important risk factors for urinary incontinence (UI) in women. Pelvic floor muscle exercises (PFME) are effective for prevention of UI. Guidelines for the management of UI recommend offering pelvic floor muscle training (PFMT) to women during their first pregnancy as a preventive strategy. The objective of this review is to understand the relationships between individual, professional, inter-professional and organisational opportunities, challenges and concerns that could be essential to maximise the impact of PFMT during childbearing years and to effect the required behaviour change. METHODS: Following systematic searches to identify sources for inclusion, we shall use a critical interpretive synthesis (CIS) approach to produce a conceptual model, mapping the relationships between individual, professional, inter-professional and organisational factors and the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. Purposive sampling will be used to identify potentially relevant material relating to topics or areas of interest which emerge as the review progresses. A wide range of empirical and non-empirical sources will be eligible for inclusion to encompass the breadth of relevant individual, professional, inter-professional and organisational issues relating to PFME during childbearing years. Data analysis and synthesis will identify key themes, concepts, connections and relationships between these themes. Findings will be interpreted in relation to existing frameworks of implementation, attitudes and beliefs of individuals and behaviour change. We will collate examples to illustrate relationships expressed in the conceptual model and identify potential links between the model and drivers for change. DISCUSSION: the CIS review findings and resulting conceptual model will illustrate relationships between factors that might affect the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. The model will inform the development and evaluation of a training package to support midwives with implementation and delivery of effective PFME during the antenatal period. The review forms part of the first phase of the United Kingdom National Institute for Health Research funded 'Antenatal Preventative Pelvic floor Exercises and Localisation (APPEAL)' programme (grant number: RP-PG-0514-20002) to prevent poor health linked to pregnancy and childbirth-related UI. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42016042792.
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Author URL.
Fletcher E, Abel GA, Anderson R, Richards SH, Salisbury C, Dean SG, Sansom A, Warren FC, Campbell JL (2017). Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners.
BMJ Open,
7(4).
Abstract:
Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners.
OBJECTIVE: Given recent concerns regarding general practitioner (GP) workforce capacity, we aimed to describe GPs' career intentions, especially those which might impact on GP workforce availability over the next 5 years. DESIGN: Census survey, conducted between April and June 2016 using postal and online responses , of all GPs on the National Health Service performers list and eligible to practise in primary care. Two reminders were used as necessary. SETTING: South West England (population 3.5 million), a region with low overall socioeconomic deprivation. PARTICIPANTS: Eligible GPs were 2248 out of 3370 (67 % response rate). MAIN OUTCOME MEASURES: Reported likelihood of permanently leaving or reducing hours spent in direct patient care or of taking a career break within the next 5 years and present morale weighted for non-response. RESULTS: Responders included 217 7 GPs engaged in patient care. of these, 863 (37% weighted, 95% CI 35 % to 39 %) reported a high likelihood of quitting direct patient care within the next 5 years. Overall, 1535 (70% weighted, 95% CI 68 % to 72 %) respondents reported a career intention that would negatively impact GP workforce capacity over the next 5 years, through permanently leaving or reducing hours spent in direct patient care, or through taking a career break. GP age was an important predictor of career intentions; sharp increases in the proportion of GPs intending to quit patient care were evident from 52 years. Only 305 (14% weighted, 95% CI 13 % to 16 %) reported high morale, while 1195 ( 54 % weighted, 95% CI 52 % to 56 %) reported low morale. Low morale was particularly common among GP partners. Current morale strongly predicted GPs' career intentions; those with very low morale were particularly likely to report intentions to quit patient care or to take a career break. CONCLUSIONS: a substantial majority of GPs in South West England report low morale. Many are considering career intentions which, if implemented, would adversely impact GP workforce capacity within a short time period. STUDY REGISTRATION: NIHR HS&DR - 14/196/02, UKCRN ID 20700.
Abstract.
Author URL.
Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Mathieson F, Dowell A (2017). The Fear Reduction Exercised Early (FREE) approach to low back pain: study protocol for a randomised controlled trial.
TRIALS,
18 Author URL.
Lloyd J, Creanor S, Price LRS, Abraham C, Dean S, Green C, Hillsdon M, Pearson V, Taylor R, Tomlinson R, et al (2017). Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health
Tarrant M, Warmoth K, Code C, Dean S, Goodwin V, Stein, Sugavanam T (2016). Creating psychological connections between intervention recipients: Development and focus group evaluation of a group singing session for people with aphasia.
BMJ Open,
6, e009652-e009652.
Abstract:
Creating psychological connections between intervention recipients: Development and focus group evaluation of a group singing session for people with aphasia
Objectives: the study sought to identify key design features that could be used to create a new framework for group-based health interventions. We designed and tested the first session of a group intervention for stroke survivors with aphasia which was aimed at nurturing new psychological connections between group members.
Setting: the intervention session, a participant focus group and interviews with intervention facilitators were held in a local community music centre in the South West of England.
Participants: a convenience sample of ten community-dwelling people with post-stroke aphasia participated in the session. Severity of aphasia was not considered for inclusion.
Intervention: Participants took part in a 90-minute group singing session which involved singing songs from a specially-prepared song book. Musical accompaniment was provided by the facilitators.
Primary and secondary outcome measures: Participants and group facilitators reported their experiences of participating in the session, with a focus on activities within the session related to the intervention aims. Researcher observations of the session were also made.
Results: Two themes emerged from the analysis, concerning experiences of the session (“developing a sense of group belonging”) and perceptions of its design and delivery (“creating the conditions for engagement”). Participants described an emerging sense of shared social identity as a member of the intervention group and identified fixed (e.g. group size, session breaks) and flexible (e.g. facilitator responsiveness) features of the session which contributed to this emergence. Facilitator interviews and researcher observations corroborated and expanded participant reports.
Conclusions: Engagement with health intervention content may be enhanced in group settings when intervention participants begin to establish positive and meaningful psychological connections with other group members. Understanding and actively nurturing these connections should be a core feature of a general framework for the design and delivery of group interventions.
Abstract.
Creanor S, Lloyd J, Hillsdon M, Dean S, Green C, Taylor RS, Ryan E, Wyatt K, HeLP Trial Management Group (2016). Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children.
Trials,
17(1).
Abstract:
Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children.
BACKGROUND: the Healthy Lifestyles Programme (HeLP) trial is being conducted to determine whether a novel school-based intervention is effective and cost-effective in preventing obesity in 9-10 year-old children. This article describes the detailed statistical analysis plan for the HeLP trial, including an amendment (and rationale for amendment) made to originally planned sensitivity analyses. METHODS AND DESIGN: the HeLP trial is a definitive, pragmatic, superiority, cluster randomised controlled trial with two parallel groups and blinded outcome assessment. This update article describes in detail (1) the primary and secondary outcomes, (2) the statistical analysis principles (including which children will be included in each analysis, how the clustered nature of the study design will be accounted for, which covariates will be included in each analysis, how the results will be presented), (3) planned sensitivity analyses, planned subgroup analyses and planned adherence-adjusted analyses for the primary outcome, (4) planned analyses for the secondary outcomes and (e) planned longitudinal analyses. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN15811706. Registered on 1 May 2012.
Abstract.
Author URL.
Hay-Smith EJC, McClurg D, Frawley H, Dean SG (2016). Exercise adherence: Integrating theory, evidence and behaviour change techniques. Physiotherapy (United Kingdom), 102(1), 7-9.
Zwisler AD, Norton RJ, Dean SG, Dalal H, Tang LH, Wingham J, Taylor RS (2016). Home-based cardiac rehabilitation for people with heart failure: a systematic review and meta-analysis.
International Journal of Cardiology,
221, 963-969.
Abstract:
Home-based cardiac rehabilitation for people with heart failure: a systematic review and meta-analysis
Aims to assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. Methods Randomised controlled trials were initially identified from previous systematic reviews of CR. We undertook updated literature searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Library to December 2015. A total of 19 trials with median follow up of 3 months were included — 17 comparisons of home-based CR to usual care (995 patients) and four comparing home and centre-based CR (295 patients). Results Compared to usual care, home-based CR improved VO2max (mean difference: 1.6 ml/kg/min, 0.8 to 2.4) and total Minnesota Living with Quality of Life score (− 3.3, − 7.5 to 1.0), with no difference in mortality, hospitalisation or study drop out. Outcomes and costs were similar between home-based and centre-based CR with the exception of higher levels of trial completion in the home-based group (relative risk: 1.2, 1.0 to 1.3). Conclusions Home-based CR results in short-term improvements in exercise capacity and health-related quality of life of heart failure patients compared to usual care. The magnitude of outcome improvement is similar to centre-based CR. Home-based CR appears to be safe with no evidence of increased risk of hospitalisation or death. These findings support the provision of home-based CR for heart failure as an evidence-based alternative to the traditional centre-based model of provision.
Abstract.
Darlow B, Perry M, Dean S, Mathieson F, Baxter GD, Dowell A (2016). Putting Physical Activity While Experiencing Low Back Pain in Context: Balancing the Risks and Benefits.
Arch Phys Med Rehabil,
97(2), 245-251.e7.
Abstract:
Putting Physical Activity While Experiencing Low Back Pain in Context: Balancing the Risks and Benefits.
OBJECTIVE: to analyze attitudes and beliefs about movement and physical activity in people with low back pain (LBP) and compare these beliefs between people with acute and chronic LBP. DESIGN: Qualitative inductive analysis of data collected via face-to-face semistructured interviews. Interviews were audio-recorded and transcribed verbatim. SETTING: Participants were purposively recruited from 1 region of New Zealand. PARTICIPANTS: Persons with LBP (N=23), consisting of individuals with acute LBP (3mo; n=11). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Themes that emerged from participant interview transcripts using analysis based on Interpretative Description. RESULTS: Participants with acute and chronic LBP made judgments about physical activity and rest using the same conceptual model. Concerns about creating more pain, tissue damage, or impairment influenced the physical activity judgments of most participants with acute and chronic LBP. These perceived risks were balanced against the perceived benefits, the most important of which were psychological or social rather than physical. Judgments made by those with acute and chronic LBP were context dependent and influenced by the nature and duration of pain, the type of physical activity, the importance of the activity, and the participant's previous experience. Participants with acute pain who had not experienced back pain previously often expressed more uncertainty, whereas those with chronic LBP appeared to have developed cognitive rules that determined physical activity decisions. CONCLUSIONS: Exploring the perceived risks, benefits, and contextual factors that influence decisions about physical activity and rest may help clinicians to understand the behavior of patients with acute and chronic LBP. Clinicians may best support their patients to engage in physical activity by providing an informed assessment of risks and an explanation about the range of potential benefits.
Abstract.
Author URL.
Perry M, Dean S, Devan H (2016). The relationship between chronic low back pain and fatigue: a systematic review.
Physical Therapy Reviews,
21(3-6), 173-183.
Abstract:
The relationship between chronic low back pain and fatigue: a systematic review
Background: Fatigue is a common non-specific symptom in the general population. The association between fatigue and pain is high and people with chronic conditions and/or pain report high prevalence of fatigue. Individuals with chronic low back pain (CLBP) often experience fatigue symptoms and those who experience fatigue are more likely to have restricted physical functioning. It is important to clarify the association between CLBP and fatigue in order to devise management strategies which alleviate and/or manage fatigue symptoms while improving physical functioning in individuals with CLBP. Objectives: the main aim of this systematic review is to determine the level of evidence supporting the association between self-reports of LBP and fatigue in individuals with CLBP. Methods: Major electronic databases were searched since inception till April 2016. Studies comparing the association between CLBP and general fatigue were included. Results: Considerable heterogeneity in the included studies precluded a meta-analysis. Five studies were included for final descriptive synthesis. There is very limited evidence to support the association between presence of CLBP and fatigue. There is moderate evidence to support the association between CLBP intensity and/or CLBP functional disability and fatigue. Conclusion: the association between fatigue and CLBP is under researched although there is moderate association between CLBP intensity and CLBP disability with fatigue. Fatigue is an important symptom that should be considered in the assessment and management of patients with CLBP.
Abstract.
Dumoulin C, Hay-Smith J, Frawley H, Mcclurg D, Alewijnse D, Bo K, Burgio K, Chen S-Y, Chiarelli P, Dean S, et al (2015). 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar.
Neurourology and UrodynamicsAbstract:
2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar
Aims: to summarize the findings and "expert-panel" consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. Methods: Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. Results: Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. Conclusion: Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.
Abstract.
Dumoulin C, Hay-Smith J, Frawley H, McClurg D, Alewijnse D, Bo K, Burgio K, Chen SY, Chiarelli P, Dean S, et al (2015). 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar.
Neurourology and Urodynamics,
34(7), 600-605.
Abstract:
2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar
Aims to summarize the findings and "expert-panel" consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. Methods Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. Results Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. Conclusion Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.
Abstract.
Norris M, Poltawski L, Dean S (2015). Developing a model of fidelity for physical rehabilitation research. Physiotherapy, 101, e1106-e1107.
Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A (2015). Easy to Harm, Hard to Heal <i>Patient Views About the Back</i>.
SPINE,
40(11), 842-850.
Author URL.
Hay-Smith J, Dean S, Frawley H, McClurg D, Dumoulin C (2015). Exercise adherence: integrating theory, evidence and behaviour change techniques. Physiotherapy, 101, e9-e10.
Levack WMM, Weatherall M, Hay-Smith EJC, Dean SG, McPherson K, Siegert RJ (2015). Goal setting and activities to enhance goal pursuit for adults with acquired disabilities participating in rehabilitation. Cochrane Database of Systematic Reviews
Taylor RS, Dalal H, Jolly K, Zawada A, Dean SG, Cowie A, Norton RJ (2015). Home-based versus centre-based cardiac rehabilitation.
Cochrane Database Syst Rev(8).
Abstract:
Home-based versus centre-based cardiac rehabilitation.
BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review originally published in 2009. OBJECTIVES: to compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: to update searches from the previous Cochrane review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1 2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked reference lists of included trials and recent systematic reviews. No language restrictions were applied. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction (MI), angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the eligibility of the identified trials and data were extracted by a single author and checked by a second. Authors were contacted where possible to obtain missing information. MAIN RESULTS: Seventeen trials included a total of 2172 participants undergoing cardiac rehabilitation following an acute MI or revascularisation, or with heart failure. This update included an additional five trials on 345 patients with heart failure. Authors of a number of included trials failed to give sufficient detail to assess their potential risk of bias, and details of generation and concealment of random allocation sequence were particularly poorly reported. In the main, no difference was seen between home- and centre-based cardiac rehabilitation in outcomes up to 12 months of follow up: mortality (relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P = 0.46, fixed-effect), cardiac events (data not poolable), exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P = 0.29, random-effects), modifiable risk factors (total cholesterol: mean difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47, random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L, 95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure: mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92, random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79 to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not poolable). Small outcome differences in favour of centre-based participants were seen in high density lipoprotein cholesterol (MD = -0.07 mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides (MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect, diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P = 0.0009, fixed-effect). In contrast, in home-based participants, there was evidence of a marginally higher levels of programme completion (RR = 1.04, 95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the programme (not poolable). No consistent difference was seen in healthcare costs between the two forms of cardiac rehabilitation. AUTHORS' CONCLUSIONS: This updated review supports the conclusions of the previous version of this review that home- and centre-based forms of cardiac rehabilitation seem to be equally effective for improving the clinical and health-related quality of life outcomes in low risk patients after MI or revascularisation, or with heart failure. This finding, together with the absence of evidence of important differences in healthcare costs between the two approaches, supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme should reflect the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in these short-term trials can be confirmed in the longer term. A number of studies failed to give sufficient detail to assess their risk of bias.
Abstract.
Author URL.
McClurg D, Frawley H, Hay-Smith J, Dean S, Chen S-Y, Chiarelli P, Mair F, Dumoulin C (2015). Limited effects from limited adherence: using behavioural theory to underpin pelvic floor muscle training programs and outcomes. Physiotherapy, 101, e970-e971.
Darlow B, Dean S, Perry M, Mathieson F, Stanley J, Melloh M, Baxter GD, Dowell A (2015). Low back pain: exploring underlying beliefs and how these have been influenced. Physiotherapy, 101, e295-e296.
Poltawski L, Boddy K, Forster A, Goodwin VA, Pavey AC, Dean S (2015). Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes.
Disabil Rehabil,
37(9), 795-801.
Abstract:
Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes.
PURPOSE: Exercise-after-stroke programmes are increasingly being provided to encourage more physical exercise among stroke survivors, but little is known about what motivates people with stroke to participate in them. This research aimed to identify factors that motivate long-term stroke survivors to exercise, and the implications for programme design. METHODS: in two separate studies, focus groups and individual interviews were used to investigate the views of long-term stroke survivors on exercise and participating in exercise programmes. Their data were analysed thematically, and the findings of the studies were synthesised. RESULTS: Eleven stroke survivors and two partners took part in two focus groups; six other stroke survivors (one with a partner) were interviewed individually. Factors reported to influence motivation were the psychological benefits of exercise, a desire to move away from a medicalised approach to exercise, beliefs about stroke recovery, and on-going support to sustain commitment. A number of potential implications of these themes for exercise programme design were identified. CONCLUSIONS: a range of personal beliefs and attitudes and external factors may affect the motivation to exercise, and these vary between individuals. Addressing these factors in the design of exercise programmes for long-term stroke survivors may enhance their appeal and so encourage greater engagement in exercise. IMPLICATIONS FOR REHABILITATION: Exercise programmes may be more attractive to long-term stroke survivors if the psychological well-being benefits of participation are emphasised in their promotion. Some participants will be more attracted by programmes that are de-medicalised, for example, by being located away from clinical settings, and led by or involving suitably-trained non-clinicians. Programmes offered in different formats may attract stroke survivors with different beliefs about the value of exercise in stroke recovery. Programmes should provide explicit support strategies for on-going engagement in exercise.
Abstract.
Author URL.
Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, Herbert J, Hay-Smith J, Frawley H, McClurg D, et al (2015). Pelvic-floor-muscle training adherence: Tools, measurements and strategies - 2011 ICS State-of-the-Science Seminar Research Paper II of IV.
Neurourology and Urodynamics,
34(7), 615-621.
Abstract:
Pelvic-floor-muscle training adherence: Tools, measurements and strategies - 2011 ICS State-of-the-Science Seminar Research Paper II of IV
Aims This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. Method Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. Results the literature was scarce for most of the studied populations except for limited research on women with UI. Outcome measures: Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. Strategies: Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. Conclusion the literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
Abstract.
Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, Herbert J, Hay-Smith J, Frawley H, Mcclurg D, et al (2015). Pelvic-floor-muscle training adherence: Tools, measurements and strategies-2011 ICS State-of-the-Science Seminar research paper II.
Neurourology and UrodynamicsAbstract:
Pelvic-floor-muscle training adherence: Tools, measurements and strategies-2011 ICS State-of-the-Science Seminar research paper II
Aims: This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. Method: Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. Results: the literature was scarce for most of the studied populations except for limited research on women with UI. Outcome measures: Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. Strategies: Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. Conclusion: the literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
Abstract.
Hay-Smith J, Dean S, Burgio K, McClurg D, Frawley H, Dumoulin C (2015). Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies - 2011 ICS State-of-the-Science Seminar research paper III of IV.
Neurourology and Urodynamics,
34(7), 622-631.
Abstract:
Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies - 2011 ICS State-of-the-Science Seminar research paper III of IV
Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing "modifiers" of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six "modifiers" of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the "modifiers" of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.
Abstract.
Hay-Smith J, Dean S, Burgio K, Mcclurg D, Frawley H, Dumoulin C (2015). Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies-2011 ICS State-of-the-Science Seminar research paper III of IV.
Neurourology and UrodynamicsAbstract:
Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies-2011 ICS State-of-the-Science Seminar research paper III of IV
Aims: This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods: Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing "modifiers" of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results: Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six "modifiers" of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions: Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the "modifiers" of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.
Abstract.
Mcclurg D, Frawley H, Hay-Smith J, Dean S, Chen S-Y, Chiarelli P, Mair F, Dumoulin C (2015). Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS State-of-the-Science Seminar research paper I of IV.
Neurourology and UrodynamicsAbstract:
Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS State-of-the-Science Seminar research paper I of IV
Aims: This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods: Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results: a brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion: a better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g. perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.
Abstract.
McClurg D, Frawley H, Hay-Smith J, Dean S, Chen SY, Chiarelli P, Mair F, Dumoulin C (2015). Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ics state-of-the-science seminar research paper i of iv.
Neurourology and Urodynamics,
34(7), 606-614.
Abstract:
Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ics state-of-the-science seminar research paper i of iv
Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results a brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion a better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g. perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.
Abstract.
Bollen JC, Dean SG, Siegert RJ, Howe TE, Goodwin VA (2014). A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties.
BMJ Open,
4(6).
Abstract:
A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties.
BACKGROUND: Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises. OBJECTIVES: a systematic review was conducted to establish what measures were available and to evaluate their psychometric properties. DATA SOURCES: MEDLINE, EMBASE, PsycINFO CINAHL (June 2013) and the Cochrane library were searched (September 2013). Reference lists from articles meeting the inclusion criteria were checked to ensure all relevant papers were included. STUDY SELECTION: to be included articles had to be available in English; use a self-report measure of adherence in relation to a prescribed but unsupervised home-based exercise or physical rehabilitation programme; involve participants over the age of 18. All health conditions and clinical populations were included. DATA EXTRACTION: Descriptive data reported were collated on a data extraction sheet. The measures were evaluated in terms of eight psychometric quality criteria. RESULTS: 58 studies were included, reporting 61 different measures including 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Only two measures scored positively for one psychometric property (content validity). The majority of measures had no reported validity or reliability testing. CONCLUSIONS: the results expose a gap in the literature for well-developed measures that capture self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises.
Abstract.
Author URL.
Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A (2014). Acute low back pain management in general practice: Uncertainty and conflicting certainties.
Journal of Family Practice,
31(6), 723-732.
Abstract:
Acute low back pain management in general practice: Uncertainty and conflicting certainties
Background. Low back pain (LBP) is a significant health problem and common reason to visit the GP. Evidence suggests GPs experience difficulty applying evidence-based guidelines. Objective. Explore GPs' underlying beliefs about acute LBP and how these influence their clinical management of patients. Methods. Eleven GPs from one geographical region within New Zealand were recruited by purposive sampling. Audio recordings of semi-structured qualitative interviews were transcribed verbatim. Data were analysed with an Interpretive Description framework. Results. Four key themes emerged related to the causes of acute LBP, GP confidence, communicating diagnostic uncertainty and encouraging movement and activity. Acute LBP was seen as a direct representation of tissue injury, consequently the assessment and management of patients' attitudes and beliefs was not a priority. Participants' confidence was decreased due to a perceived inability to diagnose or influence the tissue injury. Despite this, diagnoses were provided to patients to provide reassurance and meet expectations. Guideline recommendations regarding activity conflicted with a perceived need to protect damaged tissue, resulting in reported provision of mixed messages about the need to be both active and careful. Conclusions. GPs' initial focus upon tissue injury during acute care, and providing a diagnostic label, may influence patients' subsequent alignment with a biomedical perspective and contribute to consultation conflict and patients' perception of blame when discussion of psychosocial influences is introduced. Demonstrating the relevance of the biopsychosocial model to acute LBP may improve GPs' alignment with guidelines, improve their confidence to manage these patients and ultimately improve outcomes.
Abstract.
Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A (2014). Acute low back pain management in general practice: uncertainty and conflicting certainties. Family Practice
Norman S, Dean S, Hansford L, Ford T (2014). Clinical practitioner's attitudes towards the use of Routine Outcome Monitoring within Child and Adolescent Mental Health Services: a qualitative study of two Child and Adolescent Mental Health Services.
Clin Child Psychol Psychiatry,
19(4), 576-595.
Abstract:
Clinical practitioner's attitudes towards the use of Routine Outcome Monitoring within Child and Adolescent Mental Health Services: a qualitative study of two Child and Adolescent Mental Health Services.
Routine Outcome Monitoring (ROM) is held as a greatly important part of practice across many Health Care Services, both in the NHS and in private practice. Yet despite this, there has been little research into the attitudes of practitioners towards ROM. This paper looks at the attitudes of 50 clinicians from two Child and Adolescent Mental Health Services in greater London. The findings showed that although the practitioners were not overwhelming positive in their attitudes to ROM, neither were they overwhelming negative, and many of their concerns involved practical issues surrounding ROM that are potentially soluble. Practitioner engagement in ROM is key if ROM is to be used constructively to reflect on practice.
Abstract.
Author URL.
Cross B, Dean S, Hay-Smith J, Weatherall M (2014). Fear avoidance beliefs, held by occupational therapists, are associated with treatment recommendations.
British Journal of Occupational Therapy,
77(6), 304-312.
Abstract:
Fear avoidance beliefs, held by occupational therapists, are associated with treatment recommendations
Introduction: the purpose of this research was to explore whether New Zealand occupational therapists' recommendations for chronic low back pain are predicted by their fear avoidance beliefs. Method: in an online survey, 63 therapists rated the strength of recommendation on a four-point Likert scale (for each of: home help, equipment provision, and environmental modification) for a case study of low back pain, and completed two questionnaires about fear avoidance beliefs. The strength of recommendation (definitely not, not likely, likely, definitely yes) was analysed as an ordinal scale response variable, with important predictors each of the Fear Avoidance Beliefs Tool and the Health Care Providers Pain and Impairment Relationship Scale. Potential confounding variables were: Age, years in practice or pain practice, and receipt of extra pain education. The main response variable was the probability of recommending home help. Analysis was by proportional odds regression. Findings: 54/63 (85.7%) of the surveys had complete data. The adjusted odds ratio, per point higher on the fear avoidance belief scales, for therapists who were more likely to recommend home help was 1.19 (95% CI 1.06 to 1.35), p = 0.005 for the Fear Avoidance Belief Tool and 1.16 (95% CI 1.04 to 1.29), p = 0.006 for Health Care Providers Pain and Impairment Relationship Scale. This is consistent with those with greater fear avoidance beliefs being more likely to recommend home help. Conclusion: Occupational therapists' fear avoidance beliefs are associated with treatment recommendations that lessen activity or movement demands. These beliefs are potentially unhelpful and may reinforce avoidance behaviour in patients with chronic low back pain. © the College of Occupational Therapists Ltd.
Abstract.
Poltawski L, Norris M, Dean S (2014). Intervention fidelity: developing an experience -based model for rehabilitation research. Journal Rehabilitation Medicine, 46, 609-615.
Poltawski L, Norris M, Dean S (2014). Intervention fidelity: developing an experience-based model for rehabilitation research.
J Rehabil Med,
46(7), 609-615.
Abstract:
Intervention fidelity: developing an experience-based model for rehabilitation research.
BACKGROUND: Intervention fidelity is concerned with the extent to which interventions are implemented as intended. Consideration of fidelity is essential if the conclusions of effectiveness studies are to be credible, but little attention has been given to it in the rehabilitation literature. We describe our experiences addressing fidelity in the development of a rehabilitation clinical trial, and consider how an existing model of fidelity may be employed in rehabilitation research. METHODS: We used a model and methods drawn from the psychology literature to investigate how fidelity might be maximised during the planning and development of a stroke rehabilitation trial. We considered fidelity in intervention design, provider training, and the behaviour of providers and participants. We also evaluated methods of assessing fidelity during a trial. RESULTS: We identified strategies to help address fidelity in our trial protocol, along with their potential strengths and limitations. We incorporated these strategies into a model of fidelity that is appropriate to the concepts and language of rehabilitation. CONCLUSION: a range of strategies are appropriate to help maximise and measure fidelity in rehabilitation research. Based on our experiences, we propose a model of fidelity and provide recommendations to inform the growing literature of fidelity in this discipline.
Abstract.
Author URL.
Poltawski L, Boddy K, Forster A, Goodwin V, Pavey A, Dean S (2014). Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes. Disability and Rehabilitation
Brown M, Levack W, McPherson KM, Dean SG, Reed K, Weatherall M, Taylor WJ (2014). Survival, momentum, and things that make me "me'': patients' perceptions of goal setting after stroke.
DISABILITY AND REHABILITATION,
36(12), 1020-1026.
Author URL.
Jones B, Ingham TR, Cram F, Dean S, Davies C (2013). An indigenous approach to explore health-related experiences among Māori parents: the Pukapuka Hauora asthma study.
BMC Public Health,
13Abstract:
An indigenous approach to explore health-related experiences among Māori parents: the Pukapuka Hauora asthma study.
BACKGROUND: the prevalence of asthma for Indigenous New Zealand Māori is amongst the highest in the world. Recent evidence shows ethnic differences in asthma symptom prevalence in New Zealand have widened, with asthma symptoms and hospitalisation rates consistently higher for Māori across all age-groups, especially children and adolescents. This paper: outlines our qualitative, longitudinal research exploring the practical issues Māori children and their families face trying to achieve optimum asthma outcomes; details the research methods used within this study; and discusses the process evaluation findings of the features that made this approach successful in engaging and retaining participants in the study. METHODS: Thirty-two Māori families were recruited using a Kaupapa Māori (Māori way) Research approach. Each participated in a series of four in-depth interviews that were carried out at seasonal intervals over the course of one year. Families also took part in an interviewer-administered questionnaire and participated in a Photovoice exercise. All interviews were digitally recorded, transcribed verbatim and independently coded by two researchers. The research team then conducted the analysis and theme development. The questionnaires were analysed separately, with explanations for findings explored within the qualitative data. RESULTS: the methodology produced a 100 percent retention rate of the participating families over the course of the follow-up. This was attributed to the research collaboration, the respectful research relationships established with families, and the families' judgement that the methods used enabled them to tell their stories. The acceptability of the methodology will add to the validity and trustworthiness of the findings. CONCLUSION: Given the extent and persistence of ethnic disparities in childhood asthma management, it is imperative that an indigenous approach be taken to understanding the core issues facing Māori families. By conducting community-partnership research underpinned by an indigenous methodology, and employing a range of appropriate methods, we have successfully recruited and retained a cohort of Māori families with experiences of childhood asthma. We aim to make their voices heard in order to develop a series of culturally relevant interventions aimed at remediating these disparities.
Abstract.
Author URL.
Poltawski L, Briggs J, Forster A, Goodwin VA, James M, Taylor RS, Dean S (2013). Informing the design of a randomised controlled trial of an exercise-based programme for long term stroke survivors: lessons from a before-and-after case series study.
BMC Res Notes,
6Abstract:
Informing the design of a randomised controlled trial of an exercise-based programme for long term stroke survivors: lessons from a before-and-after case series study.
BACKGROUND: to inform the design of a randomised controlled trial (RCT) of an exercise-based programme for long term stroke survivors, we conducted a mixed methods before-and-after case series with assessment at three time points. We evaluated Action for Rehabilitation from Neurological Injury (ARNI), a personalised, functionally-focussed programme. It was delivered through 24 hours of one-to-one training by an Exercise Professional (EP), plus at least 2 hours weekly unsupervised exercise, over 12- 14 weeks. Assessment was by patient-rated questionnaires addressing function, physical activity, confidence, fatigue and health-related quality of life; objective assessment of gait quality and speed; qualitative individual interviews conducted with participants. Data were collected at baseline, 3 months and 6 months. Fidelity and acceptability was assessed by participant interviews, audit of participant and EP records, and observation of training. FINDINGS: Four of six enrolled participants completed the exercise programme. Quantitative data demonstrated little change across the sample, but marked changes on some measures for some individuals. Qualitative interviews suggested that small benefits in physical outcomes could be of great psychological significance to participants. Participant-reported fatigue levels commonly increased, and non-completers said they found the programme too demanding. Most key components of the intervention were delivered, but there were several potentially important departures from intervention fidelity. DISCUSSION: the study provided data and experience that are helping to inform the design of an RCT of this intervention. It suggested the need for a broader recruitment strategy; indicated areas that could be explored in more depth in the qualitative component of the trial; and highlighted issues that should be addressed to enhance and evaluate fidelity, particularly in the preparation and monitoring of intervention providers. The experience illustrates the value of even small sample before-and-after studies in the development of trials of complex interventions.
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Author URL.
Nunnerley JL, Hay-Smith EJC, Dean SG (2013). Leaving a spinal unit and returning to the wider community: an interpretative phenomenological analysis.
Disabil Rehabil,
35(14), 1164-1173.
Abstract:
Leaving a spinal unit and returning to the wider community: an interpretative phenomenological analysis.
PURPOSE: the study investigated the experience of community (re)integration from the perspective of people with spinal cord injury (SCI) within 12 months of discharge from a specialist spinal injuries unit in New Zealand (NZ). METHOD: Nine participants were interviewed. The verbatim transcripts were analysed using Interpretive Phenomenological Analysis (IPA). RESULTS: Three main themes were: Leaving, Not Coping with a Capital C, and Power and Control. Leaving related to the process of planning for, and discharge from the spinal unit. Not Coping with a Capital C incorporated the coping and adjustment to life following a SCI, including the role of hope. Power and Control denoted the alteration in balance of power and control following SCI which was evident both in the rehabilitation facility and within the wider community setting. CONCLUSIONS: the results indicated that the spinal unit may not adequately equip the recovering person with SCI for life in the real world. Individuals with SCI returning to the community remained hopeful of recovery of function and or cure; this focus, particularly on physical rehabilitation, potentially reduced their availability for other forms of community reintegration such as work and leisure activities.
Abstract.
Author URL.
Bond M, Pavey T, Welch K, Cooper C, Garside R, Dean S, Hyde CJ (2013). Psychological consequences of false-positive screening mammograms in the UK.
Evidence-Based Medicine,
18(2), 54-61.
Abstract:
Psychological consequences of false-positive screening mammograms in the UK
Objectives to identify the psychological effects of falsepositive screening mammograms in the UK. Methods Systematic review of all controlled studies and qualitative studies of women with a false-positive screening mammogram. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. All studies had a narrative synthesis. Results the searches returned seven includable studies (7/4423). Heterogeneity was such that meta-analysis was not possible. Studies using disease-specific measures found that, compared to normal results, there could be enduring psychological distress that lasted up to 3 years; the level of distress was related to the degree of invasiveness of the assessment. At 3 years the relative risks were, further mammography, 1.28 (95% CI 0.82 to 2.00), fine needle aspiration 1.80 (95% CI 1.17 to 2.77), biopsy 2.07 (95% CI 1.22 to 3.52) and early recall 1.82 (95% CI 1.22 to 2.72). Studies that used generic measures of anxiety and depression found no such impact up to 3 months after screening. Evidence suggests that women with false-positive mammograms have an increased likelihood of failing to reattend for routine screening, relative risk 0.97 (95% CI 0.96 to 0.98) compared with women with normal mammograms. Conclusions Having a false-positive screening mammogram can cause breast cancer-specific distress for up to 3 years. The degree of distress is related to the invasiveness of the assessment. Women with false-positive mammograms are less likely to return for routine assessment than those with normal ones. Copyright © 2013 the BMJ Publishing Group Ltd.
Abstract.
Poltawski L, Abraham C, Forster A, Goodwin VA, Kilbride C, Taylor RS, Dean S (2013). Synthesising practice guidelines for the development of community-based exercise programmes after stroke.
Implement Sci,
8Abstract:
Synthesising practice guidelines for the development of community-based exercise programmes after stroke.
BACKGROUND: Multiple guidelines are often available to inform practice in complex interventions. Guidance implementation may be facilitated if it is tailored to particular clinical issues and contexts. It should also aim to specify all elements of interventions that may mediate and modify effectiveness, including both their content and delivery. We conducted a focused synthesis of recommendations from stroke practice guidelines to produce a structured and comprehensive account to facilitate the development of community-based exercise programmes after stroke. METHODS: Published stroke clinical practice guidelines were searched for recommendations relevant to the content and delivery of community-based exercise interventions after stroke. These were synthesised using a framework based on target intervention outcomes, personal and programme proximal objectives, and recommended strategies. RESULTS: Nineteen guidelines were included in the synthesis (STRIDES; STroke Rehabilitation Intervention-Development Evidence Synthesis). Eight target outcomes, 14 proximal objectives, and 94 recommended strategies were identified. The synthesis was structured to present best practice recommendations in a format that could be used by intervention programme developers. It addresses both programme content and context, including personal factors, service standards and delivery issues. Some recommendations relating to content, and many relating to delivery and other contextual issues, were based on low level evidence or expert opinion. Where opinion varied, the synthesis indicates the range of best practice options suggested in guidelines. CONCLUSIONS: the synthesis may assist implementation of best practice by providing a structured intervention description that focuses on a particular clinical application, addresses practical issues involved in programme development and provision, and illustrates the range of best-practice options available to users where robust evidence is lacking. The synthesis approach could be applied to other areas of stroke rehabilitation or to other complex interventions.
Abstract.
Author URL.
Bond M, Pavey T, Welch K, Cooper C, Garside R, Dean S, Hyde C (2013). Systematic review of the psychological consequences of false-positive screening mammograms.
Health Technology Assessment,
17, 1-86.
Abstract:
Systematic review of the psychological consequences of false-positive screening mammograms
Background: in the UK, women aged 50-73 years are invited for screening by mammography every 3 years. In 2009-10, more than 2.24 million women in this age group in England were invited to take part in the programme, of whom 73% attended a screening clinic. of these, 64,104 women were recalled for assessment. of those recalled, 81% did not have breast cancer; these women are described as having a false-positive mammogram. Objective: the aim of this systematic review was to identify the psychological impact on women of false positive screening mammograms and any evidence for the effectiveness of interventions designed to reduce this impact. We were also looking for evidence of effects in subgroups of women. Data sources: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register for Controlled Trials, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment (HTA), Cochrane Methodology, Web of Science, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index-Science, Conference Proceeding Citation Index-Social Science and Humanities, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the International Bibliography of the Social Sciences, the British Library's Electronic Table of Contents and others. Initial searches were carried out between 8 October 2010 and 25 January 2011. Update searches were carried out on 26 October 2011 and 23 March 2012. Review methods: Based on the inclusion criteria, titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias. Results: Eleven studies were found from 4423 titles and abstracts. Studies that used disease-specific measures found a negative psychological impact lasting up to 3 years. Distress increased with the level of invasiveness of the assessment procedure. Studies using instruments designed to detect clinical levels of morbidity did not find this effect. Women with false-positive mammograms were less likely to return for the next round of screening [relative risk (RR) 0.97; 95% confidence interval (CI) 0.96 to 0.98] than those with normal mammograms, were more likely to have interval cancer [odds ratio (OR) 3.19 (95% CI 2.34 to 4.35)] and were more likely to have cancer detected at the next screening round [OR 2.15 (95% CI 1.55 to 2.98)]. Limitations: This study was limited to UK research and by the robustness of the included studies, which frequently failed to report quality indicators, for example failure to consider the risk of bias or confounding, or failure to report participants' demographic characteristics. Conclusions: We conclude that the experience of having a false-positive screening mammogram can cause breast cancer-specific psychological distress that may endure for up to 3 years, and reduce the likelihood that women will return for their next round of mammography screening. These results should be treated cautiously owing to inherent weakness of observational designs and weaknesses in reporting. Future research should include a qualitative interview study and observational studies that compare generic and disease-specific measures, collect demographic data and include women from different social and ethnic groups. © Queen's Printer and Controller of HMSO 2013.
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Wyatt KM, Lloyd JJ, Abraham C, Creanor S, Dean S, Densham E, Daurge W, Green C, Hillsdon M, Pearson V, et al (2013). The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
Trials,
14Abstract:
The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
BACKGROUND: over the last three decades there has been a substantial increase in the proportion of children who are overweight or obese. The Healthy Lifestyles Programme (HeLP) is a novel school-based intervention, using highly interactive and creative delivery methods to prevent obesity in children. METHODS/DESIGN: We describe a cluster randomised controlled trial to evaluate the effectiveness and cost effectiveness of HeLP. The intervention has been developed using intervention mapping (involving extensive stakeholder involvement) and has been guided by the Information, Motivation, Behavioural Skills model. HeLP includes creating a receptive environment, drama activities, goal setting and reinforcement activities and runs over three school terms. Piloting showed that 9 to 10 year olds were the most receptive and participative. This study aims to recruit 1,300 children from 32 schools (over half of which will have ≥19% of pupils eligible for free school meals) from the southwest of England. Participating schools will be randomised to intervention or control groups with baseline measures taken prior to randomisation. The primary outcome is change in body mass index standard deviation score (BMI SDS) at 24 months post baseline. Secondary outcomes include, waist circumference and percent body fat SDS and proportion of children classified as overweight or obese at 18 and 24 months and objectively measured physical activity and food intake at 18 months. Between-group comparisons will be made using random effects regression analysis taking into account the hierarchical nature of the study design. An economic evaluation will estimate the incremental cost-effectiveness of HeLP, compared to control, from the perspective of the National Health Service (NHS)/third party payer. An in-depth process evaluation will provide insight into how HeLP works, and whether there is any differential uptake or engagement with the programme. DISCUSSION: the results of the trial will provide evidence on the effectiveness and cost effectiveness of the Healthy Lifestyles Programme in affecting the weight status of children. TRIAL REGISTRATION: ISRCTN15811706.
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Author URL.
Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S (2013). The enduring impact of what clinicians say to people with low back pain.
Ann Fam Med,
11(6), 527-534.
Abstract:
The enduring impact of what clinicians say to people with low back pain.
PURPOSE: the purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain. METHODS: Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework. RESULTS: Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity. CONCLUSIONS: Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.
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Author URL.
Wright KA, Armstrong T, Taylor A, Dean S (2012). 'It's a Double Edged Sword':. A Qualitative Analysis of the Experiences of Exercise. Amongst People with Bipolar Disorder. Journal of Affective Disorders
Taylor WJ, Brown M, William L, McPherson KM, Reed K, Dean SG, Weatherall M (2012). A pilot cluster randomized controlled trial of structured goal-setting following stroke. Clinical Rehabilitation, 26(4), 327-338.
Abraham C, Britten N, Dean S, Greaves C, Lloyd J, Poltawski L, Wyatt KM (2012). Creating Change that Counts: Evidence-led Co-creation as a Pathway to Impact. European Health Psychologist, 14(3), 64-69.
Goodwin V, Poltawski L, Kilbride C, Abraham C, Taylor RS, Forster A, Dean SG (2012). Exercise for Stroke survivors: a synthesis of evidence-based guidelines.
JOURNAL OF AGING AND PHYSICAL ACTIVITY,
20, S245-S245.
Author URL.
Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A (2012). The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review.
European Journal of Pain (United Kingdom),
16(1), 3-17.
Abstract:
The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review
Background: it has been suggested that health care professional (HCP) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population. Methods: Electronic databases were systematically searched for all types of studies. Studies were selected by predefined inclusion criteria. Methodological quality was appraised and strength of evidence was determined. Results: Seventeen studies from eight countries which investigated the attitudes and beliefs of general practitioners, physiotherapists, chiropractors, rheumatologists, orthopaedic surgeons and other paramedical therapists were included. There is strong evidence that HCP beliefs about back pain are associated with the beliefs of their patients. There is moderate evidence that HCPs with a biomedical orientation or elevated fear avoidance beliefs are more likely to advise patients to limit work and physical activities, and are less likely to adhere to treatment guidelines. There is moderate evidence that HCP attitudes and beliefs are associated with patient education and bed rest recommendations. There is moderate evidence that HCP fear avoidance beliefs are associated with reported sick leave prescription and that a biomedical orientation is not associated with the number of sickness certificates issued for LBP. Conclusion: HCPs need to be aware of the association between their attitudes and beliefs and the attitudes and beliefs and clinical management of their patients with LBP.
Abstract.
Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A (2012). The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review.
Eur J Pain,
16(1), 3-17.
Abstract:
The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review.
BACKGROUND: it has been suggested that health care professional (HCP) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population. METHODS: Electronic databases were systematically searched for all types of studies. Studies were selected by predefined inclusion criteria. Methodological quality was appraised and strength of evidence was determined. RESULTS: Seventeen studies from eight countries which investigated the attitudes and beliefs of general practitioners, physiotherapists, chiropractors, rheumatologists, orthopaedic surgeons and other paramedical therapists were included. There is strong evidence that HCP beliefs about back pain are associated with the beliefs of their patients. There is moderate evidence that HCPs with a biomedical orientation or elevated fear avoidance beliefs are more likely to advise patients to limit work and physical activities, and are less likely to adhere to treatment guidelines. There is moderate evidence that HCP attitudes and beliefs are associated with patient education and bed rest recommendations. There is moderate evidence that HCP fear avoidance beliefs are associated with reported sick leave prescription and that a biomedical orientation is not associated with the number of sickness certificates issued for LBP. CONCLUSION: HCPs need to be aware of the association between their attitudes and beliefs and the attitudes and beliefs and clinical management of their patients with LBP.
Abstract.
Author URL.
Taylor L, Hay-Smith EJC, Dean SG (2011). Can clinical Pilates decrease pain and improve function in people complaining of non-specific chronic low back pain? a pilot study. New Zealand Journal of Physiotherapy, 1(39), 30-38.
Levack WMM, Dean SG, Siegert RJ, McPherson KM (2011). Navigating patient-centred goal setting in inpatient stroke rehabilitation: How clinicians control the process to meet pereceived professional responsibilities. Patient Education and Counselling
Dean SG, Hudson S, Hay-Smith EJC, Milosavljevic S (2011). Rural workers' experience of low back pain: exploring why they continue to work. Journal of Occupational Rehabilitation, 3(21), 395-409.
Dean SG, Hudson S, Hay-Smith EJC, Milosavljevic S (2011). Rural workers' experience of low back pain: exploring why they continue to work.
J Occup Rehabil,
21(3), 395-409.
Abstract:
Rural workers' experience of low back pain: exploring why they continue to work.
INTRODUCTION: Many New Zealand rural workers have repeated low back pain (LBP) episodes yet continue to work. We wanted to find out why, given that other manual workers with LBP often end up on long term sick leave or permanently disabled. METHODS: Our primarily qualitative approach used mixed methods to investigate rural workers with non-specific LBP. Participants (n = 33) were surveyed for demographic data, the Brief Illness Perception Questionnaire and the General Self Efficacy Scale followed by one-to-one semi-structured interviews. Analysis ranged from descriptive content to detailed qualitative Interpretative Phenomenological Analysis. RESULTS: Participants had high self efficacy scores, positive perceptions about LBP but strong beliefs that LBP is lifelong. Four distinct themes emerged. "Thinking with my head before my back" and "Knowing the risks" described participants' innovation regarding job modifications. "Just carry on" and "Love of the land" related to stoical resilience and commitment to something more than employment. CONCLUSIONS: This rural workforce adopts a 'can do' attitude to work, managing LBP within the context of having job control and flexible work practices. IMPLICATIONS: Rehabilitation interventions promoting job control and targeting positive attitudes towards getting on with work, whilst accepting LBP as part of everyday life, may have merit for other workers with LBP.
Abstract.
Author URL.
Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS (2010). Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ: British Medical Journal, 340
Brown M, Dean S, Hay-Smith EJ, Taylor W, Baxter GD (2010). Musculoskeletal pain and treatment choice: an exploration of illness perceptions and choices of conventional or complementary therapies.
Disabil Rehabil,
32(20), 1645-1657.
Abstract:
Musculoskeletal pain and treatment choice: an exploration of illness perceptions and choices of conventional or complementary therapies.
This study explored experiences of receiving treatment for musculoskeletal pain (MSKP), particularly choices of complementary and alternative medicine (CAM) and/or conventional treatment, using the illness perception dimension of Leventhal's Self-Regulatory Model as the underpinning model within the broader biopsychosocial framework of the International Classification of Functioning, Disability and Health.
Abstract.
Perry MA, Hendrick PA, Hale L, Baxter GD, Milosavljevic S, Dean SG, McDonough SM, Hurley DA (2010). Utility of the RT3 triaxial accelerometer in free living: an investigation of adherence and data loss.
Applied Ergonomics,
41(3), 469-476.
Abstract:
Utility of the RT3 triaxial accelerometer in free living: an investigation of adherence and data loss
There is strong evidence for the protective effects of physical activity on chronic health problems. Activity monitors can objectively measure free living occupational and leisure time physical activity. Utility is an important consideration when determining the most appropriate monitor for specific populations and environments. Hours of activity data collected, the reasons for activity hours not being recorded, and how these two factors might change over time when using an activity monitor in free living are rarely reported. This study investigated user perceptions, adherence to minimal wear time and loss of data when using the RT3 activity monitor in 21 healthy adults, in a variety of occupations, over three (7 day) repeated weeks of measurement in free living. An activity diary verified each day of monitoring and a utility questionnaire explored participant perceptions on the usability of the RT3. The RT3 was worn for an average of 14. h daily with 90% of participants having complete data sets. In total 6535.8 and 6092.5. h of activity data were collected from the activity diary and the RT3 respectively. An estimated 443.3. h (6.7%) of activity data were not recorded by the RT3. Data loss was primarily due to battery malfunction (45.2%). Non-adherence to wear time accounted for 169.5. h (38.2%) of data loss, of which 14. h were due to occupational factors. The RT3 demonstrates good utility for free living activity measurement, however, technical issues and strategies to manage participant adherence require consideration with longitudinal and repeated measures studies. © 2009 Elsevier Ltd.
Abstract.
Dickson BE, Hay-Smith EJC, Dean SG (2009). Demonized Diagnosis: the Influence of Stigma on Interdisciplinary Rehabilitation of Somatoform Disorder. New Zealand Journal of Physiotherapy, 3(37), 115-121.
Levack WMM, Siegert RJ, Dean SG, McPherson KM (2009). Goal planning for adults with acquired brain injury: how clinicians talk about involving family.
Brain Inj,
23(3), 192-202.
Abstract:
Goal planning for adults with acquired brain injury: how clinicians talk about involving family.
PRIMARY OBJECTIVE: Although family involvement is frequently identified as a key element of successful rehabilitation, questions remain about 'how' clinicians can best involve them. This study explored how clinicians talk about the involvement of families in goal-planning during rehabilitation of adults with acquired brain injury. RESEARCH DESIGN: Qualitative study drawing on grounded theory to elicit practitioner perspectives. METHODS AND PROCEDURES: Nine clinicians from a range of professional backgrounds were interviewed. Interview data were transcribed and analysed using the constant comparative method of grounded theory. NVivo software was used to assist with data management. MAIN OUTCOMES AND RESULTS: While family were often considered valuable contributors to the goal-planning process, they were also seen as potential barriers to the negotiation of goals between clinicians and patients and to patient-clinician relationships. Clinicians described restricting involvement of family members in situations where such involvement was thought not to be in the best interests of the patient. CONCLUSIONS: Goal-planning appeared patient-centred rather than family-centred. Further, clinicians identified concerns about extending family involvement in goal-planning. If clinicians intend to address the needs of family members as well as patients, current approaches to goal-planning (and rehabilitation funding) may need to be reconsidered.
Abstract.
Author URL.
Gregg CD, Dean S, Schneiders AG (2009). Variables associated with active spondylolysis.
Phys Ther Sport,
10(4), 121-124.
Abstract:
Variables associated with active spondylolysis.
STUDY DESIGN: Retrospective non-experimental study. OBJECTIVE: to investigate variables associated with active spondylolysis. DESIGN: a retrospective study audited clinical data over a two year period from patients with suspected spondylolysis that were referred for a SPECT bone scan. Six exploratory variables were identified and analysed using uni- and multi-variate regression from 82 patient records to determine the association between symptomatic, physical and demographic characteristics, and the presence of an active spondylolysis. SETTING: Tertiary level multidisciplinary private practice sports medicine clinic. PARTICIPANTS: all patients with low back pain that required a SPECT bone scan to confirm suspected spondylolysis. 82 subjects were included in the final sample group. MAIN OUTCOME MEASUREMENTS: the six exploratory variables included Age, Gender, Injury duration, Injury onset, Sports participation and the result of the Single Leg Hyperextension Test. The dependent outcome variable was the result of the SPECT bone scan (scan-positive or scan-negative). RESULTS: Adolescent males had a higher incidence of spondylolysis detected by SPECT bone scan compared to other patients and a statistically significant association was demonstrated for both age (p=0.01) and gender (p=0.01). Subjects with an active spondylolysis were nearly five times more likely to be male and aged less than 20 years. Furthermore, the likelihood ratio indicated that adolescent males with suspected spondylolysis were three and a half times more likely to have a positive bone scan result. The Single Leg Hyperextension Test did not demonstrate a statistically significant association with spondylolysis (p=0.47). CONCLUSIONS: Clinicians assessing for a predisposition to the development of spondylolysis should consider the gender and age of the patient and not rely on the predictive ability of the Single Leg Hyperextension Test.
Abstract.
Author URL.
Copeland JM, Taylor WJ, Dean SG (2008). Factors influencing the use of outcome measures for patients with low back pain: a survey of New Zealand physical therapists.
Phys Ther,
88(12), 1492-1505.
Abstract:
Factors influencing the use of outcome measures for patients with low back pain: a survey of New Zealand physical therapists.
BACKGROUND: Rehabilitation of patients with low back pain forms an important component of musculoskeletal physical therapist practice, yet treatment outcomes often are poorly measured. OBJECTIVE: the study examined the methods used to evaluate treatment outcomes and factors influencing the use of outcome measures by New Zealand physical therapists. DESIGN: This cross-sectional study used qualitative and quantitative methods for data collection. METHODS: Two focus groups were conducted: one in a private practice (n=6) and one in a public hospital (n=6). A survey questionnaire was mailed to all private practices listed in a telecommunication database and to outpatient physical therapy departments at public hospitals (n=579). RESULTS: the mail survey achieved a 65% response rate and showed that physical therapists use improvements in person-specific functional activities as their main outcome measure. Only 40% of the respondents reported using back-related outcome measures. The statistically significant factors determining their use were having a master's degree and an increased level of knowledge of outcome measurement, but these factors explained only 22% of the variance in the logistic regression model. Lack of time, frequently mentioned as a reason for not using standardized outcome measures, did not reach statistical significance. LIMITATIONS: the data collected relate to the physical therapists' reported or perceived behavior, which may be different from reality. CONCLUSION: Physical therapists do not routinely use outcome measures in their clinical practice. A master's degree and increased knowledge were statistically significant factors supporting increased use of outcome measures. Further research is needed on how to convey to practitioners that the information they provide can be useful and can improve patient outcomes.
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Dean SG, Young V, Elley CR, Bruton A (2008). Patient and Clinician Perceptions of Asthma Education and Management in Resistant Asthma: a Qualitative Study. New Zealand Family Physician, 35(4), 257-262.
Brown M, Hay-Smith J, Dean S, Taylor W (2007). Comments on article by Lewis and Johnson: 'The clinical effectiveness of therapeutic massage for musculoskeletal pain: a systematic review. Physiotherapy 2006;92:146-58'. Physiotherapy, 93(1), 78-79.
Young V, Dean SG, Elley CR, Bruton A (2007). Exploring the perceptions of patients and health professionals of asthma education and rehabilitation management in New Zealand.
DISABILITY AND REHABILITATION,
29(20-21), 1652-1653.
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Elley CR, Dean S, Kerse N (2007). Physical activity promotion in general practice--patient attitudes.
Aust Fam Physician,
36(12), 1061-1064.
Abstract:
Physical activity promotion in general practice--patient attitudes.
BACKGROUND: Long term adherence to primary care physical activity intervention is poor. This study explored attitudes and subjective experiences of those who received such an intervention. METHODS: Nested qualitative study within mixed methods approach, involving 15 sedentary adults from urban and rural general practices in New Zealand. Semistructured telephone interviews were conducted, transcribed, and analysed using an inductive approach to identify themes. RESULTS: Four themes emerged including: tailoring of advice given; barriers to physical activity such as weather, physical environment, time, health and psychological limitations; internal motivators such as immediate or long term psychological, health or spiritual benefits, commitment, and guilt; and the role of significant others such as health and exercise professionals in initiating advice and continuing support, social interaction and commitment or contracts made to others. DISCUSSION: This study highlights the need for a personalised approach, continued structured external support and the need to focus on barriers and facilitators.
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Hay-Smith J, Dean S (2007). Seizing the moment: How, when and why patients and health professionals engage in rehabilitation for urinary incontinence.
DISABILITY AND REHABILITATION,
29(20-21), 1638-1639.
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Hay-Smith EJC, Ryan K, Dean S (2007). The silent, private exercise: experiences of pelvic floor muscle training in a sample of women with stress urinary incontinence.
Physiotherapy,
93(1), 53-61.
Abstract:
The silent, private exercise: experiences of pelvic floor muscle training in a sample of women with stress urinary incontinence
Objectives: the study sought women's experiences of pelvic floor muscle training (PFMT) to provide insights for interpreting the findings of a randomised controlled trial of PFMT and to explore women's understandings of the exercises. Methods: Twenty women who had participated in a trial comparing two approaches to PFMT were purposively selected and interviewed by a physiotherapist/researcher about their experience of PFMT. A descriptive content analysis identified categories of meaning from the interview transcripts; the categories were grouped into themes. Results: the interviews suggested there had been blurring of the boundaries between the two PFMT programmes investigated in the trial, but it was difficult to determine how much variation had occurred, and if this might have confounded the trial result. A striking feature of the interviews was the contrast between the relatively disempowered position women were in when they first presented for PFMT, and the considerable degree of self-efficacy that PFMT required. This contrast was encapsulated by the two main themes identified in the interviews: Knowledge, power and control: the women's journey and PFMT demands personal agency. Although two PFMT self-efficacy scales have been developed it is not clear how transferable these are between different sociocultural environments. It is suggested that brief motivational interviewing, a treatment approach consistent with self-efficacy theory, might be a useful way of evaluating and increasing readiness to change and self-efficacy in clinical practice. Conclusion: Research to investigate the usefulness of brief motivational interviewing in assessing and developing PFMT self-efficacy is warranted. © 2006 Chartered Society of Physiotherapy.
Abstract.
Dean AY, Dean SG (2006). A pilot study investigating the use of the Orthosense Posture Monitor during a real-world moving and handling task. Journal of Bodywork and Movement Therapies, 10, 220-226.
Taylor WJ, Dean SG, Siegert RJ (2006). Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskeletal pain in a cross-sectional general adult population survey.
Pain,
125(3), 225-232.
Abstract:
Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskeletal pain in a cross-sectional general adult population survey.
Although evidence reveals that self-efficacy is associated with disability in people with pain, there is less known about this relationship in primary care settings and no published information in general population samples. This study aimed to assess the relationship between pain, self-efficacy, health-related quality of life, psychological distress and disability in a general population sample. A randomly selected sample from electoral registers of the lower North Island of New Zealand was mailed a survey questionnaire. Presence of musculoskeletal pain was defined as "pain present for at least seven consecutive days during the last month". Respondents were divided into three groups on the basis of pain: no pain, pain present for less than 12 months and pain present for 12 months or longer. Health Self-efficacy, General Self-efficacy, General Health Questionnaire, modified Health Assessment Questionnaire and EuroQol-5D were also included in the survey instrument. There were 289/471 (61%) returned questionnaires from eligible subjects (of an original sample of 540). General linear modelling found evidence of an association between pain status and self-efficacy with disability, explaining 16.4-18.8% of variability in mHAQ scores. In addition, we found evidence of an interaction between pain status and general self-efficacy, suggesting a stronger relationship between general self-efficacy and disability for pain present for 12 months or more. This interaction was not observed for health self-efficacy. General self-efficacy was more strongly related to psychological distress and this association was not influenced by pain status. Health-related quality of life was associated with health self-efficacy but not general self-efficacy.
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Levack WMM, Dean SG, McPherson KM, Siegert RJ (2006). How clinicians talk about the application of goal planning to rehabilitation for people with brain injury-variable interpretations of value and purpose.
Brain Inj,
20(13-14), 1439-1449.
Abstract:
How clinicians talk about the application of goal planning to rehabilitation for people with brain injury-variable interpretations of value and purpose.
PRIMARY OBJECTIVE: to explore the way clinicians talk about the value and purpose of goal planning in rehabilitation for people with brain injury. RESEARCH DESIGN: Grounded theory. METHODS AND PROCEDURES: Nine clinicians from a range of professional backgrounds were interviewed. The interview data were analysed using the constant comparative method of grounded theory. MAIN OUTCOMES AND RESULTS: While the clinicians considered goal planning important, the expressed reasons for valuing goal planning were at times unclear. The term 'goal' referred to not one but many concepts within the rehabilitation environment; goal planning was used to serve a range of different purposes. Different reasons for undertaking goal planning were interrelated but at times conflicted, potentially creating tensions within the rehabilitation environment. CONCLUSIONS: Discussions around goal planning terminology should progress from service-level agreements towards more evidenced-based international consensus. Individual services might benefit from discussing and agreeing on the purpose for goal planning in their work.
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Levack WMM, Dean S, Siegert RJ, McPherson KM, Weatherall M (2006). Is goal planning in rehabilitation effective? a systematic review. Clinical Rehabilitation, 20, 1-17.
Levack WMM, Taylor K, Siegert RJ, Dean SG, McPherson KM, Weatherall M (2006). Is goal planning in rehabilitation effective? a systematic review.
Clinical Rehabilitation,
20(9), 739-755.
Abstract:
Is goal planning in rehabilitation effective? a systematic review
Objective: to determine the evidence regarding the effectiveness of goal planning in clinical rehabilitation. Design: Systematic review. Method: MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians (ACP) Journal Club, and the Database of Abstracts of Reviews of Effects (DARE) were searched for randomized controlled trials on the therapeutic effectiveness of goal planning in the rehabilitation of adults with acquired disability. Studies were categorized by patient population and the clinical context of the study. Data were analysed using best-research synthesis, based on methodological quality determined by Physiotherapy Evidence Database (PEDro) scale scores. Results: Nineteen studies were included in this review. Study populations in these papers included patients with neurological disorders, psychiatric disorders, musculoskeletal disorders, cardiovascular disorders, respiratory disorders and dietary/endocrine disorders. Six studies investigated the immediate effects of goal planning on patient behaviour. Thirteen studies investigated the effects of goal planning in the context of a rehabilitation programme lasting more than one week. Some limited evidence was identified that goal planning can influence patient adherence to treatment regimes and strong evidence that prescribed, specific, challenging goals can improve immediate patient performance in some specific clinical contexts. However, evidence regarding how these effects translated to improved outcomes following rehabilitation programmes was inconsistent. Conclusions: This review identified that while some studies demonstrated positive effects associated with goal planning in local contexts, the best available empirical evidence regarding the generalizable effectiveness of goal planning was inconsistent and compromised by methodological limitations. © 2006 SAGE Publications.
Abstract.
Levack WMM, Dean SG, Siegert RJ, McPherson KM (2006). Purposes and mechanisms of goal planning in rehabilitation: the need for a critical distinction.
Disabil Rehabil,
28(12), 741-749.
Abstract:
Purposes and mechanisms of goal planning in rehabilitation: the need for a critical distinction.
PURPOSE: to determine a preliminary typology of purposes and mechanisms ascribed to goal planning in rehabilitation. To demonstrate the importance of making a critical distinction between these different purposes and mechanisms when reviewing or designing research on goal planning in rehabilitation. METHOD: a search of Medline, Embase, PsychINFO and CINAHL for articles on goal planning in rehabilitation. Articles were only included if they were about patient populations and made explicit statements regarding the function or purpose of goal planning in rehabilitation. Thematic analysis was used to qualitatively synthesise the purposes and mechanisms of goal planning described in the literature. RESULTS: Four major purposes for undertaking goal planning in rehabilitation are identified: (1) to improve patient outcomes (as determined by standardised outcome measures), (2) to enhance patient autonomy, (3) to evaluate outcomes, and (4) to respond to contractual, legislative or professional requirements. The first of these purposes is associated with four distinct mechanisms with the remaining three purposes appearing to relate to one underlying mechanism. CONCLUSIONS: This typology offers one approach for critically engaging with the wide-ranging issues in goal planning. Debate stemming from this work could facilitate systematic reviews of this area as well as guide research and application to practice.
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Sinnott A, Dean S (2005). Choosing appropriate measures in inpatient rehabilitation.
Hosp Med,
66(4), 205-209.
Abstract:
Choosing appropriate measures in inpatient rehabilitation.
This article aims to assist inpatient rehabilitation clinicians to choose appropriate measures. Emphasis is given to measurement processes and interpretation. The authors provide examples of measures commonly reported for five rehabilitation diagnostic groups: stroke, traumatic brain injury, spinal cord injury, multiple sclerosis and cardio-respiratory rehabilitation.
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Dean S (2005). Illness perceptions, pain and function in patients with low back pain: a prospective study.
PSYCHOLOGY & HEALTH,
20, 62-62.
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Dean SG, Smith JA, Payne S, Weinman J (2005). Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.
Disabil Rehabil,
27(11), 625-636.
Abstract:
Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.
PURPOSE: Physiotherapy for low back pain (LBP) includes exercise therapy. Unfortunately adherence is problematic. This study explores patients' and physiotherapists' perceptions of exercise adherence. METHOD: Nine LBP patients and eight physiotherapists were interviewed. Interpretative Phenomenological Analysis (IPA) was used to explore transcript data. RESULTS: the main theme 'managing time', reveals how pressure on time reflects society's view of time as a commodity. Theme components include 'the bargaining process': physiotherapists spend time listening, exploring patient beliefs, but modify patients' expectations of quick cures with the need to own their back care. 'Reviewing the future' identifies fears about long-term disability, highlighting the importance of recovery time knowledge. CONCLUSIONS: Interpreting participants' stories illustrates how investing in routine exercise could help re-interpret LBP as part of everyday life.
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Siegert RJ, McPherson KM, Dean SG (2005). Theory development and a science of rehabilitation.
Disabil Rehabil,
27(24), 1493-1501.
Abstract:
Theory development and a science of rehabilitation.
PURPOSE: This article considers the role of theory and theory building in science and specifically in rehabilitation. It is argued that rehabilitation has tended to value theory testing over theory building and some evidence is presented for this. METHOD: Some general questions concerning the role of theory in scientific progress are discussed including: What is a theory? What is the role of theory in science? What makes a good scientific theory? How does theoretical change occur in science? Where relevant these questions are discussed in terms of examples from clinical rehabilitation research. RESULTS: Two important issues arising from the preceding discussion are then considered. First is the question of whether a general or unifying theory of rehabilitation is a desirable goal. The second concerns how we might begin to develop a coherent programme of theory building in rehabilitation. CONCLUSION: More time spent on rehabilitation theory building may enhance the fruits of empirical theory testing.
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Siegert RJ, McPherson KM, Dean SG (2005). Theory development and a science of rehabilitation. Authors' response to commentaries. Disability and Rehabilitation, 27(24), 1517-1519.
Turner JR, Carroll D, Dean S, Harris MG (1987). Heart rate reactions to standard laboratory challenges and a naturalistic stressor.
Int J Psychophysiol,
5(2), 151-152.
Abstract:
Heart rate reactions to standard laboratory challenges and a naturalistic stressor.
Extreme high and low heart rate reactors were selected on the basis of responses to two laboratory stressors; a video game, and mental arithmetic. The heart rates of the same subjects were then recorded during a public speaking competition. Heart rate reactions to this more naturalistic stressor were generally in line with the laboratory-based designations.
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DEAN S, TURNER JR, CARROLL D, HARRIS MG (1986). THE RELATIONSHIP BETWEEN HEART-RATE REACTIVITY DURING LABORATORY AND REAL WORLD BEHAVIORAL CHALLENGE.
PSYCHOPHYSIOLOGY,
23(4), 432-432.
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Conferences
Gorman R, Dean S, Roach L, Horvat C, Garrett S, Kohout A (2022). Making navigation in Antarctic waters safer through coupled wave-ice forecasting.
Abstract:
Making navigation in Antarctic waters safer through coupled wave-ice forecasting
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Stokes I, Warren F, Hay-Smith J, Elders A, Bugge C, Hagen S, Dean S (2022). Pelvic Floor Muscle Training Adherence: evaluating women’s adherence to home exercise prescription in a multicentre randomised controlled trial.
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Major K, Warren F, Hay-Smith J, Bugge C, Hagen S, Elders A, Dean S (2022). Promoting adherence to pelvic floor muscle exercises: analysis of exercise prescription, prompts to exercise, and predictors of exercise diary return, during a randomised controlled trial.
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Walters L, Salmon V, Hay-Smith J, Bugge C, Hagen S, Elders A, Dean S (2022). Promoting pelvic floor muscle training adherence - Evaluating fidelity to intervention treatment delivery in a randomised controlled trial.
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Dean S, Salmon V, Terry R, Hay-Smith J, Frawley H, Chapman S, Pearson M, Boddy K, Cockcroft E, Webb S, et al (2022). Teaching effective pelvic floor muscle exercises in antenatal care: design and development of a training package for community midwives in the United Kingdom.
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Smith C, Salmon V, Jones E, Edwards E, Hay-Smith J, Frawley H, Webb S, Bick D, MacArthur C, Dean S, et al (2022). Training for midwives to support women to do their exercises during pregnancy. A mixed method evaluation of the midwife training during a feasibility and pilot randomised controlled trial.
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Taylor A, Streeter A, Ingram W, Lambert J, Dean S, Taylor R, Jolly K, Mutrie N, Greaves C (2021). The mediating effects of theory linked process measures on 12 month accelerometer recorded physical activity within the e-coacher RCT involving primary care exercise referral participants.
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Bugge C, Hay-Smith J, Grant A, Taylor A, Hagen S, McClurg D, Dean S (2019). A 24 MONTH LONGITUDINAL QUALITATIVE STUDY OF WOMEN'S EXPERIENCE OF ELECTROMYOGRAPHY BIOFEEDBACK PELVIC FLOOR MUSCLE TRAINING (PFMT) AND PFMT ALONE FOR URINARY INCONTINENCE: ADHERENCE, OUTCOME AND CONTEXT.
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Dean S, Hay-Smith J, Bugge C, McClurg D, Grant A, Taylor A, Andreis F, Elders A, Hagen S (2019). A PROCESS EVALUATION STUDY INVESTIGATING FIDELITY AND DOSE OF INTERVENTION DELIVERY AND UPTAKE OF PELVIC FLOOR MUSCLE TRAINING DELIVERED IN a RANDOMISED CONTROLLED TRIAL.
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Hay-Smith J, Peebles L, Farmery D, Dean S, Grainger R (2019). APPS-OLUTELY FABULOUS? - THE QUALITY OF PFMT SMARTPHONE APP CONTENT AND DESIGN RATED USING THE MOBILE APP RATING SCALE, BEHAVIOUR CHANGE TAXONOMY, AND GUIDANCE FOR EXERCISE PRESCRIPTION.
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Terry R, Jarvie R, Hay-Smith J, Salmon V, Pearson M, MacArthur C, Dean S (2019). ARE YOU DOING YOUR PELVIC FLOORS? AN ETHNOGRAPHIC EXPLORATION OF DISCUSSIONS BETWEEN WOMEN AND HEALTH PROFESSIONALS ABOUT PELVIC FLOOR MUSCLE EXERCISES DURING PREGNANCY.
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Hagen S, Elders A, Henderson L, Kilonzo M, McClurg D, Hay-Smith J, Dean S, Booth J, Bugge C (2019). EFFECTIVENESS AND COST-EFFECTIVENESS OF BIOFEEDBACK-ASSISTED PELVIC FLOOR MUSCLE TRAINING FOR FEMALE URINARY INCONTINENCE: a MULTICENTRE RANDOMISED CONTROLLED TRIAL.
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Calitri R, Mounce L, Abel G, Campbell J, Spencer A, Medina-Lara A, Pitt M, Shepard E, Warren F, Dean S, et al (2019). Protocol for a pragmatic cluster randomised controlled trial assessing the clinical effectiveness and cost effectiveness of electronic risk-assessment tools for cancer for patients in general practice (ERICA).
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Lloyd J, Creanor S, Logan G, Green C, Dean S, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor R, et al (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary school children: a cluster randomised controlled trial. South West Public Health (SWPH) Scientific Conference.
Tarrant M, Carter M, Adamson J, Warren F, Taylor R, Spencer A, Landa P, Code C, Dean S, Calitri R, et al (2018). Singing for People with Aphasia (SPA): results of a pilot randomised controlled trial of a group singing intervention to improve wellbeing.
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Lloyd J, Creanor S, Streeter A, Green C, Dean S, Abraham C, Hillsdon M, Taylor R, Logan G, Tomlinson R, et al (2017). Effectiveness and cost effectiveness of the ‘Healthy Lifestyles Programme’ (HeLP) cluster randomised controlled trial: a school-based obesity prevention intervention for 9-10 year olds. ISBNPA.
Lloyd J, Dean S, Abraham C, Creanor S, Green C, Hillsdon M, Taylor R, Logan G, Tomlinson R, Pearson V, et al (2017). Findings from the process evaluation of ‘Healthy Lifestyles Programme’ (HeLP) cluster randomised controlled trial: a school-based obesity prevention intervention for 9-10 year olds. International Society for Behavioural Nutrition and Physical. Activity (ISBNPA).
Salmon VE, Hay-Smith J, Jarvie R, Dean S, Oborn E, Bayliss SE, Bick D, Davenport C, Ismail KM, MacArthur C, et al (2017). OPPORTUNITIES, CHALLENGES AND CONCERNS FOR IMPLEMENTING PELVIC FLOOR MUSCLE ASSESSMENT AND TRAINING DURING CHILDBEARING YEARS: a CRITICAL INTERPRETIVE SYNTHESIS.
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Long L, Sansom A, Aylward A, Robinson S, Anderson R, Fletcher E, Welsman J, Dean S, Campbell J (2017). UNDERSTANDING WHY UK GPS ARE LEAVING GENERAL PRACTICE-A SYSTEMATIC REVIEW OF QUALITATIVE RESEARCH.
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Bugge C, Grant A, Dean S, Smith JH, McClurg D, Hagen S (2017). What does qualitative case study methodology have to offer the interpretation of findings from trials of complex interventions? Reflections from a large complex intervention study.
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Dean S, Calitri R, Shepherd A, Hollands L, Poltawski L, James M, Allison R, Stevens S, Norris M, Spencer A, et al (2016). Community-based Rehabilitation Training after Stroke (ReTrain): Results of a pilot randomised control trial (RCT).
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Lloyd J, Creanor S, Dean S, Abraham C, Green C, Hillsdon M, Taylor R, Logan G, Tomlinson R, Pearson V, et al (2016). Engagement and retention of schools, children and their families in a cluster RCT of a novel obesity prevention intervention: the Healthy Lifestyles programme (HeLP). ISBNPA.
Hollands H, Calitri R, Shepherd A, Poltawski L, Norris M, Taylor R, Dean S (2016). The ReTrain trial: Evaluating intervention fidelity via video analysis of the independently getting up off the floor (IGO) technique.
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Tarrant M, Warmoth K, Dean S, Stein K, Code C, Goodwin V, Sugavanam T (2015). Singing for people with aphasia: a template for a new group intervention.
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Lloyd J, Wyatt K, Dean S, Abraham C (2014). The healthy Lifestyles programme (HeLP): creating the conditions for change and identifying change processes. Emerging Science in the design, evaluation and implementation of behaviour change intervention symposium, International Congress of Applied Psychology (ICAP).
Lloyd J, Wyatt K, Dean S, Abraham C (2014). The healthy Lifestyles programme (HeLP): creating the conditions for change and identifying change processes. Emerging Science in the design, evaluation and implementation of behaviour change intervention symposium. International Congress of Applied Psychology (ICAP).
Dean S (2013). THE CLINICAL APPLICATION OF BEHAVIOUR CHANGE STRATEGIES TO FACILITATE ADHERENCE TO TREATMENT.
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Dean S, Goodwin VA, Poltawski L, Stiles VH, Taylor R (2013). The IGO study: a 'before and after' case series to assess the safety and teaching of a technique designed for people with stroke to Independently Get up Off the floor.
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Bond M, Pavey T, Welch K, Cooper C, Garside R, Dean S, Hyde C (2012). PSYCHOLOGICAL CONSEQUENCES OF FALSE-POSITIVE SCREENING MAMMOGRAMS IN THE UK: a SYSTEMATIC REVIEW.
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Wyatt K, Lloyd J, Dean S (2012). The Healthy Lifestyles Programme (HeLP); Creating the conditions for changing obesity related behaviours. UKSBM.
Dean SG, Hudson S, Dew K, Weatherall M, Howden-Chapman P (2008). 'Disability's between the ears not in the leg'.Exploring. the housing needs and rehabilitation experiences of people with lower limb amputation in New Zealand. International Congress of Behavioral Medicine.
Hudson S, Dew K, Dean SG, Montgomery H, Howden-Chapman P (2008). 'I can't sort of do what I wanted to do. ' housing needs and experiences of people with disability in New Zealand: a qualitative study following lower limb amputation. Warwick 5th Health Housing Conference.
Dean SG, Hudson S, Hay-Smith EJC, Milosavljevic S (2008). Exploring why people continue to work in spite of low back pain: the experiences of farm workers in rural New Zealand. 10th International Congress of Behavioral Medicine.
Dean SG, Taylor WJ, Siegert RJ (2008). Health self-efficacy but not pain predicts disability in the general adult population. 10th International Congress of Behavioral Medicine.
Levack WMM, Dean SG, McPherson KM, Siegert RJ (2008). Navigating the borderlands of patient-centred goal planning: a grounded theory investigation. 10th International Congress of Behavorial Medicine.
Dean SG, Hudson S, Hay-Smith EJC, Milosavljevic S (2008). Rural workers experience of low back pain: exploring why they continue to work. International Federation of Orthopaedic Manual Therapists.
Taylor WJ, Dean SG, Siegert RJ (2007). A low level of self-efficacy is not a risk factor for the development of musculoskeletal pain in the general adult population but low health self-efficacy is a consequence of persistent pain. Annals of Rheumatic Diseases.
Copeland J, Dean SG, Taylor W (2007). Clinical outcome measures invite recipe orientated practice. World Physical Therapy 15th International WCPT Congress.
Young V, Dean SG, Elley R, Bruton A (2007). Exploring patient and health professional preceptions of asthma education and rehabilititation management in New Zealand. Innovation in Rehabilitation Conference.
Levack W, Dean SG, McPherson K, Siegert R (2007). Goal planning for people with acquired brain injury - how clinicians talk about involving families. Innovation in Rehabilitation Conference.
Dean SG, Jera M, Sansom A, Howden-Chapman P (2007). Housing accessibility and Multiple Sclerosis: a qualitative exploration. Innovation in Rehabilitation Conference.
Hudson S, Dean SG, Dew K, Howden-Chapman P (2007). Housing needs and access experiences: Voices of people with lower limb amputations in New Zealand. Public Health Association Conference.
Hay-Smith J, Dean SG (2007). Seizing the moment: how, when and why patients' and health professionals' engage in rehabilitation for urinary incontinence. Innovation in Rehabilitation Conference.
Taylor W, Vipond N, Siegert R, Dean SG (2007). Stability of self-efficacy scores in a general population survey. Innovation in Rehabilitation Conference.
Dean SG, Weinman J, Tennant A, Taylor W (2007). The coherence subscale of the Illness Perception Questionnaire adapted for low back pain: a Rasch analysis. UK Society for Rehabilitation Research Summer Meeting.
Copeland J, Taylor W, Dean SG (2007). The role of clinical outcome measures in the treatment of low back pain - the result of two focus groups. Innovation in Rehabilitation Conference.
Dean SG, Hay-Smith EJC (2007). The special specialist: exploring how health professionals facilitate understanding and adherence to conservative treatment for women with urinary incontinence. World Physical Therapy 15th International WCPT Congress.
Hudson S, Dean SG, Howden-Chapman P, Dew K, Robinson J (2007). To explore the housing needs and experiences of people with lower limb amputations in New Zealand. Innovation in Rehabilitation Conference.
Dean SG, Hay-Smith EJC, Pollock N (2006). Do patients and health professionals share coherent views regarding treatment?. International Continence Society.
Levack WMN, Dean SG, McPherson KM, Siegert RJ (2006). How clinicians talk about the purpose, process and experience of goal planning in interdisciplinary rehabilitation. New Zealand Association of Occupational Therapy Conference.
Dean SG, Hay-Smith EJC (2006). Outside - inside: a qualitative study exploring the public and privat esperience of urinary incontinence. International Society of Behavioural Medicine 9th World Congress.
Hay-Smith J, Dean SG, Ryan K (2006). The silent private exercise: experience pelvic floor muscle training in a sample of stress urinary incontinent women. Proceedings of the New Zealand Society of Physiotherapy Conference.
Dean SG, Elley R, Young V (2005). An Interpretative Phenomenological Analysis of patient's and professionals' perceptions of adherence to asthma education and prevention: a pilot study in New Zealand primary health care. Interpretative Phenomenological Analysis Conference.
Dean SG (2005). Emotional disclosure in health care: dilemmas for health professionals and researchers. 19th Annual Conference of the European Health Psychology Society Synergy Symposium.
Dean SG (2005). Illness perceptions, pain and function in patients with low back pain: a prospective study. 19th Annual Conference of the European Health Psychology Society.
Dean SG (2005). Rethinking expectations as a physiotherapist. Applying psychology to the rehabilitation of patients with low back pain. Southern Pysiotherapy Symposium 3.
Siegert RJ, Levack W, Dean SG, McPherson K (2005). The whys and wherefores of goal setting in rehabilitation. Indian Association for Physical Medicine and Rehabilitation, XXX111 Annual National Conference.
Dean SG, Weinman J, Payne S (2005). Utility of the Orthosense Posture Monitor for facilitating exercise and postural advice for low back pain: a pilot study. 2nd International Conference on Movement Dysfunction.
Dean SG (2005). What factors contibute to treatment adherence? Using examples of self-management for urinary incontinence, asthma and low back pain. Southern Physiotherapy Symposium 3.
Dean SG, Weinman J, Payne S (2004). Exercise Therapy for Low Back Pain: a Pragmatic Controlled Trial ofa Psychological Approach to promote Adherence and Outcome. 5th Interdisciplinary World Congress on Low Back and Pelvic Pain.
Dean SG (2004). The Pain, the Patient and the Professional. New Zealand Pain Society Conference.
Dean SG, Payne S, Weinman J (2002). Pain and the Professional. UK Health Psychology Conference.
Dean SG, Weinman J, Payne S, Smith J (2001). 'Factors contributing to therapeutic exercise adherence for low back pain'. Proceedings of the British Psychological Society.
Dean SG, Weinman J, Payne S (2001). Training physiotherapists to adopt an illness perception approach with their low back pain (LBP) patients. European and UK Health Psychology Conference.
Dean SG, Weinman J, Payne S, Smith J (2000). Adhering to therapeutic exercise for low back pain. Proceedings of the British Psychological Society.
Dean SG (1999). A preliminary investigation into the perceptions of patients with regard to (a)non-specific low back pain and (b)physical activity. Proceedings of the British Psychological Society.
Dean SG (1998). Non specific low back pain - why are some patients afraid to move?. Third Interdisciplinary World Congress on Low Back and Pelvic Pain.
Dean SG (1998). The Role of Patients' Outcome Expectancy in Prediciting Adherence to Physiotherapeutic Exercises for Musculoskeletal Problems. Physiotherapy.
