Physiotherapy interventions for non-ambulatory people with multiple sclerosis

This thesis is comprised of three papers that aim to examine the literature surrounding physiotherapy interventions in non-ambulatory people with Multiple Sclerosis (PwMS), to gather information from a pilot scheme of the Exercise Buddy system in community physiotherapy and to evaluate the system formally. Multiple Sclerosis (MS) is an inflammatory neurological disease that has a considerable physical and psychological impact on those affected. Approximately one quarter of PwMS are non-ambulatory, but the amount of physiotherapy received by this population is limited. An Exercise Buddy system is where professional carers are employed to conduct home exercise programmes with PwMS under the guidance of physiotherapists, and may augment the amount of physiotherapy currently received by a non-ambulatory subgroup. A systematic review on physical rehabilitation interventions in non-ambulatory PwMS was carried out that found very little high quality studies for this population. A series of semi-structured interviews were then carried out with the participants of a pilot scheme of the Exercise Buddy system. The system was found to have excellent potential to benefit PwMS and their carers both physically and psychologically, and that adequate communication and training of Exercise Buddies were crucial to the success of the system. A randomised crossover trial of 29 non-ambulatory PwMS and their carers was carried out which found significant improvements in the physical and psychological self-perceived impact of MS in PwMS. Disability levels in PwMS were maintained and large dropout rates in carers made it difficult to make definite conclusions about the effect of either intervention. The thesis concludes with a summary of the findings and a discussion of the implications of these papers for current practice and future research

Strategies for implementing pet robots in care homes and nursing homes for residents with dementia: protocol for a modified Delphi study

Background: Pet robots are a type of technology-based innovation that have shown positive psychosocial benefts  for people with dementia in residential facilities, such as improving mood and social interaction and reducing agitation. Nevertheless, little is known about how pet robots can be implemented in care homes and nursing homes for  dementia care in real-world practice. The objectives of this study are to (1) identify contextualised implementation  strategies for implementing pet robots into care homes and nursing homes for dementia care and (2) achieve consensus on the most relevant strategies. Method: This study is informed by a preceding scoping review and qualitative study, which used the Consolidated  Framework of Implementation Research (CFIR) to identify multi-level determinants of implementation (i.e. barriers and  facilitators). We will use the CFIR-ERIC matching tool to identify relevant implementation strategies from the Expert  Recommendations for Implementing Change (ERIC) taxonomy to address these determinants. Data from the scoping review and qualitative study will be used to contextualise the generic ERIC strategies for our setting. After that,  a group of key stakeholders will be consulted to further contextualise and refne these strategies. Next, a two-round  modifed Delphi process will be conducted. Fifty-four international expert participants including healthcare professionals and organisational leaders from care homes and nursing homes and academic researchers will be recruited  through purposive sampling. During the frst Delphi round, participants will be invited to rate the relevance of each  implementation strategy on a 9-point Likert scale and provide comments or suggestions. Descriptive statistics will be  used to identify whether consensus has been obtained. Inductive qualitative content analysis will be used to analyse  and summarise textual responses for any new statements suggested by participants. Statements that do not reach  consensus and new statements suggested in round 1 will be taken to the next round, which will follow the same rating process. Discussion: This study will identify strategies for implementing pet robots in care homes and nursing homes for residents with dementia, which will have practical utility for clinicians, organisations and researchers. It will also demonstrate the practical application (and adaptation) of the CFIR-ERIC tool to identify and contextualise ERIC strategie </p

Determinants of implementing pet robots in nursing homes for dementia care

Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their  potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of  implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and  organisational leaders. Methods: A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals  and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based  on the CFIR as an a priori framework. Results: A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all fve CFIR domains. Determinants relating to the characteristics of pet robots include their design,  realisticness and interactivity, afordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external infuences (outer setting) include national regulatory guidelines, funding  and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants  include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain characteristics of individuals, determinants  were associated with individuals beliefs on the role of technology, desires to enhance residents  quality of life, and  diferential attitudes on the use of robots. Finally, in the domain implementation process assessments and care planning were identifed as determinants. Conclusions: Overall, while sentiments around determinants within CFIR domains of pet robots characteristics, outer setting and implementation process were similar, participants opinions on the determinants within the ‘inner setting"  and characteristics of individuals’ were more varied. This could be due to diferent organisational structures, disciplinary diferences and personal experiences of using pet robots. Many determinants in diferent domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation  of pet robots from research into real-world practice. </p

Establishing open science research priorities in health psychology: a research prioritisation Delphi exercise

Objective:  Research on Open Science practices in Health  Psychology is lacking. This meta-research study aimed to identify  research question priorities and obtain consensus on the Top 5  prioritised research questions for Open Science in Health  Psychology. Methods and measures: An international Delphi consensus study  was conducted. Twenty-three experts in Open Science and Health  Psychology within the European Health Psychology Society (EHPS)  suggested research question priorities to create a ‘long-list’ of  items (Phase 1). Forty-three EHPS members rated the importance  of these items, ranked their top five and suggested their own  additional items (Phase 2). Twenty-four EHPS members received  feedback on Phase 2 responses and then re-rated and re-ranked  their top five research questions (Phase 3). Results:  The top five ranked research question priorities were: 1.  ‘To what extent are Open Science behaviours currently practised  in Health Psychology?’, 2. ‘How can we maximise the usefulness  of Open Data and Open Code resources?’, 3. ‘How can Open Data  be increased within Health Psychology?’, 4. ‘What interventions  are effective for increasing the adoption of Open Science in Health  Psychology?’ and 5. ‘How can we increase free Open Access publishing in Health Psychology?’. Conclusion:  Funding and resources should prioritise the research  questions identified here. </p

A qualitative study exploring perceived barriers and enablers to fidelity of training and delivery for an intervention to reduce non-indicated imaging for low back pain

Background Non-specifc low back pain (LBP) commonly presents to primary care, where inappropriate use of imaging  remains common despite guideline recommendations against its routine use. Little is known about strategies to  enhance intervention fdelity (i.e., whether interventions were implemented as intended) for interventions developed  to reduce non-indicated imaging for LBP. Objectives We aim to inform the development of an intervention to reduce non-indicated imaging among general practitioners (GPs) and chiropractors in Newfoundland and Labrador (NL), Canada. The study objectives are: [1] To explore perceived barriers and enablers to enhancing fdelity of training of GPs and chiropractors to deliver a proposed intervention to reduce non-indicated imaging for LBP and [2] to explore perceived barriers and enablers to enhancing fdelity of delivery of the proposed intervention.Methods An exploratory,  qualitative study was conducted with GPs and chiropractors in NL. The interview guide was  informed by the National  Institutes of Health Behavior Change Consortium fdelity checklist; data analysis was guided  by the Theoretical Domains Framework (TDF). Participant quotes were coded into TDF domains, belief statements  were generated at each domain, and domains reevant to enhancing fdelity of provider training or intervention delivery  were identifed. Results The study included fve GPs and five chiropractors from urban and rural settings. Barriers and  enablers to enhancing fdelity to provider training related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3]  Reinforcement, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Emotion,  and [7] Behavioural regulation. Barriers and enablers to enhancing fdelity to intervention delivery related to seven  TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Goals, [4] Memory, attention, and decision processes, [5]  Environmental context and resources, [6] Social infuences, and [7] Behavioural regulation. Conclusion The largest perceived barrier to attending training was time; perceived enablers were incentives and  fexible training. Patient pressure, time, and established habits were perceived barriers to delivering the intervention  as intended. Participants suggested enhancement strategies to improve their ability to deliver the intervention as  intended, including reminders and check-ins with researchers. Most participants perceived intervention fdelity as  important. These results may aid in the development of a more feasible and pragmatic intervention to reduce non-indicated imaging for GPs and chiropractors in NL</p

Feasibility of an audit and feedback intervention to facilitate journal policy change towards greater promotion of transparency and openness in sports science research

Objectives: To evaluate (1) the feasibility of an audit-feedback intervention to facilitate sports science journal policy  change, (2) the reliability of the Transparency of Research Underpinning Social Intervention Tiers (TRUST) policy  evaluation form, and (3) the extent to which policies of sports science journals support transparent and open research  practices. Methods: We conducted a cross-sectional, audit-feedback, feasibility study of transparency and openness standards  of the top 38 sports science journals by impact factor. The TRUST form was used to evaluate journal policies support  for transparent and open research practices. Feedback was provided to journal editors in the format of a tailored let‑ ter. Inter-rater reliability and agreement of the TRUST form was assessed using intraclass correlation coefcients and  the standard error of measurement, respectively. Time-based criteria, fdelity of intervention delivery and qualitative  feedback were used to determine feasibility. Results: The audit-feedback intervention was feasible based on the time taken to rate journals and provide tailored  feedback. The mean (SD) score on the TRUST form (range 0–27) was 2.05 (1.99), refecting low engagement with trans‑ parent and open practices. Inter-rater reliability of the overall score of the TRUST form was moderate [ICC (2,1)=0.68  (95% CI 0.55–0.79)], with standard error of measurement of 1.17. However, some individual items had poor reliability. Conclusion: Policies of the top 38 sports science journals have potential for improved support for transparent and  open research practices. The feasible audit-feedback intervention developed here warrants large-scale evaluation as a  means to facilitate change in journal policies </p

Priority III: top 10 rapid review methodology research priorities identified using a James Lind Alliance Priority Setting Partnership

Objectives: A rapid review is a form of evidence synthesis considered a resource-efficient alternative to the conventional systematic review. Despite a dramatic rise in the number of rapid reviews commissioned and conducted in response to the coronavirus disease 2019 pandemic, published evidence on the optimal methods of planning, doing, and sharing the results of these reviews is lacking. The Priority III study aimed to identify the top 10 unanswered questions on rapid review methodology to be addressed by future research.  Study Design and Setting: A modified James Lind Alliance Priority Setting Partnership approach was adopted. This approach used two online surveys and a virtual prioritization workshop with patients and the public, reviewers, researchers, clinicians, policymakers, and funders to identify and prioritize unanswered questions.  Results: Patients and the public, researchers, reviewers, clinicians, policymakers, and funders identified and prioritized the top 10 unanswered research questions about rapid review methodology. Priorities were identified throughout the entire review process, from stakeholder involvement and formulating the question, to the methods of a systematic review that are appropriate to use, through to the dissemination of results.  Conclusion: The results of the Priority III study will inform the future research agenda on rapid review methodology. We hope this will enhance the quality of evidence produced by rapid reviews, which will ultimately inform decision-making in the context of healthcare. </p