Transmural collaborative care model for the review of antipsychotics: a feasibility study of a complex intervention

General practitioners (GPs) are often unaware of antipsychotic (AP)-induced cardiovascular risk (CVR) and therefore patients using atypical APs are not systematically monitored. We evaluated the feasibility of a complex intervention designed to review the use of APs and advise on CVR-lowering strategies in a transmural collaboration. A mixed methods prospective cohort study in three general practices in the Netherlands was conducted in 2021. The intervention comprised three steps: a digital information meeting, a multidisciplinary meeting, and a shared decision-making visit to the GP. We assessed patient recruitment and retention rates, advice given and adopted, and CVR with QRISK3 score and mental state with MHI-5 at baseline and three months post-intervention. GPs invited 57 of 146 eligible patients (39%), of whom 28 (19%) participated. The intervention was completed by 23 (82%) and follow-up by 18 participants (64%). At the multidisciplinary meeting, 22 (78%) patients were advised to change AP use. Other advice concerned medication (other than APs), lifestyle, monitoring, and psychotherapy. At 3-months post-intervention, 41% (28/68) of this advice was adopted. Our findings suggest that this complex intervention is feasible for evaluating health improvement in patients using AP in a trial

PEPTOC

Mediatio

Baseline characteristics of the participants.

<p>* Mean (SD).</p><p>^† Median (interquartile range).</p><p>PEPT = Pain Exposure Physical Therapy. CONV = conventional treatment.</p><p>Baseline characteristics of the participants.</p

Descriptives of the dependent variables and the mediator variables.

<p>All data are mean (SD).</p><p>PEPT = Pain Exposure Physical Therapy. CONV = conventional treatment. VAS = Visual Analogue Scale. FABQ = Fear-Avoidance Beliefs Questionnaire. PCS = Pain Catastrophizing Scale.</p><p>Descriptives of the dependent variables and the mediator variables.</p

Outcomes for both treatment groups at baseline and at 3, 6, and 9 months follow-up.

<p>Panel A: dependent variables pain-related disability and pain. Panel B: potential mediators fear-avoidance beliefs, pain catastrophizing, and kinesiophobia. PDI = Pain Disability Index. VAS = Visual Analogue Scale. FABQ = Fear-Avoidance Beliefs Questionnaire. PCS = Pain Catastrophizing Scale. TSK = Tampa Scale for Kinesiophobia. CONV = conventional treatment. PEPT = Pain Exposure Physical Therapy.</p

The fear-avoidance model, showing the targets of Pain Exposure Physical Therapy and graded exposure treatment.

<p>In this model, pain catastrophizing, pain-related fear and avoidance are thought to be mediators for the treatment of disability and consequently pain. Reproduced from Vlaeyen and Linton [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0123008#pone.0123008.ref007" target="_blank">7</a>]. PEPT = Pain Exposure Physical Therapy. GEXP = Graded Exposure treatment.</p

Mediation analysis with estimated group differences based on linear mixed models^*.

<p>*Linear mixed models with unstructured repeated covariance, treatment and measurement in time as factors and outcome at baseline as covariate, corrected for “extremity”, “dominant side affected”, and “time since inciting event” as confounding variables.</p><p>PEPT = Pain Exposure Physical Therapy. CONV = conventional treatment. VAS = Visual Analogue Scale. FABQ = Fear-Avoidance Beliefs Questionnaire. PCS = Pain Catastrophizing Scale.</p><p>Mediation analysis with estimated group differences based on linear mixed models^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0123008#t003fn001" target="_blank">*</a>}.</p

The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial

Contains fulltext : 109801.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is now ready for clinical evaluation. The results of an earlier performed pilot study with an n = 1 design, in which 20 patients with Complex Regional Pain Syndrome type 1 were treated with Pain Exposure Physical Therapy, were used for the design and power calculation of the present study. After completion and evaluation of this phase III study, a multi-centre implementation study will be conducted. The aim of this study is to determine whether Pain Exposure Physical Therapy can improve functional outcomes in patients with Complex Regional Pain Syndrome type 1. Methods/design This study is designed as a single-blinded, randomized clinical trial. 62 patients will be randomized with a follow-up of 9 months to demonstrate the expected treatment effect. Complex Regional Pain Syndrome type 1 is diagnosed in accordance with the Bruehl/International Association for the Study of Pain criteria. Conventional therapy in accordance with the Dutch guideline will be compared with Pain Exposure Physical Therapy. Primary outcome measure is the Impairment level SumScore, restricted version. DISCUSSION: This is the first randomized controlled study with single blinding that has ever been planned in patients with Complex Regional Pain Syndrome type 1 and does not focus on a single aspect of the pain syndrome but compares treatment strategies based on completely different pathophysiological and cognitive theories. Trial registration Clinical trials NCT00817128; National Trial Register NTR2090