Reported Outcome Measures in Degenerative Cervical Myelopathy: A Systematic Review.

OBJECTIVE: Degenerative cervical myelopathy [DCM] is a disabling and increasingly prevalent group of diseases. Heterogeneous reporting of trial outcomes limits effective inter-study comparison and optimisation of treatment. This is recognised in many fields of healthcare research. The present study aims to assess the heterogeneity of outcome reporting in DCM as the premise for the development of a standardised reporting set. METHODS: A systematic review of MEDLINE and EMBASE databases, registered with PROSPERO (CRD42015025497) was conducted in accordance with PRISMA guidelines. Full text articles in English, with >50 patients (prospective) or >200 patients (retrospective), reporting outcomes of DCM were eligible. RESULTS: 108 studies, assessing 23,876 patients, conducted world-wide, were identified. Reported outcome themes included function (reported by 97, 90% of studies), complications (reported by 56, 52% of studies), quality of life (reported by 31, 29% of studies), pain (reported by 29, 27% of studies) and imaging (reported by 59, 55% of studies). Only 7 (6%) studies considered all of domains in a single publication. All domains showed variability in reporting. CONCLUSIONS: Significant heterogeneity exists in the reporting of outcomes in DCM. The development of a consensus minimum dataset will facilitate future research synthesis.MRNK is supported by NIHR Clinician Scientist Award; PJAH holds a NIHR research professorship.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by the Public Library of Science

Implementing a community specialist team to support the delivery of integrated diabetes care: experiences in Ireland during the COVID-19 pandemic [version 1; peer review: 2 approved, 1 approved with reservations]

Background: While models of integrated care for people with chronic conditions have demonstrated promising results, there are still knowledge gaps about how these models are implemented in different contexts and which strategies may best support implementation. We aimed to evaluate the implementation of a multidisciplinary diabetes Community Specialist Team (CST) to support delivery of integrated type 2 diabetes care during COVID-19 in two health networks. Methods: A mixed methods approach was used. Quantitative data included administrative data on CST activity and caseload, and questionnaires with GPs, practice nurses (PN) and people with type 2 diabetes. Qualitative data were collected using semi-structured interviews and focus groups about the service from CST members, GPs, PNs and people with type 2 diabetes. We used the Consolidated Framework for Implementation Research framework to explain what influences implementation and to integrate different stakeholder perspectives. Results: Over a 6-month period (Dec 2020-May 2021), 516 patients were seen by podiatrists, 435 by dieticians, and 545 by CNS. Of patients who had their first CST appointment within the previous 6 months (n=29), 69% (n=20) waited less than 4 weeks to see the HCP. During initial implementation, CST members used virtual meetings to build ‘rapport’ with general practice staff, supporting ‘upskilling’ and referrals to the CST. Leadership from the local project team and change manager provided guidance on how to work as a team and ‘iron out’ issues. Where available, shared space enhanced networking between CST members and facilitated joint appointments. Lack of administrative support for the CST impacted on clinical time. Conclusions: This study illustrates how the CST benefited from shared space, enhanced networking, and leadership. When developing strategies to support implementation of integrated care, the need for administrative support, the practicalities of co-location to facilitate joint appointments, and relative advantages of different delivery models should be considered

Trends in published research.

<p>Stacked line graph of year of publication of identified studies. Retrospective studies are in blue, prospective studies in red and the number of RCTs indicated by the black line. [Pro: Prospective, Retro: Retrospective, RCT: Randomised Controlled Trial]. The number of publications has increased over time, including those deemed of higher quality (prospective and randomised).</p

Geographical variation in chosen functional outcomes.

<p>Each bar represents 100%. The use of the most prevalent outcome measures (JOA, Nurick, NDI, mJOA, JOACMEQ) are reported as percentages for each territory.</p

PRISMA flow diagram of the search strategy.

<p>PRISMA flow diagram of the search strategy.</p

Variation in chosen functional outcomes overtime.

<p>Each bar represents 100%. The use of the most prevalent outcome measures (JOA, Nurick, NDI, mJOA, JOACMEQ) are reported as percentages for each time period.</p

Outcome domains identified by this systematic review.

<p>Outcome domains identified by this systematic review.</p