Organization and management of space grant programs

The 21 Space Grant Programs represent a broad range of organizational structures which operate programs ranging in size from single university organizations to organizations including up to 41 members involving a composite of industrial organizations such as state agencies, and universities. Some of the space grant awards were made to organizations already in existence with on-going programs while other awards were made to consortia newly formed for the purpose of applying to the Space Grant Program. The workshop on organization and management of Space Grant Programs provided an opportunity for directors and program representatives to discuss and compare the relative advantages and disadvantages of the various models being used. This paper offers examples of the diversity of organizations, summarizes the common concerns to be met by each organizational model, and provides a case study of the Texas Space Grant Consortium organization

A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for Rheumatoid Arthritis evaluated in the SARAH Trial

Purpose: This study explores the experience of participants taking part in a hand exercise programme for people with rheumatoid arthritis with a focus on adherence. The exercise programme was tested in a randomised controlled trial. This parallel qualitative study will inform future implementation into clinical practice. Method: Twenty-seven semi-structured interviews from 14 participants were undertaken at 2 time points (4 and 12 months after randomisation). We collected data of participants’ experiences over time. This was guided by an interview schedule. Interview data were analysed using interpretative phenomenological analysis which is informed by phenomenological and hermeneutic theory. We recruited participants from National Health Service rheumatology and therapy departments. Results: At 4 months, 11/14 participants reported continuing with the exercises. By 12 months, 7/13 participants still reported exercising. The ability to establish a routine determined whether participants adhered to the exercise programme. This was sometimes influenced by practical issues. We also identified facilitators and barriers to regular exercise in the themes of – the therapeutic encounter, perceived benefit of exercises, attitude of mind, confidence and unpredictability. Conclusions: Establishing a routine was an important step towards participants being able to exercise independently. Therapists provided participants with skills to continue to exercise while dealing with changes in symptoms and schedules. Potential barriers to long term exercise adherence need to be taken into account and addressed for successful implementation of this programme

Aerobic and strength training exercise programme for cognitive impairment in people with mild to moderate dementia : the DAPA RCT

Background Approximately 670,000 people in the UK have dementia. Previous literature suggests that physical exercise could slow dementia symptom progression. Objectives To estimate the clinical effectiveness and cost-effectiveness of a bespoke exercise programme, in addition to usual care, on the cognitive impairment (primary outcome), function and health-related quality of life (HRQoL) of people with mild to moderate dementia (MMD) and carer burden and HRQoL. Design Intervention development, systematic review, multicentred, randomised controlled trial (RCT) with a parallel economic evaluation and qualitative study. Setting 15 English regions. Participants People with MMD living in the community. Intervention A 4-month moderate- to high-intensity, structured exercise programme designed specifically for people with MMD, with support to continue unsupervised physical activity thereafter. Exercises were individually prescribed and progressed, and participants were supervised in groups. The comparator was usual practice. Main outcome measures The primary outcome was the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog). The secondary outcomes were function [as measured using the Bristol Activities of Daily Living Scale (BADLS)], generic HRQoL [as measured using the EuroQol-5 Dimensions, three-level version (EQ-5D-3L)], dementia-related QoL [as measured using the Quality of Life in Alzheimer’s Disease (QoL-AD) scale], behavioural symptoms [as measured using the Neuropsychiatric Inventory (NPI)], falls and fractures, physical fitness (as measured using the 6-minute walk test) and muscle strength. Carer outcomes were HRQoL (Quality of Life in Alzheimer’s Disease) (as measured using the EQ-5D-3L) and carer burden (as measured using the Zarit Burden Interview). The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained from a NHS and Personal Social Services perspective. We measured health and social care use with the Client Services Receipt Inventory. Participants were followed up for 12 months. Results Between February 2013 and June 2015, 494 participants were randomised with an intentional unequal allocation ratio: 165 to usual care and 329 to the intervention. The mean age of participants was 77 years [standard deviation (SD) 7.9 years], 39% (193/494) were female and the mean baseline ADAS-Cog score was 21.5 (SD 9.0). Participants in the intervention arm achieved high compliance rates, with 65% (214/329) attending between 75% and 100% of sessions. Outcome data were obtained for 85% (418/494) of participants at 12 months, at which point a small, statistically significant negative treatment effect was found in the primary outcome, ADAS-Cog (patient reported), with a mean difference of –1.4 [95% confidence interval (CI) –2.62 to –0.17]. There were no treatment effects for any of the other secondary outcome measures for participants or carers: for the BADLS there was a mean difference of –0.6 (95% CI –2.05 to 0.78), for the EQ-5D-3L a mean difference of –0.002 (95% CI –0.04 to 0.04), for the QoL-AD scale a mean difference of 0.7 (95% CI –0.21 to 1.65) and for the NPI a mean difference of –2.1 (95% CI –4.83 to 0.65). Four serious adverse events were reported. The exercise intervention was dominated in health economic terms. Limitations In the absence of definitive guidance and rationale, we used a mixed exercise programme. Neither intervention providers nor participants could be masked to treatment allocation. Conclusions This is a large well-conducted RCT, with good compliance to exercise and research procedures. A structured exercise programme did not produce any clinically meaningful benefit in function or HRQoL in people with dementia or on carer burden

“If I can get over that, I can get over anything”—understanding how individuals with acute whiplash disorders form beliefs about pain and recovery : a qualitative study

Objectives: Beliefs held by patients have been shown to influence outcomes in acute whiplash associated disorders (WAD). The aim was to identify beliefs about pain and recovery present in the narratives of individuals with WAD and to understand how and why individuals' came to hold these beliefs. Design: A qualitative study. Interpretative Phenomenological Analysis of semi-structured interviews. Participants: Participants (. n=. 20) were enrolled in a large, pragmatic randomised controlled trial of physiotherapy for acute WAD. Participants were interviewed after they completed their treatment. Results: A range of beliefs were evident. These included beliefs about exercise and activity, ability to self-manage symptoms, expectations of recovery and competing priorities. Some beliefs appeared to be barriers to recovery despite all participants having consulted several health professionals. Health professionals were highly influential over how individuals' thought about and managed their injury. The pain experienced influenced how individuals thought and behaved as did past experiences of injury and illness. Competing priorities were a potential barrier to engaging with treatment. We identified examples of how beliefs and behaviour changed in response to information from health professionals and the pain they experienced. Conclusion: People with WAD hold a range of beliefs about pain and recovery and some appear unhelpful to recovery. Health professionals can influence these beliefs and encourage behaviours that aid recovery. Understanding how patients form beliefs may help health professionals to address unhelpful beliefs. It is important that advice and education provided is in line with the current evidenced based understanding of pain and recovery. © 2014 Chartered Society of Physiotherapy

Patterns of interaction between factors that enhance or inhibit recovering from chronic low back pain

Purpose: This interview study aimed to capture an account of change in low back pain over time and understand the interaction of known bio-psychosocial risk factors. Methods: Thirty-four participants from the Back Skills Training (BeST) UK trial, evaluating a cognitive behavioural approach intervention for LBP, gave 61 interviews. Semi-structured interviews taken once or twice post intervention explored participants’ experiences of LBP and the intervention received. Initial thematic analysis of the data gave themes, which participants spoke about in an integrated way. Rereading of whole transcripts identified interactions between themes, which we classified as helpful or unhelpful to recovery. The team also explored whether there were correlations with Roland and Morris Disability Questionnaire (RMDQ) scores from the main trial. Results: Web diagrams gave a graphic representation of the interactions between factors, which were highly individual and time specific. We identified three categories of webs; dense web (mostly unhelpful), open web (helpful and unhelpful) and sparse web (mostly helpful). These categories correlated with (RMDQ) scores. Conclusions: Facilitators as well as potential barriers to recovery give added insight when considering psychosocial risk factors. Web categories highlight patterns of interaction between psychosocial factors, which underlie levels of disability. These patterns of interaction may help to guide clinicians in their choice of treatment approaches

Exploring the use of the ‘Adapted Miracle Question’ in the assessment of low back pain

Background: Low back pain is a complex condition, often recurring or chronic, which has proved difficult to characterise. To explore an alternative approach to assessing low back pain, an expert panel adapted the 'Miracle Question' from Solution-Focused Brief Therapy. This asks about a forward scenario of waking without the problems that the client had presented with. The question was adapted to: What would you do if you did not have back pain? Objectives: To explore the use of the Adapted Miracle Question (AMQ) within an interview study of patients with low back pain. Design, setting and participants: The AMQ was used in an interview study of 34 participants recruited from the UK Back Skills Training (BeST) trial, assessing the effectiveness of a cognitive behavioural approach intervention for the management of low back pain. Responses to the AMQ were analysed thematically and then case by case. Results: Interviewees talked about details of their activities and ability to function that would be different, and about change to their quality of life. Some talked about work. Five interviewees said that it would make no difference to them. When considered overall, the responses could be categorised as: no change; some change in activity/function; a return to their pre-back pain state; and life would be transformed. Conclusion: The AMQ was straightforward to ask and prompted a breadth of responses which may be useful in tailoring treatment. This question warrants further evaluation in the clinical setting. (C) 2010 Chartered Society of Physiotherap

A multicentred randomised controlled trial of a primary care-based cognitive behavioural programme for low back pain : the back skills training (BeST) trial

Objectives: To estimate the clinical effectiveness of active management (AM) in general practice versus AM plus a group-based, professionally led cognitive behavioural approach (CBA) for subacute and chronic low back pain (LBP) and to measure the cost of each strategy over a period of 12 months and estimate cost-effectiveness. Design: Pragmatic multicentred randomised controlled trial with investigator-blinded assessment of outcomes. Setting: Fifty-six general practices from seven English regions. Participants: People with subacute and chronic LBP who were experiencing symptoms that were at least moderately troublesome. Interventions: Participants were randomised (in a ratio of 2: 1) to receive either AM+CBA or AM alone. Main outcome measures: Primary outcomes were the Roland Morris Disability Questionnaire (RMQ) and the Modified Von Korff Scale (MVK), which measure LBP and disability. Secondary outcomes included mental and physical health-related quality of life (Short Form 12-item health survey), health status, fear avoidance beliefs and pain self-efficacy. Cost utility of CBA was considered from both the UK NHS perspective and a broader health-care perspective, including both NHS costs and costs of privately purchased goods and services related to LBP. Quality-adjusted life-years (QALYs) were calculated from the five-item EuroQoL. Results: Between April 2005 and April 2007, 701 participants were randomised: 233 to AM and 468 to AM+CBA. Of these, 420 were female. The mean age of participants was 54 years and mean baseline RMQ was 8.7. Outcome data were obtained for 85% of participants at 12 months. Benefits were seen across a range of outcome measures in favour of CBA with no evidence of group or therapist effects. CBA resulted in at least twice as much improvement as AM. Mean additional improvement in the CBA arm was 1.1 [95% confidence interval (Cl) 0.4 to 1.7], 1.4 (95% Cl 0.7 to 2.1) and 1.3 (95% Cl 0.6 to 2.1) change points in the RMQ at 3, 6 and 12 months respectively. Additional improvement in MVK pain was 6.8 (95% Cl 3.5 to 10.2), 8.0 (95% Cl 4.3 to 11.7) and 7.0 (95% Cl 3.2 to 10.7) points, and in MVK disability was 4.3 (95% Cl 0.4 to 8.2), 8.1 (95% Cl 4.1 to 12.0) and 8.4 (95% Cl 4.4 to 12.4) points at 3, 6 and 12 months respectively. At 12 months, 60% of the AM+CBA arm and 31% of the AM arm reported some or complete recovery. Mean cost of attending a CBA course was 187 pound per participant with an additional benefit in QALYs of 0.099 and an additional cost of 78.06 pound. Incremental cost-effectiveness ratio was 1786.00 pound. Probability of CBA being cost-effective reached 90% at about 3000 pound and remained at that level or above; at a cost-effectiveness threshold of 20,000 pound, the CBA group had an almost 100% probability of being considered cost-effective. User perspectives on the acceptability of group treatments were sought through semi-structured interviews. Most were familiar with key messages of AM; most who had attended any group sessions had retained key messages from the sessions and two-thirds talked about a reduction in fear avoidance and changes in their behaviour. Group sessions appeared to provide reassurance, lessen isolation and enable participants to learn strategies from each other. Conclusions: Long-term effectiveness and cost-effectiveness of CBA in treating subacute and chronic LBP was shown, making this intervention attractive to patients, clinicians and purchasers. Short-term (3-month) clinical effects were similar to those found in high-quality studies of other therapies and benefits were maintained and increased over the long term (12 months). Cost per QALY was about half that of competing interventions for LBP and because the intervention can be delivered by existing NHS staff following brief training, the back skills training programme could be implemented within the NHS with relative ease

Kognitive Gruppen-Verhaltenstherapie in der primären Gesundheitsversorgung bei LWS-Syndrom : eine randomisierte, kontrollierte Studie und Analyse der Kostenwirksamkeit

Background: Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care. Methods: In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computergenerated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854. Findings: 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 per QALY. There were no serious adverse events attributable to either treatment. Interpretation: Over one year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider. Funding: National Institute for Health Research Health Technology Assessment Programme