Confidence and performance in objective structured clinical examination

Introduction: The objective structured clinical examination (OSCE )is commonly used as a standard assessment approach in midwifery education. Student’s confidence may impact on the OSCE performancebut the evidence on this is very limited. Objectives: This study aimed to evaluate the relationship between confidence and OSCE performance in midwifery students. Methods: 103 pre-registration midwifery students (42 year one students: 61 year three students) from Sheffield Hallam University took part in this study as part of their routine OSCE assessment. They completed pre- and post-exam questionnaires, which asked them to rate their confidence in the clinical skills being assessed on a scale from 1 to 10 (1=not confident; 10 =totally confident). Results: The results showed significant increases in mean confidence levels from before to after OSCE for both first and third year students (5.52 (1.25) to 6.49 (1.19); P=0.001 and 7.49(0.87) to 8.01(0.73); P<0.001, respectively). However, there was no significant correlation between confidence levels before undertaking the OSCE and the final OSCE test scores (r= 0.12; P=0.315). Conclusions: The increased level of confidence after the OSCE is important but how thisis transformed into improved clinical skills in practical settings requires further investigation. The lack of significant correlation between OSCEresults and student’s confidence, may indicate additional evidence for the objectivity of the OSCE . This, however, may be due to the inherent complexity of assessing such relationships. Larger studies with mixed methodology are required for further investigation of this important area of education and assessment research

Quality appraisal as a part of the systematic review: a review of current methods

Systematic reviews frequently underpin national and international practice guidelines. Different approaches to the systematic review process, in particular quality appraisal, have been advocated. This paper discusses these approaches and highlights possible limitations which might impact upon the validity of the conclusions drawn. Practical alternatives are offered upon which systematic reviews may be appraised and conducted

Physiotherapy practice in pulmonary hypertension: physiotherapist and patient perspectives

Pulmonary hypertension (PH) is a life-limiting disease affecting circulation to the lungs. The primary symptom of PH is breathlessness, yet research has shown that patients with PH can exercise safely and can benefit from exercise to improve exercise capacity and maintain quality of life. This study aimed to investigate the nature of physiotherapy delivered to patients with PH in the UK. This was a two-phase sequential, exploratory, mixed-methods study. Interviews were conducted with seven lead physiotherapists at specialist pulmonary hypertension centers and three patients. Survey data came from 63 physiotherapists caring for patients with PH in specialist and non-specialist settings. The findings from the two phases were triangulated and analyzed. Findings showed that physiotherapists and patients see the benefit and potential of physical activity for patients with PH to maintain functional wellbeing. However, current physiotherapy provision focuses on acute inpatient care and planning for discharge and is not therefore aligned with research evidence and clinical guidelines. In the absence of inpatient rehabilitation facilities, physiotherapists will occasionally access existing community services, e.g. pulmonary rehabilitation; however, specialist knowledge of this rare condition can be lacking in local services. There is aspiration among physiotherapists and patients for a new approach which supports patients from diagnosis with PH to end of life. This includes promoting and delivering rehabilitation and exercise interventions to achieve better health outcomes, in line with patient needs. Treatment would be commissioned and delivered within existing national health systems with physiotherapists developing strategies for health improvement

Measures of upper limb function for people with neck pain: A systematic review of measurement and practical properties (protocol)

Background Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. This review will identify all available measures of upper limb function developed for use in neck pain patients and evaluate their measurement and practical properties in order to identify those measures that are most appropriate for use in clinical practice and research. Methods/design This review will be performed in two phases. Phase one will identify all measures used to assess upper limb function for patients with neck pain. Phase two will identify all available studies of the measurement and practical properties of identified instrument. The COnsensusbased Standards for selection of health Measurement INstrument (COSMIN) will be used to evaluate the methodological quality of the included studies. To ensure methodological rigour, the findings of this review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline.Discussion Optimal management of patients with neck pain should incorporate upper limb rehabilitation. The findings of this study will assist clinicians who seek to utilise suitable and accurate measures to assess upper limb function for a patient with neck pain. In addition, the findings of this study may suggest new research directions to support the development of upper limb outcome measures for patients with neck pain

Effects of matched vs. unmatched physical therapy interventions on pain or disability in patients with neck pain - a systematic review and meta-analysis.

BackgroundThe interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient.ObjectivesTo investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability.DesignA systematic review and meta-analysis conducted following Cochrane guidelines.MethodsDatabases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures.ResultsThe literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up.ConclusionsResults suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria

Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles

Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Healthcare services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations and rescheduling of appointments across all healthcare settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the Contexts and Mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews & Dissemination (CRD) guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. “Reminders plus”, which provide additional information beyond the reminder function, may be more effective than simple reminders at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their healthcare appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, healthcare services need supportive administrative processes to enhance attendance, cancellation, rescheduling and re-allocation of appointments to other patients

Targeting the use of reminders and notifications for uptake by populations (TURNUP): a systematic review and evidence synthesis.

Background: Missed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects. Objectives: This project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments. Design: Three inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3). Data sources: Database searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics Engineers Xplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3. Methods: We conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptualframework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking. Results: A total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups. Limitations: Generally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings. Conclusions: Simple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches

Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties

There is a strong relationship between neck pain (NP) and upper limb disability (ULD). Optimal management of NP should incorporate upper limb rehabilitation and therefore include the use of an ULD measure in the assessment and management process. Clear guidance regarding the suitability of available measures does not exist. The aim of this study was to identify all available measures of ULD for populations with NP, critically evaluate their measurement properties and finally recommend a list of suitable measures. This two-phase systematic review is reported in accordance with the PRISMA statement. Phase one identified clearly reproducible measures of ULD for patients with NP. Phase two identified evidence of their measurement properties. In total, 11 papers evaluating the measurement properties of five instruments were included in this review. The instruments identified were the DASH questionnaire, the QuickDASH questionnaire, the NULI questionnaire, the SFA and the SAMP test. There was limited positive evidence of validity of the DASH, QuickDASH, NULI, SFA and SAMP. There was limited positive evidence of reliability of the NULI, SFA and SAMP. There was unknown evidence of responsiveness of the DASH and QuickDASH. Although all measures are supported by a limited amount of low quality evidence, the DASH, QuickDASH, NULI questionnaires, and the SAMP test are promising measures, but they require further robust evaluation

Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting

Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. The aim of this study was to recommend outcome measures of exercise adherence that have clinical and research utility in the musculoskeletal field. Methods: There were two key stages to the research. First, a systematic review of the availability, quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review was conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one identified all reproducible measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two identified published and unpublished evidence of the measurement and practical properties of identified measures. Study quality was assessed against the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A shortlist of measures was produced for consideration during stage two: a meeting of relevant stakeholders (n=14) in the United Kingdom. During this meeting consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings was sought. Key findings: Our systematic review identified numerous measures which had been used as measures of exercise adherence within musculoskeletal research. Of these 36 were deemed reproducible. However, only six had been evaluated as specific measures of exercise adherence for musculoskeletal research: evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development of any measure. During the consensus process the stakeholders reached agreement that none of the measures were relevant, appropriate or acceptable for use in musculoskeletal clinical or research settings. Conclusions and recommendations: Numerous exercise adherence measures are currently used within musculoskeletal research. However, many of these measures were not originally developed for this purpose; many approaches are not reproducible; and evidence of essential measurement and practical properties was only identified for a limited number of measures. Moreover, substantial methodological and quality issues were identified in the development and evaluation of the six short-listed measures which reduces confidence in the ability of these measures to reliably and validly evaluate adherence to exercise. Furthermore key stakeholders unanimously agreed that these measures were not fit for purpose. Measures of exercise adherence must be clearly conceptualised. Future development and evaluation should seek to involve patients, clinicians and researchers as active collaborators and use credible methods to develop and evaluate an appropriate measure of exercise adherence