Patients’ Expectations of Physiotherapy Treatment for Musculoskeletal Conditions

Relevance Research shows that the expectations a patient brings to treatment have important influences on the clinical relationship, experiences of treatment, the treatment process, outcomes and satisfaction with care. This influence means that patients’ expectations are important for physiotherapists, service providers and researchers to take into account in approaches to care and treatment evaluations. Research highlights the need for a better understanding of expectations of physiotherapy treatment for Msk problems to enable more effective, high quality and cost-beneficial care. Purpose The aim of this qualitative study was to explore prospective responses to an open comment item on patients’ expectations of their physiotherapy treatment that was nested within a larger research project developing and validating the Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM). Methods/Analysis The BmPROM is a generic patient self-report outcome measure developed to evaluate the effectiveness of physiotherapy treatment for musculoskeletal conditions. A validity and reliability study was undertaken with patients newly referred into five NHS physiotherapy outpatient departments in SE England. The outcome tool has open-comment items, which included a pre-treatment invitation to provide expectations of their physiotherapy treatment. A thematic analysis was undertaken of the expectations expressed to gain insights for physiotherapy practice and patient care. Results Analysis was undertaken of 563 expectations of physiotherapy treatment expressed from 224 participants (mean 50.7yrs [17-88yrs]; 60% female) experiencing a range of Msk conditions (Lower limb:30%, Upper limb:25%, Spine:28%, Other/multiple sites:17%). Five key themes were identified. Three themes were outcome-related and desired effects of treatment; Relieving symptoms, predominately pain relief; Regaining and maintaining physical abilities and function; and Improving psychological well-being by enabling coping, confidence and control. Theme four was process-related; Explanation, advice and education, where physiotherapy was seen as a resource to acquire better knowledge, skills and strategies to support resolution, management or prevention. The final theme involved recovery expectations conveyed within responses; Problem resolution and responsibility, where responses implied an expectation of a cure or one of problem management and control. Discussion and conclusions The findings provide an understanding of domains considered important or appropriate by patients when seeking care for Msk problems. The themes show overlap with studies using retrospective explorations and surveys of treatment expectations, and research on outcomes considered important to evaluate within Msk PROMs. The study has also shown that a written method of eliciting expectations can be a valuable clinical tool for use to support discussions concerning treatment aims, strategies, desired outcomes and responsibilities. These communication processes are also likely to be integral to achieving the qualities in the therapist and clinical encounters considered important to patients, of feeling listened to, consulted with and respected, and associated with satisfaction with physiotherapy and features of patient-centred care. Impact and implications Healthcare is changing as evidence-informed practice and cost-benefit drivers influence what and how care is provided. Shifts from traditional understandings about Msk problems and their management makes exploring and addressing patients’ expectations particularly important. Developing ways to support appropriate expectations of physiotherapy treatment remains an important endeavour that is integral to its effectiveness and demonstrating its value

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Assessing balance in people with bilateral vestibulopathy using the Mini-Balance Evaluation Systems Test (Mini-BESTest): feasibility and comparison with healthy control data

OBJECTIVES: Bilateral vestibulopathy (BVP) leads to unsteadiness when walking, which worsens in darkness or on uneven ground, as well as falls. Since simple balance tests struggle to distinguish between BVP and healthy participants, we aimed (1) to test if the Mini-BESTest is feasible in BVP, (2) how people with BVP perform on the Mini-BESTest and (3) to compare these scores with healthy reference data. METHODS: Fifty participants with BVP completed the Mini-BESTest. 12-month falls incidence was obtained by questionnaire. To compare the overall and sub-scores between our participants with BVP and those of healthy participants from the literature (n = 327; obtained via PubMed searches), Mann-Whitney U tests were used. Sub scores within the BVP group were also compared. Spearman correlations were used to investigate the relationships between Mini-BESTest score and age. RESULTS: No floor or ceiling effects were observed. Participants with BVP had significantly lower Mini-BESTest total scores than the healthy group. Anticipatory, reactive postural control and sensory orientation sub scores of the Mini-BESTest were significantly lower in BVP, while dynamic gait sub scores were not significantly different. A stronger negative correlation between age and Mini-BESTest total score was found in BVP than in the healthy group. Scores did not differ between patients with different falls history. CONCLUSION: The Mini-BESTest is feasible in BVP. Our results confirm the commonly reported balance deficits in BVP. The stronger negative association between age and balance in BVP might reflect the age-related decline in the remaining sensory systems with which people with BVP compensate

Quality care is equitable care: a call to action to link quality to achieving health equity within acute care surgery

Health equity is defined as the sixth domain of healthcare quality. Understanding health disparities in acute care surgery (defined as trauma surgery, emergency general surgery and surgical critical care) is key to identifying targets that will improve outcomes and ensure delivery of high-quality care within healthcare organizations. Implementing a health equity framework within institutions such that local acute care surgeons can ensure equity is a component of quality is imperative. Recognizing this need, the AAST (American Association for the Surgery of Trauma) Diversity, Equity and Inclusion Committee convened an expert panel entitled ‘Quality Care is Equitable Care’ at the 81st annual meeting in September 2022 (Chicago, Illinois). Recommendations for introducing health equity metrics within health systems include: (1) capturing patient outcome data including patient experience data by race, ethnicity, language, sexual orientation, and gender identity; (2) ensuring cultural competency (eg, availability of language services; identifying sources of bias or inequities); (3) prioritizing health literacy; and (4) measuring disease-specific disparities such that targeted interventions are developed and implemented. A stepwise approach is outlined to include health equity as an organizational quality indicator

Inclusive Teaching & Learning Case Studies in Engineering, Architecture & Affiliated Disciplines

Diversity and inclusion are core to UCD values. We seek to attract students from a wide range of social and economic backgrounds and students who reflect the true diversity of the country. And as a global university, UCD attracts international students from over 100 countries. This diversity enriches our campus, and the experience of our students. The University's strategy 2020-2024 'Rising to the Future' also recognises the importance of inclusion and diversity, in seeking to "provide an inclusive educational experience that defines international best practice and prepares our graduates to thrive in present and future societies." However, an inclusive educational experience will not be achieved by simply creating diversity in the student body. It requires that we adjust our approach in everything we do to support and encourage our students’ success. We have clearly articulated in our strategy, and further emphasised in our Education and Student Success strategy, that our goal is to "equip all our educators with the tools and resources required to embed Universal Design for Learning on an institution-wide basis"

Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry.

INTRODUCTION: Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD). METHODS: Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45-0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients. RESULTS: Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74). CONCLUSION: In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum. LEVEL OF EVIDENCE: Level IV, therapeutic/care management