scholarly journals OP0153-HPR BRIDGING GAPS ACROSS LEVELS OF CARE IN REHABILITATION OF PATIENTS WITH RHEUMATIC - AND MUSCULOSKELETAL DISEASES: RESULTS FROM A STEPPED WEDGE CLUSTER RANDOMISED CONTROLLED TRIAL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 92.2-92
Author(s):  
G. Berdal ◽  
A. L. Sand-Svartrud ◽  
M. Azimi ◽  
I. Bø ◽  
T. Nygaard Dager ◽  
...  
Keyword(s):  
Musculoskeletal Diseases ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Rehabilitation Program ◽  
Goal Achievement ◽  
Mean Difference ◽  
Sensitivity Analyses ◽  
Bridge Program ◽  
Levels Of Care ◽  
Self Assessed Health

Background:Previous research show that patients with rheumatic and musculoskeletal diseases (RMDs) benefit from rehabilitation, but the health effects are small and decline over time. Later reports reveal that the quality of rehabilitation services varies largely, with lack of coordination and continuity across levels of care. This may weaken the effect on patients’ long-lasting health, ability to self-manage their conditions and achieve their goals. We therefore developed a new, evidence-based rehabilitation program to strengthen the quality and bridge the gaps in rehabilitation services for this patient group.Objectives:To evaluate if a new rehabilitation program (the BRIDGE program) designed to improve the quality and continuity of rehabilitation across levels of care, was more effective than traditional rehabilitation in improving goal achievement, function, self-assessed health and health related quality of life (HR-QoL) in patients with RMDs.Methods:In a stepped wedge cluster randomised controlled trial 8 rehabilitation centres organised in secondary health care and located across all health regions of Norway recruited a total of 374 patients with rheumatic and musculoskeletal diseases. These patients received either traditional rehabilitation (control) (n=206), or traditional rehabilitation extended with an individually adapted complex intervention consisting of structured goal setting, plans for self-management, motivational interviewing, self-monitored digital feedback, and tailored follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE program) (n=168). Patient-reported data were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome measure was patients’ goal achievement measured by the Patient Specific Functional Scale (PSFS) (0-10, 10=best) seven months after rehabilitation stay. Secondary outcome measures were function measured by the 30-seconds Sit-To-Stand Test (30secSTS), self-assessed health and HR-QoL measured by the EuroQol instruments EQ-5D-5L-VAS (0-100, 100=best) and EQ 5D-5L-index (-1 to 1, 1=best). The main comparative analysis was performed on the intention to treat population, using all available data, by linear mixed models adjusted for the baseline scores and for the potentially confounding effects of calendar time and data clustering. Sensitivity analyses were performed on data provided by the per protocol population according to predefined criteria, in addition to centerwise comparisons of the control and intervention groups.Results:No significant treatment effects of the BRIDGE-program were demonstrated either for patients’ goal achievement (mean difference 0.1 [95% CI: -0.5, 0.8], p=0.70) (Figure 1), function (mean difference 0.9 [95% CI: - 0.4, 2.2], p=0.18), self-assessed health (mean difference -0.1 [95% CI: -4.1, 3.9], p=0.98), or HR-QoL (mean difference 0.0 [95% CI: -0.0, 0.0], p=0.99) seven months after rehabilitation. Sensitivity analyses confirmed the findings from the primary analysis. A significant proportion of missing data for the primary outcome measure (29% in the control and 41% in the intervention group), caused by errors in the digital data collection system, may impair the reliability of the results.Conclusion:The BRIDGE program was not shown to be more effective than traditional rehabilitation in terms of improving goal achievement, function, self-assessed health and HR-QoL in patients with RMDs. There is still a need for more knowledge about factors that can improve the quality, continuity and long-term health effects of rehabilitation for this patient group.Disclosure of Interests:None declared

scholarly journals Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021125 ◽  
Author(s):  
Dimity Pond ◽  
Karen Mate ◽  
Nigel Stocks ◽  
Jane Gunn ◽  
Peter Disler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Outcome Measures ◽  
Educational Intervention ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Mean Difference ◽  
Secondary Outcome ◽  
General Practices ◽  
Randomised Controlled

ObjectiveTest effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients.DesignDouble-blind, cluster randomised controlled trial.SettingGeneral practices in Australia between 2007 and 2010.ParticipantsGeneral practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist).InterventionsA practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument; (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines; (3) addressing GPs’ barriers to dementia diagnosis; and (4) a business case outlining a cost-effective dementia assessment approach.Outcome measuresPrimary outcome measures were patient quality of life and depression; secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia; (2) referral to medical specialists and/or support services; (3) patient satisfaction with care; and (4) carer quality of life, depression and satisfaction with care.ResultsThe educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002; OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024; mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007; mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185; mean difference 24.77, 95% CI 4.15 to 45.40).ConclusionPractice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication.Trial registration numberACTRN12607000117415; Pre-results.

scholarly journals Effectiveness of job rotation for preventing work-related musculoskeletal diseases: a cluster randomised controlled trial

2017 ◽  
Vol 74 (8) ◽  
pp. 543.1-544 ◽  
Author(s):  
Maria Luiza Caires Comper ◽  
Jack Tigh Dennerlein ◽  
Gabriela dos Santos Evangelista ◽  
Patricia Rodrigues da Silva ◽  
Rosimeire Simprini Padula
Keyword(s):  
Randomised Controlled Trial ◽  
Musculoskeletal Diseases ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Job Rotation ◽  
Work Related ◽  
Cluster Randomised ◽  
Randomised Controlled

scholarly journals Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania

2021 ◽  
Vol 6 (4) ◽  
pp. e005086
Author(s):  
Christopher R Sudfeld ◽  
Lilia Bliznashka ◽  
Geofrey Ashery ◽  
Aisha K Yousafzai ◽  
Honorati Masanja
Keyword(s):  
Home Visiting ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Mean Difference ◽  
Positive Effects ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
Child Cognitive Development

IntroductionEvidence on the effects of community health worker (CHW) interventions and conditional cash transfers (CCTs) on child growth and development in sub-Saharan Africa remains sparse.MethodsWe conducted a single-blind, cluster-randomised controlled trial of an integrated home-visiting health, nutrition and responsive stimulation intervention alone and in combination with CCTs to promote antenatal and child clinic attendance from 2017 to 2019 in rural Morogoro Region, Tanzania. Pregnant women and caregivers with a child <1 year of age were enrolled. Twelve villages were randomised to either (1) CHW (n=200 participants), (2) CHW+CCT (n=200) or (3) control (n=193). An intention-to-treat analysis was conducted for the primary trial outcomes of child cognitive, language and motor development assessed with the Bayley Scales of Infant and Toddler Development and child length/height-for-age z-scores (HAZ) at 18 months of follow-up.ResultsThe CHW and CHW+CCT interventions had beneficial effects on child cognitive development as compared with control (standardised mean difference (SMD): 0.15, 95% CI 0.05 to 0.24, and SMD: 0.18, 95% CI 0.07 to 0.28, respectively). The CHW+CCT intervention also had positive effects on language (SMD: 0.08, 95% CI 0.01 to 0.15) and motor (SMD: 0.16, 95% CI 0.03 to 0.28) development. Both CHW and CHW+CCT interventions had no effect on HAZ in the primary analysis; however, there were statistically significant positive effects in multivariable analyses. The CHW+CCT group (mean difference: 3.0 visits, 95% CI 2.1 to 4.0) and the CHW group (mean difference: 1.5 visits, 95% CI 0.6 to 2.5) attended greater number of child health and growth monitoring clinic visits as compared to the control group.ConclusionIntegrated CHW home-visiting interventions can improve child cognitive development and may have positive effects on linear growth. Combining CHW with CCT may provide additional benefits on clinic visit attendance and selected child development outcomes.Trial registration numberISRCTN10323949.

scholarly journals A quality indicator set for rehabilitation services for people with rheumatic and musculoskeletal diseases demonstrates adequate responsiveness in a pre–post evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne-Lene Sand-Svartrud ◽  
Gunnhild Berdal ◽  
Maryam Azimi ◽  
Ingvild Bø ◽  
Turid Nygaard Dager ◽  
...  
Keyword(s):  
Health Services ◽  
Musculoskeletal Diseases ◽  
Controlled Trial ◽  
Rehabilitation Services ◽  
Health Care Planning ◽  
Post Intervention ◽  
Bridge Program ◽  
Post Evaluation ◽  
Patient Reported

Abstract Background Quality of care is gaining increasing attention in research, clinical practice, and health care planning. Methods for quality assessment and monitoring, such as quality indicators (QIs), are needed to ensure health services in line with norms and recommendations. The aim of this study was to assess the responsiveness of a newly developed QI set for rehabiliation for people with rheumatic and musculoskeletal diseases (RMDs). Methods We used two yes/no questionnaires to measure quality from both the provider and patient perspectives, scored in a range of 0–100% (best score, 100%). We collected QI data from a multicenter stepped-wedge cluster-randomized controlled trial (the BRIDGE trial) that compared traditional rehabilitation with a new BRIDGE program designed to improve quality and continuity in rehabilitation. Assessment of the responsiveness was performed as a pre–post evaluation: Providers at rehabilitation centers in Norway completed the center-reported QIs (n = 19 structure indicators) before (T1) and 6–8 weeks after (T2) adding the BRIDGE intervention. The patient-reported QIs comprised 14 process and outcomes indicators, measuring quality in health services from the patient perspective. Pre-intervention patient-reported data were collected from patients participating in the traditional program (T1), and post-intervention data were collected from patients participating in the BRIDGE program (T2). The patient groups were comparable. We used a construct approach, with a priori hypotheses regarding the expected direction and magnitude of PR changes between T1 and T2. For acceptable responsivess, at least 75% of the hypotheses needed to be confirmed. Results All eight participating centers and 82% of the patients (293/357) completed the QI questionnaires. Responsiveness was acceptable, with 44 of 53 hypotheses (83%) confirmed for single indicators and 3 of 4 hypotheses (75%) confirmed for the sum scores. Conclusion We found this QI set for rehabilitation to be responsive when applied in rehabilitation services for adults with various RMD conditions. We recommend this QI set as a timely method for establishing quality-of-rehabilitation benchmarks, promoting important progress toward high-quality rehabilitation, and tracking trends over time. Trial registration The study is part of the larger BRIDGE trial, registered at ClinicalTrials.gov (Identifier: NCT03102814).

scholarly journals A Quality Indicator Set for Rehabilitation Services for People With Rheumatic and Musculoskeletal Diseases Demonstrates Adequate Responsiveness in A Pre–Post Evaluation

2020 ◽  
Author(s):  
Anne-Lene Sand-Svartrud ◽  
Gunnhild Berdal ◽  
Maryam Azimi ◽  
Ingvild Bø ◽  
Turid Dager ◽  
...  
Keyword(s):  
Health Services ◽  
Musculoskeletal Diseases ◽  
Controlled Trial ◽  
Rehabilitation Services ◽  
Health Care Planning ◽  
Post Intervention ◽  
Bridge Program ◽  
Post Evaluation ◽  
Patient Reported

Abstract Background: Quality of care is gaining increasing attention in research, clinical practice, and health care planning. Methods for quality assessment and monitoring, such as quality indicators (QIs), are needed to ensure health services in line with norms and recommendations. The aim of this study was to assess the responsiveness of a newly developed QI set for rehabiliation for people with rheumatic and musculoskeletal diseases (RMDs). Methods: We used two yes/no questionnaires to measure quality from both the provider and patient perspectives, scored in a range of 0%–100% (best score, 100%). We collected QI data from a multicenter stepped-wedge cluster-randomized controlled trial (the BRIDGE trial) that compared traditional rehabilitation with a new BRIDGE program designed to improve quality and continuity in rehabilitation. Assessment of the responsiveness was performed as a pre–post evaluation: Providers at rehabilitation centers in Norway completed the center-reported QIs (n=19 structure indicators) before (T1) and 6–8 weeks after (T2) adding the BRIDGE intervention. The patient-reported QIs comprised 14 process and outcomes indicators, measuring quality in health services from the patient perspective. Pre-intervention patient-reported data were collected from patients participating in the traditional program (T1), and post-intervention data were collected from patients participating in the BRIDGE program (T2). The patient groups were comparable. We used a construct approach, with a priori hypotheses regarding the expected direction and magnitude of PR changes between T1 and T2. For acceptable responsivess, at least 75% of the hypotheses needed to be confirmed. Results: All eight participating centers and 82% of the patients (293/357) completed the QI questionnaires. Responsiveness was acceptable, with 44 of 53 hypotheses (83%) confirmed for single indicators and 3 of 4 hypotheses (75%) confirmed for the sum scores. Conclusion: We found this QI set for rehabilitation to be responsive when applied in rehabilitation services for adults with various RMD conditions. We recommend this QI set as a timely method for establishing quality-of-rehabilitation benchmarks, promoting important progress toward high-quality rehabilitation, and tracking trends over time.Trial registration The study is part of the larger BRIDGE trial, registered at ClinicalTrials.gov (Identifier: NCT03102814)

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