scholarly journals An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

2020 ◽  
Author(s):  
Natalie Hall ◽  
Daniel Parker ◽  
Anita Ellen Williams
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Outcome Measures ◽  
Current Knowledge ◽  
Future Research ◽  
Advisory Group ◽  
Outcomes Of Care ◽  
Measuring Outcomes ◽  
Professional Perspectives ◽  
The Uk

Abstract Background: Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely measure outcomes to demonstrate efficacy of services. Whilst a previous study provided an overview of the use of outcome measures in orthotic practice and identified some barriers to their use, further questions emerged. Hence, this qualitative study aimed to explore orthotists’ opinions and personal experiences on the influences on outcomes, how appropriate and relevant outcomes can be measured and also how barriers to the use of outcome measures can be overcome. Methods: Following a review of the literature, an initial advisory group informed semi-structured questions. These were used to create dialogue in a focus group of 12 orthotists. Data from the focus group was transcribed verbatim and analysed using thematic analysis, creating themes and subthemes for discussion.Results: The setting of realistic and agreed goals through managing expectations, compromise and patient education/information were seen as factors that could inform and improve outcomes. Barriers to the collection of outcome measures were associated with inadequate technology to manage the data, lack of time to complete them, lack of training in them and difficulties selecting appropriate outcome measures for patients with complex problems managed by different health professionals. The participants discussed ways of addressing these barriers, such as the use of ‘snapshots’ and delegation of data collection. Conclusions: This study has revealed that measuring outcomes is considered to be an important activity. In order to achieve good outcomes, it is important to address patient expectations, discuss and establish joint goals for care at the outset and inform and include patients in the decision-making process. The identified barriers to measuring outcomes can be overcome with the solutions revealed by these participants. Hence, this study has contributed to current knowledge which has relevance for clinical practice and may provide the theoretical basis for future research.

scholarly journals An Exploratory Qualitative Study of Health Professional Perspectives on Clinical Outcomes in UK Orthotic Practice

2020 ◽  
Author(s):  
Natalie Hall ◽  
Daniel Parker ◽  
Anita Ellen Williams
Keyword(s):  
Focus Group ◽  
Outcome Measure ◽  
Current Knowledge ◽  
Successful Outcome ◽  
Future Research ◽  
Advisory Group ◽  
Patient Reported ◽  
Service Professional ◽  
Professional Perspectives ◽  
The Uk

Abstract Background: Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely record outcomes to demonstrate efficacy of services. This research aimed to explore orthotic service professional perspectives on outcomes in orthotic practice. A secondary aim was to explore potential barriers to the routine use of outcome measure tools in practice.Methods: Following a review of the literature, an initial advisory group involving experts in the field was conducted. From this, semi-structured questions were developed, and a focus group was undertaken. Data from the focus group was transcribed and analysed using thematic analysis, creating themes and subthemes for discussion.Results: The participants considered a successful outcome as a ‘usable’ orthosis, this linked to a preference for evaluation of patient reported outcomes. The setting of realistic joint goals via patient education was seen as a method of improving outcomes. Barriers to collection of data were associated with inadequate technology to manage the ‘data burden’, lack of clinical time to complete and difficulties selecting outcome measure tools for a varied population. Issues around usability of current outcome measure tools were also highlighted. Participants discussed ways of addressing these barriers, such as the use of ‘snapshots’ and delegation of data collection. Conclusions:This research is unique in that it is the first-time orthotic service professional opinions have been analysed specifically relating to outcomes, outcome measure tools and possible barriers to their use. The participants acknowledged the relevance of outcome measure tools, identified barriers to use but had created novel ways to address barriers. Further, they indicated that to achieve good outcomes it was important to address service user expectations of treatment, discuss and establish joint goals for care at the outset and communicate/ educate on the clinical reasoning process. This research has contributed to current knowledge within the field of orthotics and may provide a theoretical basis for future research in the field.

Disease and Trauma in the Children from Roman Britain

2018 ◽  
Author(s):  
Mary E. Lewis
Keyword(s):  
Iron Deficiency Anaemia ◽  
Metabolic Diseases ◽  
Current Knowledge ◽  
Skeletal Remains ◽  
Future Research ◽  
Roman Britain ◽  
Deficiency Anaemia ◽  
Roman World ◽  
The Uk ◽  
The Impact

This chapter explores our current knowledge of pathology and trauma in Romano-British non-adult samples focusing on the children from the late Roman cemetery of Poundbury Camp, Dorset. Evidence for metabolic diseases (rickets, scurvy, iron deficiency anaemia), fractures, thalassemia, congenital disorders and tuberculosis, are presented with emphasis on what their presence tells us about the impact of the Romans in Britain. Many of the large Roman sites from the UK were excavated long before diagnostic criteria for recognizing pathology in child remains were fully developed, and European studies tend only to focus on anaemia and its link to malaria. A lack of environmental evidence for the sites from which our skeletal remains are derived is also problematic, and this chapter hopes to set the agenda for future research into the health and life of children living in the Roman World.

High‐risk inferences in assessing high risk: outstanding concerns in the clinical use of the PCL‐R

2006 ◽  
Vol 8 (4) ◽  
pp. 3-18 ◽  
Author(s):  
Brian Thomas‐Peter ◽  
Jason Jones
Keyword(s):  
High Risk ◽  
Assessment Tool ◽  
Current Knowledge ◽  
Future Research ◽  
Academic Assessment ◽  
Industry Standard ◽  
Standard Assessment ◽  
Violent Recidivism ◽  
The Uk ◽  
Severe Personality Disorder

The PCL‐R has been heralded as the ‘unparalleled’ (Salekin et al, 1996) risk assessment tool for assessing risk of violent and non‐violent recidivism. In the UK, the PCL‐R looks likely to become an industry standard assessment in psychological evaluation of individuals thought to have a dangerous and severe personality disorder. However, current knowledge about the PCL‐R is unsatisfactory, and a number of issues need to be addressed before clinicians can be confident in the use of this measure. This paper highlights these issues from the perspective of the practising clinician. Questions are raised about the theoretical, methodological and treatment implications of the use of the PCL‐R. Future research needs are established in this context of caution over the use of the measure in routine clinical and academic assessment.

scholarly journals A Qualitative Study of User Perspectives on Outcomes of Orthotic Interventions

2020 ◽  
Author(s):  
Natalie Hall ◽  
Daniel Parker ◽  
Anita Ellen Williams
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Outcome Measurement ◽  
Waiting Times ◽  
Measurement Tool ◽  
Advisory Group ◽  
Professional Relationship ◽  
Positive Health ◽  
The Uk ◽  
The Impact

Abstract Background: Orthotic services offer various health benefits and it is estimated that for every £1 spent on orthotic care the savings to the NHS are up to £4. Several reports into orthotic services in the UK have reported a lack of data relating to outcomes of orthotic care. This lack of data means it is difficult to demonstrate the overall efficacy of orthotic services. There is also lack of clarity about the influences on positive outcomes and we do not know what outcomes are relevant to users. This qualitative study aimed to explore the influences on outcomes of orthotic interventions and opinions on outcome measurement from the user’s perspective. Method: An advisory group involving experts in the field along with a review of the literature was conducted. From this, semi-structured questions were developed, ethical approval obtained, and a focus group was undertaken with five users. Data was transcribed and analysed using thematic analysis.Results: The participants expressed a need for orthotic provision which enables them to function physically and psychologically in the context of all life’s activities. Current practice neglects the impact of altered body image and there is dissatisfaction related to waiting times, impacting on their desired outcomes. However, they expressed positive thoughts about the patient professional relationship and being involved in decision making. They identified fundamental issues around usability of three current outcome measure tools with no one outcome measurement tool being suitable for their complex conditions and interventions. Conclusions: Communication of the clinicians understanding about the physical, psychological and socio-economic impact of living with a chronic condition, being involved in decision making, continuity of care and timeliness of provision were identified as key factors influencing positive health outcomes. Due to the complexity of conditions presenting to orthotic services it would seem that there needs to be a range of outcome measures specific to the user’s condition and the orthoses provided for it. Mutually agreed and individualised goal setting may be a solution that ensure the user can self-monitor positive health gains and services can provide evidence for effective outcomes.

scholarly journals The patient perspective on absence of disease activity in rheumatoid arthritis: a survey to identify key domains of patient-perceived remission

2016 ◽  
Vol 76 (5) ◽  
pp. 855-861 ◽  
Author(s):  
Lilian H D van Tuyl ◽  
Martina Sadlonova ◽  
Sarah Hewlett ◽  
Bev Davis ◽  
Caroline Flurey ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Qualitative Study ◽  
Disease Activity ◽  
Patient Perspective ◽  
Disease Duration ◽  
Future Research ◽  
Short List ◽  
The Usa ◽  
The Uk ◽  
Patients Perspective

BackgroundGuidelines suggest treatment in rheumatoid arthritis (RA) to target remission, in close consultation with the patient. Our recent qualitative study of the patients' perspective on remission in RA identified 26 domains. The current study aimed to identify a short list of the most important aspects to inform future research.MethodsPatients with RA from the Netherlands, the UK, Austria, Denmark, France and the USA completed a survey that contained all domains identified in our qualitative study. They rated domains for importance (‘not important’, ‘important’ or ‘essential’ to characterise a period of remission) and if important or essential, whether this domain needs to be ‘less’, ‘almost gone’ or ‘gone’ to reflect remission. Respondents were also asked to determine their personal top 3 most important/essential domains. Frequency of specific domains in the top 3 was calculated, and domains were sorted on the percentage of patients that evaluated a particular domain as ‘essential’.ResultsOf 274 respondents, 75% were female, mean (SD) age 57(13) years, disease duration 12(9) years. The top 3 were as follows: pain (67%), fatigue (33%) and independence (19%); domains most frequently rated as ‘essential’ were as follows: pain (60%), being mobile (52%), physical function (51%), being independent (47%) and fatigue (41%). Pain needed to be less (13%), almost gone (42%) or gone (45%) to reflect remission. Similar patterns were seen for fatigue, independence, mobility and physical functioning.ConclusionPatients identified pain, fatigue and independence as the most important domains of RA disease activity that need to be improved to reflect remission.

scholarly journals Clinical commitment and competence: a qualitative study

2020 ◽  
Author(s):  
Somaye Zamanian Jahromi ◽  
Narges Shafaroodi ◽  
Laleh Lajevardi
Keyword(s):  
Job Satisfaction ◽  
Content Analysis ◽  
Focus Group ◽  
Qualitative Study ◽  
Clinical Competence ◽  
Focus Group Interview ◽  
Qualitative Content Analysis ◽  
Occupational Therapists ◽  
Future Research ◽  
And Performance

Commitment, a component of clinical competence, includes accountability and responsibility for professional roles and tasks; and, it has a positive correlation with job satisfaction and performance. This study aimed to elaborate on the concept of commitment in the field of occupational therapy using qualitative content analysis. The data was collected through interviewing 13 occupational therapists both in a focus group interview (including four participants) and in one-to-one interviews (nine other participants). The collected data was analyzed based on the Grenheim method, and commitment concept was defined under three main themes: (i) commitment to patient (five subthemes), (ii) commitment to self (three subthemes), and (iii) commitment to profession (three subthemes). This study’s findings indicated that to acquire clinical competence, therapists should be committed to their patients, to themselves, and to their profession. Future research is needed to further examine how and to what extent these commitment themes affect clinical competence as well as the interaction among them.

scholarly journals Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023873
Author(s):  
Holly Victoria Rose Sugg ◽  
Julia Frost ◽  
David A Richards
Keyword(s):  
Qualitative Study ◽  
Large Scale ◽  
Controlled Trial ◽  
Future Research ◽  
Treatment As Usual ◽  
Morita Therapy ◽  
Semistructured Interviews ◽  
Framework Approach ◽  
Randomised Controlled ◽  
The Uk

ObjectiveTo explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT.DesignQualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach.Setting and participantsParticipants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis.ResultsWe identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment.ConclusionsPeople in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants’ expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT.Trial registration numberCISRCTN17544090; Pre-results.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

Using the Change4Life Disney Branded 10-minute Shake Ups During the COVID-19 ‘Lockdown’

2020 ◽  
Author(s):  
Emily Budzynski-Seymour ◽  
James Steele ◽  
Michelle Jones
Keyword(s):  
Perceived Exertion ◽  
Affective Responses ◽  
Online Resources ◽  
Future Research ◽  
Affective States ◽  
Perceived Effort ◽  
Qualitative Feedback ◽  
Bidirectional Relationship ◽  
The Uk

Physical activity (PA) is considered essential to overall health yet it is consistently reported that children are failing to meet the recommended levels. Due to the bidirectional relationship between affective states and PA, affective responses are a potential predictor to long term engagement. Since late March 2020 the UK government enforced ‘lockdown’ measures to help control the spread of Coronavirus (COVID-19); however, this has impacted children’s PA. Using online resources at home to support PA is now common. The primary aim of this research was to investigate the use of the Change4Life 10-minute Shake Ups to support PA by examining the effects of Disney branding upon children’s (n=32) post activity affective responses and perceived exertion. The secondary was to investigate the effect of the lockdown on PA habits. Children had similar positive affective responses and perceived effort to activities; however, branding was considered to be a key contributing factor based upon qualitative feedback from parents. Children’s PA levels dropped slightly since ‘lockdown’ was imposed; though online resources have been utilised to support PA. The use of immersive elements such as characters and narrative in PA sessions, as well as utilising online resources during ‘lockdown’ appear potentially promising for future research.

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