Patients’ health outcomes after an implementation intervention targeting the physiotherapists’ clinical behaviour

Background A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach. Methods An explorative and comparative pre−/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used. Results There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support. Conclusion It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients’ outcomes in this study. Most of the patients’ health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach. Trial registration The study protocol was retrospectively registered in ClinicalTrials.gov. ID NCT03118453, March 20, 2017.

Representaciones Sociales sobre las Vacunas y la Vacunación frente al COVID 19

Las representaciones son descriptas como un estilo específico de conocimiento, un modo determinado de descifrar la realidad, aludiendo al pensamiento del sentido común, siendo asociadas a un desarrollo personal que supone una ordenación cognitiva y a la vez halla su inicio, su difusión y cambio en el contexto sociocultural. En el contexto sanitario dado a causa de la pandemia por COVID 19 y mostrando como la mayor estrategia empleada por los diferentes gobiernos del mundo la vacunación toma relevancia el conocimiento sobre las representaciones acerca de la vacunación y las vacunas. En el marco del estudio multicéntrico International COVID 19 Awareness and Responses Evaluation Study (ICARE) liderado por Montreal Behavioural Medicine Centre se desarrolló una encuesta con una muestra 3330 adultos argentinos, de entre 18 y 70 años compuesta mayoritariamente por estudiantes y profesionales universitarios. El objetivo de la investigación ha sido conocer las representaciones acerca de las vacunas y la vacunación. Entre los resultados se destacan las representaciones sociales de los participantes que exhiben una gran adherencia a la vacunación y a las vacunas, con conceptos positivos en 8 de cada de 10 y un claro sostenimiento de las medidas de protección de como aislamiento y uso de más carilla acompañando la inoculación mientras que se conviva con el COVID 19.

Contribution to the special issue on clinical ethology: Pharmacotherapeutics in clinical ethology: treatment efficacy, clinical pathology and outcome

The use of psychopharmaceutical agents is a core aspect of treatment in veterinary behavioural medicine. Psychotropic medication use has shifted the focus of treatment from purely behavioural and environmental interventions to a multi-modal approach. Objective measures of efficacy are required for the licensing of medication. Pharmacotherapeutics have come to encompass supplements and diets, in addition to prescription medications. The first part of this paper examines the efficacy of medications, supplements and diets used in behavioural medicine. Foci include the role of evolution in the types of behavioural concerns reported, the importance of defining abnormal or pathological behaviour, use of terminology that supports stratified mechanistic diagnoses aid in understanding presentation and response clusters, and rational use of medication to relieve emotional, mental and behavioural suffering, given these diagnoses and clusters. The second part of this paper examines the extent to which variation in patient response to medication can enlighten us about mechanisms and outcomes of distress using a series of 3 patient populations who are the focus of studies on separation anxiety and noise reactivity. This response surface approach can be useful for understanding differences in populations in susceptibility to behavioural pathology and in medication response, and may suggest new avenues for drug development and application.

Socratic questioning put into clinical practice

SUMMARY Socratic questioning is at the core of collaborative clinical communication, with a wide array of applications in behavioural medicine and psychotherapy. This brief article describes the process of therapeutic Socratic questioning, illustrates its clinical applications in therapy and provides a brief update on its recent developments.

Quantifying professionalism in peer review

Background The process of peer-review in academia has attracted criticism surrounding issues of bias, fairness, and professionalism; however, frequency of occurrence of such comments is unknown. Methods We evaluated 1491 sets of reviewer comments from the fields of “Ecology and Evolution” and “Behavioural Medicine,” of which 920 were retrieved from the online review repository Publons and 571 were obtained from six early career investigators. Comment sets were coded for the occurrence of “unprofessional comments” and “incomplete, inaccurate or unsubstantiated critiques” using an a-prior rubric based on our published research. Results are presented as absolute numbers and percentages. Results Overall, 12% (179) of comment sets included at least one unprofessional comment towards the author or their work, and 41% (611) contained incomplete, inaccurate of unsubstantiated critiques (IIUC). Conclusions The large number of unprofessional comments, and IIUCs observed could heighten psychological distress among investigators, particularly those at an early stage in their career. We suggest that development and adherence to a universally agreed upon reviewer code of conduct is necessary to improve the quality and professional experience of peer review.