Eric Gardiner

Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review

Poor adherence to treatment can have negative effects on outcomes and healthcare cost. However, little is known about the barriers to treatment adherence within physiotherapy. The aim of this systematic review was to identify barriers to treatment adherence in patients typically managed in musculoskeletal physiotherapy outpatient settings and suggest strategies for reducing their impact. The review included twenty high quality studies investigating barriers to treatment adherence in musculoskeletal populations. There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise. Strategies to overcome these barriers and improve adherence are considered. We found limited evidence for many factors and further high quality research is required to investigate the predictive validity of these potential barriers. Much of the available research has focussed on patient factors and additional research is required to investigate the barriers introduced by health professionals or health organisations, since these factors are also likely to influence patient adherence with treatment.

Risk factors for the onset of non-specific neck pain: a systematic review

Objective Neck pain is a common musculoskeletal disorder, but little is known about which individuals develop neck pain. This systematic review investigated factors that constitute a risk for the onset of non-specific neck pain. Design and setting A range of electronic databases and reference sections of relevant articles were searched to identify appropriate articles. Studies investigating risk factors for the onset of non-specific neck pain in asymptomatic populations were included. All studies were prospective with at least 1 year follow-up. Main results 14 independent cohort studies met the inclusion criteria for the review. Thirteen studies were assessed as high quality. Female gender, older age, high job demands, low social/work support, being an ex-smoker, a history of low back disorders and a history of neck disorders were linked to the development of non-specific neck pain. Conclusions Various clinical and sociodemographic risk factors were identified that have implications for occupational health and health policy. However, there was a lack of good-quality research investigating the predictive nature of many other variables.

Socioeconomic status predicts functional disability in patients participating in a back pain trial

Purpose. To investigate whether socioeconomic status in patients with back pain participating in a randomised controlled trial was predictive of functional disability (Roland Disability Questionnaire, RDQ). Method. Secondary analysis of data (n = 949) from a national primary care trial of physical treatments for back pain (UKBEAM trial) using multilevel modelling. The three indicators were Townsend scores, educational levels and work status. Results. All indicators were significant predictors of outcome after adjusting for baseline variables. As Townsend scores increased (indicating greater deprivation) RDQ scores (functional disability related to back pain) increased. Lower levels of educational attainment were associated with higher RDQ scores. Those ‘Not in Work’ reported markedly higher levels of RDQ scores which increased over time. There was no evidence that one particular treatment was more suitable for participants of different socioeconomic status. Conclusions. The findings from this study add to the body of literature which suggests the importance of socioeconomic factors as an influence on health, including resultant disability related to chronic musculoskeletal conditions such as back pain. Work status was particularly dominant in our findings and may suggest that helping patients with back pain back to work where appropriate, is an especially important part of the management process.

A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial)

Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches.

Prognostic factors for progressive non-specific neck pain: a systematic review

Abstract Neck pain is one of the four most commonly reported musculoskeletal disorders in the UK. Little is known about which individual neck pain sufferer goes on to have recurrent, persistent or disabling neck pain. The development and persistence of non-specific neck symptoms are thought to be related to multiple factors. This systematic review investigated the prognostic factors that may constitute a risk for recurrent, persistent or disabling problems in patients who suffer from non-specific neck pain. It included prospective studies with a minimum of 1-year follow-up period and excluded cross-sectional and case-control studies. Nine studies were included. Eight were assessed as high quality and one as lower quality. This review found strong evidence of unfavourable outcome associated with older age, a longer duration of the current episode of neck pain, a previous history of neck problems, co-existing shoulder problems and other musculoskeletal disorders. There was conflicting evidence that baseline measures of pain and disability predicted outcome. There was strong evidence that regular exercise predicted a good outcome. This evidence about prognostic indicators can guide clinicians to provide advice or treatment which may help to prevent persistent neck problems. There is an absence of high-quality research investigating the predictive nature of psychological and sociodemographic factors. This has implications for clinical practice and research alike.

Sexual health information seeking: a survey of adolescent practices.

AIMS AND OBJECTIVES To identify sources of information and support preferred by young people to understand adolescent practices as adolescents develop a sexual health knowledge base. BACKGROUND Statistics suggest that adolescents are not always making safe sexual health decisions. It is essential to develop an understanding of preferred sources of information and support to structure health and education services so that adolescents develop skills and knowledge to make safer choices. DESIGN A cross-sectional survey design. METHODS A wide-ranging questionnaire was developed using validated questions, drawn from similar adolescent lifestyle surveys and adapted with guidance from an advisory group; 2036 13-16-year-olds responded. Two questions, reporting information sources adolescents find useful and sources of approachable support, are considered here. RESULTS Adolescents find informal sources more useful and experience higher levels of comfort accessing informal support especially from their best friends and mothers. Of formal provision, school-based sources are preferred; however, sexual health information seeking is gendered and changes across year groups. The range of sexual health information sources adolescents access increases with age, and how they access these information sources changes as sexual activity increases and the information becomes more relevant. CONCLUSIONS The findings support the targeting of sexual health provision in relation to age and gender and suggest a youth-focused approach to formal provision, including outreach working and a collaborative relationship with adolescents and parents. RELEVANCE TO CLINICAL PRACTICE The findings contribute to an understanding of sources of information and support preferred by adolescents. In particular, they need to reconsider how services external to the school may be developed so they are youth-focused and approachable. Nurses need to consider how best to work in partnership with adolescents and their families to disseminate accurate information and develop relevant services.

Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis.

Abstract A cognitive behavioral approach was previously compared to a biomechanical approach (the McKenzie method) for the treatment of patients with back and neck pain in a randomized trial. Few di erences between the treatment interventions were found. The aim of this secondary analysis was to determine if any clinical characteristics distinguished those patients who responded best to the McKenzie approach. Treatment success was de- ned as 50% reduction in original functional disability scores (Roland-Morris Disability Questionnaire or Northwick Park Neck Pain Questionnaire); failure to achieve this was denied as treatment failure. A liberal definition of success was 50% improvement retained at either 6 or 12 months, whereas a strict definition of success was 50% improvement at both 6 and 12 months. Ten variables were screened by univariate regression analysis to see if they predicted success. Any signi cant variables (P < 0.1) underwent multiple regression analysis. Only 21 and 16 patients out of 102 were deemed treatment successes according to the liberal and strict de nitions, respectively. With the liberal de nition, only centralization (P = 0.065), spine region (back rather than neck pain) (P = 0.089), and duration of pain (P = 0.001) emerged as predictors from the univariate regression analysis. With the strict de nition, only the latter two variables emerged: spine region (P = 0.026) and duration of pain (P <0.01). All these variables were retained in the multiple regression analysis. In this study, duration of pain was the strongest predictor of success, although back pain and centralization had some predictive ability.

Outcomes of a nursing intervention to improve post-operative pain control at night

Abstract Postoperative pain is often poorly managed, and the control of such pain specifically at night has been neglected. This study aimed to evaluate the effectiveness of a nursing intervention designed to improve pain control through enhanced night-time nurse-patient communications. The design of the study was a before and after trial with a control ward for comparison. Two orthopaedic wards were matched in terms of organisational factors, grades of nursing staff, patient type and throughput, types of surgery, anaesthetic staff and analgesic prescribing. The intervention was comprised of a patient information package and the development of a structured night-time pain assessment which was introduced randomly to one of the two wards following baseline data collection. A total of 417 patients from the four groups (two wards pre- and post-intervention) were interviewed on the second postoperative morning about their pain (verbal rating scales), anxiety (HAD scale), and other factors during the previous night. Information about analgesic provision and other nursing input was taken from the appropriate documentation as well as directly from patients. The intervention was associated with significantly lower reported pain scores. There was an increased frequency of pain assessment but there was no change in the type or frequency of analgesic provision. The main predictors of lower pain scores were: presence of the intervention, lower anxiety scores, and trauma rather than elective surgery. The authors recommend that structured pain assessment should be introduced to wards where patients are likely to suffer pain during the night, and greater attention should be paid to the amelioration of anxiety.

Vaccination timeliness in preterm infants : an integrative review of the literature

AIMS AND OBJECTIVES To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. BACKGROUND Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. DESIGN An integrative review of the empirical literature. METHODS Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. RESULTS Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. CONCLUSION This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. RELEVANCE TO CLINICAL PRACTICE Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.