Parker Magin

Is your prescription of distance running shoes evidence-based?

Objectives: To determine whether the current practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual’s foot type is evidence-based. Data sources: MEDLINE (1950–May 2007), CINAHL (1982–May 2007), EMBASE (1980–May 2007), PsychInfo (1806–May 2007), Cochrane Database of Systematic Reviews (2nd Quarter 2007), Cochrane Central Register of Controlled trials (2nd Quarter 2007), SPORTSDiscus (1985–May 2007) and AMED (1985–May 2007). Review methods: English language articles were identified via keyword and medical subject headings (MeSH) searches of the above electronic databases. With these searches and the subsequent review process, controlled trials or systematic reviews were sought in which the study population included adult recreational or competitive distance runners, the exposure was distance running, the intervention evaluated was a running shoe with an elevated cushioned heel and pronation control systems individualised to the wearer’s foot type, and the outcome measures included either running injury rates, distance running performance, osteoarthritis risk, physical activity levels, or overall health and wellbeing. The quality of these studies and their findings were then evaluated. Results: No original research that met the study criteria was identified either directly or via the findings of the six systematic reviews identified. Conclusion: The prescription of this shoe type to distance runners is not evidence-based.

Access and participation in the community: a prospective qualitative study of driving post-stroke

Purpose: Loss of role as a driver significantly affects community participation; therefore, we aimed to explore the impact of driving issues post-stroke in community-dwelling stroke survivors. Methods: A longitudinal qualitative study of community-dwelling stroke survivors, using semi-structured interviews. Results: Twenty-two participants took part in 84 interviews over a 1-year period post-stroke. The majority of participants was independent and experienced few major depressive symptoms. ages ranged from 50 to 92 years. Emergent key themes included impact on quality of life, personal impacts, change to role performance and knowledge. Participants received inconsistent advice regarding return to driving. Confidence and availability determined public transport use. Conclusions: Driving advice should be standard practice prior to discharge. Allied health professionals can play an essential role in interventions addressing community participation, driver re-training and alternative transport use. Therapists have an important role in assisting stroke survivors to work through feelings of loss and in providing education concerning new skills to support this life transition. Implications for Rehabilitation Issues regarding driving are of major importance to stroke survivors. Allied health professionals can play a significant role in providing education and training regarding return to driving and alternate transport options. Allied health professionals have an important role in assisting stroke survivors to transition to a life without driving by working through feelings of loss and by providing education concerning new skills to support this life transition.

Study protocol: The registrar clinical encounters in training (ReCEnT) study

BackgroundPatient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.Methods/designThis is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.ConclusionsThe study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

A cross‐sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices

Background  There is considerable evidence for an association of skin diseases with psychological morbidity. This relationship is best established for acne, psoriasis and atopic eczema. Previous studies have mostly been performed in specialist dermatological practice, and there is a lack of studies that include patients from general practice and a lack of controlled studies employing multivariate analysis.

Trajectories of Psychological Distress After Stroke

PURPOSE There has been little exploration of the distinct trajectories of psychological distress after stroke and the factors that predict recovery from distress. These trajectories may assist primary care physicians by providing insight into disease onset, progression, and resolution and may be a useful way to conceptualize and understand the pattern of psychological morbidity in stroke over time. We undertook a longitudinal qualitative study to explore poststroke psychological trajectories METHODS The primary data collection method was semistructured interviews with community-dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Our sample included 23 participants (12 men, 10 women; age range 37 to 94 years) discharged from a tertiary referral hospital after a stroke; these participants subsequently participated in a total of 106 interviews over 12 months. Qualitative outcomes were participants’ perceptions at baseline, 3, 6, 9, and 12 months. Thematic saturation was achieved. RESULTS Most participants were male (54%) and had a partial anterior circulation infarction stroke subtype (57%). Four different longitudinal trajectories were identified: resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n = 3), and recovery from mood disturbance (n = 10). Recovery from mood disturbance was facilitated by gains in independence and self-esteem and by having an internal health locus of control. CONCLUSIONS Stroke survivors experienced a variety of psychological trajectories. Identifying distinct trajectories of psychological morbidity may help primary care physicians develop appropriately timed interventions to promote better mental health. Interventions require implementation over a longer duration than the current outpatient services that, in Australia, are typically provided in the first few months after stroke.

Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: a prospective qualitative study

Purpose: To explore the experience of post-stroke fatigue in community-dwelling stroke survivors with and without post-stroke mood disturbance within one year of stroke. Methods: This was a prospective qualitative cohort study including semistructured interviews undertaken at baseline (stroke onset), 3, 6, 9 and 12 months in 23 stroke survivors; eight single interviews were held with “supplementary” participants. Qualitative data analysis involved an inductive thematic approach using a process of constant comparison. Results: Thirty-one participants (17 men, 14 women; age range 37–94 years) took part in 122 interviews. The majority of participants was independent and experienced few major depressive symptoms. Three trajectories emerged regarding the participants’ experiences of fatigue including experience of fatigue, coping strategies and knowledge. Conclusions: The results of this study suggest that in spite of reasonable objective physical recovery post-stroke, fatigue in community-dwelling stroke survivors may be disabling. The use of qualitative methodology was sensitive in identifying the factors that play a role in the experience of fatigue. The essential role of health professionals in this context is to provide support and education regarding fatigue and to promote participation after stroke in therapy programs. Routine practice for stroke services should include fatigue advice prior to discharge. Implications for Rehabilitation Issues regarding fatigue are of major importance to stroke survivors. Allied health can play a significant role in providing training regarding management of fatigue symptoms to assist maintain community participation. Allied health professions have an important role in assisting stroke survivors to transition through feelings of loss and in providing education concerning new skills to assist manage symptoms of fatigue post-stroke.

Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study

Abstract Purpose: Few longitudinal studies explore post-stroke patterns of psychological morbidity and factors contributing to their change over time. We aimed to explore predictors of post-stroke depression (PSD) and post-stroke anxiety over a 12-month period. Methods: A prospective cohort study. Consecutively recruited stroke patients (n = 134) participated in face-to-face interviews at baseline, 3, 6, 9, and 12 months. Primary outcome measures were depression and anxiety (measured via Hospital Anxiety and Depression Scale). Independent variables included disability (Modified Rankin Scale), Quality-of-life (Assessment Quality-of-life), social support (Multi-dimensional Scale Perceived Social Support) and community participation (Adelaide Activities Profile (AAP)). Secondary outcomes were predictors of resolution and development of PSD and anxiety. Results: Anxiety (47%) was more common than depression (22%) at baseline. Anxiety (but not depression) scores improved over time. Anxiety post-stroke was positively associated with baseline PSD (p < 0.0001), baseline anxiety (p < 0.0001) and less disability (p = 0.042). PSD was associated with baseline anxiety (p < 0.0001), baseline depression (p = 0.0057), low social support (p = 0.0161) and low community participation (p < 0.0001). The only baseline factor predicting the resolution of PSD (if depressed at baseline) was increased social support (p = 0.0421). Factors that predicted the onset of depression (if not depressed at baseline) were low community participation (p = 0.0015) and higher disability (p = 0.0057). Conclusion: While more common than depression immediately post-stroke, anxiety attenuates while the burden of depression persists over 12 months. Clinical programs should assess anxiety and depression, provide treatment pathways for those identified, and address modifiable risk factors, especially social support and social engagement. Implications for Rehabilitation Psychological distress post stroke is persisting. Multi-disciplinary teams that establish goals with patients promoting social and community engagement could assist in managing psychological morbidity. A shift towards promoting longer-term monitoring and management of stroke survivors must be undertaken, and should consider the factors that support and hinder psychological morbidity.

Correlation and agreement of self-assessed and objective skin disease severity in a cross-sectional study of patients with acne, psoriasis, and atopic eczema.

Background  Previous studies have shown variable correlation of patients’ self‐assessed skin severity measures and clinician‐assessed objective measures of severity. But, generally, correlation has not been as good as might be expected for conditions in which the objective physical extent of skin disease is apparent to the sufferer to an extent that is not applicable in many other diseases.

Occupational violence in general practice: a whole-of-practice problem. Results of a cross-sectional study.

OBJECTIVE To examine the experiences of occupational violence in general practitioner (GP) and non-GP staff. Further objectives were to compare prevalence of violence in GP and non-GP staff and to examine levels of apprehension and perceptions of control over violence. DESIGN Cross-sectional questionnaire-based study. SETTING A network of research general practices, New South Wales, Australia. PARTICIPANTS GPs and non-GP staff--receptionist, practice-management, nursing and allied health staff. MAIN OUTCOME MEASURE(S) Experience of occupational violence during the previous 12 months. Other outcomes examined were workplace apprehension regarding violence, perception of occupational violence as a problem in general practice, and perception of control over violence in the workplace. RESULTS A total of 125 questionnaire replies were received (response rate 55%), 59.3% of GPs and 74.6% of non-GPs had experienced work-related violence during the previous 12 months. The difference was not significant (OR 0.65, 95% CI 0.20-2.06). Subjects in rural practices were more likely than those in urban practices to have experienced violence (OR 3.79, 95% CI 1.15-12.5). Personal experience of violence (OR 35.9, 95% CI 6.24-207) and a perception that violence is increasing (OR 8.33, 95% CI 1.89-36.6) were associated with apprehension regarding violence at work.

Participant demographics reported in "Table 1" of randomised controlled trials: a case of "inverse evidence"?

IntroductionData supporting external validity of trial results allows clinicians to assess the applicability of a studys findings to their practice population. Socio-economic status (SES) of trial participants may be critical to external validity given the relationship between social and economic circumstances and health. We explored how this is documented in reports of RCTs in four major general medical journals.MethodsThe contents lists of four leading general medical journals were hand searched to identify 25 consecutive papers reporting RCT results in each journal (n = 100). Data on demographic characteristics were extracted from each papers Table 1 only (or equivalent).ResultsAuthors infrequently reported key demographic characteristics relating to SES of RCT participants. Age and gender of participants were commonly reported. Less than 10% reported occupational group, employment status, income or area based measures of disadvantage.ConclusionsWithout adequate reporting of key indicators of SES in trial participants it is unclear if lower SES groups are under-represented. If such groups are systematically under-recruited into trials, this may limit the external validity and applicability of study findings to these groups. This is in spite of the higher health-care need in more disadvantaged populations. Under-representation of low SES groups could underestimate the reported effect of an intervention for those with a higher baseline risk. The marginal benefit identified in a trial with poor or no representation of lower SES participants could significantly underestimate the potential benefit to a low SES community. More transparency in this reporting and greater attention to the impact of SES on intervention outcomes in clinical trials is needed. This could be considered in the next revision of the CONSORT statement.