Dhopte Prakash, Ahmed Sara, Mayo Nancy, French Simon, Quon Jeffrey A, Bussières André
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC Canada.
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, QC Canada ; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montréal, QC Canada ; Clinical Epidemiology, McGill University Health Center, Montréal, QC Canada.
Pilot Feasibility Stud. 2016 Jul 20;2:33. doi: 10.1186/s40814-016-0076-9. eCollection 2016.
Neck pain in adults is common and a leading cause of physical disability. Recently, a guideline was developed for the management of non-specific neck pain (NSNP) with an aim to improve the quality of the delivery of chiropractic care. One key guideline recommendation is to undertake multimodal care for patients with NSNP. The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP.
METHODS/DESIGN: The design is a cluster-randomized controlled pilot and feasibility trial. Chiropractors in private practice in Canada will be approached to participate in the study. Thirty consenting chiropractors will be randomized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group. Each chiropractor will recruit five neck pain patients (a total of 150 patients) into the study. Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars, two online case scenarios, a self-management video on Brief Action Planning, and a printed copy of the practice guideline. for both chiropractors and patients include rates of (1) recruitment, (2) retention, and (3) adherence to the intervention. A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors' compliance with guideline recommendations (e.g. exercise and self-care prescriptions) at study onset and at 3 months. Secondary outcomes include scores of behavioural constructs (level of knowledge and self-efficacy) for recommended multimodal care. include pain intensity and neck pain-specific disability. Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest (recruitment, retention, adherence, pain intensity, Neck Disability Index).
Results of this study will inform the design of a larger cluster-randomized controlled trial aimed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.
https://clinicaltrials.gov/, NCT02483091.
成人颈部疼痛很常见，是身体残疾的主要原因。最近，制定了一项非特异性颈部疼痛（NSNP）管理指南，旨在提高整脊治疗的质量。该指南的一项关键建议是对NSNP患者进行多模式护理。这项初步研究的目的是通过促进管理NSNP患者的整脊师使用多模式护理，来确定实施多方面知识转化干预措施的可行性。
方法/设计：本设计为整群随机对照初步可行性试验。将邀请加拿大私人执业的整脊师参与研究。30名同意参与的整脊师将被随机分组，实验组接受基于理论的教育干预，对照组仅收到一份指南的印刷版。每位整脊师将招募5名颈部疼痛患者（共150名患者）参与研究。基于理论领域框架的相关定性研究结果为多方面干预措施的制定提供了依据，该干预措施包括一系列三场网络研讨会、两个在线病例场景、一个关于简短行动计划的自我管理视频以及一份整脊师和患者均可使用的实践指南印刷版。可行性指标包括：（1）招募率，（2）保留率，（3）对干预措施的依从性。将使用患者就诊表格中嵌入的替代指标清单，在研究开始时和3个月时评估整脊师对指南建议（如运动和自我护理处方）的遵守情况。次要结果包括推荐的多模式护理的行为构成要素得分（知识水平和自我效能感）。结局指标包括疼痛强度和颈部疼痛特异性残疾。本研究的分析将集中于为预先设定的感兴趣参数（招募率、保留率、依从性、疼痛强度、颈部残疾指数）生成点估计值和相应的95%置信区间。
本研究结果将为一项更大规模的整群随机对照试验的设计提供信息，该试验旨在评估基于理论的量身定制干预措施的有效性，并增加管理NSNP患者的整脊师对多模式护理的使用。
