School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Health Research Institute, University of Limerick, Limerick, Ireland.
BMC Musculoskelet Disord. 2022 Jul 5;23(1):643. doi: 10.1186/s12891-022-05599-w.
The evidence-based interventions of exercise and education have been strongly recommended as part of prominent clinical guidelines for hip and knee osteoarthritis (OA) for more than ten years. Despite the wealth of strong evidence that exists, implementation in practice is sub-optimal. This paper describes the key methodologies used in the co-design, tailoring, and evaluation of the IMPACT project implementation strategies, to confront this problem across multiple levels (micro, meso, macro) in public and private healthcare settings in Ireland.
Using a type III hybrid implementation-effectiveness design, a participatory, dynamic and iterative process will be used to tailor and evaluate multi-level implementation strategies using the following stages: 1) Co-design the implementation strategies with key stakeholders using best evidence, a theory-driven implementation framework (Consolidated Framework for Implementation Research), local context and expert consensus; 2) Pilot and evaluate the implementation strategies by training physiotherapists to deliver the evidence-based Good Life with osteoArthritis Denmark (GLA:D®) education and exercise programme using the implementation strategies, and conduct a mixed-methods process evaluation; 3) Adapt the implementation strategies based on implementation process evaluation indicators from stage two. The adapted strategies will be used for scale-up and sustainability in subsequent GLA:D® Ireland training programmes that will be rolled out nationally. Evaluation of effectiveness on patient and cost outcomes will continue up to 12 months post-programme delivery, using an online patient registry and pre-post design.
This implementation science project aims to use participatory health research to address a gap in management of OA across public and private healthcare settings. This research has the potential to change practice and promote a policy of exercise and physical activity referral for chronic musculoskeletal disease that utilises community engagement effectively and enacts change 'together', with involvement of researchers, decision-makers, clinicians and patients.
十年来，循证干预措施中的运动和教育一直被强烈推荐作为髋膝关节骨关节炎（OA）的重要临床指南的一部分。尽管存在大量强有力的证据，但在实践中的实施情况并不理想。本文描述了在 IMPACT 项目实施策略的共同设计、定制和评估中使用的关键方法学，以解决爱尔兰公共和私人医疗保健环境中多个层面（微观、中观、宏观）的这一问题。
使用 III 型混合实施-有效性设计，将采用参与式、动态和迭代过程，使用以下阶段来定制和评估多层次实施策略：1）使用最佳证据、理论驱动的实施框架（综合实施研究框架）、当地背景和专家共识，与主要利益相关者共同设计实施策略；2）通过培训物理治疗师来提供循证丹麦骨关节炎生活质量（GLA:D®）教育和运动计划，使用实施策略来试点和评估实施策略，并进行混合方法过程评估；3）根据第二阶段的实施过程评估指标调整实施策略。调整后的策略将用于随后在爱尔兰全国范围内开展的 GLA:D®培训计划的扩大和可持续性。将使用在线患者登记和前后设计，在方案实施后 12 个月内继续评估患者和成本结果的有效性。
本实施科学项目旨在使用参与式健康研究来解决公共和私人医疗保健环境中 OA 管理方面的差距。这项研究有可能改变实践，并促进一种针对慢性肌肉骨骼疾病的运动和体育活动转介政策，该政策有效地利用社区参与，并在研究人员、决策者、临床医生和患者的共同参与下实施变革。
