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Evaluating therapeutic effect on WOMAC subscales in osteoarthritis RCTs: When model choice matters.
Related Articles

Evaluating therapeutic effect on WOMAC subscales in osteoarthritis RCTs: When model choice matters.

J Eval Clin Pract. 2017 Apr 20;:

Authors: Lorenzoni G, Azzolina D, Soriani N, Gregori D

Abstract
RATIONALE, AIMS, AND OBJECTIVES: The study aimed at developing a method for modelling the Western Ontario and McMaster Universities index (WOMAC), accounting for correlation between its subscales and for heterogeneity of treatment effect (HTE), using data from 2 twin trials on knee osteoarthritis.
METHOD: Two randomized, double-blind, placebo-controlled clinical trials (twin trials). Studies aimed at investigating the effectiveness of a pharmacological treatment on clinical outcomes of knee osteoarthritis, measured using WOMAC index. To take into account that the WOMAC subscales are correlated and skewed, we proposed and compared multivariate gamma and Gaussian approaches with latent variable capturing correlation between outcomes. Besides the latent term, the interaction between the latent term and treatment, accounting for HTE, was further estimated.
RESULTS: Modelling the subscales by using a gamma approach accounting for skewness of data, we found out different results compared with Gaussian models. The main difference regarded the latent variable interacting with treatment (accounting for unobserved heterogeneity), which is not significant for the Gaussian approach (P value = .102) and significant in the gamma model (P value < .002). Thus, indicating that unobserved covariates affect treatment's performance. Additionally, plotting the observed and the estimated values of WOMAC index of the Gaussian and gamma models, we showed that, compared with the Gaussian, the gamma one best fits the data, especially among poor responders.
CONCLUSION: Multivariate gamma approach accounting for correlation between outcomes and for HTE has been demonstrated to be more suitable to model WOMAC subscales and to provide more information on effect of therapy.

PMID: 28425672 [PubMed - as supplied by publisher]




The patient safety climate in healthcare organizations (PSCHO) survey: Short-form development.
Related Articles

The patient safety climate in healthcare organizations (PSCHO) survey: Short-form development.

J Eval Clin Pract. 2017 Apr 20;:

Authors: Benzer JK, Meterko M, Singer SJ

Abstract
RATIONALE, AIMS, AND OBJECTIVES: Measures of safety climate are increasingly used to guide safety improvement initiatives. However, cost and respondent burden may limit the use of safety climate surveys. The purpose of this study was to develop a 15- to 20-item safety climate survey based on the Patient Safety Climate in Healthcare Organizations survey, a well-validated 38-item measure of safety climate.
METHODS: The Patient Safety Climate in Healthcare Organizations was administered to all senior managers, all physicians, and a 10% random sample of all other hospital personnel in 69 private sector hospitals and 30 Veterans Health Administration hospitals. Both samples were randomly divided into a derivation sample to identify a short-form subset and a confirmation sample to assess the psychometric properties of the proposed short form.
RESULTS: The short form consists of 15 items represented 3 overarching domains in the long-form scale-organization, work unit, and interpersonal.
CONCLUSION: The proposed short form efficiently captures 3 important sources of variance in safety climate: organizational, work-unit, and interpersonal. The short-form development process was a practical method that can be applied to other safety climate surveys. This safety climate short form may increase response rates in studies that involve busy clinicians or repeated measures.

PMID: 28425580 [PubMed - as supplied by publisher]




Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.
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Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.

J Eval Clin Pract. 2017 Apr 20;:

Authors: Ament SMC, Gillissen F, Moser A, Maessen JMC, Dirksen CD, von Meyenfeldt MF, van der Weijden T

Abstract
RATIONALE, AIMS, AND OBJECTIVES: Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success.
METHOD: An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed.
RESULTS: A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts.
CONCLUSIONS: The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological levels of the health care system and demands continuous effort in the postimplementation phase.

PMID: 28425574 [PubMed - as supplied by publisher]




Conceptualizing movement by expert Bobath instructors in neurological rehabilitation.
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Conceptualizing movement by expert Bobath instructors in neurological rehabilitation.

J Eval Clin Pract. 2017 Apr 20;:

Authors: Vaughan-Graham J, Kara Patterson, Zabjek K, Cott CA

Abstract
RATIONALE, AIMS, AND OBJECTIVES: Movement, a core aspect of physiotherapy practice, and integral to the clinical reasoning process has undergone limited theoretical development. Instead, research has focused on intervention effectiveness embedded within the positivist paradigm. The purpose of this study was to explore how expert neurorehabilitation therapists conceptualize movement as part of their clinical reasoning.
METHOD: A qualitative interpretive descriptive approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews was used. Theoretical sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA) who are recognized experts in neurorehabilitation. Interview transcripts were transcribed verbatim. Data analysis was progressive, iterative, and inductive.
RESULTS: Twenty-two IBITA instructors from 7 different countries volunteered to participate. They ranged in clinical experience from 12 to 40 years and instructor experience from 1 to 35 years. The conceptualization of movement by the IBITA instructors involves the following elements: (1) movement comprises the whole person and the whole body, not just individual body segments; (2) active alignment of body segments is integral to movement performance; and (3) efficient movement requires the relative integration of postural control/stability and selective movement/mobility.
CONCLUSIONS: The IBITA instructors conceptualize movement from a person-centred perspective. The integration of postural control and selective movement, with alignment and variability as key components, forms the foundation of their understanding of movement. Further investigation into the role of postural control in movement recovery post central nervous system lesion is required. Likewise, the dimensions of movement critical to the conceptualization of movement are not well understood from the perspective of the physiotherapist or persons with neurological impairments.

PMID: 28425221 [PubMed - as supplied by publisher]