De-implementing Prolonged Rest Advice for Concussion in Primary Care Settings: A Pilot Stepped Wedge Cluster Randomized Trial.
J Head Trauma Rehabil
; 36(2): 79-86, 2021.
Article
em En
| MEDLINE
| ID: mdl-32898029
ABSTRACT
OBJECTIVE:
To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion.SETTING:
Community.PARTICIPANTS:
Family physicians in community practice (n = 21 at 5 clinics).DESIGN:
Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits. MAINMEASURES:
The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements.RESULTS:
Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change.CONCLUSIONS:
Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Concussão Encefálica
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article