Development of a supervised exercise programme for immigrant women: Feasibility study of a practical intervention in a physiotherapy setting.

BACKGROUND: While Denmark is facing growing inequality between Danish women and immigrant women in relation to exercise and health, research on interventions and targeted exercise programmes is limited. This study aimed to test the feasibility of a physiotherapeutic supervised exercise programme for immigrant women. METHODS: Inspired by improvement research a programme was developed in cooperation with the immigrant women. The intervention was modified continuously according to the women's wishes and needs. INTERVENTION: Baseline focus-group interviews, completion of questionnaire and physical-strength tests, was followed by a 12-week supervised training period. After completion of the training the participants were re-interviewed and re-tested. RESULTS: Twenty-nine women were recruited to the training programme, and 10 attended follow-up. Mean body mass index was 34 kg/m2. Attendance rate among follow-up tested participants was 70%. The women gained knowledge about their bodies, a healthier lifestyle, and awareness of the importance of active living. CONCLUSION: It was possible to recruit and maintain immigrant women in the exercise programme. This study demonstrated the importance of involving the women in the process, and revealed important factors, such as privacy, a local setting and trust in the physiotherapists.

Healthcare inequality in compensation claims concerning acute hospital services: a Danish register-based study.

OBJECTIVE: Although citizens' equal right to acute healthcare of appropriate quality is an oft-cited goal for modern societies, healthcare disparities may persist. We aimed to investigate inequality in compensation claims and compensation payments regarding acute healthcare services. DESIGN AND SETTING: We conducted a cross-sectional study of compensation claim patterns using the Danish Patient Compensation Association (DPCA) registries. PARTICIPANTS, INTERVENTIONS AND MAIN OUTCOME MEASURES: We used register data on all cases managed by DPCA relating to acute hospital healthcare for adults (aged > 18 years) from 2007 to 2017. RESULTS: In total, the DPCA had 5556 compensation claims for injuries caused by acute care services during the years 2007-2017. Age group of 50-64 years (odds ratio (OR) = 1.37 compared with those aged 18-49 years; P < 0.001), marriage (OR = 1.14; P < 0.001), higher income (OR = 1.55; P < 0.001) and Danish origin (OR = 1.49; P < 0.001) were statistically associated with higher odds for filing a compensation claim; men (OR = 0.83; P < 0.001) and those with many co-morbidities were much less represented (OR = 0.24; P < 0.001). Male gender (OR = 1.25; P < 0.001) and higher age (OR = 2.55 (80+ years); P < 0.001) were associated with higher odds for a compensation award. Failed diagnosis was also more often at stake in men (OR = 1.38; P < 0.001) and in patients aged 50-64 years (OR = 1.17; P < 0.001) but occurred less often in patients with multiple morbidities (OR = 0.68; P < 0.001). CONCLUSIONS: Findings from our Danish material suggest some inequality in compensation claims and compensation payments regarding acute healthcare services.

Advancing practice for back pain through stratified care (STarT Back).

BACKGROUND: Low back pain (LBP) is common, however research comparing the effectiveness of different treatments over the last two decades conclude either no or small differences in the average effects of different treatments. One suggestion to explain this is that patients are not all the same and important subgroups exist that might require different treatment approaches. Stratified care for LBP involves identifying subgroups of patients and then delivering appropriate matched treatments. Research has shown that stratified care for LBP in primary care can improve clinical outcomes, reduce costs and increase the efficiency of health-care delivery in the UK. The challenge now is to replicate and evaluate this approach in other countries health care systems and to support services to implement it in routine clinical care. RESULTS: The STarT Back approach to stratified care has been tested in the National Health Service, within the UK, it reduces unnecessary overtreatment in patients who have a good prognosis (those at low risk) yet increases the likelihood of appropriate healthcare and associated improved outcomes for those who are at risk of persistent disabling pain. The approach is cost-effective in the UK healthcare setting and has been recommended in recent guidelines and implemented as part of new LBP clinical pathways of care. This approach has subsequently generated international interest, a replication study is currently underway in Denmark, however, some lessons have already been learnt. There are potential obstacles to implementing stratified care in low-and-middle-income settings and in other high-income settings outside of the UK, however, implementation science literature can inform the development of innovations and efforts to support implementation of stratified care. CONCLUSIONS: The STarT Back approach to stratified care for LBP is a promising method to advance practice that has demonstrated clinical and cost effectiveness in the UK. Over time, further evidence for both the effectiveness and the adaptations needed to test and implement the STarT Back stratified care approach in other countries is needed.

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting.

INTRODUCTION: The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting. METHODS: Poor clinical outcome at 6 months (>30 points on a 0-100 Roland Morris Disability Scale) was calculated in secondary care (n = 960) and primary care (n = 172) cohorts. The cohorts were stratified into SBT subgroups and estimates of additional risk for poor outcome were calculated [relative risk (RR), unadjusted and adjusted odds ratios]. The discriminative ability was determined using the area under the curve statistic. RESULTS: In secondary care 69.0 % and in primary care 40.2 % had poor outcome on activity limitation. Although significant, the predictive ability of the SBT in secondary care (medium-risk RR 1.5, high-risk RR 1.7) was not as strong as in primary care (medium-risk RR 2.3, high-risk RR 3.5). Adjusting for episode duration and pain intensity only changed the predictive ability marginally in secondary care. The discriminative ability of the SBT was similar in both cohorts despite differences in the predictive ability. CONCLUSION: The SBT had less predictive ability in a Danish secondary care setting compared to a Danish primary care setting for persistent activity limitation at 6 months follow-up. SBT-targeted treatment implications in secondary care were not investigated in this study.