Factors influencing imaging clinical decision-making in low back pain management. A scoping review.

BACKGROUND: The use of diagnostic imaging in low back pain (LBP) management is often inappropriate, despite recommendations from clinical practice guidelines. There is a limited understanding of factors that influence the imaging clinical decision-making (CDM) process. AIM: Explore the literature on factors influencing imaging CDM for people with LBP and consider how these findings could be used to reduce inappropriate use of imaging in LBP management. DESIGN: Scoping review. METHOD: This review followed the Preferred Reporting Items for Systematic Review extension for scoping reviews. A digital search was conducted in Medline, the Cumulative Index of Nursing and Allied Health Literature, Scopus, and the Cochrane Central Register of Controlled Trials for eligible studies published between January 2010-2023. Data reporting influences on imaging CDM were extracted. Data were then analysed through an inductive process to group the influencing factors into categories. RESULTS: After screening, 35 studies (5 qualitative and 30 quantitative) were included in the review, which reported factors influencing imaging CDM. Three categories were developed: clinical features (such as red flags, pain, and neurological deficit), non-modifiable factors (such as age, sex, and ethnicity) and modifiable factors (such as beliefs about consequences and clinical practice). Most studies reported non-modifiable factors. CONCLUSIONS: The results of this scoping review challenge the perception that imaging CDM is purely based on clinical history and objective findings. There is a complex interplay between clinical features, patient and clinician characteristics, beliefs, and environment. These findings should be considered when designing strategies to address inappropriate imaging behaviour.

Freely available, online videos to support neurological physiotherapists and students in task-specific training skill acquisition: a scoping review.

BACKGROUND: Videos to support learning of clinical skills are effective; however, little is known about the scope and educational quality of the content of freely available online videos demonstrating task-specific training (TST). This review aimed to determine the extent, characteristics of freely available online videos, and whether the content is suitable to guide skill acquisition of task-specific training for neurological physiotherapists and students. METHODS: A scoping review was conducted. Google video and YouTube were searched in December 2022. Videos that met our eligibility criteria and were explicitly designed for (TST) skill acquisition were included in the report. RESULTS: Ten videos met the inclusion criteria and were difficult to find amongst the range of videos available. Most were presented by physiotherapists or occupational therapists, originated from the USA, featured stroke as the condition of the person being treated, and involved a range of interventions (upper limb, constraint induced movement therapy, balance, bicycling). Most videos were created by universities or private practices and only two used people with a neurological condition as the participant. When the content of videos and their presentation (instruction and/or demonstration), was assessed against each key component of TST (practice structure, specificity, repetition, modification, progression, feedback), five of the videos were rated very suitable and five moderately suitable to guide skill acquisition. Most videos failed to demonstrate and provide instruction on each key component of TST and were missing at least one component, with feedback most frequently omitted. CONCLUSIONS: There are many freely available online videos which could be described as demonstrating TST; very few are suitable to guide skill acquisition. The development of a standardised and validated assessment tool, that is easy to use and assesses the content of TST videos is required to support learners to critically evaluate the educational quality of video content. Guidelines based on sound teaching theory and practice are required to assist creators of online videos to provide suitable resources that meet the learning needs of neurological physiotherapists and students.

A six-month telerehabilitation programme delivered via readily accessible technology is acceptable to people following stroke: a qualitative study.

OBJECTIVE: To explore the experiences of participants during a six-month, post-stroke telerehabilitation programme. DESIGN: A qualitative descriptive study to investigate participant experiences of ACTIV (Augmented Community Telerehabilitation Intervention), a six-month tailored exercise programme delivered by physiotherapists primarily using readily accessible telecommunication technology. Semi-structured, in-depth interviews were used to collect data, which were analysed using thematic analysis. SETTING: Interviews conducted in participants' homes or a community facility. PARTICIPANTS: Participants were eligible if they had a stroke in the previous 18 months and had participated in ACTIV. RESULTS: Twenty-one participants were interviewed. Four key themes were constructed from the data: 1. 'ACTIV was not what I call physio' (it differed from participants' expectations of physiotherapy, but they reported many positive aspects to the programme). 2. 'There's somebody there' (ongoing support from the physiotherapists helped participants find strategies to continue improving). 3. 'Making progress' (in the face of barriers, small improvements were valued). 4. 'What I really want' (participant goals were frequently more general than therapy goals and involved progress towards getting back to 'normal'). CONCLUSIONS: Although ACTIV was not what participants expected from physiotherapy, the majority found contact from a physiotherapist reduced the feeling of being left to struggle alone. Most participants found a programme with minimal face-to-face contact augmented by phone calls and encouraging text messages to be helpful and acceptable. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registration Number: ACTRN12612000464864 CONTRIBUTION OF THE PAPER.

Perceptions of a self-guided web-based exercise programme for shoulder pain after spinal cord injury: A qualitative study.

STUDY DESIGN: Qualitative study. OBJECTIVES: The benefits of exercise to reduce shoulder pain in people with spinal cord injury (SCI) are well documented. Digital health interventions offer a potential solution to overcome barriers to access rehabilitation support for exercise. The aim of this project was to gain people's perspectives to inform the development of a self-guided web-based exercise intervention. Shoulder Pain Intervention delivered over the interNet (SPIN) is a self-guided web-based intervention to prescribe, monitor, and progress evidence-based exercises for people living with SCI and shoulder pain. SETTING: Community in Auckland, New Zealand. METHODS: The Person-Based Approach was used as the framework. Using an Interpretive Descriptive methodology, data were collected in individual and focus group interviews, exploring participants' perceptions of this intervention idea. Data were analysed using conventional content analysis. RESULTS: Sixteen participants took part and asked Is it right for me?. This had three main sub-themes. Should I use it?, whether I believe it will work for me right now; Can I use it?, whether I can operate the intervention competently and confidently and Will I use it?, whether it will be responsive to my unique needs, and keep me coming back. CONCLUSIONS: Participants expressed their expectations and tipping points when considering using an intervention like this. These findings will inform and guide design and development of an acceptable technology-based intervention to increase the likelihood of engagement with a self-guided web-based exercise programme. The model developed from these themes could be used to inform future self-guided intervention development.

The Effectiveness of Self-Guided Digital Interventions to Improve Physical Activity and Exercise Outcomes for People With Chronic Conditions: A Systematic Review and Meta-Analysis.

Objective: The aim of this systematic review was to determine the effectiveness of self-guided digital physical activity (PA) and exercise interventions to improve physical activity and exercise (PA&E) outcomes for people living with chronic health conditions. Digital health interventions, especially those with minimal human contact, may offer a sustainable solution to accessing ongoing services and support for this population. Methods: A comprehensive and systematic search was conducted up to December 2021, through seven databases, for randomized trials that evaluated the effect of self-guided web- or internet-based PA interventions on physical activity or exercise outcomes. Included studies had to have interventions with minimal human contact and interaction with participants needed to be automatically generated. All studies were screened for eligibility and relevant data were extracted. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool. Standardized mean differences and 95% confidence intervals (CI) were calculated. PA data were pooled, and forest plots were generated. Results: Sixteen studies met the eligibility criteria and included a total of 2,439 participants. There was wide variation in health conditions and intervention characteristics in mode and parameters of delivery, and in the application of theory and behavioral strategies. Self-reported PA in the intervention group was greater than controls at the end of the intervention [standardized mean difference (SMD) 0.2, 95% CI = 0.1, 0.3] and at follow up (SMD 0.3, 95% CI 0.2-0.5). The difference in objectively measured PA was small and non-significant (SMD 0.3, 95% CI -0.2 to 0.9). All interventions included behavioral strategies and ten of the sixteen were underpinned by theory. Conclusions: Self-guided digital PA&E interventions provided a positive effect on PA immediately after the intervention. An unexpected and positive finding was a sustained increase in PA at follow-up, particularly for interventions where the behavioral strategies were underpinned by a theoretical framework. Interventions with minimal contact have the potential to support sustained PA engagement at least as well as interventions with supervision. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42019132464.

Participant perspectives of automated short messaging service interventions to promote physical activity: A systematic review and thematic synthesis.

Introduction: Short messaging service has the potential to improve participation in physical activity in individuals with long-term health conditions. However, successful implementation relies on participant engagement with such programmes. The aim of this study was to undertake a systematic review of qualitative literature exploring participant perspectives of short messaging service-based interventions designed to promote physical activity for people with long-term health conditions. Methods: CINHAL, MEDLINE, SPORTSDiscus, Scopus and Web of Science were searched up to 15 February 2021 looking for participants' perspectives on short messaging service programmes designed to promote physical activity in people with long-term health conditions. Included studies were analysed using thematic synthesis. Results: Eight studies involving 533 participants were included and analysed using the principles of thematic analysis and 10 descriptive themes were identified. These descriptive themes were further refined to develop five final analytical themes: taking control of my own health, from information to action, relationship with the programme, perfection required for success and increased expectations. Discussion: The findings agree with published work on the factors which influence behaviour. The findings from this synthesis demonstrate that automated short messaging service programmes to increase physical activity are generally acceptable. People report that these interventions support and encourage physical activity. The novel finding of this study was that having more regular and long-lasting contact has the potential to increase the expectations people have of healthcare services. This is a finding which needs to be considered and managed but should not discourage the use of automated short messaging service.

Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial.

BACKGROUND: The number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation. OBJECTIVE: To investigate whether ACTIV improved physical function compared with usual care. METHODS: This 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants' homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control. RESULTS: A total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up. CONCLUSIONS: ACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.