Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns.

OBJECTIVES: Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the current setup for the management of patients with CMP. The objective was to explore GP's perspectives on the challenges, needs, and visions for improving the management of patients with CMP. METHODS: A qualitative study with co-design using the future workshop approach. Eight GPs participated in the future workshop (five females). Insights and visions emerged from the GP's discussions and sharing of their experiences in managing patients with CMP. The audio-recorded data were subjected to thematic text analysis. RESULTS: The thematic analysis revealed four main themes, including (1) challenges with current pain management, (2) barriers to pain management, (3) the need for a biopsychosocial perspective, and (4) solutions and visions. All challenges are related to the complexity and diagnostic uncertainty for this patient population. GPs experienced that the patients' biomedical understanding of their pain was a barrier for management and underlined the need for a biopsychosocial approach when managing the patients. The GPs described taking on the role of coordinators for their patients with CMP but could feel ill-equipped to handle diagnostic uncertainty. An interdisciplinary unit was recommended as a possible solution to introduce a biopsychosocial approach for the examination, diagnosis, and management of the patient's CMP. CONCLUSIONS: The complexity and diagnostic uncertainty of patients with CMP warrants a revision of the current setup. Establishing an interdisciplinary unit using a biopsychosocial approach was recommended as an option to improve the current management for patients with CMP.

Competences to self-manage low back pain among care-seeking adolescents from general practice - a qualitative study.

BACKGROUND: There is limited knowledge about when and how adolescents with low back pain (LBP) interact with health care providers. This limits our understanding of how to best help these young patients. This study aimed to understand when and how care-seeking adolescents with LBP interact with health care providers and which health literacy competencies and strategies do they use to self-managing their LBP. METHOD: Ten semi-structured interviews (duration 20-40 min) were conducted online among adolescents aged 15-18 with current or recent LBP (pain duration range; 9 months - 5 years). The interview guide was informed by literature on health literacy and self-management in patients. We conducted a semantic and latent thematic data analyses. RESULTS: Three major themes emerged from the analysis: (1) Self-management, (2) Pain and Function, and (3) Communication. All adolescents were functionally limited by their pain but the main reason to consult a health care provider was an increase in pain intensity. Many were able to navigate the healthcare system, but experienced difficulties in communicating with health care providers, and many felt that they were not being taken seriously. Their first line self-management option was often over-the-counter pain medicine with limited effects. Most adolescents expressed a desire to self-manage their LBP but needed more guidance from health care providers. CONCLUSION: Adolescents with LBP seek care when pain intensifies, but they lack self-management strategies. Many adolescents want to self-manage their LBP with guidance from health care providers, but insufficient communication is a barrier for collaboration on self-management.

Exploring the barriers and facilitators for supporting adolescents with knee pains adherence to mobile health apps: A think-aloud study.

Background: Mobile health (mHealth) applications have the potential to support adolescents' self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents. Objective: This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles. Methods: Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles. Results: The analysis based on user testing with adolescents with knee pain identified three themes: "user experience and feedback," "contextual challenges," and "new features" and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs. Conclusion: Participants' motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents' cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.

Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study.

BACKGROUND: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. OBJECTIVE: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. METHODS: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. RESULTS: Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. CONCLUSIONS: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance.

Patient perspectives on data sharing regarding implementing and using artificial intelligence in general practice - a qualitative study.

BACKGROUND: Due to more elderly and patients with complex illnesses, there is an increasing pressure on the healthcare system. General practice especially feels this pressure as being the first point of contact for the patients. Developments in digitalization have undergone fast progress and data-driven artificial intelligence (AI) has shown great potential for use in general practice. To develop AI as a support tool for general practitioners (GPs), access to patients' health data is needed, but patients have concerns regarding data sharing. Furthermore, studies show that trust is important regarding the patient-GP relationship, data sharing, and AI. The aim of this paper is to uncover patient perspectives on trust regarding the patient-GP relationship, data sharing and AI in general practice. METHOD: This study investigated 10 patients' perspectives through qualitative interviews and written vignettes were chosen to elicit the patients (interviewees) perspectives on topics that they were not familiar with prior to the interviews. The study specifically investigated perspectives on 1) The patient-GP relationship, 2) data sharing regarding developing AI for general practice, and 3) implementation and use of AI in general practice using thematic analysis. The study took place in the North Denmark Region and the interviewees included had to be registered in general practice and be above 18 years in age. We included four men between 25 to 74 years in age and six women between 27 to 46 years in age. RESULTS: The interviewees expressed a high level of trust towards their GP and were willing to share their health data with their GP. The interviewees believed that AI could be a great help to GPs if used as a support tool in general practice. However, it was important for the interviewees that the GP would still be the primary decision maker. CONCLUSION: Patients may be willing to share health data to help implement and use AI in general practice. If AI is implemented in a way that preserves the patient-GP relationship and used as a support tool for the GP, our results indicate that patients may be positive towards the use of AI in general practice.

The clinical relevance of magnetic resonance imaging of the lower back.

Magnetic resonance imaging (MRI) is commonly used in the management of low back pain (LBP). This review provides an overview of the clinical relevance of degenerative MRI findings in the lumbar spine. The association between degenerative MRI findings and LBP is relatively consistent at population level, but very little research exists on the prognostic value of MRI findings and based on the current evidence, MRI cannot be used to guide treatment. Lumbar spine MRI is only recommended for patients with progressive neurological deficits, suspicion of specific pathology or in absence of progress of conservative treatment.

Machine learning in general practice: scoping review of administrative task support and automation.

BACKGROUND: Artificial intelligence (AI) is increasingly used to support general practice in the early detection of disease and treatment recommendations. However, AI systems aimed at alleviating time-consuming administrative tasks currently appear limited. This scoping review thus aims to summarize the research that has been carried out in methods of machine learning applied to the support and automation of administrative tasks in general practice. METHODS: Databases covering the fields of health care and engineering sciences (PubMed, Embase, CINAHL with full text, Cochrane Library, Scopus, and IEEE Xplore) were searched. Screening for eligible studies was completed using Covidence, and data was extracted along nine research-based attributes concerning general practice, administrative tasks, and machine learning. The search and screening processes were completed during the period of April to June 2022. RESULTS: 1439 records were identified and 1158 were screened for eligibility criteria. A total of 12 studies were included. The extracted attributes indicate that most studies concern various scheduling tasks using supervised machine learning methods with relatively low general practitioner (GP) involvement. Importantly, four studies employed the latest available machine learning methods and the data used frequently varied in terms of setting, type, and availability. CONCLUSION: The limited field of research developing in the application of machine learning to administrative tasks in general practice indicates that there is a great need and high potential for such methods. However, there is currently a lack of research likely due to the unavailability of open-source data and a prioritization of diagnostic-based tasks. Future research would benefit from open-source data, cutting-edge methods of machine learning, and clearly stated GP involvement, so that improved and replicable scientific research can be done.

Changes in Antibiotic Prescribing Patterns in Danish General Practice during the COVID-19 Pandemic: A Register-Based Study.

The World Health Organization expressed concern that antimicrobial resistance would increase during the COVID-19 pandemic due to the excessive use of antibiotics. This study aimed to explore if antibiotic prescribing patterns in general practices located in the North Denmark Region changed during the COVID-19 pandemic. The study was conducted as a registry-based study. Data was collected for every antibiotic prescription issued in general practices located in the North Denmark Region during the first year of the pandemic (1 February 2020 to 31 January 2021) and the year prior to the pandemic (1 February 2019 to 31 January 2020). Data were compared regarding antibiotic agents and the type of consultation linked to each antibiotic prescription. Results showed that antibiotic prescriptions decreased by 18.5% during the first pandemic year. The use of macrolides and lincosamides, along with combinations of penicillins and beta-lactamase -sensitive penicillins, was reduced the most. Face-to-face consultations related to an antibiotic prescription decreased by 28.5%, while the use of video consultations increased markedly. In Denmark, COVID-19 restrictions have contributed to both a lower consumption of antibiotics and a change in prescription patterns in general practice. Probably some of the COVID-19 -preventing initiatives could be of importance moving forward in the fight against antimicrobial resistance.

Six-year-old children had greater risks of functional gastrointestinal disorders if their parents had mental health conditions.

AIM: This study examined any associations between parents' mental health conditions and hospital diagnoses of functional gastrointestinal disorders (FGIDs) in offspring at the age of six. We also examined any associations between children who met these criteria and attended routine Danish preventive child health appointments. METHODS: Nationwide registers identified all children born in Denmark from 2000 to 2011 and parents' mental health conditions. Negative binomial regression analyses estimated the incidence rate ratios (IRRs) with 95% confidence intervals (CIs) of children receiving their first hospital diagnosis for an FGID at the age of six. RESULTS: We identified 750,379 children and 38% had at least one parent with a mental health condition: 24% were minor, 12% were moderate, and 2% were severe. These children faced a higher risk of an FGID diagnosis than children whose parents did not have mental health conditions. The IRRs were highest for maternal exposure: minor (1.35, 95% CI 1.29-1.42), moderate (1.58, 95% CI 1.48-1.67) and severe (1.58, 95% CI 1.38-1.81). Attending routine preventive child health examinations was associated with a higher risk of FGIDs associated with parents' mental health conditions. CONCLUSION: Paediatric FGIDs were associated with parents' mental health conditions, especially mothers, and attending routine preventive child health examinations.

The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review.

BACKGROUND: Non-specific symptoms are common and often sign of a non-serious disease. Because of this, patients with non-specific symptoms of cancer (NSSC) present a challenge for general practitioners (GP). Studies describing characteristics of patients with NSSC have been done after fast-track pathways were created to diagnose and treat patients with NSSC. This study reviews characteristics of patients with NSSC and their patient pathways. MATERIALS AND METHODS: Database searches of Embase, Cochrane, PubMed, Cinahl and Web of Science were performed. Search terms used were cancer, patient pathway, and NSSC with their synonyms. The flow diagram Preferring Reporting Items for Systematic Review was applied to the systematic search. The Newcastle-Ottawa Assessment Scale (NOS) was used to compare the quality of the included studies. RESULTS: Twelve studies met the inclusion criterias. All studies were considered to be of high methodological quality. Patient Pathway: 11-35% of patients were diagnosed with cancer. Median number of days through diagnostic process was 7-10. PATIENT CHARACTERISTICS: The most prevalent cancers included hematological-(14-30%), gastrointestinal-(13-23%) and lung cancers (13%). Rheumatological, musculoskeletal and gastrointestinal diseases were among the most common non-malignant diseases diagnosed. Weight loss, fatigue, pain and loss of appetite were the most common symptoms. Cardiovascular diseases, lung diseases, diabetes and previous diagnosed cancer were the most common comorbidities. Mean age of included patients was 60-72 years. CONCLUSION: Limited number of studies were found and they lacked sufficient heterogenic data to conduct a metaanalysis. Symptoms, diagnoses, age and gender were described with some heterogenic results. Further studies should be conducted to gather broader knowledge about patients with NSSC.

Perspectives on the treatment of sequelae after cancer: protocol of an interview study of primary care physiotherapists.

INTRODUCTION: An increasing number of patients are living with fatigue, pain and other sequelae after cancer. About 30% of these patients express a need for physical rehabilitation and patients prefer to be involved in medical decision-making. This includes being offered individualised treatment with patient-defined goals and education during all aspects of treatment by physiotherapists with empathic skills. However, physiotherapists are often unaware of the relationship between cancer and its presenting symptoms. This can lead to inappropriate care and unrealistic goalsetting for rehabilitation. This calls for greater attention towards physiotherapist's treatment and their current perspectives on how treatment can be improved in physiotherapy clinics. The aim of this study is to explore physiotherapists perspectives on barriers, facilitators and potential solutions to improve the care of sequelae after cancer in physiotherapy clinics. METHODS AND ANALYSIS: This is a qualitative interview study using individual semistructured interviews with physiotherapists using a phenomenological approach to explore their lifeworld at work. We will recruit physiotherapists working in private clinics based on a variation in gender and years of working experience in private clinics. We will conduct between 10 and 16 interviews online via Microsoft Teams and thematically analyse data supported by NVivo software. Interviewing is scheduled to take place from April 2022. ETHICS AND DISSEMINATION: This is a non-intervention and qualitative study, and the local Ethics Committee in the North Denmark Region has stated that their approval is not needed. Informants will provide a written informed consent. Study information will be sent to the informant at least 3 days prior to the interview session and information will be summarised by the interviewer before the interview.Aside from publication, results will be disseminated by two teaching institutions, a regional health care provider and DEFACTUM (a public Danish research institution focusing on increasing social equality in health).

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study.

BACKGROUND: Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). AIM: To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. DESIGN AND SETTING: Qualitative study conducted in office-based general practice in Denmark. METHODS: Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. RESULTS: The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. CONCLUSION: This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.Key pointsLittle is known about the educational needs of general practitioners striving to achieve ultrasound competences.General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills.Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

Intradural Extramedullary Ewing Sarcoma in an Adolescent Female.

A 15-year-old female experiencing lumbar pain without prior trauma. Despite being prescribed strong analgesics by her family physician, the symptoms intensified, and she was referred to diagnostic imaging. Magnetic resonance imaging revealed an intradural extramedullary tumor in the spinal canal, located behind the L3 corpora. The patient underwent neurosurgery with a complete resection of the tumor. The histopathologic examination revealed Ewing sarcoma by identifying EWSR1 gene in the extracted tissue. The patient was subsequently referred for extensive specialized oncological treatment including photon irradiation therapy and chemotherapy. Thirty-six months on from the initial diagnosis, the patient is doing well and suffers no sequelae apart from hypogonadism.

Referral criteria recognition of screeners in the Danish screening programme for hip dysplasia.

INTRODUCTION: The aim of this study was to review risk factors used in the current Danish screening programme for developmental dysplasia of the hip (DDH) and the self-reported recognition of these risk factors among midwives, general practitioners (GP) and GPs in training. METHODS: A survey of regional DDH referral guidelines was conducted through online regional guideline databases. Furthermore, risk factors used as referral criteria for DDH were compared across regions. Using an online survey, we asked midwives, GPs and GPs in training to identify which of six risk factors for DDH were currently featured as referral criteria for specialised DDH examination in the referral guidelines of their employment region. Answers were compared with the DDH referral guidelines of the responders' employment region. RESULTS: We collected 178 survey responses and 11 local and regional DDH referral guidelines. Six risk factors were identified from referral guidelines (breech presentation, oligohydramnios, family history of DDH, clubfeet, twins and premature birth). Overall, correct answer percentages for currently used risk factors for DDH as specified in the corresponding regional guidelines were: 96% (breech presentation), 90% (family history of DDH), 66% (twins), 63% (premature birth), 34% (clubfeet) and 29% (oligohydramnios). CONCLUSIONS: This study found variation in the referral criteria among Danish regional DDH referral guidelines and an overall high level of recognition for two out of six referral criteria but a low level of recognition for the remaining four. FUNDING: The authors received no financial support for the research conducted in preparation of this article. TRIAL REGISTRATION: not relevant.

PAINSTORIES - Exploring the Temporal Developments in the Challenges, Barriers, and Self-Management Needs of Adolescents with Longstanding Knee Pain: A Qualitative, Retrospective Interview Study with Young Adults Experiencing Knee Pain Since Adolescence.

Patient education is essential to enable rehabilitation and self-management of longstanding knee pain in adolescents. Currently, a lack of insights into the socio-cognitive processes governing adolescents' self-management remains an obstacle for enhancing treatment efficacy. This study developed a conceptual model for integrating adolescents' challenges and barriers into future treatments. We conducted semi-structured retrospective interviews with 14 young adults (age 21-25 years) with knee pain since adolescence (9 years mean duration). Temporal developments in participants' knee pain were captured through a memorization exercise. Data was analyzed via the General Inductive Approach. Themes were organized into a matrix, extracting a conceptual model, which was tested with eight new participants. The analysis identified seven themes. Further interpretation, via the matrix, organized these within a four-stage trajectory of; gaining awareness, knowledgeability, contextual application and reconceptualization, each with different challenges and dilemmas, participants had to overcome to progress their self-management. Testing the conceptual model, confirmed stages and highlighted acceptance as key to overcoming barriers. The study described adolescents' integration of self-management as proximal and inquiry-based, with acceptance, driving increasingly complex management behaviors. We hypothesize future interventions may benefit from exploring supporting adolescents' inquiries into their knee pain at different stages of the trajectory. PERSPECTIVE: This study presents a conceptual model and vocabulary for optimizing patient education concepts, to target the challenges, barriers and needs of adolescents with knee pain at different stages of their mastery journey. We believe our findings may inform reflections among clinicians and researchers, and development of more effective education interventions.

Antibiotic treatment of community-acquired pneumonia: A questionnaire survey in Danish general practice.

BACKGROUND: Discrepancies exist in Danish guidelines for the treatment of bacterial community-acquired pneumonia (CAP). This study aimed to investigate how general practitioners (GPs) treat adults with CAP and explore associations between GP characteristics and treatment duration. METHODS: In autumn 2020, GPs in the North Denmark Region were asked to complete an electronic questionnaire on antibiotic prescribing for CAP. Information about GP gender, age, experience and type of practice was obtained. Multivariable logistic regression was used to analyse the association between GP characteristics and treatment duration. RESULTS: A total of 298 GPs were invited to participate of whom 108 completed the survey. Penicillin V was used as first line treatment for CAP by all participants. Treatment duration varied from 5 (54.6%) to 10 days (8.3%). A 5-day course of penicillin was less likely to be prescribed by male GPs (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13-0.94) and more likely to be prescribed by GPs with 5-9 years of experience in general practice (OR 5.03, 95% CI 1.09-23.21) compared to those with 10-19 years of experience. CONCLUSION: Variation in antibiotic treatment of CAP emphasises the importance of generating solid evidence about the optimal duration regarding both effectiveness and safety.

The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study.

BACKGROUND: Low back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients' levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers' loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain. OBJECTIVE: This study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients' satisfaction with web-based information for low back pain. METHODS: This is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain. RESULTS: The index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data. CONCLUSIONS: The index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information. TRIAL REGISTRATION: ClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004.

Does the use of telephone reminders to increase survey response rates affect outcome estimates? An ancillary analysis of a prospective cohort study of patients with low back pain.

BACKGROUND: Research is often undertaken using patient-reported outcomes from questionnaires. Achieving a high response rate demands expensive and time-consuming methods like telephone reminders. However, it is unknown whether telephone reminders change outcome estimates or only affect the response rate in research of populations with low back pain (LBP). The aim is to compare baseline characteristics and the change in outcome between patients responding before and after receiving a telephone reminder. METHODS: This is an ancillary analysis of data from a prospective cohort study employing questionnaires from 812 adults with LBP lasting more than 3 months. Patients not responding to the 52-week questionnaire were sent reminder emails after two and 3 weeks and delivered postal reminders after 4 weeks. Patients still not responding were contacted by telephone, with a maximum of two attempts. Patients were categorised into three groups: 1) patients responding before a telephone reminder was performed; 2) patients responding after the telephone reminder and 3) patients not responding at all. A positive outcome was defined as a 30% improvement on the Roland Morris Disability Questionnaire after 52 weeks. RESULTS: A total of 695 patients (85.2%) responded. Of these, 643 patients were classified in Group 1 and 52 patients were classified in Group 2. One hundred seventeen were classified in Group 3. No differences in outcome or baseline characteristics was found. In Group 1, 41.3% had a positive outcome, and in Group 2 48.9% had a positive outcome (P = 0.297). In group 3, non-respondents were younger, more often unemployed, more often smokers, more often reported co-morbidity, and reported higher depression scores than respondents. CONCLUSIONS: Using a telephone reminder had no consequence on outcome estimates nor were there any differences in baseline characteristics between patients who responded before or after the telephone reminder. TRIAL REGISTRATION: The initial trial was registered in Clinicaltrials.gov ( NCT03058315 ).

Patients' Expectations of Physiotherapeutic Treatment for Long-Term Side Effects After Cancer: A Qualitative Study.

OBJECTIVE: This study aims to explore the expectations of physiotherapeutic treatment of long-term side effects (LTSEs) after cancer among patients treated in physiotherapy clinics. METHODS: This a qualitative interview study based on a phenomenological approach. Adult patients with LTSEs after cancer were recruited through The Danish Cancer Society and a private physiotherapy clinic in Denmark. Individual semi-structured interviews were carried out using Microsoft Teams based on an interview guide piloted before the interviews. Interviews were audiotaped and transcribed verbatim. Sampling was conducted with a focus on variation in LTSE. The data were analyzed using Malterud's principles of systematic text condensation and coded in NVivo 12. RESULTS: 2 males and 8 females with an average age of 55.8 years were interviewed for between 40 and 60 minutes from October to November 2020. Four main themes emerged from the interviews1: The importance of the physiotherapist's approach,2 the benefits of meeting patients with similar symptoms,3 the importance of receiving knowledge, and4 patients seeking to maintain their current state more often than aiming to improve their condition. CONCLUSIONS: Patients consulting a physiotherapy clinic with LTSE after cancer prefer the physiotherapist to have knowledge about cancer and to be emphatic. Furthermore, patients prefer to meet like-minded people and expect support to maintain their current condition rather than improve their condition.

Self-reported knowledge of national guidelines for clinical screening for hip dysplasia: a web-based survey of midwives and GPs in Denmark.

BACKGROUND: The positive predictive value of clinical hip examinations performed by generalist health professionals in screening for developmental dysplasia of the hip (DDH) is low and declining. AIM: To assess the self-reported recognition of nationally recommended clinical hip examinations in the screening programme for DDH in Denmark among midwives, GPs, and GPs in training. DESIGN & SETTING: A cross-sectional, web-based open survey study among Danish midwives, GPs, and GPs in training. METHOD: Responders were asked to identify which of six written statements of clinical hip examinations were featured in the national Danish guidelines on DDH screening. Three statements were the official statements of the Ortolani, Galeazzi, and hip abduction examinations from the national guidelines, and three statements were false and constructed by the author group. Participants were asked to select up to six statements. RESULTS: A total of 178 (58 GPs, 97 midwives, and 23 GPs in training) responses were included. Overall, 89% of responders correctly identified the Ortolani manoeuvre and 92% correctly identified one of the constructed descriptions as being false. The remaining four descriptions had significantly lower correct answer percentages ranging from 41%-58%, with significantly lower correct answer percentages of midwives for three out of all six descriptions when compared with GPs. CONCLUSION: The recognition of two out of three recommended clinical hip examinations in the Danish screening programme for DDH is low overall among current screeners. Efforts should be made to heighten the knowledge level by further education of screeners.