Enrolling and keeping participants in multiple sclerosis self-management interventions: a systematic review and meta-analysis.

OBJECTIVES: The objectives were to provide an estimate of expected enrolment and attrition rates based on published studies of existing self-management interventions for people with multiple sclerosis, and to identify contributing factors and impact on outcomes. REVIEW METHODS: A systematic literature search was conducted using Ovid MEDLINE, PsychINFO, EMBASE, AMED, CINAHL, OT Seeker, PubMed, and the Cochrane Database of Systematic Reviews databases. Controlled trials with or without randomization using either a between-group or within-person design were included if they met specified criteria. A random-effect meta-regression analysis was conducted to estimate the overall enrolment and attrition proportions, effect of person- and study-related factors, and impact on outcomes. RESULTS: A total of 48 studies, comprising 4446 persons were identified. The estimated enrolment rate was 50.3% (95% confidence interval (CI): 49.6 to 51.1) and the estimated attrition rates in the intervention and control groups were 16.8% (95% CI: 16.2 to 17.3) and 14.4% (95% CI: 13.8 to 14.9), respectively. The main reported reason for refusing to participate was lack of interest (70.6%), while the reported reasons for dropping out were mainly owing to medical issues (26.1%) and disliking the intervention (17.9%). Trial, programme, and patient-related variables were found to influence the enrolment and/or attrition rates. Studies that had a 10% higher attrition rate had an effect size that was larger by 0.19 (95% CI: 0.17 to 0.24). CONCLUSION: Greater understanding of the factors associated with enrolment and attrition rates would help in planning and developing a more appealing self-management intervention that patients can easily accept and incorporate into their everyday lives.

How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years?

Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved.Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.

Effect of ergonomics awareness in controlling work-related musculoskeletal-pain among dental students: A cross-sectional study.

BACKGROUND: Dentistry is a profession that demands a high level of physical work and excessive repetitive movements in strained positions, both of which are risk factors for developing musculoskeletal pain (MS-P). OBJECTIVE: This study aims to assess the awareness of ergonomics and physical activities in controlling MS-P among dental students. METHODS: A cross-sectional study conducted at a university dental hospital in Saudi Arabia, through a validated self-administered questionnaire, distributed to undergraduates and postgraduate's dental students. RESULTS: Out of 402 students responded to the questionnaire, 337(83.8%) reported suffering from MS-P with 67.7% of participants did not take any measures to alleviate their symptoms and the majority reported limited physical activity. Females reported significantly higher MS-P than males. Lower back (56.5%), neck (56.2%) and shoulder (50%) were the most frequently reported MS-P. Unexpectedly, undergraduate reporting significantly more pain than interns and postgraduate students (P = 0.009). The dental students' awareness of ergonomics and MSDs were insufficient. CONCLUSION: Physical activity, student's awareness of MSD and ergonomics were the major factors for controlling MS-Ps. Therefore, this study highlights the importance of enhancing students' knowledge of the importance of controlling work-related MS-P, especially during their university educational hours.

The prevalence of low back pain and risk factors in academic teaching staff at King Abdulaziz University Jeddah:\\ A cross-sectional study.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal disorder symptoms affecting adults' health in the workplace including academic settings. OBJECTIVE: To estimate the prevalence of LBP among academic teaching staff at King Abdulaziz University, as well as to identify its socio-demographic and work-related risk factors. METHODS: A cross-sectional study design was used to estimate the prevalence of LBP and the risk factors in 123 academic teaching staff members at King Abdulaziz University. Data on LBP history and disability using Oswestry Disability Index (ODI), work-related and socio-demographic characteristics of study participants were collected using a semi-structured questionnaire. The prevalence of low back pain data was analyzed using frequency and percentage descriptive statistics, and Chi-square was used to identify group differences. RESULTS: A total of 123 academic teaching staff with a mean age of 37.5 years old of whom 79 (64.2%) were females and 44 (35.8%) were males completed a self-administrative questionnaire. Using a self-rating scale, approximately a quarter of academic teaching staff had moderate disability 25.2%; 4.9% had a severe disability; only one subject 0.8% was crippled. There has been a significant relationship between the number of years of experience and the extent of low back disability (P < 0.05). The Chi-square test revealed 56.3% of takes part with 11-15 years of experience have moderate disability relative to those with 0-5 years of experience (11.1%). There was a trend towards significance among academic teaching staff for the effect of the faculty stream on low back disability (P = 0.077, Chi-square test revealed teaching staff in the medical stream had the highest percentage of participates with minimal disability (78.7%) whereas in the scientific stream had the lowest percentage of minimal disability (52%). CONCLUSION: The findings of this study have shown that there is a major problem of low back pain among academic staff at King Abdulaziz University and that the situation in other higher education institutions in Saudi Arabia is changing.

Practice style traits: do they help explain practice behaviours of stroke rehabilitation professionals?

RATIONALE: The gap in knowledge translation from research to clinical practice is under scrutiny in stroke rehabilitation. One possible reason for this gap may be a poor understanding of clinicians' practice style traits and how they influence practice behaviours. OBJECTIVES: To identify the prevalence of practice style traits in physical therapists and occupational therapists working in stroke rehabilitation and, to explore associations between these traits and practice behaviours, where practice behaviours are defined as the clinicians' reasons for choosing assessments and interventions used in practice. The influence of more traditional personal and organizational factors on practice behaviours was also explored. DESIGN: Cross-sectional survey of a representative random sample of 243 clinicians (117 occupational therapists and 126 physical therapists) working across the continuum of stroke care in Ontario, Canada. METHODS: A telephone-administered validated clinical practice survey elicited information in 4 areas: practice style traits using the validated Practice Style Questionnaire, therapists' reasons for choosing assessments and interventions (practice behaviours), personal factors and organizational factors. RESULTS: For both disciplines, the most prevalent trait was pragmatist and the least prevalent was seeker. Seekers were the most likely to use evidence-based reasons for choosing assessments, but this finding did not reach significance (chi2 = 5.430, df = 3; p = 0.14). The most typical reason for choosing an intervention was that the clinician had learned it during professional training, an interesting finding given that approximately half of clinicians had more than 10 years of experience. Of the 21 potential explanatory variables examined, few explained clinicians' reasons for choosing assessments or interventions. CONCLUSION: While understanding practice traits is not going to be the single solution to closing the knowledge translation gap, it may help to guide best practice implementation strategies.