Showing papers by "Signe Flottorp published in 2010"

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

Abstract: Strategies to implement change in health professional performance have variable impact. A potential explanation is that the barriers to implementation are different in different settings and at different times. Change may be more likely if the strategies were specifically chosen to address the identified barriers. Objectives To assess the effectiveness of strategies tailored to address specific, identified barriers to change in professional performance. The authors included 15 studies. For Comparison 1 (an intervention tailored to address identified barriers to change compared to no intervention or an intervention(s) not tailored to the barriers), there was no consistency in the results and the effect sizes varied both across and within studies. A meta-regression of a subset of the included studies, using a classical approach estimated a combined OR of 2.18 (95% CI: 1.09, 4.34), p = 0.026 in favour of tailored interventions. However, when a Bayesian approach was taken, meta-regression gave a combined OR of 2.27 (95% Credible Interval: 0.92, 4.75), which was not statistically significant.

A pragmatic randomised trial of stretching before and after physical activity to prevent injury and soreness

Abstract: Objective To determine the effects of stretching before and after physical activity on risks of injury and soreness in a community population. Design Internet-based pragmatic randomised trial conducted between January 2008 and January 2009. Setting International. Participants A total of 2377 adults who regularly participated in physical activity. Interventions Participants in the stretch group were asked to perform 30 s static stretches of seven lower limb and trunk muscle groups before and after physical activity for 12 weeks. Participants in the control group were asked not to stretch. Main outcome measurements Participants provided weekly on-line reports of outcomes over 12 weeks. Primary outcomes were any injury to the lower limb or back, and bothersome soreness of the legs, buttocks or back. Injury to muscles, ligaments and tendons was a secondary outcome. Results Stretching did not produce clinically important or statistically significant reductions in all-injury risk (HR=0.97, 95% CI 0.84 to 1.13), but did reduce the risk of experiencing bothersome soreness (mean risk of bothersome soreness in a week was 24.6% in the stretch group and 32.3% in the control group; OR=0.69, 95% CI 0.59 to 0.82). Stretching reduced the risk of injuries to muscles, ligaments and tendons (incidence rate of 0.66 injuries per person-year in the stretch group and 0.88 injuries per person-year in the control group; HR=0.75, 95% CI 0.59 to 0.96). Conclusion Stretching before and after physical activity does not appreciably reduce all-injury risk but probably reduces the risk of some injuries, and does reduce the risk of bothersome soreness. Trial registration anzctr.org.au 12608000044325.

The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.

Abstract: Background We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000); negative framing over 10 years (the number that will have CVD) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS) increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on the second decision, both within groups and overall. Conclusions For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD (70 per 1000 over 10 years), both positive and negative framing resulted in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations. Trial Registration International Standard Randomised Controlled Trial Number Register ISRCTN 33771631

Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis.

Abstract: Background and Purpose. Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Methods. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Results. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08–3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19–0.68 and OR = 8.92, 95% CI = 4.37–18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12–11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Conclusions. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice. Copyright © 2009 John Wiley & Sons, Ltd.

Effekter av tverrfaglige ambulante tjenester for pasienter med kroniske sykdommer

Abstract: av til-leggstakster for ambulant virksomhet rettet mot enkelte pasientgrupper. Helse Sør RHF bestilte en kunnskapsoversikt fra Kunnskapssenteret for å få belyst om ambulante team medfører forbedret helse for pasientene og redusert bruk av spesialisthelsetjenesten. Metode: Vi har identifi sert og oppsummert 20 systematiske oversikter om effekter av ulike former for ambulante tjenester for pasienter med kroniske sykdommer. Ambulante tjenester er her defi nert som tverrfaglig behandling på spesialisert nivå gitt av et team i eller nær hjemmet, uten at pasienten innlegges i sykehus. Tjenestene kan være gitt fra sykehuset, fra kommunen eller i samarbeid. Resultat: • Godt planlagt og koordinert tidlig utskriving av slagpasienter fra sykehus med oppfølging i hjemmet av et tverrfaglig team fører til reduksjon i et kombinert utfall av død eller behov for opphold i institusjon etter 6 måneder, det gir kortere liggetid i sykehus, og det øker muligheten for at pasientene klarer seg i eget hjem og gjenopptar daglige aktiviteter. Det utgjør trolig ingen forskjell i dødelighet. Tiltaket fører muliEffekter av tverrfaglige ambulante tjenester for pasienter med kroniske sykdommer

Utvikling av nasjonalt kvalitetssystem for primærhelsetjenesten – fastlegevirksomhet og øvrige allmennlegetjenester

Abstract: av Helseog omsorgsdepartementet a gjennomfore et prosjekt som skal munne ut i vurderinger av elementer som kan innga i et nasjonalt kvalitetssystem for de kommunale helseog omsorgstjenestene. Denne delrapporten gjor rede for status, utfordringer og muligheter med hensyn til a utvikle og implementere et nasjonalt kvalitetssystem for fastlegetjenesten og ovrige allmennlegetjenester. Hovedbudskap: • En forutsetning for a etablere et godt nasjonalt kvalitetssystem for primaerhelsetjenesten, er a fa pa plass et velfungerende IT-system. • Krav til spesialistutdanning og til vedlikehold av spesialitet for a arbeide selvstendig som allmennlege vil sikre en formell kompetanse, og bidra til at legene forpliktes til kontinuerlig faglig videreutvikling. Kompetansebasert etterutdanning, basert pa individuelle laereplaner, kan vurderes for a sikre reell faglig utvikling. • Det kan vurderes a legge inn spesifi kke krav om deltakelser i kvalitetsforbedringsarbeid, samt ferdigheter i forhold til kunnskapsbasert praksis, bade for a oppna spesialiteten, men saerlig for den femarige resertifi seringen (fortsetter pa baksiden) Utvikling av nasjonalt kvalitetssystem for primaerhelsetjenesten – fastlegevirksomhet og ovrige allmennlegetjenester