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      Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention

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          Abstract

          Background

          The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS.

          Methods

          In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery.

          Results

          Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation . The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders.

          Conclusions

          Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes .

          Electronic supplementary material

          The online version of this article (10.1186/s12998-019-0267-6) contains supplementary material, which is available to authorized users.

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          Most cited references 55

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          Development and testing of a short form of the patient activation measure.

          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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            How to Calculate Sample Size for Different Study Designs in Medical Research?

            Calculation of exact sample size is an important part of research design. It is very important to understand that different study design need different method of sample size calculation and one formula cannot be used in all designs. In this short review we tried to educate researcher regarding various method of sample size calculation available for different study designs. In this review sample size calculation for most frequently used study designs are mentioned. For genetic and microbiological studies readers are requested to read other sources.
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              Chronic disease self-management program: 2-year health status and health care utilization outcomes.

              To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. Longitudinal design as follow-up to a randomized trial. Community. Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.
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                Author and article information

                Contributors
                514-885-5105 , owis.eilayyan@mail.mcgill.ca
                aliki.thomas@mcgill.ca
                marie-christine.halle@mail.mcgill.ca
                sara.ahmed@mcgill.ca
                atibbles@cmcc.ca
                cjacobs@cmcc.ca
                smior@cmcc.ca
                connie.davis@centrecmi.ca
                evans972@umn.edu
                mjs5@pitt.edu
                heather.owens@mcgill.ca
                fadi.alzoubi@mail.mcgill.ca
                jan.barnsley@utoronto.ca
                long_c@palmer.edu
                andre.bussieres@mcgill.ca
                Journal
                Chiropr Man Therap
                Chiropr Man Therap
                Chiropractic & Manual Therapies
                BioMed Central (London )
                2045-709X
                16 October 2019
                16 October 2019
                2019
                : 27
                Affiliations
                [1 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, School of Physical and Occupational Therapy, , McGill University, ; 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada
                [2 ]ISNI 0000 0000 9810 9995, GRID grid.420709.8, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), ; 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
                [3 ]ISNI 0000 0004 0473 5995, GRID grid.418591.0, Canadian Memorial Chiropractic College, ; 6100 Leslie St, North York, ON M2H 3J1 Canada
                [4 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, University of British Columbia, ; 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
                [5 ]Centre for Collaboration, Motivation and Innovation, PO Box 1343, Vernon, BC V1T 6N6 Canada
                [6 ]ISNI 0000000419368657, GRID grid.17635.36, University of Minnesota, ; Minneapolis, MN 55455 USA
                [7 ]ISNI 0000 0004 1936 9000, GRID grid.21925.3d, University of Pittsburgh, ; 4200 Fifth Ave, Pittsburgh, PA 15260 USA
                [8 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, University of Toronto, ; 27 King’s College Cir, Toronto, ON M5S Canada
                [9 ]ISNI 0000 0004 1937 0749, GRID grid.419969.a, Palmer College, ; Davenport, 1000 Brady St, Davenport, IA 52803 USA
                Article
                267
                10.1186/s12998-019-0267-6
                6794734
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Canadian Chiropractic Guideline Initiative
                Award ID: 63630
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

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