학술논문
Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study.
Document Type
Academic Journal
Author
Marcellis LHM; Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands.; Chronisch ZorgNet, Eindhoven, The Netherlands.; Sinnige A; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.; Rutgers KM; Physique Preventiecentrum B.V, Arnhem, The Netherlands.; Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands.; Kittelson A; School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.; Spruijt S; Chronisch ZorgNet, Eindhoven, The Netherlands.; Teijink JAW; Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.; CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, Netherlands.; van der Wees PJ; Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands.; Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.; Hoogeboom TJ; Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands Thomas.Hoogeboom@radboudumc.nl.
Source
Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101710381 Publication Model: Electronic Cited Medium: Internet ISSN: 2399-6641 (Electronic) Linking ISSN: 23996641 NLM ISO Abbreviation: BMJ Open Qual Subsets: MEDLINE
Subject
Language
English
Abstract
Background: To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes.
Objectives: To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication.
Methods: An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument.
Results: Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01).
Conclusions: Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances.
Trial Registration Number: NL8838.
Competing Interests: Competing interests: The authors reported no conflicts of interest. JAWT, LHMM and SS are affiliated with Chronic CareNet. AS, AK and TJH developed the POFs.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Objectives: To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication.
Methods: An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument.
Results: Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01).
Conclusions: Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances.
Trial Registration Number: NL8838.
Competing Interests: Competing interests: The authors reported no conflicts of interest. JAWT, LHMM and SS are affiliated with Chronic CareNet. AS, AK and TJH developed the POFs.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)