Journal of evaluation in clinical practice
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Randomized Controlled Trial
Does physiotherapy management of low back pain change as a result of an evidence-based educational programme?
The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed. ⋯ Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial.
To assess the effectiveness of pre- and post-operative physiotherapy at home for unilateral total knee replacement (TKR). ⋯ Although home physiotherapy was as effective and as acceptable to patients as hospital outpatient physiotherapy for unilateral TKR, it was more expensive. Additional pre-operative home physiotherapy did not improve patient-perceived health outcomes.
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Randomized Controlled Trial Clinical Trial
Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial.
Important barriers to the wider implementation of shared decision making (SDM) and risk communication in practice remain. The attitudes of professionals undergoing training in these approaches may inform how to overcome these barriers, but there are few such data yet available. ⋯ Professionals appear receptive to patient involvement, and willing to acquire the relevant skills. SDM and risk communication training did not appear to contribute differentially to this. Practical barriers such as time constraints should probably be addressed with greater priority than the precise content of training or continuing professional development initiatives if 'involvement' is to become a commoner experience for patients in primary care.
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Randomized Controlled Trial Clinical Trial
Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence.
Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. ⋯ While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers.
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Randomized Controlled Trial Clinical Trial
Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee.
Osteoarthritis (OA) is a common and often disabling condition that predominately affects older adults. It is the commonest cause of locomotor disability and forms a major element of the workload in primary care. Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive 'unmet' information needs. ⋯ The combined quantitative and qualitative data provide insight into the patients' perspective on the causes and impact of knee OA, individual goals desired from treatment and the quality of care. There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence. Even within a tightly defined study sample participating in the intervention, a diversity of experience and goals were revealed, which highlights the importance of taking account of contextual factors and individual differences when evaluating complex interventions.