Evaluating self-help and education descriptors as a physiotherapy rehabilitation intervention in knee osteoarthritis and its impact on clinical practice.

Heyns, Joleen (2018-03)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Background: The regular use of clinical practice guidelines (CPGs) has been promoted as a way of improving care, standardising clinical decisions and treatment. However, the intervention‘s reported in the randomised controlled clinical trials (RCTs) used in CPGs is typically not fully described and may lack description making it difficult to replicate in clinical practice. There was thus need to investigate ways in which the CPG-recommended interventions could be delineated into a more clinician-friendly format, so that it could be easier to replicate in practice and therefore ensure evidence-based practice. This study will form part of a larger project. Objective: To evaluate the descriptions of physiotherapy rehabilitation interventions of self-help and education for people with specifically knee osteoarthritis (OA) in CPGs and more recent RCTs, in terms of the detail provided, and how readily they could be replicated in clinical practice. It will act as a process to ascertain logistics of methods required to extract data for intervention descriptions and form part of a larger project investigating methods in which CPGs can be made more clinician friendly. Methodology: The most recent and the highest quality CPGs for community based rehabilitation for adults living with knee OA was accessed through data clearing houses. The CPGs were critically appraised using the iCACHE tool to ensure that the guideline is of the highest quality. The RCTs that were used to compile the systematic reviews on self-help and education in the CPGs for knee OA, was retrieved and evaluated. An updated search was conducted in Pubmed and PEDro computerised databases for the RCTs published after the CPGs release date. The quality of the RCTs was critically appraised by making use of the PEDro scale. A standard evaluation approach was then taken, using a recently-published checklist, the Template for Intervention Description and Replication Checklist (TIDieR) tool, to assess elements of rehabilitation interventions used. Results were summarised using pie charts, tables or in narrative form. Results: Two CPGs were retrieved and a total of nine RCTs trials included in this review. The results of the TIDieR revealed that certain aspects were adequately described, such as ‘name of the intervention’ (77.78%), ‘intervention rationale for essential elements’ (100%), ‘description of the intervention procedures’ (88.89%), ‘mode of delivery of intervention’ (100%) and ‘details about the number; duration, intensity, and dose of intervention sessions’ (88.89%). Other aspects however scored less adequately such as ‘intervention materials and details about how to access them’ (22.22%), ‘details of intervention providers’ (44.44%), ‘location of intervention delivery and key infrastructure’ (0%), ‘details of any intervention tailoring’ (11.11%), ‘any intervention modifications throughout the study’ (0%), and ‘details of intervention fidelity assessment, monitoring, and level achieved’ (11.11%). Conclusion: Despite the availability of evidence for the use of the self-help and education for knee OA in CPGs, there remains a lack of descriptions of the interventions within RCTs. Since the reproducibility of an intervention in a clinical setting forms a crucial part of adding value to research, the lack of description and difficulty in reproducing the interventions in clinical practice, is concerning. CPGs therefore fail to bridge the gap between best practice, patient choices and local context and strategies to address this gap need to be developed.

AFRIKAANSE OPSOMMING : Agtergrond: Die gereelde gebruik van kliniese praktyk riglyne word aanbeveel as ‘n manier om versorging, kliniese besluite te standaardiseerd en behandeling te verbeter. Maar die behandelings metodes wat gerapporteer word in willekeurige gekontroleerde kliniese proefnemings wat gebruik word in kliniese praktyk riglyne, word tipies onvolledig beskryf wat dit uitdagend maak om weer te herhaal in kliniese praktyk. Daar is dus ‘n behoefte om maniere te ondersoek waardeur die kliniese praktyk riglyne aanbeveling en behandelinge kan afbreek na ‘n meer klinikus vriendelike formaat, sodat dit makliker sal wees om dit te herhaal in die praktyk en verseker dus so ‘n bewys gebaseerde praktyk. Die studie vorm deel van ‘n groter projek en skakel as deel van dit in. Doel: Om die beskrywing van fisioterapie rehabilitasie behandelings van self-help en onderrig van pasiënte, met spesifiek knie osteartritis, in kliniese praktyk riglyne en meer onlangse willekeurige gekontroleerde kliniese proefnemings (in terme van behandelings besonderhede wat beskikbaar is) te evalueer asook hoe gemaklik dit herhaal word in kliniese praktyk. Dit sal as ‘n voorloper dien om die metode op te stel vir die groter projek wat ondersoek instel om kliniese praktyk riglyne meer klinikus vriendelik te maak. Metodiek: Data stelsels is gebruik om die nuutste en beste kwaliteit kliniese praktyk riglyne vir die gemeenskap gebaseerde rehabilitasie van volwassenes met knie osteoartritis te verkry. Die kliniese praktyk riglyne is krities getakseer deur gebruik te maak van die iCACH instrument om te verseker dat die riglyne van die hoogste gehalte is. Die willekeurige gekontroleerde kliniese proefnemings wat gebruik is om die sistemiese oorsig oor self-help en onderrig in die kliniese praktyk riglyne vir knie osteoartritis, saam te stel, is nagevors en ge-evalueer. ‘n Opgedateerde ondersoek is gedoen in Pubmed en PEDro se gerekenariseerde databasisse vir die willekeurige gekontroleerde kliniese proefnemings wat na kliniese praktyk riglyne se vrystellingsdatum gepubliseer is. Die PEDro skaal is gebruik om die kwaliteit van die willekeurige gekontroleerde kliniese proefnemings krities te takseer. ‘n Standaard evaluerings aanslag is toe gevolg deur gebruik te maak van die nuutste gepubliseerde kontrolelys, Die Templaat vir Intervensie beskrywing en replikasie kontrolelys (TIDieR) om elemente van die rehabilitasie intervensie te assesseer. Sirkel grafieke, tabelle of beskrywings is gebruik om die resultate op te som. Resultate: Twee kliniese praktyk riglyne is opgespoor en nege willekeurige gekontroleerde kliniese proefnemings is ingesluit in die oorsig. Die resultate van die TIDieR toon dat sekere aspekte voldoende beskryf was soos byvoorbeeld naam van die intervensie (77,78%), intervensie rationaal vir noodsaaklike elemente (100%), beskrywing van die intervensie prosedure (88,89%), wyse van die intervensie (100%) en detail van die getal, duur, intensiteit en dosis van die intervensiesessies (88,89%). Ander aspekte was minder doeltreffend soos byvoorbeeld intervensie apparaat en inligting, hoe om dit te bekom (22,22%), inligting oor intervensie verskaffers (44,44%), plek waar intervensie plaasvind, die infrastruktuur (0%), inligting oor enige intervensie spesialisering (11,11%) enige intervensie verbetering in die studie (0%), en inligting oor die intervensie assessering, monetering en die vlak van sukses behaal. Samevatting: Ten spyte van die beskikbaarheid van bewyse vir die gebruik van self-help en onderrig van knie osteoartritis in kliniese praktyk riglyne , bestaan daar ‘n leemte vir die voorskrifte van die behandelings metodes in willekeurige gekontroleerde kliniese proefnemings. Aangesien die reproduseerbaarheid van ‘n behandelings metode in ‘n kliniese omgewing ‘n deurslaggewende rol in die navorsing speel, is die gebrek aan beskrywing en die probleem van reproduksie van die behandelings metodes in die kliniese praktyk, ‘n bekommernis. Daarom faal kliniese praktyk riglyne om die gaping te oorbrug wat ontstaan tussen die beste behandeling, die pasient se keuse, plaaslike konteks en om strategieë aan te spreek. Hierdie gaping moet dus oorbrug en ontwikkel word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103713
This item appears in the following collections: