Cargando…

Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study

OBJECTIVES: To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. DESIGN: Mixed-methods combining evidence synthesis, expert review and focus groups. SETTING: Second...

Descripción completa

Detalles Bibliográficos
Autores principales: Rushton, A, White, L, Heap, A, Calvert, M, Heneghan, N, Goodwin, P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769411/
https://www.ncbi.nlm.nih.gov/pubmed/26916690
http://dx.doi.org/10.1136/bmjopen-2015-009409
_version_ 1782418101563817984
author Rushton, A
White, L
Heap, A
Calvert, M
Heneghan, N
Goodwin, P
author_facet Rushton, A
White, L
Heap, A
Calvert, M
Heneghan, N
Goodwin, P
author_sort Rushton, A
collection PubMed
description OBJECTIVES: To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. DESIGN: Mixed-methods combining evidence synthesis, expert review and focus groups. SETTING: Secondary care involving 5 UK specialist spinal centres. PARTICIPANTS: A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. METHODS: A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. RESULTS: The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. CONCLUSIONS: A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness.
format Online
Article
Text
id pubmed-4769411
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-47694112016-03-01 Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study Rushton, A White, L Heap, A Calvert, M Heneghan, N Goodwin, P BMJ Open Rehabilitation Medicine OBJECTIVES: To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. DESIGN: Mixed-methods combining evidence synthesis, expert review and focus groups. SETTING: Secondary care involving 5 UK specialist spinal centres. PARTICIPANTS: A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. METHODS: A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. RESULTS: The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. CONCLUSIONS: A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness. BMJ Publishing Group 2016-02-25 /pmc/articles/PMC4769411/ /pubmed/26916690 http://dx.doi.org/10.1136/bmjopen-2015-009409 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Rehabilitation Medicine
Rushton, A
White, L
Heap, A
Calvert, M
Heneghan, N
Goodwin, P
Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title_full Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title_fullStr Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title_full_unstemmed Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title_short Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
title_sort development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study
topic Rehabilitation Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769411/
https://www.ncbi.nlm.nih.gov/pubmed/26916690
http://dx.doi.org/10.1136/bmjopen-2015-009409
work_keys_str_mv AT rushtona developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy
AT whitel developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy
AT heapa developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy
AT calvertm developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy
AT heneghann developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy
AT goodwinp developmentofanoptimised11physiotherapyinterventionpostfirsttimelumbardiscectomyamixedmethodsstudy