Minimal, negligible and negligent interventions

Hawe, Penelope

doi:10.1016/j.socscimed.2015.05.025

Cited by 54 publications

(54 citation statements)

References 30 publications

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“…112 However, physiotherapy interventions do not always benefit from consistency as they involve the revision of treatment plans to account for changing and uncertain experiences. 113 Evidence suggests that the fidelity to the treatment theory is more important [114][115][116] than consistent delivery of the intervention. We therefore evaluated treatment optimisation to the patients' needs and capabilities.…”

Section: Optimisation Of Prescriptionmentioning

confidence: 99%

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

Cox

O’Connor

Biggs

et al. 2018

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge.ObjectiveTo assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care.DesignParallel-group, pilot 2 × 2 factorial randomised trial with nested qualitative research and an economic analysis.SettingTwo acute hospital NHS trusts. Recruitment was carried out from September 2015 to April 2016 and follow-up was completed in July 2016.ParticipantsEligible patients were those aged ≥ 35 years who were admitted with AECOPD, who were non-acidotic and who maintained their blood oxygen saturation level (SpO2) within a prescribed range. Exclusions included the presence of comorbidities that affected the ability to undertake the interventions.Interventions(1) Hospital EPR: muscle training delivered at the patient’s hospital bed using a cycle ergometer and (2) home EPR: a pulmonary rehabilitation programme delivered in the patient’s home. Both interventions were delivered by trained physiotherapists. Participants were allocated on a 1 : 1 : 1 : 1 ratio to (1) hospital EPR (n = 14), (2) home EPR (n = 15), (3) hospital EPR and home EPR (n = 14) and (4) control (n = 15). Outcome assessors were blind to treatment allocation; it was not possible to blind patients.Main outcome measuresFeasibility of recruiting 76 participants in 7 months at two centres; intervention delivery; views on intervention/research acceptability; clinical outcomes including the 6-minute walk distance (6WMD); and costs. Semistructured interviews with participants (n = 27) and research health professionals (n = 11), optimisation assessments and an economic analysis were also undertaken.ResultsOver 7 months 449 patients were screened, of whom most were not eligible for the trial or felt too ill/declined entry. In total, 58 participants (76%) of the target 76 participants were recruited to the trial. The primary clinical outcome (6MWD) was difficult to collect (hospital EPR,n = 5; home EPR,n = 6; hospital EPR and home EPR,n = 5; control,n = 5). Hospital EPR was difficult to deliver over 5 days because of patient discharge/staff availability, with 34.1% of the scheduled sessions delivered compared with 78.3% of the home EPR sessions. Serious adverse events were experienced by 26 participants (45%), none of which was related to the interventions. Interviewed participants generally found both interventions to be acceptable. Home EPR had a higher rate of acceptability, mainly because patients felt too unwell when in hospital to undergo hospital EPR. Physiotherapists generally found the interventions to be acceptable and valued them but found delivery difficult because of staffing issues. The health economic analysis results suggest that there would be value in conducting a larger trial to assess the cost-effectiveness of the hospital EPR and hospital EPR plus home EPR trial arms and collect more information to inform the hospital cost and quality-adjusted life-year parameters, which were shown to be key drivers of the model.ConclusionsA full-scale randomised controlled trial using this protocol would not be feasible. Recruitment and delivery of the hospital EPR intervention was difficult. The data obtained can be used to design a full-scale trial of home EPR. Because of the small sample and large confidence intervals, this study should not be used to inform clinical practice.Trial registrationCurrent Controlled Trials ISRCTN18634494.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 11. See the NIHR Journals Library website for further project information.

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Section: Optimisation Of Prescriptionmentioning

confidence: 99%

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

Cox

O’Connor

Biggs

et al. 2018

Health Technol Assess

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“…Appropriate responses will require new systematic approaches that address persisting inequalities and are built upon detailed knowledge of local populations. Interventions developed in one population or setting may not be relevant in other settings, and it may be difficult to embed interventions within a service if they do not fit the needs of the population group or take local contexts into account [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia)

Beauchamp

Batterham

Dodson³

et al. 2017

BMC Public Health

127

183

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BackgroundThe need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles.MethodsNine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied.ResultsSites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers’ health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites.ConclusionsThe Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4147-5) contains supplementary material, which is available to authorized users.

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“…Thus, overly simplified conceptions of Knowledge Translation that focus solely on dissemination run the risk of missing, misunderstanding, or misrepresenting the contextual and structural changes necessary to make interventions work in “real‐world” practice—as exemplified by the low uptake of the 11+ and Nordic Hamstring exercise programs previously discussed. Further, not paying attention to the exchange of ethically sound knowledge and the complex processes that underpin Knowledge Translation as a fully formed concept runs the risk of interventions as according to Hawe that are minimal, negligible or even negligent.…”

Section: Knowledge Translation In Sem: An Over‐reliance On Synthesis mentioning

confidence: 99%

The fallacy of amelioration: Thinking through Knowledge Translation in sport and exercise medicine

2018

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Knowledge Translation, as a component of implementation science, has seen extensive popularization in Sport and Exercise Medicine (SEM) over recent years. However, in seeking better and more influential outcomes, much of SEM appears to be following Knowledge Translation fashion and fad, over ensuring function and form. This has meant that key concepts in Knowledge Translation have been conflated, the work oversimplified, and potential outcomes overhyped. In this manuscript, Knowledge Translation is, first, defined as a process. Next, we show how oversimplified versions of Knowledge Translation rely on the “fallacy of amelioration,” with problematic consequences and unintended outcomes. Finally, we move to rethinking Knowledge Translation in SEM by showing how the field can move forward through embracing Knowledge Translation as a complex process to maximize the influence and impact of its work.

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Minimal, negligible and negligent interventions

Cited by 54 publications

References 30 publications

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia)

The fallacy of amelioration: Thinking through Knowledge Translation in sport and exercise medicine

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