Conectar
Low back pain (LBP) is the leading contributor to disability globally. It has a substantial impact on the lives of those who experience it, and places considerable economic burden on healthcare systems. Despite these impacts, and the consistency of guideline recommendations, many individuals do not receive recommended LBP management. Structural barriers to accessing timely, evidence-based care, as well as public uncertainty about where to seek appropriate management, can influence the care individuals receive. Telephone and digitally based helplines assist to overcome many traditional barriers to accessing care and offer a scalable platform to improve the delivery of guideline recommended management for LBP. However, uptake of such services can be limited without targeted promotion and patient-centred design. This project aims to codesign, implement and evaluate an upgraded component of an existing Australian helpline service, tailored for people with back pain and supported by a media awareness campaign. This protocol outlines the codesign process, implementation and planned evaluation of the helpline.
This protocol uses three complementary frameworks—an iterative codesign process, the Practical Robust Implementation Sustainability Model, and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework—to guide the codesign and development, implementation and evaluation of an upgraded helpline for people with LBP. The codesign process involves key stakeholders, including consumers and clinicians, to inform the development and implementation of both the upgraded helpline service and the media campaign to raise awareness and uptake of the helpline. Data sources will include a pre–post cohort of helpline service users, routinely collected service data (eg, monthly call rate) and health system data to evaluate the broader population level impact (eg, rates of emergency department presentations for LBP in the Australian region targeted by the media campaign). Implementation evaluation will include Reach, Effectiveness, Adoption, Implementation and Maintenance as well as internal and external environmental factors that influence the success of these outcome measures.
The project was approved by the University of Sydney’s Human Research Ethics Committee (HE001081). This project involves collaboration with consumers, clinicians and other stakeholders to interpret, translate and disseminate research findings to relevant audiences.
by Jack Le Vance, Alexandra Emms, Victoria Hodgetts Morton, R. Katie Morris, Leo Gurney
High-risk pregnancies undergo regular antenatal monitoring, including cardiotocography (CTG) and ultrasound. Recently there has been an emergence of sophisticated remote telehealth interventions, potentially enabling care to be shifted into the home setting. Our aim was to evaluate the feasibility and acceptability of home CTG and home ultrasound monitoring for high-risk pregnancies. This was a single center study. Women aged ≥18 years, English speaking, singleton pregnancy, ≥ 32 weeks gestation and had at least one of four high-risk obstetric conditions were eligible. Participants were randomized to one of three groups: (1) home ultrasound; (2) home CTG; and (3) both, whilst continuing their routine antenatal care. The primary outcome was completion of 20 minutes of interpretable fetal heart recording and/or completion of an interpretable fetal ultrasound for each monitoring episode. Ultrasound interpretability was assessed for three validated criteria: fetal heartbeat, fetal movements and liquor volume assessment. Secondary outcomes included monitoring adherence, anxiety management, acceptability and safety. Fifteen participants, within three groups, completed 24 remote ultrasounds and 59 remote CTGs. Overall, the fetal heartbeat, movements and an assessment of the liquor volume were identified in 92%, 83% and 100% of all ultrasound scans respectively. 79% of all scans had all three criteria unanimously assessed. Three-quarters of all CTGs contained at least 20 minutes of continuous interpretable computerized fetal heartrate recording. Neither ethnicity, parity, BMI nor fetal presentation were significant factors for achievement of the primary outcome for both devices. There was non-significant reduction in anxiety scores before and after device usage (p = 0.19). Participants’ monitoring adherence and acceptability ratings were high in all groups. No adverse maternal-fetal outcomes relating to device usage occurred. Home ultrasound and cardiotocography are potentially feasible and acceptable to high-risk pregnant women. Larger studies are required to refine how best to implement such devices into clinical practice. ClinicalTrials ID: NCT06366711.
To explore how Australian rheumatologists perceive and recommend running for individuals with rheumatoid arthritis (RA), including their clinical experiences, observations and personal views.
Qualitative exploratory study using semistructured interviews. Interviews were conducted via Microsoft Teams, transcribed verbatim and analysed thematically using NVivo software.
Australia; interviews were conducted remotely via Microsoft Teams with participants joining from either clinical or home environments.
13 practising Australian rheumatologists recruited through purposive and snowball sampling.
Five themes were identified from thematic analysis: (1) perceived benefits of running, (2) risks and clinical cautions, (3) criteria required for discussing running, (4) barriers to running and (5) facilitators to running. Participants acknowledged various benefits of running for individuals with RA, such as improved mental health, lifestyle changes and support for joint health. Concerns included risks of running during active disease phases and overly rapid progression of training loads. Key criteria for recommending running included good disease control, the patient’s running history and personal goals. Barriers included patient concerns around joint harm, lack of guidelines and socioeconomic challenges. Facilitators included stable disease, symptom-guided pacing, gradual load increases, allied health referral and appropriate footwear.
Rheumatologists acknowledged both the potential benefits and risks of running for people with RA. Individualised recommendations based on disease status and patient preferences could enhance the integration of running into care plans. Further research is needed to develop specific guidelines and understand patient outcomes.
To assess the feasibility and acceptability of three SMS-delivered safer gambling interventions (goal setting (GS), descriptive norms (DN), injunctive norms (IN)) aimed at reducing the transition from low or moderate risk of gambling harm to problematic gambling, and the feasibility of a full-scale randomised controlled trial evaluating their effectiveness and cost-effectiveness.
Four-arm, parallel-group, pragmatic, randomised controlled feasibility study with a nested qualitative study.
The study was conducted in the UK. Participants were recruited online via UK-licensed gambling operators’ websites.
Adults aged ≥18 years, gambling online at least weekly, with low-to-moderate gambling risk levels.
Participants were block randomised in equal proportions to a delayed intervention control group or one of three 6-week text message interventions delivered via the secure messaging app WIRE: (1) GS: weekly prompts to set gambling-related goals with personalised feedback; (2) DN: weekly messages challenging misperceptions about peer gambling behaviours and (3) IN: weekly messages addressing misperceptions about peer attitudes towards gambling.
Feasibility was assessed through recruitment and retention rates, intervention adherence, data completeness and feasibility and acceptability of the interventions and study procedures. Secondary outcomes included gambling risk behaviours and cognitions, anxiety, depression, quality of life, healthcare use and productivity, measured at baseline, 7-weeks, and 3- and 6-months post-randomisation.
Recruitment took place between April 2021 and August 2022 with final follow-up in February 2023. 167 participants (mean age 51.5; 36% male) were randomised (GS=43; DN=41; IN=42; Control=41). Retention at 6-months was 95.2%, with >95% completion for all outcome measures. Intervention adherence was high, with >95% of DN and IN participants responding to ≥4 messages and 93% of GS participants setting ≥4 goals. Qualitative findings indicated broad acceptability of the interventions and study procedures.
The study was feasible to conduct, interventions and study procedures acceptable to participants, and predefined progression criteria met. Findings support proceeding to a full-scale randomised controlled trial of effectiveness and cost-effectiveness, focusing on the social norms interventions.
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