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To develop a core outcome set (COS) to capture and measure the well-being of doctors working in the National Health Service (NHS).
An online Delphi study.
UK NHS.
Participants from four stakeholder groups: (1) those who might use the COS in research, (2) organisations that measure/capture NHS staff well-being, (3) professionals with experience managing NHS staff well-being and (4) NHS doctors were identified through authorship of relevant publications, attendee lists of doctor well-being conferences and meetings, professional bodies, participation in a previous study and recommendations from others. They were recruited via email.
A two-stage process: (1) creating a list of 43 well-being outcomes informed by a systematic review of well-being measurement instruments, a survey of UK doctors and two doctor engagement workshops and (2) an online Delphi study (with two rounds) to reach consensus. Outcomes were rated on a 9-point Likert scale; ‘consensus’ was reached when ≥75% agreed that an outcome was critical for inclusion in the COS.
52 participants completed both Delphi rounds. Seven well-being outcomes met the threshold for inclusion in the COS: general well-being, health, personal safety, job satisfaction, morale, life work balance and good clinical practice.
Use of the COS has the potential to reduce heterogeneity and standardise the capture and measurement of doctor well-being, and ensure outcomes important to all stakeholders are reported.
This study was prospectively registered with the Core Outcome Measures in Effectiveness Trial initiative at www.comet-initiative.org (Registration: 1577).
by Alan Reubenson, Leo Ng, Vidya Lawton, Irmina Nahon, Rebecca Terry, Claire Baldwin, Julia Blackford, Alex Bond, Rosemary Corrigan, Megan Dalton, Amabile Borges Dario, Michael Donovan, Ruth Dunwoodie, Genevieve M. Dwyer, Roma Forbes, Alison Francis-Cracknell, Janelle Gill, Andrea Hams, Anne Jones, Taryn Jones, Belinda Judd, Ewan Kennedy, Prue Morgan, Tanya Palmer, Casey Peiris, Carolyn Taylor, Debra Virtue, Cherie Zischke, Daniel F. Gucciardi, on behalf of the Physiotherapy Clinical Education Research Collaborative (PCERC)
The Assessment of Physiotherapy Practice (APP) is a 20-item assessment instrument used to assess entry-level physiotherapy practice in Australia, New Zealand and other international locations. Initial APP reliability and validity evidence supported a unidimensional or single latent factor as the best representation of entry-level physiotherapy practice performance. However, there remains inconsistency in how the APP is interpreted and operationalised across Australian and New Zealand universities offering entry-level physiotherapy programs. In essence, the presumption that the psychometric integrity of the APP generalises across people, time, and contexts remains largely untested. This multi-site, archival replication study utilised APP assessment data from 8,979 clinical placement assessments, across 19 Australian and New Zealand universities, graduating entry-level physiotherapy students (n=1865) in 2019. Structural representation of APP scores were examined via confirmatory factor analysis and penalised structural equation models. Factor analyses indicated a 2-factor representation, with four items (1–4) for the professional dimension and 16 items (5–20) for the clinical dimension, is the best approximation of entry-level physiotherapy performance. Measurement invariance analyses supported the robustness of this 2-factor representation over time and across diverse practice areas in both penultimate and final years of study. The findings provide strong evidence for the psychometric integrity of the APP, and the 2-factor alternative interpretation and operationalisation is recommended. To meet entry-level standards students should be assessed as competent across both professional and clinical dimensions of physiotherapy practice.Physical activity has important benefits for the prevention and management of chronic diseases and healthy ageing. Health professionals have valuable opportunities to promote physical activity to a large group of people across the lifespan. Promotion of Physical Activity by Health Professionals is a hybrid type 1 effectiveness-implementation cluster randomised trial designed to evaluate the impact of physical activity promotion by health professionals (n=30 clusters) on physical activity participation in their patients (n=720). To inform the future implementation of this programme, we will be conducting a within-trial and modelled economic evaluation.
We will conduct a cost-effectiveness and cost-utility analysis from the perspective of the healthcare, aged care and disability funder. The time horizon will be 6 months for the within-trial analysis and 2 years for the modelled analysis. Data on intervention costs will be collected using trial records. Data on healthcare utilisation will be collected using data linkage. Incremental cost-effectiveness ratios (ICERs) will be reported for physical activity and quality-adjusted life years outcomes. Bootstrapping will be used to explore uncertainty around the ICERs and estimate 95% CIs. Results will be presented on a cost-effectiveness plane. The probability that the intervention would be cost-effective at varying willingness-to-pay thresholds will be presented using a cost-effectiveness acceptability curve.
Ethics approval was obtained through Sydney Local Health District (RPAH zone) Ethics Review Committee (X23-0197). The findings of this study will be disseminated through peer-reviewed journal articles and conference presentations.
Australian New Zealand Clinical Trials Registry: ACTRN12623000920695.
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