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Despite the potential benefits of physiotherapy and physical activity, awareness remains limited among patients with sequela and healthcare professionals. This study aims to explore Danish physiotherapists’ (PTs) perspectives on barriers, facilitators and potential solutions to improve the care of sequelae after cancer in physiotherapy clinics.
This qualitative study used semi-structured interviews with Danish PTs, following a published research protocol and the Criteria for Reporting Qualitative Research checklist. Danish-speaking PTs working in private clinics in Denmark were eligible to participate and were selected via purposive sampling. Online interviews with PTs were conducted in June and July 2022.
A phenomenological approach was employed for data collection and thematic analysis, allowing researchers to set aside preconceptions. Preunderstandings were stated and revisited post-analysis for validation. The interview guide was developed and validated through discussions and pilot testing. A patient panel provided feedback on the interview guide. Interviews were conducted by a trained and experienced PT and transcribed using a standardised key.
Online interviews with 12 PTs were conducted. Five themes were identified: being aware of important physiotherapy competencies, PTs’ basic education and specialisation, patients’ resources, healthcare system and organisation, and sharing knowledge regarding sequelae from cancer and potential treatments. PTs emphasised the need for specialised competencies, emotional resilience and life experience. Patients experienced financial and psychosocial barriers, while systemic issues and poor communication hindered care. PTs suggested public lists of specialised providers and broader dissemination of knowledge to reduce stigma and improve access.
PTs identify clinical and systemic challenges requiring specialisation, improved collaboration and increased awareness to enhance rehabilitation and quality of life for cancer survivors.
Chronic non-cancer pain presents a global health problem, with a significant increase in opioid prescriptions over recent decades. However, opioid therapy poses risks of adverse events, overdose and non-medical use. As a result, many patients seek to discontinue or reduce their opioid intake. Strategies for opioid tapering often lack efficacy, prompting the investigation of novel approaches like open-label placebo (OLP), that is, the administration of a placebo with full disclosure that it is a placebo. OLP has shown efficacy in chronic non-cancer pain syndromes and has been suggested as a promising candidate for medication tapering. This study aims to assess whether OLPs can enhance the reduction of daily morphine equivalent dose (MED) in chronic non-cancer pain patients and examines its potential in mitigating opioid withdrawal symptoms.
This study is designed as a randomised, controlled, single-centre trial. Participants will be randomised into either an OLP group or a control group. The study duration will span six to nine weeks, during which all participants will aim to reduce their opioid intake. Both groups will monitor their opioid intake daily using a diary app and will receive feedback on their progress of reducing opioids. Additionally, participants in the OLP group will receive OLP tablets for the entire study period. During the first week, the OLP group will undergo a one week learning phase using a classical conditioning paradigm, where each opioid intake is paired with a placebo. In the subsequent five weeks, the OLP group will enter a dose-extension phase in which only the first opioid intake of the day is paired with a placebo, and additional placebos can be taken as desired. At the end of the study, qualitative interviews will be conducted with the first 15 participants in the OLP group. The primary outcome measure is daily opioid intake. Secondary outcomes include opioid withdrawal symptoms, pain severity, disability, anxiety, depression, opioid beliefs, intervention expectancy and qualitative data. Statistical analyses will include analysis of covariance and regression models.
The ethics committee of the Canton of Zurich, Switzerland, approved the study (SNCTP-nr.: SNCTP000005853/BASEC nr.: 2023–02327).
Participants will be compensated with 100 Swiss Francs for their full participation in the study. Participants who will take part in the qualitative interview will be compensated with additional 15 Swiss Francs.
This study is registered at clinicaltrials.gov: NCT06350786.
A retrospective single-centre study. To investigate the period prevalence of pressure injury recurrence (PIR) and characteristics associated with PIR in the population of persons with spinal cord injury (SCI) who were treated with flap surgery between 2008 and 2019. A spinal cord unit (SCU) in Norway. The study is based on analysis of patient data from the electronic medical record. Crosstabs and logistic regression were used to investigate the potential correlations between the odds of PIR and potential risk characteristics. We identified 54 patients who were treated with flap surgery in the period of interest, and 47 (87%) were men. The mean age for flap surgery was 51 years (SD = 12.7). The occurrence of PIR post-flap surgery was 46% (n = 25). Factors associated with increased risk of PIR were use of manual wheelchair (65% vs. 32%, odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.06–14.33, p = 0.04) when compared with powered wheelchair, and history of PI and flap surgery at the ischial tuberosity (sit bones) (68% vs. 24%, OR = 3.67, 95% CI = 1.01–13.40, p = 0.04) compared with all other body locations. Factors associated with decreased risk of PIR were independence in position changes (29% vs. 58%, OR = 0.29, 95% CI = 0.91–0.95, p = 0.04) compared with not needing assistance with position changes, tetraplegia (C5–C8) (21% vs. 60%, OR = 0.18, CI = 0.04–0.83, p = 0.02) compared with paraplegia, and postoperative follow-up by the SCU (15% vs. 55%, OR = 0.28, 95% CI 0.03–0.76, p = 0.04) compared with no follow-up from the SCU, as well assistance from personal assistant follow-up (PAF) (26% vs. 56%, OR = 0.15, 95% CI = 0.03–0.76, p = 0.01) compared with not receiving assistance from PAF. The period prevalence of PIR post-flap surgery in the Norwegian population of people with SCI is high and increased odds of PIR were related to flap surgery on the sit bones. Reduced odds of PIR were related to tetraplegia, powered wheelchair use, follow up by PAF and the SCU. The study is registered in the Open science framework.
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