scholarly journals Development of a Feasible Implementation Fidelity Protocol Within a Complex Physical Therapy–Led Self-Management Intervention

2016 ◽  
Vol 96 (8) ◽  
pp. 1287-1298 ◽  
Author(s):  
Elaine Toomey ◽  
James Matthews ◽  
Suzanne Guerin ◽  
Deirdre A. Hurley
Keyword(s):  
Physical Therapy ◽  
Phase 1 ◽  
Implementation Fidelity ◽  
Self Report ◽  
Self Management ◽  
Phase 2 ◽  
Intervention Delivery ◽  
Direct Observations ◽  
Initial Implementation ◽  
Therapy Interventions

AbstractBackgroundImplementation fidelity is poorly addressed within physical therapy interventions, which may be due to limited research on how to develop and implement an implementation fidelity protocol.ObjectiveThe purpose of this study was to develop a feasible implementation fidelity protocol within a pilot study of a physical therapy–led intervention to promote self-management for people with chronic low back pain or osteoarthritis.DesignA 2-phase mixed-methods design was used.MethodsPhase 1 involved the development of an initial implementation fidelity protocol using qualitative interviews with potential stakeholders to explore the acceptability of proposed strategies to enhance and assess implementation fidelity. Phase 2 involved testing and refining the initial implementation fidelity protocol to develop a finalized implementation fidelity protocol. Specifically, the feasibility of 3 different strategies (physical therapist self-report checklists, independently rated direct observations, and audio-recorded observations) for assessing implementation fidelity of intervention delivery was tested, followed by additional stakeholder interviews that explored the overall feasibility of the implementation fidelity protocol.ResultsPhase 1 interviews determined the proposed implementation fidelity strategies to be acceptable to stakeholders. Phase 2 showed that independently rated audio recordings (n=6) and provider self-report checklists (n=12) were easier to implement than independently rated direct observations (n=12) for assessing implementation fidelity of intervention delivery. Good agreement (79.8%–92.8%) was found among all methods. Qualitative stakeholder interviews confirmed the acceptability, practicality, and implementation of the implementation fidelity protocol.LimitationsThe reliability and validity of assessment checklists used in this study have yet to be fully tested, and blinding of independent raters was not possible.ConclusionsA feasible implementation fidelity protocol was developed based on a 2-phase development process involving intervention stakeholders. This study provides valuable information on the feasibility of rigorously addressing implementation fidelity within physical therapy interventions and provides recommendations for researchers wanting to address implementation fidelity in similar areas.

scholarly journals Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015452 ◽  
Author(s):  
Elaine Toomey ◽  
James Matthews ◽  
Deirdre A Hurley
Keyword(s):  
Low Back Pain ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Self Report ◽  
Self Management ◽  
Low Back ◽  
Complex Behaviour ◽  
Management Intervention ◽  
Direct Observations ◽  
Audio Recordings

Objectives and designDespite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design.SettingFeasibility trial of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention (ISRCTN49875385), delivered in primary care physiotherapy.Methods and outcomes60 SOLAS sessions were delivered across seven sites by nine physiotherapists. Fidelity of delivery of prespecified intervention components was evaluated using (1) audio-recordings (n=60), direct observations (n=24) and self-report checklists (n=60) and (2) individual interviews with physiotherapists (n=9). Quantitatively, fidelity scores were calculated using percentage means and SD of components delivered. Associations between fidelity scores and physiotherapist variables were analysed using Spearman's correlations. Interviews were analysed using thematic analysis to explore potential reasons for fidelity scores. Integration of quantitative and qualitative data occurred at an interpretation level using triangulation.ResultsQuantitatively, fidelity scores were high for all assessment methods; with self-report (92.7%) consistently higher than direct observations (82.7%) or audio-recordings (81.7%). There was significant variation between physiotherapists’ individual scores (69.8% - 100%). Both qualitative and quantitative data (from physiotherapist variables) found that physiotherapists’ knowledge (Spearman's association at p=0.003) and previous experience (p=0.008) were factors that influenced their fidelity. The qualitative data also postulated participant-level (eg, individual needs) and programme-level factors (eg, resources) as additional elements that influenced fidelity.ConclusionThe intervention was delivered with high fidelity. This study contributes to the limited evidence regarding fidelity assessment methods within complex behaviour change interventions. The findings suggest a combination of quantitative methods is suitable for the assessment of fidelity of delivery. A mixed methods approach provided a more insightful understanding of fidelity and its influencing factors.Trial registration numberISRCTN49875385; Pre-results.

scholarly journals Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Carolyn Steele Gray ◽  
Terence Tang ◽  
Alana Armas ◽  
Mira Backo-Shannon ◽  
Sarah Harvey ◽  
...  
Keyword(s):  
Older Adults ◽  
Phase 1 ◽  
Care Transitions ◽  
Self Management ◽  
Complex Care ◽  
Phase 2 ◽  
Care Needs ◽  
Centered Care ◽  
Hospital To Home ◽  
Complex Care Needs

BACKGROUND Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. OBJECTIVE This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. METHODS The study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. RESULTS This project is underway and expected to be complete by Spring 2024. CONCLUSIONS Given the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. CLINICALTRIAL ClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/20220

Surveillance of Physical Activity, Sedentary Behavior and Sleep (SurPASS): A study protocol of the development and feasibility evaluation of a novel measurement system (Preprint)

2021 ◽  
Author(s):  
Patrick Crowley ◽  
Sheikh Mohammed Shariful Islam ◽  
Rasmus Kildedal ◽  
Sandra Schade Jacobsen ◽  
Jon Roslyng Larsen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sedentary Behavior ◽  
Data Privacy ◽  
Large Scale ◽  
Phase 1 ◽  
Self Report ◽  
Surveillance Systems ◽  
Phase 2 ◽  
Evaluation Phase ◽  
Feasibility Evaluation

BACKGROUND There is increasing recognition of the need for more comprehensive surveillance data, including information on physical activity of all intensities, sedentary behavior, and sleep. However, meeting this need poses significant challenges for current surveillance systems, which are mainly reliant on self-report. OBJECTIVE The primary objective of the SurPASS (Surveillance of Physical Activity Sedentary behavior and Sleep) project is to develop and evaluate the feasibility of a sensor-based system for use in the surveillance of physical activity of all intensities, sedentary behavior, and sleep. METHODS The SurPASS project involves an international, multidisciplinary team of researchers collaborating with an industrial partner. The SurPASS system consists of 1) a thigh-worn accelerometer with Bluetooth connectivity, 2) a smartphone app, 3) an integrated back-end, facilitating the automated upload, analysis, storage, and provision of personalized feedback in a manner compliant with European Union regulations on data privacy, and 4) an administrator web-interface (web-app) to monitor progress. The system development and evaluation will be performed in three phases. These phases will include gathering user input and specifications (Phase 1), the iterative development, evaluation and refinement of the system (Phase 2), and the feasibility evaluation (Phase 3). RESULTS The project started in September 2020, is currently in Phase 2, and will be completed in 2023. CONCLUSIONS If feasible, the SurPASS system could be a catalyst towards large-scale sensor-based surveillance of physical activity, sedentary behavior and sleep. It could also be adapted for cohort and interventional research, thus contributing to the generation of evidence for both interventions and public health policies and recommendations.

scholarly journals Implementing Treatment Frequency and Duration Guidelines in a Hospital-Based Pediatric Outpatient Setting: Administrative Case Report

2015 ◽  
Vol 95 (4) ◽  
pp. 678-684 ◽  
Author(s):  
Heather Hanson ◽  
Ann Tokay Harrington ◽  
Kim Nixon-Cave
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Phase 1 ◽  
Poor Response ◽  
Outpatient Setting ◽  
Physical Therapy Education ◽  
Phase 2 ◽  
Treatment Frequency ◽  
Project Description ◽  
Therapy Education

Background and Purpose Determining treatment frequency and duration of physical therapist services is an important component of outpatient pediatric physical therapist practice, yet there is little research available to inform these decisions. Treatment frequency guidelines (TFG) can assist decision making in guiding pediatric physical therapy. The purpose of this project was to examine the feasibility and application of implementing TFG in hospital-based pediatric outpatient physical therapy. Project Description Previously developed TFG were modified for use in our pediatric outpatient physical therapy department to include duration and were referred to as treatment frequency and duration guidelines (TFDG). In order to successfully implement the TFDG, there were 2 phases to the project. In phase 1, the staff were provided the guidelines and procedures in a staff meeting and via email using a PowerPoint presentation. Phase 2 was initiated due to the poor response of the staff in implementing the guidelines in their practice after phase 1. The format was changed to include formal re-education via small-group and one-on-one education sessions (phase 2). Chart reviews were completed to assess therapists' adherence to using TFDG. Outcomes Therapists' adherence to use of TFDG increased following re-education: phase 1 (n=225 charts, 31% adherence) and phase 2 (n=197 charts, 90% adherence). Discussion Treatment frequency and duration guidelines may assist in guiding frequency and duration decisions in pediatric physical therapy. Education via in-person meetings may improve adherence among staff.

Patients’ Self-Report as Predictor of Self-Harm and Violence in an Acute Psychiatric Unit. A Prospective Naturalistic Study

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J.O. Roaldset ◽  
S. Bjørkly ◽  
K.G. Gøtestam
Keyword(s):  
Hospital Stay ◽  
Psychiatric Patients ◽  
Phase 1 ◽  
Self Report ◽  
Psychiatric Ward ◽  
Phase 2 ◽  
Violent Behaviour ◽  
Self Mutilation ◽  
Self Harm ◽  
Acute Psychiatric Ward

The risk of self-harm and violent behaviour by psychiatric patients is an important clinical research topic. However, a literature search on measurement of patients’ structured self-reported assessment of future risk of violent, suicidal or self mutilating behaviour failed to disclose any published empirical research. In the acute psychiatric ward at Ålesund Hospital in Norway we conducted a study of risk assessment of self harm and violent behaviour at admittance and at discharge, followed by prospective measurement of occurred episodes.All admitted patients during one year (489 persons with 716 stays) were included. At admittance and at discharge the Violence Risk Screening-10 (V-RISK-10), items taping suicidal thoughts and behaviour, and patients’ structured self-reported risk of self-harm and violent behaviour (583 self-reports) were scored (six items: no risk-, little-, moderate-, high-, very high risk, don't know the risk, will not answer). The patients were asked to give a blood sample to measure lipids and serotonin. Incidents of aggressive behaviour (against others and self-directed) were monitored during hospital stay (phase 1) and 3, 6, 9 and 12 months after discharge (phase 2).Preliminary results pertaining to the relationship between the patients’ predictions of self-harm and violent behaviour and occurred episodes during the subsequent hospital stay (phase 1) and the first three months after discharge (phase 2), indicate that the predictive validity of patients’ self-report was highly significant both for violent behaviour, suicidal behaviour and self mutilation in phase 1 and phase 2. Effect sizes ranged from moderate to high.

scholarly journals Evaluation of Digital Technologies Tailored to Support Young People’s Self-Management of Musculoskeletal Pain: Mixed Methods Study

10.2196/18315 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e18315 ◽  
Author(s):  
Helen Slater ◽  
Jennifer N Stinson ◽  
Joanne E Jordan ◽  
Jason Chua ◽  
Ben Low ◽  
...  
Keyword(s):  
Young People ◽  
Musculoskeletal Pain ◽  
Phase 1 ◽  
Digital Technologies ◽  
Pain Interference ◽  
Digital Tools ◽  
Self Management ◽  
User Engagement ◽  
Phase 2 ◽  
Phase 3

Background Digital technologies connect young people with health services and resources that support their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain is a significant gap in the health services in Australia. Recognizing the intense resourcing required to develop and implement effective electronic health (eHealth) interventions, the adaptation of extant, proven digital technologies may improve access to pain care with cost and time efficiencies. Objective This study aimed to test the acceptability and need for adaptation of extant digital technologies, the painHEALTH website and the iCanCope with Pain app, for use by young Australians with musculoskeletal pain. Methods A 3-phased, mixed methods evaluation was undertaken from May 2019 to August 2019 in Australia. Young people aged 15 to 25 years with musculoskeletal pain for >3 months were recruited. Phases were sequential: (1) phase 1, participant testing (3 groups, each of n=5) of co-designed website prototypes compared with a control website (painHEALTH), with user tasks mapped to eHealth quality and engagement criteria; (2) phase 2, participants’ week-long use of the iCanCope with Pain app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity, and energy levels; goal setting; and accessing resources); and (3) phase 3, semistructured interviews were conducted to gain insights into participants’ experiences of using these digital technologies. Results Fifteen young people (12/15, 80% female; mean age 20.5 [SD 3.3] years; range 15-25 years) participated in all 3 phases. The phase 1 aggregated group data informed the recommendations used to guide 3 rapid cycles of prototype iteration. Adaptations included optimizing navigation, improving usability (functionality), and enhancing content to promote user engagement and acceptability. In phase 2, all participants checked in, with the highest frequency of full check-ins attributed to pain intensity (183/183, 100.0%), pain interference (175/183, 95.6%), and mood (152/183, 83.1%), respectively. Individual variability was evident for monitoring progress with the highest frequency of history views for pain intensity (51/183, 32.3%), followed by pain interference (24/183, 15.2%). For the goals set feature, 87% (13/15) of participants set a total of 42 goals covering 5 areas, most frequently for activity (35/42, 83%). For phase 3, metasynthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. A total of 4 metathemes emerged: (1) importance of user-centered design to leverage user engagement; (2) website design (features) promoting user acceptability and engagement; (3) app functionality supporting self-management; and (4) the role of wider promotion, health professional digital prescriptions, and strategies to ensure longer-term engagement. Conclusions Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people’s self-management of musculoskeletal pain.

scholarly journals Development and Testing of a Self-report Instrument to Measure Actions: Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL)

2005 ◽  
Vol 85 (6) ◽  
pp. 515-530 ◽  
Author(s):  
Andrew A Guccione ◽  
Thelma J Mielenz ◽  
Robert F DeVellis ◽  
Marc S Goldstein ◽  
Janet K Freburger ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Well Being ◽  
Descriptive Statistics ◽  
Self Report ◽  
Study Results ◽  
Movement Assessment ◽  
Adult Outpatient ◽  
Therapy Interventions ◽  
Health And Well Being

Abstract Background and Purpose. Physical therapy is faced with the challenge of producing evidence that physical therapy interventions are effective. The fundamental question confronting physical therapy is whether or not physical therapy interventions make a contribution to function, health, and well-being. The individual's ability to perform actions can serve as a theoretical construct related to movement and health around which physical therapy interventions can be assessed. To this end, the aims of this study were: (1) to develop a self-report instrument to assess ability to perform mobility actions in an adult outpatient population and (2) to assess the psychometric properties of such an instrument in the appropriate population. Subjects and Methods. An instrument was developed to assess difficulty and confidence related to 24 actions. Descriptive statistics and measures of reliability, validity, and responsiveness were computed. A total of 391 patients participated in the study. Results. The coefficient for reliability was in the required range, and measures of validity and responsiveness were established as well. Three factors were identified. Discussion and Conclusion. The instrument provides the beginning of documentation of outcomes in movement to identify the unique contributions of physical therapist practice.

scholarly journals Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study

10.2196/20220 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e20220
Author(s):  
Carolyn Steele Gray ◽  
Terence Tang ◽  
Alana Armas ◽  
Mira Backo-Shannon ◽  
Sarah Harvey ◽  
...  
Keyword(s):  
Older Adults ◽  
Phase 1 ◽  
Care Transitions ◽  
Self Management ◽  
Complex Care ◽  
Phase 2 ◽  
Care Needs ◽  
Centered Care ◽  
Hospital To Home ◽  
Complex Care Needs

Background Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. Objective This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. Methods The study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. Results This project is underway and expected to be complete by Spring 2024. Conclusions Given the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. Trial Registration ClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 International Registered Report Identifier (IRRID) PRR1-10.2196/20220

scholarly journals Evaluation of Digital Technologies Tailored to Support Young People’s Self-Management of Musculoskeletal Pain: Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Helen Slater ◽  
Jennifer N Stinson ◽  
Joanne E Jordan ◽  
Jason Chua ◽  
Ben Low ◽  
...  
Keyword(s):  
Young People ◽  
Musculoskeletal Pain ◽  
Phase 1 ◽  
Digital Technologies ◽  
Pain Interference ◽  
Digital Tools ◽  
Self Management ◽  
User Engagement ◽  
Phase 2 ◽  
Phase 3

BACKGROUND Digital technologies connect young people with health services and resources that support their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain is a significant gap in the health services in Australia. Recognizing the intense resourcing required to develop and implement effective electronic health (eHealth) interventions, the adaptation of extant, proven digital technologies may improve access to pain care with cost and time efficiencies. OBJECTIVE This study aimed to test the acceptability and need for adaptation of extant digital technologies, the pain<i>HEALTH</i> website and the <i>iCanCope with Pain</i> app, for use by young Australians with musculoskeletal pain. METHODS A 3-phased, mixed methods evaluation was undertaken from May 2019 to August 2019 in Australia. Young people aged 15 to 25 years with musculoskeletal pain for &gt;3 months were recruited. Phases were sequential: (1) phase 1, participant testing (3 groups, each of n=5) of co-designed website prototypes compared with a control website (pain<i>HEALTH</i>), with user tasks mapped to eHealth quality and engagement criteria; (2) phase 2, participants’ week-long use of the <i>iCanCope with Pain</i> app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity, and energy levels; goal setting; and accessing resources); and (3) phase 3, semistructured interviews were conducted to gain insights into participants’ experiences of using these digital technologies. RESULTS Fifteen young people (12/15, 80% female; mean age 20.5 [SD 3.3] years; range 15-25 years) participated in all 3 phases. The phase 1 aggregated group data informed the recommendations used to guide 3 rapid cycles of prototype iteration. Adaptations included optimizing navigation, improving usability (functionality), and enhancing content to promote user engagement and acceptability. In phase 2, all participants checked in, with the highest frequency of full check-ins attributed to pain intensity (183/183, 100.0%), pain interference (175/183, 95.6%), and mood (152/183, 83.1%), respectively. Individual variability was evident for monitoring progress with the highest frequency of history views for pain intensity (51/183, 32.3%), followed by pain interference (24/183, 15.2%). For the goals set feature, 87% (13/15) of participants set a total of 42 goals covering 5 areas, most frequently for activity (35/42, 83%). For phase 3, metasynthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. A total of 4 metathemes emerged: (1) importance of user-centered design to leverage user engagement; (2) website design (features) promoting user acceptability and engagement; (3) app functionality supporting self-management; and (4) the role of wider promotion, health professional digital prescriptions, and strategies to ensure longer-term engagement. CONCLUSIONS Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people’s self-management of musculoskeletal pain.

Improving Tinnitus with Mechanical Treatment of the Cervical Spine and Jaw

2013 ◽  
Vol 24 (07) ◽  
pp. 544-555 ◽  
Author(s):  
Kay Cherian ◽  
Neil Cherian ◽  
Chad Cook ◽  
James A. Kaltenbach
Keyword(s):  
Cervical Spine ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Self Report ◽  
Blurred Vision ◽  
Flexion Extension ◽  
Spine Mobility ◽  
Emotional Deficits ◽  
Therapy Interventions ◽  
Cervical Motion

Background: Tinnitus affects approximately 30–50 million Americans. In approximately 0.5–1.0% of the population, tinnitus has a moderate to severe impact on their quality of life. Musculature and joint pathologies of the head and neck are frequently associated with tinnitus and have been hypothesized to play a contributing role in its etiology. However, specific physical therapy interventions to assist in improving tinnitus have not yet been reported. Purpose: To describe the examination and treatment intervention of a patient with subjective tinnitus. Patient Description: The patient was a 42-yr-old male experiencing intermittent bilateral tinnitus, headaches, blurred vision, and neck tightness. His occupation required long-term positioning into neck protraction. Examination found limitations in cervical extension, bilateral rotation, and side bending. Asymmetry was also noted with temporomandibular joint (TMJ) movements. Upon initial evaluation the patient demonstrated functional, physical, and emotional deficits per neck, headache, and dizziness self-report scales and a score on the Tinnitus Handicap Inventory (THI) of 62. Resisted muscle contractions of the cervical spine in flexion, extension, and rotation increased his tinnitus. Intervention: Treatment focused on normalizing cervical spine mobility through repetitive movements, joint mobilization, and soft tissue massage. Results: At 2.5 mo, the patient demonstrated a complete reversal of his tinnitus after 10 physical therapy sessions as noted by his score of 0 on the THI upon discharge. He also demonstrated objective improvements in his cervical motion. This case reflected treatment targeted at cervical and TMJ impairments and notable improvements to tinnitus. Future studies should further explore the direct and indirect treatment of tinnitus by physical therapists through clinical trials.

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