Real world prospective evaluation of clinical outcomes in patients with non-metastatic castrate resistant prostate cancer treated with darolutamide

Background: The RECORD Study is a real world data, prospective evaluation of clinical outcomes in patients with nmCRPC treated with Darolutamide. This study will increase the understanding of treatment response and management and in particular informregarding use of next generation imaging in this setting. Method(s): Patient data from 9 UK centres was collected based on the recommendation of NICE for Darolutamide as an option for the treatment of non-metastatic castrate resistant prostate cancer (nmCRPC) from November 2020. Data cut-off was 15 September 2022. The study is ongoing. Result(s): 87 patients were analysed with a median age of 78 (range 61-92). Median pre-treatment PSA and PSA doubling time (PSAdT) were 13 (range 1.99-110.6) mg/L and 5.05 (range 0.6 -10) months. 42 patients (49.4%) had pre-treatment PSAdT of <6 months and 43 (50.6%) patients had PSAdT of >=6 months (2 patients had no pre-treatment PSAdT data). 6 patients (6.90%) had next generation imaging prior to initiation of Darolutamide. Median duration of treatment on Darolutamide was 17 months for patients with pre-treatment PSAdT <6 months but median duration had not been reached for patients with pre-treatment PSAdT >=6 months after 24 months of treatment, a significant difference p=0.018 (HR=0.385, 95% CI 0.17-0.88). 30 patients have come off treatment so far (34.5%);21 (70%) for disease progression, 5 (16%) for a medical cause unrelated to the drug (e.g. COVID infection, reduced performance status secondary to pre-existing Parkinson's), 3 (10%) for unacceptable toxicity (rash, Grade3 fatigue, muscle aches, memory issues), and 1 patient died (unrelated). Conclusion(s): In the RECORD study, predominantly the diagnosis of nmCRPC is based on conventional imaging. The majority of patients respond and tolerate Darolutamide well, comparable with the ARAMIS trial. There is a significant difference between time on Darolutamide for those with pre-treatment PSAdT of<6 months compared with>=6 months. Further long-term toxicity, MFS and OS data will continue to be collected prospectively within the study.

Exploring the Experiences of People Who Had a Stroke and Therapists Who Managed People with Stroke during the Covid-19 Pandemic: A Qualitative Exploratory Study

Introduction: The COVID-19 pandemic has been hugely affecting access to the health care system and quality of services for all patients including for those who had a stroke during the pandemic. It is important to explore the experiences and issues that patients and providers faced during the pandemic to identify deficits in the system. Further, we need to identify possible strategies to tailor stroke care for the benefit of those who faced challenges during the pandemic and for future patients in case of a severe wave. The aim of this study is to explore experiences of people with stroke, therapists' experiences, patients' needs and rehabilitation priorities after their stroke during the pandemic. Method(s): Semi-structured interviews were conducted using two separate topic guides for therapists who treated patients with stroke and the people who had a stroke during the pandemic. Qualitative data were analysed using a reflexive thematic analysis approach. Each interview was coded and categories were developed by two independent researchers and cross checked by a third researcher. Findings from therapists' interviews were triangulated with findings from survivors' interviews. Result(s): 22 participants (12 therapists and 10 patients) from stroke acute, subacute, and chronic settings were interviewed. The quantity and quality of care for people post-stroke has been affected by the impact of the pandemic to various extents including earlier discharge patients from acute care facilities and lack/limited care post discharge from hospital. There has been a variability in the organisational and individual responses to the changes in the care practice. Patients needed more support to address their physical and mental health issues. Remote rehabilitation and self-management strategies were facilitated by care teams as a new approaches to deliver care for stroke population. However, therapists seemed unsatisfied with the quality of care delivered and suggested that the system should be better prepared to deal with similar situations in the future. Conclusion(s): The findings of this study demonstrate the impact of the pandemic on stroke care and provide suggestions for optimal delivery of care in similar situations. Future research is warranted to examine the efficacy of new strategies such as reducing the time for acute care and remote delivery of rehabilitation for people with mild to moderate impairments post stroke.

Successful recovery following musculoskeletal trauma: protocol for a qualitative study of patients' and physiotherapists' perceptions.

BACKGROUND: Annually in the UK, 40,000-90,000 people are involved in a traumatic incident. Severity of injury and how well people recover from their injuries varies, with physiotherapy playing a key role in the rehabilitation process. Recovery is evaluated using multiple outcome measures for perceived levels of pain severity and quality of life. It is unclear however, what constitutes a successful recovery from injury throughout the course of recovery from the patient perspective, and whether this aligns with physiotherapists' perspectives. METHODS: A qualitative study using two approaches: Interpretive Phenomenological Analysis (IPA) using semi-structured interviews and thematic analysis following the Kreuger framework for focus groups. A purposive sample of 20 patients who have experienced musculoskeletal trauma within the past 4 weeks and 12 physiotherapists who manage this patient population will be recruited from a single trauma centre in the UK. Semi-structured interviews with patients at 4 weeks, 6 and 12 months following injury, and 2 focus groups with physiotherapists will be undertaken at one time point. Views and perceptions on the definition of recovery and what constitutes a successful recovery will be explored using both methods, with a focus on the lived experience and patient journey following musculoskeletal trauma, and how this changes through the process of recovery. Data from both the semi-structured interviews and focus groups will be analysed separately and then integrated and synthesised into key themes ensuring similarities and differences are identified. Strategies to ensure trustworthiness e.g., reflexivity will be employed. DISCUSSION: Recovery following musculoskeletal trauma is complex and understanding of the concept of successful recovery and how this changes over time following an injury is largely unknown. It is imperative to understand the patient perspective and whether these perceptions align with current views of physiotherapists. A greater understanding of recovery following musculoskeletal trauma has potential to change clinical care, optimise patient centred care and improve efficiency and clinical decision making during rehabilitation. This in turn can contribute to improved clinical effectiveness, patient outcome and patient satisfaction with potential service and economic cost savings. This study has ethical approval (IRAS 287781/REC 20/PR/0712).

Screening and supporting the mental health of student physiotherapists during the COVID-19 pandemic

Background/Aims The purpose of this study was to use the Model of Emotions, Adaptation and Hope as a way to screen and support physiotherapy students and understand the impact of the COVID-19 pandemic on their health by focusing on the stories (narrative) they tell. Methods This pilot mixed methods study included a convenience sample of BSc and MSc level student physiotherapists. A single screening online interview was conducted via Zoom or Skype. Students' narratives underwent qualitative analysis and quantitative analysis using the Model of Emotions, Adaptation and Hope. Results A total of 19 students took part in this study. Students identified four master plot narratives as a response to the interview: future control;lost productivity;isolation;and opportunity. Significant pre-interview to follow-up change was found in acceptance, pleasantness and energy. Conclusions It is possible to support the mental health of physiotherapy students by screening for difficulties and listening to and exploring their responses. © 2021 MA Healthcare Ltd