Exercise adherence in trials of therapeutic exercise interventions for common musculoskeletal conditions: A scoping review.

OBJECTIVE: The aims of the scoping review were to: (1) evaluate how commonly trialists assess and report adherence to exercise intervention for common musculoskeletal conditions and (2) report the levels of adherence to exercise for musculoskeletal conditions and whether this was influenced by variables of interest. METHODS: Medline, Cinahl, Embase, Emcare, and SPORTDiscus databases were searched using predefined terms. Published randomised controlled trials were included. Trials were included if they investigated the effectiveness of an exercise intervention for low back pain, shoulder pain, Achilles tendinopathy and knee osteoarthritis (we selected a priori as indicative common musculoskeletal conditions). Data extraction was performed independently by teams of two reviewers. Descriptive consolidation and qualitative synthesis were performed. RESULTS: 321 trials were included; less than half (46.7%, 150/321) measured adherence. When adherence was assessed, 21% (31/150) of trials did not report the results. Adherence levels were greater when people were supervised. Reporting adherence was more common in registered trials. Adherence was measured most frequently via self-report (47.3%, 71/150) followed by supervised sessions (32.0%, 48/150) or combination of both (20.7%, 31/150). The majority of trials (97.0%, 97/100) reported the level of adherence in terms of a frequency. CONCLUSIONS: A majority of trials investigating exercise interventions for common musculoskeletal conditions do not assess exercise adherence. Trials that were registered reported exercise adherence more frequently. The majority of trials measure adherence via self-report with reliance on only one dimension of exercise adherence (frequency).

The project ENABLE Cornerstone randomized pilot trial: Protocol for lay navigator-led early palliative care for African-American and rural advanced cancer family caregivers.

BACKGROUND: Patients newly-diagnosed with advanced cancer often rely on family caregivers to provide daily support to manage healthcare needs and maintain quality of life. Early telehealth palliative care has been shown to effectively provide an extra layer of support to family caregivers, however there has been little work with underserved populations, especially African-Americans and rural-dwellers. This is concerning given the lack of palliative care access for these underserved groups. STUDY DESIGN: Single-site, small-scale pilot randomized controlled trial (RCT) of Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African-American and rural-dwelling patients with newly-diagnosed advanced cancer. Family caregivers are paired with a trained lay navigator overseen by specialist palliative care clinicians and receive a series of brief in-person and telehealth sessions focusing on stress management and coping, caregiving skills and organization, getting help, self-care, and preparing for the future/advance care planning. This pilot trial is assessing acceptability of the intervention, feasibility of recruitment and data collection procedures, and preliminary efficacy compared to usual care on caregiver and patient quality of life and mood over 24 weeks. CONCLUSION: Once acceptability and feasibility are determined and issues addressed, the ENABLE Cornerstone intervention for underserved family caregivers of persons with advanced cancer will be primed for a fully powered efficacy RCT. Given its use of lay navigators and telehealth delivery, the intervention is potentially highly scalable and capable of overcoming many of the geographic, human resource, and cultural obstacles to accessing early palliative care support.

How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study.

AIMS: Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver's role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. METHODS: Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. FINDINGS: Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient's partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported "fair" or "poor" health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients' upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient's treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing "what if" scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. CONCLUSIONS: These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.

Does perception of drug-related harm change with age? A cross-sectional online survey of young and older people.

OBJECTIVES: To investigate how young and older people perceive the harms associated with legal and illegal drugs. DESIGN: Cross-sectional study: adults aged 18-24 years versus 45+ completed an online survey ranking the perceived harms associated with 11 drugs on 16 drug-related harm criteria. SETTING: Online survey. PARTICIPANTS: 184 participants aged 18-24 years (113 female: mean age 21: SD 1.3) and 91 participants aged 45+ (51 female: mean age 60: SD 8.5). MAIN OUTCOME MEASURES: 'Perception of drug-related harms': This was measured using a rating scale ranging from 1 (no risk of harm) to 4 (high risk of harm). Participants were also asked about sources which informed their perception on drug-related harms as well as their own personal self-reported drug experiences. RESULTS: Of the illegal drugs, heroin, methamphetamine and cocaine were rated as the most harmful and cannabis was rated as the least harmful. Alcohol and tobacco were also rated as less harmful. The results showed that perceptions of drug-related harms were inconsistent with current knowledge from research on drugs. Furthermore, perceptions on drug harms were more conservative in the 45+ group for a number of illegal drugs and tobacco. However, the 45+ age group did not perceive alcohol as any more harmful than the younger group. CONCLUSIONS: This survey demonstrates that the greatest misperception was in relation to alcohol-related harms which did not change with age. In order to minimise harms, this misperception needs to be addressed through education and policies that legislate drug use.