Barriers and facilitators associated with the upscaling of the Transmural Trauma Care Model: a qualitative study.

BACKGROUND: To assess the barriers and facilitators associated with upscaling the Transmural Trauma Care Model (TTCM), a multidisciplinary and patient-centred transmural rehabilitation care model. METHODS: Semi-structured interviews were conducted with eight trauma surgeons, eight hospital-based physiotherapists, eight trauma patients, and eight primary care physiotherapists who were part of a trauma rehabilitation network. Audio recordings of the interviews were made and transcribed verbatim. Data were analysed using a framework method based on the "constellation approach". Identified barriers and facilitators were grouped into categories related to structure, culture, and practice. RESULTS: Various barriers and facilitators to upscaling were identified. Under structure, barriers and facilitators belonged to one of five themes: "financial structure", "communication structure", "physical structures and resources", "rules and regulations", and "organisation of the network". Under culture, the five themes were "commitment", "job satisfaction", "acting as a team", "quality and efficiency of care", and "patients' experience". Under practice, the two themes were "practical issues at the outpatient clinic" and "knowledge gained". CONCLUSION: The success of upscaling the TTCM differed across hospitals and settings. The most important prerequisites for successfully upscaling the TTCM were adequate financial support and presence of "key actors" within an organisation who felt a sense of urgency for change and/or expected the intervention to increase their job satisfaction. TRIAL REGISTRATION: NL8163 The Netherlands National Trial Register, date of registration 16-11-2019.

Effectiveness and cost-effectiveness of the Transmural Trauma Care Model investigated in a multicenter trial with a controlled before-and-after design: A study protocol.

OBJECTIVE: The rehabilitation of trauma patients in primary care is challenging, and there are no guidelines for optimal treatment. Also, the organization of care is not well-structured. The Transmural Trauma Care Model (TTCM) has been developed in the Netherlands, aiming to improve patient outcomes by optimizing the organization and the quality of the rehabilitation process in primary care. A recent feasibility study showed that implementation of the TTCM at a Dutch Level 1 trauma center was feasible, patient outcomes were improved, and costs were reduced. This study aims to assess the effectiveness and cost-effectiveness of the TTCM compared to the usual care in a multicenter trial. METHODS: A multicenter trial with a controlled before-and-after design will be performed at 10 hospitals in the Netherlands. First, participating hospitals will include 322 patients in the control group, receiving usual care as provided in these specific hospitals. Subsequently, the TTCM will be implemented in all participating hospitals, and hospitals will include an additional 322 patients in the intervention group. The TTCM consists of a multidisciplinary team at the outpatient clinic (trauma surgeon and hospital-based physical therapist), an educated and trained network of primary care trauma physical therapists, and structural communication between them. Co-primary outcomes will investigate generic and disease-specific, health-related quality of life. Secondary outcomes will include pain, patient satisfaction, perceived recovery, and patient-reported physical functioning. For the economic evaluation, societal and healthcare costs will be measured. Measurements will take place at baseline and after 6 weeks, 3, 6, and 9 months. Analyses will be based on the intention-to-treat principle. Missing data will be handled using longitudinal data analyses in the effect analyses and by multivariate imputation in the economic evaluation. CONCLUSION: This trial with a controlled before-and-after design will give insight into the effectiveness and cost-effectiveness of the TTCM in a multicenter trial.

Physical therapy treatment in children with cerebral palsy after single-event multilevel surgery: a qualitative systematic review. A first step towards a clinical guideline for physical therapy after single-event multilevel surgery.

BACKGROUND: The aim of this study was to review available evidence for physical therapy treatment (PTT) after single-event multilevel surgery (SEMLS), and to realize a first step towards an accurate and clinical guideline for developing effective PTT for children with cerebral palsy (CP) after SEMLS. METHODS: A qualitative systematic review (PubMed, Medline, Embase, CINAHL, and the Cochrane Library) investigating a program of PTT after SEMLS in children aged 4-18 years with CP classified by Gross Motor Function Classification System level I-III. RESULTS: Six articles meeting the inclusion criteria were selected. The selected studies provide only incomplete descriptions of interventions, and show no consensus regarding PTT after SEMLS. Neither do they show any consensus on the outcome measures or measuring instruments. CONCLUSIONS: Based on the results of this literature review in combination with our best practice, we propose a preliminary protocol of PTT after SEMLS.

A trauma-focused approach for patients with tinnitus: the effectiveness of eye movement desensitization and reprocessing - a multicentre pilot trial.

Background: While normal tinnitus is a short-term sensation of limited duration, in 10-15% of the general population it develops into a chronic condition. For 3-6% it seriously interferes with many aspects of life. Objective: The aim of this trial was to assess effectiveness of a trauma-focused approach, eye movement desensitization and reprocessing (EMDR), in reducing tinnitus distress. Methods: The sample consisted of 35 adults with high levels of chronic tinnitus distress from five general hospitals in the Netherlands. Participants served as their own controls. After pre-assessment (T1), participants waited for a period of 3 months, after which they were assessed again (T2) before they received six 90 min manualized EMDR treatment sessions in which tinnitus-related traumatic or stressful events were the focus of treatment. Standardized self-report measures, the Tinnitus Functional Index (TFI), Mini-Tinnitus Questionnaire (Mini-TQ), Symptom Checklist-90 (SCL-90) and the Self-Rating Inventory List for Post-traumatic Stress Disorder (SRIP), were completed again halfway through treatment (T3), post-treatment (T4) and at 3 months' follow-up (T5). Results: Repeated measures analysis of variance revealed significant improvement after EMDR treatment on the primary outcome, TFI. Compared to the waiting-list condition, scores significantly decreased in EMDR treatment [t(34) = -4.25, p < .001, Cohen's dz  = .72]. Secondary outcomes, Mini-TQ and SCL-90, also decreased significantly. The treatment effects remained stable at 3 months' follow-up. No adverse events or side effects were noted in this trial. Conclusions: This is the first study to suggest that EMDR is effective in reducing tinnitus distress. Randomized controlled trials are warranted.

Antecedentes: mientras que el tinnitus normal es una sensación a corto plazo de duración limitada, en el 10-15% de los pacientes se transforma en una condición crónica. Para el 3-6% de los pacientes interfiere seriamente con muchos aspectos de la vida. El objetivo de este estudio fue evaluar la efectividad de un enfoque centrado en el trauma, la Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR), para reducir el estrés por tinnitus. Métodos: La muestra consistió en 35 adultos con altos niveles de estrés por tinnitus crónico de cinco hospitales generales en los Países Bajos. Los participantes sirvieron como sus propios controles. Después de la pre-evaluación (T1), los participantes esperaron por un período de 3 meses, después de lo cual fueron evaluados nuevamente (T2) antes de recibir seis sesiones de tratamiento EMDR manualizadas de 90 minutos en las que los eventos traumáticos o estresantes relacionados con el tinnitus fueron el foco del tratamiento. Las medidas de autorreporte estandarizadas, el Índice Funcional de Tinnitus (TFI, por su sigla en inglés), el Mini Cuestionario de Tinnitus (Mini-TQ), la Lista de Chequeo de Síntomas - 90 (SCL-90, por su sigla en inglés) y la Lista de Inventario de Autorreporte para el TEPT (SRIP, por su sigla en inglés) se completaron nuevamente durante el tratamiento (T3), postratamiento (T4) y a los 3 meses de seguimiento (T5). Resultados: el análisis de varianza de medidas repetidas (ANOVA) reveló una mejora significativa después del tratamiento con EMDR en el resultado primario TFI. Comparado con la condición de lista de espera, los puntajes disminuyeron significativamente en el tratamiento con EMDR, como mostraron las pruebas t de muestras relacionadas (t(34) = -4.25, p <0.001, Cohen's dz = 0.72). Los resultados secundarios Mini-TQ y SCL-90 también disminuyeron significativamente. Los efectos del tratamiento se mantuvieron estables a los 3 meses de seguimiento. No se observaron eventos adversos o efectos secundarios en este estudio. Conclusiones: Este es el primer estudio que sugiere que el EMDR es efectivo para reducir el estrés por tinnitus. Se requieren ensayos aleatorios controlados.

Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review.

QUESTION: Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders? DESIGN: Systematic review of studies of the psychometric properties of exercise tests. PARTICIPANTS: People older than 18 years with chronic pain, fibromyalgia and chronic fatigue disorders. INTERVENTION: Studies of the measurement properties of tests of physical capacity in people with chronic pain, fibromyalgia or chronic fatigue disorders were included. OUTCOME MEASURES: Studies were required to report: reliability coefficients (intraclass correlation coefficient, alpha reliability coefficient, limits of agreements and Bland-Altman plots); validity coefficients (intraclass correlation coefficient, Spearman's correlation, Kendal T coefficient, Pearson's correlation); or dropout rates. RESULTS: Fourteen studies were eligible: none had low risk of bias, 10 had unclear risk of bias and four had high risk of bias. The included studies evaluated: Åstrand test; modified Åstrand test; Lean body mass-based Åstrand test; submaximal bicycle ergometer test following another protocol other than Åstrand test; 2-km walk test; 5-minute, 6-minute and 10-minute walk tests; shuttle walk test; and modified symptom-limited Bruce treadmill test. None of the studies assessed maximal exercise tests. Where they had been tested, reliability and validity were generally high. Dropout rates were generally acceptable. The 2-km walk test was not recommended in fibromyalgia. CONCLUSION: Moderate evidence was found for reliability, validity and acceptability of submaximal exercise tests in patients with chronic pain, fibromyalgia or chronic fatigue. There is no evidence about maximal exercise tests in patients with chronic pain, fibromyalgia and chronic fatigue.