Experiences of remote consultation in UK primary care for patients with mental health conditions: A systematic review.

Objectives: There has been a rapid shift from face-to-face to remote consultation across healthcare settings. 90% of patients with mental health conditions are cared for entirely in primary care. Remote consultation can present challenges and benefits for patients with mental health conditions. The aim of this systematic review was to collate and examine the evidence relating to remote consultation in UK primary care on the experiences of patients with mental health conditions. Methods: Six major databases were searched for empirical studies published in the English language between 1 January 2010 and 21 October 2022. Studies were included where remote consultation occurred between a patient and primary care clinician. Outcomes of interest include mode of remote consultation, patient experiences and characteristics. Final included studies were assessed for quality, and results analysed with narrative synthesis. Results: Six studies met the inclusion criteria, covering a range of mental health conditions and remote consultation modalities (telephone, video, online, email, text-based). Patients were overall satisfied with remote consultation, with particular benefit for certain mental health conditions or anxious patients. However, several studies found that face-to-face was the preferred method, with highlighted negatives to remote consultation, such as inflexibility of online formats. Acceptability of remote consultation is context specific and influenced by the purpose of the consultation and individual patient. Remote consultation may reduce anxiety in some patients, but is potentially less acceptable than face-to-face for relational appointments. Conclusions: Acceptability of remote consultation is context dependent. There is a lack of evidence surrounding patient characteristics and access to remote consultation.

GP's role in supporting women with anal incontinence after childbirth injury: a qualitative study.

BACKGROUND: Obstetric anal sphincter injury is the most common cause of anal incontinence for women, which often has profound impacts on women's lives. GPs offer a first line of contact for many women, but we know that very few women experiencing anal incontinence postnatally report discussing it with their GPs. AIM: To identify key ways in which GPs can support women with anal incontinence caused by childbirth injuries. DESIGN AND SETTING: A qualitative study investigating women's experiences with their GP, and GPs' perspectives about providing such care. METHOD: This qualitative study combined two phases: first, a series of in-depth semi-structured interviews with women experiencing anal incontinence caused by childbirth injuries (n = 41); and second, focus groups with GPs (n = 13) stratified by experience. Thematic analysis was conducted and relevant themes from across the two datasets were examined. RESULTS: Mediating factors in GP care for women with anal incontinence caused by childbirth injuries centred around three key themes: the role of the GP, access and pathways, and communication. CONCLUSION: The findings demonstrate multifactorial challenges in identifying the problem and supporting women experiencing anal incontinence after childbirth injury in primary care settings. Many GPs lacked confidence in their role in supporting women, and women were often reluctant to seek help. Those women who did seek help often experienced frustrations consulting with their GPs. In a context where women are often reluctant to ask for help, their concerns are not always taken seriously, and where GPs do not routinely ask about anal incontinence, potential anal incontinence after childbirth injury appears to be often missed in a primary care setting.

Women's experiences of anal incontinence following vaginal birth: A qualitative study of missed opportunities in routine care contacts.

OBJECTIVES: This study aimed to explore experiences of women with anal incontinence following a childbirth injury, and to identify areas of missed opportunities within care they received. DESIGN: This is a qualitative study involving semi-structured interviews. SETTING: Participants were recruited via five hospitals in the UK, and via social media adverts and communication from charity organisations. PARTICIPANTS: Women who have experienced anal incontinence following a childbirth injury, either within 7 years of sustaining the injury, or if they identified new, or worsening symptoms of AI at the time of menopause. MAIN OUTCOME MEASURES: Main outcomes are experiences of women with anal incontinence following childbirth injury, and missed opportunities within the care they received. RESULTS: The following main themes were identified: opportunities for diagnosis missed, missed opportunities for information sharing and continuity and timeliness of care. CONCLUSIONS: Anal Incontinence following a childbirth injury has a profound impact on women. Lack of information and awareness both amongst women and healthcare professionals contributes to delays in accurate diagnosis and appropriate treatment.

Use of a pharmacy-based GP video consultation service: a mixed methods study.

BACKGROUND: Little is known about private general practice appointment services offered via video. This study aimed to explore which patients are using a video pharmacy-based general practitioner (GP) appointment service, including patterns of use, reasons for using the service, and satisfaction with the service. METHODS: Descriptive statistics and parametric and nonparametric tests were used to conduct a retrospective cross-sectional analysis of routinely collected data on consultations, and postconsultation questionnaires. Interviews were conducted with patients and GPs. RESULTS: A total of 7,928 consultations were included in the analysis. More than half of appointments were booked for the same day, with lunchtime appointments being popular. The most common health condition was respiratory conditions, and 9% of consultations were used by patients using the service more than once. At least one prescription was issued in over half of all consultations. Overall, satisfactions of consultations were high. CONCLUSIONS: The characteristics of those patients using the video consultation service match data on who uses online services in general practice. This study shows that some patients are willing to pay to use this private service because they feel it is more convenient, NHS services do not have capacity to see them at the time they need, or they do not have access to regular GP services.

Over recent years, improvements in technology have made video and telephone general practitioner (GP) appointments more popular, and the Covid-19 pandemic has increased the need for these. There are lots of companies offering private GP appointments over video, but we do not yet know much about these, or why some people choose them over traditional GP appointments. This research aimed to find out which groups of people chose to use one private service that offers GP appointments over video in pharmacies, and why they chose to use it. The service has medical equipment (such as blood pressure monitor and camera) that can be used during the video GP appointment. Information was collected about 7,928 appointments in the time the study looked at, and 10 GPs that provide appointments, and 9 patients that used the service were interviewed to find out how they felt about it. Patients using this service were satisfied with their appointment, and were satisfied with the Doctor they saw. Reasons they chose to use the service included that they could be seen quicker than their normal GP, or at a time that was more convenient to them.

Effectiveness of a Digital Intervention in Increasing Flu Vaccination-Related Risk Appraisal, Intention to Vaccinate and Vaccination Behaviour Among Pregnant Women.

BACKGROUND: Pregnant women are at increased risk of complications from flu, but uptake of flu vaccination is below 75% targets. Evidence suggests that changing illness risk appraisals may increase vaccination behaviour. In 2018-2019, researchers, public health specialists, and pregnant women co-designed a short animation targeting (unhelpful) beliefs underlying pregnant women's flu risk appraisals aiming to promote vaccination uptake. AIMS: This study aimed to examine effectiveness of a digital intervention (animation) in increasing flu vaccination among pregnant women through changing illness risk appraisals. METHOD: A prospective study design was used, involving convenience sampling of unvaccinated pregnant women recruited via a Qualtrics Online Panel. Participants received small payments via the panel for survey completion. Risk appraisals and intention to vaccinate were measured at baseline and immediately after intervention presentation (follow-up one). Six months later, a further survey (follow-up two) was administered measuring vaccination behaviour. RESULTS: Baseline and first follow-up surveys were completed by 411 participants. Watching the animation led to increased appraisals of likelihood of getting flu while pregnant and severity of flu during pregnancy, and increased intentions to accept flu vaccination during pregnancy. Of the 67 respondents who completed follow-up survey two, 38 reported having the vaccination while pregnant. CONCLUSIONS: This study provides evidence supporting the promise of the intervention. Randomized controlled trials are required to produce definitive efficacy evidence. Should such a study prove intervention effectiveness, it could be readily embedded within existing campaigns at national and local levels by public health organizations.

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists' Adherence, Beliefs, and Perspectives.

Purpose: Physiotherapists are key providers of care for patients with low back pain (LBP); however, information on Canadian physiotherapists' use of evidence-based clinical practice guidelines (EBCPGs) for LBP is lacking. We aimed to (1) describe Canadian physiotherapists' adherence to EBCPGs for LBP; (2) compare beliefs and attitudes of physiotherapists with higher and lower adherence; (3) identify predictors of adherence; and (4) gather physiotherapists' perceptions about the care provided to patients with LBP. Method: This mixed methods study involved two phases: (1) a survey containing a LBP clinical scenario and (2) qualitative semi-structured interviews with physiotherapists. Results: A total of 406 (77%) of the 525 survey respondents demonstrated higher adherence (score of 3 or 4) to EBCPGs; however, only 29.5% chose interventions to address psychosocial issues. Postgraduate training was the strongest predictor of higher adherence. Interviewed physiotherapists reported being highly satisfied with the care provided to patients with LBP even when psychosocial issues are present, despite low confidence in addressing those issues. Conclusions: Although overall adherence was high, Canadian physiotherapists do not frequently address psychosocial issues with LBP patients, and often do not feel confident or competent in that aspect of practice. This suggests an opportunity for developing additional training for addressing psychosocial issues in LBP patients.

Objectif : les physiothérapeutes sont d'importants dispensateurs de soins aux patients souffrant de douleur lombaire (DL), mais on ne possède pas d'information sur l'utilisation que font les physiothérapeutes canadiens des directives cliniques fondées sur des données probantes (DCFDP) à l'égard des DL. Les chercheurs visaient à 1) décrire l'adhésion des physiothérapeutes canadiens aux DCFDP à l'égard des DL; 2) comparer les croyances et les attitudes des physiothérapeutes à l'égard d'une adhésion plus élevée ou plus faible; 3) déterminer les prédicteurs de l'adhésion et 4) colliger les perceptions des physiothérapeutes au sujet des soins fournis aux patients ayant une DL. Méthodologie : la présente étude à méthodologie mixte a été réalisée en deux phases : 1) un sondage contenant un scénario clinique de DL et 2) une entrevue semi-structurée qualitative avec des physiothérapeutes. Résultats : au total, 406 des 525 répondants au sondage (77 %) ont démontré une plus grande adhésion (score de 3 ou 4) aux DCFDP; cependant, seulement 29,5 % ont choisi des interventions pour tenir compte des enjeux psychosociaux. Des études supérieures étaient le plus fort prédicteur d'une plus forte adhésion. Les physiothérapeutes interviewés ont déclaré être très satisfaits des soins administrés aux patients souffrant de DL, même en présence d'enjeux psychosociaux, et ce, malgré leur peu de confiance à aborder ces enjeux. Conclusions : même si l'adhésion totale était élevée, les physiothérapeutes canadiens n'abordaient pas souvent les enjeux psychosociaux auprès des patients souffrant de DL et ils ne se sentent souvent ni confiants ni compétents à l'égard de cet aspect de la pratique. Ce constat est une occasion de préparer des formations supplémentaires pour aborder les enjeux psychosociaux chez les patients souffrant de DL.

Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review.

Purpose: Multiple Canadian jurisdictions have curtailed public funding for outpatient physiotherapy services, impacting access and potentially creating or worsening inequities in access. We sought to identify evaluated organizational strategies that aimed to improve access to physiotherapy services for community-dwelling persons. Method: We used Arksey and O'Malley's scoping review methods, including a systematic search of CINAHL, MEDLINE, and Embase for relevant peer-reviewed texts published in English, French, or German, and we performed a qualitative content analysis of included articles. Results: Fifty-one peer-reviewed articles met inclusion criteria. Most studies of interventions or system changes to improve access took place in the United Kingdom (17), the United States (12), Australia (9), and Canada (8). Twenty-nine studies aimed to improve access for patients with musculoskeletal conditions; only five studies examined interventions to improve equitable access for underserved populations. The most common interventions and system changes studied were expanded physiotherapy roles, direct access, rapid access systems, telerehabilitation, and new community settings. Conclusions: Studies evaluating interventions and health system changes to improve access to physiotherapy services have been limited in focus, and most have neglected to address inequities in access. To improve equitable access to physiotherapy services in Canada, physiotherapy providers in local settings can implement and evaluate transferable patient-centred access strategies, particularly telerehabilitation and primary care integration.

Objectif : de multiples régions sociosanitaires canadiennes ont limité le financement des services de physiothérapie ambulatoires, ce qui a des conséquences sur l'accès et qui risque de créer ou d'aggraver les inégalités en matière d'accès. Les chercheurs ont cherché à définir les stratégies organisationnelles évaluées afin d'améliorer l'accès aux services de physiothérapie pour les personnes qui vivent dans la communauté. Méthodologie : les chercheurs ont utilisé les méthodologies d'étude de portée, y compris des recherches systématiques dans les bases de données CINAHL, MEDLINE et Embase pour en extraire les textes révisés par un comité de lecture publiés en anglais, en français ou en allemand, et ont effectué une analyse qualitative du contenu des articles extraits. Résultats : au total, 51 articles révisés par un comité de lecture respectaient les critères d'inclusion. La plupart des études sur les interventions ou les changements systémiques visant à améliorer l'accès ont été réalisées au Royaume-Uni (17), aux États-Unis (12), en Australie (9) et au Canada (8). Ainsi, 29 études ont visé à améliorer l'accès aux patients atteints d'affections musculosquelettiques; seulement cinq ont porté sur des interventions pour améliorer l'accès équitable aux populations mal desservies. Les interventions et les changements systémiques les plus courants étudiés dans le présent article ont entraîné un élargissement des rôles physiothérapiques, des systèmes d'accès direct, de la téléréadaptation et de nouveaux milieux communautaires. Conclusions :les études sur les interventions et les changements aux systèmes de santé pour améliorer l'accès aux services physiothérapiques ont eu une portée limitée, et la plupart ont négligé d'aborder les inégalités en matière d'accès. Pour améliorer un accès équitable aux services physiothérapiques au Canada, les dispensateurs de soins physiothérapiques locaux peuvent adopter et évaluer des stratégies d'accès transférables axées sur les patients, notamment la téléréadaptation et l'intégration des soins de première ligne.

Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba.

Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.

Objectif : un financement tant public que privé couvre les services ambulatoires de physiothérapie au Canada. On ne sait pas qui y a accès ou non, ce qui limite la possibilité de déterminer les iniquités en matière de santé et d'accès attribuables aux structures actuelles de financement. La présente étude caractérise les personnes qui accèdent à des services de physiothérapie privés à Winnipeg, afin de mieux comprendre s'il existe des iniquités, compte tenu des services de physiothérapie très limités qui sont financés par le secteur public. Méthodologie : des patients recevant des services de physiothérapie dans 32 entreprises privées, échantillonnées d'après leur variation géographique, ont rempli un sondage en ligne ou sur papier. Les chercheurs ont comparé les caractéristiques démographiques de l'échantillon aux données populationnelles de Winnipeg au moyen de tests du chi carré pour la qualité de l'ajustement. Résultats : au total, 665 adultes qui avaient accès à des services de physiothérapie ont participé. Ils étaient plus âgés et avaient un revenu et une scolarisation supérieurs aux données du recensement de Winnipeg (p < 0,001). L'échantillon contenait une plus forte proportion de femmes et de personnes blanches, et une plus faible proportion de personnes autochtones, de nouveaux arrivants et de membres des minorités visibles (p < 0,001). Conclusions : il y a des signes d'iniquité d'accès aux services de physiothérapie à Winnipeg. La cohorte qui a accès aux services de physiothérapie privés ne reflète pas l'ensemble de la population, ce qui indique que certains segments de la population ne reçoivent pas de soins.

Collaboration between primary care and a voluntary, community sector organisation: Practical guidance from the parkrun practice initiative.

Voluntary and community sector organisations are increasing their role in supporting primary care services through 'social prescribing'. parkrun is a charity that delivers free, weekly 5 km events, on a Saturday morning in areas of open space across the UK and globally. In June 2018, parkrun and the Royal College of General Practitioners launched an initiative to encourage the linking of general practitioner practices and local parkrun events. This study investigates the interaction between parkrun events and practices in order to understand why and how parkrun events' promote such linkage, and their experiences of doing so. Its purpose was to provide practical recommendations for developing the parkrun practice initiative and similar collaborations between primary care and voluntary and community sector organisations. An online survey, which included both tick box questions and free text comments was sent to Event Directors for all UK parkrun events and completed by half (322/634, 50.8%). Over two-thirds (225/322; 69.6%) of the event teams were knowingly linked with one or more general practices; and this was generally viewed as having been a positive experience and was motivated by wanting to positively impact on the health and well-being of their community. Challenges centred on the process of initiating contact between parkrun events and practices; the lack of time among parkrun event volunteers to promote the scheme; and the difficulty of clarifying parkrun event and practice responsibilities, including who takes the lead. Practical recommendations include: ensuring clear pathways of communication between event teams and practices (e.g. via a Link Worker or designated person within the practice and/or parkrun event); minimising resource implications and ensuring mutual understanding from practices and parkrun event teams as to expected roles and involvement. Our findings, while focused on the parkrun practice initiative, are likely to have relevance to other collaborations between primary care and voluntary and community sector organisations.

The development of a digital intervention to increase influenza vaccination amongst pregnant women.

OBJECTIVE: Pregnant women and unborn babies are at increased risk of complications from influenza, including pneumonia, yet in the UK, uptake of flu vaccination amongst this population remains <50%. Pregnant women hold beliefs about risks of flu and efficacy of vaccination that consistently predict them to decline vaccination. This study aimed to develop a theory and evidence-based intervention addressing these beliefs to promote flu vaccine uptake. METHODS: The intervention was developed by behavioural scientists, pregnant women, midwives, clinicians and Public Health professionals, informed by Intervention Mapping. Six predefined steps were performed in line with Intervention Mapping. RESULTS: The intervention is an animation addressing beliefs about risks of flu and efficacy of vaccination. Preliminary testing using qualitative methodology indicates the information within the animation is appropriate, and the animation is acceptable to pregnant women. CONCLUSIONS: This is the first known intervention for pregnant women, aiming to increase flu vaccination through addressing risk and efficacy appraisals. It has been implemented within seasonal flu vaccination campaigns during 2018/19 and 2019/20 within one geographically and ethnically diverse area of the UK.

Anterior cruciate ligament injury: towards a gendered environmental approach.

BACKGROUND: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. OBJECTIVE: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. APPROACH: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. CONCLUSION: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.

Which patients miss appointments with general practice and the reasons why: a systematic review.

BACKGROUND: Missed GP appointments have considerable time and cost implications for healthcare services. AIM: This systematic review aims to explore the rate of missed primary care appointments, what the reported reasons are for appointments being missed, and which patients are more likely to miss appointments. DESIGN AND SETTING: This study reports the findings of a systematic review. The included studies report the rate or reasons of missed appointments in a primary care setting. METHOD: Databases were searched using a pre-defined search strategy. Eligible studies were selected for inclusion based on detailed inclusion criteria through title, abstract, and full text screening. Quality was assessed on all included studies, and findings were synthesised to answer the research questions. RESULTS: A total of 26 studies met the inclusion criteria for the review. Of these, 19 reported a rate of missed appointments. The mean rate of missed appointments was 15.2%, with a median of 12.9%. Twelve studies reported a reason that appointments were missed, with work or family/childcare commitments, forgetting the appointment, and transportation difficulties most commonly reported. In all, 20 studies reported characteristics of people likely to miss appointments. Patients who were likely to miss appointments were those from minority ethnicity, low sociodemographic status, and younger patients (<21 years). CONCLUSION: Findings from this review have potential implications for targeted interventions to address missed appointments in primary care. This is the first step for clinicians to be able to target interventions to reduce the rate of missed appointments.

Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis.

Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n = 5624) that assessed changes in self-efficacy and were included in a random-effects meta-analysis. Interventions targeted: healthy eating (k = 4), physical activity (k = 9), sexual behaviour (k = 3) and smoking (k = 4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (g¯=0.190,CI[0.078;0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Q-between = 7.3704, p = .061, df = 3). Inclusion of the BCT 'information about social and environmental consequences' had a small, negative effect on self-efficacy (Δg¯=-0.297,Q=7.072,p=.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.

Staff and Users' Experiences of Pharmacy-Based Sexual and Reproductive Health Services: A Qualitative Interview Study from the UK.

Since August 2015, a large range of sexual health and reproductive health services have been provided in more than 120 pharmacies across Birmingham (England). Our study aimed to explore how pharmacy staff and pharmacy users experience delivering or being provided with sexual health and reproductive health services. Between March and September 2019, semi-structured interviews were conducted with 15 pharmacy staff delivering sexual and reproductive health services and 15 people who had used a sexual and reproductive health service at the pharmacy. Interviews were analysed thematically. Pharmacy users found services convenient to use and were largely satisfied with pharmacy staff consultation skills. Staff were motivated to deliver the services, although some felt that they did not receive sufficient recognition for their work. Barriers to pharmacy-based sexual and reproductive health services were identified, including lack of privacy for users, lack of staff and user awareness of the services, lack of trained staff to deliver services and lack of capacity for copper coil insertions in females presenting for emergency contraception. The identification of barriers to effective service provision can be used to improve the delivery of sexual and reproductive health services in pharmacies and lead to a greater uptake.

Operational Considerations for Physical Therapy During COVID-19: A Rapid Review.

OBJECTIVE: Physical therapists play an important role in responding to pandemic and physical disaster situations. Existing literature can provide guidance to health care leadership teams to appropriately and safely leverage physical therapy resources and skill sets during the COVID-19 pandemic. The purpose of this study was to provide a review of the pandemic and physical disaster management literature to summarize physical therapy-specific operational considerations to assist hospital-based leadership teams in planning and response efforts during the COVID-19 pandemic. METHODS: A rapid review was conducted over a 4-week time frame (April-May 2020). The review team included 3 physical therapist clinician researchers, a health librarian, and a member of the physical therapy leadership team. The initial search strategy identified 303 articles, 80 of which were retained for full-text screening. Twenty articles were included in the review. RESULTS: Five main categories of operational considerations for physical therapy during the COVID-19 pandemic were identified: (1) organizational actions, (2) staffing considerations, (3) physical therapist roles, (4) physical resources, and (5) other considerations. Additional relevant information from physical therapists' experiences in physical disaster situations was also summarized. CONCLUSION: The evidence presented within this review can be used to inform facility-based and regional planning efforts during the current COVID-19 pandemic and in general preparedness planning. IMPACT: Physical therapists have an important role to play in response efforts related to major events that impact health and wellness, including the COVID-19 pandemic. Evidence-informed, facility-based, and regional planning during the current COVID-19 pandemic will help physical therapists enhance their role in treating patients in physical therapy and rehabilitation settings.

Engagement with and delivery of the 'parkrun practice initiative' in general practice: a mixed methods study.

BACKGROUND: The parkrun practice initiative, a joint collaboration between parkrun and the Royal College of General Practitioners, was launched to encourage general practices to improve the health and wellbeing of patients and staff through participating in local 5 km parkrun events. Why and how practices engage with the initiative is unknown. AIM: To investigate engagement with and delivery of the parkrun practice initiative in general practice. DESIGN AND SETTING: Mixed methods study conducted from April-July 2019 comprising an online survey of all registered parkrun practices, and interviews and a focus group with practice staff in the West Midlands. METHOD: The designated contacts at 780 registered parkrun practices were invited to complete an online survey. A purposive sample of parkrun practice staff and non-registered practice staff took part either in semi-structured interviews or a focus group, with transcripts analysed thematically. RESULTS: Of the total number of parkrun practices, 306 (39.2%) completed the survey. Sixteen practice staff (from nine parkrun practices and four non-registered practices) took part in either semi-structured interviews (n = 12) or a focus group (n = 4). Key motivators for becoming a parkrun practice were: to improve patient and staff health and wellbeing, and to become more engaged with the community and enhance practice image. Practices most commonly encouraged patients, carers, and staff to take part in parkrun and displayed parkrun flyers and posters. Challenges in implementing activities included lack of time (both personal and during consultations) and getting staff involved. Where staff did engage there were positive effects on morale and participation. Non-registered practices were receptive to the initiative, but had apprehensions about the commitment involved. CONCLUSION: Practices were keen to improve patient and staff health. Addressing time constraints and staff support needs to be considered when implementing the initiative.

How effective are digital interventions in increasing flu vaccination amongst pregnant women? A systematic review protocol.

BACKGROUND: Pregnant women and their unborn babies are at increased risk of complications as a result of flu, yet uptake of the flu vaccination in the UK remains low. Digital interventions have proven effectiveness in changing health behaviour, but their effectiveness in increasing flu vaccination amongst pregnant women has not been examined. This protocol details the design and methodology of a systematic review and meta-analysis, examining the effectiveness of digital interventions in increasing flu vaccination amongst pregnant women. METHODS: Bibliographic databases will be searched using appropriate search terms related to vaccination, pregnancy and flu. Randomised, non-randomised, quasi randomised controlled trials and other quantitative study designs will be eligible for inclusion, and studies will present the rate of flu vaccination amongst pregnant women of digital interventions compared to non-digital interventions, or usual care. No date or study country restrictions will be put on included studies, but studies will be published in English. DISCUSSION: This is the first known systematic review to examine the effectiveness of digital interventions in increasing the rate of flu vaccination amongst pregnant women. This review has the potential to inform whether digital interventions are an appropriate and successful method of increasing flu vaccination amongst pregnant women, and to determine which mode of digital intervention is most effective. TRIAL REGISTRATION: This systematic review is registered on the international prospective register of systematic reviews (PROSPERO). Registration number pending.

ATHLETE PERCEPTIONS AND PHYSICAL PERFORMANCE EFFECTS OF THE FIFA 11 + PROGRAM IN 9-11 YEAR-OLD FEMALE SOCCER PLAYERS: A CLUSTER RANDOMIZED TRIAL.

BACKGROUND: Strong evidence supports the use of the FIFA 11 + injury risk reduction warm-up program among soccer players, but few studies have investigated its impact on physical performance and movement control in athletes younger than 12 years of age, or the athletes' opinions of participating in the program. PURPOSE: The primary purpose of this study was to measure the impact of the FIFA 11 + program on movement control [Landing Error Scoring System (LESS) and Y-Balance test (YBT)], agility, vertical jump (VJ) height, and trunk muscle endurance compared to a standard warm-up in pre-teen female athletes over one indoor soccer season. A secondary purpose was to assess the athletes' tolerance and enjoyment of the program. STUDY DESIGN: Cluster randomized controlled trial. METHODS: All six teams in the U10 and U11 female divisions of a developmental-level soccer club were cluster randomized to the FIFA 11 + program intervention group or the control group. Participants in the control group continued with a coach-determined warm-up for the duration of a five-month indoor soccer season. Pre- and post-season participants underwent physical testing using the agility T-test, Belt Mat vertical jump (VJ), and static plank tests; and two measures of neuromuscular control (LESS, YBT). Following the soccer season, the athletes in the intervention group also completed a bespoke Tolerance and Enjoyment questionnaire. RESULTS: The 11 + group (n = 25) increased their mean static plank hold time by 26.1 ± 38.5 seconds compared to the control group (n = 18), who only increased by 2.1 ± 37.1 seconds (p = 0.047). For all athletes, there were improvements in mean LESS score (0.6 ± 1.3, p = 0.003), and T-test time (0.4 ± 0.7, p = 0.001); however, YBT scores worsened by approximately 2% from pre- to postseason. No differences were found for VJ. Athletes tolerated the program well, but the majority described the enjoyment of completing the program as moderately low. CONCLUSION: This study suggests that the 11 + program may improve some aspects of physical performance in 9-11 year-old female soccer players, but the low enthusiasm for the program could have longer term adherence implications. LEVEL OF EVIDENCE: 2b.

Functional fitness for dental hygiene students: Does it make them fit to sit?

Background: Static positioning and awkward postures put dental hygienists at risk for work-related musculoskeletal disorders. These disorders often appear during professional training programs. Ergonomics education has been shown to reduce the incidence of injuries, but fitness training to improve postural awareness and endurance is not typically included in dental hygiene curricula. This study assessed the effects of a 12-week functional fitness training program on ergonomic and postural knowledge, outcome expectations and self-efficacy related to exercise, and core stability in final-year dental hygiene students. Methods: Participants (n = 24) completed surveys and core stability tests and demonstrated postural movements before and after completing a mandatory weekly training program focusing on dynamic core stabilization, aerobic exercise, and postural awareness. Results: Participants improved static plank hold time and left leg forward lunge scores, with no significant changes in right lunge or stability push-up tests. Accuracy in demonstrating postural movements in response to verbal cues improved for 2 of 6 movements. Knowledge about injury risk factors and body mechanics was relatively high at pre-test and did not change post-test. Outcome expectations and self-efficacy were not significantly different from pre- to post-test. Conclusions: Functional fitness training resulted in increased core endurance and improved execution of some movement patterns associated with good body mechanics. Our study provides evidence for the inclusion of this type of conditioning program in the dental hygiene curriculum. Further research, including more sensitive tests of physical function as well as the transfer of knowledge and safe postures into clinically relevant situations, is warranted.

Contexte: Le positionnement statique et les mauvaises postures mettent les hygiénistes dentaires à risque de troubles musculosquelettiques liés au travail. Ces troubles surviennent souvent au cours des programmes de formation professionnelle. Il a été démontré que la formation en matière d'ergonomie réduit l'incidence des blessures, alors que le conditionnement physique effectué pour améliorer la prise de conscience posturale et l'endurance ne fait généralement pas partie du programme d'étude en hygiène dentaire. La présente recherche a évalué les effets d'un programme de conditionnement physique fonctionnel de 12 semaines sur les connaissances en matière de l'ergonomie et de la posture, des attentes de résultats, de la connaissance de ses propres capacités liées à l'exercice, ainsi que de la stabilité du tronc chez les étudiants de dernière année en hygiène dentaire. Méthodologie: Les participants (n = 24) ont rempli des sondages, effectué des tests de stabilité du tronc et démontré des mouvements posturaux avant et après avoir terminé une formation hebdomadaire obligatoire axée sur la stabilisation dynamique du tronc, les exercices aérobiques et la prise de conscience posturale. Résultats: Les participants ont amélioré leurs résultats de temps de planche statique et de l'exercice de fente avant de la jambe gauche et n'ont pas montré de changements significatifs dans leurs tests d'exercice de fente avant de la jambe droite ou de répulsions, des exercices de stabilisation du tronc. La précision des mouvements posturaux en réponse aux stimulations verbales s'est améliorée dans 2 des 6 mouvements. Les connaissances sur les facteurs de risque en matière des blessures et sur la mécanique du corps étaient relativement élevées au moment du test préliminaire et n'ont pas changé après le test. Les attentes de résultats et la connaissance de ses propres capacités n'étaient pas significativement différentes entre le test préliminaire et le post-test. Conclusions: Le conditionnement physique fonctionnel s'est traduit en une meilleure endurance du tronc et une performance améliorée de certaines séquences de mouvements associés à la bonne fonction mécanique du corps. Notre étude apporte des preuves qui appuient l'ajout de ce type de programme de conditionnement au programme d'hygiène dentaire. Il est justifié de faire des recherches plus poussées, y compris des évaluations plus sensibles de la fonction physique, ainsi que du transfert des connaissances et des postures sécuritaires aux situations cliniques pertin.

Do interventions containing risk messages increase risk appraisal and the subsequent vaccination intentions and uptake? - A systematic review and meta-analysis.

PURPOSE: There is good evidence that for many behaviours, increasing risk appraisal can lead to a change in behaviour, heightened when efficacy appraisals are also increased. The present systematic review addressed whether interventions presenting a risk message increase risk appraisal and an increase in vaccination intentions and uptake. METHOD: A systematic search identified randomized controlled trials of interventions presenting a risk message and measuring risk appraisal and intentions and uptake post-intervention. Random-effects meta-analyses investigated the size of the effect that interventions had on vaccination risk appraisal and on vaccination behaviour or intention to vaccinate, and the size of the relationship between vaccination risk appraisal and vaccination intentions and uptake. RESULTS: Eighteen studies were included and 16 meta-analysed. Interventions overall had small significant effects on risk appraisal (d = 0.161, p = .047) and perceptions of susceptibility (d = 0.195, p = .025), but no effect on perceptions of severity (d = -0.036, p = .828). Interventions showed no effect on intention to vaccinate (d = 0.138, p = .195) and no effect on vaccination behaviour (d = 0.043, p = .826). Interventions typically did not include many behaviour change techniques (BCTs), with the most common BCT unique to intervention conditions being 'Information about Health Consequences'. Few of the included studies attempted to, or successfully increased, efficacy appraisals. CONCLUSIONS: Overall, there is a lack of good-quality primary studies, and existing interventions are suboptimal. The inclusion of additional BCTs, including those to target efficacy appraisals, could increase intervention effectiveness. The protocol (CRD42015029365) is available from http://www.crd.york.ac.uk/PROSPERO/. Statement of contribution What is already known on this subject? Previous research indicates that an increase in risk appraisal is associated with increased uptake in health-related behaviours. Research suggests that interventions increasing risk appraisal have a greater effect on intention when elements of efficacy appraisals are simultaneously increased. What does this study add? This is the first systematic review to examine the effect of interventions on risk appraisal and vaccination uptake using only experimental studies. Limitations of the interventions themselves, and those caused by study methods and reporting, mean that the potential value of this type of review is lost. Instead, its value is in shining a light on the paucity of experimental studies in this area, and the quality of methods and reporting used. Future experimental studies should examine interventions that focus exclusively on increasing risk and efficacy appraisal compared to controls, use conditional measures of risk, and improve reporting to enable both more accurate coding of intervention content and more accurate assessments of study bias.