Madalina Jäger | University of Southern Denmark (original) (raw)
Papers by Madalina Jäger
Background To investigate the effect of behavioural interventions targeting lifestyle behaviours ... more Background To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes.Methods Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity following the Cochrane recommendations. Data sources included MEDLINE, EMBASE, CENTRAL and CINAHL up to June 19th, 2020 and screening reference list of Cochrane reviews including people with multimorbidity, ongoing systematic reviews of the MOBILIZE project, the WHO registry and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions on physical activity, weight loss, physical function and health-related quality of life and depression. Meta-regression analyses and effectivenes...
Pilot and Feasibility Studies
Background Exercise therapy is safe and effective in people with single conditions, but the feasi... more Background Exercise therapy is safe and effective in people with single conditions, but the feasibility in people with two or more conditions is unclear. Therefore, the aim was to evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomised, controlled trial (RCT). Methods This was a mixed-methods feasibility study performed in two general hospitals and one psychiatric hospital. 20 adult patients (8 females; mean age (SD) 67 (6.9)) with at least two long-term conditions and a score of ≥ 3 on Disease Burden Impact Scale for at least one condition (at least moderate limitations of daily activities) and of ≥ 2 for at least one other condition. Patients with unstable health conditions, at risk of serious adverse events (SAE) or with terminal conditions were excluded. Participants received 12 weeks of exercise (18 60-min group-based and 6 home-based sessions) and self-management support (6 90-min group-based sessions) supervised by ...
Pilot and Feasibility Studies
Background To our knowledge, there is no intervention which includes personalised exercise therap... more Background To our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity. Methods We followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention. Results The intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained ...
Journal of Multimorbidity and Comorbidity
Background Behavior change and exercise are considered critical for successful self-management in... more Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior...
International Journal of Behavioral Medicine
Background To investigate the effect of in-person delivered behavioural interventions in people w... more Background To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. Methods Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane ‘Risk of Bias Tool’ 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI −0.12–0.87) and the effect on weight loss was uncertain...
Journal of Comorbidity & Multimorbidity, 2022
Background Behavior change and exercise are considered critical for successful self-management in... more Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people's needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COMB model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a "burning platform." Subsequent deductive application of the COMB profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and selfmanagement support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.
BMJ Open, Apr 5, 2022
Introduction To enhance health and prevent secondary consequences for patients with cardiovascula... more Introduction To enhance health and prevent secondary consequences for patients with cardiovascular disease (CVD), maintenance of an active lifestyle following participation in cardiac rehabilitation (CR) is important. However, levels of physical activity often decrease after completion of a structured CR programme. Models that support long-term behaviour change with a sustained level of physical activity are imperative. The aim of this study is to evaluate the feasibility of a mobile health intervention based on the Health Action Process Approach theoretical model of behaviour change in patients with CVD for 3 months after completion of a CR programme. Methods and analysis In a feasibility trial design, we will recruit 40 participants from CR programmes at Slagelse Hospital, the City of Slagelse (municipality), or Holbaek Hospital. After completing the standard structured CR programme, each participant will create an action plan for physical activity together with a physiotherapist. Following that, participants are sent 2 weekly text messages for 3 months. The first text message prompts physical activity, and the second will check if the action plan has been followed. If requested by participants, a coordinator will call and guide the physical activities behaviour. The feasibility of this maintenance intervention is evaluated based on predefined progression criteria. Physical activity is measured with accelerometers at baseline and at 3 months follow-up. Ethics and dissemination Study approval was waived (EMN-2021-00020) by the Research Ethics Committee of Region Zealand, Denmark. Study results will be made public and findings disseminated to patients, health professionals, decision-makers, researchers and the public. Trial registration number NCT05011994.
Background: More than half of the elderly population lives with multiple chronic conditions (i.e.... more Background: More than half of the elderly population lives with multiple chronic conditions (i.e. multimorbidity). Physical activity is low in people with multimorbidity, although being a key behaviour for survival and overall health, alongside other lifestyle behaviours. However, the effect of behavioural interventions on behavioural, physical and psychosocial outcomes have not been summarised systematically in people with multimorbidity. Purpose: To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes. Methods: Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity defined as two or more of the following conditions: osteoarthritis (of the knee or hip), hypertension, type 2 d...
Additional file 1. PRISMA 2009 Checklist.
Additional file 2: Supplementary Figure 1. 'Risk of bias' summary shown as percentage of ... more Additional file 2: Supplementary Figure 1. 'Risk of bias' summary shown as percentage of 23 individual 'Risk of bias' items for each included study. Supplementary Table 1. Impact of covariates on recruitment and retention rates. Supplementary Table 2. Impact of covariates on differential retention rates. Supplementary Figure 2. Bubble plot for the impact of age (a) and proportion of included participants with hypertension (b) on retention rates.
Supplemental Material, PRISMA-P for The benefits and harms of therapeutic exercise on physical an... more Supplemental Material, PRISMA-P for The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review by Alessio Bricca, Lasse K Harris, Madalina Saracutu, Susan M Smith, Carsten B Juhl and Søren T Skou in Journal of Comorbidity
Supplemental Material, PubMed_search_strategy for The benefits and harms of therapeutic exercise ... more Supplemental Material, PubMed_search_strategy for The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review by Alessio Bricca, Lasse K Harris, Madalina Saracutu, Susan M Smith, Carsten B Juhl and Søren T Skou in Journal of Comorbidity
Ageing Research Reviews, 2020
International Journal of Osteopathic Medicine, 2018
Persistent pain is considered a complex biopsychosocial phenomenon whose understanding and manage... more Persistent pain is considered a complex biopsychosocial phenomenon whose understanding and management is yet to be improved. More research is needed to determine the common paths that lead to developing persistent pain, to identify the populations most at risk and to develop and evaluate interventions. The last decades have seen a shift in pain management, from the biomedical model to a biopsychosocial model. There is also a significant body of evidence emphasizing the effects of osteopathy in persistent pain management. Given the relevance of psychosocial factors in aetiology and maintenance of pain, it is essential to investigate whether osteopathy has an influence on depression, anxiety, fear avoidance or pain catastrophyzing. This review will identify and synthesize relevant primary research focused on the effects of osteopathic interventions on psychosocial factors in patients living with different pain conditions. Studies were identified by searching seven databases (Medline complete, CINAHL, Cochrane Library, Psychinfo, Psycharticles, Web of Science and Scopus) between 1980 and 2017. Peer reviewed articles reporting effects of: Osteopathic manual therapy, Osteopathic Manipulation, Mobilization, Spinal manipulation, high velocity and low amplitude manipulation, massage and soft tissue treatment were extracted. A total of 16 RCTs were selected. Two out of five reported significant differences in depression; in regards to anxiety, all the four trials found significant effects; two out of three trials reported a significant reduction in fear avoidance while six out of seven trials found a significant enhancement of health status and three out of four found an increase in quality of life. The findings of this review are encouraging; suggesting that osteopathic treatment may have some effects on anxiety, fear avoidance, quality of life and general health status in populations living with persistent pain.
BMJ Open, 2018
IntroductionPersistent pain affects a large percentage of the UK population and its burden has wi... more IntroductionPersistent pain affects a large percentage of the UK population and its burden has wide ramifications that affect physical, psychological, socioeconomic and occupational status. Pain has a significant impact on people’s well-being and quality of life. Some of the most common comorbidities found in this population are depression and anxiety and also maladaptive behaviours such as fear avoidance and catastrophising.Methods and analysisThis is a protocol for a study assessing the feasibility and acceptability of a novel Acceptance and Commitment Therapy (ACT)-based intervention for people from Southwest Wales who live with persistent pain. A group of 12 participants will be recruited through the Health and Wellbeing Academy (Swansea University). After being referred by an Osteopath, and attending a brief meeting with the researcher, the participants will take part in six sessions over six consecutive weeks. ‘A Mindful Act’ is an ACT-based group programme aiming to teach peo...
<sec> <title>BACKGROUND</title> <p>Mobile applications (Apps) offer an op... more <sec> <title>BACKGROUND</title> <p>Mobile applications (Apps) offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for Apps to be recommended in clinical practice, their quality and potential for behaviour change are important.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To investigate the quality and potential for behaviour change of health Apps for patients with a chronic condition or multimorbidity (defined as two or more chronic conditions).</p> </sec> <sec> <title>METHODS</title> <p>We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of Apps available in English or Danish on App Store and Google Play for patients with one or more of the following common and disabling conditions: osteoarthritis, heart condition (heart failure and ischaemic heart disease), hypertension, type 2 diabetes mellitus, depression and chronic obstructive pulmonary disease was conducted. The search strategy combined keywords related to these conditions. One author screened the title and content of the identified apps. Subsequently, three authors independently downloaded the Apps in a smartphone and assessed the quality of the Apps and their potential for behaviour change using the Mobile App Rating Scale (MARS-21 items, score ranging 0-5, higher is better) and the App Behavior Change Scale (ABACUS-21 items, score ranging 0-21, higher is better), respectively. We included the five highest-rated and the five most downloaded apps but only assessed the quality and potential for behaviour change of the free content.</p> </sec> <sec> <title>RESULTS</title> <p>We screened 453 Apps and ultimately included 60. Most of the Apps were available in both the App Store and Google Play (58%). The overall average quality of the Apps was 3.48 (SD 0.28) on the MARS scale, and the overall potential for behaviour change was 8.07 (SD 2.30) on the ABACUS scale. Apps for depression and patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common self-monitoring features presented in the Apps in support of behaviour change were physiological (e.g., blood pressure monitoring) in 64% of the Apps, weight/diet, or physical activity in 41% and 36%, respectively, and stress management in 37%. Only 14% of the Apps were completely free, while 86% had in-app-purchase for some content.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have a low-to-moderate potential for behaviour change. Our results provide a useful overview for patients and clinicians who would like to use Apps for managing chronic conditions and suggest the need to improve the Apps in terms of quality and potential for behaviour change.</p> </sec> <sec> <title>CLINICALTRIAL</title> <p>https://osf.io/nvhuy/</p> </sec>
International Journal of Osteopathic Medicine
Trials, 2021
Aim To quantify recruitment, retention and differential retention rates and associated trial, par... more Aim To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. Data sources MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020. Study selection RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms. Data extraction and synthesis Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects m...
The aim of this study is to investigate the benefits and harms of therapeutic exercise in people ... more The aim of this study is to investigate the benefits and harms of therapeutic exercise in people with multimorbidity defined as the combination of two or more of the following conditions: knee and hip osteoarthritis, hypertension, diabetes type 2, depression, heart failure, ischaemic heart disease and chronic obstructive pulmonary disease, by performing a systematic review of randomized controlled trials (RCTs). Methods: This study will be performed according to the recommendations from the Cochrane Collaboration and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We will search for RCTs investigating the effect of therapeutic exercise in multimorbidity, as defined above, in MEDLINE, EMBASE, CENTRAL and CINAHL from 1990. Cochrane reviews on the effect of therapeutic exercise for each of the aforementioned conditions and references of the included studies will be checked for eligible studies and citation tracking will be performed in Web of Science. We will assess the risk of bias of the included studies using the Cochrane 'Risk of Bias Tool' 2.0 and the Grading of Recommendations Assessment, Development and Evaluation assessment for judging the overall quality of evidence. Meta-analyses will be performed, if possible, using a random-effects model as heterogeneity is expected due to differences in interventions and participant characteristics and outcome measures. Subgroup and metaregression analyses will be performed to explore potential predictors of outcomes. Dissemination: The results of this systematic review will be published in a peer-review journal, presented at national and international conferences and made available to end users via infographics, podcasts, press releases and videos.
Background To investigate the effect of behavioural interventions targeting lifestyle behaviours ... more Background To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes.Methods Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity following the Cochrane recommendations. Data sources included MEDLINE, EMBASE, CENTRAL and CINAHL up to June 19th, 2020 and screening reference list of Cochrane reviews including people with multimorbidity, ongoing systematic reviews of the MOBILIZE project, the WHO registry and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions on physical activity, weight loss, physical function and health-related quality of life and depression. Meta-regression analyses and effectivenes...
Pilot and Feasibility Studies
Background Exercise therapy is safe and effective in people with single conditions, but the feasi... more Background Exercise therapy is safe and effective in people with single conditions, but the feasibility in people with two or more conditions is unclear. Therefore, the aim was to evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomised, controlled trial (RCT). Methods This was a mixed-methods feasibility study performed in two general hospitals and one psychiatric hospital. 20 adult patients (8 females; mean age (SD) 67 (6.9)) with at least two long-term conditions and a score of ≥ 3 on Disease Burden Impact Scale for at least one condition (at least moderate limitations of daily activities) and of ≥ 2 for at least one other condition. Patients with unstable health conditions, at risk of serious adverse events (SAE) or with terminal conditions were excluded. Participants received 12 weeks of exercise (18 60-min group-based and 6 home-based sessions) and self-management support (6 90-min group-based sessions) supervised by ...
Pilot and Feasibility Studies
Background To our knowledge, there is no intervention which includes personalised exercise therap... more Background To our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity. Methods We followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention. Results The intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained ...
Journal of Multimorbidity and Comorbidity
Background Behavior change and exercise are considered critical for successful self-management in... more Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior...
International Journal of Behavioral Medicine
Background To investigate the effect of in-person delivered behavioural interventions in people w... more Background To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. Methods Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane ‘Risk of Bias Tool’ 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI −0.12–0.87) and the effect on weight loss was uncertain...
Journal of Comorbidity & Multimorbidity, 2022
Background Behavior change and exercise are considered critical for successful self-management in... more Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people's needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COMB model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a "burning platform." Subsequent deductive application of the COMB profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and selfmanagement support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.
BMJ Open, Apr 5, 2022
Introduction To enhance health and prevent secondary consequences for patients with cardiovascula... more Introduction To enhance health and prevent secondary consequences for patients with cardiovascular disease (CVD), maintenance of an active lifestyle following participation in cardiac rehabilitation (CR) is important. However, levels of physical activity often decrease after completion of a structured CR programme. Models that support long-term behaviour change with a sustained level of physical activity are imperative. The aim of this study is to evaluate the feasibility of a mobile health intervention based on the Health Action Process Approach theoretical model of behaviour change in patients with CVD for 3 months after completion of a CR programme. Methods and analysis In a feasibility trial design, we will recruit 40 participants from CR programmes at Slagelse Hospital, the City of Slagelse (municipality), or Holbaek Hospital. After completing the standard structured CR programme, each participant will create an action plan for physical activity together with a physiotherapist. Following that, participants are sent 2 weekly text messages for 3 months. The first text message prompts physical activity, and the second will check if the action plan has been followed. If requested by participants, a coordinator will call and guide the physical activities behaviour. The feasibility of this maintenance intervention is evaluated based on predefined progression criteria. Physical activity is measured with accelerometers at baseline and at 3 months follow-up. Ethics and dissemination Study approval was waived (EMN-2021-00020) by the Research Ethics Committee of Region Zealand, Denmark. Study results will be made public and findings disseminated to patients, health professionals, decision-makers, researchers and the public. Trial registration number NCT05011994.
Background: More than half of the elderly population lives with multiple chronic conditions (i.e.... more Background: More than half of the elderly population lives with multiple chronic conditions (i.e. multimorbidity). Physical activity is low in people with multimorbidity, although being a key behaviour for survival and overall health, alongside other lifestyle behaviours. However, the effect of behavioural interventions on behavioural, physical and psychosocial outcomes have not been summarised systematically in people with multimorbidity. Purpose: To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes. Methods: Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity defined as two or more of the following conditions: osteoarthritis (of the knee or hip), hypertension, type 2 d...
Additional file 1. PRISMA 2009 Checklist.
Additional file 2: Supplementary Figure 1. 'Risk of bias' summary shown as percentage of ... more Additional file 2: Supplementary Figure 1. 'Risk of bias' summary shown as percentage of 23 individual 'Risk of bias' items for each included study. Supplementary Table 1. Impact of covariates on recruitment and retention rates. Supplementary Table 2. Impact of covariates on differential retention rates. Supplementary Figure 2. Bubble plot for the impact of age (a) and proportion of included participants with hypertension (b) on retention rates.
Supplemental Material, PRISMA-P for The benefits and harms of therapeutic exercise on physical an... more Supplemental Material, PRISMA-P for The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review by Alessio Bricca, Lasse K Harris, Madalina Saracutu, Susan M Smith, Carsten B Juhl and Søren T Skou in Journal of Comorbidity
Supplemental Material, PubMed_search_strategy for The benefits and harms of therapeutic exercise ... more Supplemental Material, PubMed_search_strategy for The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review by Alessio Bricca, Lasse K Harris, Madalina Saracutu, Susan M Smith, Carsten B Juhl and Søren T Skou in Journal of Comorbidity
Ageing Research Reviews, 2020
International Journal of Osteopathic Medicine, 2018
Persistent pain is considered a complex biopsychosocial phenomenon whose understanding and manage... more Persistent pain is considered a complex biopsychosocial phenomenon whose understanding and management is yet to be improved. More research is needed to determine the common paths that lead to developing persistent pain, to identify the populations most at risk and to develop and evaluate interventions. The last decades have seen a shift in pain management, from the biomedical model to a biopsychosocial model. There is also a significant body of evidence emphasizing the effects of osteopathy in persistent pain management. Given the relevance of psychosocial factors in aetiology and maintenance of pain, it is essential to investigate whether osteopathy has an influence on depression, anxiety, fear avoidance or pain catastrophyzing. This review will identify and synthesize relevant primary research focused on the effects of osteopathic interventions on psychosocial factors in patients living with different pain conditions. Studies were identified by searching seven databases (Medline complete, CINAHL, Cochrane Library, Psychinfo, Psycharticles, Web of Science and Scopus) between 1980 and 2017. Peer reviewed articles reporting effects of: Osteopathic manual therapy, Osteopathic Manipulation, Mobilization, Spinal manipulation, high velocity and low amplitude manipulation, massage and soft tissue treatment were extracted. A total of 16 RCTs were selected. Two out of five reported significant differences in depression; in regards to anxiety, all the four trials found significant effects; two out of three trials reported a significant reduction in fear avoidance while six out of seven trials found a significant enhancement of health status and three out of four found an increase in quality of life. The findings of this review are encouraging; suggesting that osteopathic treatment may have some effects on anxiety, fear avoidance, quality of life and general health status in populations living with persistent pain.
BMJ Open, 2018
IntroductionPersistent pain affects a large percentage of the UK population and its burden has wi... more IntroductionPersistent pain affects a large percentage of the UK population and its burden has wide ramifications that affect physical, psychological, socioeconomic and occupational status. Pain has a significant impact on people’s well-being and quality of life. Some of the most common comorbidities found in this population are depression and anxiety and also maladaptive behaviours such as fear avoidance and catastrophising.Methods and analysisThis is a protocol for a study assessing the feasibility and acceptability of a novel Acceptance and Commitment Therapy (ACT)-based intervention for people from Southwest Wales who live with persistent pain. A group of 12 participants will be recruited through the Health and Wellbeing Academy (Swansea University). After being referred by an Osteopath, and attending a brief meeting with the researcher, the participants will take part in six sessions over six consecutive weeks. ‘A Mindful Act’ is an ACT-based group programme aiming to teach peo...
<sec> <title>BACKGROUND</title> <p>Mobile applications (Apps) offer an op... more <sec> <title>BACKGROUND</title> <p>Mobile applications (Apps) offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for Apps to be recommended in clinical practice, their quality and potential for behaviour change are important.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To investigate the quality and potential for behaviour change of health Apps for patients with a chronic condition or multimorbidity (defined as two or more chronic conditions).</p> </sec> <sec> <title>METHODS</title> <p>We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of Apps available in English or Danish on App Store and Google Play for patients with one or more of the following common and disabling conditions: osteoarthritis, heart condition (heart failure and ischaemic heart disease), hypertension, type 2 diabetes mellitus, depression and chronic obstructive pulmonary disease was conducted. The search strategy combined keywords related to these conditions. One author screened the title and content of the identified apps. Subsequently, three authors independently downloaded the Apps in a smartphone and assessed the quality of the Apps and their potential for behaviour change using the Mobile App Rating Scale (MARS-21 items, score ranging 0-5, higher is better) and the App Behavior Change Scale (ABACUS-21 items, score ranging 0-21, higher is better), respectively. We included the five highest-rated and the five most downloaded apps but only assessed the quality and potential for behaviour change of the free content.</p> </sec> <sec> <title>RESULTS</title> <p>We screened 453 Apps and ultimately included 60. Most of the Apps were available in both the App Store and Google Play (58%). The overall average quality of the Apps was 3.48 (SD 0.28) on the MARS scale, and the overall potential for behaviour change was 8.07 (SD 2.30) on the ABACUS scale. Apps for depression and patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common self-monitoring features presented in the Apps in support of behaviour change were physiological (e.g., blood pressure monitoring) in 64% of the Apps, weight/diet, or physical activity in 41% and 36%, respectively, and stress management in 37%. Only 14% of the Apps were completely free, while 86% had in-app-purchase for some content.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have a low-to-moderate potential for behaviour change. Our results provide a useful overview for patients and clinicians who would like to use Apps for managing chronic conditions and suggest the need to improve the Apps in terms of quality and potential for behaviour change.</p> </sec> <sec> <title>CLINICALTRIAL</title> <p>https://osf.io/nvhuy/</p> </sec>
International Journal of Osteopathic Medicine
Trials, 2021
Aim To quantify recruitment, retention and differential retention rates and associated trial, par... more Aim To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. Data sources MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020. Study selection RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms. Data extraction and synthesis Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects m...
The aim of this study is to investigate the benefits and harms of therapeutic exercise in people ... more The aim of this study is to investigate the benefits and harms of therapeutic exercise in people with multimorbidity defined as the combination of two or more of the following conditions: knee and hip osteoarthritis, hypertension, diabetes type 2, depression, heart failure, ischaemic heart disease and chronic obstructive pulmonary disease, by performing a systematic review of randomized controlled trials (RCTs). Methods: This study will be performed according to the recommendations from the Cochrane Collaboration and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We will search for RCTs investigating the effect of therapeutic exercise in multimorbidity, as defined above, in MEDLINE, EMBASE, CENTRAL and CINAHL from 1990. Cochrane reviews on the effect of therapeutic exercise for each of the aforementioned conditions and references of the included studies will be checked for eligible studies and citation tracking will be performed in Web of Science. We will assess the risk of bias of the included studies using the Cochrane 'Risk of Bias Tool' 2.0 and the Grading of Recommendations Assessment, Development and Evaluation assessment for judging the overall quality of evidence. Meta-analyses will be performed, if possible, using a random-effects model as heterogeneity is expected due to differences in interventions and participant characteristics and outcome measures. Subgroup and metaregression analyses will be performed to explore potential predictors of outcomes. Dissemination: The results of this systematic review will be published in a peer-review journal, presented at national and international conferences and made available to end users via infographics, podcasts, press releases and videos.