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3. Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain

Author

McLaughlin, Kevin H., Fritz, Julie M., Minick, Kate I., Brennan, Gerard P., McGee, Terrence, Lane, Elizabeth, Thackeray, Anne, Bardsley, Tyler, Wegener, Stephen T., Hunter, Stephen J., and Skolasky, Richard L.

Subjects
Care and treatment, Evaluation, Prevention, Complications and side effects, Patient outcomes, Low back pain -- Care and treatment -- Patient outcomes, Telemedicine -- Evaluation, Physical therapy -- Complications and side effects -- Patient outcomes, COVID-19 -- Prevention, Therapeutics, Physiological -- Complications and side effects -- Patient outcomes
Abstract

Introduction During the early phases of the coronavirus disease-2019 (COVID-19) pandemic, state and federal policies were modified, allowing many physical therapists in the United States to begin providing care through [...], Objective. The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods. This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a [greater than or equal to]50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results. Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion. Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact. This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach. Keywords: Patient-Centered Care, Precision Medicine, Risk Factors, Telemedicine

Published
2024
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8. Protocol for a Parallel Group Randomized Clinical Trial Comparing a Culturally Adapted Cognitive Behavioral Telerehabilitation Intervention to Usual Physical Therapy for Latino Patients With Chronic Spine Pain

Author

Gombatto, Sara P., Archer, Kristin R., Wegener, Stephen T., Hernandez, Yessenia, Lin, Shih-Fan, Godino, Job, Dyke, Jason Van, Liu, Jie, and Monroe, Katrina S.

Subjects
Diagnosis, Care and treatment, Social aspects, Economic aspects, Prevention, Demographic aspects, Patient outcomes, Low back pain -- Diagnosis -- Care and treatment, Medical care discrimination -- Prevention, Physical therapy -- Patient outcomes, Health care disparities -- Demographic aspects -- Social aspects -- Economic aspects, Discrimination in medical care -- Prevention, Therapeutics, Physiological -- Patient outcomes
Abstract

Introduction Chronic spine pain is a highly prevalent health condition, which has a profound impact on the lives of individuals affected and society. Up to 80% of the population experiences [...], Objective. Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral--based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral--based hybrid telerehabilitation intervention for Latino patients with chronic spine pain. Methods. A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses. Impact. This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain. Keywords: Adapted, Chronic, Cognitive Behavioral, Hispanic, Latino, Low Back, Neck, Pain, Physical Therapy, Spine

Published
2023
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9. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

Author

O’Hara, Nathan N., Frey, Katherine P., Stein, Deborah M., Levy, Joseph F., Slobogean, Gerard P., Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav A., Gary, Joshua L., Obremskey, William T., Seymour, Rachel B., Cuschieri, Joseph, Mullins, C. Daniel, O’Toole, Robert V., Carlini, Anthony R., Fowler, Brianna E., Taylor, Tara J., Wegener, Stephen T., Weston-Farber, Elias, Herndon, Steven Craig, Marvel, Debra, Jurkovich, Gregory J., Lee, Christopher, Malhotra, Ajai K., Riedel, Matthew D., DeCoster, Thomas A., Vercellotti, Gregory M., Wells, Jeffrey L., Westrick, Edward R., Bosse, Michael J., Christmas, A. Britton, Cunningham, Kyle William, Hsu, Joseph R., Huynh, Toan, Jacobs, David George, Kempton, Laurence B., Sims, Stephen H., Churchill, Christine, Carroll, Eben A., Babcock, Sharon, Miller, Preston R., Pilson, Holly T., Goodman, James Brett, Holden, Martha B., Weaver, Michael J., Esposito, John G., Goldhaber, Samuel Z., Heng, Marilyn, McGovern, Madeline M., Velmahos, George C., von Keudell, Arvind, Rivera, Jessica C., Gitajn, Ida Leah, Schneider, Prism S., Buckley, Richard E., Gallant, Jodi, McKay, Paula, Kleweno, Conor P., Agel, Julie, Natoli, Roman M., Gaski, Greg E., Heincelman, Carrie L., Jang, Yohan, Lopas, Luke A., McKinley, Todd O., Richard, Raveesh Daniel, Sorkin, Anthony T., Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Panjshiri, Farhanaz, Schulman, Jeff E., Ramsey, Lolita, Cuff, Jaslynn A.N., Haut, Elliott R., Warner, Stephen J., Cotton, Bryan A., Guevara, Keyla D., Claridge, Jeffrey A., Vallier, Heather A., Breslin, Mary A., Connelly, Daniel, Ghulam, Qasim M., Haac, Bryce E., LeBrun, Christopher T., Manson, Theodore T., Nascone, Jason, Pensy, Raymond A., Pollak, Andrew N., Udogwu, Ugochukwu N., Burke, Cynthia Elaine, Degani, Yasmin, DeLeon, Genaro A., Hannan, Zachary D., Healey, Kathleen M., Howe, Andrea L., Marinos, Dimitrius P., McKegg, Phillip C., McKibben, Natasha S., Zingas, Nicolas H., Evans, Andrew R., Askam, Brad M., Boulton, Christina, Weinlein, John C., Bergin, Patrick F., Bergin, Patrick F., Kutcher, Matthew E., Morellato, John, Nehete, Priyanka V., Yener, Ugur, Whiting, Paul S., Domes, Christopher, Kuhn, Gabrielle R., Gajari, Vamshi, Moreno-Diaz, Andres Fidel, Rodriguez-Baron, Elsa B., Rodriguez-Buitrago, Andres, Stinner, Daniel J., Trochez, Karen M., DePalo, Peter, Kennedy, Leah C., Lienhard, Karin, Martin, Ryan, Yee, Stephanie C., Leonard, Jordan, Arif, Hikmatullah, Brown, Krista, Deeter, Lakye Lenee, Sardesai, Neil, Bangura, Abdulai T., Demyanovich, Haley K., Eglseder, W. Andrew, Gupta, Jayesh, Isaac, Marckenley, Mulliken, Alexandra, Crisco, MJ., Lueckel, Stephanie N., Brown, Gregory A., Breazeale, Stephen, Fisher, Stephen N., Wild, Jason R., Beebe, Michael J., Khanna, Rajinder M., Brauer, Deborah, and Boyce, Robert H.

Published
2024
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10. Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopedic trauma patients: A secondary analysis of the PREVENT CLOT trial

Author

OʼHara, Nathan N., OʼToole, Robert V., Frey, Katherine P., Castillo, Renan C., Cuschieri, Joseph, Haut, Elliott R., Slobogean, Gerard P., Firoozabadi, Reza, Christmas, A. Britton, Obremskey, William T., Carlini, Anthony R., Gaski, Greg E., Kutcher, Matthew E., Marvel, Debra, Stein, Deborah M., Levy, Joseph F., Wegener, Stephen T., Fowler, Brianna E., Taylor, Tara J., Weston-Farber, Elias, Herndon, Steven Craig, Jr., DeCoster, Thomas A., Jurkovich, Gregory J., Lee, Christopher, Malhotra, Ajai K., Riedel, Matthew D., Wells, Jeffrey L., Altman, Daniel T., Westrick, Edward R., Bosse, Michael J., Karunakar, Madhav A., Cunningham, Kyle W., Huynh, Toan, Jacobs, David G., Kempton, Laurence B., Phelps, Kevin D., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Carroll, Eben A., Babcock, Sharon, Miller, Preston R., Pilson, Holly T., Goodman, James Brett, Weaver, Michael J., Esposito, John G., Goldhaber, Samuel Zachary, Heng, Marilyn, McGovern, Madeline M., Velmahos, George C., von Keudell, Arvind G., Rivera, Jessica C., Gitajn, Ida Leah, Schneider, Prism S., Buckley, Richard E., Johal, Herman S., Gallant, Jodi L., McKay, Paula, Kleweno, Conor P., Agel, Julie, Arif, Hikmatullah, McKinley, Todd O., Natoli, Roman M., Heincelman, Carrie L., Jang, Yohan, Lopas, Luke A., Mullis, Brian H., Richard, Raveesh D., Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Panjshiri, Farhanaz, Schulman, Jeff E., Ramsey, Lolita, Ahn, James, Cuff, Jaslynn A. N., Gary, Joshua L., Warner, Stephen J., Cotton, Bryan A., Vallier, Heather A., Claridge, Jeffrey A., Breslin, Mary A., Cowley, R Adams, Connelly, Daniel, Eglseder, W. Andrew, Haac, Bryce E., Healey, Kathleen Marie, LeBrun, Christopher T., Manson, Theodore, McKibben, Natasha S., Mulliken, Alexandra, Nascone, Jason, Pensy, Raymond A., Pollak, Andrew N., Sciadini, Marcus F., Udogwu, Ugochukwu N., Zingas, Nicolas, Burke, Cynthia Elaine, DeLeon, Genaro A., Hannan, Zachary D., Howe, Andrea L., Marinos, Dimitrius P., McKegg, Phillip C., Evans, Andrew R., Askam, Brad M., Joseph, Bellal, Lowe, Jason, Weinlein, John C., Bergin, Patrick F., Bhanat, Eldrin L., Khanna, Rajinder, Morellato, John, Nehete, Priyanka V., Domes, Christopher, Whiting, Paul S., Goodspeed, David C., Kuhn, Gabrielle R., Guillamondegui, Oscar D., Moreno-Diaz, Andres Fidel, Stinner, Daniel J., Pritchett, Charles, Jr., and Trochez, Karen M.

Published
2024
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11. PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients.

Author

O'Toole, Robert V, Stein, Deborah M, Frey, Katherine P, O'Hara, Nathan N, Scharfstein, Daniel O, Slobogean, Gerard P, Taylor, Tara J, Haac, Bryce E, Carlini, Anthony R, Manson, Theodore T, Sudini, Kuladeep, Mullins, C Daniel, Wegener, Stephen T, Firoozabadi, Reza, Haut, Elliott R, Bosse, Michael J, Seymour, Rachel B, Holden, Martha B, Gitajn, Ida Leah, Goldhaber, Samuel Z, Eastman, Alexander L, Jurkovich, Gregory J, Vallier, Heather A, Gary, Joshua L, Kleweno, Conor P, Cuschieri, Joseph, Marvel, Debra, Castillo, Renan C, and METRC

Subjects
METRC, orthopaedic & trauma surgery, thromboembolism, trauma management, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionPatients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. The primary aim of this trial is to compare aspirin with LMWH as a thromboprophylaxis in fracture patients.Methods and analysisPREVENT CLOT is a multicentre, randomised, pragmatic trial that aims to enrol 12 200 adult patients admitted to 1 of 21 participating centres with an operative extremity fracture, or any pelvis or acetabular fracture. The primary outcome is all-cause mortality. We will evaluate non-inferiority by testing whether the intention-to-treat difference in the probability of dying within 90 days of randomisation between aspirin and LMWH is less than our non-inferiority margin of 0.75%. Secondary efficacy outcomes include cause-specific mortality, non-fatal PE and deep vein thrombosis. Safety outcomes include bleeding complications, wound complications and deep surgical site infections.Ethics and disseminationThe PREVENT CLOT trial has been approved by the ethics board at the coordinating centre (Johns Hopkins Bloomberg School of Public Health) and all participating sites. Recruitment began in April 2017 and will continue through 2021. As both study medications are currently in clinical use for VTE prophylaxis for orthopaedic trauma patients, the findings of this trial can be easily adopted into clinical practice. The results of this large, patient-centred pragmatic trial will help guide treatment choices to prevent VTE in fracture patients.Trial registration numberNCT02984384.

Published
2021

17. Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial

Author

Coronado, Rogelio A., Master, Hiral, Bley, Jordan A., Robinette, Payton E., Sterling, Emma K., O'Brien, Michael T., Henry, Abigail L., Pennings, Jacquelyn S., Vanston, Susan W., Myczkowski, Brittany, Skolasky, Richard L., Wegener, Stephen T., and Archer, Kristin R.

Subjects
Complications and side effects, Patient outcomes, Spinal surgery -- Complications and side effects -- Patient outcomes, Cognitive-behavioral therapy -- Complications and side effects -- Patient outcomes, Cognitive therapy -- Complications and side effects -- Patient outcomes, Spine -- Surgery
Abstract

Introduction Patient-centered goal setting is a core behavioral component of rehabilitation programs, where individuals, in collaboration with a health care provider, identify and set meaningful goals based on what is [...], Objective. The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery. Methods. In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score [greater than or equal to] 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. Results. Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. Conclusions. Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. Impact. This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery. Keywords: Arthrodesis, Back Pain, Postoperative Care, Psychotherapy, Rehabilitation

Published
2022
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19. How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?

Author

Master, Hiral, Pennings, Jacquelyn S., Coronado, Rogelio A., Bley, Jordan, Robinette, Payton E., Haug, Christine M., Skolasky, Richard L., Riley, Lee H., III, Neuman, Brian J., Cheng, Joseph S., Aaronson, Oran S., Devin, Clinton J., Wegener, Stephen T., and Archer, Kristin R.

Published
2021
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21. Stratified care to prevent chronic low back pain in high-risk patients: The TARGET trial. A multi-site pragmatic cluster randomized trial

Author

Delitto, Anthony, Patterson, Charity G., Stevans, Joel M., Freburger, Janet K., Khoja, Samannaaz S., Schneider, Michael J., Greco, Carol M., Freel, Jennifer A., Sowa, Gwendolyn A., Wasan, Ajay D., Brennan, Gerard P., Hunter, Stephen J., Minick, Kate I., Wegener, Stephen T., Ephraim, Patti L., Beneciuk, Jason M., George, Steven Z., and Saper, Robert B.

Published
2021
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25. Study protocol for targeted interventions to prevent chronic low back pain in high-risk patients: A multi-site pragmatic cluster randomized controlled trial (TARGET Trial)

Author

Delitto, Anthony, Patterson, Charity G., Stevans, Joel M., Brennan, Gerard P., Wegener, Stephen T., Morrisette, David C., Beneciuk, Jason M., Freel, Jennifer A., Minick, Kate I., Hunter, Stephen J., Ephraim, Patti L., Friedman, Michael, Simpson, Kit N., George, Steven Z., Daley, Kelly N., Albert, Michael C., Tamasy, Marie, Cash, Jewel, Lake, D. Scott, Freburger, Janet K., Greco, Carol M., Hough, Linda J., Jeong, Jong-Hyeon, Khoja, Samannaaz S., Schneider, Michael J., Sowa, Gwendolyn A., Spigle, Wendy A., Wasan, Ajay D., Adams, William G., Lemaster, Chelsey M., Mishuris, Rebecca G., Plumb, Dorothy L., Williams, Charles T., and Saper, Robert B.

Published
2019
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26. Cognitive-Behavioral–Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma)

Author

Archer, Kristin R., Davidson, Claudia A., Alkhoury, Dana, Vanston, Susan W., Moore, Tanisha L., Deluca, Andrea, Betz, Joshua F., Thompson, Richard E., Obremskey, William T., Slobogean, Gerard P., Melton, Danielle H., Wilken, Jason M., Karunakar, Madhav A., Rivera, Jessica C., Mir, Hassan R., McKinley, Todd O., Frey, Katherine P., Castillo, Renan C., and Wegener, Stephen T.

Published
2022
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27. Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain

Author

McLaughlin, Kevin H, primary, Fritz, Julie M, additional, Minick, Kate I, additional, Brennan, Gerard P, additional, McGee, Terrence, additional, Lane, Elizabeth, additional, Thackeray, Anne, additional, Bardsley, Tyler, additional, Wegener, Stephen T, additional, Hunter, Stephen J, additional, and Skolasky, Richard L, additional

Published
2023
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28. Psychosocial Mechanisms of Cognitive-Behavioral-Based Physical Therapy Outcomes After Spine Surgery: Preliminary Findings From Mediation Analyses

Author

Coronado, Rogelio A., Ehde, Dawn M., Pennings, Jacquelyn S., Vanston, Susan W., Koyama, Tatsuki, Phillips, Sharon E., Mathis, Shannon L., McGirt, Matthew J., Spengler, Dan M., Aaronson, Oran S., Cheng, Joseph S., Devin, Clinton J., Wegener, Stephen T., and Archer, Kristin R.

Subjects
Psychological aspects, Care and treatment, Patient outcomes, Physical therapy -- Patient outcomes, Spinal surgery -- Patient outcomes, Cognitive-behavioral therapy -- Patient outcomes, Postoperative pain -- Care and treatment -- Patient outcomes -- Psychological aspects, Cognitive therapy -- Patient outcomes, Therapeutics, Physiological -- Patient outcomes, Spine -- Surgery, Pain, Postoperative -- Care and treatment -- Patient outcomes -- Psychological aspects
Abstract

Chronic daily pain affects over 40 million individuals in the United States, with approximately 10.6 million people reporting high-impact pain that results in significant activity limitation or participation restriction. (1) [...], Objective. Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. Methods. In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. Results. Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). Conclusions. This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. Impact. Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.

Published
2020
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33. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial.

Author

O'Hara, Nathan N., Frey, Katherine P., Stein, Deborah M., Levy, Joseph F., Slobogean, Gerard P., Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav A., Gary, Joshua L., Obremskey, William T., Seymour, Rachel B., Cuschieri, Joseph, Mullins, C. Daniel, O'Toole, Robert V., Carlini, Anthony R., Fowler, Brianna E., Taylor, Tara J., Wegener, Stephen T., Weston-Farber, Elias, and Herndon, Steven Craig

Subjects
ASPIRIN, HEPARIN, ENOXAPARIN, LOW-molecular-weight heparin, PATIENTS' attitudes, CLINICAL trials, COST analysis, PATIENT experience
Abstract

Background: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin. Methods: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales. Results: The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001). Conclusions: Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Features of Telerehabilitation and Considerations for Resource-Limited Settings: A Scoping Review.

Author

Kelly, Emily, Tingey, Jamie L., Ott, C. Jessica, Hahn, Helena, Bentley, Jacob A., Wegener, Stephen T., Zaidi, Zehra, Zia, Nukhba, and Bachani, Abdulgafoor M.

Subjects
MIDDLE-income countries, DIGITAL technology, MEDICAL information storage & retrieval systems, PATIENT education, RESEARCH funding, SELF-management (Psychology), CINAHL database, TELEREHABILITATION, DESCRIPTIVE statistics, SYSTEMATIC reviews, MEDLINE, LITERATURE reviews, VIDEOCONFERENCING, RESOURCE-limited settings, ONLINE information services, TEXT messages, LOW-income countries, INTEGRATED health care delivery
Abstract

Aim: The global need for rehabilitation is extensive yet remains significantly unmet. Health systems, especially in low- and middle-income countries (LMICs), lack structures and resources to address the rapidly growing need for rehabilitation services. Telerehabilitation offers an innovative approach to narrow health systems gaps and facilitate rehabilitation services. Few studies have investigated features and functionalities used in telerehabilitation, especially regarding implications for resource-limited settings and LMICs. This scoping review aims to identify technological features and functionalities used to deliver telerehabilitation, map them onto clinical care processes, and outline gaps and directions for future research, especially regarding considerations for resource-limited settings. Methods: This study utilized the PRISMA- checklist. Six databases were searched (PubMed, Embase, Scopus, CINAHL, Compendex, NARIC) to identify articles that described the remote delivery of rehabilitation services. Three reviewers screened and selected relevant publications. Descriptive statistics and qualitative content analysis were used to analyze full-text articles. Results: 135 articles were included in the full-text review. The publication year ranged from 1997 to 2021. The most frequently identified telerehabilitation feature was "data collection," followed by "videoconferencing," and "messaging." Features mapped onto six clinical categories, with "implementation" accounting for 41% of all features, Only 18% of articles focused on LMICs. Few papers included a comprehensive platform of features, discussed integration into health systems, or included financial analyses. Conclusions: Diverse technological tools exist for the remote delivery of rehabilitation services, but few cohesive platforms offer features across multiple clinical categories. Additionally, high income countries are overwhelmingly represented in the literature. Future directions for research include expanded focus on resource-limited settings and LMICS, discussion about financial considerations, and attention to health systems integration. Limitations: The generalizability of our findings are limited given the rapid growth of literature on telerehabilitation and continued development of apps and platforms since the time of review. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Protocol for a Parallel Group Randomized Clinical Trial Comparing a Culturally Adapted Cognitive Behavioral Telerehabilitation Intervention to Usual Physical Therapy for Latino Patients With Chronic Spine Pain

Author

Gombatto, Sara P, primary, Archer, Kristin R, additional, Wegener, Stephen T, additional, Hernandez, Yessenia, additional, Lin, Shih-Fan, additional, Godino, Job, additional, Van Dyke, Jason, additional, Liu, Jie, additional, and Monroe, Katrina S, additional

Published
2023
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41. Limb loss.

Author

Gallagher, Pamela, primary, Coffey, Laura, additional, Desmond, Deirdre M., additional, Lombard-Vance, Richard, additional, Jefferies, Philip, additional, and Wegener, Stephen T., additional

Published
2019
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