No abstract

Background Navigating the world of qualitative thematic analysis can be challenging. This is compounded by the fact that detailed descriptions of methods are often omitted from qualitative discussions. While qualitative research methodologies are now mature, there often remains a lack of fine detail in their description both at submitted peer reviewed article level and in textbooks. As one of research’s aims is to determine the relationship between knowledge and practice through the demonstration of rigour, more detailed descriptions of methods could prove useful. Rigour in quantitative research is often determined through detailed explanation allowing replication, but the ability to replicate is often not considered appropriate in qualitative research. However, a well described qualitative methodology could demonstrate and ensure the same effect. Methods This article details the codebook development which contributed to thematic analysis of qualitative data. This analysis formed part of a mixed methods multiphase design research project, with both qualitative and quantitative inquiry and involving the convergence of data and analyses. This design consisted of three distinct phases: quantitative, qualitative and implementation phases. Results and conclusions This article is aimed at researchers and doctoral students new to thematic analysis by describing a framework to assist their processes. The detailed description of the methods used supports attempts to utilise the thematic analysis process and to determine rigour to support the establishment of credibility. This process will assist practitioners to be confident that the knowledge and claims contained within research are transferable to their practice. The approach described within this article builds on, and enhances, current accepted models.

Background: It has been suggested that health care professional (HCP) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population. Methods: Electronic databases were systematically searched for all types of studies. Studies were selected by predefined inclusion criteria. Methodological quality was appraised and strength of evidence was determined. Results: Seventeen studies from eight countries which investigated the attitudes and beliefs of general practitioners, physiotherapists, chiropractors, rheumatologists, orthopaedic surgeons and other paramedical therapists were included. There is strong evidence that HCP beliefs about back pain are associated with the beliefs of their patients. There is moderate evidence that HCPs with a biomedical orientation or elevated fear avoidance beliefs are more likely to advise patients to limit work and physical activities, and are less likely to adhere to treatment guidelines. There is moderate evidence that HCP attitudes and beliefs are associated with patient education and bed rest recommendations. There is moderate evidence that HCP fear avoidance beliefs are associated with reported sick leave prescription and that a biomedical orientation is not associated with the number of sickness certificates issued for LBP. Conclusion: HCPs need to be aware of the association between their attitudes and beliefs and the attitudes and beliefs and clinical management of their patients with LBP.Cite this article as: Ben Darlow, Brona Fullen, Sarah Dean, Deirdre A. Hurley, G. David Baxter, Anthony Dowell. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review.

Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period.Design Randomised controlled trial.Setting 17 primary care practices in Wellington, New ZealandParticipants 1089 women aged 40-74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the weekIntervention Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months.Main outcome measure Physical activity assessed at baseline and 12 and 24 months. Secondary outcomes were quality of life (SF-36), weight, waist circumference, blood pressure, concentrations of fasting serum lipids, glycated haemoglobin (HbA1c), glucose, insulin, and physical fitness.Results Mean age was 58.9 (SD 7) years. Trial retention rates were 93% and 89% at 12 and 24 months, respectively. At baseline, 10% of intervention participants and 11% of control participants were achieving 150 minutes of at least moderate intensity physical activity a week. At 12 months rates increased to 43% and 30% and at 24 months to 39.3% and 32.8% (P<0.001), respectively. SF-36 physical functioning (P=0.03) and mental health (P<0.05) scores improved more in intervention compared with control participants, but role physical scores were significantly lower (P<0.01). There were no significant differences in clinical outcomes. More falls (P<0.001) and injuries (P=0.03) were recorded in the intervention group.Conclusions This programme of exercise on prescription increased physical activity and quality of life over two years, although falls and injuries also increased. This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ANZCTRN012605000490673.

PURPOSE The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.METHODS Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.RESULTS Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.CONCLUSIONS Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs. INTRODUCTIONL ow back pain is a health condition with major direct and indirect costs.1-4 Acute low back pain is assumed to have a highly positive prognosis 5 ; however, a large proportion of patients continue to experience pain and disability. 6 Psychosocial factors are important in the development of low back pain and disability. 7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally. Patients' beliefs need to be better understood to improve management of low back pain. 10,12,13 People with low back pain receive information from a range of sources, but the influence of each source is unknown.14,15 Studies have investigated activities, situations, and anatomic structures that people see as being responsible for their back pain, but not how or why beliefs have been formed. 14,[16][17][18] Health care professionals may negatively influence patient beliefs. 19There is strong evidence that patients' beliefs about low back pain are associated with their clinicians' beliefs, and moderate evidence suggests

BackgroundThe health and economic burden of physical inactivity is well documented. A wide range of primary care and community-based interventions are available to increase physical activity. It is important to identify which components of these interventions provide the best value for money. AimTo assess the cost-effectiveness of physical activity interventions in primary care and the community. Design of studySystematic review of cost-effectiveness studies based on randomised controlled trials of interventions to increase adult physical activity that were based in primary health care or the community, completed between 2002 and 2009. MethodElectronic databases were searched to identify relevant literature. Results and study quality were assessed by two researchers, using Drummond's checklist for economic evaluations. Cost-effectiveness ratios for moving one person from inactive to active, and costutility ratios (cost per quality-adjusted life-year [QALY]) were compared between interventions.

No abstract

No abstract