A multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL Trial

Battle, Ceri; Hutchings, Hayley; Driscoll, Timothy; O’Neill, Claire; Groves, Sam; Watkins, Alan; Lecky, Fiona; Jones, Sally; Gagg, James; Body, Richard; Abbott, Zoe; Evans, Peter

doi:10.1136/bmjopen-2019-029187

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Through a process of constant comparison these were further reduced to 9 themes: five process themes of study design; consent, collecting data; twitter and training were identified alongside two impact themes of making care decisions and reflective practice and finally two themes of looking to the future: mainstreaming and clinical need. Much of these data are presented in the results papers, which also considers possible improvements to the study design [17].…”

Section: Resultsmentioning

confidence: 99%

Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice

et al. 2020

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Background: In recent years, researchers and clinicians have been developing prognostic prediction tools (PPTs) as a way of identifying patients at risk of deterioration. The use of PPTs in the clinical environment not only impacts the risk of adverse outcomes for patients, but the use of these tools also effect clinical practice. Much attention has been paid to the clinical performance of PPTs. But more insight is needed on how the use of PPTs impacts clinical practice. The objective of this study was to map some of the ways in which PPTs effect clinical practice. The STUMBL (STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients) feasibility trial evaluated the use of a new prognostic prediction tool (PPT) to guide the management blunt chest wall trauma patients in the emergency departments (ED). The trial was undertaken between October 2016 and September 2018 and conducted at four sites in England and Wales. Nested within the feasibility trial was a qualitative study aimed at understanding how ED clinicians experienced and used the PPT. The qualitative methods included a focus group and telephone interviews with 9 ED clinicians. This study focused on participant perceptions of the feasibility and use of the STUMBL tool on clinical practice in the ED. Results: Clinical practice is reshaped as a result of the introduction of the STUMBL PPT into the clinical environment. The PPT enhanced reflexive awareness of prognostic practice; facilitated communication between patients and professionals; helps to guide patient outcomes; and provides a common ground for clinician discussion on prognostication. Conclusions: The qualitative data collected offered useful insights into the ways in which the tool changes clinical practice. This was a small study of the effect of one kind of PPT on clinical practice. Nevertheless, this study maps areas in which clinical practice is affected by the introduction of a PPT into the clinical environment. More research is needed to better understand these effects, and to understand how these tools become embedded in clinical practice over the longer term.

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Section: Resultsmentioning

confidence: 99%

Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice

et al. 2020

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“…The median age of this patient cohort was greater than that of some of our previous chest trauma trials with the same cohort. [12,13] The five eligible patients who were approached by the physiotherapy team, but declined to participate in the trial, were all younger than 30 years. This would have influenced the median age of participants.…”

Section: Discussionmentioning

confidence: 99%

EarLy Exercise in blunt Chest wall Trauma: a feasibility trial (ELECT Trial)

Battle

O’Neill

Toghill

et al. 2020

Preprint

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Background For patients with blunt chest wall trauma, no evidence exists regarding the optimal physiotherapy treatment aimed at addressing the longer-term complications, specifically chronic pain and disability. The overall aim of this phase of work, is to investigate whether early thoracic and shoulder girdle exercises improve chronic pain in patients with blunt chest wall trauma, when compared to normal care. Methods A single centre, parallel, feasibility randomised controlled trial was completed at a University Teaching Hospital in Wales. Adult patients with blunt chest wall trauma, admitted to hospital for greater than 24 hours, with no concurrent, immediately life-threatening injuries, were included. The intervention was a simple physiotherapy programme comprising thoracic and shoulder girdle exercises. Feasibility outcome measures included: Primary: 1) adherence to the protocol by the physiotherapy team (more than 80% of eligible patients randomised), and 2) acceptability of the intervention by the patients (less than 30% of patients dissented to participation). Secondary: 1) ability to retrieve follow up data (response rate of more than 70% of participants) and, 2) safety of the intervention compared to routine care (no more than 10% increase in serious adverse events). Results 14 patients were recruited to the trial. Clinicians randomised 100% of eligible patients during the trial period. All feasibility criteria were fully met. The intervention was safe the number of serious adverse events was comparable between the control and intervention periods. Discussion We have demonstrated that a fully powered randomised clinical trial of the ELECT Trial is feasible. Minor methodological modifications will be made for the full trial. ISRCTN Trial registration number ISRCTN 16197429

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“…We will determine the intervention costs associated with the exercise programme (which will be minimal as only one sheet of A4 paper), but more focused on the opportunity costs of staff time associated with training and delivery, through data collected during the trial and informant discussions with the project team. We will use the adapted Client Services Receipt Inventory (CSRI) developed from our previous STUMBL feasibility study in the same patient populations 10. Our clinicians and Patient and public involvement (PPI) will review the CSRI to ensure the content and format (eg, time-frame) is accurate for use in the ELECT trial.…”

Section: Methodsmentioning

confidence: 99%

“…We will use the adapted Client Services Receipt Inventory (CSRI) developed from our previous STUMBL feasibility study in the same patient populations. 10 Our clinicians and Patient and public involvement (PPI) will review the CSRI to ensure the content and format (eg, time-frame) is accurate for use in the ELECT trial. We will collect participant level health and social resource use in both the intervention and control (usual care) groups using the adapted CSRI at 3 months.…”

Section: Methodsmentioning

confidence: 99%

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

et al. 2022

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IntroductionChronic pain and disability are now well-recognised long-term complications of blunt chest wall trauma. Limited research exists regarding therapeutic interventions that can be used to address these complications. A recent feasibility study was completed testing the methods of a definitive trial. This protocol describes the proposed definitive trial, the aim of which is to investigate the impact of an early exercise programme on chronic pain and disability in patients with blunt chest wall trauma.Methods/analysisThis mixed-methods, multicentre, parallel randomised controlled trial will run in four hospitals in Wales and one in England over 12-month recruitment period. Patients will be randomised to either the control group (routine physiotherapy input) or the intervention group (routine physiotherapy input plus a simple exercise programme completed individually by the patient). Baseline measurements including completion of two surveys (Brief Pain Inventory and EuroQol 5-dimensions, 5-Levels) will be obtained on initial assessment. These measures and a client services receipt inventory will be repeated at 3-month postinjury. Analysis of outcomes will focus on rate and severity of chronic pain and disability, cost-effectiveness and acceptability of the programme by patients and clinicians. Qualitative feedback regarding acceptability will be obtained through patient and clinician focus groups.Ethics/disseminationLondon Riverside Research Ethics Committee (Reference number: 21/LO/0782) and the Health Research Authority granted approval for the trial in December 2021. Patient recruitment will commence in February 2022. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to stakeholders at professional meetings.Trial registration numberISRCTN65829737; Pre-results.

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A multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL Trial

Cited by 15 publications

References 18 publications

Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice

Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice

EarLy Exercise in blunt Chest wall Trauma: a feasibility trial (ELECT Trial)

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

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