Personalised Outcomes Forecasts of Supervised Exercise Therapy in Intermittent Claudication: An Application of Neighbours Based Prediction Methods with Routinely Collected Clinical Data

Sinnige, Anneroos; Kittelson, Andrew J; Wees, Philip J. van der; Teijink, Joep A.W.; Hoogeboom, Thomas J.

doi:10.1016/j.ejvs.2021.12.040

Cited by 6 publications

(14 citation statements)

References 28 publications

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“…Second, due to the nationwide Chronic Care Network, 13 sufficient routinely collected data are available to adequately develop personalized outcome forecasts. 14 A secondary goal was to explore for opportunities to improve the outcomes forecast tool to facilitate implementation in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

et al. 2022

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Objective Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment of patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice. Methods A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach. Results Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations; (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training. Conclusion To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols. Impact The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.

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Section: Introductionmentioning

confidence: 99%

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

et al. 2022

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“…The POFs could be used in clinical practice in different ways. For example, therapists could discuss patient expectations and promote adherence to exercise therapy at the start of the treatment, or they could monitor progress in therapy results to detect treatment success and opportunities for improvement 24…”

Section: Methodsmentioning

confidence: 99%

“…Similarly to reference charts, POFs provide insight into an individual’s personal prognosis by visualising the estimated walking distance and quality of life over the treatment trajectory. The estimates are created using historical outcomes data of patients similar to the patient of interest 24. By informing patients of the expected course and outcome of therapy, POFs may help therapists to tailor care to the needs of the individual and thereby potentially improve patient outcomes 25.…”

Section: Introductionmentioning

confidence: 99%

“…The estimates are created using historical outcomes data of patients similar to the patient of interest. 24 By informing patients of the expected course and outcome of therapy, POFs may help therapists to tailor care to the needs of the individual and thereby potentially improve patient outcomes. 25 Moreover, we expect that POFs could enable therapists to improve patient engagement and shared decision-making (SDM).…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study

Marcellis,

Sinnige,

Rutgers

et al. 2024

BMJ Open Qual

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BackgroundTo support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes.ObjectivesTo assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication.MethodsAn interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument.ResultsDifferences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01).ConclusionsIntegrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances.Trial registration numberNL8838.

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“…A potential explanation for the lack of shared decision-making in daily practice is the lack of available and useful decision aids [ 10 , 11 ]. Therefore, to elicit shared decision-making and thereby improve outcomes for patients with intermittent claudication, we developed a decision support system [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Nationwide implementation of personalized outcomes forecasts to support physical therapists in treating patients with intermittent claudication: Protocol for an interrupted time series study

Sinnige,

Kittelson,

Rutgers

et al. 2023

PLoS ONE

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Introduction Shared decision-making is the cornerstone of patient-centered care. However, evidence suggests that the application of shared decision-making in physical therapy practice is limited. To elicit shared decision-making and thereby potentially improve patient outcomes for patients with intermittent claudication, we developed a decision support system. This decision support system provides personalized outcomes forecasts that visualize the estimated walking distance of an individual patient. We hypothesize that personalized outcomes forecasts can support physical therapists in personalizing care to the needs and priorities of the individual patient to improve therapy outcomes. Research objectives The primary aim is to evaluate the impact of personalized outcomes forecasts for patients with intermittent claudication to optimize personalized treatment. Second, this study aims to evaluate the process of implementation. Methods This study uses a prospective interrupted time series (ITS) design. Participating physical therapists are divided into four clusters. Every month of the study period, a new cluster will be invited to begin using the decision support system. We aim to include data of 11,250 newly referred patients for physical therapy treatment. All therapists associated with a network of specialized therapists (Chronic CareNet) and patients treated by these therapists are eligible to participate. The decision support system, called the KomPas, makes use of personalized outcomes forecasts, which visualize the estimated outcome of supervised exercise therapy for an individual patient with intermittent claudication. Personalized outcomes forecasts are developed using a neighbors-based approach that selects patients similar to the index patient (a.k.a. neighbors) from a large database. Outcomes to evaluate impact of implementation are patients’ functional and maximal walking distance, quality of life and shared decision-making. Process evaluation will be measured in terms of utilization efficacy, including the outcomes dropout rate and reasons to (not) use the personalized outcomes forecasts. Data will be routinely collected through two online systems: the Chronic CareNet Quality system, and the website logs of the decision support system. Additionally, observations and semi-structured interviews will be conducted with a small subset of therapists. Ethics Formal medical ethical approval by the Medical Research Ethics Committees United ‘MEC-U’ was not required for this study under Dutch law (reference number 2020–6250).

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Personalised Outcomes Forecasts of Supervised Exercise Therapy in Intermittent Claudication: An Application of Neighbours Based Prediction Methods with Routinely Collected Clinical Data

Cited by 6 publications

References 28 publications

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study

Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study

Nationwide implementation of personalized outcomes forecasts to support physical therapists in treating patients with intermittent claudication: Protocol for an interrupted time series study

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