Clinical Research Oriented Workshop (CROW) Meeting: June 30, 2022

Present:   Justine Dee, Nancy Gell, Ben Littenberg, Jen Oshita, Adam Sprouse-Blum, Connie van Eeghen (6)

 1.             Warm Up: Grant budget crisis by order of $100K but Ben is here and ready

2.               Justine’s VHCURES Study “Physical therapy utilization for treatment of chronic low back pain conditions: Use of the Vermont Heath Care Uniform Reporting and Evaluation System” methods section

a.       Intro: big jump from LBP to claims and utilization – what is the gap in the literature; is it cost rather than utilization?  This is just cost to the insurer. What we have is claims paid.

                                                   i.      “Effective PT on HC utilization among patients with chronic LBP based on claims paid”

                                                 ii.      Is lowest cost the best care?  Is this about a threshold of PT visits that is ideal? And a max that does not provide further benefit?

b.       Methods:

                                                   i.      State the study design

                                                 ii.      State the eligibility criteria – Ben’s example provided

                                               iii.      Why a two year period of observation?  It varies greatly among patient experience. Two years is consistent with other studies. Add justification.

                                               iv.      Define “chronic” for the reader

                                                 v.      Consider a table or a graphic to present the unit of analysis and the concepts used to measure the hypothesis of claims paid for patient w and w/o PT

c.       Resources  

                                                   i.      From Adam: Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-1259.  Low back pain is the #1 cause of global disability.

3.                   Next week:  TBD

Recorded by: CvE

New paper for Bonnell, et al.

 

This just appeared in the "Abstracts in press" section of the Journal of the American Board of Family Medicine. Stay tuned for the full article...

Walking Habits During the COVID-19 Pandemic Are Associated with Mental and Physical Health Among Primary Care Patients Managing Multiple Chronic Conditions

Levi N. Bonnell; Jessica Clifton; Mariana Wingood; Nancy Gell; Benjamin Littenberg

Section: Brief Report

Publication Date: TBD

BACKGROUND: COVID-19 policies such as quarantining, social isolation, and lockdowns are an essential public health measure to reduce the spread of disease, but may lead to reduced physical activity. Little is known if these changes are associated with changes in physical or mental health.

METHODS: Between September 2017 and December 2018 (baseline) and March 2020 and February 2021 (Follow-up), we obtained self-reported demographic, health, and walking (only at follow-up) data on 2,042 adults in primary care with multiple chronic health conditions. We examined whether the perceived amount of time engaged in walking was different compared to pre-pandemic levels, and if this was associated with changes in PROMIS-29 mental and physical health summary scores. Multivariable linear regression controlling for demographic, health, and neighborhood information were used to assess this association.

RESULTS: Of the 2,042 participants, 9% reported more walking, 28% reported less, and 52% reported the same amount compared to pre-pandemic levels. Nearly a third of participants reported less walking during the pandemic. Multivariable models revealed that walking less or not at all was associated with negative changes in mental (ß= -1.0; 95% CI -1.6, -0.5; ß= -2.2; 95% CI -2.9, -1.4) and physical (ß= -0.9; 95% CI -1.5, -0.3; ß= -3.1; 95% CI -4.0, -2.3) health, respectively. Increasing walking was significantly associated with a positive change in physical health (ß=1.3; 95% CI 0.3, 2.2).

CONCLUSIONS: These findings demonstrate the importance of walking during the COVID-19 pandemic. Promotion of physical activity should be taken into consideration when mandating restrictions to slow the spread of disease. Primary care providers can assess patient’s walking patterns and implement brief interventions to help patients improve their physical and mental health through walking.

 

Clinical Research Oriented Workshop (CROW) Meeting: June 16, 2022

 

Clinical Research Oriented Workshop (CROW) Meeting: June 16, 2022 

Present:   Levi Bonnell, Justine Dee, Nancy Gell, Ben Littenberg, Jen Oshita, Adam Sprouse-Blum, Connie van Eeghen (7)

 1.                   Warm Up

2.                   Adam’s Scoping Review “Left- vs Right-Sided Migraine: A Scoping Review”  After abstract screening and full text review, he ended up with 27 articles. The key findings from these articles are in a table. Key question: How to structure the scoping review?

a.       Unilateral is different than a study related to left or right or both

                                                   i.      Why a scoping review rather than a systematic review: wanted to understand the lay of the land.  Purpose: Are left vs right sided migraines different entities? 

                                                 ii.      Per Journal of Public Health: a scoping review is a broad research question and is more qualitative than quantitative; used to identify parameters and gaps in a body of literature.  

b.       Kinds of findings: anatomic, physiological testing, symptomatic, sociodemographic, and maybe cognitive function/neuroscience

                                                   i.      Categorize the findings and check with co-author

                                                 ii.      Generate the outcomes related to each kind of finding

c.       Results:

                                                   i.      Left sided migraines are more severe and less common

                                                 ii.      There are testing differences

                                               iii.      Therefore, find the story that confirms, illuminates, or refutes some aspect of the world by looking for patterns that emerge from review

3.                   Next week:  TBD

Recorded by: CvE