Clinical Research Oriented Workshop (CROW) Meeting: Sept 20, 2018

Present:   Levi Bonnell, Jessica Clifton, Justine Dee, Nancy Gell, Juvena Hitt, Ben Littenberg, Jen Oshita, Gail Rose, Connie van Eeghen, Marianna Wingood

1.                   Warm Up: Introductions with Marianna Wingood, PT and PhD in CNHS

2.                   Nancy Gell: Interview Draft - The purpose of this study is to examine physical activity prescription by physical therapists. Through interviews and medical record analysis, we will characterize physical activity assessment and prescription for people receiving PT for treatment of chronic low back pain. The purpose of the interviews is to explore how physical therapists incorporate physical activity prescription in treatment plan, barriers and facilitators for prescription with the population, and how prescription rationale aligns with national recommendations (ACSM guidelines).

a.       Nancy provided a description of scope of project: is treatment plan inclusive of exercise for patients with LBP, if so, what type of exercise (several categories).  There is a movement to include exercise Rx in primary care by PCPs; there is little literature on the part of PTs who work with patients with LBP on an outpatient basis.  This is separate from their PT home maintenance program

                                                   i.      Data collection: EMR documentation (limited due to gaps in the record), with interviews of PTs to provide perceptions, including rationale, thoughts about guidelines

                                                 ii.      Mixed methods: narrowly focused interview

                                               iii.      Sampling frame: contacts through PT programs, in and out of VT

b.       Interview focuses on processes, as well as facilitators and challenges.  Time limit: 30 minutes.

                                                   i.      Consider moving some questions off-line, especially demographic questions (move to screening)

                                                 ii.      Consider changing “check box” questions to a pre-survey, that is referenced during the interview to ask deeper questions

                                               iii.      About challenges: set up the supportive lead as Jessica suggested: “We all have the experience of not providing a set of instructions.  What is an example of when that happens?  Why does it happen?”

c.       Another approach, based on Ben’s and Alan Rubin’s interest in patients with high A1c’s that have not responded with regular care, based on their own practice’s data.  Alan interviewed providers, using “In this case, what were the barriers…” and Dana (anthropologist) interviewed matching patients for their perspectives.  The results were highly informative, using qualitative research. 

                                                   i.      Nancy will start this study on 35 patients within the UVM MC system.  This approach could work.

                                                 ii.      Or use a case study/vignette to start the conversation, and then get into the experience.

d.       Introduction provides a detailed description of the guideline; consider a general description that doesn’t appear to lead the respondent. “This isn’t about PT, this about how health care providers talk about exercise.” 

e.       Assessment – this is low priority.  “How do you deal with that? What makes this challenging?” Make this an intro question only?  Or make it part of a pre-survey.

f.        Facilitators and challenges: opportunity for critical event analysis

g.       Is there a patient-centered opportunity here?  For the future. 

3.                   Next week: Connie and CR Macchi (Arizona State University) will provide a dress rehearsal of their workshop for a Collaborative Family Healthcare Association conference in October.

4.                   Future topic: Jessica Clifton’s update on outcomes of her dissertation work.

Recorded by: Connie