PERSISTE: a mixed methods protocol to identify barriers and levers to a sustainable physical activity practice among patients with chronic disease after physical activity resumption programs

Physical activity (PA) has evidence-based benefits for physical, social and mental health, but investigation of how PA interventions for patients with chronic disease affects their PA practice up to 1 year after programmes are rare. Moreover, few studies document how the context and intervention mechanisms of PA programmes affect sustainable PA practice and its determinants. The present protocol describes a mixed methods study comparing the effectiveness and conditions for the effectiveness of two PA resumption programmes (a hospital-led and a community-based programme). Using a comparative longitudinal study, 60 patients (3-month duration) will be followed for 1 year though four data collections: before (T0) and at the end (T1) of the intervention, 6 months (T2) and 1 year (T3) after the start of the programme. The primary outcome will be PA practice in min/week and categorised as light, moderate or vigorous (using International Physical Activity Questionnaire (IPAQ)), and secondary outcomes will include sedentary time in min/week (IPAQ), quality of life evaluated though the physical and mental composite scores (‘Medical Outcome Study Short Form 12’), and enjoyment using four statements rated from 1 to 5, a high score being synonymous of enjoyment (Intrinsic Motivation Inventory). Qualitative data on further determinants of PA practice and intervention mechanisms will be collected. The expected results will offer the opportunity to understand how the intervention context contributes to a more effective, sustainable PA practice. Trial registration number: NCT04954209.

Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): A Study Protocol for a Randomised Controlled Trial of a Resource Kit.

BACKGROUNDImproving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia.METHODS/DESIGNIt is a pragmatic randomised controlled trial of an online Resource Kit to enhance practice in teams managing crises in dementia care. Thirty teams managing mental health crises in dementia in community settings will be randomised between the Resource Kit intervention and treatment as usual. The primary outcome measure is psychiatric admissions to hospital for people with dementia in the teams’ catchment area recorded six months after randomisation. Other outcomes include: quality of life measures for people with dementia and their carers; practitioner impact measures; acute hospital admissions; and costs. To enhance understanding of the resource kit intervention, qualitative work will explore staff, patient and carers’ experience.DISCUSSIONThe Resource Kit intervention reflects current policy to enable home-based care for people with dementia by addressing the management of crises which threaten the viability of care at home. It is based upon a model of best practice for managing crises in dementia designed to enhance the quality of care, developed in partnership with people with dementia, carers and practitioners. If the Resource Kit is shown to be clinically and cost effective in this study, this will enhance the probability of its incorporation into mainstream practice. TRIAL REGISTRATION: ISRCTN 42855694; Registered on 04/03/2021; Protocol number: 127686/2020v9; Research Ethics Committee, 09/03/2021, Ref 21/WM/0004; IRAS ID: 289982https://doi.org/10.1186/ISRCTN42855694

Meta-analysis of reduced relative feedback frequency effect on motor learning and performance

A fundamental motor learning principle conveyed in textbooks is that augmented terminal feedback frequency differentially affects motor learning and performance. The guidance hypothesis predicts that relative to a reduced frequency of feedback, providing learners with feedback following every practice trial enhances practice performance but degrades subsequent motor learning. This change in effectiveness for each relative feedback frequency is called a reversal effect, and because it is thought that practice variables can have distinct impacts on learning and performance, delayed retention tests are considered the gold standard in motor learning research. The objectives of this meta-analysis were to a) synthesize the available evidence regarding feedback frequency, performance, and motor learning to test whether there are significant changes in effectiveness from acquisition and immediate retention to delayed retention, b) evaluate potential moderators of these effects, and c) investigate the potential influence of publication bias on this literature. We screened 1662 articles found in PubMed and PsycINFO databases as well as with reference tracing and a targeted author search. A final sample of 61 eligible papers were included in the primary analysis (k = 75, N = 2228). Results revealed substantial heterogeneity but no significant moderators, high levels of uncertainty, and no significant effect of reduced feedback frequency at any time point. Further, multilevel analyses revealed no evidence of a significant change in effect from acquisition or immediate retention to delayed retention. Z-curve analysis suggested the included studies were severely underpowered. These results suggest that robust evidence regarding feedback frequency and motor learning is lacking.

Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (Pip): A Feasibility Study

BACKGROUNDProgression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis, is the initial stage of this damage, confined to coronal pulp whilst the radicular pulp show little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology’s (ESE 2019) recent consenus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice.METHODThis feasibility study aims to identify and assess in a primary care setting, training needs of General Dental Practitioners, clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of a main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibililty study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 patients with indications of partial irreversible pulpitis. DISCUSSIONThe Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policy makers in their decision making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. TRIAL REGISTRATIONTrial registry: ISRCTNTrial registration number: 17973404Date of Registration: 28.01.2021URL of trial registry record: https://www.isrctn.com/ISRCTN17973604PROTOCOL VERSIONProtocol version: 1Date: 03.02.2021

Testing for Audience Design: a short report

In this short report, we present the results from a novel test set-up, aiming to track the practice of Audience Design (AD) in the reference production of Swedish speaking 7 year olds. AD is the conduct of altering one's communicative signal with the receiver of the signal in mind, so that they can easily infer its intended meaning. The results show a distinctive group that does not adapt production in the same manner as in a practice trial prompt for a third party without shared frame of mind. While we controlled for the participant’s knowledge of the referential objects of the test, we did not control for the participants assumptions about the world knowledge of the different addresses, which might have altered the result.

Setting up a pragmatic clinical trial in a low-resource setting: A qualitative assessment of GoLBeT, a trial of podoconiosis management in Northern Ethiopia

Background Clinical trials are often perceived as being expensive, difficult and beyond the capacity of healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the World Health Organization (WHO) World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with the reasons for delays. Methodology and principal findings Qualitative research methods were used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the trial operational team. The Global Health Research Process Map was used as a framework against which to compare the steps involved in setting up the trial. A mini-group discussion was conducted with the trial operational team after study completion for reflection and further recommendations. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design, that is, deciding on the study endpoint, where and how best to measure it, and assuring statistical power; recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration, for example with statisticians, the trial steering committee, the study monitors, and members of the local community was essential to successfully setting up the trial. Conclusions and significance Lessons learnt from this trial might guide others planning pragmatic trials in settings where research is not common, allowing them to anticipate possible challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.