@article{ref1,
title="De-implementing prolonged rest advice for concussion in primary care settings: a pilot stepped wedge cluster randomized trial",
journal="Journal of head trauma rehabilitation",
year="2020",
author="Silverberg, Noah D. and Otamendi, Thalia and Panenka, William J. and Archambault, Patrick and Babul, Shelina and MacLellan, Anna and Li, Linda C. and Canadian TBI Research Consortium, ",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion.   SETTING: Community.   PARTICIPANTS: Family physicians in community practice (n = 21 at 5 clinics).   DESIGN: Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits.   MAIN MEASURES: The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements.   RESULTS: Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change.   CONCLUSIONS: Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.<p /> <p>Language: en</p>",
language="en",
issn="0885-9701",
doi="10.1097/HTR.0000000000000609",
url="http://dx.doi.org/10.1097/HTR.0000000000000609"
}