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首页> 外文期刊>BMC Family Practice >Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation
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Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

机译：使用护理途径改善老年人的流动性和参与初级保健中的尖端，头晕和平衡障碍：可行性研究和过程评估

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Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65?years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).
机译：社区住宅老年人经常受到眩晕，头晕和平衡障碍（VDB）的影响。我们以前开发了一种护理途径（CPW），通过为一般从业者（GPS）和物理治疗师（PTS）提供标准化方法来改善流动性和参与。我们旨在评估干预的可行性，其实施策略和研究程序为后续的主要审判进行准备。今年12周的前瞻性队列可行性研究伴随着根据英国医学研究理事会的制定和评估复杂干预措施的指导设计的过程评估。包括VDB患者（≥65岁），初级保健中的GPS和PTS。干预由用于GPS的诊断筛选清单和PTS指南组成。实施策略包括特定的教育培训和电话助理。通过标准化问卷，现场备注和定性访谈收集混合方法过程评估的数据。使用描述性统计，使用内容分析进行定性数据来分析定量数据。该研究中共有五个GP实践（七个单一GPS），10个PT实践和22名患者。 GPS和患者的招募是挑战的（答复率：GP实践：28％，PT实践：39％）。百分之九十一患者和所有卫生专业人士完成了这项研究。卫生专业人员对教育培训做得很好;电话光线的利用率低（来自GPS和PTS的一个呼叫）。熟悉干预和阳性态度的申请程序的诉讼被强调为实施干预的促进者，而缺乏时间被提到是作为障碍。尽管GPS对干预方案的依从，但GPS，PTS和患者在干预中看到了益处。患者的治疗依赖物理治疗良好。数据收集中有一个小问题，但没有意外的后果。虽然过程评估为学习程序，干预及其实施策略的可行性提供了良好的支持，但我们确定了需要改进参与者，GP干预部分和数据收集程序的招聘。调查结果将通知主要的试验，以测试集群RCT中的干预措施。 Projektdatenbank Versorgungsforschung Deutschland（德国登记卫生服务研究）VFD_Mobile-Phy_17_003910，日期（注册）：30.11.2017; Deutsches Register Klinischer Studien（德国临床试验登记册）DRKS00022918，日期（注册）：03.09.2020（回顾性注册）。

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