Room for improvement: a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery

Louise F Sandal; Jonas B Thorlund; Andrew J Moore; Roger S. Ulrich; Paul A. Dieppe; Ewa M Roos

doi:10.1136/bjsports-2016-097448

Room for improvement: a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery

Louise F Sandal, Jonas B Thorlund, Andrew J Moore, Roger S. Ulrich, Paul A. Dieppe, Ewa M Roos

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Abstract

OBJECTIVE: Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy.

METHODS: In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments.

RESULTS: 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups.

CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613.

Original language	English
Journal	British Journal of Sports Medicine
Volume	53
Issue number	6
Pages (from-to)	359-367
ISSN	0306-3674
DOIs	https://doi.org/10.1136/bjsports-2016-097448
Publication status	Published - Mar 2019

Keywords

context effect
joint pain
physical environment
treatment delivery

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10.1136/bjsports-2016-097448

Room for improvementAccepted manuscript, 541 KB

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CONEX: Influence of the physical environment on treatment effect in exercise therapy for knee and hip pain
Sandal, L. (Project participant)
01/02/2013 → 01/02/2016
Project: PhD Project

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title = "Room for improvement: a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery",

abstract = "OBJECTIVE: Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy.METHODS: In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments.RESULTS: 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups.CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613.",

keywords = "context effect, joint pain, physical environment, treatment delivery",

author = "Sandal, {Louise F} and Thorlund, {Jonas B} and Moore, {Andrew J} and {S. Ulrich}, Roger and {A. Dieppe}, Paul and Roos, {Ewa M}",

note = "{\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",

year = "2019",

month = mar,

doi = "10.1136/bjsports-2016-097448",

language = "English",

volume = "53",

pages = "359--367",

journal = "British Journal of Sports Medicine",

issn = "0306-3674",

publisher = "BMJ Publishing Group",

number = "6",

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TY - JOUR

T1 - Room for improvement

T2 - a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery

AU - Sandal, Louise F

AU - Thorlund, Jonas B

AU - Moore, Andrew J

AU - S. Ulrich, Roger

AU - A. Dieppe, Paul

AU - Roos, Ewa M

PY - 2019/3

Y1 - 2019/3

N2 - OBJECTIVE: Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy.METHODS: In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments.RESULTS: 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups.CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613.

AB - OBJECTIVE: Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy.METHODS: In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments.RESULTS: 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups.CONCLUSION: Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02043613.

KW - context effect

KW - joint pain

KW - physical environment

KW - treatment delivery

U2 - 10.1136/bjsports-2016-097448

DO - 10.1136/bjsports-2016-097448

M3 - Journal article

C2 - 28768617

SN - 0306-3674

VL - 53

SP - 359

EP - 367

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 6

ER -

Room for improvement: a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery

Abstract

Keywords

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CONEX: Influence of the physical environment on treatment effect in exercise therapy for knee and hip pain

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