In our trial all therapies were delivered by physiotherapists working in a primary care based musculoskeletal service, and no extra NHS resources were required to implement the study interventions.
Notably, the majority of documents in this systematic review did not include information about the program costs or material resources required for implementing the studied intervention.
Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy.
Yearly rates were assigned to one of six categories based on when the study intervention was implemented: at baseline, during the implementation period, or during one of four 1-year intervals up to four years after implementation.
Quarterly rates were assigned to one of four categories based on when the study intervention was implemented: at baseline, during the early post-intervention period (year 1), or late post-intervention period (year 2).
10 nursing homes in the areas of Leipzig, Saxony, and Halle, Saxony-Anhalt (Germany) respectively, will be recruited that have implemented none of the study interventions in routine care prior to the study.
However, due to pragmatic concerns, the Data Safety Monitoring Board (DSMB) agreed with using only 11 practices in each arm given that one solo PCP who was randomized to the intervention arm had a protracted illness that precluded our ability to implement the intervention within the study timeline, and another solo practice allocated to the control group was unable to provide patient lists.
Due to the heterogeneity of the evidence base for the present application, namely that each study evaluated a different intervention using a different set of outcomes along with variations in the specific populations studied and those implementing the interventions, study results could not be combined nor directly compared.
Furthermore, reliance on patient advisory boards and a stakeholder panel to shape the study design and implement the intervention represent a unique approach for improving delivery of prognostic information and elicitation of EOL care preferences.
