A Randomized Trial Comparing "Push" Versus "Pull" Technology for Mobilizing Pain Evidence Into Practice Across Different Health Professions
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ClinicalTrials.gov Identifier: NCT01348802 |
Recruitment Status
:
Completed
First Posted
: May 5, 2011
Last Update Posted
: September 23, 2015
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Condition or disease | Intervention/treatment | Phase |
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Pain | Behavioral: Push + Pull Behavioral: Pull | Not Applicable |
The Problem: Pain affects all Canadians during acute injury or disease. Chronic noncancer pain affects 29% of Canadians, half of whom are unable to participate in their usual work/social roles. Pain is the primary reason that patients consult health practitioners. Research has shown the benefits, harms, and costs of numerous interventions for pain, but uptake of this knowledge is far from satisfactory. Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings.
The Research Question: The purpose of this randomized trial is to determine whether a technology-based "push" of new, high-quality pain research to physicians, nurses, rehabilitation and psychology professionals results in better knowledge and clinical decision-making around pain, when offered in addition to traditional "pull" evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence.
The Study Sample: 670 Physicians, nurses, occupational/physical therapists and psychologists ((80/group X 2 comparison groups X 4 disciplines) + 30 for dropouts)will be recruited through professional associations, websites/conferences and social media. This provides > 90% power to detect main effects; 80% power for subgroup effects.
Outcome Measures: The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/discipline will undergo chart-stimulated recall (CSR) to assess the nature and depth of evidence utilization in actual case management (0, 9 months). A different random subset of 30 participants/discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviours (0, 3, 9, 15, 18 months).
Intervention/Methods: Participants who agree to this study of a free literature service will be randomly allocated to Push + Pull versus Pull evidence support. Push + Pull is evidence on pain that is extracted from medical, nursing and rehabilitation journals and appraised for quality and relevance and sent out to clinicians (derived from the successful MacPLUS/Evidence Updates), delivered by e-mail alerts or available for searches of the accumulated database). Pull will be an intervention with a similar front-face but requires clinicians to go to the site and extract evidence from an electronic database. The trial will begin with a 3-month (repeated) baseline, during which average participant use of the standard PULL resource will be monitored. Participants will then be randomly allocated to receive PUSH + PULL or continue to use the PULL resource. After six months, participants will cross over to the alternate intervention for an additional six months. To complete the trial, both groups will finish with three months of PUSH + PULL access.
Analyses: The investigators will use an analysis of covariance (ANCOVA), where discipline and setting are covariates to assess differential responses across main effects of Push + Pull vs. Pull. Content analysis of the CSR interview will be use to describe the application of evidence within actual cases.
Impact/Timeliness: The trial will inform our understanding on information preferences and behaviours across disciplines/practice settings. If this intervention is effective, sustained support will come through professional/health system initiatives emerging to optimize pain management in Canada.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 675 participants |
Allocation: | Randomized |
Intervention Model: | Crossover Assignment |
Masking: | Double (Investigator, Outcomes Assessor) |
Primary Purpose: | Health Services Research |
Official Title: | A Randomized Trial Comparing "Push" Versus "Pull" Technology for Mobilizing Pain Evidence Into Practice Across Different Health Professions |
Study Start Date : | August 2011 |
Actual Primary Completion Date : | December 2014 |
Actual Study Completion Date : | March 2015 |
Arm | Intervention/treatment |
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Experimental: Push + Pull
Push + Pull is evidence on pain that is extracted from medical, nursing, psychology and rehabilitation journals, appraised for quality and relevance, and delivered to clinicians by e-mail alerts or available for searches of the accumulated database.
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Behavioral: Push + Pull
Push + Pull is evidence on pain that is extracted from medical, nursing, psychology and rehabilitation journals, appraised for quality and relevance, and delivered to clinicians by e-mail alerts or available for searches of the accumulated database.
|
Placebo Comparator: Pull
Pull will be an intervention with a similar front-face but requires clinicians to go to the site and extract evidence from an electronic database.
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Behavioral: Pull
Pull will be an intervention with a similar front-face but requires clinicians to go to the site and extract evidence from an electronic database.
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- Application of evidence (chart-stimulated recall) [ Time Frame: 0, 9 months ]A random subset of 30 participants/discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management.
- Skill at accessing research evidence [ Time Frame: 15 months ]A different random subset of 30 participants/discipline will be tested for their skills in accessing evidence using a standardized simulation test.
- Usage of PainPLUS [ Time Frame: Every month ]Embedded tracking of number/frequency of article access and type of evidence. Level of satisfaction with PainPLUS
- Attitudes about Evidence-Based Practice Questionnaire [ Time Frame: 0, 3, 9, 15, and 18 months ]Knowledge/Attitude/Behaviour Questionnaire
- Familiarity/Access to Technology [ Time Frame: 0 months ]

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Ages Eligible for Study: | 18 Years and older (Adult, Senior) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- licensed physicians, nurses, occupational therapists (OT), physical therapists (PT), or psychologists who see patients at least 1 day/week;
- fluent in English;
- have access to a computer at home or at work which has unrestricted access to the World Wide Web,
- have an active email account
Exclusion Criteria:
- currently participating in other knowledge translation interventions

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01348802
Canada, Ontario | |
McMaster University | |
Hamilton, Ontario, Canada, L8S 1C7 |
Principal Investigator: | Joy MacDermid, PhD | McMaster University |
Additional Information:
Publications:
Responsible Party: | Joy MacDermid, Professor, McMaster University |
ClinicalTrials.gov Identifier: | NCT01348802 History of Changes |
Other Study ID Numbers: |
CIHR-228972 |
First Posted: | May 5, 2011 Key Record Dates |
Last Update Posted: | September 23, 2015 |
Last Verified: | September 2015 |
Keywords provided by Joy MacDermid, McMaster University:
Knowledge Translation Push-out Evidence Technology-Based Knowledge Translation Pain Interdisciplinary |
Physician Rehabilitation Nursing Knowledge Uptake |