Improving Wrist Injury Pathways (I-WIP) Study (I-WIP)
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ClinicalTrials.gov Identifier: NCT05835440 |
Recruitment Status :
Recruiting
First Posted : April 28, 2023
Last Update Posted : December 5, 2023
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Wrist injuries represent a considerable problem for both patients and the NHS. Around 70,000 patients per year in the UK attend hospitals with serious wrist pain after an injury, only to find that their x-ray is considered to be 'normal'. The National Institute of Care and Health Excellence (NICE) advises that these patients should be given MRI (magnetic resonance imaging) scans early on, within 2 weeks. Early MRI gives patients the best care, by picking up the serious injuries requiring early treatment and by helping reassure those without serious injuries to get back to activities quickly. This saves the NHS staff time and money by reducing unnecessary clinic attendances. Although these benefits from early use of MRI scans, and the NICE guidance, are clear, it is know from our recent national (UK) survey that only 11 of the 87 UK hospitals that we surveyed used MRI scans for these patients.
The gap between what the best evidence suggests and what happens in clinical practice is a complex issue that requires further investigation. To develop a complex intervention to address this problem,a better understanding of the reasons why hospital services are currently unable to adopt the NICE guidance is needed. Clinical interventions in surgery exist on a spectrum from simple, such as closing a wound with stitches, to the complicated (carrying out a joint replacement for a neck of femur fracture) to complex (improving trauma theatre efficiency). The latter, more complex variety, are characterised by the 1) number of components in the intervention, 2) the range of behaviours targeted 3) the range and different levels of target recipients, 4) the expertise and skills required by those delivering and receiving the intervention 5) and or by the level of flexibility permitted in the intervention delivery. In 2000, the UK Medical Research Council (MRC) established guidance for developing and evaluating complex interventions to improve the delivery of health care services. An important stage in developing complex interventions and improving care is to fully understand current pathways and the context of care. This qualitative study aims to develop a better understanding of wrist injury pathways, and their context, in the NHS. We aim to (1) understand the barriers to early MRI for painful wrists and (2) understand what is important to patients when being treated with a wrist injury.
Condition or disease | Intervention/treatment |
---|---|
Scaphoid Fracture Wrist Injuries | Other: no intervention |
Study Type : | Observational |
Estimated Enrollment : | 70 participants |
Observational Model: | Other |
Time Perspective: | Prospective |
Official Title: | Improving Wrist Injury Pathways (I-WIP): a Qualitative Study |
Actual Study Start Date : | August 1, 2023 |
Estimated Primary Completion Date : | May 2025 |
Estimated Study Completion Date : | May 2025 |
Group/Cohort | Intervention/treatment |
---|---|
staff stakeholders
The potential stakeholders are a diverse population and will include managers, emergency department clinicians and practitioners, radiologists, radiographers, administrative staff and surgeons. A maximum total of 4 staff stakeholder interviews shall be undertaken.
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Other: no intervention
interviews |
patient participants
The patient population are adults who have sustained a traumatic wrist injury with normal X-rays and have been treated by NHS services.
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Other: no intervention
interviews |
- Thematic analysis of interview data [ Time Frame: 12 months ]thematic analysis
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Sampling Method: | Non-Probability Sample |
For aim 1, the staff stakeholders (NHS staff) shall be identified using snowballing sampling starting with the local QI project lead and the aim is to undertake up to 40 staff stakeholder interviews (maximum of 4 at each site).
For aim 2, we will undertake up to 30 patient participant interviews recruited from trauma clinics (3 at each site). As explained above, patient participants shall be sampled purposively to achieve a diversity in terms of gender and age.
Inclusion Criteria
- All participants are willing and able to give informed consent for participation in the study (including audio recording of interview). Where possible we shall use translation services to enable those who might not adequately understand various forms of information to take part
For staff stakeholders (NHS staff) - Any staff member involved in regular delivery or management of Wrist Injury Pathways (e.g. manager, nurse practitioner, physiotherapist, surgeon, administrative staff, radiologist, radiographer, emergency department clinician). This staff member must be deemed to be integral in the day to day running and/or overall management of the pathway.
For patients:
- Male or female aged over 18 years of age
- Being treated for a traumatic wrist injury with a normal initial X-ray
Exclusion Criteria
- Learning difficulty
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): NCT05835440
Contact: Gail Lang | 01865741155 | gail.lang@ndorms.ox.ac.uk |
United Kingdom | |
OUH NHS TRust | Recruiting |
Oxford, Oxon, United Kingdom, OX3 7LD | |
Contact: Gail Lang 01865741155 gail.lang@ndorms.ox.ac.uk |
Responsible Party: | University of Oxford |
ClinicalTrials.gov Identifier: | NCT05835440 |
Other Study ID Numbers: |
321650 |
First Posted: | April 28, 2023 Key Record Dates |
Last Update Posted: | December 5, 2023 |
Last Verified: | October 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Wounds and Injuries Wrist Injuries Arm Injuries |