Simon D French

Queens University of Charlotte, New York, United States

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Publications (72)166.4 Total impact

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    ABSTRACT: Background: Hot flashes (HFs) affect up to 75% of menopausal women and pose a considerable health and financial burden. Evidence of acupuncture efficacy as an HF treatment is conflicting. Objective: To assess the efficacy of Chinese medicine acupuncture against sham acupuncture for menopausal HFs. Design: Stratified, blind (participants, outcome assessors, and investigators, but not treating acupuncturists), parallel, randomized, sham-controlled trial with equal allocation. (Australia New Zealand Clinical Trials Registry: ACTRN12611000393954). Setting: Community in Australia. Participants: Women older than 40 years in the late menopausal transition or postmenopause with at least 7 moderate HFs daily, meeting criteria for Chinese medicine diagnosis of kidney yin deficiency. Interventions: 10 treatments over 8 weeks of either standardized Chinese medicine needle acupuncture designed to treat kidney yin deficiency or noninsertive sham acupuncture. Measurements: The primary outcome was HF score at the end of treatment. Secondary outcomes included quality of life, anxiety, depression, and adverse events. Participants were assessed at 4 weeks, the end of treatment, and then 3 and 6 months after the end of treatment. Intention-to-treat analysis was conducted with linear mixed-effects models. Results: 327 women were randomly assigned to acupuncture (n = 163) or sham acupuncture (n = 164). At the end of treatment, 16% of participants in the acupuncture group and 13% in the sham group were lost to follow-up. Mean HF scores at the end of treatment were 15.36 in the acupuncture group and 15.04 in the sham group (mean difference, 0.33 [95% CI, -1.87 to 2.52]; P = 0.77). No serious adverse events were reported. Limitation: Participants were predominantly Caucasian and did not have breast cancer or surgical menopause. Conclusion: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs. Primary funding source: National Health and Medical Research Council.
    No preview · Article · Jan 2016 · Annals of internal medicine

  • No preview · Article · Dec 2015
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    ABSTRACT: Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains. Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention. Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients' treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors. A multifaceted KT educational intervention targeting chiropractors' management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.
    Full-text · Article · Dec 2015 · Implementation Science
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    ABSTRACT: Objective: To determine whether physiotherapists avoid lumbar X-rays for acute non-specific low back pain and advise people to stay active. Methods: We conducted a cross sectional survey of Australian physiotherapists. 880 physiotherapists were randomly sampled from Victoria (495), South Australia (158), and Western Australia (227). Physiotherapists were asked which investigations they would order and interventions they would provide for five acute low back pain (LBP) presentations described in vignettes. Four of the five vignettes represented people who would not require a plain lumbar X-ray and would benefit from advice to stay active; one described a patient with a suspected vertebral fracture and would require a plain X-ray. Participants selected from a list of response options or provided free text responses. Results: Questionnaires were completed by 203 of 567 potentially eligible physiotherapists (response rate 36%). Across the four vignettes where an X-ray was not indicated, 75% (95%CI 71-78%) of physiotherapists reported they would practice concordant with the guidelines and not order an X-ray, and 62% (95%CI 57-66%) provided advice to stay active. Conclusions: Most physiotherapists report intended compliance with recommendations in Australian clinical practice guidelines (CPGs) regarding avoiding the use of X-rays and providing advice to stay active for people with simple acute low back pain, given a vignette based scenario. The majority of respondents reported that they would not advise bed rest. Possible opportunities to further enhance compliance need to be developed and tested to reinforce the role of CPGs in informing physiotherapy practice.
    No preview · Article · Dec 2015 · Manual therapy
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    Cecilie D Testern · Lise Hestbæk · Simon D French
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    ABSTRACT: Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration. The primary aim of this study was to determine the views and perspectives of chiropractors about diagnostic coding and explore the use of it in a chiropractic setting. A secondary aim was to compare the diagnostic coding undertaken by chiropractors and an independent coder. A codin exercise based on the International Classification of Primary Care version 2, PLUS extension (ICPC-2 PLUS) provided the 14 chiropractors with some experience in diagnostic coding, followed by an interview on the topic. The interviews were analysed thematically. The participating chiropractors and an independent coder applied ICPC-2 PLUS terms to the diagnoses of 10 patients. Then the level of agreement between the chiropractors and the coder was determined and Cohen's Kappa was used to determine the agreement beyond that expected by chance. From the interviews the three emerging themes were: 1) Advantages and disadvantages of using a clinical coding system in chiropractic practice, 2) ICPC-2 PLUS terminology issues for chiropractic practice and 3) Implementation of a coding system into chiropractic practice. The participating chiropractors did not uniformly support or condemn the idea of using diagnostic coding. However there was a strong agreement that the terminology in ICPC-2 PLUS would not be applicable or desirable for all practice types. In the coding exercise the chiropractors in total coded 202 diagnoses for 135 patients. The overall percentage agreement between the chiropractors and the coder was 52% (17% expected by chance) with a Kappa score of 0.4 (95% CI 0.3-0.7). Agreement was lower for more detailed coding (percentage agreement 35%; Kappa score of 0.3 (95% CI 0.2-0.5)). It appears that implementation of diagnostic coding would be possible in the majority of the chiropractic practices that participated in this study. However for those chiropractors who do not focus on symptoms in their approach to clinical care, it could be challenging to use the ICPC-2 PLUS coding system, since ICPC-2 PLUS is a symptom-based classification.
    Full-text · Article · Dec 2015 · Chiropractic and Manual Therapies

  • No preview · Article · Nov 2015 · Arthritis Care and Research

  • No preview · Conference Paper · Oct 2015
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    ABSTRACT: Background: Non-pharmacological interventions have been shown to have some effectiveness in adults with dizziness; however, the effectiveness of these interventions in older people is unknown. Purpose: To determine the effects of conservative non-pharmacological interventions for dizziness in older people. Data sources: Cochrane Central Register of Controlled Trials, PubMed, EMBASE, SCOPUS, CINAHL, AMED, Index to Chiropractic Literature, PsychINFO and MANTIS were searched from inception to May 2014. Study selection: Two investigators independently screened controlled trials with dizzy participants over 60 years of age. Dizziness from a specific diagnosis such as Meniere's disease and benign positional paroxysmal vertigo were excluded. Outcome measures from included studies included self-reported dizziness and postural balance. Data extraction: Two investigators independently extracted data on participants, interventions, comparison group, outcome measures and results. Methodological quality of included studies was assessed with the Cochrane Handbook 12-item risk of bias, and Cochrane Back Group 5-item clinical relevance assessment. Data synthesis: Seven articles consisting of seven controlled trials were included. All studies utilized some form of exercise as the main intervention including vestibular rehabilitation exercises, postural balance exercises, and Tai-Chi exercise. Studies had a high risk of bias with a lack of adequate randomization and allocation concealment, reporting on co-interventions, reporting on reasons for drop-outs, and reporting on participant compliance. Limitations: Heterogeneity between the included studies on interventions and outcome measures prohibited meta-analysis. Only two studies reported a significant difference between the intervention and comparison groups on self-reported dizziness. Conclusion: There is insufficient evidence to determine the effectiveness of non-pharmacological treatments for dizziness in older people. Current evidence suffers from high risk of bias and future well-designed trials are needed with adequate blinding, randomization and compliance.
    No preview · Article · Oct 2015 · Physical Therapy
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    ABSTRACT: Imaging for low back pain (LBP) remains common despite guidelines recommending against routine imaging. Patient beliefs about imaging may contribute to the problem. This study aimed to quantitatively investigate patient beliefs regarding the need for imaging in managing LBP and to investigate whether personal characteristics, pain characteristics or back pain beliefs are associated with imaging beliefs. A survey was performed of consecutive patients presenting to general medical practitioners in Sydney, Australia. Nine medical clinics were selected across varied socioeconomic regions. Survey questions assessed beliefs about the importance of imaging for LBP, collected demographic information, LBP history and general beliefs about back pain. Descriptive statistics and multivariate logistic regression were used to analyse findings. Three hundred completed surveys were collected with a 79.6% response rate. The mean age was 44 years and 60.7% of respondents were women. Exactly, 54.3% (95%CI: 48.7-58.9%) believed that imaging was necessary for the best medical care for LBP. Exactly, 48.0% (95%CI: 42.4-53.6%) believed that everyone with LBP should obtain imaging. Increased age, lower education level, non-European or non-Anglo-saxon cultural background, history of previous imaging and Back Beliefs Questionnaire scores were associated with beliefs that imaging was necessary. Approximately, half of all patients presenting to a medical doctor consider low back imaging to be necessary. This may have important implications for overutilization of low back imaging investigations. Knowledge of the factors associated with the patient's belief that imaging is necessary may be helpful in designing appropriate interventions to reduce unnecessary imaging for LBP. © 2015 European Pain Federation - EFIC®
    Full-text · Article · Aug 2015 · European journal of pain (London, England)

  • No preview · Article · Aug 2015
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    ABSTRACT: Objectives Implementation intervention effects can only be fully realised and understood if they are faithfully delivered. However the evaluation of implementation intervention fidelity is not commonly undertaken. The IMPLEMENT intervention was designed to improve the management of low back pain by general medical practitioners. It consisted of a two-session interactive workshop, including didactic presentations and small group discussions by trained facilitators. This study aimed to evaluate the fidelity of the IMPLEMENT intervention by assessing: (1) observed facilitator adherence to planned behaviour change techniques (BCTs); (2) comparison of observed and self-reported adherence to planned BCTs and (3) variation across different facilitators and different BCTs. Design The study compared planned and actual, and observed versus self-assessed delivery of BCTs during the IMPLEMENT workshops. Method Workshop sessions were audiorecorded and transcribed verbatim. Observed adherence of facilitators to the planned intervention was assessed by analysing the workshop transcripts in terms of BCTs delivered. Self-reported adherence was measured using a checklist completed at the end of each workshop session and was compared with the ‘gold standard’ of observed adherence using sensitivity and specificity analyses. Results The overall observed adherence to planned BCTs was 79%, representing moderate-to-high intervention fidelity. There was no significant difference in adherence to BCTs between the facilitators. Sensitivity of self-reported adherence was 95% (95% CI 88 to 98) and specificity was 30% (95% CI 11 to 60). Conclusions The findings suggest that the IMPLEMENT intervention was delivered with high levels of adherence to the planned intervention protocol. Trial registration number The IMPLEMENT trial was registered in the Australian New Zealand Clinical Trials Registry, ACTRN012606000098538 (http://www.anzctr.org.au/trial_view.aspx?ID=1162).
    Full-text · Article · Jul 2015 · BMJ Open
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    Preview · Article · Jun 2015 · Current Oncology
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    ABSTRACT: Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability and psychological dysfunction. To evaluate whether adding an internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater improvements in pain and function. Assessor-, therapist- and participant-blinded randomized controlled trial SETTING: Community PARTICIPANTS: 142 people over 50 years of age with self-reported hip pain consistent with hip OA INTERVENTION: Participants will be randomly allocated to: i) control - a 24 week standardized intervention comprising an 8-week internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or ii) PCST - adding an 8-week internet-based PCST protocol to the control intervention. Outcomes will be measured at baseline, 8, 24 and 52 weeks with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing and physical activity. Measures of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice towards innovative modes of psychosocial healthcare provision. © 2015 American Physical Therapy Association.
    No preview · Article · May 2015 · Physical Therapy
  • P. Hodges · A. Nielsen · S. French

    No preview · Article · May 2015 · Physiotherapy

  • No preview · Article · Apr 2015 · Osteoarthritis and Cartilage
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    ABSTRACT: Rates of imaging for low-back pain are high and are associated with increased health care costs and radiation exposure as well as potentially poorer patient outcomes. We conducted a systematic review to investigate the effectiveness of interventions aimed at reducing the use of imaging for low-back pain. We searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from the earliest records to June 23, 2014. We included randomized controlled trials, controlled clinical trials and interrupted time series studies that assessed interventions designed to reduce the use of imaging in any clinical setting, including primary, emergency and specialist care. Two independent reviewers extracted data and assessed risk of bias. We used raw data on imaging rates to calculate summary statistics. Study heterogeneity prevented meta-analysis. A total of 8500 records were identified through the literature search. Of the 54 potentially eligible studies reviewed in full, 7 were included in our review. Clinical decision support involving a modified referral form in a hospital setting reduced imaging by 36.8% (95% confidence interval [CI] 33.2% to 40.5%). Targeted reminders to primary care physicians of appropriate indications for imaging reduced referrals for imaging by 22.5% (95% CI 8.4% to 36.8%). Interventions that used practitioner audits and feedback, practitioner education or guideline dissemination did not significantly reduce imaging rates. Lack of power within some of the included studies resulted in lack of statistical significance despite potentially clinically important effects. Clinical decision support in a hospital setting and targeted reminders to primary care doctors were effective interventions in reducing the use of imaging for low-back pain. These are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain. © 8872147 Canada Inc.
    Full-text · Article · Mar 2015 · Canadian Medical Association Journal
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    ABSTRACT: Many risk factors exist for falls in the elderly. Dizziness is an important risk factor for such falls. Spinal pain has also been identified as a risk factor for these falls. In this overview of the literature, we examine studies, including trials, of neck manipulation for neck pain, unsteadiness and falls risk relevant to the elderly. We also examine two related, but not mutually exclusive, mechanisms through which a putative beneficial effect may be mediated. These are the effects of neck manipulation on neck pain and on non-specific dizziness. We focus on the available evidence primarily in terms of clinical data rather than laboratory-based measures of balance. We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined.
    Full-text · Article · Mar 2015 · JCCA. Journal of the Canadian Chiropractic Association. Journal de l'Association chiropratique canadienne
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    ABSTRACT: Objective To establish priority key messages for patients with osteoarthritis (OA).MethodsA Delphi survey and priority pairwise ranking activity was conducted. Participants included 51 OA experts from 13 countries and 9 patients (consumers) living with hip and/or knee OA. During 3 Delphi rounds, the panel of experts and consumers rated recommendations extracted from clinical guidelines and provided additional statements they considered important. When ≥70% of panel members agreed a statement was “essential,” it was retained for the next Delphi round. The final list of essential statements was reviewed by a consumer focus group and statements were modified for clarity if required. Finally, a priority pairwise ranking activity determined the rank order of the list of essential messages.ResultsEighty-five experts and 15 consumers were invited to participate; 51 experts and 9 consumers completed round 1 of the Delphi survey, and 43 experts and 8 consumers completed the final priority ranking activity. From an original list of 114 statements, 21 statements were rated as essential. Most statements (n = 17) related to nondrug treatment approaches for OA. Study limitations included that >50% of the panel comprised of physical therapists lead to high rankings of exercise and physical activity statements and also that only English-language statements were considered.ConclusionOA experts and consumers have identified and prioritized 21 key patient messages about OA. These messages may be used to inform the content of consumer educational materials to ensure patients are educated about the most important aspects of OA and its management.
    No preview · Article · Nov 2014
  • Simon French · Peter Werth · Bruce Walker

    No preview · Article · Sep 2014 · Australian family physician
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    ABSTRACT: Background: Persistent knee pain in people over 50 years of age is often attributable to knee osteoarthritis (OA), a common joint condition that causes physical and psychological dysfunction. Exercise and pain coping skills training (PCST) can help reduce the impact of persistent knee pain, however, access to health professionals who deliver these services can be challenging. With increasing access to the Internet, remotely delivered Internet-based treatment approaches may provide alternatives for healthcare delivery. This pragmatic randomised controlled trial will investigate whether an Internet-delivered intervention that combines PCST and physiotherapist-guided exercise (PCST + Ex) is more effective than online educational material (educational control) in people with persistent knee pain. Methods/design: We will recruit 148 people over 50 years of age with self-reported persistent knee pain consistent with knee OA from the Australian community. Following completion of baseline questionnaires, participants will be randomly allocated to access a 3-month intervention of either (i) online educational material, or (ii) the same online material plus an 8-module (once per week) Internet-based PCST program and seven Internet-delivered physiotherapy sessions with a home exercise programs to be performed 3 times per week. Outcomes will be measured at baseline, 3 months and 9 months with the primary time point at 3 months. Primary outcomes are average knee pain on walking (11-point numeric rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index subscale). Secondary outcomes include additional measures of knee pain, health-related quality-of-life, perceived global change in symptoms, and potential moderators and mediators of outcomes including self-efficacy for pain management and function, pain coping attempts and pain catastrophising. Other measures of adherence, adverse events, harms, use of health services/co-interventions, and process measures including appropriateness and satisfaction of the intervention, will be collected at 3, 6 and 9 months. Discussion: The findings will help determine the effectiveness and acceptability of Internet access to a combination of interventions that are known to be beneficial to people with persistent knee pain. This study has the potential to guide clinical practice towards innovative modes of healthcare provision. Trial registration: Australian New Zealand Clinical Trials Registry reference: ACTRN12614000243617.
    Full-text · Article · Aug 2014 · BMC Musculoskeletal Disorders

Publication Stats

1k Citations
166.40 Total Impact Points

Institutions

  • 2014-2015
    • Queens University of Charlotte
      • School of Rehabilitation Therapy
      New York, United States
  • 2013-2015
    • Queen's University
      • School of Rehabilitation Therapy
      Kingston, Ontario, Canada
  • 2010-2015
    • University of Melbourne
      • • Department of General Practice and Primary Health Care
      • • Centre for Health, Exercise and Sports Medicine
      • • Primary Care Research Unit (PRCU)
      Melbourne, Victoria, Australia
    • University of Vic
      Vic, Catalonia, Spain
  • 2011-2014
    • Murdoch University
      • School of Health Professions
      Perth City, Western Australia, Australia
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2006-2013
    • Monash University (Australia)
      • School of Public Health and Preventive Medicine
      Melbourne, Victoria, Australia