To explore the perspectives of librarians and information specialists (LIS) on their experience and impact as peer reviewers of systematic reviews (SRs), and on facilitators and barriers to LIS methodological peer review.

Survey and focus groups.

We surveyed LIS who completed a peer review of an SR in a randomised controlled trial conducted in BMJ, BMJ Open and BMJ Medicine from 3 January 2023 to 2 January 2024. The questionnaire sought to understand their experience, what aspects of manuscripts they focused on, perceived impact on editorial decision-making and authors’ revisions and willingness to peer review again. To better understand factors that might impact decisions to review again, we contacted survey respondents to participate in a focus group concentrating on facilitators and barriers to peer reviewing SRs.

88 LIS were eligible for participation. From the survey respondents, 27 LIS who had volunteered were randomly selected and invited to participate in a follow-up focus group.

Of the 88 LIS invited to participate in the survey, 70 (80%) responded. Most respondents had six or more years of experience as an LIS (67/70; 96%) and advising researchers on doing SRs (55/70; 79%) and had peer reviewed for a journal prior to the study (57/70; 81%). Most focused on the search and SR methods when reviewing but also commented on aspects such as research question formulation, plagiarism, study results and conclusions. Two-thirds (44/66; 67%) believed they impacted editors’ decision-making and 59% (39/66) believed they impacted the authors’ revisions. Only three factors were considered extremely or very likely to impact their decision to review again: their schedule and/or lack of time, review turnaround time and their sense of professional duty. 17 LIS (63.0%) participated in a focus group. Time was the primary barrier identified in the focus groups, followed by a sense of intimidation. LIS reported being motivated by feeling valued by editors, the enjoyment of peer reviewing, the desire to improve SR quality and peer review as a learning experience. Several expressed surprise and delight at being asked to peer review for the journals.

LIS may be an underused peer reviewing resource with methodological experience that can help editors make decisions and improve the quality of SRs. Efforts to engage LIS as peer reviewers by journal editors are likely to be well-received when LIS expertise is clearly valued, sought and heeded. We encourage both journal editors and LIS to creatively advance efforts to promote LIS as methodological peer reviewers.

https://doi.org/10.17605/OSF.IO/QVTY4.

People without access to recognised and understood speech and/or written communication methods can experience exceptional disadvantage in health settings. This can result in poor health outcomes, lengthier hospital admissions and adverse events, including preventable deaths. Despite numerous attempts to integrate augmentative and alternative communication into health settings, the first-person ‘voice’ of the patient is often not accessible or prioritised, deferring instead to others, such as parents or carers, or the ‘best guess’ by healthcare professionals. The Talking Scrubs project aims to form a bridge to augmentative and alternative communication by locating key communication icons on scrubs (and scrubs/vest) to be used with patients (in and of themselves) and/or to prompt the use of patient individualised communication methods. The paper describes the methodological process for Stage 4 of the project. Prior stages involved investigating the concept, developing and validating instrument measures and co-designing and feasibility pilot testing the scrubs/vests. Stage 4 (this protocol) aligns with the diagnostic process, to test the feasibility and effectiveness of the scrubs intervention at two large, metropolitan medical centres with 5–10 general practitioners, approximately 30 patients and up to 10 flow-on diagnostic screening clinicians such as nurses and phlebotomists. Stage 4 is the first time the instrument measures will be applied and re-tested post-validation.

Using mixed methods, Stage 4 will apply the communication self-efficacy instruments co-designed in Stage 2 and validated in Stage 3 to measure effectiveness of the scrubs intervention by comparing pre-intervention and post-intervention changes in both clinician and patient population groups. Qualitative interviews, agency recorded data and participant journal recordings (optional) will be used to identify feasibility. SPSS V.29 (IBM, Chicago, Illinois, USA) will be applied to analyse participant communication self-efficacy measures and NVIVO V.10 (Lumiverso, Denver, Colorado, USA) to the retrieved qualitative data.

Stages 3 and 4 have ethics approval from the University of South Australia Ethics Committee identification number 206 930 and are registered as a clinical trial with Australia and New Zealand Clinical Research Trials (ANZCRT) with registration number 12625000490471p. Stage 1 (national survey) and Stage 2 (stakeholder focus groups) received ethics approval from Flinders University. Findings will be disseminated through national and international health translation platforms, publications, media and on the Talking Scrubs website.

ANZCRT with the registration number ACTRN12625000490471p.

To explore National Health Service (NHS) healthcare professionals’ experiences of delivering rehabilitation for patients with Achilles tendon rupture (ATR).

Qualitative study using semistructured interviews and reflexive thematic analysis.

NHS hospital sites in the United Kingdom, providing non-surgical ATR management using the Leicester Achilles Management Protocol (LAMP).

Twenty-one NHS healthcare professionals, including physiotherapists and orthopaedic consultants with a mean of 10.8 years of clinical experience, purposively sampled based on profession and experience managing ATR.

Three main themes were identified: (1) clinical training on Achilles tendon ruptures, (2) rehabilitation following ATR and (3) the NHS service delivering rehabilitation. Participants reported limited training on ATR, leading to reduced confidence and slower rehabilitation progressions. Fear of re-injury influenced clinical decision-making, while discharge decisions were goal-oriented but constrained by service limitations.

This study highlights limited clinical training, inconsistent rehabilitation practices and NHS service constraints that collectively slow rehabilitation progress and affect return to sport following ATR. Enhanced training, service development and greater standardisation of ATR rehabilitation pathways are recommended to improve patient outcomes.

Head and neck cancer (HNC) affects the mouth, throat, salivary glands, voice box, nose or sinuses. Every year, over 12 000 people in the UK are diagnosed with HNC. Neck dissection is a key, surgical component of patient care. However, many people experience postoperative restriction in shoulder and neck movements, pain, fatigue and low mood, with only half ever returning to work.

Getting Recovery Right After Neck Dissection (GRRAND) is a two-arm, multicentre, pragmatic randomised controlled trial. The trial aims to compare clinical and cost-effectiveness of a personalised physiotherapy programme (GRRAND programme) versus usual practice, National Health Service (NHS), postdischarge care.

The planned sample size is 390 participants. Participants will be recruited from across UK sites and followed up for 12 months. The primary outcome is the shoulder pain and disability index at 12 months. Economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data, including pain, function, health-related quality of life, mental well-being, health resource use and adverse events, will be collected at 6 weeks, 3, 6 and 12 months, with exercise adherence at 6 weeks. A process evaluation will determine how GRRAND is implemented, delivered and received across clinical settings, exploring what works, for whom and under what conditions. Analysis will be on an intention-to-treat basis and reported inline with the Consolidated Standards of Reporting Trials statement.

The trial was approved by the London-Brent Research Ethics Committee (ref: 24/LO/0722) on 15 October 2024. Trial results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries and social media. This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials checklist.

ISRCTN13855775.

To assess the feasibility of conducting a definitive randomised controlled trial (RCT) to test the clinical and cost-effectiveness of a tailored exercise intervention compared with usual care for people aged 80 years and older with hip and/or knee osteoarthritis (OA) and comorbidities.

Two-arm, parallel-design, multicentre, pragmatic, feasibility RCT.

Four National Health Service outpatient physiotherapy services across England.

Adults aged 80 years and over with clinical hip and/or knee OA and ≥1 comorbidity.

Participants were randomised 1:1 via a central web-based system to be offered: (1) a 12-week tailored exercise programme or (2) usual care. Participants and outcome assessors were not blinded to treatment allocation.

(1) Ability to screen and recruit participants; (2) retention of participants at 14-week follow-up; (3) intervention fidelity (proportion of participants who received ≥4 intervention sessions as per protocol) and (4) participant engagement (assessed by home exercise adherence).

Between 12 May 2022 and 26 January 2023, 133 potential participants were screened, of whom 94 were eligible. The main reasons for ineligibility were symptoms not consistent with hip or knee OA (10/39, 25.6%) or already having had a physiotherapy appointment (8/39, 20.5%). 51 of 94 (54%) eligible participants were recruited. Participants had a mean age of 84 years (SD 3.5), 31 (60.8%) were female and 96.1% reported their ethnicity as White British (n=49/51). 45 of 51 participants (88%) provided outcome data at the 14-week follow-up time point. Four or more intervention sessions were attended by 13/25 (52%) participants. Home exercise log completion declined over time: 6/23 participants (26.1%) returned completed exercise logs for all 12 weeks. The median number of days home exercises were recorded each week was 5 (range 0–7).

This study demonstrated that a definitive trial would be feasible. Before proceeding, modifications to ensure recruitment of a diverse population and intervention fidelity should be addressed.

ISRCTN75983430.

To explore multiprofessional views about system-wide factors influencing (impeding or facilitating) the delivery of stroke mechanical thrombectomy (MT) services and/or improvements to this pathway in England.

A pragmatic exploratory qualitative study using online focus groups and semi-structured interviews with National Health Service (NHS) professionals and those working in a stroke strategic/policy lead role. We thematically analysed the data using the Framework Approach to understand participants’ views on the challenges to improving current and future MT implementation.

NHS trusts and other key stroke strategic/policy organisations covering 10 geographical regions in England and a national perspective.

A total of 29 professionals, working in an NHS clinical and managerial position and/or a stroke strategic national/regional clinical/policy lead role, participated in five focus groups and six individual semi-structured interviews between April and June 2024.

We identified five themes relating to MT implementation progress and challenges (1) workforce, (2) clinical care pathways, (3) service/system, (4) cross-cutting theme: communications and (5) cross-cutting theme: culture. Our analysis emphasised the increasing complexity and inter-related factors shaping the emergency stroke pathway for MT provision and a need to acknowledge key people-related, organisational and sociocultural factors during service planning.

Despite the challenges and complexity, professionals were optimistic that further progress would be made with MT delivery in England. However, ongoing improvement strategies are required, which also acknowledge wider cultural factors and system-wide relationships and are not just focused on care pathways and resources.