Kristian Damgaard Lyng

Introduction Caregivers of children with disabilities act as intermediaries between professionals due to fragmented communication and information sharing across sectors. The use of shared digital communication may support integrated care. Therefore, this study explored challenges and needs among caregivers and professionals and how an existing shared digital communication intervention could be adapted to support communication and coordination in this context. Methods Three future workshops involved 26 co-designers: caregivers (n=8), professionals across sectors (n=14), and software developers (n=4). Caregiver and professional data were analysed thematically, followed by matrix analysis to identify convergences, tensions, and design principles. In workshop with software developers, design principles were translated into design specifications. Results Both caregivers and professionals described how caregivers become de facto care coordinators. Clear responsibilities, continuity, and shared knowledge were identified as essential for improving communication and coordination. Shared digital communication was considered promising, but tensions emerged between accessibility and workload, and between transparency and confidentiality. The adapted intervention incorporated structured communication, shared responsibility, relational continuity, a shared overview, and a human digital coordination function. Discussion/conclusion The adapted intervention provides a foundation for cross-sector communication between caregivers and professionals and adds to the evidence base of communication solutions that may strengthen integrated care.

BACKGROUND Caregivers of children with disabilities often face substantial demands related to coordinating care across health, social, and educational services. Fragmented communication and limited information sharing across sectors place caregivers in the role of intermediaries between professionals, potentially increasing their burden and affecting family well-being. Shared digital communication solutions may support more integrated and family-centered services by facilitating communication and information exchange across sectors. However, little is known about how such solutions influence caregivers' experiences of communication, coordination, and their role as care coordinators. OBJECTIVE This study aims to evaluate and explore caregivers' perceptions of communication and coordination, before and after gaining access to a shared digital communication intervention connecting caregivers of children with disabilities and professionals across health, social, and educational sectors. Furthermore, the study explores caregivers' experiences of the impact of the intervention. METHODS This study is a convergent mixed methods evaluation conducted within a complex intervention framework as part of the SHARE IT project, which investigates a shared digital communication intervention co-designed with caregivers and professionals. Quantitative data will be collected using patient-reported outcome measures at baseline, before access to the intervention, and at the end of the intervention period. Qualitative data will be collected through follow-up semi structured interviews with a purposively selected subset of caregivers. Quantitative and qualitative findings will be integrated to provide a comprehensive understanding of changes in caregivers' perceptions of communication and coordination, their experiences of using the intervention, and the contextual factors influencing its perceived impact. RESULTS The SHARE IT project received funding in 2024. Prior to the current evaluation, an adaptation phase was conducted in 2024, including investigations of legal requirements and a co-design workshop study involving caregivers, professionals, and software developers. This was followed by a feasibility phase conducted in 2025-2026, during which the intervention was tested with caregivers of 15 children, involving 70 professionals across disciplines and sectors. Recruitment for the present evaluation began in October 2026 and is ongoing. Each family will have access to the intervention for 10 months, and data collection is expected to be completed by the end of 2027. CONCLUSIONS This study will provide insights into the potential of a shared digital communication intervention to support caregivers of children with disabilities in navigating fragmented health, social, and educational services. By integrating quantitative outcome measures with caregivers' experiences, the study will contribute to understanding how and under what circumstances shared digital communication may strengthen cross-sector coordination, promote family-centered care, and support caregivers in their role as care coordinators. The findings will inform further development and implementation of digital solutions to support more integrated services for children with disabilities and their families. CLINICALTRIAL The study was registered prospectively on the Open Science Framework (OSF) (https://osf.io/h7snd)

Objectives: Heel fat pad syndrome (HFPS) is a common but under‐investigated cause of plantar heel pain. No randomized controlled trials (RCTs) have evaluated targeted treatments. This study evaluated the immediate and short‐term effects of novel loop taping on pain, function, and fat pad thickness in adults with HFPS. Design: Two‐period crossover pilot RCT. Interventions: Participants completed two taping conditions (loop and control) in randomized order, separated by a 4‐to‐7‐day washout, with each participant serving as their own control. Outcome Measures: The primary outcome was immediate change in heel pain during the most painful weightbearing activity [0–10 numeric pain rating scale (NPRS)]. Secondary outcomes at 3 days post‐taping included changes in Foot Health Status Questionnaire (FHSQ) Pain and Function scores [0 (worst)–100 (best)] and in average 24‐h heel pain (NPRS). Mechanistic outcomes included heel fat pad thickness and pressure pain threshold (PPT). Linear mixed effects models estimated between‐condition differences. Results: Among 16 paired observations, loop taping produced a small, non‐significant between‐condition difference in change in immediate activity‐related pain (mean difference 0.8; 95% CI: −0.1 to 1.7; p = 0.10); 63% (loop) versus 25%–31% (control) met minimal clinically important difference (MCID) thresholds. Between‐condition differences favored loop taping for FHSQ Pain (20.7 points; 95% CI: 4.5 to 36.8; p = 0.02) and Function (11.3 points; 95% CI: −1.0 to 23.6; p = 0.09), exceeding MCIDs of 12.4 and 6.4 points. Fat pad thickness increased by 1.7 mm (95% CI: 1.2 to 2.3; p < 0.001) and correlated with improvement in FHSQ Pain. PPT did not differ between conditions. Conclusions: Loop taping showed favorable trends for reducing pain and improving function and significantly increased heel fat pad thickness. Although underpowered for definitive conclusions, several outcomes exceeded MCIDs. Findings support the potential of loop taping and inform primary outcome selection and design considerations for future, larger trials of this low‐cost, pathomechanics‐based intervention. Trail Registration: This RCT was registered at Clinicaltrialabas.gov (NCT05385796).

Background: Shared decision-making (SDM) is a key component in patient-centered care for people consulting health care due to chronic musculoskeletal pain, including subacromial pain syndrome (SAPS). Limited research has explored how patients, relatives, and healthcare professionals perceive the content and delivery of SDM for managing SAPS in primary care. Thus, this study aims to explore stakeholder perspectives on the content, delivery, and contextual requirements for a context-specific SDM intervention for SAPS, and to identify shared challenges and co-develop ideas to inform intervention development. Methods: We conducted three separate future workshops (patients/relatives, physiotherapists/chiropractors, and general practitioners), each consisting of structured critique, fantasy, and implementation phases. A rapid preliminary analysis of workshop data was followed by semi-structured stakeholder interviews to validate, challenge, or elaborate the findings. All data were analysed thematically using an iterative, reflexive approach. Results: Twenty-eight participants took part across three workshops: patients/relatives (n = 10), physiotherapists/chiropractors (n = 12), and general practitioners (n = 6). Six additional stakeholders provided inputs via subsequent interviews (three physiotherapists, one patient, one relative and one GP). Thematic analysis identified 20 themes and 59 sub-themes, which were refined into two overarching categories: (1) shared barriers to SDM in SAPS care, including diagnostic uncertainty, fragmented clinical care pathways, time constraints, and decision fatigue; and (2) stakeholder visions for future SDM interventions, emphasising continuity, tailored communication tools, and supportive digital ecosystems. Conclusion: Based on stakeholder input, SDM in SAPS care may consider integrating dynamic, integrated systems that account for diagnostic ambiguity, contextual constraints, and varying patient capacities. These findings provide an actionable foundation for co-developing and piloting a context specific SDM intervention for primary care.

General practice plays a central role in healthcare delivery and holds significant potential to advance sustainability by reducing its environmental footprint and promoting population health. While Denmark has implemented national and regional strategies to enhance sustainability in hospitals and secondary care, comparable initiatives in primary care remain limited, and little is known about general practitioner (GP) views on sustainability in general practice. The aim of the study was to explore GPs' views on sustainability in general practice. Eleven semi-structured interviews were conducted during November and December 2024 with GPs from all regions of Denmark. A qualitative individual interview design using interpretative reflexive thematic analysis was used. Two main themes were constructed (i) Making sense of sustainability: How GPs perceive sustainability in practice, with the subthemes: Abstract threat, concrete practices, Translating sustainability into clinical language, Financial sustainability as a prerequisite, and When social sustainability feels imposed; and (ii) Between responsibility and reluctance: the GP's role in a sustainable future, with the subthemes: Waiting for direction and delegation, and Forming sustainability as part of the professional identity. While most participants recognised sustainability as an important topic, they described challenges in transforming it into something manageable that could be incorporated into everyday clinical practice. This study underscores the need for more research and policy attention to sustainability in Danish general practice. GPs appear willing to support a sustainability transition in health care, but they require further guidance and knowledge.

Question: Do advanced practice physiotherapists succeed in conducting shared decision-making (SDM)? Design: A prospective cross-sectional observational study of patients with musculoskeletal pain and their perceptions of SDM measured using the CollaboRATE instrument. Written feedback was collected after consultation to gain understanding of patients’ experiences of their consultations. Participants: Chronic pain patients (n = 5123) diagnosed with either upper limb (n = 1230, 24%), lower limb ((n = 3044, 59.4%), or foot/ankle pain (n = 849, 16.6%) consulting an advanced practice physiotherapist across two hospitals in the UK between January 2023 and December 2024. Results: Mean total CollaboRATE scores across all items were 11.9 (±0.53). Overall, 4906 (95.8%) of participants gave the maximum CollaboRATE score of 12. No significant differences were observed between sites (p < .001). A regression model including site and pain category was statistically significant but explained minimal variance (R² = 0.004), suggesting other factors contribute more substantially to SDM perceptions. From 949 patient responses, our qualitative analysis revealed a generally positive SDM experience with advanced practice physiotherapists. Feedback clustered around five key themes: 1) feeling valued and involved, 2) communication, expertise, and clarity, 3) compassionate and professional care, 4) efficient organisation, and 5) negative experiences. Conclusion: Advanced practice physiotherapists were largely successful in facilitating SDM, with patients reporting positive experiences across both clinical sites. While quantitative findings showed minimal influence of site or pain category, qualitative insights highlighted the importance of clinician communication, empathy, and involvement of patients in care planning as key drivers of SDM perceptions.

Background: Health literacy (HL) influences communication quality, treatment adherence, and equity in care. However, how general practitioners (GPs) recognize and respond to patients’ HL in everyday clinical reasoning remains insufficiently understood. Objective: To investigate how Danish GPs incorporate patients’ health literacy into decisions about prescribing pain medication for chronic musculoskeletal pain, using insights from surveys, interviews, and a literature review. Methods: A mixed-methods design combined survey data from 39 Danish GPs, seven qualitative interviews, and a synthesis of 14 studies on HL in general practice. The literature was used to contextualize and contrast the empirical findings. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. All three datasets were integrated through mixed-methods comparison to assess convergence, divergence, and complementarity. Results: Across the integrated survey, interview, and literature findings, HL emerged as a largely implicit but consistent element of GP decision-making. In the Danish survey and interview data, some GPs explicitly reported considering HL in prescribing decisions, yet interviews showed that HL more often influenced clinical reasoning indirectly through intuition and conversation. GPs adapted communication, explanations, and treatment planning to their perceptions of patient understanding, but these adjustments were rarely guided by structured tools or frameworks. Conversation appeared as the main approach for assessing comprehension, echoing patterns observed in the literature. Many Danish GPs perceived most patients as competent and self-managing, a perception the literature cautions may mask hidden comprehension challenges. Finally, both local interviews and existing studies highlighted digital HL as an emerging theme, with GPs commonly managing patients’ online health information through conversational reframing rather than formal strategies. Conclusions: HL is tacitly integrated into GP reasoning but remains under-recognized as a professional skill. Making HL an explicit component of communication training, reflective practice, and prescribing guidelines could improve patient understanding, shared decision-making, and treatment equity.