The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a journal club. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. Post a summary of your conversation in our online discussion. (Open the article, click on the e-Letters tab, and submit a comment.) Discussion questions and information are online at: https://www.AnnFamMed.org/content/AJC.
CURRENT SELECTION
Loohuis AMM, Wessels NJ, Dekker JH, et al. App-based treatment in primary care for urinary incontinence: a pragmatic, randomized controlled trial. Ann Fam Med. 2021;19(2):102-109.
Discussion Tips
Urinary incontinence is a common and, likely, under-diagnosed condition in primary care. Treatment options in primary care include physical therapy, pessaries, and/or medications depending on the type of urinary incontinence. Most of these treatment options have small-to-moderate effect sizes. Further and more convenient treatment options would be welcome in clinical practice.
Discussion Questions
What question is asked by this study and why does it matter?
How does this study advance beyond previous research and clinical practice on this topic?
What effect size would you expect from the app-based intervention?
How strong is the study design for answering the question?
o. What is a noninferiority trial?
o. What are the benefits and weaknesses of noninferiority trials (compared to traditional superiority trials)?
o. What is the concern if a noninferiority trial is underpowered to show inferiority?
o. How does the intention-to-treat analysis differ from the per-protocol analysis? How is this different than in superiority trials?
To what degree can the findings be accounted for by:
o. How patients were selected, excluded, or lost to follow-up?
o. How the main outcome variables were measured?
o. How adherence to treatment in the intervention group was measured?
o. What treatments did usual care group receive?
o. Chance?
What are the main study findings?
How comparable is the study sample to similar patients in your practice? What is your judgment about the transport-ability of the findings?
What contextual factors are important for interpreting the findings?
o. How would you gauge the potential benefits and harms of the intervention?
How might this study change your practice? Education? Research?
Who the constituencies are for the findings, and how they might be engaged in interpreting or using the findings?
What are the next steps in interpreting or applying the findings?
What researchable questions remain?
- © 2021 Annals of Family Medicine, Inc.
References
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