Impementation of the Exercise Recommendations for the Treatment of Primary Headaches: A Qualitative Approach to the Headache Units in Catalonia

Study Overview
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Brief Summary
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Therapeutic exercise, including aerobic activity and strength training, has shown promise in treating primary headaches with a moderate effect size, despite limited evidence. Implementation requires specialized professionals, infrastructure, and defined care pathways. These strategies are cost-effective for similar chronic pain conditions. More research is needed to better understand the varying effects on headache frequency, duration, and intensity in larger patient samples.

Detailed Description
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Therapeutic exercise strategies (TES) includes modalities such as aerobic activity and strength training, which have been investigated as treatments for primary headache in recent years. These modalities have been previously summarized, and despite the fact that the body of evidence available is less than in other therapeutic modalities, this is increasing, and they are positioned as strategies with a moderate effect size and recommendation. However, its implementation is not simple and requires resources, such as professionals with specialized training, infrastructure, and clearly defined care circuits. Conversely, these strategies have demonstrated cost-effectiveness in other chronic pain conditions with similar treatment and care demands. It is of interest to increase knowledge in this area given that the size of the effect of these interventions is large, although it varies according to the analyzed variable and type of exercise modality. The reduction in days per month with headache or migraine, reduction in headache hours per month, or decrease in headache intensity has been demonstrated in a non-negligible number of patients, but larger samples are needed. The present study aimed to determine the status of exercise recommendations in the headache units of the Catalan territory and to evaluate the possible fit of specialized physiotherapy for the treatment of patients with headaches within these units based on the opinion of the responsible members of these units and available resources. Contact with the headache units of the Catalan territory will be made by email or telephone during November 2023. Semi-structured interviews and a survey developed from the interviews with the members of the units will be conducted to determine the status of exercise recommendations in the headache units of the Catalan territory and to evaluate the possible viability of specialized physiotherapy for the treatment of patients with headaches. A total of 8-12 interviews and 20-30 responses to the surveys were expected. These will include neurologists, nurses, pharmacists, managers, rehabilitation doctors, and physiotherapists linked to neurology services.

Official Title
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Implementació de Recomanacions d'Exercici Per al Tractament de Les Cefalees primàries: Una aproximació Qualitativa a Les Unitats de Cefalea a Catalunya

Conditions
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Migraine, Headache, Chronic Headache

Intervention / Treatment
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* Other: Interviews
* Other: Surveys


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be part of the headache unit Be a part of a service related to the headache unit Be a healthcare practitioner, researcher, health manager or rehabilitation service manager. Exclusion Criteria: Decline participation Unable to understand Catalan, Spanish or English

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Unit of headache and neurological pain of the Hospital Vall d'Hebron (VHIR) - Barcelona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Unit of headaches and neuralgias of the Hospital de Sant Pau - Barcelona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Unit of headache of the Hospital Sant Joan de Déu - Althaia - Manresa<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Unit of headache of the Hospital Universitari Arnau de Vilanova - Lleida<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Group of work on headaches of the Hospital Clínic de Barcelona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Headache Unit of Hospital de Bellvitge - Barcelona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Headache Unit of Hospital del Mar - Barcelona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Headache Unit of Hospital de Germans Tries i Pujol - Can Ruti - Badalona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|
| Headache Unit of Hospital Josep Trueta - Girona<br>Neurologists, nurses, pharmacists, health managers, physiotherapists, and other healthcare professionals related to the headache unit. | Other: Interviews<br>* Semi-structured interviews<br>Other: Surveys<br>* Estructured survey<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Status of exercise prescription in primary headaches | Likert Scale from 1-5: (1) Not recommended, (2) occasionally recommended, (3) usually recommended, (4) occasionally recommended and supervised by a qualified professional, (5) usually recommended and supervised by a qualified professional. Through survey and interviews. | During observation period from November 2023 to January 2024. | 
| Viability of the exercise prescription in the headache units | List of necessary resources for implementing exercise for primary headache patients reported by headache units. Qualitative information from surveys and interviews. | During observation period from November 2023 to January 2024. | 
| Relevance of exercise as a strategy for the treatment of patients with primary headaches. | Likert 1-5: (1) Not interesting for headache management, (2) Low interest for headache management (3) Moderate interest for headache management (4) High interest for headache management (5) Absolute interest for headache management. Through survey and interviews. | During observation period from November 2023 to January 2024. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Create a survey for assessing headache unit resources. | List of essencial items to be included in the headache unit survey. Discussed by consensus among authors. | During November 2023 | 
| Necessary material resources | List of material resources needed for implementing physiotherapy in the headache units. Identified through semi-structured interviews. | During observation period from November 2023 to January 2024. | 
| Necessary technological resources | List of technological resources needed for implementing physiotherapy in the headache units. Identified through semi-structured interviews. | During observation period from November 2023 to January 2024. | 
| Necessary human resources | List of human resources needed for implementing physiotherapy in the headache units. Identified through semi-structured interviews. | During observation period from November 2023 to January 2024. | 
| Necessary service resources | List of service resources needed for implementing physiotherapy in the headache units. Identified through semi-structured interviews. | During observation period from November 2023 to January 2024. | 
| Necessary additional resources | List of additional resources needed for implementing physiotherapy in the headache units. Identified through semi-structured interviews. | During observation period from November 2023 to January 2024. | 
| Acceptance to implementation therapeutic exercice strategies | Number of headache units that accepts to participate in a protocol to implement any of the therapeutic exercice strategies. | December 2023 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Primary headaches, Exercise therapy, Neurology, Headache units, Physiotherapy