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Introduction team

Our team is made up of health professionals (physicians, pharmacists, physiotherapists and midwives) who hold both clinical and academic positions. Our team focuses on the themes of access to care, health behavior and prevention, with a strong focus on the human and social sciences.

Scientific theme and general objectives

The expertise of its members is positioned in the interventional field, on the implementation and evaluation of corrective or preventive strategies combining innovation for health information and educational innovation (psychosocial and behavioral support). This approach addresses all the fields covered by public health, from the training of health professionals to the organization of care, including therapeutic education for patients, and aims to change individual and/or collective behavior.

Research topics

Accompanying learning

The team is interested in supporting the learning of the actors (understood here in the broad sense: patients
meaning: patients, caregivers, professionals...), in connection with the integration of technological innovation (support
of professional practices, collaborative care, health communication, therapeutic education
communication, therapeutic education, reinforcement of therapeutic adherence), in particular through
simulation tools.


Organization of care

The evaluation of the healthcare offer and its organization represents a major challenge for the success of the
transformation strategy of the healthcare system. The team is particularly interested in the coordination of
of the actors involved in patient care. Particular attention is paid to
primary care, triage and complex care pathways, as well as pathways involving alternative and
alternative and complementary care.

Projects in progress

DAPHNIS(Direct Access PHysio for NontraumatIc Shoulders)

Cooperation between the general practitioner and the physiotherapist in a multi-professional health structure for the management of patients with non-traumatic shoulder pathology: protocol of a cluster randomized controlled trial
Responsable(s) : Nicolas PINSAULT & Thomas LATHIERE
Contrat : DGOS-GIRCI AuRA Rescherche en soins primaires - [2022-]
Musculoskeletal disorders of the shoulder are now a public health issue because of their incidence and, consequently, the burden they impose on the French healthcare system. Among these disorders, non-traumatic pathologies seem to benefit from conservative treatment and do not require imaging in the first instance. General practices and emergency departments are the first to be confronted with these patient flows. The reorganization of professionals in the city and a strengthening of the role of non-medical health professions within the framework of coordinated practice represents an opportunity to provide more efficient care. In September 2019, a new model of access to physiotherapy care is proposed by the Minister of Solidarity and Health for musculoskeletal pathologies. The Minister of Health confirmed in 2021 this desire by affirming his support for local experiments for other musculoskeletal pathologies, before generalizing their application throughout France. To this end, we propose to set up a randomized controlled non-inferiority cluster trial comparing the implementation of a health cooperation protocol within multi-professional health centers in the Rhône-Alpes region, comparing the evaluation and direct access management of patients with a non-traumatic shoulder pathology by a physical therapist with the usual management with the attending physician as the entry point to the coordinated care pathway. In the primary analysis, we will compare the results on pain and disability at 6 months thanks to the SPADI (Shoulder Pain And Disability Index), and elements related to the innovative care pathway in the secondary analysis (duration for access to care, costs, satisfaction). The patients will be followed for 6 months, and the expected results are a non-inferiority of the innovative pathway over the usual pathway together with a decrease in costs and waiting time for a first consultation....

BANSHEE

Therapeutic efficacy and medico-economic evaluation of a first-line surgical consultation pathway versus a first-line rehabilitation pathway for non-traumatic subacromial pain
Responsable(s) : Nicolas PINSAULT & Thomas LATHIERE
Contrat : Conseil national de l'Ordre des masseur-kinésithérapeutes - [2022-]
Musculoskeletal shoulder pathologies are a social and economic burden and a source of significant disability. The low radio-clinical correlation in the population with non-traumatic cuff pathology, and the equivalence in terms of pain and function after rehabilitation management, and this at time horizons greater than 10 years, seems to make first-line physical therapy an alternative of choice to a first-line surgical consultation. The costs associated with rehabilitation seem to be lower than those of surgery, but no medico-economic evaluation has been performed in France on this subject. We therefore propose to conduct a non-inferiority, prospective, randomized controlled trial in Zelen comparing the efficacy on shoulder disability of a first-line rehabilitation care pathway versus a first-line surgical consultation pathway in the management of non-traumatic shoulder pathologies related to the rotator cuff. The primary endpoint will be the Oxford Shoulder Score, a valid and reliable disability score translated into French, evaluated at 1 year. A prospective medico-economic evaluation will be supported by this trial, the Incremental Cost Utility Ratio using the QALY will be calculated if the quality of life differs between the two groups at 1 year post-inclusion. The statistical analysis will be performed by the Grenoble data stat unit and will consist of a linear regression with adjustment on the OSS value at baseline and on the other major prognostic factors in order to reduce the residual variance and gain power. Patients will be screened by general practitioners in the Grenoble area and then included by the investigating team at the Grenoble Alpes University Hospital. They will then be followed for one year, with intermediate assessments at 3 and 6 months....

LOMBALGIP

Cooperation between the general practitioner and the physiotherapist in a multi-professional health structure for the management of patients with acute low back pain: protocol of a cluster randomized controlled trial
Responsable(s) : Nicolas PINSAULT & Amélie KECHICHIAN
Contrat : Conseil national de l'Ordre des masseur-kinésithérapeutes - [2021-]
Improving access to care and decompartmentalizing the French healthcare system are among the priorities of the Ma Santé 2022 project, led by the Ministry of Solidarity and Health. These are also issues raised in the Ségur de la santé, set up after the health crisis of 2020 (Santé, 2020). This translates into a reorganization of professionals in the city and a strengthening of the role of non-medical health professions in coordinated practice to provide more efficient health care. In September 2019, a new model of access to physical therapy care is proposed by the Minister of Solidarity and Health for benign musculoskeletal pathologies: acute low back pain and ankle sprain (Health, 2019). This new model of access to care must be framed by a cooperation protocol, and established within health structures that meet defined criteria. The recent publication of the ministerial decree in the official journal of March 8, 2020 (Appendix 9) officially authorizes the establishment of these cooperation protocols. Within these multi-professional structures, the general practitioner delegates his consultation to the physiotherapist. Eligible patients suffering from acute low back pain or ankle sprain trauma can thus consult the physiotherapist instead of the general practitioner. The criteria for inclusion and referral of patients to the general practitioner are described in the cooperation protocol. To date in France, no study has been conducted to evaluate models of care based on an extension of the scope of practice and responsibility of physiotherapists in the management of patients with musculoskeletal disorders. An evaluation of the clinical effectiveness of the "acute low back pain" cooperation protocol, authorizing the delegation of acts between the general practitioner and the physiotherapist in France, is thus necessary. This evaluation must be carried out by means of a randomized controlled trial (RCT), which has the highest level of proof to date....

ETHIC & TAC

Shared Decision Making on Care Pathways and CATs: A Pilot Study
Responsable(s) : Nicolas PINSAULT & Léo DRUART
Contrat : Institut national du cancer InCA - [2021-]
The use of complementary and alternative therapies (CATs) has been steadily increasing for several years. Certain populations are more likely than others to use this type of care, including breast cancer patients, for whom the rate of use is close to 90%. However, these populations are those for whom the risks associated with this type of care are the highest. In addition, patients rarely discuss CATs with conventional care teams. As a result, patients often place unreasonable expectations on CATs and at the same time put themselves in risky situations. The aim of this project is to help breast cancer patients to better orient themselves in their care pathway and in particular with regard to the plethora of CATs on offer so that they can make an informed decision to seek treatment. In order to reach a shared decision, a consultation will be offered to patients with the objective of discussing their past recourse, their knowledge of the care pathway, their fears and their aspirations with regard to CATs. Epistemological concepts (self-efficacy, placebo, benefit-risk ratio, etc.) will be discussed in order to allow these elements to be transposed throughout their care. The impact of this consultation on compliance with conventional treatment, satisfaction with the treatment as a whole and communication with the rest of the health care team will be evaluated. A before/after methodology will first allow us to evaluate the values taken by our judgement criteria in the usual care pathway and then in the innovative care pathway proposed by the intervention. This study will allow us to establish the feasibility of a future research project of larger scale....

PLACETHIC

Can understanding the mechanisms of placebo action compensate for the loss of efficacy associated with the revelation of placebo use? A randomized controlled trial
Responsable(s) : Nicolas PINSAULT & Léo DRUART
Contrat : Fondation APICIL - [2019-]
Background: Placebo has been studied for many years and is ever-present in healthcare. In clinical practice, its use is limited by ethical issues raised by the deception entailed by its administration. Objective: To investigate whether, when given detailed information about pain and underlying placebo mechanisms, subjects will have a response similar to that of those subjected to a procedure in which they receive a conventional placebo treatment. Methods: The study is designed as a non-inferiority randomized, parallel with a nested crossover trial. In addition, 126 subjects without any known pathology will be included. They will be randomized into two groups. Each subject will undergo three Cold Pressor Tests (CPT): calibration, condition of interest (deceptive placebo or educated placebo), and control. Our main judgment criterion will be the comparison in pain intensity experienced on the visual analog scale between the two CPTs with placebo conditions. ...
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SMASHMEDICINE

SmashMedicine: Transforming medical education
Responsable(s) : Pierre GILLOIS
Contrat : EIT Health (European Institute of Innovation and Technology) - UNIVERSITE GRENOBLE ALPES - [2020-]
Multiple-choice questions are key to training medical students in diagnostics. SmashMedicine provides crowd-sourced questions using new machine-learning methods to improve medical education....
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PAPRIKA

Patient empowerment for major surgery preparation at home.
Responsable(s) : Pierre ALBALADEJO
Contrat : EIT Health (European Institute of Innovation and Technology) - UNIVERSITE GRENOBLE ALPES - [2020-]
Preparation and follow-up are key to successful surgery. PAPRIKA provides a solution that prepares patients for surgery, thereby improving the results. PAPRIKA establishes a technologically enabled and personalised programme to prepare patients for elective surgery and provide follow-up, as a way to improve the outcomes of the operation. The programme develops close collaboration with the medical environment that empowers patients to co-create their own care....
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MOVAGE-ACT

Améliorer l'activité et la mobilité dans la communauté pour un vieillissement en bonne santé.
Responsable(s) : Pierre GILLOIS
Contrat : EIT Health (European Institute of Innovation and Technology) - UNIVERSITE GRENOBLE ALPES - [2020-2022]
With the goal of stimulating active ageing and mobility among older adults, MOVAGE-ACT will develop and implement educational and informative activities that target behavioural change. The project is designed to enable older adults to obtain new knowledge and skills on how manage their physical activity, to help combat the onset of chronic disease and to prevent a decline to dependency. Citizens will be empowered not only to live longer, but also to live well.
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Team members
Presentation of team members (introductory sentence)
   

Team coordinator(s)

Permanent members

Others members

PhD students

Contact

nicolas.pinsault@univ-grenoble-alpes.fr
Phone: 04 57 04 12 00 (secrétariat)
Address: Faculté de Médecine de Grenoble, 38700 La Tronche