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Romano V, Minns Lowe CJ. The experiences of dietitian's working in care homes in England: a qualitative study. Age Ageing 2022; 51:6527734. [PMID: 35165689 DOI: 10.1093/ageing/afac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The provision of appropriate nutritional care in care homes is a priority for health services in England. There is limited evidence demonstrating the role of dietitians within older people care homes. This study explores the experiences of dietitians working with care homes for older people in England. METHODS A qualitative study using semi-structured face-to-face or telephone interviews was conducted. Criterion and snowball purposive sampling recruited six dietitian participants. Interviews were audio recorded and transcribed verbatim. A reflexive diary was completed, and data analyses followed interpretative phenomenological analyses. Constant comparison, code-recode audits, independent coding by a supervisor, supervisory support and peer review were used to promote rigour. RESULTS Two key themes and three subthemes were identified: Theme 1 is collaboration with multidisciplinary team (MDT) professionals and its two subthemes are as follows: using support strategies (pathway/standards implementation, training/education and resident dietetic assessment) and delivering value (by benefitting more residents, demonstrating unique dietetic skills, nutritional prescription savings and meeting other professional's knowledge gap). Theme 2 is communication with MDT professionals and its subtheme is the understanding of the dietitian's role and of nutritional care. CONCLUSION Dietitians believe that they play a key role in supporting care homes with nutritional care, identifying themselves as experts and leaders, working with MDT professionals. The findings highlight the importance of a consistent approach to managing nutrition and the need for dietitians to share outcome data to improve the limited evidence-base. There is a need to agree a defined dietetic service provision to care homes in England.
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Affiliation(s)
- Vittoria Romano
- Nutrition and Dietetics Department, Central London Community Healthcare NHS Trust, Lisson Grove Health Centre, Gateforth Street, NW8 8EG
| | - Catherine J Minns Lowe
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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McCarroll C, Van't Riet C, Halter M. How is the emerging role of domiciliary physiotherapists who treat residents with dementia in nursing homes perceived by allied health professionals? A phenomenological interview study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:279-290. [PMID: 31581366 DOI: 10.1111/hsc.12862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
Dementia affects majority of older residents in nursing homes and physiotherapists are regularly involved with this population. However, little is known about the role of physiotherapists who treat residents with dementia in nursing homes. The aim of this paper was to report on an interpretivist qualitative exploration of the perceptions of both the providers of and referrers to domiciliary physiotherapy for residents with dementia in nursing homes in London. In 2015, we conducted semi-structured interviews with 10 purposively sampled participants - two were providers of physiotherapy for residents with dementia in nursing homes, five were referrers to these providers and three occupied dual roles. A thematic analysis of the verbatim transcripts identified three main themes. First were perceptions of a multifaceted but unclear role, focused on both conventional 'physical' physiotherapy interventions and specialist care, the latter being reliant on knowledge and confidence that physiotherapists did not always feel they possessed. Second were the stated challenges to the role, including the focus and organisation of the nursing home setting, with perceived lack of emphasis on rehabilitation; the progressive and demanding nature of dementia itself; a lack of continuity of nursing home and visiting health professional staff with associated need to entrust physiotherapy intervention to multiple others and the final challenge was the difficulty measuring impact. Third, despite the challenges, enablers of the role were experienced, namely collaborative working and positive previous experiences of referrers. Joining these themes were underpinning concepts of complexity and uncertainty in relation to the physiotherapy role in this setting. This paper highlights a need for enhanced collaborative working in clinical practice, enabled at organisational level, to help address some of the uncertainties expressed around the physiotherapists' role with residents with dementia in nursing homes and thereby enable improvements to processes and outcomes of their interventions.
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Affiliation(s)
- Clare McCarroll
- Intensive Community Care Team (ICCT), Merseycare NHS Foundation Trust, Liverpool, UK
| | | | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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Edwards L, Ellis B, Donnellan C, Osman H, Haboubi N, Jones M, Sunman W, Pinnington L, Phillips MF. Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study. Clin Rehabil 2019; 33:1819-1830. [PMID: 31266351 DOI: 10.1177/0269215519859621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. DESIGN Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. SETTING 22 care homes in Derbyshire and Nottinghamshire. SUBJECTS 60 care home residents with upper motor neuron syndrome-related spasticity. INTERVENTIONS No intervention. When unmet needs around spasticity management were identified, the participant's general practitioner was advised of these in writing. MAIN MEASURES Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. RESULTS Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. CONCLUSION Care home residents in this study had high levels of unmet need for spasticity management.
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Affiliation(s)
- Laura Edwards
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, Derby, UK
| | | | - Clare Donnellan
- Linden Lodge Neuro-Rehabilitation Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hanan Osman
- The Walton Centre NHS Foundation Trust and The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Naseer Haboubi
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Jones
- Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton, Derby, UK
| | - Wayne Sunman
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lorraine Pinnington
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
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Graham L, Cicero R, Clarke D, Cundill B, Ellwood A, Farrin A, Fisher J, Goodwin M, Hawkins R, Hull K, Hulme C, Trépel D, Williams R, Forster A. PATCH: posture and mobility training for care staff versus usual care in care homes: study protocol for a randomised controlled trial. Trials 2018; 19:521. [PMID: 30249295 PMCID: PMC6154918 DOI: 10.1186/s13063-018-2863-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residents of care homes have high levels of disability and poor mobility, but the promotion of health and wellbeing within care homes is poorly realised. Residents spend the majority of their time sedentary which leads to increased dependency and, coupled with poor postural management, can have many adverse outcomes including pressure sores, pain and reduced social interaction. The intervention being tested in this project (the Skilful Care Training Package) aims to increase the awareness and skills of care staff in relation to poor posture in the older, less mobile adult and highlight the benefits of activity, and how to skilfully assist activity, in this group to enable mobility and reduce falls risk. Feasibility work will be undertaken to inform the design of a definitive cluster randomised controlled trial. METHODS This is a cluster randomised controlled feasibility trial, aiming to recruit at least 12-15 residents at each of 10 care homes across Yorkshire. Care homes will be randomly allocated on a 1:1 basis to receive either the Skilful Care Training Package alongside usual care or to continue to provide usual care alone. Assessments will be undertaken by blinded researchers with participating residents at baseline (before care home randomisation) and at three and six months post randomisation. Data relating to changes in physical activity, mobility, posture, mood and quality of life will be collected. Data at the level of the home will also be collected and will include staff experience of care and changes in the numbers and types of adverse events residents experience (for example, hospital admissions, falls). Details of NHS service usage will be collected to inform the economic analysis. An embedded process evaluation will explore intervention delivery and its acceptability to staff and residents. DISCUSSION Participant uptake, engagement and retention are key feasibility outcomes. Exploration of barriers and facilitators to intervention delivery will inform intervention optimisation. Study results will inform progression to a definitive trial and add to the body of evidence for good practice in care home research. TRIAL REGISTRATION ISRCTN Registry, ISRCTN50080330 . Registered on 27 March 2017.
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Affiliation(s)
- Liz Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Robert Cicero
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - David Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - Bonnie Cundill
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Alison Ellwood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Rebecca Hawkins
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - Karen Hull
- Leeds Neurophysiotherapy, Rawdon, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Rachel Williams
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
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Sackley CM, Walker MF, Burton CR, Watkins CL, Mant J, Roalfe AK, Wheatley K, Sheehan B, Sharp L, Stant KE, Fletcher-Smith J, Steel K, Barton GR, Irvine L, Peryer G. An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation. Health Technol Assess 2016; 20:1-138. [PMID: 26927209 DOI: 10.3310/hta20150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Care home residents with stroke-related disabilities have significant activity limitations. Phase II trial results suggested a potential benefit of occupational therapy (OT) in maintaining residents' capacity to engage in functional activity. OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of a targeted course of OT in maintaining functional activity and reducing further health risks from inactivity for UK care home residents living with stroke-related disabilities. DESIGN Pragmatic, parallel-group, cluster randomised controlled trial with economic evaluation. Cluster randomisation occurred at the care-home level. Homes were stratified according to trial administrative centre and type of care provided (nursing or residential), and they were randomised 1 : 1 to either the intervention or the control arm. SETTING The setting was 228 care homes which were local to 11 trial administrative centres across England and Wales. PARTICIPANTS Care home residents with a history of stroke or transient ischaemic attack, including residents with communication and cognitive impairments, not receiving end-of-life care. INTERVENTION Personalised 3-month course of OT delivered by qualified therapists. Care workers participated in training workshops to support personal activities of daily living. The control condition consisted of usual care for residents. MAIN OUTCOME MEASURES Outcome data were collected by a blinded assessor. The primary outcome at the participant level was the Barthel Index of Activities of Daily Living (BI) score at 3 months. The secondary outcomes included BI scores at 6 and 12 months post randomisation, and the Rivermead Mobility Index, Geriatric Depression Scale-15 and European Quality of Life-5 Dimensions, three levels, questionnaire scores at all time points. Economic evaluation examined the incremental cost per quality-adjusted life-year (QALY) gain. Costs were estimated from the perspective of the NHS and Personal Social Services. RESULTS Overall, 568 residents from 114 care homes were allocated to the intervention arm and 474 residents from another 114 care homes were allocated to the control arm, giving a total of 1042 participants. Randomisation occurred between May 2010 and March 2012. The mean age of participants was 82.9 years, and 665 (64%) were female. No adverse events attributable to the intervention were recorded. Of the 1042 participants, 870 (83%) were included in the analysis of the primary outcome (intervention, n = 479; control, n = 391). The primary outcome showed no significant differences between groups. The adjusted mean difference in the BI score between groups was 0.19 points higher in the intervention arm [95% confidence interval (CI) -0.33 to 0.70, p = 0.48; adjusted intracluster correlation coefficient 0.09]. Secondary outcome measures showed no significant differences at all time points. Mean incremental cost of the Occupational Therapy intervention for residents with stroke living in UK Care Homes intervention was £438.78 (95% CI -£3360.89 to £1238.46) and the incremental QALY gain was 0.009 (95% CI -0.030 to 0.048). LIMITATIONS A large proportion of participants with very severe activity-based limitations and cognitive impairment may have limited capacity to engage in therapy. CONCLUSION A 3-month individualised course of OT showed no benefit in maintaining functional activity in an older care home population with stroke-related disabilities. FUTURE WORK There is an urgent need to reduce health-related complications caused by inactivity and to provide an enabling built environment within care homes. TRIAL REGISTRATION Current Controlled Trials ISRCTN00757750. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 15. See the Health Technology Assessment programme website for further project information.
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Affiliation(s)
- Catherine M Sackley
- Academic Department of Physiotherapy, School of Bioscience Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Marion F Walker
- Division of Rehabilitation and Ageing, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Andrea K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Bart Sheehan
- Directorate of Acute Medicine and Rehabilitation, John Radcliffe Hospital, Oxford, UK
| | - Leslie Sharp
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Katie E Stant
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Joanna Fletcher-Smith
- Division of Rehabilitation and Ageing, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Steel
- Occupational Therapy, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Garry R Barton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Lisa Irvine
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Guy Peryer
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Cook G, McNall A, Thompson J, Hodgson P, Shaw L, Cowie D. Integrated Working for Enhanced Health Care in English Nursing Homes. J Nurs Scholarsh 2016; 49:15-23. [PMID: 28094909 PMCID: PMC5298045 DOI: 10.1111/jnu.12261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 11/30/2022]
Abstract
Background The increasingly complex nature of care home residents’ health status means that this population requires significant multidisciplinary team input from health services. To address this, a multisector and multiprofessional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. Study Aims To explore the views and experiences of practitioners, social care officers, and carers involved in the enhanced health care in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of health care to older residents. Methods A qualitative constructivist methodology was adopted. The study had two stages. Stage 1 explored the experiences of the programme enhanced healthcare workforce through group, dyad, and individual interviews with 45 participants. Stage 2 involved two workshops with 28 participants to develop Stage 1 findings (data were collected during February–March 2016). Thematic and content analysis were applied. Findings The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organizational and professional boundaries that support effective decision making and problem solving. Clinical Relevance Understanding of the processes and outcomes of a model of integrated health care between public and independent sector care home services for older people.
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Affiliation(s)
- Glenda Cook
- Professor of Nursing, Northumbria University, Newcastle upon Tyne, UK
| | - Anne McNall
- Enterprise Fellow, Northumbria University, Newcastle upon Tyne, UK
| | | | - Philip Hodgson
- Senior Research Assistant, Northumbria University, Newcastle upon Tyne, UK
| | - Lynne Shaw
- Nurse Consultant older persons care, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Daniel Cowie
- Clinical Director of Transformation, Newcastle Gateshead CCG, Newcastle upon Tyne, UK
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Provision of NHS generalist and specialist services to care homes in England: review of surveys. Prim Health Care Res Dev 2015; 17:122-37. [DOI: 10.1017/s1463423615000250] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BackgroundThe number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.ObjectivesTo critically evaluate how the NHS works with care homes.MethodsA review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.ResultsFive surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.ConclusionsHistorical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population.
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Burton CR, Horne M, Woodward-Nutt K, Bowen A, Tyrrell P. What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services. Disabil Rehabil 2014; 37:1955-60. [DOI: 10.3109/09638288.2014.991454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fletcher-Smith J, Drummond A, Sackley C, Moody A, Walker M. Occupational Therapy for Care Home Residents with Stroke: What is Routine National Practice? Br J Occup Ther 2014. [DOI: 10.4276/030802214x13990455043601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Information is currently lacking on the provision of occupational therapy for care home residents with stroke. The aim of this study was to identify current routine occupational therapy practice for this stroke population. Method: A questionnaire targeting qualified occupational therapists with work experience in a care home setting was designed, piloted, and transferred to an online survey. An invitation to participate was distributed via three of the College of Occupational Therapists Specialist Sections, social networking sites, and flyers at conferences. Findings: Responses were analysed from 114 respondents representing the United Kingdom, the majority (72%) of whom were employed by the National Health Service. Ninety-two respondents (81%) had delivered occupational therapy to a care home resident with stroke in the last year but only 16% were ‘stroke specialists’. The most common aims of intervention were to: maintain participation in activities of daily living, improve posture and positioning, and provide training. Non-standardized assessment was the most common form of assessment used. The functional approach was most frequently adopted. The most frequently provided intervention was ‘seating and positioning’. Conclusion: Occupational therapy is available to some stroke survivors in care homes; however, interventions are not commonly evidence based and are not routinely delivered by stroke specialists.
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Affiliation(s)
- Joanna Fletcher-Smith
- Senior Research Occupational Therapist, University of Nottingham — School of Medicine, Faculty of Medicine and Health Sciences, Medical School, Queen's Medical Centre, Nottingham
| | - Avril Drummond
- Professor of Healthcare Research, University of Nottingham — School of Health Sciences, Faculty of Medicine and Health Sciences, Medical School, Queen's Medical Centre, Nottingham
| | - Catherine Sackley
- Professor of Rehabilitation Research, University of East Anglia — School of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Queens Building, Norwich
| | - Amy Moody
- Clinical Trial Manager, University of Nottingham — Clinical Trials Unit, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham
| | - Marion Walker
- Professor of Stroke Rehabilitation, University of Nottingham — School of Medicine, Faculty of Medicine and Health Sciences, Medical School, Queen's Medical Centre, Nottingham
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Sackley CM, Burton CR, Herron-Marx S, Lett K, Mant J, Roalfe AK, Sharp LJ, Sheehan B, Stant KE, Walker MF, Watkins CL, Wheatley K, Williams J, Yao GL, Feltham MG. A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol. BMC Neurol 2012; 12:52. [PMID: 22776066 PMCID: PMC3436864 DOI: 10.1186/1471-2377-12-52] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care. METHODS/DESIGN A cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up.Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded. DISCUSSION This study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes. TRIAL REGISTRATION ISRCTN00757750.
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Affiliation(s)
- Cath M Sackley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
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