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Chaplin WJ, Lewis HR, Shahtaheri SM, Millar BS, McWilliams DF, Gladman JRF, Walsh DA. The association of painful and non-painful morbidities with frailty: a cross sectional analysis of a cohort of community dwelling older people in England. BMC Geriatr 2024; 24:158. [PMID: 38360542 PMCID: PMC10870594 DOI: 10.1186/s12877-023-04602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The association between chronic pain and frailty might indicate that pain is an independent driver of frailty but might alternatively be explained by inclusion within frailty identification tools of morbidities that commonly lead to chronic pain. This research examines the extent to which the association of pain with frailty might be attributed to morbidities. METHODS A cross-sectional analysis of older people in a UK cohort with or at risk of musculoskeletal problems or frailty (Investigating Musculoskeletal Health and Wellbeing study), used multivariable logistic regression and Z-tests to assess the degrees of associations of pain (McGill Pain Rating Index), and painful and non-painful morbidity counts with frailty (modified FRAIL questionnaire). RESULTS Data were from 2,185 participants, 56% female, median age 73 (range 60 to 96) years. 430 (20%) participants were classified as frail. In a fully adjusted standardised model, pain (aOR 2.07 (95%CI 1.83 to 2.33) and 'any' morbidity aOR (1.74 (95%CI 1.54 to 1.97) were both significantly associated with frailty. When morbidity was subclassified as painful or non-painful, painful (aOR 1.48 (95%CI 1.30 to 1.68) and non-painful (aOR1.39 (95%CI 1.24 to 1.56)) morbidities each were associated with frailty, as also was pain (aOR 2.07 (95%CI 1.83 to 2.34, p < 0.001). CONCLUSIONS Pain is associated with frailty, over and above any effect of painful and non-painful morbidities. This forms the justification for future research which focuses on pain management in the identification, prevention, and treatment of frailty.
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Affiliation(s)
- W J Chaplin
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England.
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England.
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England.
- Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, England.
| | - H R Lewis
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- School of Medicine, University of Nottingham, Nottingham, England
| | - S M Shahtaheri
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - B S Millar
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - D F McWilliams
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - J R F Gladman
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
- Centre for Rehabilitation & Ageing Research, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
| | - D A Walsh
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, Nottingham, England
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Chaplin WJ, Lewis HR, Shahtaheri S, Millar BS, McWilliams DF, Gladman JRF, Walsh DA. 1321 THE ASSOCIATION OF PAINFUL AND NON-PAINFUL COMORBIDITIES WITH FRAILTY. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
Introduction
Chronic pain is associated with frailty. We hypothesised that painful comorbidities would be more strongly associated with frailty than non-painful comorbidities.
Method
Data were from Investigating Musculoskeletal Health and Wellbeing, a UK-based cohort of people with or at risk of musculoskeletal problems or frailty. Average pain over the previous month was assessed using an 11-point numerical rating scale (NRS). The original FRAIL questionnaire comprises five self-report items: Fatigue, Resistance, Ambulation, Illnesses and Loss of weight. In this study risk of frailty was operationalised using a modified FRAIL questionnaire, omitting the “illnesses” item which related to comorbidities. Comorbidities were classified as either ‘painful’ or ‘non-painful’ based on the International Association for the Study of Pain chronic pain classification criteria. Ordinal logistic regression models explored associations of comorbidity counts with frailty.
Results
Cross-sectional data were from 2473 participants, 57% female, median age 72 (range 40 to 96) years. 518 (21%) participants were classified as frail. Mean (SD) pain score was 5.5 (2.5). Median (IQR) painful comorbidities was 2 (1 to 3) and non-painful 1 (0 to 2). Highest comorbidity frequency: arthritis (66%) and hypertension (38%). Pain was associated with frailty (OR 1.58 (1.52 to 1.64)). Painful comorbidities (aOR 1.64 (1.54 to 1.75) and non-painful comorbidities (aOR 1.31 (1.21 to 1.41)) were both associated with frailty when included in the same multivariable model adjusted for age, sex and BMI.
Conclusions
Painful comorbidities were most strongly associated with frailty, although non-painful comorbidities also contributed. Pain and frailty are interconnected, and this might in part be due to comorbidities or their treatments. These findings provide justification for further research to identify the mechanisms through which pain is involved in frailty and to include pain management in interventions to ameliorate frailty.
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Affiliation(s)
- W J Chaplin
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
| | - H R Lewis
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham School of Medicine,
| | - S Shahtaheri
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
| | - B S Millar
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
| | - D F McWilliams
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
| | - J R F Gladman
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
- University of Nottingham Centre for Rehabilitation and Ageing Research, Injury, Recovery and Inflammation Sciences,
| | - D A Walsh
- University of Nottingham Academic Rheumatology, Injury, Recovery and Inflammation Sciences,
- University of Nottingham Pain Centre Versus Arthritis,
- University of Nottingham NIHR Biomedical Research Centre,
- Sherwood Forest Hospitals NHS Foundation Trust , Mansfield, Nottingham
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Aloraibi S, Booth V, Robinson K, Lunt EK, Godfrey D, Caswell A, Kerr M, Ollivere B, Gordon AL, Gladman JRF. Optimal management of older people with frailty non-weight bearing after lower limb fracture: a scoping review. Age Ageing 2021; 50:1129-1136. [PMID: 33993209 PMCID: PMC8266651 DOI: 10.1093/ageing/afab071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group. Methods MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term ‘non-weight bearing’. All study types were included. Analysis was by narrative synthesis. Results No papers were identified from a search using the key phrase ‘non-weight bearing’. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing. Discussion These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process.
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Affiliation(s)
| | - Vicky Booth
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Katie Robinson
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Eleanor Katharine Lunt
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Margaret Kerr
- Member of PPI, University of Nottingham, Nottingham, UK
| | - Benjamin Ollivere
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam Lee Gordon
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - J R F Gladman
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
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Ong T, Sahota O, Gladman JRF. The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 2020; 31:363-370. [PMID: 31696271 PMCID: PMC7010649 DOI: 10.1007/s00198-019-05198-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023]
Abstract
Patients hospitalised with vertebral fragility fractures were elderly, multimorbid and frail and lead to poor outcomes. Their hospital treatment needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes. PURPOSE Patients admitted to hospital with vertebral fragility fractures are elderly and have complex care needs who may benefit from specialist multidisciplinary input. To date, their characteristics and outcomes have not been reported sufficiently. This study aims to justify such a service. METHODS Patients admitted with an acute vertebral fragility fracture over 12 months were prospectively recruited from a university hospital in England. Data were collected soon after their admission, at discharge from hospital and 6 months after their hospital discharge on their characteristics, pain, physical functioning, and clinical outcomes. RESULTS Data from 90 participants were analysed. They were mainly elderly (mean age 79.7 years), multimorbid (69% had ≥ 3 comorbid condition), frail (56% had a Clinical Frailty Scale score ≥ 5), cognitively impaired (54% had a MoCA score of < 23) and at high risk of falls (65% had fallen ≥ 2 in the previous year). Eighteen percent died at 6 months. At 6 months post-hospital discharge, 12% required a new care home admission, 37% still reported their pain to be severe and physical functioning was worse compared with their preadmission state. CONCLUSION Patients hospitalised with vertebral fragility fractures were elderly, multimorbid, frail and are susceptible to persistent pain and disability. Their treatment in hospital needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes.
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Affiliation(s)
- T Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - J R F Gladman
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
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Ong T, Sahota O, Gladman JRF. 91IS THERE A ROLE FOR AN ORTHOGERIATRIC MODEL OF CARE IN THE MANAGEMENT OF VERTEBRAL FRAGILITY FRACTURES IN HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy200.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Ong
- Division of Rehabilitation and Ageing, University of Nottingham
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - J R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham
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Kabboord AD, Godfrey D, Gordon AL, Gladman JRF, van Balen R, Achterberg WP, van Eijk M. 38PREDICTIVE VALIDITY OF A SEVERITY WEIGHTED FUNCTIONAL COMORBIDITY INDEX IN GERIATRIC REHABILITATION. Age Ageing 2018. [DOI: 10.1093/ageing/afy121.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A D Kabboord
- Leiden University Medical Centre, Leiden, The Netherlands
| | - D Godfrey
- Lings Bar Hospital, Nottinghamshire Healthcare NHS Foundation Trust
| | - A L Gordon
- School of Medicine, University of Nottingham
| | | | - R van Balen
- Leiden University Medical Centre, Leiden, The Netherlands
| | - W P Achterberg
- Leiden University Medical Centre, Leiden, The Netherlands
| | - M van Eijk
- Leiden University Medical Centre, Leiden, The Netherlands
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Chadborn NH, Zubair M, Sousa L, Dening T, Gladman JRF, Gordon AL, Goodman C. 37REALIST REVIEW OF USING COMPREHENSIVE GERIATRIC ASSESSMENT IN CARE HOMES; FINDINGS FROM THE PROACTIVE HEALTHCARE OF OLDER PEOPLE IN CARE HOMES (PEACH) STUDY. Age Ageing 2018. [DOI: 10.1093/ageing/afy121.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N H Chadborn
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham
| | - M Zubair
- School of Health and Applied Research, University of Sheffield
| | - L Sousa
- Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon
| | - T Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham
| | - J R F Gladman
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham
- National Institute of Health Research Collaboration
| | - A L Gordon
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham
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8
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Usman A, Lewis S, Hinsliff-Smith K, Long A, Housley G, Jordan J, Gage H, Dening T, Gladman JRF, Gordon AL. 46MEASURING HEALTH RELATED QUALITY OF LIFE OF CARE HOME RESIDENTS, COMPARISON OF SELF-REPORT BY OLDER PEOPLE WITH CAPACITY TO CONSENT AND STAFF PROXIES USING EQ-5D-5L AND HOWRU. Age Ageing 2018. [DOI: 10.1093/ageing/afy121.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Usman
- School of Medicine, University of Nottingham, UK
| | - S Lewis
- School of Medicine, University of Nottingham, UK
| | | | - A Long
- School of Medicine, University of Nottingham, UK
| | - G Housley
- School of Medicine, University of Nottingham, UK
| | - J Jordan
- School of Economics, University of Surrey, UK
| | - H Gage
- School of Economics, University of Surrey, UK
| | - T Dening
- School of Medicine, University of Nottingham, UK
| | | | - A L Gordon
- School of Medicine, University of Nottingham, UK
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Gordon AL, Craig C, Chadborn N, Devi R, Garden G, Hinsliff-Smith K, Gladman JRF. 39RESEARCH PRIORITIES IN CARE HOMES: RESULTS FROM A NOMINAL GROUP WORKSHOP. Age Ageing 2018. [DOI: 10.1093/ageing/afy121.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
- East Midlands Research into Ageing Network, East Midlands Collaboration for Leadership in Research and Applied Health Care, Nottingham, UK
| | - C Craig
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - N Chadborn
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
| | - R Devi
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
| | - G Garden
- Division of Rehabilitation and Ageing, University of Nottingham, UK
| | - K Hinsliff-Smith
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
| | - J R F Gladman
- East Midlands Research into Ageing Network, East Midlands Collaboration for Leadership in Research and Applied Health Care, Nottingham, UK
- Division of Rehabilitation and Ageing, University of Nottingham, UK
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Robinson KR, Long AL, Leighton P, Armstrong S, Pulikottill-Jacob R, Gladman JRF, Gordon AL, Logan P, Anthony KA, Harwood RH, Blackshaw PE, Masud T. Chair based exercise in community settings: a cluster randomised feasibility study. BMC Geriatr 2018; 18:82. [PMID: 29614960 PMCID: PMC5883353 DOI: 10.1186/s12877-018-0769-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. Methods A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. Results 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. Conclusion There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible. Trial registration ISRCTN27271501. Date registered: 30/01/2018. Electronic supplementary material The online version of this article (10.1186/s12877-018-0769-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K R Robinson
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK. .,Duncan McMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - A L Long
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - P Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - S Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - J R F Gladman
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), Nottingham, UK.,Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK
| | - P Logan
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - K A Anthony
- Division of Rehabilitation and Ageing. Medical School, University of Nottingham, Nottingham, UK
| | - R H Harwood
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P E Blackshaw
- Medical Physics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Masud
- Nottingham Biomedical Research Centre (BRC): Musculoskeletal Disease (MSK) theme, Nottingham, UK.,Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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11
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Lunt E, Gladman JRF, Banks V, Gordon AL. 147Higher ASA Grades, Abnormal Renal Function And Co-Morbid Cardiopulmonary Disease Associate With Poorer Outcomes In Older People Undergoing Emergency Laparotomy. Age Ageing 2017. [DOI: 10.1093/ageing/afx060.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
After a stroke people can find outdoor mobility difficult, but a targeted occupational therapy intervention has been shown to help people to get out of the house more often. This study describes the intervention. The occupational therapists who provided the intervention kept records of the number and duration of therapy sessions, the goal of therapy and the activities undertaken. As part of the trial, functional and mobility outcome assessments were completed by the participants 4 and 10 months after recruitment and were used to compare the goals set with the goals achieved and the mobility performance. Eighty-six participants were randomised to, and 78 received, the intervention. They received a median of 6 (mean 4.7, SD 1.9) sessions, with an average of 40 minutes per session. Sixty (77%) of the participants achieved their primary goal. Those who did not had greater functional limitations at the start of the study than those who did. Walking was the most common goal (17/78, 22%) and the most performed activity (135 times, 33%). Thirteen participants achieved walking and 12 of these were still walking outside at the 10-month assessment. Three-quarters of people with stroke were therefore able to achieve their outdoor mobility goals after an occupational therapy intervention.
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Logan PA, Murphy A, Drummond AER, Bailey S, Radford KA, Gladman JRF, Walker MF, Robertson K, Edmans JA, Conroy S. An Investigation of the Number and Cost of Assistive Devices Used by Older People Who Had Fallen and Called a 999 Ambulance. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - A Murphy
- Nottingham City Primary Care Trust
| | | | - S Bailey
- Nottingham Integrated Community Equipment Service
| | | | | | | | - K Robertson
- Nottinghamshire County Teaching Primary Care Trust
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14
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Abstract
The objectives of this research were to survey the use of transport by stroke patients in the community and study its relationship to their activities of daily living and mood. The records of 90 consecutive stroke patients receiving community occupational therapy in a rehabilitation trial were surveyed for entries of therapy related to transport. A further 50 stroke patients in the same study were surveyed about their use of transport one year after discharge from hospital. In the survey of occupational therapy notes, a transport assessment had been recorded for all 90 patients. Of these, 22 patients had been given leaflets describing the range of transport options locally but had been unable to use these options. In the survey of transport use, 42/50 (84%) patients surveyed at one year responded. Twenty-one (50%) had used transport on their own, six of whom scored <26/66 on the Extended Activities of Daily Living scale (indicating that they needed help in most activities of daily living). Twenty-one (50%) patients had not travelled alone, four of whom scored >48/66 on the Extended Activities of Daily Living scale (very able in activities of daily living). Only 1 (2%) patient had used specialist transport and 22 (52%) reported that they did not get out as much as they wished. Despite receiving advice, these patients did not use specialist transport options, yet many still wanted to get out more. The reason for this is unclear but it is not due simply to physical disability.
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Abstract
Introduction: Many people who have had a stroke want to get out of their house more often. This study explored attitudes and barriers to the use of transport with the aim of informing rehabilitation. Method: Semi-structured interview study of 24 community-dwelling people who had had a stroke, purposively sampled to find people with a variety of recent experiences of transport. Interviews were taped and transcribed. Analysis was by constant comparative methodology, to develop emerging themes and concepts. Results: Interviewees wanted to travel for specific purposes but also for its own sake. Many could no longer use their car. This gave them less flexibility to travel and reduced their autonomy. Barriers to using alternative forms of transport were fear of injury or embarrassment from falling, an associated lack of confidence, inadequate information about transport services, perceptions about the cost of taxis and pavement vehicles (scooters) and environmental factors such as the weather. Those who could drive, or who lived with someone who did, gave the most positive descriptions of transport use. Those reliant on family or friends felt they could ask only for help getting to health-related appointments and those who used specialist transport services provided the most negative descriptions of transport. Conclusions: Many of the barriers to transport use after stroke may be amenable to intervention. An intervention package capable of re-enabling people to drive or be driven, to use a pavement scooter safely, to provide information about the alternatives and to encourage best use of public transport is worth developing.
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Affiliation(s)
- P A Logan
- University of Nottingham, Nottingham, UK.
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Walker GM, Logan P, Gordon AL, Conroy S, Armstrong S, Robertson K, Ward M, Frowd N, Darby J, Arnold G, Gladman JRF. 45 * ARE ACCELEROMETERS A USEFUL WAY TO MEASURE ACTIVITY IN CARE HOME RESIDENTS? Age Ageing 2015. [DOI: 10.1093/ageing/afv032.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gordon AL, Mjojo J, Forrester-Paton C, Forrester-Paton J, Bracewell N, Mitchell H, Masud T, Gladman JRF, Blundell AG. 95 * UPDATING THE BRITISH GERIATRICS SOCIETY RECOMMENDED UNDERGRADUATE CURRICULUM AGAINST TOMORROW'S DOCTOR'S 3. Age Ageing 2014. [DOI: 10.1093/ageing/afu041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abdullah A, Omar AN, Mulcahy R, Clapp A, Tullo E, Carrick-Sen D, Newton J, Hirst B, Krishnaswami V, Foster A, Vahidassr D, Chavan T, Matthew A, Trolan CP, Steel C, Ellis G, Ahearn DJ, Lotha K, Shukla P, Bourne DR, Mathur A, Musarrat K, Patel A, Nicholson G, Nelson E, McNicholl S, McKee H, Cuthbertson J, Nelson E, Nicholson G, McNicholl S, McKee H, Cuthbertson J, Lunt E, Lee S, Okeke J, Daniel J, Naseem A, Ramakrishna S, Singh I, Barker JR, Weatherburn AJ, Thornton L, Daniel J, Okeke J, Holly C, Jones J, Varanasi A, Verma A, Singh I, Foster JAH, Carmichael C, Cawston C, Homewood S, Leitch M, Martin J, McDicken J, Lonnen J, Bishop-Miller J, Beishon LC, Harrison JK, Conroy SP, Gladman JRF, Sim J, Byrne F, Currie J, Ollman S, Brown S, Wilkinson M, Manoj A, Hussain F, Druhan A, Thompson M, Tsang J, Soh J, Offiah C, Coughlan T, O'Brien P, McCabe DJH, Murphy S, McManus J, O'Neill D, Collins DR, Warburton K, Maini N, Cunnington AL, Mathew P, Hoyles K, Lythgoe M, Brewer H, Western-Price J, Colquhoun K, Ramdoo K, Bowen J, Dale OT, Corbridge R, Chatterjee A, Gosney MA, Richardson L, Daunt L, Ali A, Harwood R, Beveridge LA, Harper J, Williamson LD, Bowen JST, Gosney MA, Wentworth L, Wardle K, Ruddlesdin J, Baht S, Roberts N, Corrado O, Morell J, Baker P, Whiller N, Wilkinson I, Barber M, Maclean A, Frieslick J, Reoch A, Thompson M, Tsang J, McSorley A, Crawford A, Sarup S, Niruban A, Edwards JD, Bailey SJ, May HM, Mathieson P, Jones H, Ray R, Prettyman R, Gibson R, Heaney A, Hull K, Manku B, Bellary S, Ninan S, Chhokar G, Sweeney D, Nivatongs W, Wong SY, Aung T, Kalsi T, Babic-Illman G, Harari D, Aljaizani M, Pattison AT, Pattison AT, Aljaizani M, Fox J, Reilly S, Chauhan V, Azad M, Youde J, Lagan J, Cooper H, Komrower D, Price V, von Stempel CB, Gilbert B, Bouwmeester N, Jones HW, Win T, Weekes C, Hodgkinson R, Walker S, Le Ball K, Muir ZN. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gladman JRF, Edmans JA, Bradshaw L, Conroy SP, Soong JTY, Reyholds M, Jamil S, Thakkar K, Jacklin A, Dickinson E, Soong JTY, Reyholds M, Jamil S, Thakkar K, Jacklin A, Dickinson E, Walesby KE, Sumukadas D, Ramage L, McMurdo MET, Mangoni AA, Witham MD, Williams M, Fitzjohn B, MacMahon M. Health services research. Age Ageing 2013. [DOI: 10.1093/ageing/aft103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Logan PA, Coupland CAC, Gladman JRF, Sahota O, Stoner-Hobbs V, Robertson K, Tomlinson V, Ward M, Sach T, Avery AJ. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 2010; 340:c2102. [PMID: 20460331 PMCID: PMC2868162 DOI: 10.1136/bmj.c2102] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital. DESIGN Randomised controlled trial. SETTING Community covered by four primary care trusts, England. PARTICIPANTS 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. INTERVENTIONS Referral to community fall prevention services or standard medical and social care. MAIN OUTCOME MEASURES The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. Analysis was by intention to treat. RESULTS 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group (incidence rate ratio 0.45, 95% confidence interval 0.35 to 0.58, P<0.001). The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale (all P<0.05) at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up (incidence rate ratio 0.60, 95% confidence interval 0.40 to 0.92, P=0.018). CONCLUSION A service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital. TRIAL REGISTRATION Current Controlled Trials ISRCTN67535605.
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Aziz NA, Leonardi-Bee J, Phillips M, Gladman JRF, Legg L, Walker MF. Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev 2008; 2008:CD005952. [PMID: 18425928 PMCID: PMC6464721 DOI: 10.1002/14651858.cd005952.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current practice of rehabilitation intervention mainly concentrates on the first six months of stroke. At present, there is no agreed consensus about the benefits of such a service more than one year after stroke. OBJECTIVES To ascertain whether therapy-based rehabilitation services can influence outcome one year or more after stroke. SEARCH STRATEGY We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched September 2007), Effective Practice and Organisation of Care Group (last searched October 2006) and Dementia and Cognitive Improvement Group (last searched October 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), PEDro (1952 to October 2006), British Nursing Index (1993 to October 2006), DARE (1994 to October 2006), HMIC (1979 to October 2006) and NHS EED (1991 to October 2006). We also searched dissertation databases and ongoing trials and research registers, scanned reference lists and contacted researchers and experts in the field. SELECTION CRITERIA All randomised controlled trials of community-based stroke patients, in which at least 75% were recruited one year after stroke and received a therapy-based rehabilitation intervention that was compared with conventional care. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data on a number of pre-specified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living at the end of scheduled follow up. MAIN RESULTS We identified five trials of 487 participants that were eligible for the review. Overall, there was inconclusive evidence as to whether therapy-based rehabilitation intervention one year after stroke was able to influence any relevant patient or carer outcome. Trials varied in design, type of interventions provided, quality, and outcomes assessed. AUTHORS' CONCLUSIONS This review highlights the dearth of evidence investigating long-term therapy-based rehabilitation interventions for patients with stroke.
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Affiliation(s)
- N A Aziz
- Universiti Kebangsaan Malaysia, Department of Family Medicine, Medical Faculty, Cheras, Kuala Lumpur, Malaysia, 53000.
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Legg L, Drummond A, Leonardi-Bee J, Gladman JRF, Corr S, Donkervoort M, Edmans J, Gilbertson L, Jongbloed L, Logan P, Sackley C, Walker M, Langhorne P. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. BMJ 2007; 335:922. [PMID: 17901469 PMCID: PMC2048861 DOI: 10.1136/bmj.39343.466863.55] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2007] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke. DESIGN Systematic review and meta-analysis. DATA SOURCES The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline, Embase, CINAHL, PsycLIT, AMED, Wilson Social Sciences Abstracts, Science Citation Index, Social Science Citation, Arts and Humanities Citation Index, Dissertations Abstracts register, Occupational Therapy Research Index, scanning reference lists, personal communication with authors, and hand searching. REVIEW METHODS Trials were included if they evaluated the effect of occupational therapy focused on practice of personal activities of daily living or where performance in such activities was the target of the occupational therapy intervention in a stroke population. Original data were sought from trialists. Two reviewers independently reviewed each trial for methodological quality. Disagreements were resolved by consensus. RESULTS Nine randomised controlled trials including 1258 participants met the inclusion criteria. Occupational therapy delivered to patients after stroke and targeted towards personal activities of daily living increased performance scores (standardised mean difference 0.18, 95% confidence interval 0.04 to 0.32, P=0.01) and reduced the risk of poor outcome (death, deterioration or dependency in personal activities of daily living) (odds ratio 0.67, 95% confidence interval 0.51 to 0.87, P=0.003). For every 100 people who received occupational therapy focused on personal activities of daily living, 11 (95% confidence interval 7 to 30) would be spared a poor outcome. CONCLUSIONS Occupational therapy focused on improving personal activities of daily living after stroke can improve performance and reduce the risk of deterioration in these abilities. Focused occupational therapy should be available to everyone who has had a stroke.
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Affiliation(s)
- Lynn Legg
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER.
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Abstract
BACKGROUND we evaluated a specialist community-based dementia service to establish whether high quality care was being delivered and the conditions for doing so. The service was in an urban part of Rushcliffe Primary Care Trust, Nottinghamshire, United Kingdom. The service comprised an assessment team of an occupational therapist, a community psychiatric nurse and a community care officer, supported by 235 h per week of care delivered by a team of specially trained community care workers. METHODS a qualitative study was performed using non-participant observation, semi-structured interviews and focus groups, and analysed using a thematic framework approach. There were 2 focus groups involving staff, 11 interviews of staff and stakeholders, and interviews of 15 carers of people with dementia. RESULTS the care provided was appreciated by carers, and the service was approved by staff and stakeholders. Care was delivered using a rehabilitative style that aimed to maintain personhood, rather than to promote independence. Clients were usually referred with the object of preventing unwanted admission to institutional care but, over time, moving into an institution ceased to be a uniformly undesirable outcome. The service's resources were reduced during the evaluation period, in part to meet mental health needs in intermediate care services. CONCLUSIONS an appropriately resourced and constructed specialist service using an adaptive rehabilitation approach aimed at maintaining personhood can deliver good individualised care to people with dementia, but specific and appropriate commissioning for these services is needed to nurture them.
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Affiliation(s)
- J R F Gladman
- Division of Rehabilitation and Ageing, B Floor Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Hart E, Lymbery M, Gladman JRF. Methodological understandings and misunderstandings in interprofessional research: experiences of researching transitional rehabilitation for older people. J Interprof Care 2005; 19:614-23. [PMID: 16373217 DOI: 10.1080/13561820500215152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Drawing on our shared experience of a mixed-methods evaluation of a rehabilitation scheme for older people in six residential care homes in Nottingham, this paper examines the challenges and rewards of interprofessional research. A social anthropologist, social work academic and medical academic respectively, we explore understandings and misunderstandings that arose during the two-year research process as we sought to integrate quantitative and qualitative findings from a randomized controlled trial (RCT) and an ethnographic study conducted in parallel. We identify ways in which it was possible to overcome the danger of fragmentation, which we argue may be inherent in interprofessional research. This includes a recognition that researchers from different disciplinary backgrounds may use different "key symbols" to view the world but that professional knowledge and expertise may enable researchers to transcend such disciplinary boundaries and to hear what each is saying to the other for the benefit of improved collaboration.
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Affiliation(s)
- Elizabeth Hart
- Faculty of Medicine and Health Sciences, School of Nursing, University of Nottingham, UK.
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Miller P, Gladman JRF, Cunliffe AL, Husbands SL, Dewey ME, Harwood RH. Economic analysis of an early discharge rehabilitation service for older people. Age Ageing 2005; 34:274-80. [PMID: 15764621 DOI: 10.1093/ageing/afi058] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE to measure the cost-effectiveness of an early discharge and rehabilitation service (EDRS) in Nottingham, UK. DESIGN data were collected during a randomised controlled trial. METHODS cost and cost-effectiveness analyses were conducted from the perspective of service providers (health and social services) over a period of 12 months. Resource variables included were the EDRS intervention, the initial acute hospital admission (from randomisation), readmission to hospital, hospital outpatient visits, stays in nursing and residential homes, general practitioner contact, community health services and social services. The effectiveness measure was the EuroQol EQ-5D score, from which quality-adjusted life years (QALY) were calculated. Cost-effectiveness was calculated as cost per QALY gained. RESULTS at 12 months the mean untransformed total cost for the EDRS was 8,361 pound sterling compared to 10,088 pound sterling for usual care, a saving of 1,727 pound sterling (P = 0.05). Cost-effectiveness acceptability curves showed a high probability that the EDRS was cost effective across a range of monetary values for a QALY. CONCLUSIONS the Nottingham EDRS was likely to be more cost effective than usual care.
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Affiliation(s)
- P Miller
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
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Abstract
While intermediate care is an international phenomenon, it is particularly developed in the UK where it is a central element of the Government's response to the care needs for older people (The National Service Framework of Older People. London: HMSO). In the UK, intermediate care services are proliferating despite lack of evidence of effectiveness. We present the findings of an ethnographic study of an intermediate care scheme in six residential care homes that examined the perspectives of three key groups--older people, care home managers and rehabilitation staff. We discovered a consensus among managers and rehabilitation staff that the scheme was successful, yet no such agreement existed amongst older people. We also found that the scheme created the conditions for the emergence of a more optimistic vision of the potential of older people, with rehabilitation assistants seeing core elements of their work in a new light. However, much of what was characterised as 'rehabilitation' was more a process of adaptation to the norms, expectations and values of the institution. Our findings point in positive and negative directions: positive in that this scheme may have generated a new culture of more personalised care amongst experienced care staff, and negative in showing the limitations of a rehabilitation scheme that is not based within a person's own living environment. Our findings have implications for policy makers, researchers and managers of services.
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Affiliation(s)
- Elizabeth Hart
- Senior Lecturer in Social Anthropology, School of Nursing (Room B50), The University of Nottingham, Nottingham NG7 2UH, UK.
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Abstract
OBJECTIVE To evaluate an occupational therapy intervention to improve outdoor mobility after stroke. DESIGN Randomised controlled trial. SETTING General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital. PARTICIPANTS 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group. INTERVENTIONS Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group). MAIN OUTCOME MEASURES Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire. RESULTS Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months. CONCLUSION A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.
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Affiliation(s)
- P A Logan
- University of Nottingham, School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD
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Walker MF, Leonardi-Bee J, Bath P, Langhorne P, Dewey M, Corr S, Drummond A, Gilbertson L, Gladman JRF, Jongbloed L, Logan P, Parker C. Individual Patient Data Meta-Analysis of Randomized Controlled Trials of Community Occupational Therapy for Stroke Patients. Stroke 2004; 35:2226-32. [PMID: 15272129 DOI: 10.1161/01.str.0000137766.17092.fb] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. METHODS Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control. RESULTS We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL. CONCLUSIONS Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.
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Affiliation(s)
- M F Walker
- University of Nottingham, United Kingdom.
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Logan PA, Gladman JRF, Drummond AER, Radford KA. A study of interventions and related outcomes in a randomized controlled trial of occupational therapy and leisure therapy for community stroke patients. Clin Rehabil 2003; 17:249-55. [PMID: 12735531 DOI: 10.1191/0269215503cr593oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To undertake a detailed analysis of therapy provided in a multicentred randomized controlled trial of activities of daily living (ADL) and leisure (TOTAL), testing the hypothesis that specific interventions given in the trial affected specific aspects of outcome. SUBJECTS Three hundred and nine stroke patients who had been randomly allocated to receive either occupational therapy aimed at ADL activities (n = 156) or leisure (n = 153). MEASURES Number, duration and type of activity undertaken per patient. Barthel Index, Extended Activities of Daily Living Scale (EADL) and Nottingham Leisure Questionnaire (NLQ) six months after entry to the study. METHOD Activities that had been used in treatment were coded and categorized. Frequently used activities identified. These activities were matched to items from the six-month outcome measures. Patient independence in these outcome items was compared between the leisure and ADL groups. RESULTS Three hundred and nine therapy record forms were returned. Patients received a median of ten sessions with a median duration of 55 minutes. The ADL group received significantly more, mobility training, transfer training, cleaning, dressing, cooking and bathing training (chi-squared, p < 0.05). Sport, creative activities, games, hobbies, gardening, entertainment and shopping were used significantly more in the leisure group (chi-squared, p < 0.05) than the ADL group. Fifteen items from the outcome measures were identified as specific to these interventions. There were no statistically significant differences in outcome on these 15 items between the ADL and leisure groups (chi-squared, p > 0.05). CONCLUSIONS We found no evidence that specific ADL or leisure interventions led to improvements in specific relevant outcomes. We believe that these findings should prompt a review of the relationship between process and outcome of occupational therapy.
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Affiliation(s)
- P A Logan
- Division of General Practice, University of Nottingham, Nottingham, UK.
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Abstract
OBJECTIVE To assess the effect of cognitive assessment on the functional outcome of stroke patients and quality of life for both patients and their carers. DESIGN A multicentre, single-blind, randomized controlled trial. SETTING AND PARTICIPANTS Two hundred and twenty-eight stroke patients were recruited from hospital wards in three UK centres. INTERVENTIONS Patients were screened for cognitive impairment and randomly allocated to either routine care (116 patients) or routine care plus a detailed cognitive assessment (112 patients). MAIN OUTCOME MEASURES Outcome was assessed three and six months after recruitment by an independent assessor blind to the intervention on Extended ADL, Cognitive Failures Questionnaire, General Health Questionnaire-28 for patients and carers and Carer Strain Index. RESULTS There was no significant difference between the two groups in patients' functional outcome, perceived cognitive ability, level of psychological distress or satisfaction with care. There was a trend for the assessment group to have lower levels of carer strain (p = 0.06). CONCLUSIONS The provision of information about cognitive assessment in stroke rehabilitation may decrease carer strain.
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Affiliation(s)
- M McKinney
- School of Psychology, University of Nottingham, University Park, UK
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Gladman JRF, Venkatesan P, Berman P, Barer DH, Macfarlane JT. Outcomes of Pneumonia in the Elderly. Age Ageing 1990. [DOI: 10.1093/ageing/19.suppl_2.p17-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gladman JRF, Barer DH. Patient preferences and randomised clinical trials. West J Med 1989. [DOI: 10.1136/bmj.299.6700.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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