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Baird K, Byrne A, Cockayne S, Cunningham-Burley R, Fairhurst C, Adamson J, Vernon W, Torgerson DJ. Can routine assessment of older people's mental health lead to improved outcomes: A regression discontinuity analysis. PLoS One 2024; 19:e0300651. [PMID: 38502676 PMCID: PMC10950230 DOI: 10.1371/journal.pone.0300651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/09/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To assess whether case finding for depression among people aged 65 and above improves mental health. DESIGN Opportunistic evaluation using a regression discontinuity analysis with data from a randomised controlled trial. SETTING The REFORM trial, a falls prevention study that recruited patients from NHS podiatry clinics. PARTICIPANTS 1010 community-dwelling adults over the age of 65 with at least one risk factor for falling (recent previous fall or fear of falling). INTERVENTION Letter sent to patient's General Practitioner if they scored 10 points or above on the 15-item Geriatric Depression Scale (GDS-15) informing them of the patient's risk of depression. MAIN OUTCOME MEASURE GDS-15 score six months after initial completion of GDS-15. RESULTS 895 (88.6%) of the 1010 participants randomised into REFORM had a valid baseline and six-month GDS-15 score and were included in this study. The mean GDS-15 baseline score was 3.5 (SD 3.0, median 3.0, range 0-15); 639 (71.4%) scored 0-4, 204 (22.8%) scored 5-9 indicating mild depression, and 52 (5.8%) scored 10 or higher indicating severe depression. At six months follow-up, those scoring 10 points or higher at baseline had, on average, a reduction of 1.08 points on the GDS-15 scale (95% confidence interval -1.83 to -0.33, p = 0.005) compared to those scoring less than 10, using the simplest linear regression model. CONCLUSION Case finding of depression in podiatry patients based on a GDS-15 score of 10 or more followed by a letter to their General Practitioner significantly reduced depression severity. Whether this applies to all older patients in primary care is unknown. Further research is required to confirm these findings. Regression discontinuity analyses could be prespecified and embedded within other existing research studies.
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Affiliation(s)
- Kalpita Baird
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Ailish Byrne
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | | | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Wesley Vernon
- University of Huddersfield, Huddersfield, United Kingdom
| | - David J. Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
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Lawton R, Murray J, Baxter R, Richardson G, Cockayne S, Baird K, Mandefield L, Brealey S, O'Hara J, Foy R, Sheard L, Cracknell A, Breckin E, Hewitt C. Evaluating an intervention to improve the safety and experience of transitions from hospital to home for older people (Your Care Needs You): a protocol for a cluster randomised controlled trial and process evaluation. Trials 2023; 24:671. [PMID: 37838678 PMCID: PMC10576890 DOI: 10.1186/s13063-023-07716-z] [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: 07/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Older patients often experience safety issues when transitioning from hospital to home. The 'Your Care Needs You' (YCNY) intervention aims to support older people to 'know more' and 'do more' whilst in hospital so that they are better prepared for managing at home. METHODS A multi-centre cluster randomised controlled trial (cRCT) will evaluate the effectiveness and cost-effectiveness of the YCNY intervention. Forty acute hospital wards (clusters) in England from varying medical specialities will be randomised to deliver YCNY or care-as-usual on a 1:1 basis. The primary outcome will be unplanned hospital readmission rates within 30 days of discharge. This will be extracted from routinely collected data of at least 5440 patients (aged 75 years and older) discharged to their own homes during the 4- to 5-month YCNY intervention period. A nested cohort of up to 1000 patients will be recruited to the study to collect secondary outcomes via follow-up questionnaires at 5-, 30- and 90-day post-discharge. These will include measures of patient experience of transitions, patient-reported safety events, quality of life and healthcare resource use. Unplanned hospital readmission rates at 60 and 90 days of discharge will be collected from routine data. A process evaluation (primarily interviews and observations with patients, carers and staff) will be conducted to understand the implementation of the intervention and the contextual factors that shape this, as well as the intervention's underlying mechanisms of action. Fidelity of intervention delivery will also be assessed across all intervention wards. DISCUSSION This study will establish the effectiveness and cost-effectiveness of the YCNY intervention which aims to improve patient safety and experience for older people during transitions of care. The process evaluation will generate insights about how the YCNY intervention was implemented, what elements of the intervention work and for whom, and how to optimise its implementation so that it can be delivered with high fidelity in routine service contexts. TRIAL REGISTRATION UK Clinical Research Network Portfolio: 44559; ISTCRN: ISRCTN17062524. Registered on 11/02/2020.
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Affiliation(s)
- Rebecca Lawton
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK.
- School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
| | - Ruth Baxter
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | | | | | - Jane O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Alison Cracknell
- Leeds Centre for Older People's Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edmund Breckin
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
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Heapy C, Norman P, Cockayne S, Thompson AR. The effectiveness of mindfulness-based cognitive therapy for social anxiety symptoms in people living with alopecia areata: a single-group case-series design. Behav Cogn Psychother 2023; 51:381-395. [PMID: 37550306 DOI: 10.1017/s1352465823000292] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an immunological disorder characterised by hair loss. Individuals with AA report high levels of social anxiety. One intervention that holds potential for reducing social anxiety in individuals with AA is mindfulness-based cognitive therapy (MBCT). AIMS Our key aim was to investigate whether MBCT reduces social anxiety in individuals with AA. The study also investigated whether MBCT reduces depression, general anxiety, and increases quality of life and increases trait mindfulness in individuals with AA. METHOD Five participants with AA took part in an 8-session in-person MBCT intervention. A multiple-baseline single-group case series design was adopted. Idiographic measures of social anxiety were measured each day from baseline, through intervention, to follow-up. Standardised questionnaires of trait mindfulness, social anxiety, depression, anxiety, and quality of life were completed at baseline, post-intervention, and at 4-week follow-up. RESULTS All participants completed the MBCT course, but one participant was excluded from the idiographic analysis due to a high amount of missing data. The remaining four participants demonstrated reductions in idiographic measures of social anxiety from baseline to follow-up. These effects were larger between baseline and follow-up, than between baseline and post-intervention. Two participants demonstrated significant improvement in standardised measures of wellbeing from baseline to follow-up - they also practised mindfulness most regularly at home between sessions. CONCLUSION MBCT may be effective in reducing social anxiety and improving wellbeing in individuals with AA, although this might be dependent on the extent to which participants regularly practise mindfulness exercises.
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Affiliation(s)
- Connor Heapy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Sarah Cockayne
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Andrew R Thompson
- Department of Psychology, University of Sheffield, Sheffield, UK
- South Wales Clinical Psychology Training Programme, Cardiff University and Cardiff and Vale University Health Board, School of Psychology, Tower Building, Park Place, Cardiff, UK
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Vasiliou VS, Russell H, Cockayne S, Coelho GLDH, Thompson AR. A network analysis of psychological flexibility, coping, and stigma in dermatology patients. Front Med (Lausanne) 2023; 10:1075672. [PMID: 37261125 PMCID: PMC10227518 DOI: 10.3389/fmed.2023.1075672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Despite the negative effects of stigma in individuals with skin conditions, interventions to address its effects are rare. This might be in part due to a continued lack of understanding as to how individuals respond to stigma. Methods In this study, we employed a step-case analytic method, using traditional regression, moderation, and network analyses, to examine the role of psychological flexibility (PF) with stigmatized experiences, and stigma-related outcomes. We run a cross-sectional study (n = 105 individuals with various skin conditions) and analyzed stigma-related variables. We included variables examining perceived stigmatization (PSQ), anxiety (GAD-7), depression (PHQ-9), well-being (EQ5D5L), and variables stemming from the PF model (CompACT), presented as three coping with stigma responses, namely "open," "aware," and "active.". Results Using network analysis, the most influential or central variables that contributed to stigma were generalized anxiety, perceived stigmatization, and valued actions. In relation to PF, being open to the experience of stigma (as opposed to avoidance), keeping a distance from stigmatized thoughts (as opposed to self-stigmatizing), and bringing attention to value-based committed actions (as opposed to passivity) were all found to contribute to less stigmatized experiences. Discussion The results indicate that two of the three skills of the PF model ("open" and "active") may be important targets for interventions targeting stigma in people living with skin conditions.
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Affiliation(s)
- Vasilis S. Vasiliou
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Hellen Russell
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Sarah Cockayne
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Andrew R. Thompson
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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5
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Baxter R, Murray J, Cockayne S, Baird K, Mandefield L, Mills T, Lawton R, Hewitt C, Richardson G, Sheard L, O'Hara JK. Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the 'Your Care Needs You' intervention versus usual care. Pilot Feasibility Stud 2022; 8:222. [PMID: 36183129 PMCID: PMC9525931 DOI: 10.1186/s40814-022-01180-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background The ‘Your Care Needs You’ (YCNY) intervention aims to increase the safety and experience of transitions for older people through greater patient involvement during the hospital stay. Methods A cluster randomised controlled feasibility trial was conducted on NHS inpatient wards (clusters) where ≥ 40% of patients were routinely ≥ 75 years. Wards were randomised to YCNY or usual care using an unequal allocation ratio (3:2). We aimed to recruit up to 20 patients per ward. Follow-up included routine data collection and questionnaires at 5-, 30-, and 90-days post-discharge. Eligible patients were ≥ 75 years, discharged home, stayed overnight on participating wards, and could read and understand English. The trial assessed the feasibility of delivering YCNY and the trial methodology through recruitment rates, outcome completion rates, and a qualitative evaluation. The accuracy of using routinely coded data for the primary outcome in the definitive trial was assessed by extracting discharge information for up to ten nonindividual consenting patients per ward. Results Ten wards were randomised (6 intervention, 4 control). One ward withdrew, and two wards were unable to deliver the intervention. Seven-hundred twenty-one patients were successfully screened, and 161 were recruited (95 intervention, 66 control). The patient post-discharge attrition rate was 17.4% (n = 28). Primary outcome data were gathered for 91.9% of participants with 75.2% and 59.0% providing secondary outcome data at 5 and 30 days post-discharge respectively. Item completion within questionnaires was generally high. Post-discharge follow-up was terminated early due to the COVID-19 pandemic affecting 90-day response rates (16.8%). Data from 88 nonindividual consenting patients identified an error rate of 15% when using routinely coded data for the primary outcome. No unexpected serious adverse events were identified. Most patients viewed YCNY favourably. Staff agreed with it in principle, but ward pressures and organisational contexts hampered implementation. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients’ health, capacity, and preferences. Conclusions If implementation challenges can be overcome, YCNY represents a step towards involving older people as partners in their care to improve the safety and experience of their transitions from hospital to home. Trial registration ISRCTN: 51154948. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01180-3.
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Affiliation(s)
- Ruth Baxter
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK. .,School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | | | | | - Thomas Mills
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | - Jane K O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Healthcare, University of Leeds, Leeds, UK
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Backhouse MR, Parker DJ, Morrison SC, Anderson J, Cockayne S, Adamson JA. Correction: Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus. Trials 2022; 23:381. [PMID: 35534905 PMCID: PMC9087954 DOI: 10.1186/s13063-022-06324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mitchell EJ, Goodman K, Wakefield N, Cochran C, Cockayne S, Connolly S, Desai R, Hartley S, Lawton SA, Oatey K, Rhodes S, Savage JS, Taylor J, Youssouf NFJ. Clinical trial management: a profession in crisis? Trials 2022; 23:357. [PMID: 35477835 PMCID: PMC9044377 DOI: 10.1186/s13063-022-06315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.
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Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - K Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0NA, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Cochran
- Centre for Healthcare and Randomised Controlled Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, AB23 2ZD, UK
| | - S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Connolly
- Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R Desai
- King's Ophthalmology Research Unit, King's College Hospital, London, SE5 9RS, UK
| | - S Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - S A Lawton
- Keele Clinical Trials Unit, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - K Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - S Rhodes
- Exeter Clinical Trials Unit, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J S Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - N F J Youssouf
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Frost G, Liddle M, Cockayne S, Cunningham-Burley R, Fairhurst C, Torgerson DJ. Relationship between age, workplace slips and the effectiveness of slip-resistant footwear among healthcare workers. Inj Prev 2022; 28:256-258. [PMID: 35414517 PMCID: PMC9132862 DOI: 10.1136/injuryprev-2022-044533] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022]
Abstract
Objectives To explore any age-related trend in workplace slip rate and assess the effectiveness of appropriate slip-resistant footwear in preventing workplace slips by age. Methods Secondary data analysis of the Stopping Slips among Healthcare Workers trial, a two-arm randomised controlled trial conducted between March 2017 and May 2019. 4553 National Health Service (NHS) staff across seven sites in England were randomised 1:1 to the intervention group (provision of 5* GRIP-rated slip-resistant footwear) or the control group (usual work footwear). The primary outcome was self-reported workplace slips, ascertained primarily through weekly text messages throughout the 14-week trial follow-up and analysed using mixed-effects negative binomial regression. This paper reports a control group-only analysis of the association between age and slip rate, and a full intention-to-treat analysis of the effectiveness of slip-resistant footwear by age. Results The mean age of participants was 43 years (range 18–74). In the control group-only analysis, slip rate differed by age (p<0.001) with those aged 60+ having double the slip rate of those aged <30 years (95% CI 1.40 to 2.87). In the intention-to-treat analysis, the interaction between allocation and age was statistically significant (p=0.002). In addition, for all age groups except those aged <30 years, the slip rate in the intervention group was statistically significantly lower than the control group; the smallest incidence rate ratio (ie, the biggest effect) was 0.39 (95% CI 0.24 to 0.64) in the 60+ age group. Conclusion The provision of appropriate slip-resistant footwear was more effective at reducing workplace slips for older NHS staff.
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Affiliation(s)
- Gillian Frost
- HSE Science and Research Centre, Health and Safety Executive, Buxton, Derbyshire, UK
| | - Mark Liddle
- HSE Science and Research Centre, Health and Safety Executive, Buxton, Derbyshire, UK
| | - Sarah Cockayne
- York Trials Unit, University of York, York, North Yorkshire, UK
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Backhouse MR, Parker DJ, Morison SC, Anderson J, Cockayne S, Adamson JA. Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus. Trials 2022; 23:286. [PMID: 35410282 PMCID: PMC8996675 DOI: 10.1186/s13063-022-06251-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children with symptomatic flat feet (pes planus) frequently present for care but there remains uncertainty about how best to manage their condition. There is considerable variation in practice between and within professions. We intend to conduct a three-arm trial to evaluate three frequently used interventions for pes planus (exercise and advice, exercise and advice plus prefabricated orthoses, and exercise and advice plus custom made orthoses). Each of these interventions are complex and required developing prior to starting the trial. This paper focusses on the development process undertaken to develop the interventions. Methods We used a modified Nominal Group Technique combining an electronic survey with two face-to-face meetings to achieve consensus on the final logic model and menu of options for each intervention. Using the Nominal Group Technique across consecutive meetings in combination with a questionnaire is novel, and enabled us to develop complex interventions that reflect contemporary clinical practice. Results In total 16 healthcare professionals took part in the consensus. These consisted of 11 podiatrists, two orthotists, two physiotherapists, and one orthopaedic surgeon. Both meetings endorsed the logic model with amendments to reflect the wider psychosocial impact of pes planus and its treatment, as well as the increasing use of shared decision making in practice. Short lists of options were agreed for prefabricated and custom made orthoses, structures to target in stretching and strengthening exercises, and elements of health education and advice. Conclusions Our novel modification of the nominal group technique produced a coherent logic model and shortlist of options for each of the interventions that explicitly enable adaptability. We formed a consensus on the range of what is permissible within each intervention so that their integrity is kept intact and they can be adapted and pragmatically applied. The process of combining survey data with face-to-face meetings has ensured the interventions mirror contemporary practice and may provide a template for other trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06251-7.
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James S, Parker A, Cockayne S, Rodgers S, Fairhurst C, Torgerson DJ, Rhodes S, Cotterill S. Including a pen and/or cover letter, containing social incentive text, had no effect on questionnaire response rate: a factorial randomised controlled Study within a Trial. F1000Res 2021; 9:623. [PMID: 35106140 PMCID: PMC8772525 DOI: 10.12688/f1000research.23767.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Postal questionnaires are frequently used in randomised controlled trials to collect outcome data on participants; however, poor response can introduce bias, affect generalisability and validity, and reduce statistical power. The objective of this study was to assess whether a pen and/or social incentive text cover letter sent with a postal follow-up questionnaire increased response rates in a trial. Method: A two-by-two factorial randomised controlled trial was embedded within the OTIS host trial. Participants due their 12-month (final) follow-up questionnaire were randomised to be sent: a pen; a social incentive text cover letter; both; or neither. The primary outcome measure was the proportion of participants in each group who returned the questionnaire. Secondary outcomes were: time to return, completeness of the questionnaire, necessity of a reminder letter, and the cost effectiveness. Results: The overall 12-month questionnaire response rate was 721 out of 755 (95.5%). Neither the pen nor social incentive cover letter had a statistically significant effect on response rate: pen 95.2% vs. no pen 95.8%, adjusted OR 0.90 (95% CI 0.45 to 1.80; p=0.77); social incentive cover letter 95.2% vs. no social incentive cover letter 95.8%, adjusted OR 0.84 (95% CI 0.42 to 1.69, p=0.63). No statistically significant differences were observed between either of the intervention groups on time to response, need for a reminder or completeness. Therefore, neither intervention was cost-effective. Conclusions: We found no evidence of a difference in response rates associated with the inclusion of a pen and/or social incentive cover letter with the final follow-up postal questionnaire of the host trial. However, when these results are combined with previous SWATs, the meta-analysis evidence remains that including a pen increases response rates. The social incentive cover letter warrants further investigation to determine effectiveness. Trial registration:
ISRCTN22202133 (21st June 2020).
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Affiliation(s)
- Sophie James
- York Trials Unit, University of York, UK, York, Y010 5DD, UK
| | - Adwoa Parker
- York Trials Unit, University of York, UK, York, Y010 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, University of York, UK, York, Y010 5DD, UK
| | - Sara Rodgers
- York Trials Unit, University of York, UK, York, Y010 5DD, UK
| | | | | | - Sarah Rhodes
- Centre for Biostatistics, University of Manchester, Manchester, M13 9PL, UK
| | - Sarah Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, M13 9PL, UK
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Corbacho B, Keding A, Chuang LH, Ramos-Goni JM, Joshi K, Cockayne S, Torgerson D. Comparison of the EQ-5D-5L and the EQ-5D-3L using individual patient data from the REFORM trial. F1000Res 2021. [DOI: 10.12688/f1000research.54554.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: This study compares the 5-level version of the EQ-5D (5L) with the 3-level version EQ-5D (3L) in older adults using individual patient data from the REFORM (REducing Falls with Orthoses and a Multifaceted podiatry intervention) trial. Methods: EQ-5D-5L and EQ-5D-3L were administered to men and women (n=151) over the age of 65 years alongside the REFORM trial. The two versions of the EQ-5D were assessed in terms of feasibility, level of consistency, ceiling effect and discriminatory power. We also undertook a comparison of the performance of different EQ-5D-3L and EQ-5D-5L value sets. Results: The proportion of participants that returned a complete questionnaire was higher for the 5L (96.7%) than for the 3L (92.7%). Missing values among dimensions were on average 1.59% (5L) and 1.45% (3L). The ceiling effect was reduced from 18.2% (3L) to 6% (5L). On average the proportion of inconsistent responses between both descriptive systems was 3.25%. Redistribution from 3L to 5L showed valid results for the majority of consistent level combinations, with slight inconsistency in the case of Anxiety/Depression. For the 5L, 67 unique health states were observed for the 5L compared to 27 for the 3L. The absolute informatively improved with the new classification system (5.48 for 5L versus 3.91 for 3L) and relative discriminatory power improved slightly on average (0.90 for 5L versus 0.84 for 3L). The mean difference between the EQ-5D-5L and EQ-5D-3L values was 0.091 (range -0.345 to 0.505); whilst the mean difference between the EQ-5D-5L and the crosswalk values was 0.082 (range -0.035 to 0.293). Conclusion: In the REFORM clinical trial involving an elderly population, our study supported the feasibility and convergent validity of both EQ-5D-3L and EQ-5D-5L. Results suggest that the 5L improves the ceiling effect and discriminatory power. The EQ-5D-5L scores were significantly higher than both EQ-5D-3L and crosswalk.
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Madurasinghe VW, Bower P, Eldridge S, Collier D, Graffy J, Treweek S, Knapp P, Parker A, Rick J, Salisbury C, Man MS, Torgerson D, Sheridan R, Sullivan F, Cockayne S, Dack C. Can we achieve better recruitment by providing better information? Meta-analysis of 'studies within a trial' (SWATs) of optimised participant information sheets. BMC Med 2021; 19:218. [PMID: 34551765 PMCID: PMC8459527 DOI: 10.1186/s12916-021-02086-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The information given to people considering taking part in a trial needs to be easy to understand if those people are to become, and then remain, trial participants. However, there is a tension between providing comprehensive information and providing information that is comprehensible. User-testing is one method of developing better participant information, and there is evidence that user-tested information is better at informing participants about key issues relating to trials. However, it is not clear if user-testing also leads to changes in the rates of recruitment in trials, compared to standard trial information. As part of a programme of research, we embedded 'studies within a trial' (SWATs) across multiple ongoing trials to see if user-tested materials led to better rates of recruitment. METHODS Seven 'host' trials included a SWAT evaluation and randomised their participants to receive routine information sheets generated by the research teams, or information sheets optimised through user-testing. We collected data on trial recruitment and analysed the results across these trials using random effects meta-analysis, with the primary outcome defined as the proportion of participants randomised in a host trial following an invitation to take part. RESULTS Six SWATs (n=27,805) provided data on recruitment. Optimised participant information sheets likely result in little or no difference in recruitment rates (7.2% versus 6.8%, pooled odds ratio = 1.03, 95% CI 0.90 to 1.19, p-value = 0.63, I2 = 0%). CONCLUSIONS Participant information sheets developed through user testing did not improve recruitment rates. The programme of work showed that co-ordinated testing of recruitment strategies using SWATs is feasible and can provide both definitive and timely evidence on the effectiveness of recruitment strategies. TRIAL REGISTRATION Healthlines Depression (ISRCTN14172341) Healthlines CVD (ISRCTN27508731) CASPER (ISRCTN02202951) ISDR (ISRCTN87561257) ECLS (NCT01925625) REFORM (ISRCTN68240461) HeLP Diabetes (ISRCTN02123133).
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Affiliation(s)
- Vichithranie W Madurasinghe
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7L, UK
| | - Peter Bower
- NIHR School for Primary Care Research, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
| | - Sandra Eldridge
- Centre for Clinical Trials and Methodology, Institute of Population Health Sciences, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - David Collier
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Jonathan Graffy
- Arbury Road Surgery 114, Arbury Road, Cambridge, CB4 2JG, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Room 306, 3rd Floor, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Peter Knapp
- Department of Health Sciences, University of York & the Hull York Medical School, York, UK
| | - Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jo Rick
- National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Mei See Man
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - David Torgerson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Rebecca Sheridan
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Frank Sullivan
- University of St. Andrews North Haugh, St. Andrews, Fife, KY16 9T, UK
| | - Sarah Cockayne
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Charlotte Dack
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
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Cockayne S, Pighills A, Adamson J, Fairhurst C, Crossland S, Drummond A, Hewitt CE, Rodgers S, Ronaldson SJ, McCaffery J, Whiteside K, Scantlebury A, Robinson-Smith L, Cochrane A, Lamb SE, Boyes S, Gilbody S, Relton C, Torgerson DJ. Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT. Health Technol Assess 2021; 25:1-118. [PMID: 34254934 PMCID: PMC8287374 DOI: 10.3310/hta25460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Falls and fall-related fractures are highly prevalent among older people and are a major contributor to morbidity and costs to individuals and society. Only one small pilot trial has evaluated the effectiveness of a home hazard assessment and environmental modification in the UK. This trial reported a reduction in falls as a secondary outcome, and no economic evaluation was undertaken. Therefore, the results need to be confirmed and a cost-effectiveness analysis needs to be undertaken. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a home hazard assessment and environmental modification delivered by occupational therapists for preventing falls among community-dwelling people aged ≥ 65 years who are at risk of falling, relative to usual care. DESIGN This was a pragmatic, multicentre, modified cohort randomised controlled trial with an economic evaluation and a qualitative study. SETTING Eight NHS trusts in primary and secondary care in England. PARTICIPANTS In total, 1331 participants were randomised (intervention group, n = 430; usual-care group, n = 901) via a secure, remote service. Blinding was not possible. INTERVENTIONS All participants received a falls prevention leaflet and routine care from their general practitioner. The intervention group were additionally offered one home environmental assessment and modifications recommended or provided to identify and manage personal fall-related hazards, delivered by an occupational therapist. MAIN OUTCOME MEASURES The primary outcome was the number of falls per participant during the 12 months from randomisation. The secondary outcomes were the proportion of fallers and multiple fallers, time to fall, fear of falling, fracture rate, health-related quality of life and cost-effectiveness. RESULTS The primary analysis included all 1331 randomised participants and indicated weak evidence of a difference in fall rate between the two groups, with an increase in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% confidence interval 0.99 to 1.38; p = 0.07). A similar proportion of participants in the intervention group (57.0%) and the usual-care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the secondary outcomes. The base-case cost-effectiveness analysis from an NHS and Personal Social Services perspective found that, on average per participant, the intervention was associated with additional costs (£18.78, 95% confidence interval £16.33 to £21.24), but was less effective (mean quality-adjusted life-year loss -0.0042, 95% confidence interval -0.0041 to -0.0043). Sensitivity analyses demonstrated uncertainty in these findings. No serious, related adverse events were reported. The intervention was largely delivered as intended, but recommendations were followed to a varying degree. LIMITATIONS Outcome data were self-reported by participants, which may have led to inaccuracies in the reported falls data. CONCLUSIONS We found no evidence that an occupational therapist-delivered home assessment and modification reduced falls in this population of community-dwelling participants aged ≥ 65 years deemed at risk of falling. The intervention was more expensive and less effective than usual care, and therefore it does not provide a cost-effective alternative to usual care. FUTURE WORK An evaluation of falls prevention advice in a higher-risk population, perhaps those previously hospitalised for a fall, or given by other professional staff could be justified. TRIAL REGISTRATION Current Controlled Trials ISRCTN22202133. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Queensland Health, Mackay Base Hospital, Mackay, QLD, Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catherine E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah J Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jennifer McCaffery
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Katie Whiteside
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Lyn Robinson-Smith
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah E Lamb
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sophie Boyes
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Simon Gilbody
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Clare Relton
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Cunningham-Burley R, Roche J, Fairhurst C, Cockayne S, Hewitt C, Iles-Smith H, Torgerson DJ. Enclosing a pen to improve response rate to postal questionnaire: an embedded randomised controlled trial. F1000Res 2021; 9:577. [PMID: 33728040 PMCID: PMC7941094 DOI: 10.12688/f1000research.23651.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Poor response to questionnaires collecting outcome data in randomised controlled trials (RCTs) can affect the validity of trial results. The aim of this study within a trial (SWAT) was to evaluate the effectiveness of including a pen with a follow-up postal questionnaire on response rate. Methods: A two-armed RCT was embedded within SSHeW (Stopping Slips among Healthcare Workers), a trial of slip-resistant footwear to reduce slips in NHS staff. Participants were randomised 1:1 to receive a pen or no pen with their follow-up questionnaire. The primary outcome was the proportion of participants who returned the questionnaire. Secondary outcomes were: time to response, completeness of response, and whether a postal reminder notice was required. Data were analysed using logistic regression, linear regression and Cox proportional hazards regression. Results: Overall, 1466 SSHEW trial participants were randomised into the SWAT. In total, 13 withdrew from the host trial before they were due to be sent their follow-up questionnaire, 728 participants received a pen with their questionnaire, and 725 did not receive a pen. A questionnaire was returned from 67.7% of the pen group and 64.7% of the group who did not receive a pen. There was no significant difference in return rates between the two groups (OR 1.15, 95% CI 0.92 to 1.43, p=0.22), nor level of completeness of the questionnaires (AMD -0.01, 95% CI 0.06 to 0.05, p=0.77). There was weak evidence of a reduction in the proportion of participants requiring a reminder and in time to response in the pen group. Conclusion: Inclusion of a pen with the follow-up postal questionnaire sent to participants in the SSHeW trial did not statistically significantly increase the response rate. These results add to the body of evidence around improving response rates in trials. Trial registration: ISRCTN 33051393 (for SSHEW). Registered on 14/03/2017.
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Affiliation(s)
| | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Heather Iles-Smith
- Research and Innovation Department, The Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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15
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Cockayne S, Fairhurst C, Zand M, Frost G, Liddle M, Cunningham-Burley R, Hewitt C, Iles-Smith H, Green L, Bain E, Mogradia M, Torgerson DJ. Slip-resistant footwear to reduce slips among health-care workers: the SSHeW RCT. Public Health Res 2021. [DOI: 10.3310/phr09030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In Great Britain, 100,000 injuries due to slips, trips and falls on the level (as opposed to falls from a height, e.g. a ladder) occur in the workplace each year. They are the most common cause of non-fatal injury in the workplace, accounting for 30% of all those injuries reported to the Health and Safety Executive. Nearly 1 million working days are lost because of slips, trips and falls each year.
Objectives
To assess the clinical effectiveness and cost-effectiveness of 5-star, GRIP-rated, slip-resistant footwear in preventing slips in the workplace compared with usual footwear.
Design
A two-arm, multicentre, randomised controlled trial with an economic evaluation and qualitative study.
Setting
Seven NHS trusts in England.
Participants
NHS staff aged ≥ 18 years, working at least 22.5 hours per week in clinical, general or catering areas who owned a mobile phone. Staff required to wear protective footwear were excluded.
Interventions
Intervention participants were offered 5-star, GRIP-rated, slip-resistant footwear. The waiting list control group were asked to wear their usual work shoes for the duration of the study and were offered the trial footwear at the end of their participation.
Main outcome measures
The primary outcome was the incidence rate of self-reported slips in the workplace over 14 weeks. Secondary outcomes included the incidence rate of falls either resulting from a slip or not resulting from a slip, proportion of participants reporting a slip, fall or fracture, time to first slip and fall, health-related quality of life and cost-effectiveness.
Results
A total of 4553 eligible NHS staff were randomised (2275 to the intervention arm and 2278 to the control arm). In total, 6743 slips were reported [2633 in the intervention group (mean 1.16 per participant, range 0–36 per participant) and 4110 in the control group (mean 1.80 per participant, range 0–83 per participant)]. There was a statistically significant reduction in the slip rate in the intervention group relative to the control group (incidence rate ratio 0.63, 95% confidence interval 0.57 to 0.70; p < 0.001). Statistically significant reductions were observed in falls from a slip (incidence rate ratio 0.51, 95% confidence interval 0.28 to 0.92; p = 0.03), the proportion of participants who reported a slip (odds ratio 0.58, 95% confidence interval 0.50 to 0.66; p < 0.001) or fall (odds ratio 0.73, 95% confidence interval 0.54 to 0.99; p = 0.04) and the time to first slip (hazard ratio 0.73, 95% confidence interval 0.67 to 0.80; p < 0.001). Half of the intervention participants wore the shoes all the time at work. Incremental cost per quality-adjusted life-year in the base case was £38,900 from the NHS perspective and –£60,400 (i.e. cost saving) from the societal perspective.
Limitations
This was an unblinded trial in which outcome data were participant self-reported, which may have led to inaccuracies in the reported slip data. Exposure to the trial footwear was lower than hoped.
Conclusions
The offer and provision of 5-star, GRIP-rated footwear reduced slips in the workplace, was acceptable to participants and could be cost-effective.
Future work
Replication of the study within other settings may be required to evaluate the clinical effectiveness and cost-effectiveness in other environments settings, such as catering and factories.
Trial registration
Current Controlled Trials ISRCTN33051393.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 3. See the NIHR Public Journals Library website for further project information. The Health and Safety Executive provided some research costs.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | | | | | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Lorraine Green
- National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | | | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Cockayne S, Fairhurst C, Frost G, Liddle M, Cunningham-Burley R, Zand M, Hewitt C, Iles-Smith HM, Green L, Torgerson DJ. Slip-resistant footwear reduces slips among National Health Service workers in England: a randomised controlled trial. Occup Environ Med 2021; 78:oemed-2020-106914. [PMID: 33452038 PMCID: PMC8223622 DOI: 10.1136/oemed-2020-106914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Assess the effectiveness of 5* GRIP-rated slip-resistant footwear in preventing slips in the workplace compared to usual footwear (control group). METHODS A multicentre, randomised controlled trial; 4553 National Health Service (NHS) staff were randomised 1:1 to the intervention group (provided with 5* GRIP-rated slip-resistant footwear) or the control group. The primary outcome of incidence rate of self-reported slips in the workplace over 14 weeks was analysed using a mixed-effects negative binomial model. Secondary outcome measures included incidence rate of falls from a slip, falls not from a slip, proportion of participants reporting a slip, fall or fracture and time to first slip and fall. RESULTS 6743 slips were reported: 2633 in the intervention group (mean 1.16 per participant, range 0 to 36) and 4110 in the control group (mean 1.80 per participant, range 0 to 83). There was a statistically significant reduction in slip rate in the intervention group relative to the control group (incidence rate ratio (IRR) 0.63, 95% CI 0.57 to 0.70, p<0.001). Statistically significant differences, in favour of the intervention group, were observed in falls from a slip (IRR 0.51, 95% CI 0.28 to 0.92, p=0.03), the proportion of participants who reported a slip (OR 0.58, 95% CI 0.50 to 0.66, p<0.001) or fall (OR 0.73, 95% CI 0.54 to 0.99, p=0.04) and time to first slip (HR 0.73, 95% CI 0.67 to 0.80, p<0.001). CONCLUSIONS The offer and provision of 5* GRIP-rated footwear reduced slips in NHS staff in the workplace. TRIAL REGISTRATION NUMBER ISRCTN33051393.
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Affiliation(s)
- Sarah Cockayne
- Health Sciences, University of York, York, North Yorkshire, UK
| | | | - Gillian Frost
- HSE Science and Research Centre, Health and Safety Executive, Buxton, Derbyshire, UK
| | - Mark Liddle
- HSE Science and Research Centre, Health and Safety Executive, Buxton, Derbyshire, UK
| | | | - Michael Zand
- Science Divison - Economic and Social Analysis, Health and Safety Executive Bootle Headquarters, Bootle, Sefton, UK
| | | | - Heather M Iles-Smith
- Shool of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Lorraine Green
- Chapel Allerton Hospital Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Booth A, Mitchell AS, Mott A, James S, Cockayne S, Gascoyne S, McDaid C. An assessment of the extent to which the contents of PROSPERO records meet the systematic review protocol reporting items in PRISMA-P. F1000Res 2020; 9:773. [PMID: 32850123 PMCID: PMC7431973 DOI: 10.12688/f1000research.25181.2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 01/07/2023] Open
Abstract
Background: PROSPERO is an international prospective register for systematic review protocols. Many of the registrations are the only available source of information about planned methods. This study investigated the extent to which records in PROSPERO contained the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Methods: A random sample of 439 single entry PROSPERO records of reviews of health interventions registered in 2018 was identified. Using a piloted list of 19 PRISMA-P items, divided into 63 elements, two researchers independently assessed the registration records. Where the information was present or not applicable to the review, a score of 1 was assigned. Overall scores were calculated and comparisons made by stage of review at registration, whether or not a meta-analysis was planned and whether or not funding/sponsorship was reported. Results: Some key methodological details, such as eligibility criteria, were relatively frequently reported, but much of the information recommended in PRISMA-P was not stated in PROSPERO registrations. Considering the 19 items, the mean score was 4.8 (SD 1.8; median 4; range 2-11) and across all the assessed records only 25% (2081/8227) of the items were scored as reported. Considering the 63 elements, the mean score was 33.4 (SD 5.8; median 33; range 18-47) and overall, 53% (14,469/27,279) of the elements were assessed as reported. Reporting was more frequent for items required in PROSPERO than optional items. The planned comparisons showed no meaningful differences between groups. Conclusions: PROSPERO provides reviewers with the opportunity to be transparent in their planned methods and demonstrate efforts to reduce bias. However, where the PROSPERO record is the only available source of
a priori reporting, there is a significant shortfall in the items reported, compared to those recommended. This presents challenges in interpretation for those wishing to assess the validity of the final review.
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Affiliation(s)
- Alison Booth
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Alex S Mitchell
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Andrew Mott
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Sophie James
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Samantha Gascoyne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Catriona McDaid
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
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18
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Booth A, Mitchell AS, Mott A, James S, Cockayne S, Gascoyne S, McDaid C. An assessment of the extent to which the contents of PROSPERO records meet the systematic review protocol reporting items in PRISMA-P. F1000Res 2020; 9:773. [PMID: 32850123 DOI: 10.12688/f1000research.25181.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background: PROSPERO is an international prospective register for systematic review protocols. Many of the registrations are the only available source of information about planned methods. This study investigated the extent to which records in PROSPERO contained the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Methods: A random sample of 439 single entry PROSPERO records of reviews of health interventions registered in 2018 was identified. Using a piloted list of 19 PRISMA-P items, divided into 63 elements, two researchers independently assessed the registration records. Where the information was present or not applicable to the review, a score of 1 was assigned. Overall scores were calculated and comparisons made by stage of review at registration, whether or not a meta-analysis was planned and whether or not funding/sponsorship was reported. Results: Some key methodological details, such as eligibility criteria, were relatively frequently reported, but much of the information recommended in PRISMA-P was not stated in PROSPERO registrations. Considering the 19 items, the mean score was 4.8 (SD 1.8; median 4; range 2-11) and across all the assessed records only 25% (2081/8227) of the items were scored as reported. Considering the 63 elements, the mean score was 33.4 (SD 5.8; median 33; range 18-47) and overall, 53% (14,469/27,279) of the elements were assessed as reported. Reporting was more frequent for items required in PROSPERO than optional items. The planned comparisons showed no meaningful differences between groups. Conclusions: PROSPERO provides reviewers with the opportunity to be transparent in their planned methods and demonstrate efforts to reduce bias. However, where the PROSPERO record is the only available source of a priori reporting, there is a significant shortfall in the items reported, compared to those recommended. This presents challenges in interpretation for those wishing to assess the validity of the final review.
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Affiliation(s)
- Alison Booth
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Alex S Mitchell
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Andrew Mott
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Sophie James
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Samantha Gascoyne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Catriona McDaid
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
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Cockayne I, Cockayne S. Edward Ernest Cockayne. Assoc Med J 2020. [DOI: 10.1136/bmj.m2388] [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: 11/03/2022]
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Scantlebury A, Cockayne S, Fairhurst C, Rodgers S, Torgerson D, Hewitt C, Adamson J. Qualitative research to inform hypothesis testing for fidelity-based sub-group analysis in clinical trials: lessons learnt from the process evaluation of a multifaceted podiatry intervention for falls prevention. Trials 2020; 21:348. [PMID: 32317024 PMCID: PMC7171824 DOI: 10.1186/s13063-020-04274-6] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ensuring fidelity to complex interventions is a challenge when conducting pragmatic randomised controlled trials. We explore fidelity through a qualitative process evaluation, which was conducted alongside a pragmatic, multicentre, two-arm cohort randomised controlled trial: the REFORM (Reducing Falls with Orthoses and a Multifaceted podiatry intervention) trial. The paper aims, through a qualitative process evaluation, to explore some of the factors that may have affected the delivery of the REFORM intervention and highlight how project-specific fidelity can be assessed using a truly mixed-methods approach when informed by qualitative insights. Design Semi-structured qualitative interviews carried out as part of a process evaluation. Interviews were analysed thematically. Setting Seven NHS trusts in the UK and a University podiatry school in Ireland. Interviews were undertaken face-to-face or over the telephone. Participants Twenty-one REFORM trial participants and 14 podiatrists who delivered the REFORM intervention. Results Factors affecting fidelity included: how similar the intervention was to routine practice; the challenges of delivering a multifaceted intervention to a heterogeneous older population; and practical issues with delivery such as time and training. Trial participants’ views of the intervention, whether falls prevention is a personal priority, their experience of being part of a trial and individual factors such as medical conditions may also have affected intervention fidelity. Conclusions Our process evaluation highlighted factors that were perceived to have affected the fidelity of the REFORM intervention and in doing so demonstrates the importance of considering fidelity when designing and evaluating pragmatic trials. We propose a number of recommendations of how important project-specific insights from qualitative work can be incorporated into the design of fidelity measurement of future trials, which build on existing conceptual fidelity frameworks. In particular, we encourage adopting a mixed-methods approach whereby qualitative insights can be used to suggest ways to enhance quantitative data collection facilitating integration through hypothesis generation, hypothesis testing and seeking explanation for trial findings. This will provide a framework of enabling measures of fidelity to be incorporated into the understanding of trial results which has been relatively neglected by existing literature. Trial registration ISRCTN Registry: ISRCTN68240461. Registered on 01/07/2011.
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Affiliation(s)
- Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
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21
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Thompson A, Cockayne S. It's the worry that got him in the end: the importance in treating melanoma holistically and dealing with fear of recurrence. Br J Dermatol 2020; 182:821-822. [DOI: 10.1111/bjd.18886] [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: 11/29/2022]
Affiliation(s)
- A.R. Thompson
- South Wales Clinical Psychology Training Cardiff University 11th Floor, Tower Building, 70 Park Place Cardiff CF10 3AT U.K
| | - S. Cockayne
- Dermatology Department Sheffield University Teaching Hospitals NHS Foundation Trust Royal Hallamshire Hospital Glossop Rd Sheffield S10 2JF U.K
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Cochrane A, Welch C, Fairhurst C, Cockayne S, Torgerson DJ. An evaluation of a personalised text message reminder compared to a standard text message on postal questionnaire response rates: an embedded randomised controlled trial. F1000Res 2020; 9:154. [PMID: 32399201 PMCID: PMC7194505 DOI: 10.12688/f1000research.22361.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Research outcome data is commonly collected using postal questionnaires; however, poor response can introduce bias and reduce statistical power. Text messaging is simple, cost-effective, and can be customised to the individual. Personalised, reminder text messages may improve response rates. Methods: A two-arm, parallel group ‘Study within a Trial’ (SWAT) was embedded within the Occupational Therapist Intervention Study (OTIS), a randomised controlled trial of a home assessment for falls prevention in older people. OTIS participants who provided a mobile phone number were randomly allocated (1:1) to receive either a personalised text message (Title, Surname, plus York Trials Unit (YTU) text) or the standard YTU text alone, prior to receiving their four-month post-randomisation follow-up postal questionnaire. The primary outcome measure was the proportion of participants who returned the questionnaire. Secondary outcomes were: time to response, completeness of response, requirement of a reminder letter, and cost-effectiveness. Binary data were compared using logistic regression and time to response by Cox proportional hazards regression. Results: A total of 403 participants were randomised: 201 to the personalised text and 202 to the standard text. Of the 283 participants included in the final analysis, 278 (98.2%) returned their questionnaire; 136 (97.8%) for the personalised text versus 142 (98.6%) for the standard text (adjusted odds ratio 0.64, 95% CI 0.10 to 3.88, p=0.63). The median time to response was nine days in both groups. In total, 271 (97.5%) participants returned a complete questionnaire; 133 (97.8%) in the personalised text versus 138 (97.2%) for the standard text. In total, 21 reminder letters were sent. The additional cost of personalised text messages was £0.04 per participant retained. Conclusions: Personalised texts were not superior to standard texts in any outcome assessed in our study. Further SWATs are needed to perform a meta-analysis and obtain more evidence. Registration:
ISRCTN22202133;
SWAT 35.
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Johnson MJ, Cockayne S, Currow DC, Bell K, Hicks K, Fairhurst C, Gabe R, Torgerson D, Jefferson L, Oxberry S, Ghosh J, Hogg KJ, Murphy J, Allgar V, Cleland JG, Clark AL. Oral modified release morphine for breathlessness in chronic heart failure: a randomized placebo-controlled trial. ESC Heart Fail 2019; 6:1149-1160. [PMID: 31389157 PMCID: PMC6989293 DOI: 10.1002/ehf2.12498] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/19/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023] Open
Abstract
AIMS Morphine is shown to relieve chronic breathlessness in chronic obstructive pulmonary disease. There are no definitive data in people with heart failure. We aimed to determine the effectiveness and cost-effectiveness of 12 weeks morphine therapy for the relief of chronic breathlessness in people with chronic heart failure compared with placebo. METHODS AND RESULTS Parallel group, double-blind, randomized, placebo-controlled, phase III trial of 20 mg daily oral modified release morphine was conducted in 13 sites in England and Scotland: hospital/community cardiology or palliative care outpatients. The primary analysis compared between-group numerical rating scale average breathlessness/24 hours at week 4 using a covariance pattern linear mixed model. Secondary outcomes included treatment-emergent harms (worse or new). The trial closed early due to slow recruitment, randomizing 45 participants [average age 72 (range 39-89) years; 84% men; 98% New York Heart Association class III]. For the primary analysis, the adjusted mean difference was 0.26 (95% confidence interval, -0.86 to 1.37) in favour of placebo. All other breathlessness measures improved in both groups (week 4 change-from-baseline) but by more in those assigned to morphine. Neither group was excessively drowsy at baseline or week 4. There were no between-group differences in quality of life (Kansas) or cognition (Montreal) at any time point. There was no exercise-related desaturation and no change between baseline and week 4 in either group. There was no change in vital signs at week 4. The natriuretic peptide measures fell in both groups but by more in the morphine group [morphine 2169 (1092, 3851) pg/mL vs. placebo 2851 (1694, 5437)] pg/mL. There was no excess serious adverse events in the morphine group. Treatment-emergent harms during the first week were more common in the morphine group; all apart from 1 were ≤ grade 2. CONCLUSIONS We could not answer our primary objectives due to inadequate power. However, we provide novel placebo-controlled medium-term benefit and safety data useful for clinical practice and future trial design. Morphine should only be prescribed in this population when other measures are unhelpful and with early management of side effects.
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Affiliation(s)
- Miriam J. Johnson
- Wolfson Palliative Care Research CentreUniversity of HullHullHU6 7RXUK
| | | | - David C. Currow
- Wolfson Palliative Care Research CentreUniversity of HullHullHU6 7RXUK
- IMPACCT, Faculty of HealthUniversity of Technology SydneyUltimoNSWAustralia
| | - Kerry Bell
- York Trials UnitUniversity of YorkYorkUK
| | - Kate Hicks
- York Trials UnitUniversity of YorkYorkUK
| | | | - Rhian Gabe
- Hull York Medical School and York Trials UnitUniversity of YorkYorkUK
| | | | | | - Stephen Oxberry
- Calderdale & Huddersfield Foundation TrustHuddersfield Royal InfirmaryHuddersfieldUK
| | - Justin Ghosh
- Department of CardiologyScarborough HospitalScarboroughUK
| | - Karen J. Hogg
- Department of CardiologyGlasgow Royal Infirmary, University of GlasgowGlasgowUK
| | - Jeremy Murphy
- Department of CardiologyDarlington Memorial HospitalDarlingtonUK
| | - Victoria Allgar
- Hull York Medical School and Department of Health SciencesUniversity of YorkYorkUK
| | - John G.F. Cleland
- Robertson Centre for Biostatistics & Clinical Trials, Institute of Health & Well‐beingUniversity of GlasgowGlasgowUK
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McCaffery J, Mitchell A, Fairhurst C, Cockayne S, Rodgers S, Relton C, Torgerson DJ. Does handwriting the name of a potential trial participant on an invitation letter improve recruitment rates? A randomised controlled study within a trial. F1000Res 2019; 8:659. [PMID: 31543954 PMCID: PMC6733374 DOI: 10.12688/f1000research.18939.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Accepted: 04/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Randomised controlled trials (RCTs) often fail to recruit to target, resulting in a lack of generalisability of findings. A wide range of strategies for potentially increasing recruitment have been identified; however, their effectiveness has not been established. The aim of this study within a trial (SWAT) was to evaluate the effectiveness of handwritten personalisation of an invitation letter as part of a trial recruitment pack on recruitment to a host RCT. Methods: A pragmatic, two-armed RCT was conducted, embedded within an existing falls prevention trial (OTIS) in men and women aged 65 years and over living in the community. Participants were randomised 1:1 to receive an OTIS recruitment pack containing an invitation letter on which their name was handwritten (intervention group), or one on which it was printed (control group). The primary outcome was randomisation into the host trial. Secondary outcomes related to trial eligibility and retention. Analyses were via logistic regression and Cox Proportional Hazards regression. Results: Of the 317 SWAT participants, 12 (3.8%) were randomised into the OTIS trial: 3 (handwritten: 3/159 [1.9%]; printed: 9/158 [5.7%]; difference -3.8%, 95% CI -8.0% to 0.4%). There was weak evidence, against the intervention, of a difference in the likelihood of participants being randomised into the host trial between the two groups (OR 0.32, 95% CI 0.08 to 1.20, p=0.09). There were no statistically significant differences between the intervention and control groups on any of the secondary outcomes. Conclusions: There was no evidence that personalisation of invitation letters improved recruitment to the OTIS trial. However, due to the small sample size, the results should be interpreted with caution. These findings need to be replicated across larger studies and wider populations. Registration: ISRCTN22202133.
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Affiliation(s)
- Jennifer McCaffery
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - Alex Mitchell
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - Sarah Cockayne
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - Sara Rodgers
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - Clare Relton
- SCHARR, University of Sheffield, Sheffield, South Yorkshire, S1 4DA, UK
| | - David J. Torgerson
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
| | - OTIS Study Team
- Department of Health Sciences, University of York, York, North Yorkshire, YO10 5DD, UK
- SCHARR, University of Sheffield, Sheffield, South Yorkshire, S1 4DA, UK
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25
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Whiteside K, Flett L, Mitchell A, Fairhurst C, Cockayne S, Rodgers S, Torgerson D. Using pens as an incentive for trial recruitment of older adults: An embedded randomised controlled trial. F1000Res 2019; 8:315. [PMID: 30984388 PMCID: PMC6446499 DOI: 10.12688/f1000research.18300.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Accepted: 03/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Meeting recruitment targets for randomised controlled trials is challenging. This trial evaluated the effectiveness of including a pen within the trial invitation pack on the recruitment of older adults into a randomised controlled trial. Methods: This trial was embedded within the Occupational Therapist Intervention Study, a falls-prevention randomised controlled trial. Potential participants (n = 1862), who were posted an invitation pack from two General Practitioner practices, were randomised to either not receive a pen (n = 1295) or receive a pen (n = 648) with their invitation pack, using a 2:1 ratio. The primary outcome was the likelihood of being randomised, and therefore fully recruited, to the host trial. To be randomised to the host trial, participants had to: return a consent form and screening form; be eligible on their screening form; and return a baseline questionnaire and a monthly falls calendar. Secondary outcomes were: the likelihood of returning (and time to return) a screening form; being eligible for the host trial; and remaining in the trial for at least 3 months. Results: The likelihood of being randomised to the host trial did not differ between the pen group (4.5%) and no pen group (4.3%; odds ratio 1.04; 95% confidence interval: 0.65 to 1.67; p = 0.86). There were marginal differences in secondary outcomes in favour of the pen group, particularly in screening form return rates, though these differences were not statistically significant. Conclusion: Pens may not be an effective incentive for the recruitment of older adults into randomised controlled trials, though future trials are required. Registration: ISRCTN22202133; SWAT 37.
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Affiliation(s)
- Katie Whiteside
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Lydia Flett
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - OTIS Study Group
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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26
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Cockayne S, Fairhurst C, Frost G, Hewitt C, Liddle M, Zand M, Iles-Smith H, Green L, Cunningham-Burley R, Torgerson D. SSHeW study protocol: does slip resistant footwear reduce slips among healthcare workers? A randomised controlled trial. BMJ Open 2018; 8:e026023. [PMID: 30446577 PMCID: PMC6252757 DOI: 10.1136/bmjopen-2018-026023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Slips, trips and falls are common causes of injuries in the workplace. It is estimated that in Great Britain, nearly 1 million days are taken off work due to these injuries. There is some evidence to suggest this accident burden could be reduced by the use of slip resistant footwear. This protocol describes a multicentre trial investigating the effectiveness and cost-effectiveness of slip resistant footwear to prevent slips in National Health Service (NHS) staff working in clinical, general or catering environments. METHODS AND ANALYSIS A two-arm, randomised controlled trial conducted within England, with 4400 NHS staff, aged 18 years and above, who adhere to a dress code policy and work in a clinical, catering or general hospital environment. Participants will be randomised 1:1 to the intervention or waiting list control group. The intervention group will be offered a pair of 5-star GRIP rated slip resistant footwear. The control group will be offered the footwear at the end of the trial. The primary outcome is the incidence rate of self-reported slips in the workplace over a 14-week period, as reported via weekly text messages. Secondary outcomes include: time to first slip/fall, proportion of participants who slip and fall over 14 weeks and incidence rate of falls resulting from and not resulting from a slip in the workplace over 14 weeks. An economic evaluation will assess cost-effectiveness, in terms of cost per quality-adjusted life year gained. A nested qualitative study will explore the acceptability of the footwear and compliance. ETHICS AND DISSEMINATION This protocol received a favourable ethical opinion from the University of York, Department of Health Sciences Research Governance Committee. The trial results will be published in peer-reviewed journals and at conferences. A summary of the findings will be made available to participants. TRIAL REGISTRATION NUMBER ISRCTN33051393; Pre results.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | | | - Lorraine Green
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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27
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Cockayne S, Pighills A, Adamson J, Fairhurst C, Drummond A, Hewitt C, Rodgers S, Ronaldson SJ, Lamb SE, Crossland S, Boyes S, Gilbody S, Relton C, Torgerson DJ. Can occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol. BMJ Open 2018; 8:e022488. [PMID: 30206086 PMCID: PMC6144405 DOI: 10.1136/bmjopen-2018-022488] [Citation(s) in RCA: 12] [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: 02/20/2018] [Revised: 06/08/2018] [Accepted: 08/14/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Falls and fall-related injuries are a serious cause of morbidity and cost to society. Environmental hazards are implicated as a major contributor to falls among older people. A recent Cochrane review found an environmental assessment, undertaken by an occupational therapist, to be an effective approach to reducing falls. However, none of the trials included a cost-effectiveness evaluation in the UK setting. This protocol describes a large multicentre trial investigating the clinical and cost-effectiveness of environmental assessment and modification within the home with the aim of preventing falls in older people. METHODS AND ANALYSIS A two-arm, modified cohort randomised controlled trial, conducted within England, with 1299 community-dwelling participants aged 65 years and above, who are at an increased risk of falls. Participants will be randomised 2:1 to receive either usual care or home assessment and modification. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by monthly patient self-report falls calendars. Secondary self-reported outcome measures include: the proportion of single and multiple fallers, time to first fall over a 12-month period, quality of life (EuroQoL EQ-5D-5L) and health service utilisation at 4, 8 and 12 months. A nested qualitative study will examine the feasibility of providing the intervention and explore barriers, facilitators, workload implications and readiness to employ these interventions into routine practice. An economic evaluation will assess value for money in terms of cost per fall averted. ETHICS AND DISSEMINATION This study protocol (including the original application and subsequent amendments) received a favourable ethical opinion from National Health Service West of Scotland REC 3. The trial results will be published in peer-reviewed journals and at conference presentations. A summary of the findings will be sent to participants. TRIAL REGISTRATION NUMBER ISRCTN22202133; Pre-results.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Queensland Health, Mackay Australia and James Cook University, Mackay Base Hospital, Townsville, Australia
| | - Joy Adamson
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Avril Drummond
- School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah J Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Shelley Crossland
- Community Mental Health Team, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Sophie Boyes
- Occupational Therapy Department, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Simon Gilbody
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Clare Relton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Rodgers S, Sbizzera I, Cockayne S, Fairhurst C, Lamb SE, Vernon W, Watson J, Hewitt C, Torgerson D. A study update newsletter or Post-it® note did not increase postal questionnaire response rates in a falls prevention trial: an embedded randomised factorial trial. F1000Res 2018; 7:1083. [PMID: 30863532 PMCID: PMC6402081 DOI: 10.12688/f1000research.14591.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Accepted: 02/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Participants not returning data collection questionnaires is a problem for many randomised controlled trials. The resultant loss of data leads to a reduction in statistical power and can result in bias. The aim of this study was to assess whether the use of a study update newsletter and/or a handwritten or printed Post-it® note sticker increased postal questionnaire response rates for participants of a randomised controlled trial. Method: This study was a factorial trial embedded within a host trial of a falls-prevention intervention among men and women aged ≥65 years under podiatric care. Participants were randomised into one of six groups: newsletter plus handwritten Post-it®; newsletter plus printed Post-it®; newsletter only; handwritten Post-it® only; printed Post-it® only; or no newsletter or Post-it®. The results were combined with those from previous embedded randomised controlled trials in meta-analyses. Results: The overall 12-month response rate was 803/826 (97.2%) (newsletter 95.1%, no newsletter 99.3%, printed Post-it® 97.5%, handwritten Post-it® 97.1%, no Post-it® 97.1%). The study update newsletter had a detrimental effect on response rates (adjusted odds ratio 0.14, 95% CI 0.04 to 0.48, p<0.01) and time to return the questionnaire (adjusted hazard ratio 0.86, 95% CI 0.75 to 0.99, p=0.04). No other statistically significant differences were observed between the intervention groups on response rates, time to response, and the need for a reminder. Conclusions: Post-it® notes have been shown to be ineffective in three embedded trials, whereas the evidence for newsletter reminders is still uncertain.
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Affiliation(s)
- Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Illary Sbizzera
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah E. Lamb
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Wesley Vernon
- Division of Podiatry and Clinical Sciences, School of Human and Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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29
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Rodgers S, Sbizzera I, Cockayne S, Fairhurst C, Lamb SE, Vernon W, Watson J, Hewitt C, Torgerson D. A nested randomised controlled trial of a newsletter and Post-it® note did not increase postal questionnaire response rates in a falls prevention trial. F1000Res 2018; 7:1083. [PMID: 30863532 PMCID: PMC6402081 DOI: 10.12688/f1000research.14591.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 10/07/2023] Open
Abstract
Background: Attrition (i.e. when participants do not return the questionnaires) is a problem for many randomised controlled trials. The resultant loss of data leads to a reduction in statistical power and can lead to bias. The aim of this study was to assess whether a pre-notification newsletter and/or a handwritten or printed Post-it® note sticker, as a reminder, increased postal questionnaire response rates for participants of randomised controlled trials. Method: This study was a factorial trial embedded within a trial of a falls-prevention intervention among men and women aged ≥65 years under podiatric care. Participants were randomised into one of six groups: newsletter plus handwritten Post-it®; newsletter plus printed Post-it®; newsletter only; handwritten Post-it® only; printed Post-it® only; or no newsletter or Post-it®. The results were combined with those from previous embedded randomised controlled trials in a meta-analysis. Results: The 12-month response rate was 803/826 (97.2%) (newsletter 95.1%, no newsletter 99.3%, printed Post-it® 97.5%, handwritten Post-it® 97.1%, no Post-it® 97.1%). Pre-notification with a newsletter had a detrimental effect on response rates (adjusted odds ratio (OR), 0.14; 95% CI, 0.04 to 0.48; p<0.01) and time to return the questionnaire (adjusted hazard ratio, 0.86; 95% CI, 0.75 to 0.99; p=0.04). No other statistically significant differences were observed between the intervention groups on response rates, time to response, and the need for a reminder. Conclusions: Post-it® notes have been shown to be ineffective in three embedded trials, whereas the evidence for newsletter reminders is still uncertain.
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Affiliation(s)
- Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Illary Sbizzera
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah E. Lamb
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Wesley Vernon
- Division of Podiatry and Clinical Sciences, School of Human and Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Corbacho B, Cockayne S, Fairhurst C, Hewitt CE, Hicks K, Kenan AM, Lamb SE, MacIntosh C, Menz HB, Redmond AC, Rodgers S, Scantlebury A, Watson J, Torgerson DJ. Cost-Effectiveness of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People: The REducing Falls with Orthoses and a Multifaceted Podiatry Intervention Trial Findings. Gerontology 2018; 64:503-512. [PMID: 29945150 DOI: 10.1159/000489171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falls are a major cause of morbidity among older people. Multifaceted interventions may be effective in preventing falls and related fractures. OBJECTIVE To evaluate the cost-effectiveness alongside the REducing Falls with Orthoses and a Multifaceted podiatry intervention (REFORM) trial. METHODS REFORM was a pragmatic multicentre cohort randomised controlled trial in England and Ireland; 1,010 participants (> 65 years) were randomised to receive either a podiatry intervention (n = 493), including foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet, or usual podiatry treatment plus a falls prevention leaflet (n = 517). PRIMARY OUTCOME incidence of falls per participant in the 12 months following randomisation. SECONDARY OUTCOMES proportion of fallers and quality of life (EQ-5D-3L) which was converted into quality-adjusted life years (QALYs) for each participant. Differences in mean costs and QALYs at 12 months were used to assess the cost-effectiveness of the intervention relative to usual care. Cost-effectiveness analyses were conducted in accordance with National Institute for Health and Clinical Excellence reference case standards, using a regression-based approach with costs expressed in GBP (2015 price). The base case analysis used an intention-to-treat approach on the imputed data set using multiple imputation. RESULTS There was a small, non-statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73-1.05, p = 0.16). Participants allocated to the intervention group accumulated on average marginally higher QALYs than the usual care participants (mean difference 0.0129, 95% CI -0.0050 to 0.0314). The intervention costs were on average GBP 252 more per participant compared to the usual care participants (95% CI GBP -69 to GBP 589). Incremental cost-effectiveness ratios ranged between GBP 19,494 and GBP 20,593 per QALY gained, below the conventional National Health Service cost-effectiveness thresholds of GBP 20,000 to GBP 30,000 per additional QALY. The probability that the podiatry intervention is cost-effective at a threshold of GBP 30,000 per QALY gained was 0.65. The results were robust to sensitivity analyses. CONCLUSION The benefits of the intervention justified the moderate cost. The intervention could be a cost-effective option for falls prevention when compared with usual care in the UK.
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Affiliation(s)
- Belen Corbacho
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Caroline Fairhurst
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Catherine E Hewitt
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Kate Hicks
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Anne-Maree Kenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sara Rodgers
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Arabella Scantlebury
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Judith Watson
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - David J Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
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31
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Cockayne S, Rodgers S, Green L, Fairhurst C, Adamson J, Scantlebury A, Corbacho B, Hewitt CE, Hicks K, Hull R, Keenan AM, Lamb SE, McIntosh C, Menz HB, Redmond A, Richardson Z, Vernon W, Watson J, Torgerson DJ. Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial). Health Technol Assess 2018. [PMID: 28621259 DOI: 10.3310/hta21240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care. DESIGN A pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS In total, 1010 participants aged ≥ 65 years were randomised (intervention, n = 493; usual care, n = 517) via a secure, remote service. Blinding was not possible. INTERVENTIONS All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness. RESULTS The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI -£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS Owing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK Further research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN68240461. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Robin Hull
- Podiatry Department, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Anne-Maree Keenan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah E Lamb
- Oxford NIHR Biomedical Research Unit, Oxford, UK
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, National University of Ireland Galway, Galway, Ireland
| | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Wesley Vernon
- Podiatry Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Hashmi F, Fairhurst C, Cockayne S, Cullen M, Bell K, Coleman E, Harrison‐Blount M, Torgerson D. The
EV
erT2 (Effective Verruca Treatments 2) trial: a randomized controlled trial of needling vs. nonsurgical debridement for the treatment of plantar verrucae. Br J Dermatol 2017; 177:1285-1292. [DOI: 10.1111/bjd.15751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- F. Hashmi
- School of Health Sciences University of Salford Brian Blatchford Building Salford M6 6PU U.K
| | - C. Fairhurst
- Department of Health Sciences University of York York Trials Unit, ARRC Building, Ground Floor York YO10 5DD U.K
| | - S. Cockayne
- Department of Health Sciences University of York York Trials Unit, ARRC Building, Ground Floor York YO10 5DD U.K
| | - M. Cullen
- School of Health Sciences University of Salford Brian Blatchford Building Salford M6 6PU U.K
| | - K. Bell
- Department of Health Sciences University of York York Trials Unit, ARRC Building, Ground Floor York YO10 5DD U.K
| | - E. Coleman
- Department of Health Sciences University of York York Trials Unit, ARRC Building, Ground Floor York YO10 5DD U.K
| | - M. Harrison‐Blount
- School of Health Sciences University of Salford Brian Blatchford Building Salford M6 6PU U.K
| | - D. Torgerson
- Department of Health Sciences University of York York Trials Unit, ARRC Building, Ground Floor York YO10 5DD U.K
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Jesurasa A, Mukherjee J, Quhill F, Cockayne S, Kebell S. E24. HYDROXYCHLOROQUINE RETINOPATHY: HOW SHOULD THIS RISK BE MONITORED? Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex063.023] [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: 11/14/2022] Open
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Cockayne S, Fairhurst C, Adamson J, Hewitt C, Hull R, Hicks K, Keenan AM, Lamb SE, Green L, McIntosh C, Menz HB, Redmond AC, Rodgers S, Torgerson DJ, Vernon W, Watson J, Knapp P, Rick J, Bower P, Eldridge S, Madurasinghe VW, Graffy J. An optimised patient information sheet did not significantly increase recruitment or retention in a falls prevention study: an embedded randomised recruitment trial. Trials 2017; 18:144. [PMID: 28351376 PMCID: PMC5370466 DOI: 10.1186/s13063-017-1797-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 02/08/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Randomised controlled trials are generally regarded as the ‘gold standard’ experimental design to determine the effectiveness of an intervention. Unfortunately, many trials either fail to recruit sufficient numbers of participants, or recruitment takes longer than anticipated. The current embedded trial evaluates the effectiveness of optimised patient information sheets on recruitment of participants in a falls prevention trial. Methods A three-arm, embedded randomised methodology trial was conducted within the National Institute for Health Research-funded REducing Falls with ORthoses and a Multifaceted podiatry intervention (REFORM) cohort randomised controlled trial. Routine National Health Service podiatry patients over the age of 65 were randomised to receive either the control patient information sheet (PIS) for the host trial or one of two optimised versions, a bespoke user-tested PIS or a template-developed PIS. The primary outcome was the proportion of patients in each group who went on to be randomised to the host trial. Results Six thousand and nine hundred patients were randomised 1:1:1 into the embedded trial. A total of 193 (2.8%) went on to be randomised into the main REFORM trial (control n = 62, template-developed n = 68; bespoke user-tested n = 63). Information sheet allocation did not improve recruitment to the trial (odds ratios for the three pairwise comparisons: template vs control 1.10 (95% CI 0.77–1.56, p = 0.60); user-tested vs control 1.01 (95% CI 0.71–1.45, p = 0.94); and user-tested vs template 0.92 (95% CI 0.65–1.31, p = 0.65)). Conclusions This embedded methodology trial has demonstrated limited evidence as to the benefit of using optimised information materials on recruitment and retention rates in the REFORM study. Trial registration International Standard Randomised Controlled Trials Number registry, ISRCTN68240461. Registered on 01 July 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1797-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Joy Adamson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Catherine Hewitt
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Robin Hull
- Podiatry Services, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK
| | - Kate Hicks
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Anne-Maree Keenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Lorraine Green
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Caroline McIntosh
- School of Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Hylton B Menz
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sara Rodgers
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - David J Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Wesley Vernon
- The School of Human & Health Sciences, Division of Podiatry, University of Huddersfield, Huddersfield, UK
| | - Judith Watson
- Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Jo Rick
- Medical Research Council North West Hub for Trials Methodology Research, National Institute of Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, National Institute of Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Vichithranie W Madurasinghe
- Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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Arundel C, Jefferson L, Bailey M, Cockayne S, Hicks K, Loughrey L, Rodgers S, Torgerson DJ. A randomized, embedded trial of pre-notification of trial participation did not increase recruitment rates to a falls prevention trial. J Eval Clin Pract 2017; 23:73-78. [PMID: 27320133 DOI: 10.1111/jep.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To design and evaluate the effectiveness of a pre-notification leaflet about research to increase recruitment to a randomized controlled trial (RCT). METHODS A methodological, two-arm, RCT was conducted, embedded within an existing cohort RCT (REFORM). Participants were randomized for the embedded trial, using a 1:2 ratio (intervention : control) before being randomized for REFORM. Controls received a trial recruitment pack. The intervention group received an additional pre-notification leaflet 2-3 weeks before the recruitment pack. Primary and secondary analyses were conducted using relative risk, the Cox proportional hazards model and incremental cost-effectiveness ratios. RESULTS Of the 1436 intervention group participants, 73 (5.1%) were randomized into the REFORM trial compared with 126 (4.4%) of the 2878 control group participants. The associated relative risk (1.16) was not statistically significant [95% confidence interval (CI) 0.88-1.56]. Return rate was not significantly increased (relative risk 1.10, 95% CI 0.92-1.28) nor time to return decreased (hazard ratio: 1.11, 95% CI 0.93-1.33). Incremental cost-effectiveness ratios indicated the intervention may be cost-effective if the true estimate of effect was close to the upper bound of the associated 95% CI. CONCLUSION Pre-notification for potential trial participants demonstrated a small difference to randomization (0.7% difference) and return rates (1.1% difference) in favour of the intervention. Results should however be interpreted with caution as CIs for these estimates cross the point of no effect. Nevertheless, this research enhances existing evidence for pre-notification to increase recruitment rates, with further development and assessment of this potentially cost-effective intervention being recommended.
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Affiliation(s)
- Catherine Arundel
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Laura Jefferson
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Matthew Bailey
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Sarah Cockayne
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Kate Hicks
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Lorraine Loughrey
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - Sara Rodgers
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
| | - David J Torgerson
- York Trials Unit - Department of Health Sciences, The University of York, York, UK
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- York Trials Unit - Department of Health Sciences, The University of York, York, UK
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36
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Cockayne S, Adamson J, Clarke A, Corbacho B, Fairhurst C, Green L, Hewitt CE, Hicks K, Kenan AM, Lamb SE, McIntosh C, Menz HB, Redmond AC, Richardson Z, Rodgers S, Vernon W, Watson J, Torgerson DJ. Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial). PLoS One 2017; 12:e0168712. [PMID: 28107372 PMCID: PMC5249075 DOI: 10.1371/journal.pone.0168712] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/03/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. DESIGN Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. RESULTS In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. CONCLUSION There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION ISRCTN ISRCTN68240461.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Lorraine Green
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Catherine E. Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Anne-Maree Kenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sarah E. Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Hylton B. Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C. Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Wesley Vernon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, Sheffield, United Kingdom
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - David J. Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
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Jefferson L, Fairhurst C, Cooper E, Hewitt C, Torgerson T, Cook L, Tharmanathan P, Cockayne S, Torgerson D. No difference found in time to publication by statistical significance of trial results: a methodological review. JRSM Open 2016; 7:2054270416649283. [PMID: 27757242 PMCID: PMC5052771 DOI: 10.1177/2054270416649283] [Citation(s) in RCA: 4] [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] [Indexed: 12/22/2022] Open
Abstract
Objective Time-lag from study completion to publication is a potential source of publication bias in randomised controlled trials. This study sought to update the evidence base by identifying the effect of the statistical significance of research findings on time to publication of trial results. Design Literature searches were carried out in four general medical journals from June 2013 to June 2014 inclusive (BMJ, JAMA, the Lancet and the New England Journal of Medicine). Setting Methodological review of four general medical journals. Participants Original research articles presenting the primary analyses from phase 2, 3 and 4 parallel-group randomised controlled trials were included. Main outcome measures Time from trial completion to publication. Results The median time from trial completion to publication was 431 days (n = 208, interquartile range 278–618). A multivariable adjusted Cox model found no statistically significant difference in time to publication for trials reporting positive or negative results (hazard ratio: 0.86, 95% CI 0.64 to 1.16, p = 0.32). Conclusion In contrast to previous studies, this review did not demonstrate the presence of time-lag bias in time to publication. This may be a result of these articles being published in four high-impact general medical journals that may be more inclined to publish rapidly, whatever the findings. Further research is needed to explore the presence of time-lag bias in lower quality studies and lower impact journals.
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Affiliation(s)
- L Jefferson
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - C Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - E Cooper
- Elderly medicine, York Hospital, York YO31 8HE, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - T Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - L Cook
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - P Tharmanathan
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - D Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
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Cockayne S, Hewitt C, Hashmi F, Hicks K, Concannon M, McIntosh C, Thomas K, Hall J, Watson J, Torgerson D, Watt I. Implementation of blinded outcome assessment in the Effective Verruca Treatments trial (EverT) - lessons learned. J Foot Ankle Res 2016; 9:21. [PMID: 27408622 PMCID: PMC4941023 DOI: 10.1186/s13047-016-0155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trials using inadequate levels of blinding may report larger effect sizes than blinded studies. It has been suggested that blinded outcome assessment in open trials may in some cases be undertaken by assessments of photographs. The aim of this paper is to explore the effect of using different methods to assess the primary outcome in the EVerT (Effective Verruca Treatments) trial. It also aims to give an overview of the experiences of using digital photographs within the trial. METHODS We undertook a secondary analysis to explore the effect of using three different methods to assess the primary outcome in the EVerT trial: assessment of digital photographs by blinded healthcare professionals; blinded healthcare professional assessment at the recruiting site and patient self-report. The verruca clearance rates were calculated using the three different methods of assessment. A Cohen's kappa measure of inter-rater agreement was used to assess the agreement between the methods. We also investigated the experiences of healthcare professionals using digital photographs within the trial. RESULTS Digital photographs for 189 out of 240 (79 %) patients in the trial were received for outcome assessment. Of the 189 photographs, 30 (16 %) were uninterpretable. The overall verruca clearance rates were 21 % (43/202,) using the unblinded patient self-reported outcome, 6 % (9/159,) using blinded assessment of digital photographs and 14 % (30/210,) using blinded outcome assessment at the site. CONCLUSIONS Despite differences in the clearance rates found using different methods of outcome assessment, this did not change the original conclusion of the trial, that there is no evidence of a difference in effectiveness between cryotherapy and salicylic acid. Future trials using digital photographs should consider individual training needs at sites and have a backup method of assessment agreed a priori. TRIAL REGISTRATION ISRCTN Registry ISRCTN18994246.
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Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Catherine Hewitt
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Farina Hashmi
- School of Health Sciences, University of Salford, Salford, UK
| | - Kate Hicks
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Michael Concannon
- The School of Human & Health Sciences, Division of Podiatry, University of Huddersfield, Huddersfield, UK
| | - Caroline McIntosh
- Discipline of Podiatry, The National University of Ireland, Galway, Republic of Ireland
| | - Kim Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jill Hall
- The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Judith Watson
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - David Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Ian Watt
- Department of Health Sciences, York Trials Unit, University of York, York, UK ; Hull York Medical School, York, UK
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Clark AL, Johnson M, Fairhurst C, Torgerson D, Cockayne S, Rodgers S, Griffin S, Allgar V, Jones L, Nabb S, Harvey I, Squire I, Murphy J, Greenstone M. Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure. Health Technol Assess 2016; 19:1-120. [PMID: 26393373 DOI: 10.3310/hta19750] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home oxygen therapy (HOT) is commonly used for patients with severe chronic heart failure (CHF) who have intractable breathlessness. There is no trial evidence to support its use. OBJECTIVES To detect whether or not there was a quality-of-life benefit from HOT given as long-term oxygen therapy (LTOT) for at least 15 hours per day in the home, including overnight hours, compared with best medical therapy (BMT) in patients with severely symptomatic CHF. DESIGN A pragmatic, two-arm, randomised controlled trial recruiting patients with severe CHF. It included a linked qualitative substudy to assess the views of patients using home oxygen, and a free-standing substudy to assess the haemodynamic effects of acute oxygen administration. SETTING Heart failure outpatient clinics in hospital or the community, in a range of urban and rural settings. PARTICIPANTS Patients had to have heart failure from any aetiology, New York Heart Association (NYHA) class III/IV symptoms, at least moderate left ventricular systolic dysfunction, and be receiving maximally tolerated medical management. Patients were excluded if they had had a cardiac resynchronisation therapy device implanted within the past 3 months, chronic obstructive pulmonary disease fulfilling the criteria for LTOT or malignant disease that would impair survival or were using a device or medication that would impede their ability to use LTOT. INTERVENTIONS Patients received BMT and were randomised (unblinded) to open-label LTOT, prescribed for 15 hours per day including overnight hours, or no oxygen therapy. MAIN OUTCOME MEASURES The primary end point was quality of life as measured by the Minnesota Living with Heart Failure (MLwHF) questionnaire score at 6 months. Secondary outcomes included assessing the effect of LTOT on patient symptoms and disease severity, and assessing its acceptability to patients and carers. RESULTS Between April 2012 and February 2014, 114 patients were randomised to receive either LTOT or BMT. The mean age was 72.3 years [standard deviation (SD) 11.3 years] and 70% were male. Ischaemic heart disease was the cause of heart failure in 84%; 95% were in NYHA class III; the mean left ventricular ejection fraction was 27.8%; and the median N-terminal pro-B-type natriuretic hormone was 2203 ng/l. The primary analysis used a covariance pattern mixed model which included patients only if they provided data for all baseline covariates adjusted for in the model and outcome data for at least one post-randomisation time point (n = 102: intervention, n = 51; control, n = 51). There was no difference in the MLwHF questionnaire score at 6 months between the two arms [at baseline the mean score was 54.0 (SD 18.4) for LTOT and 54.0 (SD 17.9) for BMT; at 6 months the mean score was 48.1 (SD 18.5) for LTOT and 49.0 (SD 20.2) for BMT; adjusted mean difference -0.10, 95% confidence interval (CI) -6.88 to 6.69; p = 0.98]. At 3 months, the adjusted mean MLwHF questionnaire score was lower in the LTOT group (-5.47, 95% CI -10.54 to -0.41; p = 0.03) and breathlessness scores improved, although the effect did not persist to 6 months. There was no effect of LTOT on any secondary measure. There was a greater number of deaths in the BMT arm (n = 12 vs. n = 6). Adherence was poor, with only 11% of patients reporting using the oxygen as prescribed. CONCLUSIONS Although the study was significantly underpowered, HOT prescribed for 15 hours per day and subsequently used for a mean of 5.4 hours per day has no impact on quality of life as measured by the MLwHF questionnaire score at 6 months. Suggestions for future research include (1) a trial of patients with severe heart failure randomised to have emergency oxygen supply in the house, supplied by cylinders rather than an oxygen concentrator, powered to detect a reduction in admissions to hospital, and (2) a study of bed-bound patients with heart failure who are in the last few weeks of life, powered to detect changes in symptom severity. TRIAL REGISTRATION Current Controlled Trials ISRCTN60260702. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 75. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew L Clark
- Hull York Medical School, Castle Hill Hospital, Cottingham, UK
| | | | - Caroline Fairhurst
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - David Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Sara Rodgers
- Department of Health Sciences, York Trials Unit, University of York, York, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | | | - Lesley Jones
- School of Social Sciences, University of Hull, Hull, UK
| | - Samantha Nabb
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Ian Harvey
- Department of Academic Cardiology, Castle Hill Hospital, Cottingham, UK
| | - Iain Squire
- Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Jerry Murphy
- Department of Cardiology, Darlington Memorial Hospital, Darlington, UK
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Garner A, Colton H, Ali R, Cockayne S. CC5 A Case of Urticarial Vasculitis leading to HIV diagnosis. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.44] [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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Cockayne S, Adamson J, Bower P, Corbacho B, Fairhurst C, Farndon L, Hicks K, Keenan AM, Knapp P, Lamb S, Loughrey L, McIntosh C, Menz H, Redmond A, Rick J, Rodgers S, Vernon W, Watson J, Torgerson D. The reform patient information sheet sub study - an embedded trial evaluating the enhancement of patient information sheets to improve recruitment. Trials 2015. [PMCID: PMC4660066 DOI: 10.1186/1745-6215-16-s2-p87] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cockayne S, Adamson J, Corbacho B, Fairhurst C, Farndon L, Hicks K, Keenan AM, Lamb S, Loughrey L, McIntosh C, Menz H, Redmond A, Rodgers S, Vernon W, Watson J, Torgerson D. The reform study: a case study of embedded trials. Trials 2015. [PMCID: PMC4660340 DOI: 10.1186/1745-6215-16-s2-p174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hashmi F, Torgerson D, Fairhurst C, Cockayne S, Bell K, Cullen M, Harrison-Blount M. EVerT2-needling versus non-surgical debridement for the treatment of verrucae: study protocol for a single-centre randomised controlled trial. BMJ Open 2015; 5:e009406. [PMID: 26603251 PMCID: PMC4663427 DOI: 10.1136/bmjopen-2015-009406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Verrucae are extremely common, and are experienced by most people at some time during their lives. Although most verrucae will spontaneously disappear without treatment, many patients seek treatment, often because they have persisted for many years, are unsightly or painful or prevent them from doing sports or other activities. There are many different treatments available; including the Falknor's needling procedure. To date, there has only been one small trial evaluating the clinical effectiveness of this treatment and no health economic analysis has been undertaken. The Effective Verruca Treatments (EVerT2) trial aims to evaluate the clinical and cost-effectiveness of the needling procedure for the treatment of verrucae. METHODS AND ANALYSIS This single-centre randomised controlled trial will recruit 58 participants (aged 18 years and over with a plantar verruca) from Salford Podiatry Clinic patient lists and the surrounding area. If the participant presents with multiple verrucae, an 'index' verruca (largest and thickest lesion) will be identified and patients will be randomised 1:1 to the intervention group to receive the needling treatment or the control group to have the callus overlying the verruca debrided. The primary outcome is complete clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes include clearance and recurrence of the treated verruca, clearance of all verrucae, number of verrucae remaining, change in size of the index verruca, pain, and participant satisfaction. A cost-effectiveness analysis of the needling versus callus debridement will be carried out from the perspective of health services over a time horizon of 12 weeks. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Salford, Department of Health Sciences Ethical Approval Committee (HSCR15/24) and the University of York, Department of Health Sciences Research Governance Committee (HSRGC/2014/98/B). Findings will be disseminated through publication and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16429440.
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Affiliation(s)
- Farina Hashmi
- University of Salford, School of Health Sciences, Manchester, UK
| | | | | | - Sarah Cockayne
- Department of Health Sciences, University of York, York, UK
| | - Kerry Bell
- Department of Health Sciences, University of York, York, UK
| | - Michelle Cullen
- University of Salford, School of Health Sciences, Manchester, UK
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Swaris B, Wright A, Inman R, Cockayne S. P40 Penile squamous cell carcinoma in a patient treated with etanercept for psoriasis. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.84] [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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Cockayne S, Adamson J, Corbacho Martin B, Fairhurst C, Hewitt C, Hicks K, Hull R, Keenan AM, Lamb SE, Loughrey L, McIntosh C, Menz HB, Redmond AC, Rodgers S, Vernon W, Watson J, Torgerson D. The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people. BMJ Open 2014; 4:e006977. [PMID: 25518875 PMCID: PMC4275677 DOI: 10.1136/bmjopen-2014-006977] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 10/22/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Falls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play a role in reducing falls. Two Cochrane systematic reviews identified only one study of a podiatry intervention aimed to reduce falls, which was undertaken in Australia. The REFORM trial aims to evaluate the clinical and cost-effectiveness of a multifaceted podiatry intervention in reducing falls in people aged 65 years and over in a UK and Irish setting. METHODS AND ANALYSIS This multicentre, cohort randomised controlled trial will recruit 2600 participants from routine podiatry clinics in the UK and Ireland to the REFORM cohort. In order to detect a 10% point reduction in falls from 50% to 40%, with 80% power 890 participants will be randomised to receive routine podiatry care and a falls prevention leaflet or routine podiatry care, a falls prevention leaflet and a multifaceted podiatry intervention. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by patient self-report falls diary. Secondary self-report outcome measures include: the proportion of single and multiple fallers and time to first fall over a 12-month period; Short Falls Efficacy Scale-International; fear of falling in the past 4 weeks; Frenchay Activities Index; fracture rate; Geriatric Depression Scale; EuroQoL-five dimensional scale 3-L; health service utilisation at 6 and 12 months. A qualitative study will examine the acceptability of the package of care to participants and podiatrists. ETHICS AND DISSEMINATION The trial has received a favourable opinion from the East of England-Cambridge East Research Ethics Committee and Galway Research Ethics Committee. The trial results will be published in peer-reviewed journals and at conference presentations. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN68240461 assigned 01/07/2011.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Robin Hull
- Podiatry Services, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Harrogate, UK
| | - Anne Maree Keenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Lorraine Loughrey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Hylton B Menz
- Faculty of Health Sciences, Lower Extremity and Gait Studies Program, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Wesley Vernon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, Sheffield, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Clark L, Fairhurst C, Hewitt CE, Birks Y, Brabyn S, Cockayne S, Rodgers S, Hicks K, Hodgson R, Littlewood E, Torgerson DJ. A methodological review of recent meta-analyses has found significant heterogeneity in age between randomized groups. J Clin Epidemiol 2014; 67:1016-24. [DOI: 10.1016/j.jclinepi.2014.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 12/20/2022]
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Cockayne S, Pattenden J, Worthy G, Richardson G, Lewin R. Nurse facilitated Self-management support for people with heart failure and their family carers (SEMAPHFOR): a randomised controlled trial. Int J Nurs Stud 2014; 51:1207-13. [DOI: 10.1016/j.ijnurstu.2014.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Mejía A, Richardson G, Pattenden J, Cockayne S, Lewin R. Cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme compared with usual care using a CBT manual alone for patients with heart failure: secondary analysis of data from the SEMAPHFOR trial. Int J Nurs Stud 2014; 51:1214-20. [DOI: 10.1016/j.ijnurstu.2014.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 11/25/2022]
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Cockayne S, Torgerson D, Watt I. No proved benefit for cryotherapy over salicylic acid in treating verrucas. BMJ 2014; 348:g4090. [PMID: 24963076 DOI: 10.1136/bmj.g4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - David Torgerson
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Ian Watt
- Department of Health Sciences, University of York, York YO10 5DD, UK
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Clark L, Fairhurst C, Hewitt C, Birks Y, Brabyn S, Cockayne S, Rodgers S, Hicks K, Hodgson R, Littlewood E, Torgerson D. Assessing the presence of selection bias in meta-analyses of randomised trials using baseline heterogeneity. Trials 2013. [PMCID: PMC3981136 DOI: 10.1186/1745-6215-14-s1-o96] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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