Background provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence and skills of staff who provide care. This trial assessed the feasibility of undertaking a definitive evaluation of a posture and mobility training programme for care staff. Design and setting a cluster randomised controlled feasibility trial with embedded process evaluation. Ten care homes in Yorkshire, United Kingdom, were randomised (1:1) to the skilful care training package (SCTP) or usual care (UC). Participants residents who were not independently mobile. Intervention SCTP—delivered by physiotherapists to care staff. Objectives and measurements key objectives informed progression to a definitive trial. Recruitment, retention and intervention uptake were monitored. Data, collected by a blinded researcher, included pain, posture, mobility, hospitalisations and falls. This informed data collection feasibility and participant safety. Results a total of 348 residents were screened; 146 were registered (71 UC, 75 SCTP). Forty two were lost by 6 months, largely due to deaths. While data collection from proxy informants was good (>95% expected data), attrition meant that data completion rates did not meet target. Data collection from residents was poor due to high levels of dementia. Intervention uptake was variable—staff attendance at all sessions ranged from 12.5 to 65.8%. There were no safety concerns. Conclusion care home and resident recruitment are feasible, but refinement of data collection approaches and intervention delivery are needed for this trial and care home research more widely.

Objectives to compare care staff proxies with care home residents’ self-assessment of their health-related quality of life (HRQoL). Methods we assessed the degree of inter-rater reliability between residents and care staff proxies for the EQ-5D-5L index, domains and EQ Visual Analogue Scale at baseline, 3 months and 6 months, collected as part of the PATCH trial. We calculated kappa scores. Interpreted as <0 no agreement, 0–0.2 slight, 0.21–0.60 fair to moderate and >0.6 substantial to almost perfect agreement. Qualitative interviews with care staff and researchers explored the challenges of completing these questions. Results over 50% of the HRQoL data from residents was missing at baseline compared with a 100% completion rate by care staff proxies. A fair-to-moderate level of agreement was found for the EQ-5D-5L index. A higher level of agreement was achieved for the EQ-5D-5L domains of mobility and pain. Resident ‘non-completers’ were more likely to: be older, have stayed a longer duration in the care home, have lower Barthel Index and Physical Activity and Mobility in Residential Care (PAM-RC) scores, a greater number of co-morbidities and have joined the trial through consultee agreement. Interviews with staff and researchers indicated that it was easier to rate residents’ mobility levels than other domains, but in general it was difficult to obtain data from residents or to make an accurate proxy judgement for those with dementia. Conclusions whilst assessing HRQoL by care staff proxy completion provides a more complete dataset, uncertainty remains as to how representative these values are for different groups of residents within care homes.

The population of older people in care homes has been under-represented in health research, possibly due to the complexity and challenges of conducting research in this setting. This article describes the challenges faced and solutions found by researchers working on the REACH: research in enhancing physical activity in care homes and PATCH: posture and mobility training for care staff versus usual care in care homes, cluster randomised controlled trials (cRCTs). The researchers successfully recruited residents and collected data for both trials but experienced challenges over the course of their involvement with the participating care homes. These challenges included adapting to the care homes setting; identifying gatekeepers and planning visits; building relationships with staff and residents; collecting data from residents, staff and care notes; and buy-in from managers. Having skilled researchers who have knowledge of and are attuned to care home environments was critical to the trials' success.

The Charity Commission of England and Wales supports and regulates the charity sector whose emergence can be traced back to the early seventeenth century. However, there has been limited academic scrutiny of its regulatory approach particularly regarding Muslim-identified charities. This article first challenges the Commission's claim to be an independent body, and second questions whether its contemporary role reveals institutional Islamophobia. It is argued that, since partnering with the UK government's “Prevent” agenda – or war on terror – to control ungoverned spaces for extremism, the Commission has assumed a policing role. This role is analysed through discourse theory and a Foucauldian approach to disciplinary techniques. To analyse the repertoire of institutionalised Islamophobia, the study draws upon Carmichael and Hamilton's definition of institutional racism, the Parekh Report, and Pilkington's ten components of institutional racism. In challenging the Commission's claim to independence, the article highlights the changes in its practices and structure. It argues the structural changes have deflected accountabilities of the board members and chair and resulted in the politicisation of their selection process. Furthermore, the shifts in the Commission's practices have had a disproportionate impact on Muslim charities, where thirty-eight per cent of all disclosed statutory investigations conducted are on Muslim charities despite representing only 1.21 per cent of the sector. This article provides a discourse analysis of the regulatory approach of a significant public body and departs from investigations of subjective and media representations of Muslims that have monopolised research on Islamophobia.

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