A phase II exploratory cluster randomized controlled trial of a group mobility training and staff education intervention to promote urinary continence in UK care homes

Sackley, Catherine; Rodriguez, Natalie A; Berg, Maayken van den; Badger, Frances; Wright, Chris; Besemer, Jelske; Reeuwijk, Katarina T V van; Wely, Leontine van

doi:10.1177/0269215508089058

Cited by 35 publications

(60 citation statements)

References 25 publications

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“…49 The unadjusted ICC for the BI measure in the present trial was 0.36 at baseline and 0.10 for baseline to 3 months. After allowing for the effect of the treatment arm, TACs and type of care home, the ICC for the primary BI measure reduced to 0.09 (95% CI 0.05 to 0.17).…”

Section: Intracluster Correlation Coefficientmentioning

confidence: 49%

“…79 Furthermore, the BI was used in previous studies assessing the efficacy of OT, and the data from our study are suitable to be incorporated into meta-analyses. 34,48,49 For pragmatic reasons, we chose to use the shortened BI scale between 0 and 20. 77 A higher score signifies that a person has more independence in ADL.…”

Section: Primary Outcome Measurementioning

confidence: 99%

“…This design factor was based on an estimate of intracluster correlation coefficient (ICC) of 0.4 and an average of 10 residents per care home observed in previous research. 48,49 The ICC used in the sample size calculation was estimated from data related to several pilot studies from a single site with relatively small numbers of care homes. A larger estimate of ICC was used than the ICC observed during the OTCH pilot trial in the interest ensuring an adequately powered study.…”

Section: Sample Sizementioning

confidence: 99%

“…47,[48][49][50][51] The evidence relating specifically to stroke survivors living in care homes is extremely limited. A systematic review considering the efficacy of providing OT to stroke survivors living in care homes was conducted by our research team.…”

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confidence: 99%

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An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

Sackley

Walker

Burton

et al. 2016

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Background Care home residents with stroke-related disabilities have significant activity limitations. Phase II trial results suggested a potential benefit of occupational therapy (OT) in maintaining residents’ capacity to engage in functional activity. Objective Evaluate clinical and cost effectiveness of a targeted course of OT in maintaining functional activity and reducing further health risks from inactivity for UK care home residents living with stroke-related disabilities. Design Pragmatic, parallel-group, cluster randomised controlled trial with economic evaluation. Cluster randomisation occurred at the care home level. Homes were stratified according to trial administrative centre, and type of care provided (nursing or residential) and randomised 1:1 to either the intervention or control arm. Setting 228 care homes local to 11 trial administrative centres across England and Wales. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including residents with communication and cognitive impairments, not receiving end of life care. 114 care homes (n=568 residents) were allocated to the intervention arm; 114 homes (n=474 residents) to the control arm. Randomisation of participating homes occurred between May 2010 and March 2012. Intervention Personalised three-month course of OT delivered by qualified therapists. Care workers participated in training workshops to support personal activities of daily living. The control condition consisted of usual care for residents. Main outcome measures Primary outcome at the participant level: Barthel Index of Activities of Daily Living at three months. Secondary outcomes at the participant level: Barthel Index scores at six and twelve months post-randomisation, and the Rivermead Mobility Index, Geriatric Depression Scale-15, and EuroQol EQ-5D-3L questionnaire at all time-points. An economic evaluation examined the incremental cost per quality-adjusted life year (QALY) gain, costs were estimated from the perspective of the NHS and personal social services. Results Participants mean age= 82.9 years, 665/1042 (64%) were female. 2538 OT sessions were delivered to 498 participants in the intervention group (mean visits/participant =5.1, SD=3.0). No adverse events attributable to the intervention were recorded. The primary outcome showed no significant differences between groups. The adjusted mean difference in the Barthel Index score between groups was 0.19 points higher in the intervention arm (95% CI -0.33 to 0.70, p=0.48, adjusted ICC 0.09). Secondary outcome measures showed no significant differences at all time-points. Mean incremental cost of the OTCH intervention was £438.78 (CI £-360.89 to £1238.46), and the incremental QALY gain was 0.009 (CI -0.030 to 0.048). Conclusion A three-month individualised course of OT, showed no benefit in maintaining functional activity in an older care home population with stroke-related disabilities. Limitations A high proportion of participants with very severe activity-based limitations and cog...

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Section: Intracluster Correlation Coefficientmentioning

confidence: 49%

Section: Primary Outcome Measurementioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

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confidence: 99%

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An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

Sackley

Walker

Burton

et al. 2016

Health Technol Assess

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“…This is in contrast with findings in some other UK-based cluster randomised care home studies, which have found intracluster correlation coefficients in the range 0.37 to 0.49 for some outcome measures. 86,215 These intracluster correlation coefficients were, however, for measures such as the Barthel Index and the Rivermead Mobility Index, which were collected by independent assessors rather than directly from residents. Our largest intracluster correlation coefficient for assessment data, collected directly from residents, was 0.09 for the Short Physical Performance Battery; a larger intracluster correlation coefficient for measuring an outcome that is dependent on environmental and, possibly, assessor factors is not surprising.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

Underwood

Lamb²,

Eldridge³

et al. 2013

Health Technol Assess

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 06/02/01. The contractual start date was in February 2008. The draft report began editorial review in January 2012 and was accepted for publication in July 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health.

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Physical rehabilitation for older people in long-term care

Crocker

Forster

Young

et al. 2013

Cochrane Database of Systematic Reviews

153

121

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Analysis 1.30. Comparison 1 Rehabilitation versus control, Outcome 30 TUG Test (by gender).. .. .. .. Analysis 1.31. Comparison 1 Rehabilitation versus control, Outcome 31 Walking speed (by risk of bias).. .. . Analysis 1.32. Comparison 1 Rehabilitation versus control, Outcome 32 Walking speed (by duration of intervention). Analysis 1.33. Comparison 1 Rehabilitation versus control, Outcome 33 Walking speed (by mode of delivery).. . Analysis 1.34. Comparison 1 Rehabilitation versus control, Outcome 34 Walking speed (by baseline walking speed). Analysis 1.35. Comparison 1 Rehabilitation versus control, Outcome 35 Walking speed (by age).. .. .. .. Analysis 1.36. Comparison 1 Rehabilitation versus control, Outcome 36 Walking speed (by gender).. .. .. . Analysis 1.37. Comparison 1 Rehabilitation versus control, Outcome 37 Walking speed (by distance walked).. .. Analysis 1.38. Comparison 1 Rehabilitation versus control, Outcome 38 Death (by risk of bias).. .. .. .. Analysis 1.39. Comparison 1 Rehabilitation versus control, Outcome 39 Death (by duration of intervention).. .. Analysis 1.40. Comparison 1 Rehabilitation versus control, Outcome 40 Death (by mode of delivery).. .. .. Analysis 1.41. Comparison 1 Rehabilitation versus control, Outcome 41 Death (by age

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A phase II exploratory cluster randomized controlled trial of a group mobility training and staff education intervention to promote urinary continence in UK care homes

Abstract: Group mobility training and staff education to promote continence is feasible and acceptable for use with care home residents, including those with cognitive impairment.

Cited by 35 publications

References 25 publications

An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

Physical rehabilitation for older people in long-term care

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