Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

Abstract

BackgroundJoint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures.MethodsThe development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes.ResultsGraphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners.ConclusionsIn view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.Trial registrationGerman clinical trials register, reference number DRKS00010037 (12 February 2016).

Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: A process evaluation of a cluster-randomised pilot trial

“…Overall, our study con rms the multi-step change mechanisms hypothesised with the underlying Theory of Planned Behaviour (TPB) [28]. The assumptions of the PECAN logic model, which indicated that the residents' health status, time resources and the collaboration with different stakeholders are the in uencing factors for a successful implementation, have been con rmed in this piloting phase [17].…”

“…In consultation with the head nurse the facilitators promoted changes on the organisational level to disseminate the PECAN principles. This included nursing team training sessions, individual counselling, the distribution of lea ets and posters, the de-novo-development of a guidance for managing joint contractures according the core aspects of the PECAN intervention or the adaptation of an existing guidance, environmental adaptations in the nursing home, as well as the redistribution of tasks involving the nursing home management, the nursing team and the interprofessional team (i.e., social workers, physicians and therapists) [17].…”

“…This process evaluation has clear strengths. The PECAN intervention was developed according to the UK MRC framework [19], and is, with the background of the ICF [8], founded on a strong theoretical base in a eld where evidence is sparse [17]. We used a multitude of proven implementation strategies in combination, which is in line with the expert recommendations for implementing change [57].…”

“…A feasibility testing stage is strongly recommended to avoid implementation or evaluation failure [20]. Although our intervention was developed with practitioners and nursing home experts [17], our piloting stage identi ed important optimisation needs for our implementation strategy. In addition, as a participation-orientated complex intervention, PECAN responds to a demand from a recent meta-analysis [58].…”

“…The involvement of informal caregivers is also crucial [12]. A successful intervention for nursing home residents with joint contractures has to consider the interaction between joint contractures, the individuals' daily life and the in uence of environmental and personal factors, and should also address all healthcare professionals involved in the treatment of the affected individuals [17]. Therefore, the intervention must by its very nature be complex.…”