A cluster randomised feasibility trial evaluating six-month nutritional interventions in the treatment of malnutrition in care home-dwelling adults: recruitment, data collection and protocol

Effect of a combined programme of dietary restriction and physical activity on the physical function and body composition of obese middle-aged and older adults with knee OA (DRPA): protocol for a feasibility study

INTRODUCTION

Knee osteoarthritis (OA) is the most common chronic illness among older adults. Up to the submission date of this protocol, there are no published UK studies reporting the efficacy of a combined intervention programme of physical activity and dietary restriction on the musculoskeletal function of obese older adults with knee OA in spite of the clinical recommendation for exercise and diet for people with knee OA. The aim of this study is to assess the feasibility and acceptability of a combined dietary restriction and physical activity intervention programme and collect preliminary data.

METHOD AND ANALYSIS

This single-arm intervention study is scheduled to begin in September 2017 and conclude in November 2018. It will take place at the Royal Orthopaedic Hospital (ROH), Birmingham and the School of Sport, Exercise and Rehabilitation Sciences (SportExR), University of Birmingham. Participants will receive a physiotherapy usual care programme for knee OA for 1 month, after which they will continue to exercise in their local gym/leisure facility for 3 months. Participants will also follow dietary restriction throughout the 4-month intervention. Mixed analysis techniques will be used to analyse the quantitative and qualitative outcome measures.

ETHICS AND DISSEMINATION

It is approved by ROH R&D Foundation Trust and the Health Research Authority. The Consort Guidelines and checklist will be reviewed prior to generating any publications for the trial to ensure they meet the standards required for submission to high-quality peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN12906938.

A cluster randomised feasibility pilot trial evaluating involving community-dwelling older adults in activities in relation to meals in a rehabilitation program; recruitment, data collection and protocol

Background

Community-dwelling older adults receiving support at home such as meals-on-wheels may lose the ability to preserve social, cognitive, and functional abilities, when becoming accustomed to and dependent of community aged care. When still able to cook older adults often hold some control over the foods that are prepared and which they eat, and which helps to foster identity. The purpose of this study is to assess feasibility of outcome measurements and sample size when conducting a pilot cluster randomized trial to evaluate community-dwelling older adults being involved in activities in relation to meals in a rehabilitation program.

Methods

This cluster randomized controlled study will consist of two clusters of a total of 5 community aged care areas; the intervention cluster, which hold 3 community aged care areas and the control cluster which hold 2 areas. The 130 community-dwelling older adults, receiving meals-on-wheels, will randomly be allocated to either the intervention cluster consisting of 8 weeks of participation in a rehabilitation program led by a Case Manager or the control cluster receiving usual community aged care. The primary outcome will be assessment of data collection (ratio between completed- and non-completed data) and assessment of sample size. The secondary clinical outcomes will be health-related quality of life (EQ-5D-3 L), muscle strength (chair stand), nutritional status (weight/BMI), loneliness (UCLA scale), mental well-being (Warwich-Edinburgh scale), self-efficacy (General Self-Efficacy scale), satisfaction with food-related life (SWFL scale) and refrigerator content.

Discussion

This study evaluates community-dwelling older adults receiving support at home, using involvement in activities related to meals with a rehabilitation approach, and this is a new area of research and will therefore be contributing in developing and refining consistent practices of rehabilitation programs.

Trial registration

ClinicalTrials.gov (registration no: NCT03289598). The protocol has been sent to the Danish Ethical Board which has concluded that approval is not needed and that the study can be carried on as described. Approval by The Danish Data Protection Agency has been giving through general approval for use of data in The City of Odense and will follow rules for obtaining the data accordingly.

Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting

INTRODUCTION

Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial.

METHODS AND ANALYSIS

Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3-4 physiotherapists) and a focus group (n=6-8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes).

ETHICS AND DISSEMINATION

This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542).

TRIAL REGISTRATION NUMBER

ISRCTN84528320.