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Caprioli T, Mason S, Tetlow H, Limbert S, Reilly S, Giebel C. "Necessity is the mother of invention": Experiences of accessing and delivering dementia-related support services by information communication technology during the pandemic in the UK. DEMENTIA 2024:14713012241272906. [PMID: 39117353 DOI: 10.1177/14713012241272906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
INTRODUCTION The remote delivery of dementia-related support services by information communication technology, defined as any hardware or software, including the telephone and videoconferencing software, increased during the coronavirus pandemic. To guide the future use of information communication technology, this study explored the experiences of delivering and accessing social care and support services during the pandemic in the UK. METHOD Remote semi-structured interviews with social care and support providers, people with dementia and family carers were conducted between May-December 2022. Topic guides were co-developed with two public advisors (one former family carer, one person with dementia) and garnered information on delivering and accessing services during the pandemic. Audio recordings were transcribed verbatim. Employing a mixture of inductive and deductive analytic approaches, a thematic analysis was conducted. RESULTS Twenty-one interviews (n = 14 social care and support providers; n = 6 family carers; n = 2 people with dementia) were conducted. Three themes were generated: adapting to changing circumstances; responding to unmet needs by information communication technology and information communication technology should be a tool, not the default. Social care and support providers' creativity and motivation facilitated the adoption of information communication technology, however, available resources and guidance varied. While some people with dementia and family carers benefitted from accessing services by information communication technology to address some needs, the format was not suitable for everyone. CONCLUSIONS Beyond the coronavirus pandemic, the use of information communication technology within service delivery needs to be carefully considered, to avoid disenfranchising some people with dementia and family carers, while empowering people with the option of how to access services. Digital training and guidelines advising the use of information communication technology within service delivery may facilitate its improved use during the current landscape, and amidst future pandemics.
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Affiliation(s)
- Thaïs Caprioli
- NIHR ARC NWC, UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Stephen Mason
- Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Hilary Tetlow
- NIHR ARC NWC, UK
- Liverpool Service User Reference Forum (SURF), UK
| | | | | | - Clarissa Giebel
- NIHR ARC NWC, UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
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Lorito CD, Pollock K, Booth V, Howe L, Goldberg S, Godfrey M, Dunlop M, Harwood RH, Wardt VVD. Social participation in the promoting activity, independence and stability in early dementia (PrAISED), a home-based therapy intervention for people living with dementia: a realist evaluation. BMC Geriatr 2024; 24:615. [PMID: 39026228 PMCID: PMC11264791 DOI: 10.1186/s12877-024-05086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 05/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Interventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England. METHODS This was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory. RESULTS Two CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers' support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers' risk-aversion/gatekeeping attitude, which in turn would lead to participants' increased participation in social activities. CONCLUSION The PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes.
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Affiliation(s)
- Claudio Di Lorito
- Department of Primary Care & Population Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Vicky Booth
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Louise Howe
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Maureen Godfrey
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marianne Dunlop
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK.
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Saragosa M, Goraya F, Serrano F, Nowrouzi-Kia B, Guilcher S, Abdul Aziz Y, Gohar B. From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives. Healthcare (Basel) 2024; 12:1050. [PMID: 38786460 PMCID: PMC11120773 DOI: 10.3390/healthcare12101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.
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Affiliation(s)
- Marianne Saragosa
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Farwa Goraya
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Frances Serrano
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Sara Guilcher
- Department of Physical Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Yasmin Abdul Aziz
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
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Harwood RH, Goldberg SE, Brand A, van Der Wardt V, Booth V, Di Lorito C, Hoare Z, Hancox J, Bajwa R, Burgon C, Howe L, Cowley A, Bramley T, Long A, Lock J, Tucker R, Adams EJ, O'Brien R, Kearney F, Kowalewska K, Godfrey M, Dunlop M, Junaid K, Thacker S, Duff C, Welsh T, Haddon-Silver A, Gladman J, Logan P, Pollock K, Vedhara K, Hood V, Das Nair R, Smith H, Tudor-Edwards R, Hartfiel N, Ezeofor V, Vickers R, Orrell M, Masud T. Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial. BMJ 2023; 382:e074787. [PMID: 37643788 PMCID: PMC10463053 DOI: 10.1136/bmj-2023-074787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the effectiveness of an exercise and functional activity therapy intervention in adults with early dementia or mild cognitive impairment compared with usual care. DESIGN Randomised controlled trial. SETTING Participants' homes and communities at five sites in the United Kingdom. PARTICIPANTS 365 adults with early dementia or mild cognitive impairment who were living at home, and family members or carers. INTERVENTION The intervention, Promoting activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED), was a specially designed, dementia specific, rehabilitation programme focusing on strength, balance, physical activity, and performance of activities of daily living, which was tailored and progressive and addressed risk and the psychological needs of people with dementia. Up to 50 therapy sessions were provided over 12 months. The control group received usual care plus a falls risk assessment. Procedures were adapted during the covid-19 pandemic. MAIN OUTCOME MEASURES The primary outcome was score on the carer (informant) reported disability assessment for dementia scale 12 months after randomisation. Secondary outcomes were self-reported activities of daily living, physical activity, quality of life, balance, functional mobility, fear of falling, frailty, cognition, mood, carer strain, service use at 12 months, and falls between months 4 and 15. RESULTS 365 patient participants were randomised, 183 to intervention and 182 to control. The median age of participants was 80 years (range 65-95), median Montreal cognitive assessment score was 20 out of 30 (range 13-26), and 58% (n=210) were men. Intervention participants received a median of 31 therapy sessions (interquartile range 22-40) and reported completing a mean 121 minutes of PrAISED exercise each week. Primary outcome data were available for 149 intervention and 141 control participants. Scores on the disability assessment for dementia scale did not differ between groups: adjusted mean difference -1.3, 95% confidence interval -5.2 to 2.6; Cohen's d effect size -0.06, 95% confidence interval -0.26 to 0.15; P=0.51). Upper 95% confidence intervals excluded small to moderate effects on any of the range of outcome measures. Between months 4 and 15 the intervention group experienced 79 falls and the control group 200 falls (adjusted incidence rate ratio 0.78, 95% confidence interval 0.5 to 1.3; P=0.3). CONCLUSION The intensive PrAISED programme of exercise and functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health status outcomes, despite good uptake. Future research should consider alternative approaches to maintaining ability and wellbeing in people with dementia. TRIAL REGISTRATION ISRCTN Registry ISRCTN15320670.
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Affiliation(s)
- Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Veronika van Der Wardt
- Department of General, Preventative and Rehabilitation Medicine, Philipps-Universität Marburg 35032 Marburg, Germany
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudio Di Lorito
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Jennie Hancox
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rupinder Bajwa
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Clare Burgon
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Louise Howe
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Trevor Bramley
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Annabelle Long
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Juliette Lock
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Rachael Tucker
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Emma J Adams
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Rebecca O'Brien
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Fiona Kearney
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Katarzyna Kowalewska
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | | | - Kehinde Junaid
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
| | - Simon Thacker
- Centre for Research and Development, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Carol Duff
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Tomas Welsh
- The RICE Centre, Research Institute for the Care of Older People, Royal United Hospital, Bath, UK
| | - Annette Haddon-Silver
- Oxford Health NHS Foundation Trust, Research and Development, Warneford Hospital, Oxford, UK
| | - John Gladman
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Kavita Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Victoria Hood
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Roshan Das Nair
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- SINTEF, Torgarden, Trondheim, Norway
| | - Helen Smith
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Rhiannon Tudor-Edwards
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Robert Vickers
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Martin Orrell
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Di Lorito C, van der Wardt V, Pollock K, Howe L, Booth V, Logan P, Gladman J, Masud T, das Nair R, Goldberg S, Vedhara K, O’Brien R, Adams E, Cowley A, Bosco A, Hancox J, Burgon C, Bajwa R, Lock J, Long A, Godfrey M, Dunlop M, Harwood RH. The facilitators and barriers to improving functional activity and wellbeing in people with dementia: a qualitative study from the process evaluation of Promoting Activity, Independence and Stability in Early Dementia (PrAISED). Age Ageing 2023; 52:afad166. [PMID: 37603841 PMCID: PMC10442073 DOI: 10.1093/ageing/afad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The PRomoting Activity, Independence and Stability in Early Dementia (PrAISED) study delivered an exercise and functional activity programme to participants living with dementia. A Randomised Controlled Trial showed no measurable benefits in activities of daily living, physical activity or quality of life. OBJECTIVE To explore participants' responses to PrAISED and explain why an intervention that might be expected to have produced measurable health gains did not do so. METHODS A process evaluation using qualitative methods, comprising interviews and researcher notes. SETTING Data were collected in participants' homes or remotely by telephone or videoconferencing. SAMPLE A total of 88 interviews were conducted with 44 participants living with dementia (n = 32 intervention group; n = 12 control group) and 39 caregivers. A total of 69 interviews were conducted with 26 therapists. RESULTS Participants valued the intervention as proactively addressing health issues that were of concern to them, and as a source of social contact, interaction, information and advice. Facilitators to achieving positive outcomes included perceiving progress towards desired goals, positive expectations, therapists' skills and rapport with participants, and caregiver support. Barriers included: cognitive impairment, which prevented independent engagement and carry-over between sessions; chronic physical health problems and intercurrent acute illness and injury; 'tapering' (progressively infrequent supervision intended to help develop habits and independent activity); and the COVID-19 pandemic. CONCLUSIONS Self-directed interventions may not be appropriate in the context of dementia, even in the mild stages of the condition. Dementia-specific factors affected outcomes including caregiver support, rapport with therapists, availability of supervision, motivational factors and the limitations of remote delivery. The effects of cognitive impairment, multimorbidity and frailty overwhelmed any positive impact of the intervention. Maintenance of functional ability is valued, but in the face of inevitable progression of disease, other less tangible outcomes become important, challenging how we frame 'health gain' and trial outcomes.
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Affiliation(s)
- Claudio Di Lorito
- Division of Primary Care and Population Health, University College London, UK
| | | | | | - Louise Howe
- School of Medicine, University of Nottingham, UK
| | - Vicky Booth
- School of Medicine, University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, UK
| | - John Gladman
- School of Medicine, University of Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, UK
| | | | | | | | | | - Emma Adams
- School of Medicine, University of Nottingham, UK
| | - Alison Cowley
- School of Medicine, University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, UK
| | | | - Jennie Hancox
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Clare Burgon
- School of Health Sciences, University of Nottingham, UK
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