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Conroy B, Murphy N, Romero-Ortuno R, Cunningham C, Horgan F. Examining the factors associated with community ambulation in an older adult day hospital population. Eur Geriatr Med 2022; 13:1137-1147. [PMID: 35788972 DOI: 10.1007/s41999-022-00666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The ability of an older adult to walk independently in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, outdoor mobility is often one of the first activities, where a decline is observed. The aim of this study was to examine the factors associated with community ambulation in community dwelling older adults attending a day hospital. METHODS This was a cross-sectional observational study design. Inclusion criteria were community dwelling older adults, over 65 years, attending a day hospital and able to ambulate at least 10 m with or without an assistive device. The primary outcome measure was a community ambulation questionnaire. A range of other outcome measures were completed assessing motor, cognitive, executive function and behavioural domains. Multivariate logistic regression was employed to identify independent predictors of community ambulation. RESULTS 161 participants completed this study. The median age was 83 years (IQR 9), 64% were female and 49.1% lived alone. 55.3% of participants were classified as independent community ambulators. Mean gait speed was 0.8 m/s, median TUG score was 16.6 s and median frailty was 4 (IRQ 2) using the Clinical Frail Scale. Self-efficacy (p < 0.001) and gait speed (p = 0.030) were independently associated with community ambulation. CONCLUSIONS The findings demonstrate the complexity and multifactorial nature of community ambulation in older adults. This suggests the need to adopt a broader approach to the management of older adults, to promote the achievement of independent community ambulation.
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Affiliation(s)
- Bronagh Conroy
- Physiotherapy Department, St James's Hospital, Dublin 8, Ireland.
| | - Niamh Murphy
- Physiotherapy Department, St James's Hospital, Dublin 8, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing (MISA), St James's Hospital, Dublin 8, Ireland
| | - Conal Cunningham
- Mercer's Institute for Successful Ageing (MISA), St James's Hospital, Dublin 8, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
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Blackwood B, Morris KP, Jordan J, McIlmurray L, Agus A, Boyle R, Clarke M, Easter C, Feltbower RG, Hemming K, Macrae D, McDowell C, Murray M, Parslow R, Peters MJ, Phair G, Tume LN, Walsh TS, McAuley DF. Co-ordinated multidisciplinary intervention to reduce time to successful extubation for children on mechanical ventilation: the SANDWICH cluster stepped-wedge RCT. Health Technol Assess 2022; 26:1-114. [PMID: 35289741 DOI: 10.3310/tcfx3817] [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: 11/22/2022] Open
Abstract
BACKGROUND Daily assessment of patient readiness for liberation from invasive mechanical ventilation can reduce the duration of ventilation. However, there is uncertainty about the effectiveness of this in a paediatric population. OBJECTIVES To determine the effect of a ventilation liberation intervention in critically ill children who are anticipated to have a prolonged duration of mechanical ventilation (primary objective) and in all children (secondary objective). DESIGN A pragmatic, stepped-wedge, cluster randomised trial with economic and process evaluations. SETTING Paediatric intensive care units in the UK. PARTICIPANTS Invasively mechanically ventilated children (aged < 16 years). INTERVENTIONS The intervention incorporated co-ordinated multidisciplinary care, patient-relevant sedation plans linked to sedation assessment, assessment of ventilation parameters with a higher than usual trigger for undertaking an extubation readiness test and a spontaneous breathing trial on low levels of respiratory support to test extubation readiness. The comparator was usual care. Hospital sites were randomised sequentially to transition from control to intervention and were non-blinded. MAIN OUTCOME MEASURES The primary outcome measure was the duration of invasive mechanical ventilation until the first successful extubation. The secondary outcome measures were successful extubation, unplanned extubation and reintubation, post-extubation use of non-invasive ventilation, tracheostomy, post-extubation stridor, adverse events, length of intensive care and hospital stay, mortality and cost per respiratory complication avoided at 28 days. RESULTS The trial included 10,495 patient admissions from 18 paediatric intensive care units from 5 February 2018 to 14 October 2019. In children with anticipated prolonged ventilation (n = 8843 admissions: control, n = 4155; intervention, n = 4688), the intervention resulted in a significantly shorter time to successful extubation [cluster and time-adjusted median difference -6.1 hours (interquartile range -8.2 to -5.3 hours); adjusted hazard ratio 1.11, 95% confidence interval 1.02 to 1.20; p = 0.02] and a higher incidence of successful extubation (adjusted relative risk 1.01, 95% confidence interval 1.00 to 1.02; p = 0.03) and unplanned extubation (adjusted relative risk 1.62, 95% confidence interval 1.05 to 2.51; p = 0.03), but not reintubation (adjusted relative risk 1.10, 95% confidence interval 0.89 to 1.36; p = 0.38). In the intervention period, the use of post-extubation non-invasive ventilation was significantly higher (adjusted relative risk 1.22, 95% confidence interval 1.01 to 1.49; p = 0.04), with no evidence of a difference in intensive care length of stay or other harms, but hospital length of stay was longer (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.97; p = 0.01). Findings for all children were broadly similar. The control period was associated with lower, but not statistically significantly lower, total costs (cost difference, mean £929.05, 95% confidence interval -£516.54 to £2374.64) and significantly fewer respiratory complications avoided (mean difference -0.10, 95% confidence interval -0.16 to -0.03). LIMITATIONS The unblinded intervention assignment may have resulted in performance or detection bias. It was not possible to determine which components were primarily responsible for the observed effect. Treatment effect in a more homogeneous group remains to be determined. CONCLUSIONS The intervention resulted in a statistically significant small reduction in time to first successful extubation; thus, the clinical importance of the effect size is uncertain. FUTURE WORK Future work should explore intervention sustainability and effects of the intervention in other paediatric populations. TRIAL REGISTRATION This trial is registered as ISRCTN16998143. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Kevin P Morris
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Joanne Jordan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Lisa McIlmurray
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Roisin Boyle
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Mike Clarke
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Christina Easter
- Institute of Applied Health, University of Birmingham, Birmingham, UK
| | - Richard G Feltbower
- School of Medicine, Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Karla Hemming
- Institute of Applied Health, University of Birmingham, Birmingham, UK
| | - Duncan Macrae
- Paediatric Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Clíona McDowell
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Margaret Murray
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Roger Parslow
- School of Medicine, Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - Glenn Phair
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, UK
| | - Timothy S Walsh
- Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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McDonough SM, Howes SC, Dillon M, McAuley J, Brady J, Clarke M, Clarke M, Lait E, McArdle D, O'Neill T, Wilson I, Niven A, Williams J, Tully MA, Murphy MH, McDonough CM. A study protocol for a randomised controlled feasibility trial of an intervention to increase activity and reduce sedentary behaviour in people with severe mental illness: Walking fOR Health (WORtH) Study. Pilot Feasibility Stud 2021; 7:205. [PMID: 34782018 PMCID: PMC8590967 DOI: 10.1186/s40814-021-00938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background People with severe mental illness (SMI) are less physically active and more sedentary than healthy controls, contributing to poorer physical health outcomes in this population. There is a need to understand the feasibility and acceptability, and explore the effective components, of health behaviour change interventions targeting physical activity and sedentary behaviour in this population in rural and semi-rural settings. Methods This 13-week randomised controlled feasibility trial compares the Walking fOR Health (WORtH) multi-component behaviour change intervention, which includes education, goal-setting and self-monitoring, with a one-off education session. It aims to recruit 60 inactive adults with SMI via three community mental health teams in Ireland and Northern Ireland. Primary outcomes are related to feasibility and acceptability, including recruitment, retention and adherence rates, adverse events and qualitative feedback from participants and clinicians. Secondary outcome measures include self-reported and accelerometer-measured physical activity and sedentary behaviour, anthropometry measures, physical function and mental wellbeing. A mixed-methods process evaluation will be undertaken. This study protocol outlines changes to the study in response to the COVID-19 pandemic. Discussion This study will address the challenges and implications of remote delivery of the WORtH intervention due to the COVID-19 pandemic and inform the design of a future definitive randomised controlled trial if it is shown to be feasible. Trial registration The trial was registered on clinicaltrials.gov (NCT04134871) on 22 October 2019.
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Affiliation(s)
- Suzanne M McDonough
- Centre for Health and Rehabilitation Technologies, School of Health Sciences, Ulster University, Shore Road, Newtownabbey, BT37 0QB, UK. .,School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland. .,School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Sarah C Howes
- Centre for Health and Rehabilitation Technologies, School of Health Sciences, Ulster University, Shore Road, Newtownabbey, BT37 0QB, UK
| | - Maurice Dillon
- Louth Meath Mental Health Services, Midlands Louth Meath Community Healthcare Organisation CHO, Dublin, Ireland
| | - Judith McAuley
- Community Mental Health Team, Northern Health and Social Care Trust, Antrim, UK
| | - John Brady
- Community Mental Health Team, Western Health and Social Care Trust, Omagh, UK
| | - Mary Clarke
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Duana McArdle
- Louth Meath Mental Health Services, Midlands Louth Meath Community Healthcare Organisation CHO, Dublin, Ireland
| | - Tony O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ailsa Niven
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, BT37 0QB, UK
| | - Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Jordanstown Campus, Newtownabbey, BT37 0QB, UK
| | - Catherine M McDonough
- Louth Meath Rehabilitation Service, Midlands Louth Meath Community Healthcare Organisation CHO, Dublin, Ireland
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Healthcare Professionals' Application and Integration of Physical Activity in Routine Practice with Older Adults: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111222. [PMID: 34769742 PMCID: PMC8582732 DOI: 10.3390/ijerph182111222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Healthcare professionals (HCPs) have a key role in promoting physical activity, particularly among populations at greatest risk of poor health due to physical inactivity. This research explored HCPs’ knowledge, decision making, and routine practice of physical activity promotion with older adults. Furthermore, it aimed to enhance our understanding of the supports that HCPs need to effectively promote physical activity in routine practice across a wide range of healthcare professions, settings, and sectors. Semi-structured online interviews were completed with HCPs between November 2020–March 2021. Data were first analysed by coding instances within the transcripts, mapping onto relevant Theoretical Domains Framework (TDF) domains utilising a deductive thematic analysis approach. The data were then analysed utilising an inductive approach to thematically generate explanatory subthemes within the identified domains. Participants (n = 63) included general practitioners (15.87%), occupational therapists (30.16%), physiotherapists (38.10%), and nurses (15.87%) from the island of Ireland (Ireland and Northern Ireland). Of those interviewed, 10 (15.87%) were male and 53 (84.13%) were female. Two thirds (65.08%) were HCPs practicing in Ireland. Domains and subthemes related to the application of physical activity, and emergent themes on developing practice to support the application and integration of physical activity in routine practice are discussed. HCPs identified that focused education, appropriate training, and access to tailored resources are all essential to support the promotion of physical activity in routine practice. For such supports to be effective, a ‘cultural shift’ is required in HCP training and health service provision to adopt the growing evidence base that physical activity promotion must be part of disease prevention and treatment in routine practice. HCPs highlighted a range of areas for service development to support them to promote physical activity. Further research is required to explore the feasibility of implementing these recommendations in routine practice.
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O’Brien J, Mason A, Cassarino M, Chan J, Setti A. Older Women's Experiences of a Community-Led Walking Programme Using Activity Trackers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189818. [PMID: 34574741 PMCID: PMC8468609 DOI: 10.3390/ijerph18189818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Promoting physical activity amongst older adults represents a major public health goal and community-led exercise programmes present benefits in promoting active lifestyles. Commercial activity trackers potentially encourage positive behaviour change with respect to physical exercise. This qualitative study investigated the experiences and attitudes of older adults following a 6-week community-led walking programme utilising activity trackers. Eleven community-dwelling older women aged 60+ completed individual phone interviews following their involvement in the programme. The programme, codesigned with a group of senior citizens, equipped participants with wrist-worn activity trackers and included biweekly check-in sessions with a researcher to monitor progress and support motivation. Interviews explored participants’ experiences of the programme and of using activity trackers for the purpose of becoming more active. A thematic analysis produced three main themes: ‘programme as a source of motivation’, ‘user experiences with the technology’ and ‘views on social dimension of the programme’. Overall, participants highlighted the self-monitoring function of activity trackers as most beneficial for their exercise levels. This study provides insights into the personal and social factors perceived by older adults in relation to being part of a community-led programme using activity trackers. It highlights the role of the programme and trackers in maintaining motivation to stay active.
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Affiliation(s)
- Jessica O’Brien
- School of Applied Psychology, University College Cork, T23 XA50 Cork, Ireland; (M.C.); (J.C.); (A.S.)
- Correspondence:
| | - Amy Mason
- Department of Physical Education and Sport Science, University of Limerick, V94 TPX Limerick, Ireland;
| | - Marica Cassarino
- School of Applied Psychology, University College Cork, T23 XA50 Cork, Ireland; (M.C.); (J.C.); (A.S.)
| | - Jason Chan
- School of Applied Psychology, University College Cork, T23 XA50 Cork, Ireland; (M.C.); (J.C.); (A.S.)
| | - Annalisa Setti
- School of Applied Psychology, University College Cork, T23 XA50 Cork, Ireland; (M.C.); (J.C.); (A.S.)
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Healthcare Professionals Promotion of Physical Activity with Older Adults: A Survey of Knowledge and Routine Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116064. [PMID: 34199893 PMCID: PMC8200063 DOI: 10.3390/ijerph18116064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/29/2021] [Indexed: 11/21/2022]
Abstract
Healthcare professionals have a key role in promoting physical activity, particularly among populations at greatest risk of poor health due to physical inactivity. This research aimed to develop our understanding of healthcare professionals knowledge, decision making and routine practice of physical activity promotion with older adults. A cross-sectional survey was conducted with practicing healthcare professionals in general practice, physiotherapy, occupational therapy and nursing in Ireland and Northern Ireland. We received 347 eligible responses, with 70.3% of all respondents agreeing that discussing physical activity is their job and 30.0% agreeing that they have received suitable training to initiate conversations with patients about physical activity. Awareness of the content and objectives of national guidelines for physical activity varied considerably across the health professions surveyed. Less than a third of respondents had a clear plan on how to initiate discussions about physical activity in routine practice with older adults. Assessment of physical activity was not routine, neither was signposting to physical activity supports. Considering the COVID-19 pandemic and its implications, 81.6% of all respondents agreed that healthcare professionals can play an increased role in promoting physical activity to older adults as part of routine practice. Appropriate education, training and access to resources are essential for supporting healthcare professionals promotion of physical activity in routine practice. Effective physical activity promotion in healthcare settings has the potential for health benefits at a population level, particularly in older adult populations.
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