1
|
Roberts S, Nucera R, Dowd T, Turner K, Langston K, Keller H, Bell J, Angus RL. Prospective validation of the Global Leadership Initiative on Malnutrition criteria for identifying malnutrition in hospitals: A protocol and feasibility pilot study. Nutr Clin Pract 2024. [PMID: 38711239 DOI: 10.1002/ncp.11156] [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: 12/07/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The aim of this study was to pilot a protocol for prospective validation of the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospital patients and evaluate its feasibility and patient acceptability. METHODS The validation protocol follows the GLIM consortium's rigorous methodological guidance. Protocol feasibility was assessed against criteria on recruitment (≥50%) and data collection completion (≥80%); protocol acceptability was assessed via patient satisfaction surveys and interviews. Adult inpatients in a tertiary hospital underwent four nutrition assessments (each by a different assessor); two Subjective Global Assessments (SGAs) and two GLIM assessments. All five GLIM criteria were assessed with bioelectrical impedance analysis used for muscle mass. Interrater reliability, criterion validity, and predictive validity were reported to detect trends. RESULTS All primary feasibility criteria were met (consent rate 76%; data for GLIM criterion validity collected on 83% participants). Of predictive outcome data, 100% of hospital-related data, 82% of 6-month mortality data, and 39% of 6-month health-related quality of life data were collected. The mean (SD) age of participants was 61.0 ± 16.2 years, and 51.5% were male. The median (interquartile range) length of stay and body mass index were 7 (4-15) days and 25.6 (24.2-33.0) kg/m2, respectively. GLIM criteria diagnosed 70% of the patients as malnourished vs 55% with SGA. Most patients found the data collection acceptable with minimal burden. CONCLUSION The methods outlined in this rigorous GLIM validation protocol are feasible to undertake in hospitals and acceptable to patients. This paper provides practical methodological guidance for future prospective GLIM validation studies.
Collapse
Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Romina Nucera
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Tobias Dowd
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Kyleigh Turner
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Keanne Langston
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Ontario, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Jack Bell
- Allied Health, The Prince Charles Hospital, Metro North Healthcare, Chermside, Queensland, Australia
| | - Rebecca L Angus
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| |
Collapse
|
2
|
Wong K, Kinsella N, Seth J, Nicol D, Cahill D, Kasivisvanathan R, Withington J, Moghul M, Moss CL, Van Hemelrijck M, Giorgakoudi K, Cottrell C, Yates E, Khoo V, James ND. COmparing Urolift and Standard Transurethral resection of prostate Ahead of Radiotherapy in men with urinary symptoms secondary to prostate enlargement in Southwest London and North Cumbria (CO-STAR): a study protocol for a randomised feasibility study. BMJ Open 2023; 13:e076621. [PMID: 37802612 PMCID: PMC10565132 DOI: 10.1136/bmjopen-2023-076621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Patients undergoing prostate radiotherapy with an enlarged prostate can have short-term and long-term urinary complications. Currently, transurethral resection of the prostate (TURP) is the mainstay surgical intervention for men with urinary symptoms due to an enlarged prostate prior to radiotherapy. UroLift (NeoTract, Pleasanton, CA, USA) is a recent minimally invasive alternative, widely used in benign disease but is untested in men with prostate cancer. METHODS AND ANALYSIS A multicentre, two-arm study designed in collaboration with a Patient Reference Group to assess the feasibility of randomising men with prostate cancer and coexisting urinary symptoms due to prostate enlargement to TURP or UroLift ahead of radiotherapy. 45 patients will be enrolled and randomised (1:1) using a computer-generated programme to TURP or UroLift. Recruitment and retention will be assessed over a 12 month period. Information on clinical outcomes, adverse events and costs will be collected. Clinical outcomes and patient reported outcome measures will be measured at baseline, 6 weeks postintervention and 3 months following radiotherapy. A further 12 in-depth interviews will be conducted with a subset of patients to assess acceptability using the Theoretical Framework of Acceptability. Descriptive analysis on all outcomes will be performed using Stata (StataCorp V.2021). ETHICS AND DISSEMINATION The trial has been approved by the Research Ethics Committee (REC) NHS Health Research Authority (HRA) and Health and Care Research Wales (HCRW). The results will be published in peer-reviewed journals, presented at national meetings and disseminated to patients via social media, charity and hospital websites. TRIAL REGISTRATION NUMBER NCT05840549.
Collapse
Affiliation(s)
- Kathie Wong
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
- Urology, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Netty Kinsella
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jai Seth
- Urology, St George's Hospital, London, UK
| | - David Nicol
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Declan Cahill
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Masood Moghul
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Kyriaki Giorgakoudi
- City, University of London, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research UK, London, UK
| | - Chris Cottrell
- Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Emma Yates
- Royal Marsden Hospital NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research Division of Cancer Therapeutics, London, UK
| | - Nicholas D James
- Department of Oncology, Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| |
Collapse
|
3
|
Schormann ALA, Pillny M, Haß K, Lincoln TM. "Goals in Focus"-a targeted CBT approach for motivational negative symptoms of psychosis: study protocol for a randomized-controlled feasibility trial. Pilot Feasibility Stud 2023; 9:72. [PMID: 37131247 PMCID: PMC10152726 DOI: 10.1186/s40814-023-01284-4] [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: 06/10/2022] [Accepted: 03/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The reduction of goal-directed behavior is the main characteristic in motivational negative symptoms of psychosis as it accounts for the long-term decline in psychological well-being and psychosocial functioning. However, the available treatment options are largely unspecific and show only small effects on motivational negative symptoms. Interventions that directly target the relevant psychological mechanisms are likely to be more effective. For "Goals in Focus", we translated findings from basic clinical research on mechanisms underlying motivational negative symptoms into a tailored and comprehensive novel psychological outpatient treatment program. With this study, we will test the feasibility of the therapy manual and the trial procedures. We also aim to examine first estimates of the effect size that can be expected from "Goals in Focus" to inform the sample size calculation of a subsequent fully powered trial. METHODS Thirty participants diagnosed with a schizophrenia spectrum disorder and at least moderate motivational negative symptoms will be randomly assigned to either 24 sessions of "Goals in Focus" over the course of 6 months (n = 15) or to a 6-month wait-list control group (n = 15). Single-blind assessments will be conducted at baseline (t0) and 6 months after baseline completion (t1). Feasibility outcomes include patient recruitment, retention, and attendance rates. Acceptability will be rated by trial therapists and by participants at end of treatment. Primary outcome for effect size estimation is the motivational negative symptom subscale sum score of the Brief Negative Symptom Scale at t1 corrected for baseline values. Secondary outcomes include psychosocial functioning, psychological well-being, depressive symptoms, expressive negative symptoms, negative symptom factor scores, and goal pursuit in everyday life. DISCUSSION The feasibility and acceptability data will be used to improve trial procedures and the "Goals in Focus" intervention where necessary. The treatment effect on the primary outcome will provide the basis for the sample size calculation for a fully powered RCT. TRIAL REGISTRATION 1) ClinicalTrials.gov, NCT05252039 . Registered on 23 February 2022. 2) Deutsches Register Klinischer Studien, DRKS00018083 . Registered on 28 August 2019.
Collapse
Affiliation(s)
- Alisa L A Schormann
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Katharina Haß
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| |
Collapse
|
4
|
Mellor K, Albury C, Dutton SJ, Eldridge S, Hopewell S. Recommendations for progression criteria during external randomised pilot trial design, conduct, analysis and reporting. Pilot Feasibility Stud 2023; 9:59. [PMID: 37061720 PMCID: PMC10105402 DOI: 10.1186/s40814-023-01291-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/30/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND External randomised pilot trials aim to assess whether a future definitive Randomised Controlled Trial (RCT) is feasible. Prespecified progression criteria help guide the interpretation of pilot trial findings to decide whether, and how, a definitive RCT should be conducted. This commentary presents a set of proposed recommendations for progression criteria to guide researchers when (i) designing, (ii) conducting, (iii) analysing and (iv) reporting external randomised pilot trials. METHODS Recommendations were developed following a mixed methods approach. This involved (i) a methodological review of pilot trial publications, (ii) a cross-sectional study of pilot trial research funding applications, (iii) qualitative interviews with pilot trial researchers and (iv) a survey of corresponding authors of identified pilot trial publications. Initial recommendations were refined following two consultation stakeholder workshops held in July 2022. Recommendations for progression criteria for external randomised pilot trials: i. DESIGN consider progression criteria from the earliest opportunity; map progression criteria to feasibility objectives; consider quantitative and qualitative interpretations of feasibility; provide justification; develop guidelines rather than rules; seek input from relevant stakeholders. ii. Conduct: regularly monitor pilot trial data against progression criteria. iii. ANALYSIS avoid considering each progression criterion in isolation; engage in discussion with relevant stakeholders; consider context and other factors external to the pilot trial; consider feasibility (can we?) and progression (will we?). iv. Reporting: we propose a reporting checklist in relation to progression criteria and recommend reporting in a table format for clarity. CONCLUSION These recommendations provide a helpful resource for researchers to consider progression criteria at different stages of external randomised pilot trials. We have produced a simple infographic tool to summarise these recommendations for researchers to refer to. Further research is needed to evaluate whether these proposed recommendations should inform future development, or update, of established guidelines for the design, conduct, analysis and reporting of external randomised pilot trials.
Collapse
Affiliation(s)
- Katie Mellor
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England.
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Sandra Eldridge
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| |
Collapse
|
5
|
Molassiotis A, Xie YJ, Leung AYM, Ho GWK, Li Y, Leung PHM, Wang HL, Chen CXR, Tong DWK, Siu JYM, Lau JTF. A Community-Based Participatory Research Approach to Developing and Testing Social and Behavioural Interventions to Reduce the Spread of SARS-CoV-2: A Protocol for the ' COPAR for COVID' Programme of Research with Five Interconnected Studies in the Hong Kong Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13392. [PMID: 36293972 PMCID: PMC9603243 DOI: 10.3390/ijerph192013392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While a number of population preventive measures for COVID-19 exist that help to decrease the spread of the virus in the community, there are still many areas in preventative efforts that need improvement or refinement, particularly as new strains of the virus develop. Some of the key issues currently include incorrect and/or inconsistent use of face masks, low acceptance of early screening or vaccination for COVID-19, vaccine hesitance, and misinformation. This is particularly the case in some vulnerable populations, such as older people with chronic illnesses, ethnic minorities who may not speak the mainstream language well and children. The current protocol introduces a large programme of research through five interrelated studies that all focus on social and behavioural interventions to improve different aspects of community-related preventative indicators. Hence, the specific objectives of the overall programme are to (1) increase early testing for COVID-19 and promote the uptake of COVID-19 vaccines in the community (Study 1); (2) increase COVID-19-related health literacy and vaccine literacy and promote improved preventative measures in minority ethnic groups, chronically ill populations and caregivers (Study 2); (3) strengthen the public's motivation to stay at home and avoid nonessential high-risk activities (Study 3); (4) decrease COVID-19 vaccine hesitancy (Study 4); and (5) enhance the adherence to COVID-19-related hygiene practices and the uptake of early testing in school children (Study 5). METHODS We will utilise a community-based participatory research (CBPR) approach in the proposed studies. All studies will incorporate an intervention development phase in conjunction with key community stakeholders, a feasibility study and an execution stage. A variety of self-reported and objective-based measures will be used to assess various outcomes, based on the focus of each study, in both the short- and long-term, including, for example, the 8-item self-reported eHealth Literacy Scale (eHEAL) and objective measures such as vaccine uptake. DISCUSSION Theory-driven interventions will address each study's focus (e.g., social distancing, promotion of vaccine uptake, eHealth education, preventive measures and early detection). Improvements are expected to be seen in the outcomes of vulnerable and high-risk groups. Decreased infection rates are expected due to improved preventative behaviours and increased vaccine uptake. Long-term sustainability of the approach will be achieved through the CBPR model. The publication of this protocol can assist not only in sharing a large-scale and complex community-based design, but will also allow all to learn from this, so that we will have better insight in the future whether sharing of study designs can elicit timely research initiatives.
Collapse
Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Health and Social Care Research Centre, University of Derby, Derby DE22 1GB, UK
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Angela Y. M. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Polly Hang-Mei Leung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hua Li Wang
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | | | | | - Judy Yuen-man Siu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
6
|
Aschbrenner KA, Kruse G, Gallo JJ, Plano Clark VL. Applying mixed methods to pilot feasibility studies to inform intervention trials. Pilot Feasibility Stud 2022; 8:217. [PMID: 36163045 PMCID: PMC9511762 DOI: 10.1186/s40814-022-01178-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pilot feasibility studies serve a uniquely important role in preparing for larger scale intervention trials by examining the feasibility and acceptability of interventions and the methods used to test them. Mixed methods (collecting, analyzing, and integrating quantitative and qualitative data and results) can optimize what can be learned from pilot feasibility studies to prepare rigorous intervention trials. Despite increasing use of mixed method designs in intervention trials, there is limited guidance on how to apply these approaches to address pilot feasibility study goals. The purpose of this article is to offer methodological guidance for how investigators can plan to integrate quantitative and qualitative methods within pilot feasibility studies to comprehensively address key research questions. METHODS We used an informal consensus-based process informed by key methodological resources and our team's complementary expertise as intervention researchers and mixed methodologists to develop guidance for applying mixed methods to optimize what can be learned from pilot feasibility studies. We developed this methodological guidance as faculty in the Mixed Methods Research Training Program (MMRTP) for the Health Sciences (R25MH104660) funded by the National Institutes of Health through the Office of Behavioral and Social Science Research. RESULTS We provide the following guidance for applying mixed methods to optimize pilot feasibility studies: (1) identify feasibility domain(s) that will be examined using mixed methods, (2) align quantitative and qualitative data sources for the domain(s) selected for mixing methods, (3) determine the timing of the quantitative and qualitative data collection within the flow of the pilot study, (4) plan integrative analyses using joint displays to understand feasibility, and (5) prepare to draw meta-inferences about feasibility and implications for the future trial from the integrated data. CONCLUSIONS By effectively integrating quantitative and qualitative data within pilot feasibility studies, investigators can harness the potential of mixed methods for developing comprehensive and nuanced understandings about feasibility. Our guidance can help researchers to consider the range of key decisions needed during intervention pilot feasibility testing to achieve a rigorous mixed methods approach generating enhanced insights to inform future intervention trials.
Collapse
Affiliation(s)
| | - Gina Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA
| | - Joseph J Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Vicki L Plano Clark
- School of Education Research Methods, University of Cincinnati, Cincinnati, USA
| |
Collapse
|
7
|
Castle EM, Dijk G, Asgari E, Shah S, Phillips R, Greenwood J, Bramham K, Chilcot J, Greenwood SA. The Feasibility and User-Experience of a Digital Health Intervention Designed to Prevent Weight Gain in New Kidney Transplant Recipients—The ExeRTiOn2 Trial. Front Nutr 2022; 9:887580. [PMID: 35677553 PMCID: PMC9168981 DOI: 10.3389/fnut.2022.887580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Half of kidney transplant recipients (KTRs) gain more than 5% of their body weight in the first year following transplantation. KTRs have requested support with physical activity (PA) and weight gain prevention, but there is no routine care offered. There are few high-quality studies investigating the clinical value of diet, PA or combined interventions to prevent weight gain. The development and evaluation of theoretically informed complex-interventions to mitigate weight gain are warranted. The aims of this mixed-methods randomized controlled trial (RCT) were to explore the feasibility, acceptability and user-experience of a digital healthcare intervention (DHI) designed to prevent post-transplant weight gain, in preparation for a large multi-center trial. New KTRs (<3 months) with access to an internet compatible device were recruited from a London transplant center. The usual care (UC) group received standard dietary and PA advice. The intervention group (IG) received access to a 12-week DHI designed to prevent post-transplant weight gain. Primary feasibility outcomes included screening, recruitment, retention, adherence, safety and hospitalizations and engagement and experience with the DHI. Secondary outcomes (anthropometrics, bioimpedance, arterial stiffness, 6-minute walk distance and questionnaires) were measured at baseline, 3- and 12-months. 38 KTRs were screened, of which 32 (84.2%) were eligible, and of those 20 (62.5%) consented, with 17 participants (85%) completing baseline assessment (Median 49 years, 58.8% male, Median 62 days post-transplant). Participants were randomized using a computer-generated list (n = 9 IG, n = 8 UC). Retention at 12-months was 13 (76.4%) (n = 6 IG, n = 7 UC). All a priori progression criteria were achieved. There were no associated adverse events. Reflexive thematic analysis revealed four themes regarding trial participation and experience whilst using the DHI. Halting recruitment due to COVID-19 resulted in the recruitment of 40% of the target sample size. Mixed-methods data provided important insights for future trial design. A definitive RCT is warranted and welcomed by KTRs.
Collapse
Affiliation(s)
- Ellen M. Castle
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
- *Correspondence: Ellen M. Castle ; orcid.org/0000-0002-6961-6108
| | - Giulia Dijk
- Department of Nutrition and Dietetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elham Asgari
- Kidney Services Team, Guy's and St Thomas' NHS Foundation Trust London, London, United Kingdom
| | - Sapna Shah
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| | - Rachel Phillips
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, London, United Kingdom
| | - James Greenwood
- Victor Horsley Department of Neurosurgery, University College London Hospital, London, United Kingdom
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sharlene A. Greenwood
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| |
Collapse
|
8
|
Billany RE, Smith AC, Hutchinson GM, Graham-Brown MPM, Nixon DGD, Bishop NC. Feasibility and acceptability of high-intensity interval training and moderate-intensity continuous training in kidney transplant recipients: the PACE-KD study. Pilot Feasibility Stud 2022; 8:106. [PMID: 35597974 PMCID: PMC9123685 DOI: 10.1186/s40814-022-01067-3] [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: 04/21/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Kidney transplant recipients (KTRs) exhibit unique elevated inflammation, impaired immune function, and increased cardiovascular risk. Although exercise reduces cardiovascular risk, there is limited research on this population, particularly surrounding novel high-intensity interval training (HIIT). The purpose of this pilot study was to determine the feasibility and acceptability of HIIT in KTRs. Methods Twenty KTRs (male 14; eGFR 58±19 mL/min/1.73 m2; age 49±11 years) were randomised and completed one of three trials: HIIT A (4-, 2-, and 1-min intervals; 80–90% watts at V̇O2peak), HIITB (4×4 min intervals; 80–90% V̇O2peak) or MICT (~40 min; 50–60% V̇O2peak) for 24 supervised sessions on a stationary bike (approx. 3x/week over 8 weeks) and followed up for 3 months. Feasibility was assessed by recruitment, retention, and intervention acceptability and adherence. Results Twenty participants completed the intervention, and 8 of whom achieved the required intensity based on power output (HIIT A, 0/6 [0%]; HIITB, 3/8 [38%]; MICT, 5/6 [83%]). Participants completed 92% of the 24 sessions with 105 cancelled and rescheduled sessions and an average of 10 weeks to complete the intervention. Pre-intervention versus post-intervention V̇O2peak (mL/kg-1/min-1) was 24.28±4.91 versus 27.06±4.82 in HIITA, 24.65±7.67 versus 27.48±8.23 in HIIT B, and 29.33±9.04 versus 33.05±9.90 in MICT. No adverse events were reported. Conclusions This is the first study to report the feasibility of HIIT in KTRs. Although participants struggled to achieve the required intensity (power), this study highlights the potential that exercise has to reduce cardiovascular risk in KTRs. HIIT and MICT performed on a cycle, with some modification, could be considered safe and feasible in KTRs. Larger scale trials are required to assess the efficacy of HIIT in KTRs and in particular identify the most appropriate intensities, recovery periods, and session duration. Some flexibility in delivery, such as incorporating home-based sessions, may need to be considered to improve recruitment and retention. Trial registration ISRCTN, ISRCTN17122775. Registered on 30 January 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01067-3.
Collapse
Affiliation(s)
- Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alice C Smith
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel G D Nixon
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| |
Collapse
|
9
|
Smith H, Budworth L, Grindey C, Hague I, Hamer N, Kislov R, van der Graaf P, Langley J. Co-production practice and future research priorities in United Kingdom-funded applied health research: a scoping review. Health Res Policy Syst 2022; 20:36. [PMID: 35366898 PMCID: PMC8976994 DOI: 10.1186/s12961-022-00838-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interest in and use of co-production in healthcare services and research is growing. Previous reviews have summarized co-production approaches in use, collated outcomes and effects of co-production, and focused on replicability and reporting, but none have critically reflected on how co-production in applied health research might be evolving and the implications of this for future research. We conducted this scoping review to systematically map recent literature on co-production in applied health research in the United Kingdom to inform co-production practice and guide future methodological research. METHODS This scoping review was performed using established methods. We created an evidence map to show the extent and nature of the literature on co-production and applied health research, based on which we described the characteristics of the articles and scope of the literature and summarized conceptualizations of co-production and how it was implemented. We extracted implications for co-production practice or future research and conducted a content analysis of this information to identify lessons for the practice of co-production and themes for future methodological research. RESULTS Nineteen articles reporting co-produced complex interventions and 64 reporting co-production in applied health research met the inclusion criteria. Lessons for the practice of co-production and requirements for co-production to become more embedded in organizational structures included (1) the capacity to implement co-produced interventions, (2) the skill set needed for co-production, (3) multiple levels of engagement and negotiation, and (4) funding and institutional arrangements for meaningful co-production. Themes for future research on co-production included (1) who to involve in co-production and how, (2) evaluating outcomes of co-production, (3) the language and practice of co-production, (4) documenting costs and challenges, and (5) vital components or best practice for co-production. CONCLUSION Researchers are operationalizing co-production in various ways, often without the necessary financial and organizational support required and the right conditions for success. We argue for accepting the diversity in approaches to co-production, call on researchers to be clearer in their reporting of these approaches, and make suggestions for what researchers should record. To support co-production of research, changes to entrenched academic and scientific practices are needed. Protocol registration details: The protocol for the scoping review was registered with protocols.io on 19 October 2021: https://dx.doi.org/10.17504/protocols.io.by7epzje .
Collapse
Affiliation(s)
- Helen Smith
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom. .,Bradford Institute for Health Research, Bradford, United Kingdom.
| | - Luke Budworth
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Chloe Grindey
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Isabel Hague
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom.,Bradford Institute for Health Research, Bradford, United Kingdom
| | - Natalie Hamer
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Roman Kislov
- Faculty of Business and Law Manchester, Metropolitan University, Manchester, United Kingdom.,School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,NIHR Applied Research Collaboration Greater Manchester, Manchester, United Kingdom
| | - Peter van der Graaf
- NIHR Applied Research Collaboration North East and North Cumbria, Cumbria, United Kingdom.,School of Health and Life Sciences, Teeside University, Middlesbrough, United Kingdom
| | - Joe Langley
- Lab4Living, Sheffield Hallam University, Sheffield, United Kingdom
| |
Collapse
|
10
|
Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
Collapse
Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| |
Collapse
|
11
|
Eysenbach G, Martin F, Clyne W, Clark CCT, Matouskova G, McGillion M, Turner A. A Digital Self-management Program (Help to Overcome Problems Effectively) for People Living With Cancer: Feasibility Randomized Controlled Trial. J Med Internet Res 2021; 23:e28322. [PMID: 34738912 PMCID: PMC8726569 DOI: 10.2196/28322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/25/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We present the results of a feasibility, randomized waitlist control group (CG) parallel design study with a 1:1 allocation ratio. Participants were randomized into an intervention group (IG) or a waitlist CG. The intervention was a 6-week digital self-management program, Help to Overcome Problems Effectively (HOPE), for people with cancer. OBJECTIVE This study aims to test the feasibility of a digitally delivered self-management program for people with cancer. This will inform the design of a definitive randomized controlled trial. In addition, a preliminary assessment of the impact of the HOPE program via secondary outcomes will be used to assess signals of efficacy in a trial context. METHODS Participants were drawn from an opportunity sample, referred by Macmillan Cancer Support, and were invited via email to participate in the study (N=61). Primary outcomes were rates of recruitment, retention, follow-up, completion and adherence, sample size and effect size estimation, and assessment of progression criteria for a definitive trial. Secondary outcomes were self-report measures of participants' positive mental well-being, depression, anxiety, and patient activation (ie, confidence in managing their cancer). The intervention and data collection took place on the web. RESULTS The recruitment rate was 77% (47/61). A total of 41 participants completed the baseline questionnaires and were randomized to either the IG (n=21) or the waitlist CG (n=20). The retention rate (attending all program sessions) was greater than 50% (all: 21/41, 51%, IG: 10/21, 48%; and CG: 11/20, 55%). The follow-up rate (completing all questionnaires) was greater than 80% (all: 33/41, 80%; IG: 16/21, 76%; and CG: 17/20, 85%). The completion rate (attending ≥3 sessions and completing all questionnaires) was greater than 60% (all: 25/41, 61%; IG: 13/21, 62%; and CG: 12/20, 60%). Engagement data showed that participants viewed between half (5.1/10, 51%) and three-quarters (12.2/16, 76%) of the pages in each session. CONCLUSIONS All progression criteria for a definitive trial were met, as supported by the primary outcome data. The IG showed improved postprogram scores on measures of positive mental well-being, depression, anxiety, and patient activation. A full-scale trial of the digital HOPE program for people with cancer will allow us to fully evaluate the efficacy of the intervention relative to a CG. TRIAL REGISTRATION ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24264.
Collapse
Affiliation(s)
| | - Faith Martin
- Centre for Intelligent Healthcare, Research Institute for Health and Wellbeing, Coventry University, Coventry, United Kingdom
| | - Wendy Clyne
- National Institute for Health Research, Research Design Service South West, Peninsula Medical School, University of Plymouth, Devon, United Kingdom
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Research Institute for Health and Wellbeing, Coventry University, Coventry, United Kingdom
| | - Gabriela Matouskova
- Hope For The Community, Community Interest Company, The Enterprise Hub, Coventry, United Kingdom
| | | | - Andrew Turner
- Centre for Intelligent Healthcare, Research Institute for Health and Wellbeing, Coventry University, Coventry, United Kingdom
| |
Collapse
|
12
|
Fakolade A, Cameron J, McKenna O, Finlayson ML, Freedman MS, Latimer-Cheung AE, Pilutti LA. Physical Activity Together for People With Multiple Sclerosis and Their Care Partners: Protocol for a Feasibility Randomized Controlled Trial of a Dyadic Intervention. JMIR Res Protoc 2021; 10:e18410. [PMID: 34061040 PMCID: PMC8207253 DOI: 10.2196/18410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/13/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity (PA) is beneficial for all people; however, people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with advanced disabilities and their care partners. Objective The objective of this study is to determine the feasibility of a dyadic PA intervention for people with advanced MS and their care partners. Methods This study is a randomized controlled feasibility trial of a 12-week intervention, with 1:1 allocation into an immediate intervention condition or delayed control condition. A target of 20 people with MS–care partner dyads will be included. The outcomes will be indicators of process, resources, management, and scientific feasibility. Participant satisfaction with the intervention components will be evaluated using a satisfaction survey. The subjective experience of participation in the study will be explored using semistructured interviews. Results The project is funded by the Consortium of Multiple Sclerosis Centers. This protocol was approved by the Ottawa Hospital Research Ethics Board (20190329-01H) and the University of Ottawa Research Ethics Board (H-09-19-4886). The study protocol was registered with ClinicalTrials.gov in February 2020. The findings of this feasibility trial will be disseminated through presentations at community events to engage the MS population in the interpretation of our results and in the next steps. The results will also be published in peer-reviewed journals and presented to the scientific community at national and international MS conferences. Conclusions The data collected from this feasibility trial will be used to refine the intervention and materials in preparation for a pilot randomized controlled trial. Trial Registration ClinicalTrials.gov NCT04267185; https://clinicaltrials.gov/ct2/show/NCT04267185. International Registered Report Identifier (IRRID) PRR1-10.2196/18410
Collapse
Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Julie Cameron
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Odessa McKenna
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Marcia L Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mark S Freedman
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
13
|
A Pilot Randomized Controlled Trial of Interval Training and Sleep Hygiene for Improving Sleep in Older Adults. J Aging Phys Act 2021; 29:993-1002. [PMID: 33837158 DOI: 10.1123/japa.2020-0207] [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: 06/22/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/18/2022]
Abstract
The primary objective of this pilot randomized controlled trial was to study the feasibility (recruitment and retention rates) for interval training and sleep hygiene (SH) in adults aged above 60 years. Thirteen out of 46 screened individuals from a home for older adults in Shirdi (Maharashtra, India) were randomly assigned by permuted block randomization to either an interval training with SH group (n = 6) or an SH alone group (n = 7). The authors measured sleep with the S+ sleep monitor manufactured by ResMed (USA) Pittsburgh Sleep Quality Index and quality of life with Short Form-12 health survey version 2. Interval training consisted of 8 weeks of stationary cycling, whereas SH consisted of lecture and handouts. Recruitment was 38.2%, retention was >80% for both the interventions, and there was one loss to follow-up in SH. Interval training and SH were feasible for older adults and supported a full-scale randomized controlled trial.
Collapse
|
14
|
Fylan B, Ismail H, Hartley S, Gale CP, Farrin AJ, Gardner P, Silcock J, Alldred DP. A non-randomised feasibility study of an intervention to optimise medicines at transitions of care for patients with heart failure. Pilot Feasibility Stud 2021; 7:85. [PMID: 33766141 PMCID: PMC7995719 DOI: 10.1186/s40814-021-00819-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background Heart failure affects 26 million people globally, and the optimal management of medicines is crucial for patients, particularly when their care is transferred between hospital and the community. Optimising clinical outcomes requires well-calibrated cross-organisational processes with staff and patients responding and adapting to medicines changes. The aim of this study was to assess the feasibility of implementing a complex intervention (the Medicines at Transitions Intervention; MaTI) co-designed by patients and healthcare staff. The purpose of the intervention was to optimise medicines management across the gaps between secondary and primary care when hospitals handover care. The study objectives were to (1) assess feasibility through meeting specified progression criteria to proceed to the trial, (2) assess if the intervention was acceptable to staff and patients, and (3) determine whether amendment or refinement would be needed to enhance the MaTI. Methods The feasibility of the MaTI was tested in three healthcare areas in the North of England between July and October 2017. Feasibility was measured and assessed through four agreed progression to trial criteria: (1) patient recruitment, (2) patient receipt of a medicines toolkit, (3) transfer of discharge information to community pharmacy, and (4) offer of a community pharmacy medicines review/discussion or medicines reconciliation. From the cardiology wards at each of the three NHS Acute Trusts (sites), 10 patients (aged ≥ 18 years) were recruited and introduced to the ‘My Medicines Toolkit’ (MMT). Patients were asked to identify their usual community pharmacy or nominate a pharmacy. Discharge information was transferred to the community pharmacy; pharmacists were asked to reconcile medicines and invited patients for a medicines use review (MUR) or discussion. At 1 month following discharge, all patients were sent three questionnaire sets: quality-of-life, healthcare utilisation, and a patient experience survey. In a purposive sample, 20 patients were invited to participate in a semi-structured interview about their experiences of the MaTI. Staff from hospital and primary care settings involved in patients’ care were invited to participate in a semi-structured interview. Patient and staff interviews were analysed using Framework Analysis. Questionnaire completion rates were recorded and data were descriptively analysed. Results Thirty-one patients were recruited across three sites. Eighteen staff and 18 patients took part in interviews, and 19 patients returned questionnaire sets. All four progression to trial criteria were met. We identified barriers to patient engagement with the intervention in hospital, which were compounded by patients’ focus on returning home. Some patients described not engaging in discussions with staff about medicines and lacking motivation to do so because they were preoccupied with returning home. Some patients were unable or unwilling to attend a community pharmacy in person for a medicines review. Roles and responsibilities for delivering the MaTI were different in the three sites, and staff reported variations in time spent on MaTI activities. Staff reported some work pressures and staff absences that limited the time they could spend talking to patients about their medicines. Clinical teams reported that recording a target dose for heart failure medicines in patient-held documentation was difficult as they did not always know the ideal or tolerable dose. The majority of patients reported receiving the patient-held documentation. More than two-thirds reported being offered a MUR by their community pharmacists. Conclusions Delivery of the Medicines at Transitions Intervention (MaTI) was feasible at all three sites, and progression to trial criteria were met. Refinements were found to be necessary to overcome identified barriers and strengthen delivery of all steps of the intervention. Necessary changes to the MaTI were identified along with amendments to the implementation plan for the subsequent trial. Future implementation needs to take into account the complexity of medicines management and adaptation to local context.
Collapse
Affiliation(s)
- Beth Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK. .,NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ, UK. .,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK.
| | - Hanif Ismail
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - Jonathan Silcock
- School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.,Wolfson Centre for Applied Health Research, Bradford, BD9 6RJ, UK
| | - David P Alldred
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Bradford Institute for Health Research, Temple Bank House, Bradford, BD9 6RJ, UK.,School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
| | | |
Collapse
|
15
|
Hurst H, Jones E, Ormandy P, Brettle A, Nixon AC, Young H, Mooney A, Winterbottom A, Bekker H, Brown E, Murtagh FE, Da Silva-Gane M, Coyle D, Finnigan R. Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multiprofessional scoping review protocol. BMJ Open 2021; 11:e040715. [PMID: 33727262 PMCID: PMC7970237 DOI: 10.1136/bmjopen-2020-040715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Reported outcomes for older people with advanced chronic kidney disease (CKD) often focus on survival and mortality and little attention is paid to symptom burden and health-related quality of life. Recognising frailty and providing interventions that may improve outcomes have been studied in the general population with a growing research interest within CKD. METHODS AND ANALYSIS A scoping review will be undertaken following a recommended process to understand relevant research and priorities for older people living with frailty and advanced CKD. Databases will be searched and following a systematic process by a core team, a final list of included studies will be analysed. Focus groups will then be conducted with older people with advanced CKD to incorporate stakeholder views. ETHICS AND DISSEMINATION Our scoping review will use robust methodology to identify relevant literature focused on outcomes and care priorities for older people with advanced CKD. Ethical approval will be sought to conduct the focus groups. The result of this review will be disseminated through patient networks and national conferences. The interdisciplinary team collaborating plan to continue work in this area to improve the care and management of older people with advanced CKD.
Collapse
Affiliation(s)
- Helen Hurst
- Elderly Health, Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth Jones
- Renal Dietetics, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford School of Nursing Midwifery and Social Work, Manchester, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Salford, Manchester, UK
| | - Andrew Christopher Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Hannah Young
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Mooney
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Anna Winterbottom
- Psychology, University of Leeds Leeds Institute of Health Sciences, Leeds, Leeds, UK
| | - Hilary Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Edwina Brown
- Renal, Imperial College London/Hammersmith Hospital, London, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Maria Da Silva-Gane
- Renal Medicine, Lister Hospital, Stevenage, Hertfordshire, UK
- Renal Medicine, Lister Hospital, Stevenage, Hertfordshire, UK
| | - David Coyle
- Kideny Patiemt, Patient Representative, Manchester, UK
| | | |
Collapse
|
16
|
Silverberg ND, Otamendi T, Panenka WJ, Archambault P, Babul S, MacLellan A, Li LC. De-implementing Prolonged Rest Advice for Concussion in Primary Care Settings: A Pilot Stepped Wedge Cluster Randomized Trial. J Head Trauma Rehabil 2021; 36:79-86. [PMID: 32898029 DOI: 10.1097/htr.0000000000000609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion. SETTING Community. PARTICIPANTS Family physicians in community practice (n = 21 at 5 clinics). DESIGN Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits. MAIN MEASURES The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements. RESULTS Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change. CONCLUSIONS Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.
Collapse
Affiliation(s)
- Noah D Silverberg
- Division of Physical Medicine & Rehabilitation (Dr Silverberg), Rehabilitation Sciences (Ms Otamendi), and Departments of Psychiatry (Dr Panenka), Pediatrics (Dr Babul), and Physical Therapy (Dr Li), The University of British Columbia, Vancouver, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Dr Silverberg and Ms MacLellan); BC Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada (Dr Panenka); British Columbia Provincial Neuropsychiatry Program, Vancouver, British Columbia, Canada (Dr Panenka); Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, Ontario, Canada (Dr Archambault); Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Lévis, Quebec, Canada (Dr Archambault); Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Quebec, Canada (Dr Archambault); Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada (Dr Babul); and Arthritis Research Canada, Richmond, British Columbia, Canada (Dr Li); on behalf of the Canadian TBI Research Consortium
| | | | | | | | | | | | | |
Collapse
|
17
|
Roberts S, Chaboyer W, Hopper Z, Marshall AP. Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study. Nutrients 2021; 13:nu13020314. [PMID: 33499271 PMCID: PMC7910973 DOI: 10.3390/nu13020314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.
Collapse
Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| | - Zane Hopper
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
| | - Andrea P. Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| |
Collapse
|
18
|
Newman ANL, Kho ME, Harris JE, Zamir N, McDonald E, Fox-Robichaud A, Solomon P. CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery. Pilot Feasibility Stud 2021; 7:13. [PMID: 33407923 PMCID: PMC7788703 DOI: 10.1186/s40814-020-00760-5] [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: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients. Methods We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events. Results We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4). Conclusions In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample. Trial registration This trial was registered with Clinicaltrials.gov (NCT02976415). Registered November 29, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00760-5.
Collapse
Affiliation(s)
- Anastasia N L Newman
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. .,Hamilton General Hospital, Hamilton, Ontario, Canada.
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nasim Zamir
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ellen McDonald
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Alison Fox-Robichaud
- Hamilton General Hospital, Hamilton, Ontario, Canada.,Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
19
|
Young HML, March DS, Highton PJ, Graham-Brown MPM, Churchward DC, Grantham C, Goodliffe S, Jones W, Cheung MM, Greenwood SA, Eborall HC, Conroy S, Singh SJ, Smith AC, Burton JO. Exercise for people living with frailty and receiving haemodialysis: a mixed-methods randomised controlled feasibility study. BMJ Open 2020; 10:e041227. [PMID: 33148767 PMCID: PMC7640592 DOI: 10.1136/bmjopen-2020-041227] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Frailty is highly prevalent in haemodialysis (HD) patients, leading to poor outcomes. This study aimed to determine whether a randomised controlled trial (RCT) of intradialytic exercise is feasible for frail HD patients, and explore how the intervention may be tailored to their needs. DESIGN Mixed-methods feasibility. SETTING AND PARTICIPANTS Prevalent adult HD patients of the CYCLE-HD trial with a Clinical Frailty Scale Score of 4-7 (vulnerable to severely frail) were eligible for the feasibility study. INTERVENTIONS Participants in the exercise group undertook 6 months of three times per week, progressive, moderate intensity intradialytic cycling (IDC). OUTCOMES Primary outcomes were related to feasibility. Secondary outcomes were falls incidence measured from baseline to 1 year following intervention completion, and exercise capacity, physical function, physical activity and patient-reported outcomes measured at baseline and 6 months. Acceptability of trial procedures and the intervention were explored via diaries and interviews with n=25 frail HD patients who both participated in (n=13, 52%), and declined (n=12, 48%), the trial. RESULTS 124 (30%) patients were eligible, and of these 64 (52%) consented with 51 (80%) subsequently completing a baseline assessment. n=24 (71% male; 59±13 years) dialysed during shifts randomly assigned to exercise and n=27 (81% male; 65±11 years) shifts assigned to usual care. n=6 (12%) were lost to follow-up. The exercise group completed 74% of sessions. 27%-89% of secondary outcome data were missing. Frail HD patients outlined several ways to enhance trial procedures. Maintaining ability to undertake activities of daily living and social participation were outcomes of primary importance. Participants desired a varied exercise programme. CONCLUSIONS A definitive RCT is feasible, however a comprehensive exercise programme may be more efficacious than IDC in this population. TRIAL REGISTRATION NUMBERS ISRCTN11299707; ISRCTN12840463.
Collapse
Affiliation(s)
- Hannah M L Young
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Research and Innovation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel S March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Patrick J Highton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Darren C Churchward
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Charlotte Grantham
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - William Jones
- Emergency Department, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mei-Mei Cheung
- Renal, Respiratory and Cardiovascular Clinical Management Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sharlene A Greenwood
- Department of Physiotherapy and Renal Medicine, King's College Hospital, London, UK
- Department of Renal Medicine, King's College London, London, UK
| | - Helen C Eborall
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Unit, Leicester, UK
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| |
Collapse
|