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Coulman E, Gore N, Moody G, Wright M, Segrott J, Gillespie D, Petrou S, Lugg-Widger F, Kim S, Bradshaw J, McNamara R, Jahoda A, Lindsay G, Shurlock J, Totsika V, Stanford C, Flynn S, Carter A, Barlow C, Hastings R. Early positive approaches to support for families of young children with intellectual disability: the E-PAtS feasibility RCT. Public Health Res 2022. [DOI: 10.3310/heyy3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Parents of children with intellectual disability are 1.5–2 times more likely than other parents to report mental health difficulties. There is a lack of clinically effective and cost-effective group well-being interventions designed for family carers of young children with intellectual disability.
Aim
To examine the feasibility of a randomised controlled trial of the clinical effectiveness and cost-effectiveness of the Early Positive Approaches to Support (E-PAtS) intervention.
Design
A feasibility study (including randomisation of families into a two-arm trial), questionnaires to assess the feasibility of proposed outcome measures (including resource use and health-related quality of life) and practitioner/family carer interviews. An additional question was included in an online UK survey of families, conducted by the research team to assess usual practice, and a survey of provider organisations.
Setting
Families recruited from community contexts (i.e. third sector, local authority services, special schools) and self-referral. The E-PAtS intervention was delivered by trained community-based providers.
Participants
Families with at least one child aged 1.5–5 years with an intellectual disability. At least one parent had to have English-language ability (spoken) for E-PAtS programme participation and participants had to provide informed consent.
Interventions
E-PAtS intervention – two caregivers from each family invited to eight 2.5-hour group sessions with usual practice. Usual practice – other support provided to the family, including other parenting support.
Objectives
To assess randomisation willingness/feasibility, recruitment of providers/parents, retention, usual practice, adherence, fidelity and feasibility of proposed outcome measures (including the Warwick–Edinburgh Mental Well-Being Scale as the proposed primary outcome measure, and parent anxiety/depression, parenting, family functioning/relationships, child behavioural/emotional problems and adaptive skills, child and parent quality of life, and family services receipt as the proposed secondary outcome measures).
Results
Seventy-four families (95 carers) were recruited from three sites (with 37 families allocated to the intervention). From referrals, the recruitment rate was 65% (95% confidence interval 56% to 74%). Seventy-two per cent of families were retained at the 12-month follow-up (95% confidence interval 60% to 81%). Exploratory regression analysis showed that the mean Warwick–Edinburgh Mental Well-Being Scale well-being score was 3.96 points higher in the intervention group (95% confidence interval –1.39 to 9.32 points) at 12 months post randomisation. High levels of data completeness were achieved on returned questionnaires. Interviews (n = 25) confirmed that (1) recruitment, randomisation processes and the intervention were acceptable to family carers, E-PAtS facilitators and community staff; (2) E-PAtS delivery were consistent with the logic model; and (3) researchers requesting consent in future for routine data would be acceptable. Recorded E-PAtS sessions demonstrated good fidelity (96% of components present). Adherence (i.e. at least one carer from the family attending five out of eight E-PAtS sessions) was 76%. Health-related quality-of-life and services receipt data were gathered successfully. An online UK survey to assess usual practice (n = 673) showed that 10% of families of young children with intellectual disability received any intervention over 12 months. A provider survey (n = 15) indicated willingness to take part in future research.
Limitations
Obtaining session recordings for fidelity was difficult. Recruitment processes need to be reviewed to improve diversity and strategies are needed to improve primary outcome completion.
Conclusions
Study processes were feasible. The E-PAtS intervention was well received and outcomes for families were positive. A barrier to future organisation participation is funding for intervention costs. A definitive trial to test the clinical effectiveness and cost-effectiveness of E-PAtS would be feasible.
Trial registration
Current Controlled Trials ISRCTN70419473.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nick Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jeremy Segrott
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Geoff Lindsay
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | - Vaso Totsika
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Catherine Stanford
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Samantha Flynn
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | | | - Richard Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
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Coulman E, Gore N, Moody G, Wright M, Segrott J, Gillespie D, Petrou S, Lugg-Widger F, Kim S, Bradshaw J, McNamara R, Jahoda A, Lindsay G, Shurlock J, Totsika V, Stanford C, Flynn S, Carter A, Barlow C, Hastings RP. Early Positive Approaches to Support (E-PAtS) for Families of Young Children With Intellectual Disability: A Feasibility Randomised Controlled Trial. Front Psychiatry 2021; 12:729129. [PMID: 34992552 PMCID: PMC8725992 DOI: 10.3389/fpsyt.2021.729129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Parents of children with intellectual disabilities are likely to experience poorer mental well-being and face challenges accessing support. Early Positive Approaches to Support (E-PAtS) is a group-based programme, co-produced with parents and professionals, based on existing research evidence and a developmental systems approach to support parental mental well-being. The aim of this study was to assess the feasibility of community service provider organisations delivering E-PAtS to parents/family caregivers of young children with intellectual disability, to inform a potential definitive randomised controlled trial of the effectiveness and cost-effectiveness of E-PAtS. Methods: This study was a feasibility cluster randomised controlled trial, with embedded process evaluation. Up to two parents/family caregivers of a child (18 months to <6 years old) with intellectual disability were recruited at research sites and allocated to intervention (E-PAtS and usual practise) or control (usual practise) on a 1:1 basis at cluster (family) level. Data were collected at baseline and 3 and 12 months' post-randomisation. The following feasibility outcomes were assessed: participant recruitment rates and effectiveness of recruitment pathways; retention rates; intervention adherence and fidelity; service provider recruitment rates and willingness to participate in a future trial; barriers and facilitating factors for recruitment, engagement, and intervention delivery; and feasibility of collecting outcome measures. Results: Seventy-four families were randomised to intervention or control (n = 37). Retention rates were 72% at 12 months post-randomisation, and completion of the proposed primary outcome measure (WEMWBS) was 51%. Recruitment of service provider organisations and facilitators was feasible and intervention implementation acceptable. Adherence to the intervention was 76% and the intervention was well-received by participants; exploratory analyses suggest that adherence and attendance may be associated with improved well-being. Health economic outcome measures were collected successfully and evidence indicates that linkage with routine data would be feasible in a future trial. Conclusions: The E-PAtS Feasibility RCT has demonstrated that the research design and methods of intervention implementation are generally feasible. Consideration of the limitations of this feasibility trial and any barriers to conducting a future definitive trial, do however, need to be considered by researchers. Clinical Trial Registration: https://www.isrctn.com, identifier: ISRCTN70419473.
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Affiliation(s)
- Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Nick Gore
- Tizard Centre, University of Kent, Cornwallis North East, Canterbury, United Kingdom
| | - Gwenllian Moody
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Jeremy Segrott
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jill Bradshaw
- Tizard Centre, University of Kent, Cornwallis North East, Canterbury, United Kingdom
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Geoff Lindsay
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom
| | | | - Vaso Totsika
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia
| | - Catherine Stanford
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom
| | - Samantha Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom
| | - Annabel Carter
- Tizard Centre, University of Kent, Cornwallis North East, Canterbury, United Kingdom
| | - Christian Barlow
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Richard P. Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom
- Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia
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Shurlock J, Gratton B, Wilson L, Heatley R, Roach M, Dayer M, Furniss G. Rapid rollout of a pacemaker home monitoring service during the 2020 COVID-19 pandemic. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In an effort to reduce non-essential face to face contact during the COVD pandemic our pacemaker service was restructured in March 2020 to home monitoring only. Home monitors were issued at implant and wound reviews were done remotely via photo messages at one month or if prompted by the patient. Existing patients were given monitors on an ad hoc basis. A dedicated physiologist worked off site on home monitoring clinics. We assessed the impact on our service and on patient experience of these changes one year after implementation.
Methods
Baseline characteristics of age at implant and distance of home address from hospital were collected from all patients undergoing pacemaker home monitoring. Patients were surveyed using an adapted version of the Generic Short Patient Experiences Questionnaire (GS-PEQ). Comparison was made with our standard face-to-face follow-up model (1, 3, and 12 months).
Results
Data was collected for 326 patients. 233 received a new permanent pacemaker from March 2020 onwards and 93 existing patients were issued with a home monitor. Average age at pacemaker implant was 80.6 years (±9.9 years). The average one-way distance from home to outpatient clinic saved was 15.1 miles (±10.4 miles). 567 face-to-face appointments were saved. On an average day the off-site physiologist reviewed over 100 patient records a day, contacted 10 patients by phone and dictated reports on 20 patients (14 clinic patients and 6 alerts).
Of patients surveyed 88% agreed with the statement “I feel safe being cared for solely with a remote monitoring service” and 84% agreed with the statement “I receive the same standard of care via remote monitoring and face-to-face appointments”. Time saved by avoiding a face to face appointment was more than 1 hour for 90% of respondents. Respondents requested communication of reassuring monitoring, the ability to contact the pacing team in the event of concerns and clearer instructions for the home monitoring device.
Only 34% of newly implanted patients were able to send a photo message of their wound without prompting. We did not get a post procedure photo in 38% and the rest either spoke to us about the wound or had a face-to face visit. There was a significant difference in mean age between those who sent a photo (73.7 years) and those who didn't (81.4 years) (P=0.0006).
Conclusion
Rapid role out of a remote monitoring service for permanent pacemakers across a large county was feasible, produced significant savings in clinic time and was well received by patients. There were significant time savings for physiologists and patients. However remote wound monitoring in elderly patients was problematic due to the difficulty of sending photo messages.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Shurlock
- Musgrove Park Hospital, Taunton, United Kingdom
| | - B Gratton
- Musgrove Park Hospital, Taunton, United Kingdom
| | - L Wilson
- Musgrove Park Hospital, Taunton, United Kingdom
| | - R Heatley
- Musgrove Park Hospital, Taunton, United Kingdom
| | - M Roach
- Musgrove Park Hospital, Taunton, United Kingdom
| | - M Dayer
- Musgrove Park Hospital, Taunton, United Kingdom
| | - G Furniss
- Musgrove Park Hospital, Taunton, United Kingdom
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Coulman E, Hastings R, Gore N, Gillespie D, McNamara R, Petrou S, Segrott J, Bradshaw J, Hood K, Jahoda A, Lindsay G, Lugg-Widger F, Robling M, Shurlock J, Totsika V. The Early Positive Approaches to Support (E-PAtS) study: study protocol for a feasibility cluster randomised controlled trial of a group programme (E-PAtS) for family caregivers of young children with intellectual disability. Pilot Feasibility Stud 2020; 6:147. [PMID: 33024571 PMCID: PMC7532596 DOI: 10.1186/s40814-020-00689-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Children with intellectual disability have an IQ < 70, associated deficits in adaptive skills and are at increased risk of having clinically concerning levels of behaviour problems. In addition, parents of children with intellectual disability are likely to report high levels of mental health and other psychological problems. The Early Positive Approaches to Support (E-PAtS) programme for family caregivers of young children (5 years and under) with intellectual and developmental disabilities is a group-based intervention which aims to enhance parental psychosocial wellbeing and service access and support positive development for children. The aim of this study is to assess the feasibility of delivering E-PAtS to family caregivers of children with intellectual disability by community parenting support service provider organisations. The study will inform a potential, definitive RCT of the effectiveness and cost-effectiveness of E-PAtS. Methods This study is a feasibility cluster randomised controlled trial, with embedded process evaluation. Up to 2 family caregivers will be recruited from 64 families with a child (18 months to 5 years) with intellectual disability at research sites in the UK. Participating families will be allocated to intervention: control on a 1:1 basis; intervention families will be offered the E-PAtS programme immediately, continuing to receive usual practice, and control participants will be offered the opportunity to attend the E-PAtS programme at the end of the follow-up period and will continue to receive usual practice. Data will be collected at baseline, 3 months post-randomisation and 12 months post-randomisation. The primary aim is to assess feasibility via the assessment of: recruitment of service provider organisations; participant recruitment; randomisation; retention; intervention adherence; intervention fidelity and the views of participants, intervention facilitators and service provider organisations regarding intervention delivery and study processes. The secondary aim is preliminary evaluation of a range of established outcome measures for individual family members, subsystem relationships and overall family functioning, plus additional health economic outcomes for inclusion in a future definitive trial. Discussion The results of this study will inform a potential future definitive trial, to evaluate the effectiveness and cost-effectiveness of the E-PAtS intervention to improve parental psychosocial wellbeing. Such a trial would have significant scientific impact internationally in the intellectual disability field. Trial registration ISRCTN70419473
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Affiliation(s)
- Elinor Coulman
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Richard Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, CV4 7AL UK
| | - Nick Gore
- Tizard Centre, University of Kent, Cornwallis North East, Canterbury, CT2 7NF UK
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL UK
| | - Jeremy Segrott
- DECIPHer Centre Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Jill Bradshaw
- Tizard Centre, University of Kent, Cornwallis North East, Canterbury, CT2 7NF UK
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, G12 8RZ, Glasgow, UK
| | - Geoff Lindsay
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, CV4 7AL UK
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Jacqui Shurlock
- The Challenging Behaviour Foundation, The Old Courthouse, New Road Avenue, Chatham, Kent, ME4 6BE UK
| | - Vaso Totsika
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Wing B, Maple House, Tottenham Court Road, London, UK
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Shurlock J, Wang G, Pitsiladis Y. THE EFFECTS OF ALTITUDE TRAINING ON BLOOD GENE EXPRESSION PROFILES IN ORDER TO COMPARE AND DIFFERENTIATE FROM A PREVIOUSLY IDENTIFIED “MOLECULAR SIGNATURE” OF RHUEPO DOPING. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096900.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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