scholarly journals 101 A Posture and Mobility Training Package for Care Home Staff: Results of A Cluster Randomised Controlled Feasibility Trial

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i34-i36
Author(s):  
L Graham ◽  
B Cundill ◽  
A Ellwood ◽  
J Fisher ◽  
M Goodwin ◽  
...  
Keyword(s):  
Care Home ◽  
Direct Care ◽  
Care Staff ◽  
Feasibility Trial ◽  
Direct Care Staff ◽  
Intervention Delivery ◽  
Care Home Staff ◽  
Mobility Training ◽  
Randomised Controlled

Abstract Introduction Provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve physical well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence, skills and abilities of care home staff. This trial assessed the feasibility of undertaking a definitive evaluation of the Skilful Care Training Package (SCTP) - a posture and mobility training programme developed by physiotherapists for care home staff. Methods A parallel-group, cluster randomised controlled feasibility trial was undertaken in ten care homes in Yorkshire. Five were randomised to receive SCTP, five to usual care. SCTP was delivered by specialist physiotherapists, with the intention of training all direct care staff. Following consent, data were collected from and about residents with restricted mobility (those fulfilling the eligibility criteria) at baseline, three and six months post-randomisation by blinded researchers. Outcome measurement included resident mobility, posture, pain and quality of life. The feasibility of recruitment, retention, data collection and intervention delivery was assessed. Results All residents (348) at participating homes were screened for eligibility. 250 were eligible and 146 took part. Follow-up was balanced between arms, with an overall loss-to-follow-up rate of 28.8% at six months. Where residents were available for six-month follow-up, proxy data provision was excellent (97.1% - 100% of expected data). Difficulty collecting data directly from residents was experienced (43.3% of expected data) due to high levels of cognitive impairment. Staff attendance at training met or was close to pre-specified criteria for acceptability in three homes, with 63.0%, 63.6% and 65.8% direct care staff attending all sessions, and >85% attending at least one session across all three homes. However attendance fell short of acceptability in two homes, with only 21.4% and 12.5% staff attending all sessions. Conclusions It is feasible to recruit and follow-up residents in a randomised trial comparing SCTP and usual care. Proxy data collection is a successful method, but collection of data from residents is difficult. Intervention delivery success was variable, illustrating heterogeneity between care homes. Future research will be informed by learning from those homes with greater intervention compliance. Work should be undertaken to investigate how best to collect meaningful data from residents.

scholarly journals A posture and mobility training package for care home staff: results of a cluster randomised controlled feasibility trial (the PATCH trial)

2020 ◽  
Vol 49 (5) ◽  
pp. 821-828
Author(s):  
Liz Graham ◽  
Alison Ellwood ◽  
Karen Hull ◽  
Jill Fisher ◽  
Bonnie Cundill ◽  
...  
Keyword(s):  
Data Collection ◽  
Care Home ◽  
Well Being ◽  
Care Staff ◽  
Feasibility Trial ◽  
Training Package ◽  
Cluster Randomised ◽  
Mobility Training ◽  
Randomised Controlled ◽  
Intervention Uptake

Abstract Background provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence and skills of staff who provide care. This trial assessed the feasibility of undertaking a definitive evaluation of a posture and mobility training programme for care staff. Design and setting a cluster randomised controlled feasibility trial with embedded process evaluation. Ten care homes in Yorkshire, United Kingdom, were randomised (1:1) to the skilful care training package (SCTP) or usual care (UC). Participants residents who were not independently mobile. Intervention SCTP—delivered by physiotherapists to care staff. Objectives and measurements key objectives informed progression to a definitive trial. Recruitment, retention and intervention uptake were monitored. Data, collected by a blinded researcher, included pain, posture, mobility, hospitalisations and falls. This informed data collection feasibility and participant safety. Results a total of 348 residents were screened; 146 were registered (71 UC, 75 SCTP). Forty two were lost by 6 months, largely due to deaths. While data collection from proxy informants was good (>95% expected data), attrition meant that data completion rates did not meet target. Data collection from residents was poor due to high levels of dementia. Intervention uptake was variable—staff attendance at all sessions ranged from 12.5 to 65.8%. There were no safety concerns. Conclusion care home and resident recruitment are feasible, but refinement of data collection approaches and intervention delivery are needed for this trial and care home research more widely.

scholarly journals Promoting activity, Independence and stability in early dementia (PrAISED): a, multisite, randomised controlled, feasibility trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sarah E. Goldberg ◽  
◽  
Veronika van der Wardt ◽  
Andy Brand ◽  
Clare Burgon ◽  
...  
Keyword(s):  
Adverse Events ◽  
Falls Prevention ◽  
Feasibility Trial ◽  
Moderate Intensity ◽  
Eligibility Criteria ◽  
Intervention Delivery ◽  
Link Type ◽  
Early Dementia ◽  
Randomised Controlled

Abstract Background We tested the feasibility of delivering and evaluating a complex therapy intervention which aimed to promote activity and independence for people with early dementia (PrAISED). Feasibility questions were on: recruitment, randomisation, intervention delivery, adherence and withdrawals, level of supervision required, adverse events, data collection and sample size assumptions. Methods We conducted a three-arm, multi-site, single-blind, randomised controlled feasibility trial. Eligibility criteria were aged 65 years or older, diagnosed mild dementia or mild cognitive impairment, able to walk without human help, and communicate in English, no co-morbidities that prevented participation in cognitive assessment and capacity to give consent. Participants were recruited from Memory Assessment Service clinics and the ‘Join Dementia Research’ register. Patient participants were randomised 1:1:1 to a high intensity supervision PrAISED intervention, moderate intensity supervision PrAISED intervention or brief falls prevention assessment and advice (control). The PrAISED intervention aimed for participants to complete three hours of PrAISED exercises a week for 12 months. It included individualised activity and exercise plans and supervised exercises with regular re-assessment and progression, and was delivered by occupational therapists, physiotherapists and rehabilitation support workers. Primary efficacy outcome was the Disability Assessment for Dementia (DAD), measured after 12 months. Secondary outcomes included physical activity, quality of life, mood, cognition, strength, balance, rate of falls, frailty and carer strain. Falls and activity were ascertained by monthly diary. Results Between September 2016 and March 2017 we recruited 60 patient participants and 54 carer participants from two sites. Forty-nine patient participants completed a follow-up interview. Feasibility outcomes were mostly satisfactory, including recruitment and retention, intervention delivery and data completeness for most scales used. We could not maintain blinding of researchers at follow-up and experienced difficulties collecting data using some questionnaires and devices. Participants only completed a mean 77 (moderate supervision) and 71 (high supervision) minutes per week of PrAISED exercises over 12 months. We recorded 19 adverse events, none serious and related to the intervention. Conclusion We conclude that with some adjustments to the trial protocol, it is feasible to deliver the PrAISED intervention and conduct a trial. Trial registration ClinicalTrials.gov: NCT02874300 (first posted 22nd August 2016), ISRCTN: 10550694 (date assigned 31st August 2016).

A Competency-Based “Hands-On” Training Package for Direct-Care Staff

1987 ◽  
Vol 12 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Mary R. Burch ◽  
Maxin L. Reiss ◽  
Jon S. Bailey
Keyword(s):  
Care Facility ◽  
Direct Care ◽  
Care Staff ◽  
Multiple Baseline ◽  
Direct Care Staff ◽  
Baseline Design ◽  
Training Package ◽  
Hands On ◽  
Competency Based

This study evaluated the effectiveness of a “hands-on” and videotape training package in teaching direct care staff in an Intermediate Care Facility to conduct daily activities for persons labeled profoundly mentally retarded. A proficiency checklist of desired staff behaviors was developed and staff were provided with hands-on competency-based training. With the use of a multiple baseline design (across two groups of staff), it was shown that staff performance in conducting the activities improved after the training was implemented, and that skills maintained at a 3-week follow-up check.

Training Direct Care Staff in Goal Planning with Elderly People

1986 ◽  
Vol 14 (3) ◽  
pp. 192-209 ◽  
Author(s):  
Christine Barrowclough ◽  
Ian Fleming
Keyword(s):  
Training Programme ◽  
Small Sample ◽  
Direct Care ◽  
Care Staff ◽  
Direct Care Staff ◽  
Planning Techniques ◽  
Vast Number ◽  
Elderly Individuals ◽  
Goal Planning

Although there have been a vast number of reports on training direct care staff in behavioural techniques, little work has been reported pertaining to elderly individuals. This paper describes how a method of constructing, implementing and evaluating individual plans – goal planning – was adapted for use with elderly clients. Direct care staff in a number of different establishments were trained in goal planning techniques with elderly clients and evaluations of their goal planning skills were made after training. Most trainees acquired the skills to an acceptable level and in the small sample studied, this was maintained at four month follow-up. Some measures of the effectiveness of the implementation of the goal planning and its maintenance after training are reported, and limitations of the training programme are discussed.

Evaluation of the Educational Effectiveness of an Instructional Package on Developmental Disabilities

1980 ◽  
Vol 4 (1) ◽  
pp. 24-29
Author(s):  
Lothar Mader ◽  
Patricia Resick ◽  
Donald Witzke ◽  
Joseph Ferrara ◽  
Eric Rudrud
Keyword(s):  
Developmental Disabilities ◽  
Staff Training ◽  
Direct Care ◽  
Care Staff ◽  
Educational Effectiveness ◽  
Direct Care Staff ◽  
Visual Component ◽  
Presentation Modes ◽  
Instructional Package

A newly developed audio-visual staff training package on the legal and historical aspects of developmental disabilities was assessed for its educational effectiveness. Separate evaluations were made of the component parts of the package. From a residential institution serving the developmentally disabled, 100 direct care staff were selected randomly and assigned to five groups. These groups were presented with either the audio-visual component, the workbook, or the combined audiovisual and workbook components of the package. Two groups were pretested and all five groups received a posttest and a three week follow-up test The results indicated significant learning effects which were maintained through the follow-up period. There were no differences between the three presentation modes in educational effectiveness but the slide-tape only presentation was more efficient and was preferred by the participants. Based on the results of the study, further development of audio-visual staff training packages is encouraged.

scholarly journals 102 Process Evaluation Exploring the Delivery and Uptake of Posture and Mobility Training for Staff in Care Homes

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i34-i36
Author(s):  
R Williams ◽  
D Clarke ◽  
L Graham ◽  
R Hawkins ◽  
B Cundill ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Care Homes ◽  
Positive Interaction ◽  
Complex Needs ◽  
Care Home Staff ◽  
Mobility Training ◽  
Randomised Controlled

Abstract Introduction Provision of care for care home residents with complex needs is challenging. Physiotherapists can play a major role in enhancing the confidence, skills and abilities of care home staff. The Skilful Care Training Package (SCTP) aims to provide staff with an understanding of good posture and training in skilled facilitation of movement. This process evaluation explored barriers and facilitators to delivery and uptake of the SCTP within the context of a feasibility cluster randomised controlled trial (cRCT) in 10 care homes. Methods A mixed methods process evaluation, incorporating non-participant observations and interviews, conducted in the five care homes receiving the SCTP intervention. Interviews were audio recorded and transcribed verbatim; resident conversations were captured via a Dictaphone and/or field-notes. Data analysis used the Framework approach. Results Fourteen staff training sessions were observed. Interviews with 22 staff and four trainers, and 13 conversations with residents were completed. Five factors influenced delivery and uptake of the SCTP:Organisational factors: strategies to publicise and facilitate access to training improved attendance; a convenient training location and trainer flexibility encouraged attendance and staff engagement.Intervention delivery: a practical participatory element to the training was highly valued; adapting the training to meet the needs of the homes was well-received.Engagement and interaction: relating training to workplace and residents’ experiences engaged staff; high levels of engagement and positive interaction within the training sessions were reported; challenges relating to staff hierarchy affected training delivery in some homes.Intervention content: posture and mobility elements were seen as important; however, some repetition with prior training was highlighted.Training impact: there were indications that staff adopted SCTP techniques. Staff reported an increase in their wellbeing and confidence in movement facilitation; cascade training was reported in some homes. Conclusions Training was well-received, and feedback on its impact was largely positive. Practical elements were viewed favourably over classroom-based learning. Intervention content should be revised to optimise focus and avoid overlap with other training.

The Constructional Approach to “Problem Behaviour” in an Institutionalized Setting

1984 ◽  
Vol 12 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Ian Fleming
Keyword(s):  
Direct Care ◽  
Care Staff ◽  
Behavioural Intervention ◽  
Direct Care Staff ◽  
Problem Behaviour ◽  
Mentally Handicapped

This paper describes the successful application of a behavioural intervention to the inappropriate behaviour of a severely mentally handicapped hospital resident. The intervention was based on the Constructional approach and at sixth week follow-up the effects had been maintained. Furthermore, there was evidence that these had generalised to other behaviours. Significant changes were noted in the attitudes of direct care staff and it is suggested that these may have been attributable to the nature of the approach used. The Constructional approach was considered ethically and practically superior to alternatives which would have concentrated alone on reducing or removing behaviour in the client's limited repertoire.

scholarly journals 71 Ultrasound directed reduction of Colles’ type distal radial fractures in ED (UDiReCT): a feasibility randomized controlled trial

2020 ◽  
Vol 37 (12) ◽  
pp. 835.3-836
Author(s):  
Hamza Malik ◽  
Andrew Appelboam ◽  
Gordon Taylor ◽  
Daryl Wood ◽  
Karen Knapp
Keyword(s):  
Data Collection ◽  
Controlled Trial ◽  
Wrist Fracture ◽  
Recruitment Rate ◽  
Feasibility Trial ◽  
Point Of Care Ultrasound ◽  
Distal Radial Fractures ◽  
Definitive Trial ◽  
Randomised Controlled

Aims/Objectives/BackgroundWrist fractures are among the commonest injuries seen in the emergency department (ED). Around 25% of these injuries have Colles’ type fracture displacement and undergo manipulation in the ED. In the UK, these manipulations are typically done ‘blind’ without real time imaging and recent observational studies show that over 40% of the injuries go on to require surgical fixation (due to inadequate initial reduction or re-displacement). Point of care ultrasound has been used to guide and improve wrist fracture reductions but it’s effect on subsequent outcome is not established. We set up and ran the UK’s first randomised controlled feasibility trial comparing standard and ultrasound guided ED wrist fracture manipulations to test a definitive trial protocol, data collection and estimate recruitment rate towards a future definitive trial.Methods/DesignWe conducted a 1:1, single blind, parallel group, randomised controlled feasibility trial in two UK hospitals. Adults with Colles’ type distal radial fractures requiring manipulation in the ED were recruited by supervising emergency physicians supported by network research nurses. Participants were randomised to ultrasound directed fracture manipulation (intervention) or standard care with sham ultrasound (controls). The trial was run through Exeter Clinical Trials Unit and consent, randomisation and data collection conducted electronically in REDCap cloud. All participants were followed up at 6 weeks to record any surgical intervention and also underwent baseline and 3 month quality of life (EQ-5D-5L) and wrist function (Patient Rated Wrist Evaluation (PRWE) assessments.Results/ConclusionsWe recruited 47 patients in total, with 23 randomised to the interventional arm and 24 randomised to the control arm. We were able to follow up 100% of the patients for the 6 week follow up. Data analysis and results will be presented at the time of the conference.

scholarly journals Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 182-183
Author(s):  
James Faraday ◽  
Clare Abley ◽  
Catherine Exley ◽  
Joanne Patterson
Keyword(s):  
Nursing Homes ◽  
Ethnographic Study ◽  
Direct Care ◽  
Care Staff ◽  
Direct Care Staff ◽  
Structured Interviews ◽  
Staff Members ◽  
People With Dementia ◽  
Comparison Approach ◽  
The Right

Abstract More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.

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