scholarly journals From a research trial to routine practice: stakeholders’ perceptions and experiences of referrals to the National Exercise Referral Scheme (NERS) in Wales

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kelly Morgan ◽  
Jennifer Lewis ◽  
Jemma Hawkins ◽  
Graham Moore
Keyword(s):  
Controlled Trial ◽  
Patient Characteristics ◽  
Routine Practice ◽  
Structured Interviews ◽  
Effective Interventions ◽  
Included Patient ◽  
Perceived Effects ◽  
Randomised Controlled ◽  
Exercise Referral ◽  
Exercise Referral Scheme

Abstract Background Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered in primary care across Wales, UK. Few studies have revisited effective interventions years into their delivery in routine practice to understand how implementation, and perceived effects, have been maintained over time. This study explores perceptions and experiences of referral to NERS among referrers, scheme deliverers and patients. Methods Individual, semi-structured interviews were conducted with 50 stakeholders: scheme referrers (n = 9); scheme deliverers (n = 22); and referred patients (n = 19). Convenience sampling techniques were used to recruit scheme referrers and purposive sampling to recruit scheme deliverers and patients. Thematic analysis was employed. Results Analyses resulted in five key themes; referrer characteristics, geographical disparities in referral and scheme access, reinforcements for awareness of the scheme, patient characteristics and processes and context underpinning a referral. Overall there was a high concordance of views between all three stakeholder groups and barriers and facilitators were found to be entwined within and across themes. Referral barriers persisting since the earlier trial included a lack of consultation time and a lack of referral feedback. Newly identified barriers included a lack of scheme awareness and a referral system perceived to be time intensive and disjointed. Key referral facilitators included patient self-referrals, a growing scheme reputation and promotional activities of scheme deliverers. Conclusions Findings provide evidence that could inform the further development of NERS and wider exercise referral schemes to ensure the referral process is timely, efficient and equitable.

scholarly journals A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017211 ◽  
Author(s):  
Carme Martín-Borràs ◽  
Maria Giné-Garriga ◽  
Anna Puig-Ribera ◽  
Carlos Martín ◽  
Mercè Solà ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Community Resources ◽  
Randomised Controlled ◽  
Exercise Referral ◽  
Exercise Referral Scheme

IntroductionStudies had not yet overcome the most relevant barriers to physical activity (PA) adherence. An exercise referral scheme (ERS) with mechanisms to promote social support might enhance adherence to PA in the long term.SettingA randomised controlled trial in 10 primary care centres in Spain.ObjectiveTo assess the effectiveness of a primary care-based ERS linked to municipal resources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period.Participants422 insufficiently active participants suffering from at least one chronic condition were included. 220 patients (69.5 (8.4) years; 136 women) were randomly allocated to the intervention group (IG) and 202 (68.2 (8.9) years; 121 women) to the control group (CG).InterventionsThe IG went through a 12-week standardised ERS linked to community resources and with inclusion of mechanisms to enhance social support. The CG received usual care from their primary care practice.OutcomesThe main outcome measure was self-report PA with the International Physical Activity Questionnaire and secondary outcomes included stages of change and social support to PA practice.Data collectionParticipant-level data were collected via questionnaires at baseline, and at months 3, 9 and 15.BlindingThe study statistician and research assessors were blinded to group allocation.ResultsCompared with usual care, follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA (IG: 1373±1845 metabolic equivalents (MET) min/week, n=195; CG: 919±1454 MET min/week, n=144; P=0.009). Higher adherence (in terms of a more active stage of change) was associated with higher PA level at baseline and with social support.ConclusionsPrescription from ordinary primary care centres staff yielded adherence to PA practice in the long term. An innovative ERS linked to community resources and enhancing social support had shown to be sustainable in the long term.Trial registration numberNCT00714831; Results.

scholarly journals Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community-dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027073 ◽  
Author(s):  
Laura Coll-Planas ◽  
Sergi Blancafort Alias ◽  
Mark Tully ◽  
Paolo Caserotti ◽  
Maria Giné-Garriga ◽  
...  
Keyword(s):  
Physical Activity ◽  
Controlled Trial ◽  
Management Strategies ◽  
Community Dwelling ◽  
Self Management ◽  
Qualitative And Quantitative ◽  
Perceived Effects ◽  
Randomised Controlled ◽  
Exercise Referral

IntroductionSITLESS is a randomised controlled trial determining whether exercise referral schemes can be enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity in the long term, in community-dwelling older citizens. The intervention is complex and requires a process evaluation to understand how implementation, causal mechanisms and context shape outcomes. The specific aims are to assess fidelity and reach of the implementation, understand the contextual aspects of each intervention site, evaluate the mechanisms of impact, and explore perceived effects.Methods and analysisFollowing the Medical Research Council guidance on complex interventions, a combination of qualitative and quantitative procedures is applied, including observational checklists and attendance registries, standardised scales (ie, Marcus’s Self-Efficacy Questionnaire, Physical Activity Self-Regulation Scale and the Lubben Social Network Scale) at baseline, postintervention and follow-up assessments, semistructured questionnaires gathering contextual characteristics, and participant observations of the sessions. Semistructured interviews and focus groups with the participants and trainers are conducted at postintervention and during the follow-up to explore their experiences. Outcomes from the standardised scales are analysed as moderators within the impact evaluation. Descriptive results on context and perceived effects complement results on impact. The qualitative and quantitative findings will help to refine the logic model to finally support the interpretation of the results on the effectiveness of the intervention.Ethics and disseminationThe study design was approved by the respective Ethical Committee of Ramon Llull University, Southern Denmark, Northern Ireland and Ulm University. Participation is voluntary, and all participants are asked to sign informed consent before starting the study. A dissemination plan operationalises how to achieve a social impact by reaching academic and non-academic stakeholders. A data management plan describes the specific data sets and regulates its deposition and curation. All publications will be open access.Trial registration numberNCT02629666; Pre-results.

scholarly journals Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial

2008 ◽  
Vol 192 (3) ◽  
pp. 224-231 ◽  
Author(s):  
Jocelyn Catty ◽  
Pascale Lissouba ◽  
Sarah White ◽  
Thomas Becker ◽  
Robert E. Drake ◽  
...  
Keyword(s):  
Mental Illness ◽  
Randomised Controlled Trial ◽  
Severe Mental Illness ◽  
Controlled Trial ◽  
Patient Characteristics ◽  
Employment Outcomes ◽  
Social Needs ◽  
Vocational Outcomes ◽  
Randomised Controlled ◽  
Ips Model

BackgroundAn international six-centre randomised controlled trial comparing individual placement and support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.AimsTo determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes.MethodPatient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS.ResultsPatients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.ConclusionsThe IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

scholarly journals Prevalence of Vitamin D Deficiency and Its Relationship with Clinical Outcomes in Patients with Fibromyalgia: a Systematic Review of the Literature

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar M. E. Ali
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Patient Flow ◽  
Controlled Trial ◽  
Cost Effective ◽  
Therapeutic Benefit ◽  
Vitamin D Supplementation ◽  
Effective Interventions ◽  
Randomised Controlled ◽  
And Control

Abstract Fibromyalgia is a debilitating chronic condition which poses a therapeutic challenge to the clinician. With a large backlog in patient flow subsequent to the COVID-19 pandemic and rising numbers of patients with post-acute sequelae of COVID-19 (PASC) presenting with fibromyalgia-like clinical features, there is an increasingly pressing need to identify broad cost-effective interventions. Low levels of vitamin D have previously been reported in patients with fibromyalgia, though any causative link has been difficult to establish. A systematic literature review on the association between vitamin D deficiency and fibromyalgia was performed examining retrospective evidence both for and against an association between vitamin D deficiency (VDD) and fibromyalgia and evaluating the therapeutic benefit from supplementation. A group of six studies were selected based on relevance, use of controls, quality of research and citations. Four primary studies assessing the prevalence of VDD in fibromyalgia patients versus controls were evaluated with a total 3,496 subjects. Three included females only and one larger study assessed males. Two (n = 313) concluded the presence of a statistically significant association, and two (n = 161) found none. Two randomised controlled trials assessing the effect of vitamin D supplementation in a total of 80 subjects found conflicting results, with pain reduction in one and none in the other. It is likely there exists an association between VDD deficiency and fibromyalgia in a large subset of patients, although establishing primary causation is difficult. There is a need for larger randomised controlled trial designs with more effective comparison with healthy subjects and control for confounding factors. Given VDD is a major problem in the general population, we recommend supplementation be recommended by healthcare professionals to fibromyalgia patients for the purpose of maintaining bone health given their potentially increased susceptibility to developing deficiency and its sequelae.

scholarly journals Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nathalie Claus ◽  
Lisa Marzano ◽  
Johanna Loechner ◽  
Kornelija Starman ◽  
Alessandra Voggt ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
Controlled Trial ◽  
Complex Interventions ◽  
Qualitative Evaluation ◽  
Behavioural Intervention ◽  
Structured Interviews ◽  
Cognitive Behavioural ◽  
Family Based ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Background Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children’s risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants’ perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice. Methods 18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention. Results The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was. Conclusions Managing parents’ expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions. Trial registration The original RCT this evaluation is a part of was registered under NCT02115880.

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