Contemporary splinting practice in the UK for adults with neurological dysfunction: A cross-sectional survey

This article is made available through the Brunel Open Access Publishing Fund.Aim: To explore the contemporary splinting practice of UK occupational therapists and physiotherapists for adults with neurological dysfunction. Method: Cross-sectional online survey of members of the Association of Chartered Physiotherapists in Neurology and College of Occupational Therapists Specialist Section Neurological Practice. Results: Four hundred and twenty therapists completed the survey. Contracture management is the most common rationale for therapists splinting adults with neurological dysfunction. Other shared therapeutic goals of splinting include maintaining muscle and joint alignment, spasticity management, function, pain management and control of oedema. Considerable clinical uncertainty was uncovered in practice particularly around wearing regimens of splints. Most therapists have access to locally-derived splinting guidelines, which may contribute to this diversity of practice. Conclusions: This study provides a unique insight into aspects of contemporary splinting practice among UK therapists, who belong to a specialist neurological professional network and work in a number of different health-care settings with adults who have a neurological condition. Study findings show a wide variation in splinting practice, thereby indicating a potential need for national guidance to assist therapists in this area of clinical uncertainty. Further research is required to establish best practice parameters for splinting in neurological rehabilitation

What and how: doing good research with young people, digital intimacies, and relationships and sex education

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. As part of a project funded by the Wellcome Trust, we held a one-day symposium, bringing together researchers, practitioners, and policymakers, to discuss priorities for research on relationships and sex education (RSE) in a world where young people increasingly live, experience, and augment their relationships (whether sexual or not) within digital spaces. The introduction of statutory RSE in schools in England highlights the need to focus on improving understandings of young people and digital intimacies for its own sake, and to inform the development of learning resources. We call for more research that puts young people at its centre; foregrounds inclusivity; and allows a nuanced discussion of pleasures, harms, risks, and rewards, which can be used by those working with young people and those developing policy. Generating such research is likely to be facilitated by participation, collaboration, and communication with beneficiaries, between disciplines and across sectors. Taking such an approach, academic researchers, practitioners, and policymakers agree that we need a better understanding of RSE’s place in lifelong learning, which seeks to understand the needs of particular groups, is concerned with non-sexual relationships, and does not see digital intimacies as disconnected from offline everyday ‘reality’

Examining the relationship between physical illness and depression: Is there a difference between inflammatory and non inflammatory diseases? A cohort study

BACKGROUND: There is evidence that inflammation may play a role in the association between physical illness and depression. Our aim was to compare the impact of chronic medical conditions on incidence of depression and to examine if risk of depression varies in terms of the presence and degree of inflammation. METHODS: This is a secondary analysis conducted within the Spanish sample of the predictD-study. PARTICIPANTS: 5437. PRIMARY OUTCOME: Incident major depression measured with the Composite International Diagnostic Interview. EXPOSURE: Presence of chronic medical conditions recorded by GPs using the International Classification of Primary Care, ICPC-2. All analyses were conducted using multivariable logistic regression to allow adjustment for confounders. RESULTS: The odds of depression are higher in almost all inflammatory than in non-inflammatory illnesses. There is an increasing risk of depression as a consequence of an increasing inflammatory load, with higher odds of depression in the autoimmune group than in the cardio-metabolic group, while both had higher odds of depression than the non-inflammatory groups. CONCLUSIONS: Inflammation may be part of the pathway by which chronic physical illness leads to depression. Future studies should examine the role of inflammation in the prevention and management of depression

Becoming or remaining agitated: the course of agitation in people with dementia living in care homes: the English longitudinal Managing Agitation and Raising Quality of Life (MARQUE) study

Care home residents with dementia often have accompanying agitation. We investigated agitation’s course at 5 time-points in 1,424 people with dementia over 16 months in 86 English care homes. We categorized baseline agitation symptoms on the Cohen-Mansfield Agitation Inventory (CMAI) into none (CMAI = 29; 15%), subclinical (CMAI = 30–45; 45%), or clinically-significant (CMAI > 45; 40%). 88% of those with no agitation at baseline remained free of clinically-significant agitation at all follow-ups. Seventy percent of those exhibiting clinically-significant agitation at baseline had clinically-significant agitation at some follow-ups. Over a 16-month observation period, this study finds many care home residents with dementia never develop clinically significant agitation and interventions should be for treatment not prevention

Comparing proxy rated quality of life of people living with dementia in care homes

Background: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently

Burnout in UK care home staff and its effect on staff turnover: MARQUE English national care home longitudinal survey

BACKGROUND: staff burnout and turnover lead to care home residents receiving poorer quality care. Burnout is thought to cause turnover, but this has never been investigated. We know little about which care home staffs are burnt out. AIMS: to explore burnout's relationship with staff turnover and prevalence and predictors of burnout. METHOD: we calculated the relationship between Maslach Burnout Inventory scores and future staff turnover (12-month number of staff leaving/number employed). We explored staff, resident and care home predictors of burnout, measured as emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). RESULTS: two-thousand sixty-two care staff in 97 care home units participated. Median yearly staff turnover was 22.7%, interquartile range (IQR) 14.0-37.7%. Care staff recorded low median burnout (median EE: 14, IQR: 7-22; DP: 1, IQR: 0-5; PA 42, IQR: 36-45). We found no association between staff burnout and turnover rate. Younger staff age was associated with higher burnout (EE coefficient - 0.09; 95% confidence interval (CI): -0.13, -0.05; DP -0.02; 95% CI: -0.04, -0.01; PA 0.05; 95% CI: 0.02, 0.08). Speaking English as a second language predicted higher EE (1.59; 95% CI: 0.32, 2.85), males had higher DP (0.02; 95% CI: 0.01, 0.04) and staff working only night shifts lower PA (-2.08; 95% CI: -4.05, -1.30). CONCLUSIONS: we found no association between care homes staff burnout level and staff turnover rates. It is a myth that burnout levels are high. Interventions for burnout could focus on at-risk groups. Future studies could consider turnover at an individual level

ANTLER statistical analysis plan, Version 3, 16 January 2020

This analysis plan sets out the methods of analysing the predetermined primary, secondary and health economic outcomes for ANTLER, which will be reported in the National Institute for Health Research, Health Technology Assessment report at the end of the trial and also in the main peer review paper(s) to result from this randomised controlled trial. The analysis and reporting of this trial will conform to the CONSORT and CHEERS statements and the appropriate standard operating procedures written by Priment Clinical Trials Unit. Further information on this trial can be found in the protocol version 7.0 (26/11/2018). The protocol is stored on: S:\Pop_Health\PCPH_Priment\Projects\Current\CTIMPS\ANTLER\6. Protocol\ANTLER_protocol_v7_20181126.pdf

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey

OBJECTIVE: As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. METHODS: We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014–2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. RESULTS: Seventy-one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen-Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. CONCLUSIONS: Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia-friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes