Interventions to reduce dependency in personal activities of daily living in community-dwelling adults who use homecare services: protocol for a systematic review

Background There is a growing demand for services whereby individuals receive assistance from care workers for personal care within the home. This has led to the development of re-ablement or restorative homecare services that provide time-limited input aimed at reducing dependency in personal activities of daily living, and preventing or delaying the need for further homecare support. However, little is currently known about how such interventions are configured, or how they may affect individuals’ ability to carry out personal care independently. Methods/Design We will seek to identify studies that compare an intervention designed to reduce dependency in personal activities of daily living with routine input or usual care as the control. We will include randomised controlled trials, nonrandomised controlled trials, and controlled before and after studies. We will also include interrupted time series studies. We shall search electronic databases in addition to searching for ongoing and unpublished studies, and where appropriate will contact key authors. Two reviewers will independently screen articles for inclusion; will assess risk of bias using quality assessment tools; and will carry out data extraction using pre-prepared forms. Any disagreements, at any stage, will be resolved by discussion and the involvement of a third reviewer if needed. We will produce a narrative summary of the results. A meta-analysis will be conducted if sufficient data are available of appropriate quality and comparability. Discussion The findings from this review will inform future practice within homecare re-ablement services; will inform policy decisions about the structure, organisation and content of such services; and will identify areas where further research is warranted

Occupational Therapy in HomEcare Re-ablement Services (OTHERS): study protocol for a randomized controlled trial

Background Homecare re-ablement services have been developed by local authorities in England in response to the government agenda for health and social care. These services aim to optimize users’ independence and ability to cope at home, and reduce the need for ongoing health and social care services. However, there is currently limited evidence and guidance regarding the optimum configuration and delivery of re-ablement services. In particular, the impact of occupational therapy input on service user outcomes has been highlighted as a specific research priority. Methods/Design This feasibility randomized controlled trial (RCT) will recruit 50 people from one local authority led homecare re-ablement service in England. Those who provide informed consent will be randomized to receive either usual homecare re-ablement (without routine occupational therapy input) or usual homecare re-ablement plus an enhanced program targeted at activities of daily living (ADL), delivered by an occupational therapist. The primary aim of this study is to assess the feasibility of conducting a further, powered study. The participant outcomes assessed will be independence in personal and extended ADL, health and social care-related quality of life, number of care support hours, falls, acute and residential admissions and use of health and social care services. These will be assessed at two weeks, three months and six months post-discharge from the re-ablement service. Discussion To our knowledge, this is the first RCT of occupational therapy in homecare re-ablement services. The results of this study will lay the foundations for a further powered study. The findings will be relevant to researchers, clinicians, commissioners and users of adult social care services

Improving safety for older public transport users (OPTU) - a feasibility study

On the whole, the UK public transport system is generally considered to provide a safe means of mobility. However, each year, around 6,000 people are reported by the UK police to be injured whilst using buses with more than 400 persons killed or seriously injured. Approximately 50% of those injured or killed are aged over 65 years (Department for Transport 2008). However it is thought that there are many more injured older bus-users who are not included in the national statistics and whom may now avoid travelling on public transport because of previous injuries and experiences. Whilst free travel (particularly on buses) has allowed senior citizens the freedom to travel for pleasure and social inclusion, injuries or near-falls that may occur during the journey can impact on future decisions to travel leading in some cases to anxiety/fear of sustaining further injury, loss of personal mobility and ultimately social isolation. This Feasibility Study was funded within the Medical Research Council (MRC) Lifelong Health and Wellbeing programme in order to examine the general safety (but not security) of older public transport users. It explores injury type and causation and proposes design interventions for injury prevention with an overall objective of exploring how public transport use could possibly be made safer for older transport-users. A mixed methods design was used to collect and collate data from a number of sources. These included published research literature, national accident datasets, bus-operator records, service user consultations and other stakeholder consultations with groups representing the 60+ year’s age group. The ultimate aim was to develop a pilot injury surveillance database that could in principle be used to determine vehicle design requirements, transport operator procedures and transport-user behaviors that could prevent injuries from occurring...(continues)

Injuries to older users of buses in the UK

The increasing age of the United Kingdom (UK) population coupled with enhanced life expectancy impacts on transport-user demographics and will affect transport planning in the years ahead. Whilst passenger car use is the ultimate means of personal independence, at some point the physiological and psychological impact of age-related conditions will inevitably shift people out of their vehicles and onto public transport systems. Overall, public transport is seen to be vital for social inclusion (Lucas et al 2008) and it is considered a safe means of mobility. However, it is important that the public and, in particular, the elderly perceive it to be so. Injuries (across a spectrum of severities) do occur during public transport use from time to time. In fact, over 5,000 people are injured on UK buses each year alone with over 300 bus-users killed/seriously injured (Department for Transport, 2012). This study was designed to examine the nature of injuries and their causes to older bus-users with the aim being to establish where design countermeasures may be indicated. The study uses descriptive statistics to analyse linked (accident and injury) data involving a sample of older bus-users. Most incidents in the linked dataset were non-collisions (62 per cent) resulting in 1,381 recorded injuries in those aged 60+ years, of which 46 per cent were 'slight' and 54 per cent 'serious'

Low back pain patients' experiences of work modifications; A qualitative study

Background: Research indicates that work modifications can reduce sickness absence and work disability due to low back pain. However, there are few studies that have described modified work from the perspective of patients. A greater understanding of their experiences may inform future workplace management of employees with this condition. Methods: Individual semi-structured interviews were conducted with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. Data was analysed thematically. Results: Many participants had made their own work modifications, which were guided by the extent of control they had over their hours and duties, colleague support, and their own beliefs and attitudes about working with back pain. A minority of the participants had received advice or support with work modifications through occupational health. Access to these services was limited and usually followed lengthy sickness absence. Implementation largely rested with the manager and over-cautious approaches were common. Conclusions: There was little evidence of compliance with occupational health guidance on modified work. There appears to be insufficient expertise among managers and occupational health in modifying work for employees with low back pain and little indication of joint planning. On the whole, workers make their own modifications, or arrange them informally with their manager and colleagues, but remain concerned about working with back pain. More effective and appropriate application of modifications may increase employees' confidence in their ability to work

Additional file 1 of Prevalence of symptoms of anxiety and depression one year after intensive care unit admission for COVID-19

Supplementary Material 1

Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high-income countries

Each year more than 6000 people are injured on public buses in the UK, approximately half of whom are aged 65 or over. This review synthesises the published literature on the epidemiology of non-collision injuries occurring in older people using public buses, to enable understanding of the size and nature of the problem of injuries, and to explore strategies for improving the safety of public transport for older people. We searched PubMed, Embase, CINAHL, web of science, and Transport Research International Documentation (TRID). Studies were included if they were cross-sectional, case-control or cohort Studies. Pairs of reviewers independently screened Studies for inclusion, assessed risk of bias, and extracted data. Ten studies were included in the review. Older people and women were found to be over-represented in non-collision injuries. Most injuries occurred during daytime hours and on weekdays. Injuries most commonly occurred whilst passengers were standing and either moving around the bus, boarding, or alighting, and whilst the bus was accelerating or decelerating. Bruising was the most common injury amongst emergency department attenders, although between 18% and 33% suffered more serious injuries such as fractures or dislocations. Many injuries to older public transport users are potentially preventable public transport needs to be safe and accessible, and to be perceived as such by older people to ensure independence in outdoor mobility

Exploring post-stroke fatigue from the perspective of stroke survivors: what strategies help? A qualitative study

Post-stroke fatigue is a research priority for stroke survivors and health professionals but there is limited evidence to guide management. We aimed to explore (1) the experience of post-stroke fatigue from the perspective of stroke survivors and their caregivers and (2) fatigue management strategies that are used. This was a qualitative study using semi-structured interviews. People with self-reported post-stroke fatigue and caregivers were recruited using maximum variation sampling. Analysis was done via the framework approach. We recruited 17 stroke survivors, nine male (53%), most under 65 years (n = 12, 76%), and greater than 1-year post-stroke (n = 16, 94%, range 10-months to 22-years). One-third of participants self-reported having aphasia (n = 5, 36%). We also recruited eight caregivers, most of whom were female (n = 7, 88%). We identified four themes: (1) fatigue is unexpected after stroke and symptoms vary; (2) the individual experience of fatigue is complex, influenced by multifactorial and biopsychosocial factors; (3) learning to adapt and accept fatigue; and (4) Strategies to manage fatigue and personal approaches to rest. Post-stroke fatigue experience varies presenting cognitively, physically, and psychologically according to a complex interplay of biopsychosocial factors and personal triggers. Self-management strategies are individualised and include organisation, medications, lifestyle modifications, and peer support.Implications for rehabilitationPost-stroke fatigue is a complex individual experience involving biopsychosocial factors, and stroke survivors need assistance to identify their triggers and support from family, peers, and the stroke community to live well with fatigue.Fatigue is not commonly discussed by health professionals and stroke survivors need simple, practical advice over the long-term to reduce fear and distress.There are a range of strategies that may be helpful. Stroke survivors may benefit from adopting problem-solving approaches, trial pacing, lifestyle modifications and planning, and find forms of rest that work for them. Post-stroke fatigue is a complex individual experience involving biopsychosocial factors, and stroke survivors need assistance to identify their triggers and support from family, peers, and the stroke community to live well with fatigue. Fatigue is not commonly discussed by health professionals and stroke survivors need simple, practical advice over the long-term to reduce fear and distress. There are a range of strategies that may be helpful. Stroke survivors may benefit from adopting problem-solving approaches, trial pacing, lifestyle modifications and planning, and find forms of rest that work for them.</p

Supplementary_file_I – Supplemental material for Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units

<p>Supplemental material, Supplementary_file_I for Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units by David J Clarke, Louisa-Jane Burton, Sarah F Tyson, Helen Rodgers, Avril Drummond, Rebecca Palmer, Alex Hoffman, Matthew Prescott, Pippa Tyrrell, Lianne Brkic, Katie Grenfell and Anne Forster in Clinical Rehabilitation</p

sj-docx-3-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-3-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p