Injury Epidemiology and Prevention Research
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Research projects

Current studies 

 

Safe at Home 

Evaluation of a national home safety equipment scheme.

 

More information about this research

 

What we are doing

We are measuring hospital admissions due to home injuries in children under the age of 4 in families that did, and did not receive home safety equipment as part of the national, government funded, Safe At Home programme - https://www.rospa.com/home-safety/advice/child-safety/safe-at-home/   We want to know if the scheme was effective at reducing injury occurrence and if it was cost-effective in terms of saving the NHS money.

Why we are doing it

NICE guidelines recommend the provision of free home safety equipment for families under the age of 5 who may not be able to afford their own equipment.  However not all areas of the country currently have such schemes available.   Whilst we know that families appreciate these kinds of schemes and often take up the offer of equipment, we don’t know whether ultimately they result in a reduction in injury occurrence.  If we find that the scheme is associated with a reduction in injuries, and that the programme is cost-effective, we will work with Public Health England, NICE and charities such as RoSPA and CAPT to help disseminate the findings and promote the implementation of schemes in areas where they are not available.

What the benefits will be

It is important that we provide injury prevention interventions that are effective and cost effective.  We don’t always have this information available however.  Now that the national scheme has finished we have an opportunity to look at injury rates before, during and after the scheme was in place.  We will do this by analysing nationally available hospital admission information to measure injury-related hospital admissions at these time points.  Whilst we cannot measure less severe injuries, that maybe only presented to the GP or A&E, the study should give us good insight as to whether schemes are effective and cost effective from a the perspective of healthcare resource use.

Preventing injuries in young children is important.  Every week in the UK a child dies from an injury and most of these are preventable.  By providing the best available evidence regarding the provision of safety equipment we are enabling healthcare commissioners, like Public Health teams in local authorities or Clinical Commissioning Groups, to make the best decisions regarding their funding of prevention services.

 
  • Funded by: NIHR National School for Primary Care Research
  • Study dates: August 2017 – July 2018
  • Contact: Elizabeth Orton

 

 

Stay One Step Ahead

Evaluating the Implementation of Systematic Evidence-Based Child Home Safety Promotion.

 

More information about this research

 

Background

Unintentional injuries are common in pre-school children and especially amongst those living in more disadvantaged areas. We know that home safety education and helping parents to obtain and use home safety equipment helps makes homes safer. We also know that intensive home visiting programmes starting around the time of birth which are aimed improving a range of child health outcomes are effective in reducing unintentional injuries in young children. However, we know less about how to translate these research findings into routine practice.

Nottingham CityCare was awarded Big Lottery funding for a 10 year project, called Small Steps Big Changes. This aims to improve the health of children in disadvantaged electoral wards within Nottingham, and includes an innovative home visiting programme provided by family mentors. As part of the Small Steps Big changes project, evidence-based home safety promotion is being provided in Small Steps Big Changes wards and the Stay one Step Ahead project is evaluating its implementation.. 

Objectives

(a) The primary objective is to determine whether implementing systematic evidence-based home safety promotion improves key home safety practices (having a fitted and working smoke alarm, having a safety gate on stairs and keeping poisons out of reach).

(b) Secondary objectives include evaluating the impact on child home injury rates, on other safety practices, on parental knowledge and self-efficacy, acceptability of and satisfaction with the home safety promotion, barriers and facilitators to making homes safer and cost-effectiveness.

Methods

Controlled before and after study comparing outcomes between Small Steps Big Changes wards and control wards who provide usual care in terms of home safety promotion. Data will be collected using a range of methods including questionnaires, interviews and observations of home safety promotion. 

 
  • Funded by: Nottingham CityCare
  • Study dates: April 2017 – March 2021
  • ContactStudy Co-ordinator

 

 

 

The PhISICAL Activity Intervention in Community-based AduLts (PhISICAL) Study 

Investigating the implementation of the FaME falls-prevention exercise programme. 

 

More information about this research

 

What we are doing

Improving the strength and balance of older people can be effective in reducing the number of falls people have. With an aging population and high healthcare costs associated with falls it is important that programmes to improve strength and balance are available locally. The Falls Management Exercise programme (FaME) is recommended by NICE as an effective intervention for this but hasn’t been implemented widely yet across the UK. Our aim is to study the implementation of FaME in two very different areas of the East Midlands in order to understand the factors that make such a programme a success or not.

Why we are doing it

A study in 2014 showed that FaME increased physical activity levels and significantly reduced falls by 26 per cent. Falls are an important cause of disability and loss of independence in older age. It is thought about one in three adults, aged over 65, fall each year. In England, fall admissions account for 4 million hospital bed days each year, costing the NHS £2 billion. Falls can lead to loss of confidence, increased social isolation and severe injuries which for some people mean they must move into high cost residential care. As the number of older people is increasing in the UK, this problem is set to get worse.

What the benefits will be

By increasing physical activity the FaME results in improvements in strength and balance of older people, which can help reduce the number of falls.

 
  • Funded by: Better Care Fund and CLAHRC East Midlands
  • Study dates: September 2015 – August 2018
  • Contact: Elizabeth Orton

 

 

Keeping Active

Regular physical activity (PA) reduces the risk of type 2 diabetes, osteoporosis, cardiovascular disease, some cancers and falls in older adults. Adults are recommended to do at least 150 minutes/week of moderate to vigorous PA, but most older adults do not meet this target.

 

More information about this research

 

Background

The applicants recently completed a large primary care based cluster RCT (ProAct65+ trial) demonstrating group falls prevention exercise classes were effective in promoting PA and preventing falls among older people. Continuing PA after exercise interventions is needed to maintain health benefits, but little is known about how to achieve this. 

Objectives

(a) identify factors associated with continuation of PA after exercise programmes in older people and

(b) explore reasons for and barriers and facilitators for PA continuation.

Methods

A mixed methods study using quantitative data already collected during the ProAct65+ trial will be used to address objective (a) and a qualitative study of approximately 30 ProAct65+ participants (15 who continued PA and 15 who did not) and partners/carers of 10 of these participants will be used to address objective (b). The quantitative study will use random effects logistic regression to assess associations between a range of exposures (socio-demographic, falls risk, health status, quality of life, functional assessments, fear of falling, baseline PA, social network, expectations attitudes and beliefs about exercise) and PA at 12 and 24 months post intervention. The qualitative study will recruit ProAct65+ participants from GP practices in Nottingham/Derby, using maximum variation sampling to ensure diversity in age, gender, falls risk and fear of falling. Interviews will be analysed using Framework analysis. 

 
  • Funded by: NIHR School for Primary Care Research
  • Study dates: October 2015 – September 2016
  • ContactStudy Co-ordinator

 

 

 

National Child Unintentional Injury Prevention Survey

 

CAPT, The University of Nottingham and RoSPA are currently undertaking research on preventing unintentional injuries in childhood. They will be sending a questionnaire to all Local Authorities in England and Wales. The focus is the under 5s.

 

More information about this research

 

This research will:
1. Investigate how LAs are involved in child unintentional injury prevention,
2. Explore factors that are important in making decisions about prioritisation of injury prevention work, and
3. Help develop a toolkit to assist in commissioning child injury prevention programmes.
To make the toolkit useful to all LAs they want to hear from LAs that have large programmes of injury prevention work through to those that are doing less work in this area. The survey only takes 5-10 minutes to complete. All responses will be treated confidentially and individual Las will not be identified in any publications from the project. Your support would be greatly appreciated.
Research Team:
Anna Chisholm, Researcher.
Kevin Lowe, Head of Consultancy and Training Services, CAPT.
Shelia Merrill, Public Health Advisor, RoSPA.
Professor Denise Kendrick, Professor of Primary Care Research and General Practitioner.
Dr Michael Watson, Associate Professor in Public Health.
Dr Elizabeth Orton, Consultant in Public Health.
Further information: Anna Chisholm mzyalch@nottingham.ac.uk
Publications
 
 

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Injury epidemiology using primary care data

Using primary care data to identify those people most at risk of injury, understand better the short and long term consequences of injury and factors that affect the likelihood of injury occurring.

More about this research 

Aim

In the UK a subset of GP practices have joined together to make their patient records available to researchers in large databases. We are currently using two databases: The Clinical Practice Research Datalink (CPRD), linked with Hospital Episodes Statistics data and The Health Improvement Network (THIN) database.

The databases are large, with many millions of records and are therefore very representative of the UK population. This allows us to answer questions about health and disease with more certainty than traditional sources of information.

However, importantly, all the information is anonymised so we do not know the identity of individual patients. Nevertheless we can observe records over long periods of time and look at a range of lifestyle and medical factors that shed light on the causes, risk factors and consequences of injury.

Objectives

  • To describe the occurrence of injury in the UK across a range of demographics including age, sex, geographic location, socio-economic status and over time.
  • To identify factors that increase an individual’s risk of injury, including behavioural, medical, family/social and environmental factors.
  • To establish the long term consequences of injury and investigate the factors that might affect this, such as concurrent mental or physical problems, social circumstances or personal factors such as age.

In doing this, we hope to provide accurate information about the burden of injury in order to develop evidence-based policy, target interventions more effectively and analyse the effect of policy and medical advancements at a population level.

Publications

 
 

Cycling infrastructure - a Cochrane review

To evaluate the effectiveness of different types of cycling infrastructure at reducing cycling injuries in cyclists by type of infrastructure.

More information

  • Funded by: National Institute for Health Research
  • Study dates: January 2013 – March 2014
  • ContactStudy Co-ordinator
 

 

Completed projects

"Keeping Children Safe At Home" Programme

The ‘Keeping Children Safe at Home’ research programme aims to find the best advice about preventing accidents in young children at home, and to work with Children’s Centres to find suitable ways of passing on this advice to parents.

More information about this programme

  • Funded by: National Institute for Health Research Programme Grant
  • Completed 2015
 

Impact of Injuries Study

Injuries to working age adults account for more than 400,000 hospital visits in England, and 2.8 million emergency department attendances a year. This project attempts to address the lack of information on psychological problems following injury and the extent to which patients' needs are being met.

More information about the Impact of Injuries study

  • Funded by: Nottinghamshire, Derbyshire and Lincolnshire CLAHRC
  • Completed 2014  
 

ProAct65+ Study

The ProAct65+ study is comparing a community group exercise programme and home based exercise with usual care for people aged 65 and over in primary care.  

More information about the ProACT65+ study

The ProAct65+ study is comparing a community group exercise programme and home based exercise with usual care for people aged 65 and over in primary care.

Objectives

  • To determine the effect on continuation of exercise of two evidence based exercise programmes designed for older people, compared with usual care.
  • To determine the health benefits of the programmes for patients starting at various levels of physical activity.
  • To estimate the costs of the exercise interventions and to assess the cost-effectiveness of community group exercise, and home-supported exercise compared with usual care.
  • To determine the acceptability of the programmes, adherence rates, enabling factors and barriers to future implementation.
  • To determine participants’ perceptions of the value of exercise, and the predictors of continued exercise.

Design

A cluster controlled trial using minimisation for allocation at the level of general practice in two centres (London and Nottingham/Derby).

Interventions include the Otago home-based exercise programme (OEP) and a community based exercise programme (FaME).

Participants will be aged 65+ who can walk around independently indoors and outdoors (with or without a walking aid) and would be physically able to take part in a group exercise class, who are not already receiving any long term physiotherapy.

Outcome measures

Primary outcome:

The proportions of patients reaching the recommended physical activity target of at least 30 minutes of activity of moderate intensity on at least 5 days each week.

Secondary outcomes:

  • direct health benefits of exercise i.e. functional and psychological status;
  • rate of falls and the number and nature of falls, and fear of falling
  • predictors of exercise adherence
  • quality of life
  • NHS costs

 

Publications

 
  • Funded by: NIHR HTA grant
  • Completed 2013
 

Fear of Falling

A systematic review to collect and examine high quality evidence on the effect of prescribed or provided exercise on reducing fear of falling among community dwelling older people.

More information about the Fear of Falling study

Objectives

A systematic review to collect and examine high quality evidence on the effect of prescribed or provided exercise on reducing fear of falling among community dwelling older people.

Design

A systematic review of randomised and quasi-randomised controlled trials reporting single component interventions prescribing or providing exercise compared to routine care or “placebo” interventions which are not thought to increase exercise, and measuring fear of falling as a primary or secondary outcome measure.

The majority of the study population comprises people aged 65 years and over, and whose populations are not restricted to individuals who experience a specific condition, either at home or in places of residence that do not provide nursing care or rehabilitation.

Outcome measures

Primary outcome measures: fear of falling, including:

  • direct measurement of fear of falling
  • falls efficacy
  • balance confidence

Secondary outcome measures including:  

  • occurrence of falls
  • activity avoidance or restriction
  • depression and/or anxiety
  • cost of exercise interventions for reducing fear of falling

Publications

 
  • Completed 2013
 

FAST Parent programme

The study aimed to develop and test the feasibility of delivering a Children’s Centre based parenting programme to prevent recurrent unintentional home injuries to children aged 0-4 years; compared to normal care for such children.

Results from the FAST Parent programme

  • Mytton JA, Towner EM, Kendrick D, Stewart-Brown S, Emond A, Ingram J, Blair PS, Powell J, Mulvaney C, Thomas J, Deave T, Potter B. Inj Prev doi:10.1136/injuryprev-2012-040689
 

 

  • Funded by: National Institute for Health Research
  • Study dates: 2011-2013   
 

"Safe at Home" Evaluation

An evaluation of the Safe At Home - The National Home Safety Equipment Scheme.

Results from the Safe at Home evaluation 

 
  • Completed: 2011
 

"Child Safety Education Coalition" (CSEC) Evaluation

An evaluation of CSEC, a national coalition which is a membership organisation hosted by the Royal Society for the Prevention of Accidents (RoSPA). It was set up to “encourage and support activities which contribute to a reduction in unintended injuries to children and young people”.

Results  from the CSEC evaluation

 
  • Completed: 2011
 

REFINE

A systematic review to collect and examine high quality evidence on the effect of prescribed or provided exercise on reducing fear of falling among community dwelling older people.

More information about the REFINE study

Design

A systematic review of randomised and quasi-randomised controlled trials reporting single component interventions prescribing or providing exercise compared to routine care or “placebo” interventions which are not thought to increase exercise, and measuring fear of falling as a primary or secondary outcome measure.

The majority of the study population comprises people aged 65 years and over, and whose populations are not restricted to individuals who experience a specific condition, either at home or in places of residence that do not provide nursing care or rehabilitation.

Outcome measures

Primary outcome measures: fear of falling, including:

  • direct measurement of fear of falling
  • falls efficacy
  • balance confidence

Secondary outcome measures including:  

  • occurrence of falls
  • activity avoidance or restriction
  • depression and/or anxiety
  • cost of exercise interventions for reducing fear of falling
 
  • Completed: 2012
 

 

Injury Epidemiology and Prevention Research

The University of Nottingham


telephone: +44 (0) 115 846 6901
email:denise.kendrick@nottingham.ac.uk