Bathing Adaptations in the Homes of Older Adults: A feasibility RCT and qualitative interview study (The BATH-OUT Study)
Falls in Care Homes (FinCH) - Trial
Falls in Care Homes - Feasibility study
A two year feasibility study looking at the Guide to Action to prevent falls in Care Homes (GtACH) tool in care homes. Check-in
People fall, more specifically one third of the UK’s hip fractures occur in care homes due to a fall, which is devastating to the patient, the carers and costly to the NHS.
Our research team has developed and published a falls prevention intervention called the Guide to Action to prevent falls in Care Homes (GtACH) but it has not been tested to see if it can prevent falls without restricting liberty.
Wynne Williams – manager of Church Farm Nursing Home – talks about her involvement in the FICH study
We will be trialling the Guide to Action for falls prevention in Care Homes (GtACH) tool with residents and evaluating the research processes to determine the possibility of running a larger study in the future to answer primarily the question: "Does the GtACH reduce falls in care homes?". We aim to recruit 68 care home residents from six care homes in Nottingham.
A range of methods have been employed to identify important study outcomes namely; questionnaires, interviews and tri-axial accelerometers.
The study also welcomes opinions and advice from the public, service users and staff throughout the conduct of the trial.
- Study dates: 2012-2014
- Funders: NIHR Research for Patient Benefit award
- Principle investigator/contact: Professor Pip Logan
Regaining confidence after stroke (RCAS)
People with stroke often lose their confidence and have low mood. We aim to help these people regain their confidence and hope this will result in an engagement with treatment, increased participation in activities, improved chance of working and a reduced reliance on social care services.
We have interviewed patients to explore the meaning of confidence, we are designing a confidence questionnaire and are evaluating a group intervention.
Getting older people out of hospital earlier (CIRACT)
In this randomised controlled trial we are using a community based rehabilitation team to come into the acute hospital and pull medically stable patients out of hospital and back to their home continuing treatment at home.
We are comparing the results to routine care.
Improving health outcomes for people with a fractured neck of femur (FEMuR)
We are working with a team based in Wales who are exploring the best way to provide rehabilitation for people who have fallen and fractured their neck of femur.
We will use published literature, a survey, a cohort study and clinical experts to develop an intervention.
Balance and the Mind
Developing and evaluating treatments for the risk to balance and gait from cognitive impairment through a focus on "executive function".
The physical and psychological consequences of falls contribute to the many problems facing people with dementia. People with dementia are at least twice as likely to fall as those without it.
Half of people who fracture their hip after a fall have dementia. Fear of falling also leads to anxiety. Restrictive responses to the risk of falls may threaten autonomy and quality of life.
Great progress has been made in falls prevention in older people through interventions such as the treatment of associated medical conditions, strength and balance training, and environmental modification. But it seems that these interventions either do not work or are insufficient for people with dementia.
This is likely to be because cognitive impairment itself is a major fall risk factor for which there is currently no proven treatment, and because cognitive impairment interferes with the delivery of existing treatments.
In “The Balanced Mind”, we aim to develop and evaluate treatments for the risk to balance and gait from cognitive impairment through a focus on “executive function” – the mental control and moderation of gait and balance.
We also aim to modify existing falls treatments so that they are appropriate for people with problems following instructions or remembering them.
Our initial work aims to measure falls risk factors and prevalence in people with early dementia, and understand the perspectives of people with dementia and their carers about the feasibility and acceptability of falls prevention treatments.
We will also develop a new set of fall prevention treatments and approaches suitable for people with dementia.
- Study dates: 2012-2014
- Funders: NIHR Programme Development Grant, Nottingham University Hospitals Research &Innovation funding, and Nottingham University Hospitals Charitable Funds
- Co-investigator/contact: Professor Pip Logan
A selection of our past studies are listed below:
Getting out of the house after stroke
A randomised controlled trial to test if an occupational therapy treatment package could be used to overcome the problems faced by people with stroke who cannot get out of the house.
The result was that people having occupational therapy did get out of the house more often.
- Logan PA, Gladman JRF, Dyas J. An interview study of the use of transport by people who have had a stroke. Clinical Rehabilitation 2004:18:703-708.
- Logan PA, Gladman JRF, Avery AJ, Walker MF, Dyas J, Groom L. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. BMJ 2004;329:1372-1375.
- Logan P, Walker MF, Gladman JRF. Description of an occupational therapy intervention aimed at improving outdoor mobility. Br J OT 2006;69:2-6.
Getting out of the house after stroke - a multi-centre RCT
This research followed on from an earlier single centre study of the same name.
This large rehabilitation study was a multi centre randomised controlled trial to evaluate a rehabilitation intervention aimed at improving outdoor mobility for people who have had a stroke.
Eight centres agreed to take part: Nottingham City, Nottinghamshire County, Lincoln, Gateshead, Lanarkshire, Wolverhampton, North Somerset, Kent.
676 people who have had stroke took part and half of these were randomly allocated to receive the rehabilitation.
We measured whether the rehabilitation improves people’s quality of life, permits them to take more journeys and to perform more activities of daily living.
An economic evaluation of the intervention was undertaken.
Falls prevention in patients who call an ambulance because of a fall and who are not transported to hospital
Large numbers of people fall at home and call an ambulance as a result. Frequently, they are not taken to hospital by patient consent or insistence. Typically, no further action is taken, and often the falls recur. She postulated that a community falls prevention service might be both effective and acceptable.
Working with the East Midlands Ambulance Service and the community falls prevention teams in the Nottingham area, we conducted a RCT with an integral economic study.
We found that referral of these patients by the ambulance service to the community falls prevention team led to a large fall in the rate of falls. This was not achieved by restricting the activity of the older people – on the contrary the service led to increased levels of activities of daily living. Better still, the service led to lower levels of fear of falling, which can be as distressing as the physical consequences of falling.
- "Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial." Phillipa A Logan, C A C Coupland, J R F Gladman, O Sahota, V Stoner-Hobs, K Robertson, V Tomlinson, M Ward, T Sach and A J Avery, BMJ 2010;340:c2102, doi: 10.1136/bmj.c2102.