Strategies to enhance routine physical activity in care home residents: the REACH research programme including a cluster feasibility RCT

• DOI: 10.3310/pgfar09090
• Publication Date: 2021-08-23T13:45:25Z
• Authors: Anne Forster; Mary Godfrey; John Green; Nicola McMaster; Jennifer Airlie; Bonnie Cundill; Rebecca Lawton; Rebecca Hawkins; Claire Hulme; Karen Birch; Lesley Brown; Robert Cicero; Thomas Frederick ...; Bryony Dawkins; David R Ellard; Alison Ellwood; Joan Firth; Bev Gallagher; Liz Graham; Louise Johnson; Adelaide Lusambili; Joachim Marti; Carolyn McCrorie; Vicki McLellan; Ismail Patel; Arvin Prashar; Najma Siddiqi; Dominic Trépel; Ian Wheeler; Alan Wright; John Young; Amanda Farrin
• Keywords: feasibility studies; organisational culture; 610; physical activity; residential care; complex intervention; aged; 03 medical and health sciences; 0302 clinical medicine; sedentary behaviour; accelerometry; Public aspects of medicine; RA1-1270; activities of daily living; cluster randomised controlled trial

Background Care home residents are mainly inactive, leading to increased dependency and low mood. Although exercise classes may increase activity, a more sustainable model is engage staff in increasing routine activity. Objectives The objectives were develop preliminarily test strategies enhance the physical activity of care improve their physical, psychological social well-being through five overlapping workstreams. Design This trial had mixed-methods research design feasibility undertaking an evaluative study consisting gaining understanding opportunities for barriers enhancing homes (workstream 1); testing assessment instruments 2); developing intervention process mapping 3); refining provisional setting clarifying outcome measurement 4); cluster randomised [introduced via three facilitated workshops at baseline (with physiotherapist input), 2 weeks artist input) months], with embedded health economic evaluations 5). Setting was set 12 residential differing size, location, ownership provision Yorkshire, UK. Participants participants elderly residents, carers, managers homes. Intervention MoveMore, designed whole home, encourage support movement daily routines. Main measures main related acceptability implementing full-scale terms recruitment retention delivery, completion reporting data outcomes (including hours accelerometer wear, sedentary behaviour type activity), safety cost Results Workstream 1 – detailed life needs produced, facilitators identified. Key factors included ethos care; organisation, management delivery use space; residents’ 22 (73.3%) out 30 who wore hip valid (≥ 8 on ≥ 4 days week). 3 practical mechanisms developed, informed by advisory group stakeholders outputs from workstreams 2, framed mapping. action groups convened four refine intervention, further development implementation strategies. whole-home involving engagement stakeholder implement cyclical change 5 153 recruited trial. Recruitment varied (40–89%). Five seven usual care. Predetermined progression criteria (green); (amber); collection follow-up 52% provided usable 9 months (red), > 75% reported (green, but self-reported resident red), 26% loss [just missing green criterion (no greater than 25%)] concerns (green). Limitations Observations movements not conducted private spaces. Working identify appropriate challenging. Take-up suboptimal some sites. It possible make reliably decision most end point(s) future definitive Conclusions A developed that owned delivered staff. conducting controlled successfully tested: target numbers recruited, demonstrating it recruit trial, although this time-consuming resource heavy. large collected, which comprehensive picture environment, Extensive quantitative qualitative work comprehensively explored neglected area research. Completion ethnographic range settings enabled production in-depth will be helpful other researchers considering organisational setting. Future content requires optimisation refinement prior full evaluation. Consideration could given recommended, simplified, core set, would facilitate population. Trial registration Current Controlled Trials ISRCTN16076575. Funding project funded National Institute Health Research (NIHR) Programme Grant Applied programme published ; Vol. 9, No. 9. See NIHR Journals Library website information.