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An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study.
Health Technol Assess. 2019 10; 23(59):1-208.HT

Abstract

BACKGROUND

Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS.

OBJECTIVES

To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention.

DESIGN

This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted.

SETTING

This study was set in the community.

PARTICIPANTS

The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia.

INTERVENTIONS

This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks.

MAIN OUTCOME MEASURES

(1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden).

RESULTS

A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful.

CONCLUSIONS

The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.

Authors+Show Affiliations

University of Exeter Medical School, University of Exeter, Exeter, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK.Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Norwich Medical School, University of East Anglia, Norwich, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.VOICE, Newcastle University, Newcastle upon Tyne, UK.Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.

Pub Type(s)

Clinical Trial
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31661058

Citation

Allan, Louise M., et al. "An Intervention to Improve Outcomes of Falls in Dementia: the DIFRID Mixed-methods Feasibility Study." Health Technology Assessment (Winchester, England), vol. 23, no. 59, 2019, pp. 1-208.
Allan LM, Wheatley A, Smith A, et al. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess. 2019;23(59):1-208.
Allan, L. M., Wheatley, A., Smith, A., Flynn, E., Homer, T., Robalino, S., Beyer, F. R., Fox, C., Howel, D., Barber, R., Connolly, J. A., Robinson, L., Parry, S. W., Rochester, L., Corner, L., & Bamford, C. (2019). An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technology Assessment (Winchester, England), 23(59), 1-208. https://doi.org/10.3310/hta23590
Allan LM, et al. An Intervention to Improve Outcomes of Falls in Dementia: the DIFRID Mixed-methods Feasibility Study. Health Technol Assess. 2019;23(59):1-208. PubMed PMID: 31661058.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. AU - Allan,Louise M, AU - Wheatley,Alison, AU - Smith,Amy, AU - Flynn,Elizabeth, AU - Homer,Tara, AU - Robalino,Shannon, AU - Beyer,Fiona R, AU - Fox,Christopher, AU - Howel,Denise, AU - Barber,Robert, AU - Connolly,Jim Anthony, AU - Robinson,Louise, AU - Parry,Steve Wayne, AU - Rochester,Lynn, AU - Corner,Lynne, AU - Bamford,Claire, PY - 2019/10/30/entrez PY - 2019/10/30/pubmed PY - 2020/9/29/medline KW - ACCIDENTAL FALLS KW - DEMENTIA KW - HEALTH SERVICES NEEDS AND DEMAND KW - INTERVENTIONS KW - PILOTS KW - PROSPECTIVE STUDIES SP - 1 EP - 208 JF - Health technology assessment (Winchester, England) JO - Health Technol Assess VL - 23 IS - 59 N2 - BACKGROUND: Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES: To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN: This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING: This study was set in the community. PARTICIPANTS: The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS: This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES: (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS: A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS: The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information. SN - 2046-4924 UR - https://www.unboundmedicine.com/medline/citation/31661058/An_intervention_to_improve_outcomes_of_falls_in_dementia:_the_DIFRID_mixed_methods_feasibility_study_ L2 - https://doi.org/10.3310/hta23590 DB - PRIME DP - Unbound Medicine ER -