Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation
Identifieur interne : 000320 ( Main/Exploration ); précédent : 000319; suivant : 000321Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation
Auteurs : David R. Ellard [Royaume-Uni] ; Margaret Thorogood [Royaume-Uni] ; Martin Underwood [Royaume-Uni] ; Clive Seale [Royaume-Uni] ; Stephanie Jc Taylor [Royaume-Uni]Source :
- BMC Medicine ; 2014.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Depression (epidemiology), Depression (psychology), Depression (therapy), Early Medical Intervention (methods), Early Medical Intervention (standards), England (epidemiology), Exercise Therapy (methods), Exercise Therapy (psychology), Exercise Therapy (standards), Female, Follow-Up Studies, Home Care Services (standards), Humans, Male, Patient Participation (methods), Patient Participation (psychology), Process Assessment (Health Care) (methods), Process Assessment (Health Care) (standards), Treatment Outcome.
- MESH :
- geographic , epidemiology : England.
- epidemiology : Depression.
- methods : Early Medical Intervention, Exercise Therapy, Patient Participation, Process Assessment (Health Care).
- psychology : Depression, Exercise Therapy, Patient Participation.
- standards : Early Medical Intervention, Exercise Therapy, Home Care Services, Process Assessment (Health Care).
- therapy : Depression.
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Treatment Outcome.
Abstract
The ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect.
The OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known.
Homes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises.
The intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms.
Url:
DOI: 10.1186/1741-7015-12-1
PubMed: 24386900
PubMed Central: 3882778
Affiliations:
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Ellard</name><affiliation wicri:level="1"><nlm:aff id="I1">Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Thorogood, Margaret" sort="Thorogood, Margaret" uniqKey="Thorogood M" first="Margaret" last="Thorogood">Margaret Thorogood</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Underwood, Martin" sort="Underwood, Martin" uniqKey="Underwood M" first="Martin" last="Underwood">Martin Underwood</name><affiliation wicri:level="1"><nlm:aff id="I1">Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Seale, Clive" sort="Seale, Clive" uniqKey="Seale C" first="Clive" last="Seale">Clive Seale</name><affiliation wicri:level="1"><nlm:aff id="I3">Brunel University, Uxbridge, London UB8 3PH, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brunel University, Uxbridge, London UB8 3PH</wicri:regionArea><wicri:noRegion>London UB8 3PH</wicri:noRegion></affiliation></author><author><name sortKey="Taylor, Stephanie Jc" sort="Taylor, Stephanie Jc" uniqKey="Taylor S" first="Stephanie Jc" last="Taylor">Stephanie Jc Taylor</name><affiliation wicri:level="4"><nlm:aff id="I4">Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24386900</idno><idno type="pmc">3882778</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882778</idno><idno type="RBID">PMC:3882778</idno><idno type="doi">10.1186/1741-7015-12-1</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000C97</idno><idno type="wicri:Area/Pmc/Curation">000C97</idno><idno type="wicri:Area/Pmc/Checkpoint">000085</idno><idno type="wicri:source">PubMed</idno><idno type="wicri:Area/PubMed/Corpus">000182</idno><idno type="wicri:Area/PubMed/Curation">000182</idno><idno type="wicri:Area/PubMed/Checkpoint">000134</idno><idno type="wicri:Area/Ncbi/Merge">000B62</idno><idno type="wicri:Area/Ncbi/Curation">000B62</idno><idno type="wicri:Area/Ncbi/Checkpoint">000B62</idno><idno type="wicri:Area/Main/Merge">000309</idno><idno type="wicri:Area/Main/Curation">000320</idno><idno type="wicri:Area/Main/Exploration">000320</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation</title><author><name sortKey="Ellard, David R" sort="Ellard, David R" uniqKey="Ellard D" first="David R" last="Ellard">David R. Ellard</name><affiliation wicri:level="1"><nlm:aff id="I1">Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Thorogood, Margaret" sort="Thorogood, Margaret" uniqKey="Thorogood M" first="Margaret" last="Thorogood">Margaret Thorogood</name><affiliation wicri:level="1"><nlm:aff id="I2">Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Underwood, Martin" sort="Underwood, Martin" uniqKey="Underwood M" first="Martin" last="Underwood">Martin Underwood</name><affiliation wicri:level="1"><nlm:aff id="I1">Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL</wicri:regionArea><wicri:noRegion>Coventry CV4 7AL</wicri:noRegion></affiliation></author><author><name sortKey="Seale, Clive" sort="Seale, Clive" uniqKey="Seale C" first="Clive" last="Seale">Clive Seale</name><affiliation wicri:level="1"><nlm:aff id="I3">Brunel University, Uxbridge, London UB8 3PH, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brunel University, Uxbridge, London UB8 3PH</wicri:regionArea><wicri:noRegion>London UB8 3PH</wicri:noRegion></affiliation></author><author><name sortKey="Taylor, Stephanie Jc" sort="Taylor, Stephanie Jc" uniqKey="Taylor S" first="Stephanie Jc" last="Taylor">Stephanie Jc Taylor</name><affiliation wicri:level="4"><nlm:aff id="I4">Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></analytic><series><title level="j">BMC Medicine</title><idno type="e-ISSN">1741-7015</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Depression (epidemiology)</term><term>Depression (psychology)</term><term>Depression (therapy)</term><term>Early Medical Intervention (methods)</term><term>Early Medical Intervention (standards)</term><term>England (epidemiology)</term><term>Exercise Therapy (methods)</term><term>Exercise Therapy (psychology)</term><term>Exercise Therapy (standards)</term><term>Female</term><term>Follow-Up Studies</term><term>Home Care Services (standards)</term><term>Humans</term><term>Male</term><term>Patient Participation (methods)</term><term>Patient Participation (psychology)</term><term>Process Assessment (Health Care) (methods)</term><term>Process Assessment (Health Care) (standards)</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>England</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Depression</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Early Medical Intervention</term><term>Exercise Therapy</term><term>Patient Participation</term><term>Process Assessment (Health Care)</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Depression</term><term>Exercise Therapy</term><term>Patient Participation</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Early Medical Intervention</term><term>Exercise Therapy</term><term>Home Care Services</term><term>Process Assessment (Health Care)</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Depression</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect.</p></sec><sec><title>Methods</title><p>The OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known.</p></sec><sec><title>Results</title><p>Homes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises.</p></sec><sec><title>Conclusions</title><p>The intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Llewellyn Jones, Rh" uniqKey="Llewellyn Jones R">RH Llewellyn-Jones</name></author><author><name sortKey="Baikie, Ka" uniqKey="Baikie K">KA Baikie</name></author><author><name sortKey="Smithers, H" uniqKey="Smithers H">H Smithers</name></author><author><name sortKey="Cohen, J" uniqKey="Cohen J">J Cohen</name></author><author><name sortKey="Snowdon, J" uniqKey="Snowdon J">J Snowdon</name></author><author><name sortKey="Tennant, Cc" uniqKey="Tennant C">CC Tennant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mann, Ah" uniqKey="Mann A">AH Mann</name></author><author><name sortKey="Graham, N" uniqKey="Graham N">N Graham</name></author><author><name sortKey="Ashby, D" 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uniqKey="Cooney G">GM Cooney</name></author><author><name sortKey="Dwan, K" uniqKey="Dwan K">K Dwan</name></author><author><name sortKey="Greig, Ca" uniqKey="Greig C">CA Greig</name></author><author><name sortKey="Lawlor, Da" uniqKey="Lawlor D">DA Lawlor</name></author><author><name sortKey="Rimer, J" uniqKey="Rimer J">J Rimer</name></author><author><name sortKey="Waugh, Fr" uniqKey="Waugh F">FR Waugh</name></author><author><name sortKey="Mcmurdo, M" uniqKey="Mcmurdo M">M McMurdo</name></author><author><name sortKey="Mead, Ge" uniqKey="Mead G">GE Mead</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement><orgName><li>Université de Londres</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Ellard, David R" sort="Ellard, David R" uniqKey="Ellard D" first="David R" last="Ellard">David R. Ellard</name></noRegion><name sortKey="Seale, Clive" sort="Seale, Clive" uniqKey="Seale C" first="Clive" last="Seale">Clive Seale</name><name sortKey="Taylor, Stephanie Jc" sort="Taylor, Stephanie Jc" uniqKey="Taylor S" first="Stephanie Jc" last="Taylor">Stephanie Jc Taylor</name><name sortKey="Thorogood, Margaret" sort="Thorogood, Margaret" uniqKey="Thorogood M" first="Margaret" last="Thorogood">Margaret Thorogood</name><name sortKey="Underwood, Martin" sort="Underwood, Martin" uniqKey="Underwood M" first="Martin" last="Underwood">Martin Underwood</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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