9 results on '"PRASHAR, ARVIN"'
Search Results
2. An intervention to support stroke survivors and their carers in the longer term: results of a cluster randomised controlled feasibility trial (LoTS2Care).
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Forster, Anne, Ozer, Seline, Brindle, Richard, Barnard, Lorna, Hardicre, Natasha, Crocker, Thomas F., Chenery, Marie, Moreau, Lauren, Wright, Alan, Burton, Louisa-Jane, Hartley, Suzanne, Hulme, Claire, Dawkins, Bryony, Holloway, Ivana, House, Allan, Hewison, Jenny, Farrin, Amanda, on behalf of the LoTS2Care Programme Team, Atkinson, Ross, and Prashar, Arvin
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STROKE patients ,MENTAL health - Abstract
Background: To address the limited provision of longer-term stroke care, we conducted a programme of research (LoTS2Care) to develop and test an intervention to form part of a replicable longer-term care strategy. New Start, a programme of facilitated self-management, was developed to be delivered at 6 months post-stroke by trained facilitators. Here, we report the findings from the final workstream of this programme, which aimed to evaluate the feasibility and acceptability of implementing a future definitive cluster randomised controlled trial of the developed intervention (New Start) to support stroke survivors and their carers in the longer term. Methods: A feasibility cluster randomised controlled trial was conducted in English and Welsh NHS stroke services. Stroke services (clusters) were randomised on a 1:1 basis to implement New Start or continue with usual care only. Community-dwelling stroke survivors between 4 and 6 months post-stroke were invited to participate in the trial by post. Outcome measures were collected via post at 3, 6 and 9 months after recruitment. Recruitment and follow-up rates, delivery and uptake of the intervention, data collection feasibility (including postal outcome measures of health and disability, mental well-being at 3, 6, and 9 months post-recruitment) and safety were assessed. Results: Ten stroke services were recruited. A total of 1127 stroke survivors were screened for participation, and 269 were registered (New Start, n = 145; usual care, n = 124). Retention was high with 239 (89%) stroke survivors being available for follow-up at 9 months, and high return rates of postal questionnaires were achieved (80.3% at 9 months). Intervention training was successfully delivered, and New Start was offered to 95.2% of trial participants in the intervention arm. Uptake was variable, however, ranging from 11.8 to 75.0%. There were no safety concerns. Conclusions: Stroke service recruitment and longer-term stroke survivor postal recruitment and outcome data collection are feasible; however, refinement of intervention targeting and delivery is required prior to undertaking a definitive trial. Trial registration: ISRCTN38920246. Registered 22 June 2016 (http://www.isrctn.com/ISRCTN38920246). [ABSTRACT FROM AUTHOR]
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- 2023
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3. Giving older workers a voice: constraints on the employment of older people in the North West of England
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Porcellato, Lorna, Carmichael, Fiona, Hulme, Claire, Ingham, Barbara, and Prashar, Arvin
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- 2010
4. Strategies to enhance routine physical activity in care home residents: the REACH research programme including a cluster feasibility RCT
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Forster, Anne, primary, Godfrey, Mary, additional, Green, John, additional, McMaster, Nicola, additional, Airlie, Jennifer, additional, Cundill, Bonnie, additional, Lawton, Rebecca, additional, Hawkins, Rebecca, additional, Hulme, Claire, additional, Birch, Karen, additional, Brown, Lesley, additional, Cicero, Robert, additional, Crocker, Thomas Frederick, additional, Dawkins, Bryony, additional, Ellard, David R, additional, Ellwood, Alison, additional, Firth, Joan, additional, Gallagher, Bev, additional, Graham, Liz, additional, Johnson, Louise, additional, Lusambili, Adelaide, additional, Marti, Joachim, additional, McCrorie, Carolyn, additional, McLellan, Vicki, additional, Patel, Ismail, additional, Prashar, Arvin, additional, Siddiqi, Najma, additional, Trépel, Dominic, additional, Wheeler, Ian, additional, Wright, Alan, additional, Young, John, additional, and Farrin, Amanda, additional
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- 2021
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5. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT
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Forster, Anne, primary, Ozer, Seline, additional, Crocker, Thomas F, additional, House, Allan, additional, Hewison, Jenny, additional, Roberts, Elaine, additional, Dickerson, Josie, additional, Carter, Gill, additional, Hulme, Claire, additional, Fay, Matthew, additional, Richardson, Gillian, additional, Wright, Alan, additional, McKevitt, Christopher, additional, McEachan, Rosemary, additional, Foy, Robbie, additional, Barnard, Lorna, additional, Moreau, Lauren, additional, Prashar, Arvin, additional, Clarke, David, additional, Hardicre, Natasha, additional, Holloway, Ivana, additional, Brindle, Richard, additional, Hall, Jessica, additional, Burton, Louisa-Jane, additional, Atkinson, Ross, additional, Hawkins, Rebecca J, additional, Brown, Lesley, additional, Cornwall, Nicola, additional, Dawkins, Bryony, additional, Meads, David, additional, Schmitt, Laetitia, additional, Fletcher, Marie, additional, Speed, Michael, additional, Grenfell, Katie, additional, Hartley, Suzanne, additional, Young, John, additional, and Farrin, Amanda, additional
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- 2021
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6. ‘If they don't use it, they lose it’: how organisational structures and practices shape residents’ physical movement in care home settings
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HAWKINS, REBECCA J., primary, PRASHAR, ARVIN, additional, LUSAMBILI, ADELAIDE, additional, ELLARD, DAVID R., additional, and GODFREY, MARY, additional
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- 2017
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7. ‘If they don't use it, they lose it’: how organisational structures and practices shape residents’ physical movement in care home settings.
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HAWKINS, REBECCA J., PRASHAR, ARVIN, LUSAMBILI, ADELAIDE, ELLARD, DAVID R., and GODFREY, MARY
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BODY movement , *CORPORATE culture , *GROUNDED theory , *INTERVIEWING , *NURSING care facilities , *SCIENTIFIC observation , *ORGANIZATIONAL change , *ETHNOLOGY research , *QUALITATIVE research , *ORGANIZATIONAL structure , *RESIDENTIAL care , *SEDENTARY lifestyles , *PHYSICAL activity , *PSYCHOLOGY - Abstract
Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Strategies to enhance routine physical activity in care home residents: the REACH research programme including a cluster feasibility RCT
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Forster A, Godfrey M, Green J, McMaster N, Airlie J, Cundill B, Lawton R, Hawkins R, Hulme C, Birch K, Brown L, Cicero R, Crocker TF, Dawkins B, Ellard DR, Ellwood A, Firth J, Gallagher B, Graham L, Johnson L, Lusambili A, Marti J, McCrorie C, McLellan V, Patel I, Prashar A, Siddiqi N, Trépel D, Wheeler I, Wright A, Young J, and Farrin A
- Abstract
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 to engage staff and residents in increasing routine activity., Objectives: The objectives were to develop and preliminarily test strategies to enhance the routine physical activity of care home residents to improve their physical, psychological and social well-being through five overlapping workstreams., Design: This trial had a mixed-methods research design to develop and test the feasibility of undertaking an evaluative study consisting of gaining an understanding of the opportunities for and barriers to enhancing physical activity in care homes (workstream 1); testing physical activity assessment instruments (workstream 2); developing an intervention through a process of intervention mapping (workstream 3); refining the provisional intervention in the care home setting and clarifying outcome measurement (workstream 4); and undertaking a cluster randomised feasibility trial of the intervention [introduced via three facilitated workshops at baseline (with physiotherapist input), 2 weeks (with artist input) and 2 months], with embedded process and health economic evaluations (workstream 5)., Setting: The trial was set in 12 residential care homes differing in size, location, ownership and provision in Yorkshire, UK., Participants: The participants were elderly residents, carers, managers and staff of care homes., Intervention: The intervention was MoveMore, designed for the whole home, to encourage and support the movement of residents in their daily routines., Main Outcome Measures: The main outcome measures related to the feasibility and acceptability of implementing a full-scale trial in terms of recruitment and retention of care homes and residents, intervention delivery, completion and reporting of baseline data and outcomes (including hours of accelerometer wear, hours of sedentary behaviour and hours and type of physical activity), and safety and cost data (workstream 5)., Results: Workstream 1 – through a detailed understanding of life in a care home, a needs assessment was produced, and barriers to and facilitators of activity were identified. Key factors included ethos of care; organisation, management and delivery of care; use of space; and the residents’ daily routines. Workstream 2 – 22 (73.3%) out of 30 residents who wore a hip accelerometer had valid data (≥ 8 hours on ≥ 4 days of the week). Workstream 3 – practical mechanisms for increasing physical activity were developed, informed by an advisory group of stakeholders and outputs from workstreams 1 and 2, framed by the process of intervention mapping. Workstream 4 – action groups were convened in four care homes to refine the intervention, leading to further development of implementation strategies. The intervention, MoveMore, is a whole-home intervention involving engagement with a stakeholder group to implement a cyclical process of change to encourage and support the movement of residents in their daily routines. Workstream 5 – 12 care homes and 153 residents were recruited to the cluster randomised feasibility trial. Recruitment in the care homes varied (40–89%). Five care homes were randomised to the intervention and seven were randomised to usual care. Predetermined progression criteria were recruitment of care homes and residents (green); intervention delivery (amber); and data collection and follow-up – 52% of residents provided usable accelerometer data at 9 months (red), > 75% of residents had reported outcomes at 9 months (green, but self-reported resident outcomes were red), 26% loss of residents to follow-up at 9 months [just missing green criterion (no greater than 25%)] and safety concerns (green)., Limitations: Observations of residents’ movements were not conducted in private spaces. Working with care home residents to identify appropriate outcome measures was challenging. Take-up of the intervention was suboptimal in some sites. It was not possible to make a reliably informed decision on the most appropriate physical activity end point(s) for future use in a definitive trial., Conclusions: A whole-home intervention was developed that was owned and delivered by staff and was informed by residents and staff. The feasibility of conducting a cluster randomised controlled trial was successfully tested: the target numbers of care homes and residents were recruited, demonstrating that it is possible to recruit care home residents to a cluster randomised trial, although this process was time-consuming and resource heavy. A large data set was collected, which provided a comprehensive picture of the environment, residents and staff in care homes. Extensive quantitative and qualitative work comprehensively explored a neglected area of health and social care research. Completion of ethnographic work in a range of settings enabled the production of an in-depth picture of life in care homes that will be helpful for other researchers considering organisational change in this setting., Future Work: The content and delivery of the intervention requires optimisation and the outcome measurement requires further refinement prior to undertaking a full trial evaluation. Consideration could be given to a recommended, simplified, core outcome set, which would facilitate data collection in this population., Trial Registration: Current Controlled Trials ISRCTN16076575., Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research programme and will be published in full in Programme Grant for Applied Research ; Vol. 9, No. 9. See the NIHR Journals Library website for further project information., (Copyright © Queen’s Printer and Controller of HMSO 2021. This work was produced by Forster et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.)
- Published
- 2021
- Full Text
- View/download PDF
9. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT
- Author
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, and Farrin A
- Abstract
Background: It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified., Objectives: The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations)., Design: Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales., Setting: The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales., Participants: Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services., Data Sources: Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified., Intervention: Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks., Results: A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains., Conclusions: We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation., Future Work: Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation., Trial Registration: Current Controlled Trials ISRCTN38920246., Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 9, No. 3. See the NIHR Journals Library website for further project information., (Copyright © Queen’s Printer and Controller of HMSO 2021. This work was produced by Forster et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.)
- Published
- 2021
- Full Text
- View/download PDF
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