• Achieving ecological validity of occupation-based interventions for healthy aging

      Orellano-Colon, E.M.; Varas-Diaz, N.; Bernal, G.; Mountain, Gail (2014-12)
      Aim: To develop a culturally sensitive occupation-based health promotion intervention for older Hispanic adults who live alone. Methods: We used a mixed method design for the content validation of the intervention and the Ecological Validity Model (EVM) to culturally center the intervention. In the quantitative phase, aging experts as well as community members from two activity centers for the elderly in Puerto Rico completed a content validity ratio exercise. In the qualitative phase, we conducted three focus groups with these participants. Data analysis included content validity ratio and a directed content analysis. Results: This resulted in a working version of the intervention protocol addressing the eight dimensions of the EVM. Conclusions: The EVM can be used to culturally center preventive interventions to other ethnic minority groups to augment the external validity and cultural competence of interventions. Future research must test the feasibility of this new intervention.
    • Adopt a care home: an intergenerational initiative bringing children into care homes

      Di Bona, L.; Kennedy, S.; Mountain, Gail (2019-07)
      Dementia friendly communities, in which people living with dementia actively participate and those around them are educated about dementia, may improve the wellbeing of those living with dementia and reduce the associated stigma. The Adopt a Care Home scheme aims to contribute towards this by teaching schoolchildren about dementia and linking them with people living with dementia in a local care home. Forty-one children, ten people living with dementia and eight school / care home staff participated in a mixed methods (questionnaires, observations, interviews and focus groups) evaluation to assess the scheme’s feasibility and impact. Data were analysed statistically and thematically. The scheme was successfully implemented, increased children’s dementia awareness and appeared enjoyable for most participants. Findings, therefore, demonstrate the scheme’s potential to contribute towards dementia friendly communities by increasing children’s knowledge and understanding of dementia and engaging people living with dementia in an enjoyable activity, increasing their social inclusion.
    • Alzheimer Europe's position on involving people with dementia in research through PPI (patient and public involvement)

      Gove, Dianne M.; Diaz-Ponce, A.; Georges, J.; Moniz-Cook, E.; Mountain, Gail; Chattat, R.; Øksnebjerg, L.; The European Working Group of People with Dementia (2017)
      This paper reflects Alzheimer Europe’s position on PPI (patient and public involvement) in the context of dementia research and highlights some of the challenges and potential risks and benefits associated with such meaningful involvement. The paper was drafted by Alzheimer Europe in collaboration with members of INTERDEM and the European Working Group of People with Dementia. It has been formally adopted by the Board of Alzheimer Europe and endorsed by the Board of INTERDEM and by the JPND working group ‘Dementia Outcome Measures - Charting New Territory’. Alzheimer Europe is keen to promote the involvement of people with dementia in research, not only as participants but also in the context of PPI, by generating ideas for research, advising researchers, being involved in consultations and being directly involved in research activities. This position paper is in keeping with this objective. Topics covered include, amongst others, planning involvement, establishing roles and responsibilities, training and support, managing information and input from PPI, recognising the contribution of people with dementia involved in research in this way, promoting and protecting the rights and well-being of people with dementia, training and support, and promoting an inclusive approach and the necessary infrastructure for PPI in dementia research.
    • Assistive technology: creating and engaging collaborative communities

      Bangar, S.; Mountain, Gail; Cudd, P. (2015)
      This paper outlines the remit of the UK Engineering and Physical Sciences Research Council KT-EQUAL (Knowledge Transfer for Extending Quality of Life for older and disabled people) programme. Case examples drawing on the range of activities undertaken by KT-EQUAL highlight where assistive technology developments have been facilitated, the value of network activities and an underpinning model of engagement and collaboration. Given an increasing emphasis on the impact of research the model and innovative approaches deployed by KT-EQUAL are even more crucial in future developments which aim to ensure that research can be used to benefit society.
    • Community ageing research 75+ study (CARE75+): an experimental ageing and frailty research cohort

      Heaven, A.; Brown, L.; Young, J.; Teale, E.; Hawkins, R.; Spilsbury, K.; Mountain, Gail; Young, T.; Goodwin, V.; Hanratty, B.; et al. (2019-03)
      Introduction The Community Ageing Research 75+ Study (CARE75+) is a longitudinal cohort study collecting an extensive range of health, social and economic data, with a focus on frailty, independence and quality of life in older age. CARE75+ is the first international experimental frailty research cohort designed using Trial within Cohorts (TwiCs) methodology, to align applied epidemiological research with clinical trial evaluation of interventions to improve the health and well-being of older people living with frailty. Methods and analysis Prospective cohort study using a TwiCs design. One thousand community-dwelling older people (≥75 years) will be recruited from UK general practices. Nursing home residents, those with an estimated life expectancy of 3 months or less and people receiving palliative care will be excluded. Data collection assessments will be face to face in the person’s home at baseline, 6 months, 12 months, 24 months and 48 months, including assessments of frailty, cognition, mood, health-related quality of life, comorbidity, medications, resilience, loneliness, pain and self-efficacy. A modified protocol for follow-up by telephone or web based will be offered at 6 months. Consent will be sought for data linkage and invitations to additional studies, including intervention studies using the TwiCs design. A blood sample biobank will be established for future basic science studies. Ethics and dissemination CARE75+ was approved by the NRES Committee Yorkshire and the Humber—Bradford Leeds 10 October 2014 (14/YH/1120). Formal written consent is sought if an individual is willing to participate and has capacity to provide informed consent. Consultee assent is sought if an individual lacks capacity. Study results will be disseminated in peer-reviewed scientific journals and scientific conferences. Key study results will be summarised and disseminated to all study participants via newsletters, local older people’s publications and local engagement events. Results will be reported on a bespoke CARE75+ website.
    • Community occupational therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID] programme): study protocol for a randomised controlled trial

      Wenborn, J.; Hynes, S.M.; Moniz-Cook, E.; Mountain, Gail; Poland, F.; King, M.; Omar, R.Z.; Morris, S.; Vernooij-Dassen, M.; Challis, D.; et al. (2016-02-03)
      Background A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. Methods/Design This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40 % of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists. Discussion COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK.
    • Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study

      Fitzsimmons, D.A.; Thompson, J.; Bentley, C.L.; Mountain, Gail (2016-08-22)
      Background: The increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation. Methods: Patients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services. Results: Seven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service. Conclusions: Although recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.
    • Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations

      Chatters, R.; Newbould, L.; Sprange, K.; Hind, D.; Mountain, Gail; Shortland, K.; Powell, L.; Gossage-Worrall, R.; Chater, T.; Keetharuth, A.; et al. (2018-02)
      Background: Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research.
    • Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations

      Webster, L.; Groskreutz, D.; Grinbergs-Saull, A.; Howard, R.; O'Brien, J.T.; Mountain, Gail; Banerjee, S.; Woods, B.; Perneczky, R.; Lafortune, L.; et al. (2017-06-29)
      There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia. We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification. Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties. This is the first review to identify the 81 outcome measures the research community uses for disease-modifying trials in mild-to-moderate dementia. Our recommendations will facilitate designing, comparing and meta-analysing disease modification trials in mild-to-moderate dementia, increasing their value.
    • A Core Outcome Set For Disease Modification Trials In Mild-To-Moderate Dementia: A Systematic Review And Consensus Recommendations

      Webster, L.; Groskreutz, D.; Grinbergs-Saull, A.; Howard, R.; O'Brien, J.T.; Mountain, Gail; Banerjee, S.; Woods, B.; Perneczky, R.; Lafortune, L.; et al. (2017)
    • Dementia care mapping in long-term care settings: a systematic review of the evidence

      Barbosa, Ana; Lord, Kathryn; Blighe, Alan J.; Mountain, Gail (2017-10)
      This systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings. The review was limited to studies that used Dementia Care Mapping as an intervention and included outcomes involving either care workers and/or people living with dementia. Searches were conducted in PubMed, Web of Knowledge, CINAHL, PsychINFO, EBSCO and Scopus and manually from identified articles reference lists. Studies published up to January 2017 were included. Initial screening of identified papers was based on abstracts read by one author; full-text papers were further evaluated by a second author. The quality of the identified papers was assessed independently by two authors using the Cochrane Risk of Bias Tool. A narrative synthesis of quantitative findings was conducted. We identified 6 papers fulfilling predefined criteria. Studies consist of recent, large scale, good quality trials that had some positive impacts upon care workers’ stress and burnout and benefit people with dementia in terms of agitated behaviours, neuropsychiatric symptoms, falls and quality of life. Available research provides preliminary evidence that Dementia Care Mapping may benefit care workers and people living with dementia in care settings. Future research should build on the successful studies to date and use other outcomes to better understand the benefits of this intervention.
    • Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project

      Amirabdollahian, F.; Ates, S.; Basteris, A.; Cesario, A.; Buurke, J.H.; Hermens, H.J.; Hofs, D.; Johansson, E.; Mountain, Gail; Nasr, N.; et al. (2014-12)
      Changes in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one’s home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy. Objective: this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke. Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient’s exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation. Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability. Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction.
    • Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations

      Webster, L.; Groskreutz, D.; Grinbergs-Saull, A.; Howard, R.; O'Brien, J.T.; Mountain, Gail; Banerjee, S.; Woods, B.; Perneczky, R.; Lafortune, L.; et al. (2017-05)
      We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification.
    • Does telehealth monitoring identify exacerbations of chronic pulmonary disease and reduce hospitalisations? An analysis of systems data

      Kargiannakis, M.; Fitzsimmons, D.A.; Bentley, C.L.; Mountain, Gail (2017-03-22)
      Background: The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective: The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods: A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention. Results: Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions: It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home.
    • Enablers and challenges to occupational therapists’ research engagement: A qualitative study

      Di Bona, L.; Wenborn, J.; Field, B.; Hynes, S.M.; Ledgerd, R.; Mountain, Gail; Swinson, T. (2017-08)
      Introduction: To develop occupational therapy’s evidence base and improve its clinical outcomes, occupational therapists must increase their research involvement. Barriers to research consumption and leadership are well documented, but those relating to delivering research interventions, less so. Yet, interventions need to be researched within practice to demonstrate their clinical effectiveness. This study aims to improve understanding of challenges and enablers experienced by occupational therapists who deliver interventions within research programmes. Method: Twenty-eight occupational therapists who participated in the Valuing Active Life in Dementia (VALID) research programme reported their experiences in five focus groups. Data were analysed thematically to identify key and subthemes. Results: Occupational therapists reported that overwhelming paperwork, use of videos, recruitment and introducing a new intervention challenged their research involvement, whereas support, protected time and a positive attitude enabled it. The impact of these challenges and enablers varied between therapists and organisations. Conclusion: Challenges and enablers to research involvement can be identified but must be addressed within individual and organisational contexts. Multifaceted collective action to minimise challenges and maximise enablers can facilitate clinicians’ involvement in research. Using this approach should enable occupational therapists to increase their research involvement, thus demonstrating the clinical effectiveness of their interventions.
    • Environmental restrictors to occupational participation in old age: exploring differences across gender in Puerto Rico

      Orellano-Colon, E.M.; Mountain, Gail; Rosario, M.; Colon, Z.M.; Acevedo, S.; Tirado, J. (2015-09-10)
      Many older adults face challenges that prevent them from accomplishing common daily activities such as moving around, home maintenance, and leisure activities. There is still a need to examine and understand how environmental factors impact daily participation across gender. This study sought to make a qualitative comparison of gender differences regarding environmental barriers to participation in daily occupations from the perspectives of older adults who live alone in Puerto Rico. Twenty-six Hispanic older adults, 70 years or older participated in this study. We used a descriptive qualitative research design in which researchers administered an in-depth interview to each participant. The results elucidated that women were more likely than men to experience restricted participation due to lack of accessibility of the built environment and transportation systems. The findings could help with the development of tailored, occupation-based, preventive interventions that address gender specific environmental barriers and promote greater participation among both women and men. Further research is required to explore whether these environmental barriers to occupational participation remain consistent across living situations, socioeconomic status and ethnicity.
    • Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption

      Taylor, J.; Coates, E.; Brewster, L.; Mountain, Gail; Wessels, B.; Hawley, M.S. (2015-02)
      Aims To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Background The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012–June 2013. Findings Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions The mainstreaming of telehealth hinges on clinical ‘buy-in’. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice.
    • The experience of living with stroke and using technology: opportunities to engage and co-design with end users

      Nasr, N.; Leon, B.; Mountain, Gail; Nijenhuis, S.M.; Prange, G.B.; Sale, P.; Amirabdollahian, F. (2016)
      Purpose: We drew on an interdisciplinary research design to examine stroke survivors’ experiences of living with stroke and with technology in order to provide technology developers with insight into values, thoughts and feelings of the potential users of a to-be-designed robotic technology for home-based rehabilitation of the hand and wrist. Method: Ten stroke survivors and their family carers were purposefully selected. On the first home visit, they were introduced to cultural probe. On the second visit, the content of the probe packs were used as prompt to conduct one-to-one interviews with them. The data generated was analysed using thematic analysis. A third home visit was conducted to evaluate the early prototype. Results: User requirements were categorised into their network of relationships, their attitude towards technology, their skills, their goals and motivations. The user requirements were used to envision the requirements of the system including providing feedback on performance, motivational aspects and usability of the system. Participants’ views on the system requirements were obtained during a participatory evaluation. Conclusion: This study showed that prior to the development of technology, it is important to engage with potential users to identify user requirements and subsequently envision system requirements based on users’ views.
    • Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

      Nijenhuis, S.M.; Prange, G.B.; Amirabdollahian, F.; Sale, P.; Infarinato, F.; Nasr, N.; Mountain, Gail; Hermens, H.J.; Stienen, A.H.A.; Buurke, J.H.; et al. (2015-10-09)
      Background: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings.
    • Future of an ageing population evidence review; Developing medical fitness and wellbeing environments to maintain health and wellbeing over the lifecourse

      Mountain, Gail; Gomersall, T.; Taylor, J. (2015-07-20)
      Background and methods This report is derived from a review of the research evidence on physical activity interventions and initiatives, interventions to support self-management/ self-care of long-term conditions and digitally enabled care services and technologies. The aim was to use existing evidence to envision future services and associated infrastructure. The Evidence Review involved scoping the literature for topics researched and to determine the nature of that research. Rapid-scoping review methods were applied to trusted sources, and searches for specific key texts were conducted. A separate search was conducted to identify literature relevant to each domain. A narrative was then produced from the review findings. Review findings The evidence base for physical activity interventions is growing. There has been significant recent investment in the development and evaluation of interventions to promote activity and reduce sedentary behaviour at the individual, community and population levels. The evidence to link higher levels of physical activity to positive health outcomes and disease prevention is convincing, both in ‘well’ populations and in those with long-term health conditions. Self-management interventions are heterogeneous in nature but common elements exist across the majority of them. The consensus in the literature is that self-management will become increasingly important due to unsustainable demands upon services. Evaluation of selfmanagement interventions reveals a small but varying effect across a wide range of outcomes. However, little is known about the mechanisms by which these interventions work and how these might vary across differing conditions and populations. Technology is being increasingly used to support service delivery in a wide range of contexts, and for the delivery of a variety of interventions including fitness and self-management. There is strong evidence supporting the use of technology for remote monitoring of people with longterm conditions, but further research is required. Implications Digital applications are already altering established patterns of service delivery. The findings presented here reveal varying results of efficacy which do not accord with the optimistic future described in various envisaging reports. Research has yet to consider unwanted and unforeseen effects of moving towards technology-enabled services. It is also important to consider how to effectively harness new health data emerging from the use of eHealth systems, technology-enabled services and health-tracking devices. There is an ongoing requirement to evaluate new technologies and technology-enabled services in ways that provide both timely and robust answers, particularly as technology development is a continually moving target. These considerations are discussed in this report.