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ATTILA – Assistive Technology and Telecare to maintain Independent Living At home for people with dementia

It has been estimated that over the next two decades the number of people aged 85 and over will increase by two-thirds (Wanless, 2006). Over half of all users of adult social care are aged 65 and over (Department of Health 2003) and a steep rise in the numbers of people living with dementia is expected over the next few decades. The financial cost of caring for people with dementia is significant (Knapp & Prince 2007) and the social and psychological cost to unpaid care givers is great (Bebbington et. al 2001).

Assistive technology and telecare (ATT) are relatively new ways of delivering support to people with health and social care needs. The provision of sensors, passive monitoring and alerting devices are claimed to support individuals’ independence, to reduce the burden on unpaid care-givers, and to reduce health and social care costs.

The evidence base to support use of ATT is currently limited. ATTILA is a randomised controlled trial which compares outcomes amongst people with dementia who receive ATT and those who receive equivalent community services but not ATT. The working hypothesis of the trial is that fewer people in the ATT group will go into institutional care over the four year period for which the study is funded, and that the intervention will be cost effective. The trial will also consider the impact of ATT on carer burden and quality of life, the number of serious adverse incidents involving compromises of patient safety and the acceptability & reliability of ATT packages.

ATTILA aims to randomise a total of 500 service users, in a 1:1 ratio, to ATT (intervention) and non ATT (control) groups in a multicentre trial in seven sites in England (Lambeth, Southwark, Croydon, Lancashire, Oxford, Suffolk, and Cambridgeshire). If you would like further information about the trial, or have potential participants, please contact:

Andrew Bateman (Local Principal Investigator): 01353 652169 andrew.bateman@ozc.nhs.uk
Rachel Winson (Research OT): 01353 652161 rachel.winson@ccs.nhs.uk


HeART of Stroke

About our current RfPB research

Over 100,000 people experience a stroke in the UK each year (DoH, 2007). Rehabilitative services currently focus on physical difficulties leaving psychological difficulties ‘hidden’: Low mood (Hackett et al., 2005), feelings of uncertainty, loss of confidence, social isolation and a need to ‘get their lives back’ (Salter et al., 2008) are commonly reported. If untreated such difficulties can impair rehabilitative outcomes (e.g. Gillen et al., 2001) and increase financial burdens for the stroke survivor, their family members (Bulley et al., 2010) and the NHS (Saka et al., 2009). Currently offered talking therapies may be beneficial (Hackett et al., 2008) but may not be suitable for the third of stroke survivors left with communication difficulties (Bakheit et al., 2007).

In an Arts for Health (AfH) approach, people are supported in small groups to feel safe to express themselves through creative activity. This allows access to inner resources not available in everyday life (Beesley et al., 2011) and a working towards resolution of ‘hidden’ psychological difficulties. As verbal skills are not a necessity an AfH approach may be preferable for those with communication difficulties. AfH groups have already been shown to be helpful in GP practices for people with low self-esteem/low confidence (Van de Venter, 2011) but have not yet been tested after stroke.

HeART of Stroke is a two centre randomised controlled feasibility study, of an Arts for Health (AfH) group to support self-confidence and psychological wellbeing following a stroke. Half of 64 stroke survivors across two sites (Bournemouth and Cambridge) will be randomised to either an AfH group alongside usual care OR usual care only. In order to inform a future multi-centre Randomised Controlled Trial, aims of HeART of Stroke are to a) assess the suitability of the study design and process differences between sites b) assess the suitability of the outcome measures c) explore service users experience qualitatively and d) assess costs.

If you would like further information about the study, or have potential participants, please contact:

Samantha Nunn (Research Assistant): 01223 885262 samantha.nunn@nhs.net
Fergus Gracey (Local Principal Investigator): 01353 652165 fergus.gracey@ozc.nhs.uk


Memory rehab in multiple sclerosis

NeuroText as a memory aid for people with multiple sclerosis

Approximately 40-60% of people with multiple sclerosis (MS) have memory problems (Rao, 1995). The few randomised trials that have been conducted offer some support for the effectiveness of memory rehabilitation. However, systematic reviews assessing the effectiveness of memory rehabilitation for people with MS have so far been inconclusive, and report that included studies were of poor quality (O’Brien, Chiaravalloti, Goverover & DeLuca, 2008; das Nair, Ferguson, Stark & Lincoln, 2012). The authors concluded that more research is required to determine whether memory rehabilitation for people with MS is effective in reducing disability or not.

An expert review panel underscored the need for cognitive rehabilitation interventions for people with MS, and recommended strategies, including the use of compensatory devices (Multiple Sclerosis Society, 2006). There is currently little evidence to support the use of compensatory strategies for memory problems for people with MS. Compensatory strategies for cognitive impairment have been more widely examined in patients with stroke or traumatic brain injury. Wilson and colleagues (2001) examined NeuroPage, an external memory aid, which sends specific reminders regarding important tasks to patients’ individual pagers. NeuroPage significantly reduced everyday failures of memory in people with brain injury at relatively low cost (Wilson, Emslie, Quirk & Evans, 2001). The NeuroPage service has since expanded to send messages to mobile phone, as well as pagers.

Therefore this study evaluates the effectiveness of NeuroPage in reducing everyday memory problems for people with MS, employing randomisation and blinding procedures; a control condition; and by employing commonly used subjective report outcome measures. The intervention has been named ‘NeuroText’ for clarity, in light of the increasing use of texts on mobile phones, and the decreasing use of pagers. 

This study will allow development of the existing evidence base that backs the existing NeuroPage service to cover a broader range of client populations. The intervention offers a potentially efficient means for MS services to provide rehabilitation in terms of staff time, acceptability to client and carer, and reduced need for face-to-face contact.

We acknowledge the support of the MS Society to make this research possible.

We are recruiting throughout Cambridgeshire and Nottinghamshire. If you would like further information on the trial or think it could be of use to your patient group, please contact:

Rachel Goodwin (PhD Student and co-investigator) on 0758 212 9039 or lwxrag@nottingham.ac.uk


Item Responses in Rehabilitation Outcome Research

One of the strands of our research at The Oliver Zangwill Centre involves examining the psychometric properties of our outcome measures. In particular, Rasch analysis techniques are being used to examine data collected using the EBIQ, DEX and several other outcome questionnaires and Neuropsychological Tests.

Projects have been funded by support from the East of England SHA PEARL scheme,  the EoE CARA scheme and NIHR CLAHRC. So far we have completed work on the baseline EBIQ data, baseline DEX, baseline modified Carer Strain Index, carer DEX. We have started to explore the impact of rehabilitation on the item difficulty and person location metrics, in addtion to considering opportunities for computer adaptive testing.

Recent work has been in collaboration with Mr Luning Sun and Prof John Rust of the Psychometrics Centre in Cambridge. Papers are listed in 2013 Conference Presentation Section

A wide range of papers on this theme have been presented at conferences & workshops.   Abstract titles are listed on our research publications webpages. Since these papers we have attracted visiting scholars and collaborators to work with us on this endeavour of improving outcomes in brain injury rehabilitation.

For more information about Rasch Analysis I recommend the Rasch Measurement Transactions available online at [http://www.rasch.org/rmt/].

Andrew Bateman andrew.bateman@ozc.nhs.uk


 

 

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Ely
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