Development and testing of strategies to enhance physical activity in care homes (REACH)

The project aims to develop and preliminary test strategies to enhance physical activity in the daily life routines of care home residents to improve their physical, psychological and social well-being.

One consequence of an ageing population is a steady increase in demand for long-term care. Residents in long-term care are particularly high users of hospital services and admissions to hospital are disruptive to their well-being. Observational research has reported that many care home residents spend the majority of their time inactive, with low levels of interaction with staff. This leads to increased dependency and low mood.

Although one way to increase activity is for physiotherapists to provide exercise classes, with the limited number of such staff available this is an unrealistic option for many. We have reviewed the evidence for ways to increase activity in residents which have been of benefit. One approach is to enhance routine activity, for example promoting activities of daily living such as walking to the toilet, walking to the dining room, and making the most of routine opportunities to promote activity. We propose a programme of research to work with care home staff and residents to develop and test methods to enhance activity.

Five overlapping workstreams will be undertaken.

Workstream 1: we will undertake observational (ethnographic) work to test the understandings we have gained from previous work within a wider range of care homes. Work will include observations and interviews to clarify our thinking on barriers, opportunities and factors that indicate that a care home (and their staff) are open to change.

Workstream 2: Clarification of measures
We aim to improve levels of physical activity and therefore require a valid and reliable measure of activity in a population of frail older people. In development work we have identified activity monitors (accelerometers) as possible measures and propose to test these with a larger population of residents and evaluate newly developed physical activity questionnaires.

Workstream 3: Using information obtained in the development work and previous workstreams we will use techniques of intervention mapping to develop practical mechanisms for increasing activity and appropriate methods of implementation (for example, training materials).

Workstream 4: Working with action groups (which will include residents and staff) in four care homes we will refine the proposed mechanisms and methods to promote practical implementation in a range of care home settings.

Workstream 5: We will undertake a feasibility study in 12 care homes, to test for feasibility and effect on physical function, mood and quality of life; and to gather data to inform a future large scale trial.

Participant criteria

This research is being undertaken in care homes for older people, run by an independent provider (private, voluntary or non-profit making). We aim to be inclusive of the majority of residents in these homes. However, residents that are unwell, bed-bound, or near to death will not be included in any aspect of the study.

Patient recruitment and on-going engagement for the current projects

This research programme has been developed and refined by on-going interaction with the Bradford Care Home Forum: a group of care home owners and managers who meet alternate months to discuss all issues relating to provision of services and support within their homes. Forum members have welcomed the suggestion of finding ways to increase physical activity amongst residents, and acknowledged the difficulties of providing exercise classes in which many residents do not want to participate. We have visited homes and discussed our work with residents. We sought advice on methods, particularly the acceptability of researchers undertaking observations — it was considered acceptable providing privacy was respected. A lay co-applicant on the programme bid assisted in the development work for this proposed programme and is a continuing member of the Programme Management Group.

Recruitment of care homes: Selected homes are purposefully different from each other in terms of size, setting and ownership and urban/ rural setting. One of the homes selected has a dementia unit in order to enhance our knowledge and understanding of residents with dementia. We have selected homes that report success in encouraging engagement with activities, and others which have achieved more limited success in this regard.

Recruitment of participants: Care Home Managers have provided their consent for this study to be undertaken. Notices have been put around care homes recruited so far notifying participants of the research we will be undertaking, and informing them that they may be approached by researchers to see if they want to take part in the study. Researchers are approaching care home residents and their relatives/friends as well as staff, and asking them if they would be interested in taking part in this research.

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 T, Dawkins B, Ellard D, Ellwood A, Firth J, Gallagher B, Graham L, Johnson L, Lusambili A, Marti J, McCrorie C, McLellen V, Patel I, Prashar A, Siddiqi N, Trépel D, Wheeler I, Wright A, Young J, Farrin A. Strategies to enhance routine physical activity in care home residents: the REACH research programme including a cluster feasibility RCT. Programme Grants Applied Research 2021;9(9). https://doi.org/10.3310/pgfar09090

Forster A, Airlie J, Ellwood A, Godfrey M, Green J, Cundill B, Dawkins B, McMaster N, Hulme C, Cicero R, McLellan V, Graham L, Gallagher B, Ellard DR, Firth J, Farrin A, the REACH Programme Team. An intervention to increase physical activity in care home residents: results of a cluster-randomised, controlled feasibility trial (the REACH trial). Age and Ageing 2021; afab130. https://doi.org/10.1093/ageing/afab130

Hawkins R, Prashar A, Lusambili A, Ellard DR. ‘If they don’t use it, they lose it’: how organisational structures and practices shape residents’ physical movement in care home settings. Ageing and Society 2018;38(9):1817-1842. https://doi.org/10.1017/S0144686X17000290

Ellwood A, Airlie J, Cicero R, Cundill B, Ellard DR, Farrin A, Godfrey M, Graham L, Green J, McLellan V, Siddiqi N, Forster A, on behalf of the REACH Programme Team. Recruiting Care Homes to a Randomised Controlled Trial. Trials 2018;19(1):535. https://doi.org/10.1186/s13063-018-2915-x

Forster A, Airlie J, Birch K, Cicero R, Cundill B, Ellwood A, Godfrey M, Graham L, Green J, Hulme C, Lawton R, McLellan V, McMaster N, Farrin A, on behalf of the REACH Programme Team. Research Exploring Physical Activity in Care Homes (REACH): study protocol for a randomised controlled trial. Trials 2017;18:182. https://doi.org/10.1186/s13063-017-1921-8

Crocker T, Forster A, Young J, Brown L, Ozer S, Smith J, Green J, Hardy J, Burns E, Glidewell E, Greenwood DC. Physical rehabilitation for older people in long-term care. Cochrane Database Systematic Reviews CD004294 2013 https://doi.org/10.1002/14651858.CD004294

Who is responsible for your data:

The joint data controllers for REACH trial are the sponsor organisation, Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) and the University of Leeds (UoL). This means that both organisations are responsible for how your data is collected, stored, shared and used.

What information do we collect about you:

Staff within the NHS collect information from you and your medical records for this research and send it to the Clinical Trials Research Unit (CTRU) at the University of Leeds. The CTRU will use your name, address, and contact details to contact you about the research study, namely for the purpose of sending questionnaires and providing any study updates.

Your NHS number, gender, initials, date of birth and postcode will be shared with NHS Digital, to obtain information about you from your electronic health care records. We will do this because it is a more efficient way to collect certain data about your health. By using data routinely collected from hospital/health visits, we can reduce the burden (such as the number of researcher contacts) on you and your hospital. When we do this linking, we will only use the data mentioned above to identify you, and we will follow strict rules when working with other organisations to maintain confidentiality and to protect your data. You can read more about NHS Digital here: https://digital.nhs.uk/about-nhs-digital.

The information received from NHS Digital and that from NHS staff will be entered into a database held securely at the Clinical Trials Research Unit.
Individuals from the BTHFT (the study sponsor) and regulatory organisations may look at your medical and research records to make sure the study has been run correctly. The only people at BTHFT and UoL who will have access to information that identifies you are the people involved in study follow-up (e.g. posting questionnaires) or auditing the data. People who do not need to know who you are will not be able to see your name or contact details. Your data will have a code number instead.

How long we keep your data:

Bradford Teaching Hospitals NHS Foundation Trust and the University of Leeds will keep your data for a minimum period of 5 years after the end of the study, after which it will be securely destroyed.

How we protect your data:

We protect your personal data against unauthorised access, unlawful use, accidental loss, corruption or destruction.
We use technical measures such as encryption and password protection to protect your data and the systems they are held in. We also use operational measures to protect the data, for example by limiting the number of people who have access to the databases in which your data is held and using unique reference numbers to identify participants rather than names wherever possible.
We keep these security measures under review and refer to Bradford Teaching Hospitals NHS Foundation Trust and the University of Leeds Information Security Policies to keep up to date with current best practice.

Sharing your data:

Your personal data collected and managed by the University of Leeds will be used to carry out the follow-up of this trial, including linking your personal data with data held by NHS Digital. In order to do this, we will provide your initials, gender, date of birth, NHS number and postcode to NHS Digital. The information we have about you will be linked with the information held by NHS Digital. This will be done in a secure and confidential manner.
It is possible that the information collected about you might be shared with other research teams to answer new research questions in the future. If this happened, the information would be anonymised so that no-one would be able to identify you from it.

Your rights:

Your rights to access, change or move your information are limited, as we need to manage your information in specific ways in order for the research to be reliable and accurate. If you withdraw from the study, we will keep the information about you that we have already obtained. To safeguard your rights, we will use the minimum personally-identifiable information possible.
You can find out more about how we use your information:
https://www.hra.nhs.uk/information-about-patients/
https://www.bradfordhospitals.nhs.uk/privacy-statement/
https://ctru.leeds.ac.uk/privacy/

Our legal basis to process your data:

Organisations processing personal data need a legal basis for that processing activity. For public authorities, such as the NHS and Universities, the most appropriate lawful bases when processing personal data and health data (defined as special category data) for the purposes of research are:
Article 6:1(e): Specific task in the ‘public interest’ or task that has a clear basis in law, and
Article 9:2(j): Special category data used for “Archiving in the public interest, scientific or historical research or statistical purposes”, with a basis in law.
To ensure we carry out the research to the highest standards we comply with the UK Policy Framework for Health and Social Care Research. You can learn more about research standards here: https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/

Complaints:

If you wish to raise a complaint on how we have handled your personal data, you can contact the Data Protection Officer who will investigate the matter.
University of Leeds Data Protection Officer

• Phone +44 (0) 113 2431751
• Email: dpo@leeds.ac.uk

If you are not satisfied with our response or believe we are processing your personal data in a way that is not lawful you can complain to the Information Commissioner’s Office (ICO) by visiting https://ico.org.uk/make-a-complaint/ or by calling their helpline on 0303 123 1113.

This summary presents independent research funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Development and preliminary testing of strategies to enhance routine physical activity in care homes, RP-PG-1210-12017). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.