Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation

被引:29
作者
Ellard, David R. [1 ]
Thorogood, Margaret [2 ]
Underwood, Martin [1 ]
Seale, Clive [3 ]
Taylor, Stephanie J. C. [4 ]
机构
[1] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Warwick Clin Trials Unit, Coventry CV4 7AL, W Midlands, England
[2] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry CV4 7AL, W Midlands, England
[3] Brunel Univ, Uxbridge UB8 3PH, Middx, England
[4] Univ London, Blizard Inst, Barts & London Sch Med & Dent, London, England
关键词
Elderly residential care; Process evaluation; Exercise; Depression; Culture change; Cluster randomised controlled trial; LOWER-EXTREMITY FUNCTION; QUALITY-OF-LIFE; RANDOMIZED-TRIAL; NURSING-HOMES; PEOPLE; DISABILITY; SYMPTOMS; PROTOCOL; PROGRAM;
D O I
10.1186/1741-7015-12-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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页数:11
相关论文
共 31 条
[1]  
[Anonymous], EQ 5D STAND INSTR US
[2]  
[Anonymous], QUEST QUAL INQ QUAL
[3]  
[Anonymous], DOES PHYS ENV PREDIC
[4]   Feasibility of a mental practice intervention in stroke patients in nursing homes; a process evaluation [J].
Braun, Susy M. ;
van Haastregt, Jolanda C. ;
Beurskens, Anna J. ;
Gielen, Alexandra I. ;
Wade, Derick T. ;
Schols, Jos M. .
BMC NEUROLOGY, 2010, 10
[5]   Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: A cluster-randomized controlled trial [J].
Conradsson, Mia ;
Littbrand, Hakan ;
Lindelof, Nina ;
Gustafson, Yngve ;
Rosendahl, Erik .
AGING & MENTAL HEALTH, 2010, 14 (05) :565-576
[6]   Exercise for depression [J].
Cooney, Gary M. ;
Dwan, Kerry ;
Greig, Carolyn A. ;
Lawlor, Debbie A. ;
Rimer, Jane ;
Waugh, Fiona R. ;
McMurdo, Marion ;
Mead, Gillian E. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (09)
[7]   The OPERA trial: a protocol for the process evaluation of a randomised trial of an exercise intervention for older people in residential and nursing accommodation [J].
Ellard, David R. ;
Taylor, Stephanie J. C. ;
Parsons, Suzanne ;
Thorogood, Margaret .
TRIALS, 2011, 12
[8]  
Fetterman D.M., 1998, ETHNOGRAPHY STEP STE
[9]   MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[10]   Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery [J].
Guralnik, JM ;
Ferrucci, L ;
Pieper, CF ;
Leveille, SG ;
Markides, KS ;
Ostir, GV ;
Studenski, S ;
Berkman, LF ;
Wallace, RB .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2000, 55 (04) :M221-M231