Warwick Clinical Trials Unit:
Rehabilitation Research
www.warwick.ac.uk/go/ctu
Overview
OPERA
OLDER PEOPLE’S EXERCISE IN RESIDENTIAL ACCOMMODATION
Selected Publications
Warwick Clinical Trials Unit is an academic unit undertaking clinical
trials addressing real issues of local, national and international
importance.
• Gates S, Fisher JD, Cooke MW, Carter YH, Lamb SE (2008) Multi-factorial
We lead or support the development of high quality randomised
controlled trials in selective, focused areas that are consistent with the
research strategy of Warwick Medical School, and in which the
University of Warwick has a key stake in the intellectual property.
Our main research themes include Emergency and Critical Care,
Rehabilitation, Cancer, and Methodology. This poster provides an
overview of our Rehabilitation research.
BeST
The Back Skills Training (BeST) trial is a multi-centre randomised
controlled trial of low back pain.
Its aim was to assess the clinical and cost effectiveness of active
management (AM) compared to an active management + cognitive
behavioural approach (AM+CBA) in participants with
moderate/severe low back pain. The CBA component was led by
trained health professionals in six weekly group-based sessions.
Participants were followed up for 3, 6 and 12 months after
randomisation.
701 participants were identified in a general practice setting and
randomised to the trial in a ratio of 2:1 (233 on AM: 468 on
AM+CBA).
AM+CBA, compared to AM alone, was found to significant improve
disability (primary outcome) caused by low back pain, over all the
three time points (3 months: p=0.0026; 6 months: p<0.0001; 12
months: p=0.0008).
AM+CBA, compared to AM alone, was found to significant improve
pain, physical activity, general health and quality of life. It was found
to be significantly more cost effective.
Contact
Dr Ranjit Lall
r.lall@warwick.ac.uk
(024) 765-74649
POSTER TEMPL ATE BY:
www.PosterPresentations.com
OPERA
assessment & targeted intervention for preventing falls & injuries among older
people in community & emergency care settings: systematic review & metaanalysis, British Medical Journal; Jan 19; 336 (7636) 130-3.
• Lamb SE, Lall R, Hansen Z, Withers E, Griffiths F, Szczepura A, Barlow J,
Underwood MR (2007) Design considerations in a clinical trial of cognitive
behavioural intervention for the management of low back pain in primary care:
Back Skills Training Trial, BMC Musculoskeletal Disorders; 8:14
Falls
SARAH
Older People’s Exercise intervention in Residential and nursing
accommodation (OPERA) is a large cluster randomised trial at the
start of recruitment phase.
Falls are a major health problem for older adults, causing acute
injuries and longer term problems such as disability, fear of falling,
and loss of independence.
Strengthening and Stretching for people with Rheumatoid Arthritis of
the Hands (SARAH) is a multi-centre randomised controlled trial in
the pilot phase.
It aims to explore the clinical and cost-effectiveness of a whole
home physical activity intervention to reduce depression in older
people living in residential and nursing homes
Approximately 1200 participants will be recruited from 77 homes in
NE London and the West Midlands. The primary outcome for the
study is the prevalence of depression twelve months after
randomisation.
Earlier systematic reviews of randomised trials of fall prevention
interventions concluded that multifactorial falls risk assessment
followed by targeting of interventions to an individual’s risk factors is
an effective strategy for reducing falls.
It aims to estimate the clinical and cost effectiveness of hand
exercises for people with Rheumatoid Arthritis.
Approximately 480 adults will be recruited from across the
country. Patients will be randomised to one of the following options:
·
An advice session. Patients will attend for a single session
with a specially trained therapist who will advise and discuss on how
best to protect hand joints during every day function.
·
An advice session on joint protection, identical to the above,
followed by a further five sessions of supervised exercise with a
specially trained therapist. These sessions will be spread over 12
weeks and will encourage patients to strengthen and stretch their
hands and arms.
Whole home Interventions:
• Control -Depression awareness training for RNH staff delivered by
a Research Nurse
• Exercise Intervention -Physical activation programme built into
normal routine, complemented by twice weekly group-based
exercise delivered by a physiotherapist
Alongside the main study a process evaluation using both
qualitative and quantitative data collection will explore the process
of implementing the whole-home intervention.
Contact
Rachel Potter
R.Potter@warwick.ac.uk
(024) 76 575290
Falls clinic services implementing this type of intervention have now
been introduced throughout the NHS but without any evidence about
the optimum configuration, they have varied in location, skill mix,
assessments, and interventions offered. We conducted a new
systematic review to update the evidence for the effectiveness of
this strategy.
We included 19 trials. There was no clear reduction in the number
of people falling during follow-up (RR 0.91, 95% CI 0.82, 1.02) or the
incidence of fall-related injuries (RR 0.90, 95% CI 0.68, 1.20). There
were no data on the most important outcomes, the rates of falls and
injuries. Further research is therefore warranted.
Patients will be asked to attend for assessments and fill in some
questionnaires about their condition at three time points up to twelve
months after joining the study.
Contact
Contact
Dr Simon Gates
s.gates@warwick.ac.uk
(024)76 575850
Mark Williams
m.a.williams.3@warwick.ac.uk
(024) 76 574648