Research projects

Trauma of at least moderate severity (Injury Severity Score (ISS) >8) is a major cause of death, disability and NHS resource use. Many survivors experience physical and psychological problems, reduced quality of life and difficulty returning to work, with psychological and occupational needs frequently unmet. Systematic reviews demonstrate vocational rehabilitation (VR) improves return-to-work in some conditions, but it is not known if VR is effective for trauma survivors who often suffer multiple injuries, affecting several body regions, with psychological and/or cognitive problems impacting on their ability to work.

Aim

To develop, evaluate and assess implementation of an early vocational rehabilitation intervention to enhance return-to-work and improve quality of life and wellbeing in people with at least moderate trauma.

Methods

The programme comprises four work-packages (WPs), with Patient and Public Involvement (PPI) throughout the research programme.

WP1 develops theory and the VR intervention through an iterative process including trauma survivor focus groups, key informant interviews and co-production.

WP2 is a multicentre non-randomised feasibility study including surveys and nested qualitative interviews. In order to respond to the Covid-19 pandemic, WP2 has been adapted to develop the VR intervention and the therapist training for remote delivery and assess the feasibility, fidelity, acceptability and barriers and facilitators to delivering the VR intervention remotely.  

WP3 is a multicentre pragmatic individually randomised controlled trial evaluating clinical and cost effectiveness of the intervention in working age adults admitted to major trauma centres with an injury severity score of >8. The intervention is a case-coordinated package of individually tailored VR provided by occupational therapists and psychological support provided by clinical psychologists plus usual care. The control arm receives treatment as usual. The primary outcome measure is return-to-work (including voluntary work and full-time education) 12 months post-randomisation.

WP4 is a process evaluation nested within WP3 and an implementation study assessing intervention fidelity, factors affecting intervention quality and enablers and barriers to intervention implementation.

Background

NICE guidelines recommend the provision of free home safety equipment for families under the age of 5 who may not be able to afford their own equipment.  However not all areas of the country currently have such schemes available.   Whilst we know that families appreciate these kinds of schemes and often take up the offer of equipment, we don’t know whether they actually result in a reduction in injury occurrence.  

Objectives

We are measuring hospital admissions due to home injuries in children under the age of 4 in families that did, and did not receive home safety equipment as part of the national, government funded, Safe At Home programme -  We want to know if the scheme was effective at reducing injury occurrence and if it was cost-effective in terms of saving the NHS money.

If we find that the scheme is associated with a reduction in injuries, and that the programme is cost-effective, we will work with Public Health England, NICE and charities such as RoSPA and CAPT to help disseminate the findings and promote the implementation of schemes in areas where they are not.

Methods  

We are evaluating this scheme using a controlled interrupted time series analysis.  Using hospital admission data from England and Wales, we will compare hospital admissions rates in areas that did and did not implement the scheme before the scheme started, during the 2 years of scheme rollout and the four years after rollout.   Whilst we cannot measure less severe injuries, that maybe only presented to the GP or A&E, the study should give us good insight as to whether schemes are effective and cost effective from a the perspective of healthcare resource use.

How we use data

In this study we are using Hospital Episodes Statistics data, provided by NHS Digital. The University's privacy notice explains how we use data.

Background

Unintentional injuries are common in pre-school children and especially amongst those living in more disadvantaged areas. We know that home safety education and helping parents to obtain and use home safety equipment helps makes homes safer. We also know that intensive home visiting programmes starting around the time of birth which are aimed improving a range of child health outcomes are effective in reducing unintentional injuries in young children. However, we know less about how to translate these research findings into routine practice.

Nottingham CityCare was awarded Big Lottery funding for a 10 year project, called Small Steps Big Changes. This aims to improve the health of children in disadvantaged electoral wards within Nottingham, and includes an innovative home visiting programme provided by family mentors. As part of the Small Steps Big changes project, evidence-based home safety promotion is being provided in Small Steps Big Changes wards and the Stay one Step Ahead project is evaluating its implementation.. 

Objectives

(a) The primary objective is to determine whether implementing systematic evidence-based home safety promotion improves key home safety practices (having a fitted and working smoke alarm, having a safety gate on stairs and keeping poisons out of reach).

(b) Secondary objectives include evaluating the impact on child home injury rates, on other safety practices, on parental knowledge and self-efficacy, acceptability of and satisfaction with the home safety promotion, barriers and facilitators to making homes safer and cost-effectiveness.

Methods

Controlled before and after study comparing outcomes between Small Steps Big Changes wards and control wards who provide usual care in terms of home safety promotion. Data will be collected using a range of methods including questionnaires, interviews and observations of home safety promotion. 

Background

The 2017/18 NHS GP contract requires primary care providers to use evidence-based frailty identification tools to risk-stratify all patients over 65 years of age.  Those patients flagged as moderately or severely frail should be clinically reviewed and if severe frailty is confirmed, providers have been asked to consider offering relevant interventions. However, little is known about how the frailty contractual requirement is being implemented in primary care and the barriers and facilitators GPs encounter when routinely risk-stratifying, identifying, and providing interventions for people living with frailty in primary care.

Objectives

(1) To explore GP perceptions about frailty and risk stratifying people to identify and manage frailty

(2) To explore GP perceptions about the ways in which the frailty identification contractual requirements are being applied in primary care

(3) To explore GP perceptions of the impact of implementing the contractual requirements on patients, primary care workload and demand for other services

Methods

Survey of GPs working in NHS Clinical Commissioning Groups in Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire and Northamptonshire to identify participants for semi-structured interviews. 

Publications

1.       Mulla E, Orton E, Kendrick D. GP views on the routine identification of older people living with frailty in primary care. The British journal of general practice : the journal of the Royal College of General Practitioners. 2020;70(suppl 1).

The ProAct65+ trial demonstrated group falls prevention exercise classes (FaME) were effective in promoting physical activity (PA) and preventing falls among older people. Continuing PA after exercise interventions is needed to maintain health benefits, but little is known about how to achieve this. 

Objectives

The objectives of this study were to:

1. identify factors associated with continuation of PA after exercise programmes in older people and
2. explore reasons for and barriers and facilitators for PA continuation.

Methods

Mixed-methods study using quantitative data collected during the ProAct65+ trial was used to address objective 1 and a qualitative study of ProAct65+ participants (some  who continued PA and some who did not) and partners/carers of some of these participants was used to address objective 2. Random effects logistic regression was used to assess associations between a range of exposures (socio-demographic, falls risk, health status, quality of life, functional assessments, fear of falling, baseline PA, social network, expectations attitudes and beliefs about exercise) and PA at 12 and 24 months post intervention. The qualitative study recruited ProAct65+ participants from GP practices in Nottingham/Derby, using maximum variation sampling to ensure diversity in age, gender, falls risk and fear of falling.

Publications

1. Lafond, N., Maula, A., Iliffe, S., Vedhara, K., Audsley, S., Kendrick, D., & Orton, E. (2019). ‘We got more than we expected.’ Older people’s experiences of falls-prevention exercise interventions and implications for practice; a qualitative study. Primary Health Care Research & Development, 20, E103. doi:10.1017/S1463423619000379.

2. Maula A, LaFond N, Orton E, Iliffe S, Audsley S, Vedhara K, Kendrick D. Use it or lose it: a qualitative study of the maintenance of physical activity in older adults. BMC Geriatric. 2019 Dec 12;19(1):349. doi: 10.1186/s12877-019-1366-x.

3. Kendrick D, Orton E, Lafond N, Audsley S, Maula A,  Morris R, Vedhara K, Iliffe S.  Keeping Active: Maintenance of physical activity after exercise programmes for older adults.  Public Health. 2018 Nov;164:118-127. doi: 10.1016/j.puhe.2018.08.003. Epub 2018 Oct 1.  

Unintentional home injuries are a major public health issue in childhood. Recent guidance (e.g. NICE guidance, Public Health England guidance) recommends actions to be taken by local authorities to reduce injury rates and inequalities, but evidence is lacking on the extent to which such guidance is followed.

Objectives

This study aimed to describe and quantify child home injury prevention activities of local authorities (LAs) in England and health boards (HBs) in Wales

Methods

Survey of Directors of Public Health in all 153 upper-tier LAs in England and 7 HBs in Wales. The questionnaire covered the five broad areas recommended for injury prevention activities in NICE guidelines including current activities, joint working, injury prevention coordinators, strategic documents and decision making about injury prevention.

Publications

1.       Chisholm A, Watson MC, Jones SJ, Kendrick D. Child injury prevention: a survey of local authorities and health boards. International Journal of Health Promotion and Education. 2017;55(4):205-14.

Regular physical activity reduces mortality from all causes, and the risk of falls and hip fractures. Physical activity levels are lower in older than younger populations and the best way of increasing older people’s physical activity in the short and longer term is unclear. The ProAct65+ study is comparing a community group exercise programme and home based exercise with usual care for people aged 65 and over in primary care.

Objectives

The objectives of the ProAct65+ study are to:

1. determine the effect on continuation of exercise of two evidence based exercise programmes designed for older people, compared with usual care.
2. determine the health benefits of the programmes for patients starting at various levels of physical activity.
3. estimate the costs of the exercise interventions and to assess the cost-effectiveness of community group exercise, and home-supported exercise compared with usual care.
4. determine the acceptability of the programmes, adherence rates, enabling factors and barriers to future implementation.
5. determine participants’ perceptions of the value of exercise, and the predictors of continued exercise.

Methods

Three-arm cluster controlled trial using minimisation for allocation at the level of general practice in two centres (London and Nottingham/Derby). The three arms include the Otago home-based exercise programme (OEP), a community based exercise programme (FaME) and a control arm which receives usual care. Participants will be aged 65+ who can walk around independently indoors and outdoors (with or without a walking aid) and would be physically able to take part in a group exercise class, who are not already receiving any long term physiotherapy. The primary outcome measure is the proportion of participants reaching the recommended physical activity target of at least 150 minutes per week of physical activity of at least moderate intensity.

View the Publications list for the PRoAct65+ Study

Background

Falls are very common in older people and can result in injury, hospitalisation, disability and loss of independence. Fear of falling is also common amongst older people and can impact negatively on physical activity, social participation and quality of life. High levels of fear of falling can increase the risk of future falls, but low levels can be protective for falling.

Objectives

The objective of this study was to determine the effect of exercise interventions on fear of falling in community-dwelling people aged 65 years and over.

Methods

Cochrane systematic review of randomised and quasi-randomised controlled trials reporting single component interventions prescribing or providing exercise compared to routine care or non-exercise interventions. Exercise interventions included gait, balance and function; strength or resistance; flexibility; 3-dimensional (e.g. Tai Chi) and endurance. To be eligible studies had to measure fear of falling as a primary or secondary outcome measure. Meta-analysis estimated risk ratios (and 95%CI) for binary outcomes and standardised mean differences (and 95% CI) for continuous outcomes.

 Publications

 1.       Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews. 2014;11:CD009848.

2.       Kumar A, Delbaere K, Zijlstra GA, Carpenter H, Iliffe S, Masud T, et al. Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis. Age and ageing. 2016;45(3):345-52.

Background

Unintentional injuries are a major cause of preventable death amongst children aged under 5 years and result in a substantial number of hospital admissions and emergency department attendances in the UK. Children who have suffered an unintentional injury are at increased risk of future injuries and interventions can be targeted at families whose children are at higher injury risk. Parenting programmes, most commonly delivered in the home to individual families can reduce injuries in pre-school children. However, it is not known whether delivering parenting programmes to groups of parents outside the home are also effective.

Objectives

The objectives of this feasibility study are to:

(1)  Develop a parenting programme to prevent recurrent unintentional home injuries in preschool children

(2)  Develop a tool for parents to report unintentional home injuries occurring to their preschool children.

(3)  Assess methods for the recruitment and retention of parents to a cluster randomised feasibility study

(4)  Determine the training, equipment and facilities needed for the delivery of the programme

(5)  Establish appropriate primary and secondary outcome measures and methods for their collection

(6)  Determine how ‘normal care’ in a comparison arm should be defined

(7)  Determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and

(8)  Produce estimates of effect sizes to inform sample size estimation for a main trial.

Methods

Multicentre cluster randomised, unblinded trial set in eight children’s centres in Bristol and Nottingham, UK. Participants will be 96 parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. The intervention will comprise the First-aid Advice and Safety Training (FAST) parenting programme, comprising parenting support and skills combined with first aid and home safety advice. The main outcome measures will be parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation.

Publications

1.       Mytton J, Ingram J, Manns S, Stevens T, Mulvaney C, Blair P, et al. The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial. Health Technology Assessment. 2014;18(3).

2.       Mytton JA, Towner EM, Kendrick D, Stewart-Brown S, Emond A, Ingram J, et al. The First-aid Advice and Safety Training (FAST) parents programme for the prevention of unintentional injuries in preschool children: a protocol. Injury Prevention. 2014;20(1):e2.

The National Safe at Home Scheme provided a combination of home safety equipment, installation, professional training and education for disadvantaged families in areas with the highest accident rates. It was established in February 2009 with £18 million provided by the Department for Education (formerly Department for Children, Schools and Families). It operated for two years ending in March 2011.

Objectives

The objectives of the evaluation were to:

(1)         Evaluate the processes of establishing Safe At Home

(2)         Determine changes in provision of home safety equipment in targeted areas

(3)         Determine changes in numbers of qualified staff working to support families to keep their children safe at home

(4)         Evaluate the impact of Safe At Home on those determinants of unintended injury which are amenable to change through the provision of home safety equipment

(5)         Assess the impact of Safe At Home on raising awareness amongst vulnerable families

(6)         Estimate the contribution of Safe At Home to reducing injury outcomes for children aged 0-5 years if continued long term

(7)         Conduct an examination of costs

Methods

The evaluation employed a range of methods within a series of component studies, each of which fed into the seven evaluation objectives shown below. The methods included postal surveys, one-to-one interviews, discussion groups, direct observation, case studies, documentary analysis and postcode mapping of family data.

Publications

1.       Errington G, Watson M, Hamilton T, Mulvaney C, Smith S, Binley S, Coupland C, Kendrick D, Walsh P. Evaluation of the National Safe At Home Scheme. Final report for the Royal Society for the Prevention of Accidents. September 2011. 

2.       Errington G, Watson M, Hamilton T, Mulvaney C, Smith S, Binley S, Coupland C, Kendrick D, Walsh P. Evaluation of the National Safe At Home Scheme. Research Tool Supplement to the Final Report for the Royal Society for the Prevention of Accidents. September 2011. 

3.       Mulvaney CA, Watson MC, Hamilton T, Errington G. Delivery of a national home safety equipment scheme in England: a survey of local scheme leaders. Perspect Public Health. 2013 Nov;133(6):314-9. doi: 10.1177/1757913913490489. Epub 2013 Jun 14. PMID: 23771681.

Background

CSEC was charged with improving the provision of practical safety education to give more children and young people the skills, knowledge and confidence to keep themselves safe in a range of situations and so help reduce the likelihood of injury or harm to children and young people. The aim of CSEC was to encourage and support activities which contribute to a reduction in unintended injuries to children and young people. CSEC had six main functions: 1. Auditing, mapping and targeting 2. Policy and advocacy work 3. Building the evidence base for effective practice 4. Information sharing 5. Establishing quality assurance programmes 6. Coordinating a network of unintended injury prevention programmes.

Objectives

The objectives of the evaluation were to:

(1)         Evaluate the processes of establishing the CSEC

(2)         Explore the ways in which risk competence is acquired and used by children and young people aged 0-18 years through involvement in practical safety education

(3)         Understand the impact of CSEC in increasing provision of practical safety education through:

1. Auditing existing provision of practical safety education in eight regions of England (four high focus regions, matched with four similar regions for comparison)
2. Monitoring changes in provision over the lifetime of CSEC‟s initial phase (until the end of March 2011).

(4)         Evaluate the impact of CSEC on those determinants of unintended injury which are amenable to change through practical safety education

(5)         Estimate the contribution of CSEC to reducing injury outcomes for children and young people aged 0-18 years if continued long term

(6)         Analyse the costs of CSEC and its activities and undertake a comparative economic evaluation of five permanent experiential learning safety centres

Methods

A range of evaluation methods was used to capture the complexities of the Coalition. Data was collected using a variety of methods. These methods included observational studies, telephone interviews, self-completion questionnaires, content analysis of documents and case studies.

Publications

1.       Mulvaney C, Watson M, Errington G, Coupland C, Kendrick D, Walsh P. Evaluation of the Child Safety Education Coalition (CSEC) Final report Produced for The Royal Society for the Prevention of Accidents. March 2011.

Falls in hospital amongst older people are a major problem and more than half of these falls occur at the bedside. Falls can lead to physical and psychological morbidity and are resource intensive for health services. Bed and chair pressure sensors offer an innovative approach to reducing falls in hospital. However the clinical and cost-effectiveness of using such sensors in the UK is unknown.

Objectives

The objectives of the trial are to assess clinical effectiveness and cost-effectiveness of bed and chair pressure sensors in reducing in-patient falls amongst elderly patients

Methods

Pragmatic, parallel arm, unblended, randomised controlled trial of bed and bedside chair sensors using radio-pagers to reduce in-patient bedside falls in acute, general medical, elderly care wards in a UK hospital. The intervention comprised a bed and bedside chair pressure sensor linked wirelessly to a radio-pager carried by nursing team members. An absence of pressure on the sensor of at least 5 seconds triggered an alert. The primary outcome measure was the number of in-patient bedside falls per 1,000 bed days.

Publications

1.       Vass CD, Sahota OS, Drummond A, Kendrick D, Gladman J, Sach T, et al. REFINE (Reducing Falls in In-patient Elderly) - a randomised controlled trial. Trials. 2009;10:83.

2.       Sahota O, Drummond A, Kendrick D, Grainge MJ, Vass C, Sach T, et al. REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial. Age and ageing. 2014;43 247-53.