Research issue
Long term conditions effect people of all ages and can leave people with physical limitations such as being unable to walk, eat, wash or drive a car. They may have cognitive and mood disorders such as poor memory, depression, anxiety and fatigue. They are more likely to fall over and have a fracture than an age matched population. These changes can make people housebound, depressed, dependent and in poorer health, leading to increased use of health and social care services and possibly a move into a care home.
There is very little research evidence or clinical guidance for patients, community based therapists, nurses or GP’s about which techniques should be implemented, how services should be configured, or how the environment should be changed to improve or maintain health.
What we are doing about ...
Reducing falls
We wish to reduce the number, rate and impact of falls on older adults, stroke patients and people with dementia by developing specific rehabilitation programmes and evaluating their clinical and cost effectiveness.
take a look at how we are achieving this...
We have a large programme of research aimed at reducing falls in older people, stroke patients, people with dementia and people living in care homes. We are developing and evaluating falls prevention rehabilitation interventions.
We have found that people who have called an ambulance due to a fall but are not admitted to hospital can benefit from being referred to community rehabilitation services and that this is a very cost effective intervention. We are exploring the use of chair based exercises in care homes by completing a Delphi study and survey of staff with a view to understanding and formally evaluating this treatment.
We are completing a feasibility randomised controlled trial evaluating a care home staff training intervention with the aim of reducing the number of falls in care homes. This study is being completed jointly with care home owners and managers and the community rehabilitation services. Once finished we will complete a large multi centre study.
We are working with a team based in Wales who are exploring the best way to provide rehabilitation for people who have fallen and fractured their neck of femur. We will use published literature, a survey, a cohort study and clinical experts to develop an intervention.
Improving outdoor mobility participation
We are tackling the problem by learning how medical conditions impact on people’s participation in activities and by evaluating rehabilitation techniques. We have developed and published an outdoor mobility programme and evaluated it in 15 UK sites. We work with patients and the public in all our projects.
take a look at how we are achieving this...
We have a number of projects aimed at improving outdoor mobility for people with stroke, dementia and older adults:
We have evaluated an outdoor mobility rehabilitation intervention in a large UK based study and found that people many year post stroke can increase their outdoor mobility participation after rehabilitation.
We are now researching whether self monitoring devices can improve outdoor mobility.
We are working with colleagues in Australia to implement a rehabilitation programme aimed at getting people out and about after stroke and using GPS’s as an outcome measure.
Although public transport has become easier to use, with level access, more handles and spaces for wheelchairs people are still falling and having injuries. We are working with the Loughborough University to understand and reduce accidents on public transport.
Outcomes
Our research has led to:
- ambulance services in the UK setting up a clinical protocol for paramedics to refer patients directly to the falls prevention service and have funded a specialist service to deal with older adults who need picking up from the floor.
- stroke services across the UK providing outdoor mobility rehabilitation
Outdoor mobility rehabilitation
- Logan PA, Gladman JRF, Avery AJ, Walker MF, Groom L, Dyas. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. British Medical Journal Dec 11th 2004 329:1372-5
- Logan PA, Walker MF, Gladman JRF. Description of an Occupational Therapy Intervention aimed at Improving Outdoor Mobility. British Journal of occupational Therapy 2006 69(1):2-6
- Logan Pip, et al , A multi-centre randomized controlled trial of rehabilitation aimed at improving outdoor mobility for people after stroke: study protocol for a randomized controlled trial Trials.2012, 13:86.DOI: 10.1186/1745-6215-13-86
Falls prevention
- Logan, PA; Coupland, CAC; Gladman, JRF, et al Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. . British Medical Journal 2010; 340 c2102
- Robertson K, Logan P, Ward M, Pollard J, Gordon A, Williams W, Watson J. Thinking falls-taking action: a falls prevention tool for care homes.Br J Community Nurs. 2012 May;17(5):206-9
- Robertson K, Logan PA, Adams G, Conroy S. Thinking falls - taking action: a guide to action for falls prevention. British Journal of Community Nursing 2010 15 (8) 406-10
Opportunities for allied health professionals
PhD student & occupational therapist Jane Horne talks about the research opportunities available to allied health professionals