Emma Stanmore

Risk factors for falls in adults with rheumatoid arthritis: a prospective study

To investigate the association between potential risk factors and falls in community‐dwelling adults with rheumatoid arthritis (RA).

Fall incidence and outcomes of falls in a prospective study of adults with rheumatoid arthritis.

To determine the incidence of falls and to investigate the consequences of falls in adults with rheumatoid arthritis (RA).

Crossing professional and organizational boundaries: The implementation of generic Rehabilitation Assistants within three organizations in the northwest of England

Purpose. New generic support worker roles are being developed within rehabilitation and intermediate care services throughout the UK, as a consequence of staff shortages and the policy drive to look at new ways of working to meet the needs of older people. This paper describes a joint project between a Primary Care Trust, an Acute Trust and Social Services in one region in the northwest of England. It aims to describe the process of introducing new roles within rehabilitation and evaluates the acceptability and integration within different settings. Methods. Thirty support worker staff from an Acute Trust, Primary Care Trust and Social Services were trained over a period of 18 months to become generic Rehabilitation Assistants (RAs). A total of 55 semi-structured interviews of patients, associated professionals and RAs were conducted to examine the acceptability and integration of the new role. The interviews were tape-recorded, concurrently transcribed, inductively analysed and categorized into themes. Results. Several factors appeared to influence the acceptance and integration of the new role, namely: Prior experience and the degree of role change, familiarity and inter-staff relationships, role distinction and contribution and resources and management. Despite many challenges, patients, professionals and the RAs reported huge appreciation of the new role. Conclusions. The evaluation demonstrates how an innovative, inter-organizational approach can deliver new solutions to address workforce issues. Further research is recommended nationally, to track the development and evaluate the effectiveness of similar roles.

The effect of active video games on cognitive functioning in clinical and non-clinical populations: a meta-analysis of randomized controlled trials

HighlightsThis is the first meta‐analysis of active video games (‘exergames’) for cognition.Our search identified 17 randomized controlled trials with 926 participants in total.Exergames improved cognition in both clinical and non‐clinical populations.Significant effects were found executive functions, attention and visuospatial skills. Abstract Physically‐active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively‐demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta‐analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non‐clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random‐effects meta‐analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist‐only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain‐specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta‐analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

Motivational Determinants of Exergame Participation for Older People in Assisted Living Facilities: Mixed-Methods Study

Background Exergames (exercise-based videogames) for delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect-based technologies; however, little is known about the factors affecting their uptake and usage by older people. Objective The aim of this study was to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Methods Mixed methods were employed in which 14 semistructured interviews were conducted with older people (n=12, aged 59-91 years) from 2 assisted living facilities in the North West of the United Kingdom. The older people participated in a 6-week trial of exergames along with one manager and one physiotherapist; 81 h of observation and Technology Acceptance Model questionnaires were conducted. Results The findings suggest that the participants were intrinsically motivated to participate in the exergames because of the enjoyment experienced when playing the exergames and perceived improvements in their physical and mental health and social confidence. The social interaction provided in this study was an important extrinsic motivator that increased the intrinsic motivation to adhere to the exergame program. Conclusions The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation.

Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

Background Ageing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits. Objective This study explored facilitators and barriers to the implementation of monitoring technologies in care homes. Design Embedded multiple-case study with qualitative methods. Setting Three dementia-specialist care homes in North-West England. Participants Purposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents. Methods 36 semi-structured interviews with staff, relatives and residents; 175 h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis. Results Findings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice. Conclusion Implementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.

A mixed study systematic review of social media in nursing and midwifery education: Protocol

AIM To synthesize evidence on the use of social media in nursing and midwifery education. BACKGROUND Social media is one type of online platform that is being explored to determine if there is value in using interactive, digital communication tools to support how nurses and midwives learn in a variety of settings. DESIGN A sequential explanatory synthesis approach will be used for this mixed study review. METHOD Five bibliographic databases; PubMed, MEDLINE, CINAHL, Scopus, and ERIC will be searched using a combination of keywords relevant to social networking and social media, nursing and midwifery, and education. The search will not be limited by year of publication. Titles, abstracts, and full papers will be screened by two independent reviewers against inclusion and exclusion criteria, with any disagreements resolved via a third reviewer. Selected studies will undergo quality assessment and data extraction. Data synthesis will occur in three sequential phases, with quantitative and qualitative data analysed separately and then integrated where possible to provide a conceptual framework illustrating learning via social media. Funding for this review was confirmed in May 2016 by Sigma Theta Tau International and the National League for Nursing. DISCUSSION The mixed study systematic review will produce the first rigorous synthesis on the use of social media in nursing and midwifery education and will have important implications for educators as well as students. It will also highlight knowledge gaps and make recommendations on the use of this novel technology in higher and continuing education.

The Rheumatoid Arthritis and Falls (RAF) study: a prospective study of fall risk factors in adults with rheumatoid arthritis

Abstract Background Rheumatoid arthritis is linked to an increased risk of falls resulting in osteoporotic fractures, which may involve lower limb joints, leading to impaired mobility, impaired balance, and postural instability. This study aimed to investigate the association between potential risk factors and falls in community dwelling adults with rheumatoid arthritis. Methods Adults with rheumatoid arthritis were recruited from four outpatient clinics in the northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services, and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue, and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded. Findings 559 adults with rheumatoid arthritis (386 women, 173 men, aged 18–88 years) had baseline measurements taken. 535 (96%) participants completed 1-year follow-up. Univariate logistic regression showed that falls risk was independent of age and gender. Multivariate logistic regression revealed that a history of multiple falls in the previous 12 months was the most significant predictive risk factor (odds ratio 5·3 [95% CI 2·3–12·3], p=0 Interpretation Adults of all ages with rheumatoid arthritis are at high risk of falls. In clinical practice, patients with rheumatoid arthritis at high risk of falls can be identified by asking whether they have fallen in the past year. The management of swollen and tender lower limb joints, fatigue, and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Funding Arthritis Research UK.

Social media in nursing and midwifery education: a mixed study systematic review

AIM To synthesize evidence on the effectiveness of social media in nursing and midwifery education. BACKGROUND Social media are being explored to see if these online tools can support teaching, learning, and assessment. DESIGN A mixed study systematic review. DATA SOURCES A systematic search of PubMed, MEDLINE, CINAHL, Scopus, and ERIC was run in January 2016. An updated search was run in June 2017. No date limits were applied. METHODS Titles, abstracts, and full papers were screened against inclusion criteria by two independent reviewers, who extracted and quality assessed data. Synthesis followed a sequential explanatory approach. RESULTS Twelve studies were included. Social media seemed to support students to acquire new knowledge and skills. The learning process centred on the interactive nature of the platforms which allow information to be dynamically shared and discussed in near real time. The characteristics of social media enabled social support and a more student-centred setting, which appeared to enhance collaborative learning, although information quality was sometimes problematic. Learning via social media was underpinned by how well the educational interventions were organized, digital literacy and e-Professionalism of students and faculty, the accessibility of the online applications, and personal motivation. CONCLUSION This review provides the first rigorous synthesis of social media in nursing and midwifery education. A new Social Media Learning Model was conceptualized to aid our understanding of learning via this technology. Knowledge gaps are identified and recommendations on how to capitalize on social media to improve learning in higher and continuing education provided.

Multidimensional care burden in Parkinson’s-related dementia

Background and Objective: Providing care to people with Parkinson-related dementia (PwPRD) may result in significant stress, strain, and burden for life partners. A common measurement of life partner burden is the Zarit Burden Interview (ZBI), which considers “burden” as a unitary concept; however, burden is highly complex and most likely comprises several dimensions. This study aimed to explore the factor structure of the ZBI in life partners of PwPRD and to examine the relationships among the emerging factors and the demographic and clinical features. Methods: Life partners of PwPRD participated in home-based quantitative assessments and self-completed postal questionnaires. The assessment battery included ZBI, measures of relationship satisfaction, mood, stress, resilience, health, quality of life, feelings related to care provision, and sociodemographic questions. Data on PwPRDs’ motor and neuropsychiatric symptom severity were also elicited in home-based assessments. Results: An exploratory factor analysis (principal axis factoring) of ZBI, conducted with 127 life partners, revealed five burden dimensions: social and psychological constraints, personal strain, interference with personal life, concerns about future, and guilt. These burden factors were associated with lower relationship satisfaction, mental health, and resilience, and higher stress, anxiety, depression, resentment, negative strain, and PwPRD motor severity. In multiple linear regression analyses, where each factor score was the dependent variable, stress, negative strain, and resentment emerged as significant predictors of specific burden dimensions. Conclusions: Burden is a complex and multidimensional construct. Interventions should address specific types of burden among life partners of PwPRD to support couples’ relationships and maintain quality of life.