Gillian Ward

Fall detectors: a review of the literature

Purpose – The aim of this review is to explore recent literature regarding the development of fall detector technology as part of a service evaluation on the use of fall detectors across the region funded by NHS West Midlands. It also aims to explore the application and the use of products designed to detect falls and alert for help from end‐user and health and social care staff perspectives.Design/methodology/approach – A comprehensive review of the literature of the last ten years was conducted, search terms were used to identify relevant literature from research databases and the main themes from the literature were summarised. This work was carried out to inform a service evaluation of the use of fall detectors across the West Midlands region and was funded by NHS West Midlands.Findings – It was found that whilst there are a wide variety of new technologies regarding fall detectors in development, the range of technologies currently available through health and social services to users are limited. He...

Clinical Audit of the Outcome of Individualised Occupational Therapy Goals

To reflect on clinical effectiveness and revise practice to ensure quality of patient care, the Community Occupational Therapy Service in Leicester developed an individualised outcome measure and audit system. Audits were undertaken in 1997 and 1998 and the results showed a positive outcome in 88% and 90% of individual goals respectively. Improvements to practice achieved through auditing the outcomes of occupational therapy were increased patient involvement in goal setting, improved documentation and treatment planning and positive marketing of the service to general practitioners.

Brief Report: Do Service Dog Providers Placing Dogs with Children with Developmental Disabilities Use Outcome Measures and, If So, What Are they?

The aim of this study was to identify the outcomes expected and assessed by those providing service dogs to children with developmental disabilities. Seventeen registered service dog providers were invited to complete a mixed methods online survey. Five providers, who prepared dogs to work with a wide range of conditions and behaviours, mainly Asperger’s syndrome, autism and communication disorders, completed the survey. All five participants reported that they expected to see positive changes as a consequence of the service dog placement, in both the recipient child and their family, including improvements in attention span and language skills, as well as increased familial cohesion. Survey responses indicated that not all desired outcomes were routinely assessed. The range of assessments used were interviews, intake conversations, pre-placement questionnaires, child social dairies filled in by parents, follow up surveys after placement, and child observation by parents. No specifically named valid and reliable clinical or research measures were referred to, showing an emphasis on assessments from parents and service dog providers. It is not clear whether pre-intervention assessments are repeated systematically at follow-up, which could show robust intervention effects. There is scope for professionals in developmental disability to work with service dog providers to improve the evidence base in this field.

Standardised Assessment: A Comparison of the Community Dependency Index and the Barthel Index with an Elderly Hip Fracture Population

The Community Dependency Index (CDI) is a standardised outcome measure of independence in self-care activities, based upon the Barthel Index, for the assessment of disabled and elderly people living in the community. The operational definitions take account of the influence that the environment has on a persons ability to carry out activities of daily living. This paper reports the results of a longitudinal study of two groups of community-dwelling elderly people who had sustained a hip fracture. The inter-rater reliability of the CDI was assessed, the agreement between the CDI and the Barthel Index was assessed and the sensitivity to change over time of the two measures was compared. The CDI was found to be equally as sensitive to a change in overall scores as the Barthel Index but tended to give lower scores. This trend has important implications for its use as an outcome measure of independence in activities of daily living following trauma.

Creative approaches to service design: Using co-creation to develop a consumer focused assistive technology service

BACKGROUND: The United Kingdom is challenged in terms of how it provides services for the growing number of older people and the associated rise of those living with long term health conditions into old age. Demographic and technological changes present a real opportunity for the assisted living technology industry to develop new innovations to connect and enable dispersed families to provide support to their loved ones within a consumer marketplace. OBJECTIVE:Under the dallas i-Focus programme, the Advanced Digital Institute, with partner Coventry University, developed the Warm Neighbourhoods R AroundMe TM service to help people live at home and enable friends and family to support them using existing connected home sensor technologies to detect usual daily routines. METHOD: A new, consumer-focussed assistive technology service was designed through co-creation. The service was piloted over 3 months within 12 personal “neighbourhoods” using a Living Lab methodology. RESULTS: Results were overwhelmingly positive. Participants easily saw the AroundMe TM service as a consumer offering. Participants found the service reassuring and unobtrusive whilst promoting independence of the main user and providing support for carers. CONCLUSIONS: It became apparent that a unique selling point of the new service was that it was distinguishable from other existing message and emergency response type services to focus on wellbeing and “I’m okay” information as opposed to “I need help”. Within a consumer market it seems that people are willing to pay for peace of mind and reassurance. Success of the pilot service was due to the application of established service design principles to make the service effective and desirable and testing within a Living Lab to develop a simple service that fits technology into the daily lives of families.

The Development of a Clinical Audit Database Using the Westcotes Individualised Outcome Measure

The Westcotes Individualised Outcome Measure and audit system were designed to measure the outcome of occupational therapy in achieving a patient’s goals. Following assessment, problems are identified and categorised using an agreed goal list. Goals for each problem are then negotiated with the patient and, following intervention, the goal is measured using an outcome code. This code is recorded against the specific goal number on the patient’s occupational therapy documentation. A manual system was developed to collate the outcomes. A full description of the outcome measure has been published (Eames et al 1999). Although the manual system was able to measure the outcomes for all the goals and highlight those areas of occupational therapy that had positive outcomes, it was a system that relied on sifting through patients’ notes and collating the information by hand. This was time consuming and expensive in staff hours. The information provided was limited, relating outcomes directly to goals without consideration of other variables such as age and diagnosis. To facilitate this type of data analysis and enable crossreferencing of outcomes with age, diagnosis, amount and type of intervention, or to enable comparisons between different types of treatment, the development of a computerised database was necessary.

Exploration of information needs and development of resources to inform and support those at risk of falling

BACKGROUND: There is a lack of information surrounding assistive technology in general, but in particular, surrounding fall detectors and their use. This paper describes the results specifically pertaining to access to and provision of information regarding fall detectors which arose from a previous project exploring the use of fall detectors in the West Midlands. OBJECTIVE: To develop a range of resources to help inform and support people at risk of falling, based upon the findings of a previous project which aimed to evaluate the use of fall detectors in the West Midlands. METHODS: A combination of focus groups and user interviews were used to explore the successful and unsuccessful use of fall detectors across the West Midlands region in the UK. A range of resources were iteratively developed based upon the findings of these user interviews. RESULTS: There was a lack of information for both the public and health and social care professionals with regards to the availability, advantages, disadvantages, indication and contra-indications of fall detectors, as well as lack of wider information regarding falls. CONCLUSIONS: The project developed a range of information resources based upon the project findings, which have been so far well-received by the public and health and social care professionals. Further research must be conducted to ascertain full impact.

Clinical Governance: The Link between Practice and Education

The New NHS (Department of Health 1997) and A First Class Service (Department of Health 1998) set out the Government’s strategy for ensuring that quality of care becomes the driving force for the development of health services, with clinical governance being the central mechanism for making this strategy happen. Clinical governance is defined as ‘a framework through which NHS organisations are accountable for continuously improving the quality of their services’ (Department of Health 1998, p33). Sealey (1999, p264) clarified this as including ‘the use of evidence-based practice, standards for practice, clinical guidelines, clinical audit, complaints procedures, risk management, incorporating clients’ views, training and continued professional development’. Clinical governance requires health authorities, primary care groups and acute trusts to develop new skills to deliver improved standards of patient care. Some of these skills will build on existing expertise, such as clinical audit and quality monitoring, but a wide range of educational and professional development initiatives will also be necessary. This paper outlines: ■ The role of a lead for the professions allied to medicine (PAMs) in the development of a clinical governance plan for an occupational therapy service in a large acute trust ■ The partnerships that need to be developed at a local level between trusts and occupational therapy education providers to support the acquisition of these new skills at undergraduate and postgraduate levels.

Assisted living technologies and the consumer market: how is it developing?

Purpose A three-year research study, funded by Innovate UK, Consumer Models for Assisted Living (COMODAL) aimed to support the development of the consumer market for electronic assisted living technology (eALT) products and services, particularly for people aged 50-70, approaching older age and retirement themselves or with caring responsibilities for family or friends. The purpose of the COMODAL study was to gain a greater understanding of their needs and behaviours relating to the acquisition of eALT and develop sustainable consumer-led business models that might address these needs and support business development within a consumer market (Ward et al., 2016). The purpose of this paper is to present a follow up study to explore how the market may have changed since the publication of the research findings. Design/methodology/approach An online survey was used to collect both qualitative and quantitative data from individuals working in the supply and distribution of assisted living technologies in the UK regarding how their businesses had developed in the past two years. Findings The results showed that since the publication of the COMODAL research there have been changes in the way that the consumer market for eALT is being approached, not only with more direct marketing focused on consumer’s needs but also in direct partnerships with local authorities that offer greater choice with an improved range of products. Originality/value This is the first paper in the UK to follow up the impact of the original COMODAL research and explore its influence on the development of the consumer market for eALT.

Apps and wearables for monitoring physical activity and sedentary behaviour: A qualitative systematic review protocol on barriers and facilitators:

Objective Monitoring of physical activity and sedentary behaviours by mobile phone applications (apps) and wearable technology (wearables) may improve these health behaviours. This systematic review aims to synthesise the qualitative literature on the barriers and facilitators of using apps and wearables for monitoring physical activity and/or sedentary behaviour in adults. Methods This review protocol is registered in PROSPERO (CRD42017070194). Scientific databases including CINAHL Complete, MEDLINE, PsycINFO, SPORTDiscus, Cochrane Library and Scopus will be searched for relevant studies published from 1 January 2012 to the date the searches are conducted. Studies will be included if they incorporated adults who used an app or wearable for monitoring physical activity and/or sedentary behaviour; explored the barriers and/or facilitators of using an app and/or wearable; and were published in English. Following duplicate screening of titles and abstracts, full texts of potentially eligible papers will be screened to identify studies using qualitative approaches to explore barriers and facilitators of using apps and/or wearables for monitoring physical activity and/or sedentary behaviour. Discrepancies will be resolved through consensus or by consulting a third screener. Relevant excerpts (quotes and text) from the included papers will be extracted and analysed thematically. The Critical Appraisal Skills Programme Qualitative Research Checklist will be used to appraise included studies. Conclusion The results of this work will be useful for those intending to monitor physical activity and/or sedentary behaviour using these technologies.