Lauren Powell

A preventative lifestyle intervention for older adults (Lifestyle Matters): a randomised controlled trial

Abstract Objectives to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. Participants 288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015. Interventions lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and one to one sessions. Main outcome measures the primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong Gierveld Loneliness Scale), assessed at 6 and 24 months. Results data on 262 (intervention = 136; usual care = 126) participants were analysed using intention to treat analysis. Mean SF-36 MH scores at 6 months differed by 2.3 points (95 CI: −1.3 to 5.9; P = 0.209) after adjustments. Conclusions analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline. Trial Registration ISRCTN67209155.

Addressing design and suitability barriers to Telecare use: Has anything changed?

BACKGROUND: Issues relating to design and suitability of Telecare were raised twenty years ago. We explored the views of non-users of Telecare and examined whether design-related barriers exist today despite significant technological advances. OBJECTIVE: To examine the reasons why people choose not to adopt Telecare, with specific focus on reasons relating to design and suitability of the intervention. METHODS: Individual qualitative semi-structured interviews were conducted with people who were not using or had actively declined Telecare, a voice which is rarely heard in Telecare-barrier research. Framework analysis was used to identify existing and emergent themes for n=22 participants. RESULTS: Sub-themes relating to design and suitability of Telecare were explored: Stigma, i.e. Telecare as symbolising old age and lost independence; Design, including stigmatising aesthetics and inappropriate use; Alternative options, i.e. propensity to seek non-Telecare solutions; Awareness of the devices and service; and Cost. CONCLUSIONS: Barriers to Telecare use are similar for both users and non-users. Our results indicate that design-related barriers have yet to be addressed despite the technological revolution. The cost model of Telecare services is becoming more consumer-driven. Thus Telecare design needs to exploit technological advances in order to improve wellbeing and allow individuals their choice and independence.

Assessing Walking Strategies Using Insole Pressure Sensors for Stroke Survivors

Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up such as walking. Using data analysis and machine learning techniques, common patterns and strategies from different users to achieve different tasks can be automatically extracted. In this paper, we present the results obtained for the automatic detection of different strategies used by stroke survivors when walking as integrated into an Information Communication Technology (ICT) enhanced Personalised Self-Management Rehabilitation System (PSMrS) for stroke rehabilitation. Fourteen stroke survivors and 10 healthy controls have participated in the experiment by walking six times a distance from chair to chair of approximately 10 m long. The Rivermead Mobility Index was used to assess the functional ability of each individual in the stroke survivor group. Several walking strategies are studied based on data gathered from insole pressure sensors and patterns found in stroke survivor patients are compared with average patterns found in healthy control users. A mechanism to automatically estimate a mobility index based on the similarity of the pressure patterns to a stereotyped stride is also used. Both data gathered from stroke survivors and healthy controls are used to evaluate the proposed mechanisms. The output of trained algorithms is applied to the PSMrS system to provide feedback on gait quality enabling stroke survivors to self-manage their rehabilitation.

What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review

A number of technologies to help self-manage attention deficit hyperactivity disorder (ADHD) in children and young people (YP) have been developed. This review will assess the level of evidence for the use of such technologies. The review was undertaken in accordance with the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. 7545 studies were screened. Fourteen studies of technology that aim to self-manage difficulties associated with ADHD in children and YP were included. Primary outcome measures were measures that assessed difficulties related to ADHD. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, the Cochrane Library, ProQuest ASSIA, PsycINFO and Scopus. The methodological quality of the studies was assessed. This review highlights the potential for the use of technology in paediatric ADHD management. However, it also demonstrates that current research lacks robustness; using small sample sizes, non-validated outcome measures and little psychoeducation component. Future research is required to investigate the value of technology in supporting children and YP with ADHD and a focus psychoeducation is needed.

Identification of Walking Strategies of People With Osteoarthritis of the Knee Using Insole Pressure Sensors

Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up. Using data analysis and machine learning techniques, common patterns and strategies from different users to execute different tasks can be extracted. In this paper, we present the evaluation results of the impact that clinically diagnosed osteoarthritis of the knee at early stages has on insole pressure sensors while walking at normal speeds focusing on the effects caused at points, where knee forces tend to peak for normal users. From the different parts of the foot affected at high knee force moments, the forefoot pressure distribution and the heel to forefoot weight reallocation strategies have shown to provide better correlations with the user’s perceived pain in the knee for OA users with mild knee pain. This paper shows how the time differences and variabilities from two sensors located in the metatarsal zone while walking provide a simple mechanism to detect different strategies used by users suffering OA of the knee from control users with no knee pain. The weight dynamic reallocation at the midfoot, when moving forward from heel to forefoot, has also shown to positively correlate with the perceived knee pain. The major asymmetries between pressure patterns in both feet while walking at normal speeds are also captured. Based on the described features, automatic evaluation self-management rehabilitation tools could be implemented to continuously monitor and provide personalized feedback for OA patients with mild knee pain to facilitate user adherence to individualized OA rehabilitation.

Recruitment of older adults to three preventative lifestyle improvement studies

BackgroundRecruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions).MethodsDuring the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process.ResultsReferrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit.ConclusionsRecruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research.Trial registrationInternational Standard Randomised Controlled Trial Registry, ID: ISRCTN28645428 (Putting Life In Years RCT). Registered on 11 April 2012;International Standard Randomised Controlled Trial Registry, ID: ISRCTN67209155 (Lifestyle Matters RCT). Registered on 22 March 2012;ClinicalTrials.gov, ID: NCT03054311 (Lifestyle Matters feasibility study). Registered retrospectively on 19 January 2017.

Sensor Optimization in Smart Insoles for Post-Stroke Gait Asymmetries Using Total Variation and L 1 Distances

By deploying pressure sensors on insoles, the forces exerted by the different parts of the foot when performing tasks standing up can be captured. The number and location of sensors to use are important factors in order to enhance the accuracy of parameters used in assessment while minimizing the cost of the device by reducing the number of deployed sensors. Selecting the best locations and the required number of sensors depends on the application and the features that we want to assess. In this paper, we present a computational process to select the optimal set of sensors to characterize gait asymmetries and plantar pressure patterns for stroke survivors based upon the total variation and L1 distances. The proposed mechanism is ecologically validated in a real environment with 14 stroke survivors and 14 control users. The number of sensors is reduced to 4, minimizing the cost of the device both for commercial users and companies and enhancing the cost to benefit ratio for its uptake from a national healthcare system. The results show that the sensors that better represent the gait asymmetries for healthy controls are the sensors under the big toe and midfoot and the sensors in the forefoot and midfoot for stroke survivors. The results also show that all four regions of the foot (toes, forefoot, midfoot, and heel) play an important role for plantar pressure pattern reconstruction for stroke survivors, while the heel and forefoot region are more prominent for healthy controls.

Making Telecare desirable rather than a last resort

ABSTRACT Despite reported benefits of Telecare use for older adults, uptake of Telecare in the United Kingdom remains relatively low. Non-users of Telecare are an under-researched group in the Telecare field. We conducted 22 qualitative individual semi-structured interviews to explore the views and opinions of current non-users of Telecare regarding barriers and facilitators to its use, and explored considerations which may precede their decision to accept, or reject, Telecare. Framework analysis identified a number of themes which influence the outcome and timing of this decision, including peace of mind (for the individual and their family), the strength and composition of an individuals support network, the impact of changing personal and health circumstances, and lack of communication about Telecare (e.g. advertising). A cost–benefit decision process appears to take place for the potential user, whereby the benefit of peace of mind is weighed against perceived ‘costs’ of using Telecare. Telecare is often perceived as a last resort rather than a preventative measure. A number of barriers to Telecare use need to be addressed if individuals are to make fully informed decisions regarding their Telecare use, and to begin using Telecare at a time when it could provide them with optimal benefit. Although the study was set in England, the findings may be relevant for other countries where Telecare is used.