Zoe Richardson
University of York
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PLOS ONE | 2017
Sarah Cockayne; Joy Adamson; Arabella Clarke; Belen Corbacho; Caroline Fairhurst; Lorraine Green; Catherine Hewitt; Kate Hicks; Anne-Maree Kenan; Sarah E Lamb; Caroline McIntosh; Hylton B. Menz; Anthony C. Redmond; Zoe Richardson; Sara Rodgers; Wesley Vernon; Judith Watson; David Torgerson
Background Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. Design Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. Results In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. Conclusion There was a small reduction in falls. The intervention may be cost-effective. Trial Registration ISRCTN ISRCTN68240461
Health Technology Assessment | 2017
Sarah Cockayne; Sara Rodgers; Lorraine Green; Caroline Fairhurst; Joy Adamson; Arabella Scantlebury; Belen Corbacho; Catherine Hewitt; Kate Hicks; Robin Hull; Anne-Maree Keenan; Sarah E Lamb; Caroline McIntosh; Hylton B. Menz; Anthony C. Redmond; Zoe Richardson; Wesley Vernon; Judith Watson; David Torgerson
BACKGROUND Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care. DESIGN A pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS In total, 1010 participants aged ≥ 65 years were randomised (intervention, n = 493; usual care, n = 517) via a secure, remote service. Blinding was not possible. INTERVENTIONS All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness. RESULTS The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI -£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS Owing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK Further research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN68240461. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information.
BMC Public Health | 2017
Cath Jackson; Helen Bedford; Francine M Cheater; Louise Condon; Carol Emslie; Lana Ireland; Philippa Kemsley; Susan Kerr; Helen J Lewis; Julie Mytton; Karen Overend; Sarah Redsell; Zoe Richardson; Christine Shepherd; Lesley Smith; Lisa Dyson
BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1.Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake;2.Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult).MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.Trial registrationCurrent Controlled Trials ISRCTN20019630.
BMJ Open | 2018
Helen Elsey; Tracey Farragher; Sandy Tubeuf; Rachel Bragg; Marjolein Elings; Cathy Brennan; Rochelle Gold; Darren Shickle; Nyantara Wickramasekera; Zoe Richardson; Janet E Cade; Jenni Murray
Objectives To assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services. Design Pilot study using questionnaires to assess quality of life, individually linked to police and probation data. Setting The pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management. Participants We recruited 134 adults (over 18) serving COs in England, 29% female. Results 52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder. Conclusions Recruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies.
Archives of Disease in Childhood | 2016
Helen Bedford; H Beach; Francine M Cheater; Louise Condon; Annie Crocker; Lisa Dyson; Carol Emslie; Susan Kerr; P Kemsley; Lana Ireland; Helen J Lewis; Julie Mytton; Karen Overend; Sarah Redsell; Zoe Richardson; C Shepherd; Lesley Smith; Cath Jackson
Aims To investigate the barriers and facilitators to acceptability and uptake of immunisation among Gypsy/Traveller communities in the UK. Methods We interviewed 174 Gypsy/Travellers from five communities: Romanian/Slovakian Roma, English Gypsy, Irish Travellers, English Roma, Scottish Showpeople, in four UK cities: Interviews gathered views about the influences on their immunisation behaviours (childhood, adult flu and pertussis vaccines) and ideas for improving uptake in their community. Interview data were analysed using the framework approach. The Social Ecological Model provided the theoretical framework. Results General acceptance of immunisation based on social norms and trust in health professionals was expressed by approximately half of the participants from the English Roma and London Irish Traveller communities in two cities; three quarters of the English Gypsy/Irish Traveller community and Scottish Showpeople; and almost all of the Romanian/Slovakian Roma participants. Concerns about specific vaccines were evident for particular communities e.g. pertussis vaccine in pregnancy for the English/Irish Traveller community in one city, MMR for the Scottish Showpeople. A belief that having the HPV vaccination would imply that Traveller girls are promiscuous was evident for a minority of Travellers in four communities (not Scottish Showpeople). Romanian/Slovakian Roma communities identified language barriers to accessing immunisation services and low literacy across all communities resulted in people being unable to read immunisation leaflets or letters/texts about appointments and struggling to make sense of conversations with health professionals. Relationships with health professionals appeared to be very important. Recall and reminder systems (letters, texts, phone calls) were seen as effective for the majority of participants including those who regularly travel. Most did not appear to have problems with attending appointments for immunisations although some talked about the difficulty of registering with a GP practice without a fixed address and being unable to get an appointment within two weeks. Conclusion Although these Travellers’ accounts of the barriers and facilitators to immunisation have consistency with the wider population, there are some important differences between communities. Immunisation services need to be aware of Gypsy/Traveller communities in their area and tailor services accordingly.
Health Technology Assessment | 2016
Cath Jackson; Lisa Dyson; Helen Bedford; Francine M Cheater; Louise Condon; Annie Crocker; Carol Emslie; Lana Ireland; Philippa Kemsley; Susan Kerr; Helen J Lewis; Julie Mytton; Karen Overend; Sarah Redsell; Zoe Richardson; Christine Shepherd; Lesley Smith
Public Health Research | 2018
Helen Elsey; Rachel Bragg; Marjolein Elings; Cathy Brennan; Tracey Farragher; Sandy Tubeuf; Rochelle Gold; Darren Shickle; Nyantara Wickramasekera; Zoe Richardson; Janet E Cade; Jenni Murray
Health Services and Delivery Research | 2018
Elizabeth Littlewood; Shehzad Ali; Lisa Dyson; Ada Keding; Pat Ansell; Della Bailey; Debrah Bates; Catherine Baxter; Jules Beresford-Dent; Arabella Clarke; Samantha Gascoyne; Carol Gray; Lisa Hackney; Catherine Hewitt; Dorothy Hutchinson; Laura Jefferson; Rachel Mann; David Marshall; Dean McMillan; Alice North; Sarah Nutbrown; Emily Peckham; Jodi Pervin; Zoe Richardson; Kelly Swan; Holly Taylor; Bev Waterhouse; Louise Wills; Rebecca Woodhouse; Simon Gilbody
Archive | 2016
Cath Jackson; Lisa Dyson; Helen Bedford; Francine M Cheater; Louise Condon; Annie Crocker; Carol Emslie; Lana Ireland; Philippa Kemsley; Susan Kerr; Helen J Lewis; Julie Mytton; Karen Overend; Sarah Redsell; Zoe Richardson; Christine Shepherd; Lesley Smith
Archive | 2016
Cath Jackson; Lisa Dyson; Helen Bedford; Francine M Cheater; Louise Condon; Annie Crocker; Carol Emslie; Lana Ireland; Philippa Kemsley; Susan Kerr; Helen J Lewis; Julie Mytton; Karen Overend; Sarah Redsell; Zoe Richardson; Christine Shepherd; Lesley Smith