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BMC Geriatr. 2018 Feb 28;18(1):61. doi: 10.1186/s12877-018-0745-z.

Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study.

Author information

1
Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany. Susanne.Saal@uk-halle.de.
2
Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
3
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
4
German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
5
Institute for General, Family and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
6
Institute of Social Medicine and Epidemiology, Nursing research group, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
7
CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Living Lab on Ageing and Long-Term Care, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
8
University of Applied Sciences for Social Work, Education and Nursing, Dürerstraße 25, 01307, Dresden, Germany.
9
Faculty of Applied Health and Social Sciences, Rosenheim University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.

Abstract

BACKGROUND:

Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures.

METHODS:

The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes.

RESULTS:

Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners.

CONCLUSIONS:

In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.

TRIAL REGISTRATION:

German clinical trials register, reference number DRKS00010037 (12 February 2016).

KEYWORDS:

Complex intervention; Contractures; Disability and health (ICF); International classification of functioning; Nursing homes; Quality of life; Social participation

PMID:
29490617
PMCID:
PMC5831216
DOI:
10.1186/s12877-018-0745-z
[Indexed for MEDLINE]
Free PMC Article

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