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Implementation, Mechanisms of Effect and Context of an Integrated Care Intervention for Vulnerable Families in Central Sydney Australia

Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods. Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why.

Complexe interventies

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course

AbstractBackground: Ecological models are currently the most used approaches to classify and conceptualise determinantsof sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplaybetween determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework,grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span andintervention and policy planning and evaluation.Methods: A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours(SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting andranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 andFebruary 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The lasttwo phases were completed during a two-day consensus meeting in June 2015.

Steps to recovery

BACKGROUND: Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS: In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION: This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION: Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.

Facilitators and barriers for the implementation of the dynamic school day

From September 2024 onwards we will start the development of an educational innovation for Dutch primary schools to design a dynamic school day (a school day in which sedentary learning is regularly interrupted by moments of physical activity) for their local context. A number of Dutch primary schools already successfully implemented a more dynamic school day. In this qualitative study, we set out to assess the facilitators and barriers that several stakeholders faced during the implementation of the dynamic school day. We also set out to assess preferences of pupils with respect to a more dynamic school day. In preparation of the development phase, we will conduct semi-structured interviews with stakeholders of 3 Dutch primary schools (spring 2024). The interview guide will be based on the MRC guideline for conducting process evaluations of complex interventions. For each school, we seek to include: 1) the physical education teacher, 2) a classroom teacher who finds it easy to organize physical activities during the school day, 3) a classroom teacher who finds it difficult to organize physical activities during the school day, 4) a member of the management team. If relevant, we will also interview other stakeholders involved in the implementation of the dynamic school day. We will present the factors that may facilitate or hinder the implementation of a dynamic school day in the Dutch context. We will use these results to develop a set of potential implementation strategies that can serve as a source of inspiration for other Dutch primary schools in their process to develop a dynamic school day for their local context.

Surviving critical illness: what is next?

BACKGROUND: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?METHODS: A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5.RESULTS: Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed.CONCLUSIONS: A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.