Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

Underwood, Martin; Lamb, Sarah E; Eldridge, Sandra; Sheehan, Bart; Slowther, Anne; Spencer, Anne; Thorogood, Margaret; Atherton, Nicky; Bremner, Stephen; Devine, Angela; Díaz-Ordaz, Karla; Ellard, David R; Potter, Rachel; Spanjers, K; Taylor, Stephanie J C

doi:10.3310/hta17180

Cited by 43 publications

(41 citation statements)

References 140 publications

(218 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…That nearly half of our participants were depressed, and that only a quarter of these cases were identified as depressed in care-home records underscores the relevance of depression as an important and neglected health problem needing treatment (appendix p 2). 8 A quarter of residents were excluded by care-home managers because their health was very poor, or because of concerns that approaching the resident might cause distress (figure 2). Residents excluded because of very poor health would have been unlikely to be able to participate in the exercise groups and thus unlikely to benefit from the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…We delivered exercise in groups to enhance adherence, increase social interaction, and reduce the cost per resident 9,10 . The exercise classes were designed to provide a moderate intensity strength and aerobic training stimulus 8 . The twice-weekly physiotherapist-led 45 min sessions ran for up to 12 months (intended length 12 months, no minimum duration) in each home and provided a moderately intense exercise stimulus via progressive aerobic and resistance training activities to be done while sitting and standing, using simple, accessible exercise equipment supported by music tracks selected for their facilitatory effects 11 .…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial

et al. 2013

View full text Add to dashboard Cite

SummaryBackgroundDepression is common and is associated with poor outcomes among elderly care-home residents. Exercise is a promising low-risk intervention for depression in this population. We tested the hypothesis that a moderate intensity exercise programme would reduce the burden of depressive symptoms in residents of care homes.MethodsWe did a cluster-randomised controlled trial in care homes in two regions in England; northeast London, and Coventry and Warwickshire. Residents aged 65 years or older were eligible for inclusion. A statistician independent of the study randomised each home (1 to 1·5 ratio, stratified by location, minimised by type of home provider [local authority, voluntary, private and care home, private and nursing home] and size of home [<32 or ≥32 residents]) into intervention and control groups. The intervention package included depression awareness training for care-home staff, 45 min physiotherapist-led group exercise sessions for residents (delivered twice weekly), and a whole home component designed to encourage more physical activity in daily life. The control consisted of only the depression awareness training. Researchers collecting follow-up data from individual participants and the participants themselves were inevitably aware of home randomisation because of the physiotherapists' activities within the home. A researcher masked to study allocation coded NHS routine data. The primary outcome was number of depressive symptoms on the geriatric depression scale-15 (GDS-15). Follow-up was for 12 months. This trial is registered with ISRCTN Register, number ISRCTN43769277.FindingsCare homes were randomised between Dec 15, 2008, and April 9, 2010. At randomisation, 891 individuals in 78 care homes (35 intervention, 43 control) had provided baseline data. We delivered 3191 group exercise sessions attended on average by five study participants and five non-study residents. Of residents with a GDS-15 score, 374 of 765 (49%) were depressed at baseline; 484 of 765 (63%) provided 12 month follow-up scores. Overall the GDS-15 score was 0·13 (95% CI −0·33 to 0·60) points higher (worse) at 12 months for the intervention group compared with the control group. Among residents depressed at baseline, GDS-15 score was 0·22 (95% CI −0·52 to 0·95) points higher at 6 months in the intervention group than in the control group. In an end of study cross-sectional analysis, including 132 additional residents joining after randomisation, the odds of being depressed were 0·76 (95% CI 0·53 to 1·09) for the intervention group compared with the control group.InterpretationThis moderately intense exercise programme did not reduce depressive symptoms in residents of care homes. In this frail population, alternative strategies to manage psychological symptoms are required.FundingNational Institute for Health Research Health Technology Assessment.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial

et al. 2013

View full text Add to dashboard Cite

show abstract

“…However, guidance on the conduct of research involving people who lack capacity is often not clearly understood, even by research ethics committees 8 or easily put into practice. 9 When cluster-randomised trials are conducted in residential homes, there are additional ethical challenges, as well as statistical challenges. [10][11][12] In these trials, clusters are randomised rather than individuals themselves.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Consent processes in cluster-randomised trials in residential facilities for older adults: a systematic review of reporting practices and proposed guidelines

et al. 2013

View full text Add to dashboard Cite

ObjectiveTo assess the quality of reported consent processes of cluster-randomised trials conducted in residential facilities for older people and to explore whether the focus on improving the general conduct and reporting of cluster-randomised trials influenced the quality of conduct and reporting of ethical processes in these trials.DesignSystematic review of cluster-randomised trials reports, published up to the end of 2010.Data sourcesNational Library of Medicine (Medline) via PubMed, hand-searches of BMJ, Journal of the American Medical Association, BMC Health Services Research, Age and Ageing and Journal of the American Geriatrics Society, reference search in Web of Knowledge and consultation with experts.Eligibility for selecting studiesPublished cluster-randomised trials where the unit of randomisation is a part or the whole of a residential facility for older people, without language or year of publication restrictions.ResultsWe included 73 trials. Authors reported ethical approval in 59, obtaining individual consent in 51, and using proxies for this consent in 37, but the process to assess residents’ capacity to consent was clearly reported in only eight. We rated only six trials high for the quality of consent processes. We considered that individual informed consent could have been waived legitimately in 14 of 22 trials not reporting obtaining consent. The proportions reporting ethical approval and quality of consent processes were higher in recent trials.ConclusionsRecently published international recommendations regarding ethical conduct in cluster-randomised trials are much needed. In relation to consent processes when cognitively impaired individuals are included in these trials, we provide a six-point checklist and recommend the minimum information to be reported. Those who lack capacity in trials with complex designs should be afforded the same care in relation to consent as competent adults in trials with simpler designs.

show abstract

“…Although it was a large, adequately powered trial of a 12-month-long intervention, the OPERA trial found no detectable effect of the intervention on either the prevalence or incidence of depression [6,8]. There was also no observable effect on any of the predefined secondary outcomes.…”

Section: Introductionmentioning

confidence: 99%

Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation

Ellard

Thorogood

Underwood

et al. 2014

BMC Med

107

View full text Add to dashboard Cite

BackgroundThe ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect.MethodsThe OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known.ResultsHomes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises.ConclusionsThe intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms.

show abstract

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

Cited by 43 publications

References 140 publications

Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial

Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial

Consent processes in cluster-randomised trials in residential facilities for older adults: a systematic review of reporting practices and proposed guidelines

Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation

Contact Info

Product

Resources

About