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Feasibility of the MAINTAIN intervention to support independence after a fall for people with dementia: a pilot cluster randomised controlled trial in participants own homes

Por: Greene · L. · Connors · J. · Hulme · C. · Ukoumunne · O. C. · Barber · R. · Bingham · A. · Conroy · S. · Fox · C. · Duff · C. · Goodwin · V. · Gordon · A. L. · Hall · A. J. · Harwood · R. H. · Jackson · T. · Litherland · R. · Morgan-Trimmer · S. · Parry · S. W. · Sharma · A. · Whale · B. · A
Objectives

To evaluate the feasibility of conducting a full-scale randomised controlled trial to assess the clinical and cost-effectiveness of the MAINTAIN intervention, designed to support recovery and independence following a fall among people living with dementia.

Design

Pilot cluster randomised controlled trial (c-RCT).

Setting

Community-based healthcare services across six UK sites representing primary and secondary care settings.

Participants

31 participant-carer dyads were recruited. Eligibility criteria included a diagnosis of dementia and a recent fall. Exclusion criteria included severe comorbidity precluding participation. The consent rate was 84%, and retention at follow-up was 81%.

Interventions

The MAINTAIN intervention comprised tailored, home-based therapy sessions delivered by trained professionals, focusing on functional recovery, confidence and re-engagement in daily activities, compared with usual care. The intervention was delivered over 12 weeks with booster sessions up to week 24, with the full trial period lasting 28 weeks.

Primary and secondary outcome measures

Feasibility outcomes included recruitment and retention rates, intervention adherence and data completeness for outcome and economic measures. Exploratory outcomes assessed functional performance and quality of life. Feasibility outcomes were assessed at baseline, 12 weeks and 28 weeks.

Results

Recruitment occurred over an 8-month period (September 2023–April 2024) across six UK sites. Most intervention participants (89%) attended at least 60% of planned sessions. Completion rates for outcome and economic data were high, indicating strong acceptability and feasibility of both the intervention and trial procedures.

Conclusions

The pilot c-RCT demonstrated that recruitment, retention and intervention delivery were feasible and well accepted. Findings support progression to a definitive trial to evaluate the effectiveness and cost-effectiveness of the MAINTAIN intervention.

Trial registration number

ISRCTN16413728 (International Standard Randomised Controlled Trial Number registry).

Enhancing communication confidence and competence: using simulation-based education in perinatal palliative care

Por: Tatterton · M. J. · Whaley · V.

Commentary on: Chen HW, Cheng SF, Hsiung Y, et al. Training perinatal nurses in palliative communication by using scenario-based simulation: A quasi-experimental study. Nurse Educ Pract. 2024. 75:103885. doi: 10.1016/j.nepr.2024.103885

Implications for practice and research

  • Scenario-based simulation (SBS) is an effective method of enhancing the confidence and competence of nurses supporting families who require perinatal palliative care.

  • Further research should focus on the durability of skills acquired through SBS as well as exploring the impact of SBS on a more diverse sample.

  • Context

    Communication is a cornerstone of nursing practice and fundamental to establishing and maintaining relationships with individuals and their families. Nurses involved in the provision of perinatal palliative care work with women, babies and their families, during pregnancy, delivery and in the neonatal period. Effective therapeutic relationships with women and families empower parents, providing control and validation,1 enabling positive...

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