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REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement - feasibility study for a randomised controlled trial

Por: Bertram · W. · Penfold · C. · Glynn · J. · Johnson · E. · Burston · A. · Rayment · D. · Howells · N. · White · S. · Wylde · V. · Gooberman-Hill · R. · Blom · A. · Whale · K.
Objectives

To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement.

 Design

Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study.

 Setting

Two National Health Service (NHS) secondary care hospitals in England and Wales.

 Participants

Preoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0–28 on the Sleep Condition Indicator questionnaire.

 Intervention

The REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals.

 Outcome measures

The primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients.

 Results

Screening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable.

 Conclusions

This feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible.

 Trial registration number

ISRCTN14233189.

The development of Midwifery Unit Standards for Europe

Por: Dr Juliet Rayment · Dr Lucia Rocca-Ihenacho · Mary Newburn · Ellen Thaels · Batinelli Laura · Professor Christine a McCourt
The WHO Global Strategy for Women's, Children's and Adolescents’ Health 2016-2030 emphasises the importance of maternity services in preventing illness and promoting optimal clinical outcomes (Every Woman Every Child, 2015). Midwifery has been recognised as having huge potential for transformation; worldwide, over 50 health outcomes could be improved by expanding provision and access to quality midwifery care (Renfrew, et al., 2014). Midwifery care is also associated with efficient use of resources (Renfrew, et al., 2014).

Project 20: Midwives’ insight into continuity of care models for women with social risk factors: What works, for whom, in what circumstances, and how

Por: Hannah Rayment-Jones · Sergio A. Silverio · James Harris · Angela Harden · Jane Sandall
Women with social risk factors such as those living in poverty and social isolation, seeking asylum or refugee status, experiencing domestic abuse, mental illness, learning difficulties, and substance abuse problems, have significantly higher rates of poor birth outcomes compared to their more advantaged counterparts (Draper, 2019, Biro, 2017, Lindquist, 2015, Blumenshine, 2010, Smith 2009). In both the UK and the US women from black and minority ethnic backgrounds [BME] also experience unacceptably high rates of morbidity and mortality compared to their white counterparts, regardless of their socio-economic status (Knight et al, 2018).
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