Abstract
. Background
. The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed ‘intermediate care’ services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People’s Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury.
.
. Methods
. A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation.
.
. Discussion
. This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated.
.
. Trial registration
. ISRCTN 13927531. Registered on April 19, 2017.
.

In July 2019, Belo Horizonte hosted an international workshop for 27 junior researchers, whose participants were from Brazil and the United Kingdom. This three-day meeting organized by the Universidade Federal de Minas Gerais and the University of East Anglia addressed challenges in cognitive impairment and dementia, with particular interest in public perceptions, diagnosis and care management. The purpose of this report is to highlight the outcomes of the above-mentioned workshop regarding the topic of public perceptions (part I). Discussions focused on differences and similarities between countries, as well as on identifying main issues that required collaborative and creative solutions. After these group discussions, four core themes emerged: I) cognitive impairment; II) dementia - beyond Alzheimer's disease; III) prevention; and IV) stigma. National and international initiatives to deal with public misperceptions about cognitive impairment and dementia were discussed.

Outcomes for people with hip fracture are poor with approximately only 33% of people returning to their prior level of function and only 24% of people independently mobile by six months after hip fracture. The presence of dementia further worsens outcomes with a significantly increased risk of nursing home admission or death. Physiotherapy is a core treatment for people following surgery for hip fracture, yet there is little evidence to guide physiotherapists how to treat this population. The overall aim of this thesis was to determine the evidence surrounding the physiotherapy treatment for people with dementia following hip fracture and explore the experiences of those involved, thus leading to the development of an intervention which could be tested for feasibility.
A series of four related studies were undertaken. The first of which was a scoping review which highlighted a paucity of evidence guiding the physiotherapy interventions for this population. Thirteen different databases were searched, with 26 articles being included in the review. Where there was evidence, there was a failure to describe the physiotherapy intervention. Consequently, two qualitative studies were undertaken.

The first qualitative study explored the experiences of physiotherapists treating this population and involved semi-structured interviews with twelve physiotherapists. Physiotherapists cited resource pressures, historical reliance of biomedical practices and lack of knowledge as being the main barriers to adopting a person centred care approach that was described as a gold standard of care.

The second study explored the experiences of six people with dementia (and five carers) receiving physiotherapy. Both studies concurred that the approach undertaken by the physiotherapist was often biomedical in nature and this failed to meet the needs of the person with dementia and did not reflect a person centred care approach that is suggested for this population. Patients and their carers reported the desire for treatment to be more person centred, but appreciated that physiotherapists were not able to deliver this.

Data from the qualitative studies, in conjunction with existing biomedical evidence, informed the development of a logic model depicting a community based physiotherapy intervention for people with dementia following hip fracture. This formed the basis for the final stage of the thesis whereby a mixed-methods feasibility study was undertaken. The logic model incorporated the qualitative data and pre-existing physiological evidence in conjunction with components of behaviour change. The feasibility of recruiting to this study was poor, qualitative inquiry suggested that people with dementia were not being referred for on-going physiotherapy following discharge to the community setting. Failure to recruit to the study meant that testing of the intervention in a clinical setting was not possible. Further qualitative analysis proposed that people with dementia were being reported to have “no rehabilitation potential” in the acute setting as their assessment relied on biomedical measures of assessment. This label then prevented them from being offered further rehabilitation in community settings.

Collectively, these series of studies suggested that the failure to approach people with dementia following hip fracture with a biopsychosocial approach, not only reduced their ability to improve, but actually prevented them from being given an opportunity to receive rehabilitation.

BACKGROUND: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents' health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents' experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents' enjoyment of meals, and resulting health and wellbeing. METHODS: Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. RESULTS: the dining experience was a focal point for participants' broader experiences of residing in a care home. Three themes pertaining to residents' experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. CONCLUSION: Mealtimes are a mainstay of life in a care home through which residents' experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.

BACKGROUND: it is estimated that people with dementia are approximately three times more likely to fracture their hip than sex and age matched controls. A report by the Chartered Society of Physiotherapy found that this population have poor access to rehabilitation as inpatients and in the community. A recent scoping review found a paucity of research in this area, indeed there has been no qualitative research undertaken with physiotherapists. In order to address this evidence gap, the aim of this current study was to explore the experiences of physiotherapists treating this population. METHODS: Semi-structured interviews with physiotherapists were undertaken in order to gain an in-depth understanding of how they manage this population. Physiotherapists were recruited from all over the UK and a purposive sampling strategy was employed. Thematic analysis was utilised. RESULTS: a total of 12 physiotherapists were interviewed, at which stage data saturation was reached as no new themes were emerging. The participants had a broad range of experience both in physical and mental health settings. Analysis identified three separate themes: challenges, "thinking outside the box" and realising potential. Physiotherapists felt significant pressures and challenges regarding many aspects of the management of this population. Mainly this was the result of pressures placed on them by guidelines and targets that may not be achievable or appropriate for those with dementia. The challenges and importance of risk taking was also highlighted for this population with an appreciation that standard treatment techniques may need adapting. "Rehabilitation potential" was highlighted as an important consideration, but challenging to determine. CONCLUSION: Interventions for the management of people with dementia and hip fracture need to consider that a traditional biomedical physiotherapy approach may not be the most appropriate approach to use with this population. However physiotherapists reported feeling pressurised to conform to a biomedical approach.

Objective: to establish the current evidence base for the use of orthotics and taping for people with osteoporotic vertebral fracture (OVF)
Design: Systematic review of quantitative and qualitative studies
Data sources: Medline, Medline-In Process, EMBASE, AMED, CINAHL, PEDro, TRIP, EThOS, ProQuest Dissertations and Theses and Cochrane (CDSR, DARE, CMR, HTA, EED) plus Cochrane Central, UK Clinical Research Network portfolio, Controlled Clinical Trials register and the Australian and New Zealand Clinical Trials register.
Eligibility criteria for selecting studies: all study designs were considered if they reported in English and evaluated the impact of using an external support, such as a spinal brace, orthosis or postural tape, with adults with osteoporotic vertebral fracture. All outcomes were considered.
Results: Nine studies were included comprising two parallel-group randomised controlled trials, four randomised crossover trials, two before-after (single arm) studies and a parallel group observational study. No qualitative studies were identified. A wide range of outcomes assessing impairments, activities and participation were assessed but the findings were mixed. The quality of studies was limited.
Conclusion: the current evidence for using orthotic devices or taping for people with OVF is inconsistent and of limited quality and therefore careful consideration should be taken by clinicians before prescribing them in practice.
Registration: PROSPERO (CRD 42015020893)