Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial

Helen Killaspy, Louise Marston, Nicholas Green, Isobel Harrison, Melanie Lean, Sarah Cook, Tim Mundy, Thomas Craig, Frank Holloway, Gerard Leavey, Leonardo Koeser, Paul McCrone, Maurice Arbuthnott, Rumana Z Omar, Michael King

    Research output: Contribution to journalArticle

    28 Citations (Scopus)

    Abstract

    Background
    Mental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.

    Methods
    We did a single-blind, two-arm, cluster-randomised controlled trial in 40 mental health inpatient rehabilitation units across England. Units were randomly allocated to either a manual-based staff training programme delivered by a small intervention team (intervention group, n=20) or standard care (control group, n=20). The primary outcome was patients' engagement in activities 12 months after randomisation, measured with the time use diary. With this measure, both the degree of engagement in an activity and its complexity are recorded four times a day for a week, rated on a scale of 0–4 for every period (maximum score of 112). Analysis was by intention-to-treat. Random-effects models were used to compare outcomes between study groups. Cost-effectiveness was assessed by combining service costs with the primary outcome. This study is registered with Current Controlled Trials (ISRCTN25898179).

    Findings
    Patients' engagement in activities did not differ between study groups (coefficient 1·44, 95% CI −1·35 to 4·24). An extra £101 was needed to achieve a 1% increase in patients' engagement in activities with the study intervention.

    Interpretation
    Our training intervention did not increase patients' engagement in activities after 12 months of follow-up. This failure could be attributable to inadequate implementation of the intervention, a high turnover of patients in the intervention units, competing priorities on staff time, high levels of patients' morbidity, and ceiling effects because of the high quality of standard care delivered. Further studies are needed to identify interventions that can improve outcomes for people with severe and complex psychosis.

    Funding
    National Institute for Health Research.
    LanguageEnglish
    Pages38-48
    JournalLancet Psychiatry
    Volume2
    Issue number1
    Early online date16 Dec 2014
    DOIs
    Publication statusPublished - 31 Jan 2015

    Fingerprint

    Single-Blind Method
    Patient Participation
    Inpatients
    Rehabilitation
    Randomized Controlled Trials
    Psychotic Disorders
    Intention to Treat Analysis
    Quality of Health Care
    Health
    Random Allocation
    England
    Cost-Benefit Analysis
    Outcome Assessment (Health Care)
    Morbidity
    Education
    Costs and Cost Analysis
    Control Groups
    Psychiatric Rehabilitation

    Keywords

    • Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind
    • cluster-randomised controlled trial

    Cite this

    Killaspy, Helen ; Marston, Louise ; Green, Nicholas ; Harrison, Isobel ; Lean, Melanie ; Cook, Sarah ; Mundy, Tim ; Craig, Thomas ; Holloway, Frank ; Leavey, Gerard ; Koeser, Leonardo ; McCrone, Paul ; Arbuthnott, Maurice ; Omar, Rumana Z ; King, Michael. / Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial. In: Lancet Psychiatry. 2015 ; Vol. 2, No. 1. pp. 38-48.
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    abstract = "BackgroundMental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.MethodsWe did a single-blind, two-arm, cluster-randomised controlled trial in 40 mental health inpatient rehabilitation units across England. Units were randomly allocated to either a manual-based staff training programme delivered by a small intervention team (intervention group, n=20) or standard care (control group, n=20). The primary outcome was patients' engagement in activities 12 months after randomisation, measured with the time use diary. With this measure, both the degree of engagement in an activity and its complexity are recorded four times a day for a week, rated on a scale of 0–4 for every period (maximum score of 112). Analysis was by intention-to-treat. Random-effects models were used to compare outcomes between study groups. Cost-effectiveness was assessed by combining service costs with the primary outcome. This study is registered with Current Controlled Trials (ISRCTN25898179).FindingsPatients' engagement in activities did not differ between study groups (coefficient 1·44, 95{\%} CI −1·35 to 4·24). An extra £101 was needed to achieve a 1{\%} increase in patients' engagement in activities with the study intervention.InterpretationOur training intervention did not increase patients' engagement in activities after 12 months of follow-up. This failure could be attributable to inadequate implementation of the intervention, a high turnover of patients in the intervention units, competing priorities on staff time, high levels of patients' morbidity, and ceiling effects because of the high quality of standard care delivered. Further studies are needed to identify interventions that can improve outcomes for people with severe and complex psychosis.FundingNational Institute for Health Research.",
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    Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial. / Killaspy, Helen; Marston, Louise; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Cook, Sarah; Mundy, Tim; Craig, Thomas; Holloway, Frank; Leavey, Gerard; Koeser, Leonardo; McCrone, Paul; Arbuthnott, Maurice; Omar, Rumana Z; King, Michael.

    In: Lancet Psychiatry, Vol. 2, No. 1, 31.01.2015, p. 38-48.

    Research output: Contribution to journalArticle

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    AU - Killaspy, Helen

    AU - Marston, Louise

    AU - Green, Nicholas

    AU - Harrison, Isobel

    AU - Lean, Melanie

    AU - Cook, Sarah

    AU - Mundy, Tim

    AU - Craig, Thomas

    AU - Holloway, Frank

    AU - Leavey, Gerard

    AU - Koeser, Leonardo

    AU - McCrone, Paul

    AU - Arbuthnott, Maurice

    AU - Omar, Rumana Z

    AU - King, Michael

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    N2 - BackgroundMental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.MethodsWe did a single-blind, two-arm, cluster-randomised controlled trial in 40 mental health inpatient rehabilitation units across England. Units were randomly allocated to either a manual-based staff training programme delivered by a small intervention team (intervention group, n=20) or standard care (control group, n=20). The primary outcome was patients' engagement in activities 12 months after randomisation, measured with the time use diary. With this measure, both the degree of engagement in an activity and its complexity are recorded four times a day for a week, rated on a scale of 0–4 for every period (maximum score of 112). Analysis was by intention-to-treat. Random-effects models were used to compare outcomes between study groups. Cost-effectiveness was assessed by combining service costs with the primary outcome. This study is registered with Current Controlled Trials (ISRCTN25898179).FindingsPatients' engagement in activities did not differ between study groups (coefficient 1·44, 95% CI −1·35 to 4·24). An extra £101 was needed to achieve a 1% increase in patients' engagement in activities with the study intervention.InterpretationOur training intervention did not increase patients' engagement in activities after 12 months of follow-up. This failure could be attributable to inadequate implementation of the intervention, a high turnover of patients in the intervention units, competing priorities on staff time, high levels of patients' morbidity, and ceiling effects because of the high quality of standard care delivered. Further studies are needed to identify interventions that can improve outcomes for people with severe and complex psychosis.FundingNational Institute for Health Research.

    AB - BackgroundMental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.MethodsWe did a single-blind, two-arm, cluster-randomised controlled trial in 40 mental health inpatient rehabilitation units across England. Units were randomly allocated to either a manual-based staff training programme delivered by a small intervention team (intervention group, n=20) or standard care (control group, n=20). The primary outcome was patients' engagement in activities 12 months after randomisation, measured with the time use diary. With this measure, both the degree of engagement in an activity and its complexity are recorded four times a day for a week, rated on a scale of 0–4 for every period (maximum score of 112). Analysis was by intention-to-treat. Random-effects models were used to compare outcomes between study groups. Cost-effectiveness was assessed by combining service costs with the primary outcome. This study is registered with Current Controlled Trials (ISRCTN25898179).FindingsPatients' engagement in activities did not differ between study groups (coefficient 1·44, 95% CI −1·35 to 4·24). An extra £101 was needed to achieve a 1% increase in patients' engagement in activities with the study intervention.InterpretationOur training intervention did not increase patients' engagement in activities after 12 months of follow-up. This failure could be attributable to inadequate implementation of the intervention, a high turnover of patients in the intervention units, competing priorities on staff time, high levels of patients' morbidity, and ceiling effects because of the high quality of standard care delivered. Further studies are needed to identify interventions that can improve outcomes for people with severe and complex psychosis.FundingNational Institute for Health Research.

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    KW - cluster-randomised controlled trial

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