Allie Welsh

Aims: To evaluate the effect of exercise-based cardiac rehabilitation (CR) on the severity of angina, health-related quality of life (HRQoL), and exercise capacity in adults living with microvascular angina (MVA). Methods and results: Fourteen online databases were searched to identify randomized controlled trials (RCTs) comparing adults with MVA receiving CR to those receiving a control intervention involving no exercise. Meta-analyses using random-effects models were used to calculate mean differences or standardized mean differences (SMD). Of 15 873 reports identified, 5 studies (222 participants) were included. Risk of bias for all outcomes were judged as ‘some concerns’ or ‘high’. Mean ages ranged from 51 to 64 years, and 97.3% were women. Meta-analysis of CR’s effect on the severity of angina was not feasible due to limited data. Meta-analysis on HRQoL was conducted at the domain level of Short Form-36 questionnaire (two RCTs; n = 76) and on exercise capacity measured by peak VO2 (three RCTs; n = 101). The HRQoL outcome was classified as ‘very low certainty’, indicating very little confidence in the effect estimates. The meta-analysis on exercise capacity showed a clinically meaningful change in peak VO2 in favour of CR, with a 4.16 mL/kg/min increase in peak VO2 (SMD of 1.06, 95% CI −0.7 to 2.19, very low certainty). Conclusion: CR may improve exercise capacity in patients living with MVA compared to controls; however, the evidence is very uncertain. High-quality RCTs are needed to rigorously determine the impact of CR on the severity of angina, HRQoL, and exercise capacity in patients living with MVA.

Objectives: To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. Design: Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. Setting: National Health Service (NHS) providers in five English hospitals. Participants: Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. Intervention: Usual care: usual NHS care. Experimental: usual NHS care plus a caregiver–patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. Randomisation and blinding: Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. Main outcome measures: Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. Results: 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. Conclusions: The HIP HELPER programme was acceptable to patient–caregiver dyads and health professionals. The COVID-19 pandemic impacting on site’s ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. Trial registration number: ISRCTN13270387 .

Objectives This study aims to illuminate the perspectives of informal caregivers who support people following hip fracture surgery. Design A qualitative study embedded within a now completed multicentre, feasibility randomised controlled trial (HIP HELPER). Setting Five English National Health Service hospitals. Participants We interviewed 20 participants (10 informal caregivers and 10 people with hip fracture), following hip fracture surgery. This included one male and nine females who experienced a hip fracture; and seven male and three female informal caregivers. The median age was 72.5 years (range: 65–96 years), 71.0 years (range: 43–81 years) for people with hip fracture and informal caregivers, respectively. Methods Semistructured, virtual interviews were undertaken between November 2021 and March 2022, with caregiver dyads (person with hip fracture and their informal caregiver). Data were analysed thematically. Findings We identified two main themes: expectations of the informal caregiver role and reality of being an informal caregiver; and subthemes: expectations of care and services; responsibility and advocacy; profile of people with hip fracture; decision to be a caregiver; transition from hospital to home. Conclusion Findings suggest informal caregivers do not feel empowered to advocate for a person’s recovery or navigate the care system, leading to increased and unnecessary stress, anxiety and frustration when supporting the person with hip fracture. We suggest that a tailored information giving on the recovery pathway, which is responsive to the caregiving population (ie, considering the needs of male, younger and more active informal caregivers and people with hip fracture) would smooth the transition from hospital to home. Trial registration number ISRCTN13270387.Cite Now

Aims This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. Methods This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals. Discussion A multicentre recruitment approach will provide greater external validity across population characteristics in England. The mixed-methods approach will permit in-depth examination of the intervention and trial design parameters. The findings will inform whether and how a definitive trial may be undertaken to test the effectiveness of this caregiver intervention for patients after hip fracture surgery. Cite this article: Bone Jt Open 2021;2(11):909–920.