Browsing by Person "White, Claire"

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Efficacy of targeted versus non-targeted exercise and behavioural interventions on fatigue in multiple sclerosis: systematic review and meta-analysis
(PROSPERO, 2016-08-22) Moss-Morris, Rona; Mercer, Tom; White, Claire; van der Linden, Marietta; Thomas, Sarah; Harrison, Anthony; Safari, Reza; Norton, Sam
Review question(s) The specific objectives are to: (1) Provide a narrative synthesis of all the interventions, including a summary of the nature of the intervention using the Template for intervention Description and Replication (TiDieR), and assessment of study quality (risk of bias), alongside the standardised intervention effect sizes. As a detailed synthesis already includes studies evaluating interventions specifically targeting MS fatigue (ref: CRD42016033763), the narrative synthesis will focus on studies evaluating interventions that (a) do not specifically target fatigue, or (b) measured fatigue as a secondary outcome. (2) Conduct (pair-wise) meta-analyses to pool effect sizes across intervention types (exercise, behavioural, mixed) and estimate statistical heterogeneity. (3) Directly compare specific types of targeted versus non-targeted exercise, behavioural and combined interventions on fatigue in multiple sclerosis, using network meta-analyses. (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to health care professional (HCP) contact, type of MS, and study quality (i.e. risk of bias).
Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: The PEDAL RCT
(National Institute for Health Research, 2021-06) Greenwood, Sharlene A.; Koufaki, Pelagia; Macdonald, Jamie; Bulley, Catherine; Bhandari, Sunil; Burton, James; Dasgupta, Indranil; Farrington, Kenneth; Ford, Ian; Kalra, Philip A.; Kumwenda, Mick; Macdougall, Iain C.; Messow, Claudia-Martina; Mitra, Sandip; Reid, Chante; Smith, Alice C.; Taal, Maarten W.; Thomson, Peter C.; Wheeler, David C.; White, Claire; Yaqoob, Magdi; Mercer, Tom
Background Whether or not clinically implementable exercise interventions in haemodialysis patients improve quality of life remains unknown. Objectives The PEDAL (PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease) trial evaluated the clinical effectiveness and cost-effectiveness of a 6-month intradialytic exercise programme on quality of life compared with usual care for haemodialysis patients. Design We conducted a prospective, multicentre randomised controlled trial of haemodialysis patients from five haemodialysis centres in the UK and randomly assigned them (1 : 1) using a web-based system to (1) intradialytic exercise training plus usual-care maintenance haemodialysis or (2) usual-care maintenance haemodialysis. Setting The setting was five dialysis units across the UK from 2015 to 2019. Participants The participants were adult patients with end-stage kidney disease who had been receiving haemodialysis therapy for > 1 year. Interventions Participants were randomised to receive usual-care maintenance haemodialysis or usual-care maintenance haemodialysis plus intradialytic exercise training. Main outcome measures The primary outcome of the study was change in Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score (from baseline to 6 months). Cost-effectiveness was determined using health economic analysis and the EuroQol-5 Dimensions, five-level version. Additional secondary outcomes included quality of life (Kidney Disease Quality of Life Short Form, version 1.3, generic multi-item and burden of kidney disease scales), functional capacity (sit-to-stand 60 and 10-metre Timed Up and Go tests), physiological measures (peak oxygen uptake and arterial stiffness), habitual physical activity levels (measured by the International Physical Activity Questionnaire and Duke Activity Status Index), fear of falling (measured by the Tinetti Falls Efficacy Scale), anthropometric measures (body mass index and waist circumference), clinical measures (including medication use, resting blood pressure, routine biochemistry, hospitalisations) and harms associated with intervention. A nested qualitative study was conducted. Results We randomised 379 participants; 335 patients completed baseline assessments and 243 patients (intervention, n = 127; control, n = 116) completed 6-month assessments. The mean difference in change in physical component summary score from baseline to 6 months between the intervention group and control group was 2.4 arbitrary units (95% confidence interval –0.1 to 4.8 arbitrary units; p = 0.055). Participants in the intervention group had poor compliance (49%) and very poor adherence (18%) to the exercise prescription. The cost of delivering the intervention ranged from £463 to £848 per participant per year. The number of participants with harms was similar in the intervention (n = 69) and control (n = 56) groups. Limitations Participants could not be blinded to the intervention; however, outcome assessors were blinded to group allocation. Conclusions On trial completion the primary outcome (Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score) was not statistically improved compared with usual care. The findings suggest that implementation of an intradialytic cycling programme is not an effective intervention to enhance health-related quality of life, as delivered to this cohort of deconditioned patients receiving haemodialysis. Future work The benefits of longer interventions, including progressive resistance training, should be confirmed even if extradialytic delivery is required. Future studies also need to evaluate whether or not there are subgroups of patients who may benefit from this type of intervention, and whether or not there is scope to optimise the exercise intervention to improve compliance and clinical effectiveness. Trial registration Current Controlled Trials ISRCTN83508514. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 40. See the NIHR Journals Library website for further project information.
Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews
(PLoS, 2018-10-12) Hulme, Katrin; Safari, Reza; Thomas, Sarah; Mercer, Tom; White, Claire; van der Linden, Marietta; Moss-Morris, Rona; Nater, Urs M.
Objective: Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions.
Randomized Trial—PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis
(International Society of Nephrology, 2021-05-30) Greenwood, Sharlene A.; Koufaki, Pelagia; Macdonald, Jamie; Bhandari, Sunil; Burton, James; Dasgupta, Indranil; Farrington, Kenneth; Ford, Ian; Kalra, Philip A.; Kean, Sharon; Kumwenda, Mick; Macdougall, Iain C.; Messow, Claudia-Martina; Mitra, Sandip; Reid, Chante; Smith, Alice C.; Taal, Maarten W.; Thomson, Peter C.; Wheeler, David C.; White, Claire; Yaqoob, Magdi; Mercer, Tom
Introduction: Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and costeffectiveness of a 6-month intradialytic exercise program.
The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: Study design and baseline data for a multicentre randomized controlled trial
(Oxford University Press, 2020-09-10) Greenwood, Sharlene A.; Koufaki, Pelagia; Macdonald, Jamie; Bhandari, Sunil; Burton, James; Dasgupta, Indranil; Farrington, Kenneth; Ford, Ian; Kalra, Philip A.; Kean, Sharon; Kumwenda, Mick; Macdougall, Iain C.; Messow, Claudia-Martina; Mitra, Sandip; Reid, Chante; Smith, Alice C.; Taal, Maarten W.; Thomson, Peter C.; Wheeler, David C.; White, Claire; Yaqoob, Magdi; Mercer, Tom
Background Exercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK.
Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis
(Elsevier, 2019-08-28) Moss-Morris, Rona; Harrison, Anthony M.; Safari, Reza; Norton, Sam; van der Linden, Marietta; Picariello, Federica; Thomas, Sarah; White, Claire; Mercer, Tom
Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.
Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis
(SAGE, 2021-04-20) Harrison, Anthony M.; Safari, Reza; Mercer, Tom; Picariello, Federica; van der Linden, Marietta; White, Claire; Moss-Morris, Rona; Norton, Sam
Background: Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment.
Which exercise or behavioural fatigue interventions are effective for people with multiple sclerosis (MS)? A systematic review with detailed intervention breakdown and meta-analysis
(PROSPERO, 2016-06-01) Moss-Morris, Rona; Mercer, Tom; White, Claire; Thomas, Sarah; van der Linden, Marietta; Harrison, Anthony; Safari, Reza; Norton, Sam
Review question(s) The overall aim of this review is to provide guidance as to which of the existing exercise and behavioural interventions appear most promising for the treatment of MS fatigue. The specific objectives are to: (1) Provide a narrative synthesis of all the interventions including a breakdown of the key contextual and treatment components of each of the interventions, the acceptability of the interventions (uptake and adherence), and the study quality (risk of bias) alongside the standardized intervention effect sizes. (2) Conduct meta-analyses of effect sizes across interventions with similar key intervention components. (3) Compare the overall effect sizes of the exercise and behavioral interventions followed by subgroup analysis within each of these groups (e.g. behavioral interventions: energy conservation, CBT, combined; exercise interventions: aerobic endurance, strength, balance and combined). (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to whether interventions were guided by theory or not, different levels of health care professional contact (e.g. email support, telephone, face-to-face), types of MS, comparators used, and study quality.