Title: The role of primary care in reducing the decline in physical function and physical activity in people with long-term conditions; what works, for whom and in what circumstances? A realist synthesis of evidence.
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Aims: This proposal aims to conduct a realist evidence synthesis with embedded co-production and co-design, to provide evidence-based recommendations about how best to help people with long-term conditions, in the primary care setting, to maintain and improve their physical function and become more physically active. Background: Long-term conditions comprise the biggest burden on the NHS and primary care services. ‘Physical function’ can be defined as an individual's capacity to undertake the physical tasks of everyday living. People with long-term conditions often have reduced physical functioning and become less able to live independently and, despite the clear benefits for health and functioning, are also less physically active. Long-term conditions are managed routinely in primary care, with assessment and treatment aligning closely to the medical model of illness. However, physical function and physical activity are often not given as much priority. Psychosocial factors influencing physical function and physical activity also need consideration. A new way is needed to address the decline in physical function and physical activity in people with long-term conditions as part of primary care service delivery. Methods: This realist synthesis will use established methods and will embed the principles of co-production and co-design. Stage 1 will develop initial programme theory based on a scoping search of the scientific and grey literature, as well as two stakeholder workshops to generate initial ideas and theories. A stakeholder analysis will identify relevant stakeholders. These are likely to include patients, GPs, practice nurses, therapists and others involved in improving physical function and promoting physical activity. Stage 2 involves more focussed literature searching, data extraction and synthesis to provide evidence to support the initial programme theories. We will focus our searching on physical activity interventions that are part of primary care service delivery and include assessment of physical function. However, we will iteratively broaden our searches to include relevant areas such as studies from secondary care, the voluntary sector and social care. We will tease out the complexities relating to whether or not something works, for whom and in what circumstances and develop (C)ontext, (M)echanism and (O)utcome (CMO) configurations. A taxonomy of physical activity interventions suitable for optimising physical function for people with long-term conditions will be produced. Stage 3 involves testing and refining the programme theories. We will seek additional input from stakeholders in order to refine the final programme theories. The resulting theories will feed into Stage 4. This stage involves three sequential co-design stakeholder workshops where ideas for service innovation will be developed. A final knowledge mobilisation event will take place in order to address issues relevant to wider implementation to ensure that the intervention is relevant, useable and accessible to stakeholders. It will provide the content for a suite of dissemination materials (such as short video), for development by the design team. Dissemination: A protocol and overall findings paper will be written and published in a scientific journal. The materials from the knowledge mobilisation event will be used for targeted dissemination to relevant groups. PPI representatives will be invited to facilitate dissemination activities.

Lay abstract: Aims: Your ‘physical function’ describes how well you can perform activities that are essential for daily living and staying independent, such as walking to the shops or standing up from a chair. People with long-term conditions, such as arthritis or diabetes, often become less able to do these tasks and are less physically active. The number of people living with long-term conditions is increasing. The purpose of this research is to work with patients and health professionals to work out how best to help people with long-term conditions maintain and improve their physical function and become more physically active. Background: People with long-term conditions visit their GP surgery for regular check-ups and it is the first place they visit with their symptoms. However, physical function is often not given as much priority as other measurements, such as body weight or blood pressure. If a person’s physical function is poor, it means they are less able to look after themselves and do things they enjoy. Improving physical activity is an important way of improving physical function and is very helpful for many long-term conditions. Despite this, most people do not do enough physical activity. Therefore, it is important to pay attention to physical function and physical activity when a person visits their GP surgery. It is also important to consider psychological and social factors. However, we do not know the best way to address physical function and physical activity when people visit their GP surgery for regular check-ups. Methods: We will examine previous studies that have looked at improving physical function and physical activity in primary care. Rather than only finding out whether or not something works, we will find out what works (or doesn’t work), for whom and in what circumstances. This is especially helpful when investigating complex areas, such as improving physical function and physical activity. We will start by developing working theories about why some interventions have worked in primary care or others have not. We will talk to patients and health professionals involved in improving physical function and promoting physical activity to help us with this. This will help us refine our working theories. We will also describe these theories clearly and check that they make sense, including with patient and public representatives. We will end up with a final set of recommendations about how best to help people fulfil their functional potential when they visit their GP surgery. These recommendations will be taken forward to the ‘co-design’ stage. This stage will involve three creative workshops during which two to three ideas of new ways to improve physical function and physical activity will be developed. There will also be a workshop to develop ways of sharing the new findings from the study. A wide range of patients and people involved in the care of people with long-term conditions will be invited to participate in these workshops. Dissemination: We will invite patient and public representatives to be involved in our dissemination activities. Two research publications will be written. One will focus on how we completed the project and one will focus on the findings and recommendations. Reports will be written for the NIHR and we will write to everyone who took part. We will also present our findings at scientific meetings and share with professionals and with the public in a variety of ways, such as by making a video.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE