Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study

Susanne Saal*, Gabriele Meyer, Katrin Beutner, Hanna Klingshirn, Ralf Strobl, Eva Grill, Eva Mann, Sascha Kopke, Michel H. C. Bleijlevens, Gabriele Bartoszek, Anna-Janina Stephan, Julian Hirt, Martin Muller

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures. Methods: The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes. Results: Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners. Conclusions: In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.
Original languageEnglish
Article number61
Number of pages10
JournalBMC Geriatrics
Publication statusPublished - 28 Feb 2018


  • Contractures
  • Nursing homes
  • Social participation
  • International classification of functioning
  • Disability and health (ICF)
  • Complex intervention
  • Quality of life
  • ICF

Cite this