Photo of Professor Nefyn Williams

Professor Nefyn Williams PhD FRCGP

Professor in Primary Care Primary Care & Mental Health

Research

Fracture in the Elderly Multidisciplinary Rehabilitation

FEMuR III RCT
FEMuR III RCT

We have developed a rehabilitation programme in the community, for those aged over 60 years, following surgical treatment of hip fracture. This involved a realist review, a survey and focus groups. The methods for a future randomised controlled trial (RCT) were tested in a randomised feasibility study. This research project linked researchers from all of the schools of the College of Health and Behavioural Sciences. A phase III definitive multi-centre RCT of the intervention funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme is in progress (HTA Reference Number 16/167/09). HTA final report for FEMuR phases I and II. This RCT has been open in nine sites and had recruited 96 patients and 10 carers, with a recruitment rate of two patient participants per site per month open to recruitment, and a retention rate of 83%, which has fulfilled the progression criteria of the internal pilot. However, recruitment to the trial is currently suspended because of the COVID-19 pandemic. When trial recruitment resumes, updated trial recruitment information can will be found on the website FEMuR III

Function First - be active, stay independent

We co-designed a physical activity intervention for long-term conditions managed in primary care. As people age and accumulate long-term conditions, physical function declines. In order to reduce declining physical function, people with long-term conditions need to become more physically active. Primary care is well placed to reduce this decline, but management of long-term conditions does not prioritise physical activity promotion. The aim of this research project was to develop a programme theory explaining how interventions improve physical activity and function, in people with long-term conditions, then to use this programme theory to co-design a prototype intervention. We used realist synthesis to combine evidence from the literature with the views of stakeholders. Five context CMO statements were developed to explain how physical activity could be promoted to enhance physical functioning (and also psychosocial functioning) in people with long-term conditions, who are managed in primary care:

1. Primary care settings are characterised by competing demands, and improving physical activity and physical function are not prioritised in a busy practice (C). If the practice team culture is aligned to promote and support the elements of physical literacy (M), then physical activity promotion will become routine and embedded in usual care (O).
2. Physical activity promotion in primary care is inconsistent and uncoordinated (C). If specific resources are allocated to physical activity promotion (in combination with an aligned practice culture) (M), then this will improve opportunities to change behaviour (O).
3. People with long-term conditions have varying levels of physical function and physical activity, different attitudes to physical activity and differing access to local resources that enable physical activity (C). If physical activity promotion is adapted to individual needs, priorities and preferences, and considers local resource availability (M), then this will facilitate a sustained improvement in physical activity (O).
4. Many primary care practice staff have a lack of knowledge and confidence to promote physical activity (C). If staff develop an improved sense of capability through education and training (M), then they will increase their engagement in physical activity promotion (O).
5. If a programme is credible to patients and professionals (C), trust and confidence in the programme will develop (M) and more patients and professionals engage with the programme (O).

This programme theory informed three co-design workshops and one knowledge mobilisation workshop to develop a prototype intervention. This prototype consisted of:
• Resources designed to encourage a culture of physical literacy amongst staff and within the practice.
• Suggestions for changing the layout of the practice and other promotional materials to create an environment that encourages physical activity.
• Materials to help develop the role of a credible professional who will facilitate behaviour change during consultations with people with long-term conditions.
• Identification of community resources, which can address barriers to the uptake of physical activity, such as community transport schemes.
• Plans to develop, or adapt, an electronic directory of local physical activity opportunities, clubs and groups.

A culture of physical activity promotion is needed in primary care, with appropriate resources, training and a credible intervention. A future research programme will refine and test the prototype intervention.

Rehabilitation of chronic disease such as osteoarthritis and cancer; and the promotion of physical activity in primary care populations

The Hip and Knee Book
The Hip and Knee Book

We have written an evidence based booklet promoting physical activity for patients with osteoarthritis of the hip or knee called the Hip and Knee Book, which has sold over 17,000 copies. A pilot RCT of this booklet found only a small relative improvement in illness, exercise, and fear-avoidance beliefs and physical activity levels. We have performed a systematic review of exercise referral schemes, which informed a RCT and economic evaluation with an extensive process evaluation commissioned as part of the roll out of the Welsh National Exercise Referral Scheme (NERS) across 12 local health board (LHB) areas in Wales. This was a rare example of a RCT nested within a public health policy initiative. The results have informed NICE guidance and contributed to Welsh government policy on physical activity, including the expansion of the National Exercise Referral Scheme to include other chronic diseases.

Research Grants

NIHR Applied Research Collaboration North West Coast

DEPARTMENT OF HEALTH & SOCIAL CARE (UK) (DOH/DHSC/NIHR), LIVERPOOL CLINICAL COMMISSIONING GROUP (UK)

October 2019 - September 2024

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.

DEPARTMENT OF HEALTH & SOCIAL CARE (UK) (DOH/DHSC/NIHR)

September 2018 - February 2020

PhD sponsorship A Abu Elkhair 201455943

LIBYAN EMBASSY IN LONDON

February 2020 - January 2021

A definitive multi-centre randomised controlled trial and economic evaluation of a community-based rehabilitation package following hip fracture (FEMUR III)

DEPARTMENT OF HEALTH & SOCIAL CARE (UK) (DOH/DHSC/NIHR)

August 2018 - January 2022