'Walk Buds': A walking intervention to increase physical activity, physical fitness, and emotional wellbeing, in 9-13 year old children with intellectual disabilities. Results of a clustered randomised feasibility trial.

BACKGROUND: Children with intellectual disability are less physically active and more sedentary than typically developing peers. To date no studies have tested the feasibility of a school-based walking intervention for children with Intellectual Disability. METHOD: A clustered randomised controlled trial (cRCT), with an embedded process evaluation, was used to test the feasibility of a school-based walking intervention. Eight schools (n = 161 pupils aged 9-13 years) were randomised into either an intervention arm or an 'exercise as usual' arm. Measures included physical activity, physical fitness and emotional wellbeing. Baseline and 3-month follow-up data were collected. RESULTS: The 'Walk Buds' intervention was found to be acceptable to teaching staff and pupils, with an uptake rate of the walking sessions offered of 84%. CONCLUSION: A number of challenges were experienced, relating to the COVID-19 pandemic, and difficulties collecting accelerometer data. Barriers, facilitators and required changes identified through the mixed methods process evaluation are discussed.

'Walk Buds': A walking programme to increase physical activity, physical fitness and emotional wellbeing, in 9-13 yr old children with intellectual disability. A study protocol for a clustered RCT.

BACKGROUND: Young people with intellectual disabilities are traditionally less physically fit compared to their non-disabled peers. While the health benefits of increasing physical activity are evident, there remains a lack of evidence on how to increase physical activity and reduce sedentary behaviour in young people with intellectual disabilities. Walking interventions, including those delivered in school settings, have been found to significantly increase physical activity levels of young people without disabilities. However, to date there has been a paucity of studies testing walking interventions for young people with intellectual disabilities in school settings. In an earlier study we developed the Walk Buds school-based walking programme for children with intellectual disability (aged 9-13 yrs), which incorporated a paired buddy component. AIM: We plan to conduct a clustered feasibility RCT that will enable us to examine the acceptability of the Walk Buds programme, randomisation, and outcome measures, check the fidelity programme delivery, and identify the facilitators and barriers to the implementation of the programme. METHODS: This study is a two-arm, cRCT feasibility trial where eight schools will be randomised into either an intervention arm (Walk Buds) or an 'exercise as usual' arm. We are aiming to recruit between 130 and 160 young people with intellectual disabilities. Outcome measures will be recorded at baseline and three-months post-intervention. A process evaluation will explore the factors that could impact on the internal and external validity of a future cRCT and the intervention's logic model. DISCUSSION: Walk Buds is the first theoretically underpinned, peer-led, multi-component, manualised school-based walking programme that aims to increase physical activity, physical fitness, and emotional wellbeing in 9-13 yr old children with intellectual disabilities.

Developing curricular-content and systems-related impact indicators for intellectual disability awareness training for acute hospital settings: A modified International Delphi Survey.

AIM: To identify, and reach consensus on, curricular-content and delivery methods, as well as ways to maximize the impact of intellectual disability awareness training programmes in acute hospital settings. BACKGROUND: With the continuing evidence of avoidable deaths and unwarranted variations in the quality of care to people with an intellectual disability in acute hospitals, it could be purported that current training provided to hospital staff appears to be making a minimal difference in the care provided to this population. DESIGN: A two-round modified Delphi survey was conducted between June 2020-January 2021. METHODS: International experts from primary healthcare and hospital settings, and intellectual disability health fields participated in the survey. Initial curricular-content items were developed from the literature, and based on the combined clinical and academic experience base of the authors. Items were evaluated in terms of agreement/consensus, importance and stability of responses. There were 57 expert responses in Round 1 and 45 in Round 2. RESULTS: The consensus was reached with regard to 55 of 65 curricular-content indicators relating to Aims, Design, Content and Delivery. Ten curricular-content indicators failed to be agreed on relating to the mode of training delivery. With regard to systems-related impact indicators, 28 out of 31 reached consensus. The expert panel identified and agreed on seven system barriers that could obstruct the successful implementation of the awareness training programmes in acute hospital settings. CONCLUSIONS: This is the first international Delphi survey to agree on curricular-content and identify systems-related facilitators for intellectual disability awareness training. Potential system barriers have been highlighted which could be addressed by systemic improvement. Implications for developing, and robustly testing the efficacy of, intellectual disability awareness training programmes are discussed, as are the implications for other cognitively impaired populations. IMPACT: In order to maximize the impact, investment in acute hospital staff education will need to be accompanied by wider changes to systems and structures concerning the governance of service provision for people with an intellectual disability.