From successful randomised controlled trial to national roll-out. The REtirement in ACTion [REACT] programme targeting older people with mobility limitations

Good physical function is crucial to maintaining independence and quality of life into older age. In the UK, one in three (31%) adults aged over 65 have mobility-related disability. This is a major public health issue significantly reducing independence and quality of life and increasing health and social care costs. There is a pressing need for integrated, neighbourhood level support for services that focus on compressing the period spent living with disability/frailty and increasing years with good quality of life. The NIHR-funded Retirement into Action (REACT) randomised controlled trial provided definitive evidence that the REACT group-based, exercise and behavioural maintenance programme prevents mobility decline and is cost effective. The study involved 777 adults at high risk of mobility-related disability and demonstrated that these older adults can improve and maintain their physical functioning over 24 months. Health economic evaluation showed that, largely due to reduced hospital costs, the intervention saved more money than it cost. This makes it a particularly attractive prospect for wider-scale implementation via NHS Integrated Care Boards (ICBs) which have been tasked by the Secretary of State to rebalance spending from acute to community care, treatment to prevention. Furthermore, we have a duty to accelerate the implementation of research with strong findings into routine practice. The 3-year programme of work in this bid will deliver REACT at scale in two separate Integrated Care Systems (ICSs) in Bristol, North Somerset, South Gloucester [BNSSCG] and in North Central London [NCL], providing a blueprint for future commissioning of REACT across the UK. In doing this, we will confirm real-world effectiveness and model the costs and consequences to the ICS, while also understanding the contextual factors that impact wider implementation. Using a systems approach and working with our partners we will focus the intervention on deprived areas with a greater proportion of Black, South Asian and other ethnic communities. Years 1 and 2 will include a “Foundation” stage followed by “Expansion” and “Amplification” stages. We will mobilise partnerships, train instructors, identify venues, develop inclusive participant-identification and recruitment pathways, tailored for the local communities. We will deliver at least 25 REACT groups in each region to at least 750 older adults at high risk of mobility-related disability, participating in the programme for 12 months. We will focus on: 1. Translating REACT into everyday business, ensuring practical implementation at scale without losing fidelity to the core intervention principles. 2. Co-production of programme materials to address the specific cultural needs and preferences of local communities. 3. Support to recruit and train REACT instructors from local diverse communities to maximise the engagement of underserved populations. 4. Apply two key principles throughout: a) Maximising diversity, equity and inclusivity and b) Co-production with diverse stakeholders in local authorities, public health, Integrated Care Boards (ICBs)s, Voluntary and Community Sector (VCS) and service users. We will conduct detailed health economic and implementation evaluations. The implementation evaluation will use a mixed-methods, participatory action research approach to deliver an implementation-focused process evaluation, guided by a robust implementation framework (CFIR). The health economic evaluation will assess the costs and consequences of the programme from an ICS perspective and model these forward (using an existing health economic model of REACT from our the RCT) to inform the ICS Boards about the economic costs and consequences of commissioning of REACT in the long term. These two research components will inform production of a REACT Implementation Toolkit, including implementation case studies from the two regions, an economic ‘business case’, guidance on recruitment strategies, setting up and running the REACT programme and overcoming barriers to /leveraging enablers of delivery.