Managing mobility outcomes in vulnerable seniors ( MMOVeS ): a randomized controlled pilot study

Abstract

Objective:

To estimate feasibility and potential for efficacy of an individualized, exercise-focused, self-management program (i.e. Managing Mobility Outcomes In Vulnerable Seniors (MMOVeS)), in comparison to exercise information in improving mobility after six months among seniors recently discharged from hospital.

Design:

Randomized pilot study.

Setting:

Two McGill University-teaching hospitals.

Subjects:

Community dwelling seniors, aged 70 years and older, recently discharged from either participating hospitals.

Interventions:

The physiotherapy-facilitated intervention consisted of (1) evaluation of mobility capacity, (2) setting short- and long-term goals, (3) delineation of an exercise treatment plan, (4) an educational booklet to enhance mobility self-management skills, and (5) six monthly telephone calls. Control group received a booklet with information on exercises targeting mobility limitations in seniors.

Main measures:

Mobility, pain, and health status were assessed at baseline and at six months using multiple indicators drawn from Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Lower Extremity Functional Scale (LEFS) and Short-Form (SF)-36.

Results:

In all, 26 people were randomized to the intervention (mean age: 81 ± 8; 39% women), and 23 were randomized to the control (mean age: 79 ± 7; 33% women). The odds ratio for the mobility outcomes combined was 3.08 and the 95% confidence interval excluded 1 (1.65–5.77). The odds ratio for pain and health perception favored the MMOVeS group, but the 95% confidence interval included the null value.

Conclusions:

This feasibility study highlights the potential for efficacy of an individualized, exercise-focused, self-management program in comparison to exercise information in improving mobility outcome for seniors. Furthermore, a home-program combining self-management skills and exercise taught with minimal supervision prove to be feasible. Finally, data from this study can be used to estimate sample size for a confirmatory trial.

Keywords

Older adults exercise program self-management skills goal setting mobility

Get full access to this article

View all access options for this article.

References

Canadian Institute for Health Information (CIHI). Health Care in Canada, 2011—a focus on seniors and aging, 2011, https://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdf

Krumholz

HM.

Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368(2): 100–102.

Fairhall

et al . Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomised controlled trial. Age Ageing 2014; 43(5): 616–622.

Daniels

et al . Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 2008; 8: 278.

De Vries

et al . Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev 2012; 11(1): 136–149.

Passalent

Landry

Cott

CA.

Exploring wait list prioritization and management strategies for publicly funded ambulatory rehabilitation services in Ontario, Canada: further evidence of barriers to access for people with chronic disease. Healthc Policy 2010; 5(4): e139.

Holman

Lorig

Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep 2004; 119(3): 239–243.

Lorig

Sobel

Laurent

Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema and others. Boulder, Colorado: Bull Publishing Company, 2000.

Stratford

Binkley

Hart

et al . Interpreting lower extremity functional status score. Physiotherapy Can 2005; 57: 154–162.

10.

Binkley

Stratford

Lott

et al . The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999; 79: 371–383.

11.

Franchignoni

et al . Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study. Arch Phys Med Rehabil 2010; 91(9): 1370–1377.

12.

Franchignoni

et al . Psychometric properties of QuickDASH—a classical test theory and Rasch analysis study. Man Ther 2011; 16(2): 177–182.

13.

Hays

Morales

LS.

The RAND-36 measure of health-related quality of life. Ann Med 2001; 33(5): 350–357.

14.

Hays

Sherbourne

Mazel

RM.

The rand 36-item health survey 1.0. Health Econ 1993; 2(3): 217–227.

15.

Hoffmann

et al . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348: g1687.

16.

Bagiella

Clinical trials in rehabilitation: single or multiple outcomes?

Arch Phys Med Rehabil 2009; 90(11): S17–S21.

17.

Mayo

et al . Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial. Clin Rehabil 2014; 28(12): 1198–1209.

18.

Mayo

Scott

Evaluating a complex intervention with a single outcome may not be a good idea: an example from a randomised trial of stroke case management. Age Ageing 2011; 40(6): 718–724.

19.

Altman

DG.

Confidence intervals for the number needed to treat. BMJ 1998; 317(7168): 1309.

20.

Hsieh

et al . An overview of variance inflation factors for sample-size calculation. Eval Health Prof 2003; 26(3): 239–257.

21.

Mayo

Understanding analyses of randomized trials. In: Bailar

Hoaglin

(eds) Medical uses of statistics. Hoboken, NJ: John Wiley & Sons (originally published in The New England Journal of Medicine), 2009, pp.195–237.

22.

Sanchez

Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments. Diabetes Educ 2011; 37(3): 381–391.

23.

Begum

et al . Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes. Diabetes Res Clin Pract 2011; 93(2): 260–267.

24.

Hibbard

Greene

Tusler

Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Manag Care 2009; 15(6): 353–360.

25.

Jerant

Moore-Hill

Franks

Home-based, peer-led chronic illness self-management training: findings from a 1-year randomized controlled trial. Ann Fam Med 2009; 7(4): 319–327.

26.

Lorig

et al . Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care 2001; 39(11): 1217–1223.

27.

Lorig

et al . Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37(1): 5–14.

28.

Osborne

et al . Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians. J Rheumatol 2007; 34(5): 1112–1117.

29.

Chodosh

et al . Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 2005; 143(6): 427–438.

30.

Warsi

et al . Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med 2004; 164(15): 1641–1649.

31.

Vries

et al . Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up. J Cachexia Sarcopenia Muscle 2016; 7: 422–435.

32.

Figueiredo

Mayo

NE.

What pilot studies tell us!

Disabil Rehabil 2015; 37(18): 1694–1695.

33.

Weeks

Noteboom

JT.

Using the number needed to treat in clinical practice. Arch Phys Med Rehabil 2004; 85(10): 1729–1731.

34.

Citrome

Compelling or irrelevant? Using number needed to treat can help decide. Acta Psychiatr Scand 2008; 117(6): 412–419.

35.

Latham

et al . Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA 2014; 311(7): 700–708.

36.

Lee

et al . The statistical interpretation of pilot trials: should significance thresholds be reconsidered? BMC Med Res Methodol 2014; 14(1): 41.

37.

Daltroy

et al . Discrepancies between self-reported and observed physical function in the elderly: the influence of response shift and other factors. Soc Sci Med 1999; 48(11): 1549–1561.

38.

Guralnik

et al . Physical performance measures in aging research. J Gerontol 1989; 44(5): M141–M146.

39.

McHorney

CA.

Ten recommendations for advancing patient-centered outcomes measurement for older persons. Ann Intern Med 2003; 139(5 Pt 2): 403–409.

40.

Schwartz

Sprangers

MA.

Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med 1999; 48(11): 1531–1548.

41.

Statistics Canada. Percentage using medications, by number of medications, household and institutional populations aged 65 or older, 2009, www.statscan.gc.ca/pub/82-003-x/2009001/article/10801/findings-resultats-eng.htm

42.

Eldridge

et al . Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS ONE 2016; 11(3): e0150205.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.40 MB

0.68 MB

0.16 MB