Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial
Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial
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DOI：
10.1186/1741-7015-10-120
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发表时间：
2012-10-15
期刊：
影响因子：
9.3
通讯作者：
Cameron, Ian D.
中科院分区：
文献类型：
--
作者：
Fairhall, Nicola;Sherrington, Catherine;Cameron, Ian D.
背景：增强体弱老年人活动能力的干预措施是维持健康和独立所必需的，但缺乏有效干预措施的明确证据。我们的目的是评估多因素干预对体弱老年人活动相关残疾的影响。方法：我们对澳大利亚悉尼241名体弱的社区老年人进行了一项随机对照试验。根据心血管健康研究的定义，参与者被归类为身体虚弱，没有严重的认知障碍，最近从老年护理和康复服务中出院。实验组接受了为期12个月的多因素、跨学科干预，目标是确定的脆弱因素。两名物理治疗师提供了一项针对活动能力的家庭锻炼计划，并与其他卫生专业人员协调心理和医疗状况的管理。对照组接受常规护理。使用国际功能、残疾和健康分类框架，在基线、3个月和12个月时测量行动能力领域的残疾。使用生活空间评估和目标实现量表来评估参与（对生活情境的参与）。活动（执行移动任务）使用4米步行和自我报告测量来测量。结果：参与者平均年龄为83.3岁（SD: 5.9岁）。在招募的参与者中，216人（90%）在12个月后接受了随访。在此时间点，干预组在目标实现量表（优势比2.1；95%可信区间（CI） 1.3 ~ 3.3, P = 0.004）和生活空间评估（4.68分，95% CI 1.4 ~ 9.9, P = 0.005）得分显著优于对照组。在参与或对走出家门的能力的满意度的全球衡量标准上，各组之间没有差异。在活动水平上，干预组在4 m以上行走速度比对照组快0.05 m/s (95% CI 0.0004 ~ 0.1, P = 0.048)，并且在急性护理后活动测量中得分更高（P < 0.001）。结论：干预减少了体弱老年人的活动相关残疾。这种益处在与行动能力有关的残疾的参与和活动水平上都是明显的。
Background: Interventions that enhance mobility in frail older people are needed to maintain health and independence, yet definitive evidence of effective interventions is lacking. Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people.Methods: We conducted a randomised, controlled trial with 241 frail community-dwelling older people in Sydney, Australia. Participants were classified as frail using the Cardiovascular Health Study definition, did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service. The experimental group received a 12 month multifactorial, interdisciplinary intervention targeting identified frailty components. Two physiotherapists delivered a home exercise program targeting mobility, and coordinated management of psychological and medical conditions with other health professionals. The control group received usual care. Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning, Disability and Health framework. Participation (involvement in life situations) was assessed using the Life Space Assessment and the Goal Attainment Scale. Activity (execution of mobility tasks) was measured using the 4-metre walk and self-report measures.Results: The mean age of participants was 83.3 years (SD: 5.9 years). Of the participants recruited, 216 (90%) were followed-up at 12 months. At this time point, the intervention group had significantly better scores than the control group on the Goal Attainment Scale (odds ratio 2.1; 95% confidence interval (CI) 1.3 to 3.3, P = 0.004) and Life Space Assessment (4.68 points, 95% CI 1.4 to 9.9, P = 0.005). There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house. At the activity level, the intervention group walked 0.05 m/s faster over 4 m (95% CI 0.0004 to 0.1, P = 0.048) than the control group, and scored higher on the Activity Measure for Post Acute Care (P < 0.001).Conclusions: The intervention reduced mobility-related disability in frail older people. The benefit was evident at both the participation and activity levels of mobility-related disability.