Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial
Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial
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DOI：
10.1016/j.jagp.2019.08.008
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发表时间：
2019-12-01
影响因子：
7.2
通讯作者：
Shrout, Patrick E.
中科院分区：
文献类型：
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作者：
Alegria, Margarita;Frontera, Walter;Shrout, Patrick E.
目的：为了测试残疾预防干预措施的可接受性和有效性，积极的思想，强大的机构（PMSB），由准专业人员提供给大多数移民老人四种语言。设计：307名参与者的随机试验，平均随机分为干预或加强常规护理。设置：社区为基础的组织在马萨诸塞州，纽约，佛罗里达，和波多黎各服务的少数民族长者。在2015年5月至2019年3月期间的基线、2、6和12个月收集的数据。参会人员：讲英语、西班牙语、普通话或粤语的成年人，年龄60岁以上，不寻求残疾预防服务，但符合情绪症状升高和轻度至中度身体功能障碍的条件。干预措施：10个认知行为治疗（PM）的个人会议，同时提供了36个小组会议的加强运动训练（SB）超过6个月相比，加强日常护理。衡量标准：可接受性定义为满意度和出席率>50%。通过情绪症状（HSCL-25和GAD-7）、功能表现（SPPB）、自报残疾（LLFDI）和残疾天数（WHODAS 2.0）的变化确定有效性。结果：约77.6%的干预参与者参加了一半以上的PM会议; 53.4%参加了一半以上的SB会议。6个月时的意向治疗分析显示了显著的干预效果：SPPB和LLFDI功能改善，HSCL-25情绪症状降低。12个月时的意向治疗分析显示，LLFDI和HSCL-25的效果仍然显著，干预后6个月的残疾天数（根据WHODAS 2.0）显著减少。结论：PMSB提供的准专业人员在社区为基础的组织表现出良好的可接受性，似乎改善功能，符合效益的影响表明遵守作为一个重要的决定因素的干预反应。
Objective: To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages. Design: Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care. Setting: Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019. Participants: English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction. Interventions: Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care. Measurements: Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0). Results: Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25 . Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention. Conclusions: PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.