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Silva LGDC, da Silva SLA, Freire JCG, Nascimento EDS, de Andrade PR, Pereira DS, Brito GEG. Exercise-based physiotherapeutic interventions in frailty syndrome: A systematic review and meta-analysis. Physiother Res Int 2024; 29:e2092. [PMID: 38704834 DOI: 10.1002/pri.2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/03/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To identify the effect of exercise interventions on physical frailty in community-dwelling older adults. METHODS Relevant articles were searched in MEDLINE, LILACS, Scielo, Embase, and PEDro in November 2022, based on a protocol registered in PROSPERO and according to items prescribed in Report for Systematic Reviews and Meta-Analyses, using Health Sciences Descriptors (DeCS) and free terms for search strategy, with no language restrictions. The studies were considered if they had been published between January 2010 and November 2022, and were randomized clinical trials in which pre-frail and frail older community-dwelling adults had undergone exercise-based physical therapy. RESULTS The systematic review found 5360 citations; after screening, abstract, and full-text screening for eligibility, seven studies were included, involving 1304 participants overall. The exercise modalities differed substantially between studies. The meta-analysis identified a statistically significant difference in frailty between older adults who exercised compared with those who exercised with no or minimal intervention. No heterogeneity between articles was observed, and the risk of bias was considered low according to funnel plot visual inspection. CONCLUSIONS The results of this review suggest that physical therapy programs are effective in decreasing levels of physical frailty in community-dwelling older adults.
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Affiliation(s)
| | | | | | | | | | - Daniele Sirineu Pereira
- Physical Education, Physiotherapy and Occupational Therapy Center, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Akowuah E, Mathias A, Bardgett M, Harrison S, Kasim AS, Loughran K, Ogundimu E, Trevis J, Wagnild J, Witharana P, Hancock HC, Maier RH. Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) - a study protocol. BMJ Open 2023; 13:e065992. [PMID: 36604134 PMCID: PMC9827267 DOI: 10.1136/bmjopen-2022-065992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Prehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery. METHODS AND ANALYSIS PrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes. ETHICS AND DISSEMINATION A favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13860094.
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Affiliation(s)
- Enoch Akowuah
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ayesha Mathias
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Harrison
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Kirsti Loughran
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Jason Trevis
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | | | - Pasan Witharana
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca H Maier
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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McIsaac DI, Fergusson DA, Khadaroo R, Meliambro A, Muscedere J, Gillis C, Hladkowicz E, Taljaard M. PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores. BMJ Open 2022; 12:e064165. [PMID: 35940835 PMCID: PMC9364396 DOI: 10.1136/bmjopen-2022-064165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Frailty is a strong predictor of adverse postoperative outcomes. Prehabilitation may improve outcomes after surgery for older people with frailty by addressing physical and physiologic deficits. The objective of this trial is to evaluate the efficacy of home-based multimodal prehabilitation in decreasing patient-reported disability and postoperative complications in older people with frailty having major surgery. METHODS AND ANALYSIS We will conduct a multicentre, randomised controlled trial of home-based prehabilitation versus standard care among consenting patients >60 years with frailty (Clinical Frailty Scale>4) having elective inpatient major non-cardiac, non-neurologic or non-orthopaedic surgery. Patients will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of >3 weeks of prehabilitation (exercise (strength, aerobic and stretching) and nutrition (advice and protein supplementation)). The study has two primary outcomes: in-hospital complications and patient-reported disability 30 days after surgery. Secondary outcomes include survival, lower limb function, quality of life and resource utilisation. A sample size of 750 participants (375 per arm) provides >90% power to detect a minimally important absolute difference of 8 on the 100-point patient-reported disability scale and a 25% relative risk reduction in complications, using a two-sided alpha value of 0.025 to account for the two primary outcomes. Analyses will follow intention to treat principles for all randomised participants. All participants will be followed to either death or up to 1 year. ETHICS AND DISSEMINATION Ethical approval has been granted by Clinical Trials Ontario (Project ID: 1785) and our ethics review board (Protocol Approval #20190409-01T). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER NCT04221295.
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Affiliation(s)
- Daniel I McIsaac
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rachel Khadaroo
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Meliambro
- Patient Engagement, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | | | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Emily Hladkowicz
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Zak M, Sikorski T, Wasik M, Courteix D, Dutheil F, Brola W. Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature. Int J Environ Res Public Health 2022; 19:2985. [PMID: 35270677 PMCID: PMC8910391 DOI: 10.3390/ijerph19052985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 02/06/2023]
Abstract
Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients' condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
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Arai M. Evaluating the usefulness of Ninjin'yoeito Kampo medicine in combination with rehabilitation therapy in patients with frailty complicated by intractable dizziness. Neuropeptides 2021; 90:102189. [PMID: 34481223 DOI: 10.1016/j.npep.2021.102189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Patients with chronic intractable dizziness (henceforth referred to as "intractable dizziness") have a high risk of developing frailty complications. This warrants investigation of a combined treatment for intractable dizziness and frailty. Ninjin'yoeito (NYT), a traditional Japanese medicine (Kampo medicine), is reportedly effective in treating frailty and sarcopenia. Herein, we report on the results of a retrospective study that involved the combined application of NYT and dizziness rehabilitation therapy (henceforth referred to as "dizziness rehabilitation"). Of the 31 patients with intractable dizziness, 14 developed frailty, indicating a complication rate of 45.2%. This in turn was approximately 4 times higher than the previously reported rates. Eleven patients became non-frail after 6 months of the combined treatment, and their improvement rate was 78.6%. The aforementioned combination therapy not only improved dizziness but also improved frailty. Following 6 months of combined treatment, patients in the frailty group exhibited improvement in the Dizziness Handicap Inventory score, frailty symptoms, Kihon checklist score, and visual analog scale score (fatigue), and approached the pre-treatment values of those in the non-frailty group. Together, our results highlight the need to combine the treatment for intractable dizziness and frailty.
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Affiliation(s)
- Motohiro Arai
- Department of Dizziness and Balance Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan; Department of Otorhinolarygology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
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Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R. Prioritizing movement to address the frailty phenotype in heart failure. Prog Cardiovasc Dis 2021; 67:26-32. [PMID: 33556427 PMCID: PMC8342629 DOI: 10.1016/j.pcad.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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Zhang J, Liu Z, Liu Y, Ye L. Exercise interventions for older people at risk for frailty: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25940. [PMID: 34011071 PMCID: PMC8137036 DOI: 10.1097/md.0000000000025940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Frailty is a state of age-related reduced physiological reserve characterized by an increased risk of adverse clinical outcomes. Studies have shown that exercise can improve frailty in older people. However, it remains to be seen which exercises will most improve the fitness of older people with frailty or those at the risk for frailty.Objective: This protocol aims to determine whether physical exercise can improve frailty in older people, and if which methods are most effective. METHODS We searched the following databases for relevant articles published between January 1, 2012 and January 1, 2021: PubMed, EMBASE, the Cochrane Library, Wanfang, the China National Knowledge Infrastructure, Clinical Trials Database, and the Science Network. Two independent reviewers will carry out data extraction, discuss and resolve differences, and obtain consensus from the third author. We will select randomized control trials (RCTs) according to the preformulated inclusion criteria. The main outcomes in this study are scores from Fried Frailty Phenotype Criteria; the Frailty Trait Scale-short form; the SHARE Frailty Instrument; the FRAIL scale; the Gérontopôle Frailty Screening Tool; the Clinical Frailty Scale, the Rockwood and Mitnitsky Frailty Index; the Study of Osteoporotic Fractures Index; the Edmonton Frailty Scale; the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index; the Multidimensional Prognostic Index; the Tilburg Frailty Indicator; PRISMA-7; the Groningen Frailty Indicator; the Sherbrooke Postal Questionnaire; and the Kihon Checklist. Secondary outcomes are muscle strength, gait velocity, stair-climbing power, and level of spontaneous physical activity. If the heterogeneity test shows slight or no statistical heterogeneity, a fixed effects model will be used for data synthesis; otherwise, a random effects model will be used. We will develop a unified data extraction table that includes a number of parameters. The Cochrane Cooperative Bias Risk Tool will be used to evaluate the methodological quality of the selected RCTs. RevMan Manager 5.3 and STATA 14.0 will be used for data analysis if enough RCTs (more than 10) are identified and selected. RESULT The final results will provide information on the effectiveness of intervention programs for frail older adul and further demonstrate which exercise programs are more effective and which methods can significantly improve frailty. CONCLUSION This protocol will contribute to the development of more effective interventions for elderly individuals with frailty. ETHICS AND DISSEMINATION This study applies existing literature references; therefore, ethical approval is not required. INPLASY REGISTRATION NUMBER INPLASY202130107.
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Affiliation(s)
- Jianna Zhang
- West China School of Nursing
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhixi Liu
- West China School of Nursing
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- West China School of Nursing
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Ye
- West China School of Nursing
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, China
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Vilches-Moraga A, Price A, Braude P, Pearce L, Short R, Verduri A, Stechman M, Collins JT, Mitchell E, Einarsson AG, Moug SJ, Quinn TJ, Stubbs B, McCarthy K, Myint PK, Hewitt J, Carter B. Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study. BMC Med 2020; 18:408. [PMID: 33334341 PMCID: PMC7746415 DOI: 10.1186/s12916-020-01856-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. METHODS Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. RESULTS Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58-81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6-24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1-3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97-4.11); CFS 5, 3.77 (1.94-7.32); CFS 6, 4.04 (2.09-7.82); CFS 7, 2.16 (1.12-4.20); and CFS 8, 3.19 (1.06-9.56). CONCLUSIONS Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
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Affiliation(s)
- A Vilches-Moraga
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - A Price
- Salford Royal Hospital Foundation Trust, Salford, England
| | - P Braude
- North Bristol NHS Trust, Bristol, England
| | - L Pearce
- Faculty of Medical and Human Services, University of Manchester, Manchester, England
- Salford Royal Hospital Foundation Trust, Salford, England
| | - R Short
- Department of Biostatistics and Health Informatics, King's College London, London, England
| | - A Verduri
- University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - M Stechman
- University Hospital of Wales, Cardiff University, Cardiff, Wales
| | - J T Collins
- Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Newport, Wales
| | - E Mitchell
- North Bristol NHS Trust, Bristol, England
| | | | - S J Moug
- Royal Alexandra Hospital, Paisley, Scotland
| | - T J Quinn
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - K McCarthy
- North Bristol NHS Trust, Bristol, England
| | - P K Myint
- University of Aberdeen, Aberdeen, Scotland
| | - J Hewitt
- Aneurin Bevan Health Board, Cardiff University, Cardiff, Wales
| | - B Carter
- Department of Biostatistics and Health Informatics, King's College London, London, England.
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Yao S, Zheng P, Ji L, Ma Z, Wang L, Qiao L, Wan Y, Sun N, Luo Y, Yang J, Wang H. The effect of comprehensive assessment and multi-disciplinary management for the geriatric and frail patient: A multi-center, randomized, parallel controlled trial. Medicine (Baltimore) 2020; 99:e22873. [PMID: 33181655 PMCID: PMC7668452 DOI: 10.1097/md.0000000000022873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.
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Affiliation(s)
- Simin Yao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | - Peipei Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- Peking University Fifth School of Clinical Medicine, Dong Dan, Beijing
| | | | - Zhao Ma
- Department of Rehabilitation
| | | | - Linlin Qiao
- Department of TCM, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Yuhao Wan
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Yao Luo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
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Zhao J, Chau JPC, Zang Y, Lo SHS, Choi KC, Liang S. The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility. Medicine (Baltimore) 2020; 99:e21805. [PMID: 32846817 PMCID: PMC7447489 DOI: 10.1097/md.0000000000021805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER CRD 42019142681.
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Affiliation(s)
- Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Surui Liang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Carli F, Bessissow A, Awasthi R, Liberman S. Prehabilitation: finally utilizing frailty screening data. Eur J Surg Oncol 2020; 46:321-325. [PMID: 31954550 DOI: 10.1016/j.ejso.2020.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The elderly colorectal cancer patients tend to be frail, at nutrition risk with multiple comorbidities. In view of the stress on the body by surgery and recovery, it makes sense if patients are prepared before appropriately so that they can recover earlier and better. Prehabilitation prior to major surgery has attracted the attention of clinicians recently, and this review highlights the steps that need to be taken to implement a multidisciplinary program. Such programs requires a paradigm shift in the sense that all players need to be working in team for the benefit of patinets' outcome.
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Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
| | - Amal Bessissow
- Department of Internal Medicine, McGill University, Montreal, Quebec, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
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Cordes T, Bischoff LL, Schoene D, Schott N, Voelcker-Rehage C, Meixner C, Appelles LM, Bebenek M, Berwinkel A, Hildebrand C, Jöllenbeck T, Johnen B, Kemmler W, Klotzbier T, Korbus H, Rudisch J, Vogt L, Weigelt M, Wittelsberger R, Zwingmann K, Wollesen B. A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project. BMC Geriatr 2019; 19:369. [PMID: 31870314 PMCID: PMC6929376 DOI: 10.1186/s12877-019-1386-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 12/15/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. METHODS A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). DISCUSSION This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. TRIAL REGISTRATION The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.
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Affiliation(s)
- Thomas Cordes
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Laura L. Bischoff
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nadja Schott
- Department of Sports and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Claudia Voelcker-Rehage
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Charlotte Meixner
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Luisa-Marie Appelles
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Michael Bebenek
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andre Berwinkel
- Department of Sport & Health Sciences, University of Paderborn, Paderborn, Germany
| | - Claudia Hildebrand
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Thomas Jöllenbeck
- Department of Sport & Health Sciences, University of Paderborn, Paderborn, Germany
| | - Bettina Johnen
- Department of Sports and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Klotzbier
- Department of Sports and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Heide Korbus
- Department of Sports and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Julian Rudisch
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Lutz Vogt
- Institute of Sports Sciences, Goethe-University Frankfurt, Frankfurt, Germany
| | - Matthias Weigelt
- Department of Sport & Health Sciences, University of Paderborn, Paderborn, Germany
| | - Rita Wittelsberger
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Bettina Wollesen
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
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Abstract
Cardiac rehabilitation plays a key role in the care of older patients after a coronary event. Hospitalizations are prevented and quality of life, exercise capacity, and physical function are improved. Almost 50% of cardiac rehabilitation participants are older adults (>65 years), many of whom are frail or deconditioned. Resistance training, as a component of cardiac rehabilitation, improves muscle strength, endurance, and physical function. The purpose of this review is to describe the effects of resistance training in cardiac rehabilitation for older adults with a particular focus on physical function.
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Affiliation(s)
- Sherrie Khadanga
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, 62 Tilley Drive, South Burlington, VT 05403, USA.
| | - Patrick D Savage
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, 62 Tilley Drive, South Burlington, VT 05403, USA
| | - Philip A Ades
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, 62 Tilley Drive, South Burlington, VT 05403, USA
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Abstract
Sarcopenia is a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality. It occurs commonly as an age-related process in older people, influenced not only by contemporaneous risk factors, but also by genetic and lifestyle factors operating across the life course. It can also occur in mid-life in association with a range of conditions. Sarcopenia has become the focus of intense research aiming to translate current knowledge about its pathophysiology into improved diagnosis and treatment, with particular interest in the development of biomarkers, nutritional interventions, and drugs to augment the beneficial effects of resistance exercise. Designing effective preventive strategies that people can apply during their lifetime is of primary concern. Diagnosis, treatment, and prevention of sarcopenia is likely to become part of routine clinical practice.
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Affiliation(s)
| | - Avan A Sayer
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; National Institute for Health Research, Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University, Newcastle upon Tyne, UK
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15
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Marcusson J, Nord M, Johansson MM, Alwin J, Levin LÅ, Dannapfel P, Thomas K, Poksinska B, Sverker A, Olaison A, Cedersund E, Kelfve S, Motel-Klingebiel A, Hellström I, Kullberg A, Böttiger Y, Dong HJ, Peolsson A, Wass M, Lyth J, Andersson A. Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden. BMJ Open 2019; 9:e027847. [PMID: 31122995 PMCID: PMC6538001 DOI: 10.1136/bmjopen-2018-027847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER NCT03180606.
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Affiliation(s)
- Jan Marcusson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Nord
- Family Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria M Johansson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Petra Dannapfel
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Susanne Kelfve
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | | | - Ingrid Hellström
- Department of Social and Welfare Studies, Faculty of Health Sciences, Norrköping University, Norrköping, Sweden
| | - Agneta Kullberg
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ylva Böttiger
- Clinical Pharmacology, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Physiotherapy, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Wass
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Agneta Andersson
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
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Lelli D, Pérez Bazan LM, Calle Egusquiza A, Onder G, Morandi A, Ortolani E, Mesas Cervilla M, Pedone C, Inzitari M. 25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study. Osteoporos Int 2019; 30:887-895. [PMID: 30652217 DOI: 10.1007/s00198-019-04845-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population. INTRODUCTION Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. METHODS We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. RESULTS We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]). CONCLUSIONS In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.
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Affiliation(s)
- D Lelli
- Area di Geriatria, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - L M Pérez Bazan
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - A Calle Egusquiza
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Onder
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Morandi
- Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy
| | - E Ortolani
- Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy
| | - M Mesas Cervilla
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - C Pedone
- Area di Geriatria, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Inzitari
- Parc Sanitari Pere Virgili, Barcelona, Spain
- Vall d'Hebrón Institute of Research, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kokorelias KM, Munce S, McGilton KS, Cronin SM, Wang CD, Eftekhar P, Cheng DK, Vellani S, Jaglal S, Salbach NM, Kontos P, Colella TJF, Grigorovich A, Cameron JI. Frailty in the context of rehabilitation interventions for adults: protocol for a scoping review. BMJ Open 2019; 9:e024838. [PMID: 30772856 PMCID: PMC6398710 DOI: 10.1136/bmjopen-2018-024838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Although a growing number of frail adults can benefit from rehabilitation services, few are included in rehabilitation services, and reasons for their exclusion are not well understood. To inform research directions in rehabilitation for all adults (aged 18 years and older), we will conduct a scoping review to describe (1) the characteristics of frail adult individuals included in rehabilitation interventions (eg, age range, inclusion and exclusion criteria that are applied), (2) the type of rehabilitation interventions that are used for individuals who are considered frail and (3) the commonly reported outcome measures used for these rehabilitation interventions. METHODS This scoping review will be guided by Arksey and O'Malley's methodological framework. Ageline, Cochrane CINAHL, Embase, MEDLINE, Pubmed, OTSeeker, PeDRO, PsycINFO and Scopus databases will be systematically searched for articles relevant to rehabilitation interventions and health services. To be eligible for inclusion, studies must report on the outcomes from an intervention that involves all individuals (aged 18 and older) who are considered frail. Only English-language, peer-reviewed publications between 1990 and 2018 will be included. A two-step screening process will consist of (1) a title and abstract review and (2) full-text review. In both levels of screening, a minimum of two investigators will independently screen the title and abstract of all retrieved citations for inclusion against a set of minimum inclusion criteria. ANALYSIS Results will be presented as a narrative synthesis to facilitate the integration of diverse evidence. ETHICS AND DISSEMINATION This study does not require ethics approval. By examining the current state of rehabilitation interventions for frail adults, this scoping review can offer insight into rehabilitation needs and models of care. It can also guide future rehabilitation research for frail adults. We will share our results with frail adults during a consultation meeting and publish a manuscript in a peer-reviewed rehabilitation journal.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Sarah Munce
- LIFEspan Service, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Kathy S McGilton
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shawna M Cronin
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chen D Wang
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Parvin Eftekhar
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Darren K Cheng
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Shirin Vellani
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tracey J F Colella
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institution, University Health Network, Cardiac Rehabilitation and Prevention Program, Toronto, Ontario, Canada
| | - Alisa Grigorovich
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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18
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Affiliation(s)
- Jennifer C Lai
- Division of Gastroenterology & Hepatology, Department of Medicine, University of California, San Francisco, CA, USA. Cirrhosis Care Clinic, Division of Gastroenterology & Hepatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology & Hepatology, Department of Medicine, University of California, San Francisco, CA, USA. Cirrhosis Care Clinic, Division of Gastroenterology & Hepatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Chen CH, Lin YH, Chen CH, Wang YH, Yeh ML, Cheng TL, Wang CZ. Transforming growth factor beta 1 mediates the low-frequency vertical vibration enhanced production of tenomodulin and type I collagen in rat Achilles tendon. PLoS One 2018; 13:e0205258. [PMID: 30307981 PMCID: PMC6181323 DOI: 10.1371/journal.pone.0205258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/22/2018] [Indexed: 11/19/2022] Open
Abstract
Vertical vibration (VV) is a whole-body vibration with mechanical loading that commonly used in rehabilitation and sports training to increase athlete muscle strength. Our previous study showed that low-magnitude, low-frequency VV at 8 Hz and 10 Hz increased myoblast myogenesis. Herein, we investigated whether a VV frequency at low-frequency 5-10 Hz has anabolic effects on tenocytes and improves tendon stiffness. In primary tenocytes, 10 Hz VV treatment increased the tenogenic marker gene expression of tenomodulin and extracellular matrix type I collagen but decreased decorin expression. qPCR and Enzyme-Linked Immunosorbent Assay (ELISA) results showed that TGF-β1 expression was increased in tenocytes after 3 days of 10 Hz VV treatment in vitro and in Achilles tendons after 3 weeks in vivo. Tenomodulin expression and Achilles tendon stiffness were significantly increased in Achilles tendons after 3 weeks in vivo. We also showed that the TGF-β1 receptor inhibitor SB431542 (10 μM) decreased the expression of tenomodulin and type I collagen but increased the decorin expression in tenocytes. These results indicated that the 10 Hz VV stimulated anabolic effects in tenocytes by increasing TGF-β1 expression that subsequently increases the expression of tenomodulin and type I collagen, and increased the Achilles tendon stiffness. This study provides insight into the low-frequency 10 Hz VV treatment improves tendon properties and can minimizes the risk of ligament/tendon reinjure during rehabilitation.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsiung Lin
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yan-Hsiung Wang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, No.1 University Road, Tainan City, Taiwan
| | - Tsung-Lin Cheng
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chau-Zen Wang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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Gabrovec B, Veninšek G, Samaniego LL, Carriazo AM, Antoniadou E, Jelenc M. The role of nutrition in ageing: A narrative review from the perspective of the European joint action on frailty - ADVANTAGE JA. Eur J Intern Med 2018; 56:26-32. [PMID: 30082117 DOI: 10.1016/j.ejim.2018.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE There is sufficient evidence that nutrition and frailty status are related. In order to deliver quality management of frail and pre-frail patients, clinicians and dieticians should understand the role of nutrition in the concept of frailty. This study examines the role of nutrition in ageing in general, malnutrition and the risk of frailty, individual nutritional factors as the risk factors of frailty and lastly nutritional interventions that have a significant role in frailty. METHODS A literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published between 2002 and 2017. From 39,885 initial hits, 28 publications were selected. RESULTS Malnutrition or being at risk of malnutrition increases the risk of frailty and its consequences. With regard to the importance of recognizing malnutrition and the risk of malnutrition, the Mini Nutritional Assessment is a validated tool with acceptable sensitivity/specificity to be used for screening and assessment. Frail patients who are at an elevated risk of falls and fractures need Vitamin D supplementation. The promotion of a Mediterranean diet and a protein intake of at least 1-1.2 g per kilogram of body weight per day is beneficial. CONCLUSIONS One of the main variable risk factors for the development of frailty can be unsuitable nourishment and there is evidence that nutrition and frailty status are related. Successful comprehensive management of frailty requires a balanced healthy nutrition at all ages, preferably in combination with physical activity.
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Affiliation(s)
- Branko Gabrovec
- Center for Health Care Research, National Institute of Public Health, Slovenia.
| | - Gregor Veninšek
- Center for Geriatric Medicine, University Medical Centre Ljubljana, Slovenia
| | - Luz López Samaniego
- Progress and Health Foundation, Regional Ministry of Health of Andalusia, Spain
| | | | | | - Marjetka Jelenc
- Center for Health Care Research, National Institute of Public Health, Slovenia
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21
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McIsaac DI, Saunders C, Hladkowicz E, Bryson GL, Forster AJ, Gagne S, Huang A, Lalu M, Lavallee LT, Moloo H, Nantel J, Power B, Scheede-Bergdahl C, Taljaard M, van Walraven C, McCartney CJL. PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. BMJ Open 2018; 8:e022057. [PMID: 29934394 PMCID: PMC6020976 DOI: 10.1136/bmjopen-2018-022057] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Exercise prehabilitation may improve outcomes after surgery. Frailty is a key predictor of adverse postoperative outcomes in older people; the multidimensional nature of frailty makes this a population who may derive substantial benefit from exercise prehabilitation. The objective of this trial is to test the efficacy of exercise prehabilitation to improve postoperative functional outcomes for people living with frailty having cancer surgery with curative intent. METHODS AND ANALYSIS We will conduct a single-centre, parallel-arm randomised controlled trial of home-based exercise prehabilitation versus standard care among consenting patients >60 years having elective cancer surgery (intra-abdominal and intrathoracic) and who are frail (Clinical Frailty Scale >4). The intervention consists of > 3 weeks of exercise prehabilitation (strength, aerobic and stretching). The primary outcome is the 6 min walk test at the first postoperative clinic visit. Secondary outcomes include the short physical performance battery, health-related quality of life, disability-free survival, complications and health resource utilisation. The primary outcome will be analysed by intention to treat using analysis of covariance. Outcomes up to 1 year after surgery will be ascertained through linkage to administrative data. ETHICS AND DISSEMINATION Ethical approval has been granted by our ethics review board (Protocol Approval #2016009-01H). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER NCT02934230; Pre-results.
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Affiliation(s)
- Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chelsey Saunders
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Hladkowicz
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory L Bryson
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sylvain Gagne
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Allen Huang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Manoj Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Luke T Lavallee
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Nantel
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Barbara Power
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Population Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Abstract
INTRODUCTION The beneficial effect of dietary omega-3 supplementation in younger adults or older people with acute or chronic disease is established. Knowledge is now needed about the effect in medically stable older people. The objective of this study is to examine and assess the evidence for a role of dietary omega-3 polyunsaturated fatty acid (PUFA) supplementation in older adults on (1) muscle mass and muscle strength, (2) inflammatory biomarkers and (3) physical activity. METHODS AND ANALYSIS A systematic review and data synthesis will be conducted of randomised controlled trials in older people not recruited for any given disease diagnosis. Placebo-controlled studies reporting interventions involving dietary supplementation of omega-3 PUFAs, eicosapentaenoic acid and docosahexaenoic acid will be included. Outcomes must include changes from baseline to last available follow-up for one or more of the following: muscle mass, inflammatory biomarkers, physical activity, walking speed, weight change, hand grip strength or muscle strength. Once the search strategy has been carried out, two independent researchers will assess relevant papers for eligibility. Articles up until 31 December 2017 in any language will be included. We will provide a narrative synthesis of the findings from the included studies. Studies will be grouped for meta-analysis according to the outcome(s) provided. Where studies have used the same type of intervention, with the same outcome measure, we will pool the results using a random effects meta-analysis, with standardised mean differences for continuous outcomes and risk ratios for binary outcomes, and calculate 95% CI and two-sided p values for each outcome. ETHICS AND DISSEMINATION No research ethics approval is required for this systematic review as no confidential patient data will be used. The results of this systematic review will be disseminated through publication in an open-access peer-reviewed journal and through conference presentations. PROSPERO REGISTRATION NUMBER CRD42017080240.
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Affiliation(s)
- Joanne Stocks
- NIHR Nottingham BRC, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- NIHR Nottingham BRC, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Ferrante LE, Pisani MA, Murphy TE, Gahbauer EA, Leo-Summers LS, Gill TM. The Association of Frailty With Post-ICU Disability, Nursing Home Admission, and Mortality: A Longitudinal Study. Chest 2018; 153:1378-1386. [PMID: 29559308 DOI: 10.1016/j.chest.2018.03.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/12/2018] [Accepted: 03/01/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Frailty is a strong indicator of vulnerability among older persons, but its association with ICU outcomes has not been evaluated prospectively (ie, with objective measurements obtained prior to ICU admission). Our objective was to prospectively evaluate the relationship between frailty and post-ICU disability, incident nursing home admission, and death. METHODS The parent cohort included 754 adults aged ≥ 70 years, who were evaluated monthly for disability in 13 functional activities and every 18 months for frailty (1998-2014). Frailty was assessed using the Fried index, where frailty, prefrailty, and nonfrailty were defined, respectively, as at least three, one or two, and zero criteria (of five). The analytic sample included 391 ICU admissions. RESULTS The mean age was 84.0 years. Frailty and prefrailty were present prior to 213 (54.5%) and 140 (35.8%) of the 391 admissions, respectively. Relative to nonfrailty, frailty was associated with 41% greater disability over the 6 months following a critical illness (adjusted risk ratio, 1.41; 95% CI, 1.12-1.78); prefrailty conferred 28% greater disability (adjusted risk ratio, 1.28; 95% CI, 1.01-1.63). Frailty (odds ratio, 3.52; 95% CI, 1.23-10.08), but not prefrailty (odds ratio, 2.01; 95% CI, 0.77-5.24), was associated with increased nursing home admission. Each one-point increase in frailty count (range, 0-5) was associated with double the likelihood of death (hazard ratio, 2.00; 95% CI, 1.33-3.00) through 6 months of follow-up. CONCLUSIONS Pre-ICU frailty status was associated with increased post-ICU disability and new nursing home admission among ICU survivors, and death among all admissions. Pre-ICU frailty status may provide prognostic information about outcomes after a critical illness.
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Affiliation(s)
- Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
| | - Margaret A Pisani
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Evelyne A Gahbauer
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Linda S Leo-Summers
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Beltrán Troncoso P, Formiga F. [Rehabilitation in elderly frail patients with acute heart failure. Training in REHAB-HF Pilot Study]. Rev Esp Geriatr Gerontol 2018; 53:63-65. [PMID: 29173998 DOI: 10.1016/j.regg.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Paola Beltrán Troncoso
- Sección de riesgo vascular y rehabilitación cardiaca de la Sociedad Española de Cardiología, SEC, Servicio de Cardiología, Hospital Moisés Broggi, Barcelona, España.
| | - Francesc Formiga
- Progama de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de LLobregat, Barcelona, España
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Calle A, Onder G, Morandi A, Bellelli G, Ortolani E, Pérez LM, Mesas M, Sanniti A, Mazzanti P, Platto CN, Gentile S, Martinez N, Roquè M, Inzitari M. Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) Multi-Centric study. J Nutr Health Aging 2018; 22:1099-1106. [PMID: 30379309 DOI: 10.1007/s12603-018-1060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation. OBJECTIVE The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults. DESIGN Multi-centric cohort study. Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016. MEASUREMENTS The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission. RESULTS We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an ortho-pedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG. CONCLUSIONS Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.
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Affiliation(s)
- A Calle
- Alicia Calle, MD, Parc Sanitari Pere Virgili, Esteve Terradas Nº30, 08023 Barcelona, Spain, Tel: +34 932594102, E-mail:
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Wong SG, Maida E, Harvey D, Wagner N, Sonnadara R, Amin N. Evaluation of a physiatrist-directed prehabilitation intervention in frail patients with colorectal cancer: a randomised pilot study protocol. BMJ Open 2017; 7:e015565. [PMID: 28600373 PMCID: PMC5734287 DOI: 10.1136/bmjopen-2016-015565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Prehabilitation interventions have shown efficacy in the orthopaedic and cardiothoracic surgical populations, but there has been limited evidence for general surgical patients. We present the protocol for a pilot trial of a novel prehabilitation intervention, consisting of a physiatrist-directed preoperative assessment and treatment programme. METHODS AND ANALYSIS This is a single-centre pilot randomised controlled trial investigating physiatrist-directed prehabilitation for a 4 to 6-week preoperative period. We will block randomise 40-50 participants awaiting surgery for colorectal cancer to prehabilitation versus control. Participants in the prehabilitation arm will undergo assessment by a physiatrist and enrol in a supervised exercise programme. The control group will not undergo any prehabilitation interventions in the preoperative period. Our primary outcome is feasibility, measured by examining recruitment, refusal, retention and adherence rates as well as participant satisfaction and feedback. Secondary outcomes include physical fitness, functional ability, health-related quality of life, postoperative complications, mortality, readmissions, length of stay, prehabilitation interventions performed and exercise complications. ETHICS AND DISSEMINATION This study has been approved by the Hamilton Integrated Research Ethics Board (HIREB reference number 2015-0090-GRA). The results of this pilot study will be used to design a full-scale study and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02531620; Pre-results.
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Affiliation(s)
- Sherman G Wong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eugene Maida
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Harvey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Natalie Wagner
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Ranil Sonnadara
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Nalin Amin
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Abstract
OBJECTIVES To explore the views and experiences of patients on the care they have received while enrolled on the Northumberland High Risk Patient Programme (NHRPP). This programme involved case finding of frail patients using a multidisciplinary team (MDT)-led community case management programme, and support of patients through care planning and regular reviews using primary, community, secondary and social care professionals. DESIGN A qualitative study using semistructured interviews, which were digitally recorded, transcribed and subject to thematic analysis. SETTING Community patients receiving primary care in the county of Northumberland, England. PARTICIPANTS 23 participants took part, of which 16 were patients enrolled on the NHRPP, and 7 carers. GP practices were selected purposively by size, deprivation and location, and patients identified and invited by General Practitioners to participate. RESULTS 4 main themes emerged from the data: awareness and understanding of the NHRPP, confidence in the primary healthcare team, limitations of home care and the active role of being a patient. Despite having a low level of awareness of the details of the NHRPP, participants did think that its broad aim made sense. Participants discussed their high level of satisfaction with their care and access to team members. However, some limitations of alternatives to hospital care were identified, including the need to consider psychological as well as medical needs, the importance of overnight care and the needs of those without informal carers. Finally, participants discussed the active nature of being a patient under the NHRPP if they were to contribute fully to planning and managing their own care. CONCLUSIONS This study has identified that a programme of MDT-led case management was generally very well received by patients and their families. However, a number of factors were identified that could improve the implementation of the programme and further research needs to be undertaken to address these.
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Affiliation(s)
- Alice Gowing
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tom Gorman
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Duncan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Abstract
OBJECTIVES The objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an occupational therapist, in homecare reablement. DESIGN Feasibility parallel group RCT. SETTING Single-site local authority homecare reablement service. PARTICIPANTS People referred for homecare reablement with ability to consent. Exclusion criteria were as follows: inability to speak English, receiving other community therapy services, needing two or more to assist transfer and receiving end-of-life care. CONTROL 'Usual care' was 6 weeks of homecare reablement delivered by social care workers (no routine health professional input). INTERVENTION A targeted ADL programme, delivered by an occupational therapist incorporating goal setting, teaching/practising techniques, equipment/adaptations and provision of advice/support. This was in addition to usual care. OUTCOME MEASURES Aspects of feasibility including eligibility, recruitment, intervention delivery, attrition and suitability and sensitivity of outcome measures. Participant outcomes were personal and extended ADL, quality of life, falls and use of health and social care services. RESULTS 30 participants were recruited, 15 to each arm, which was 60% of those eligible. Data from 22 (73%) were analysed at 6 months. Of the 15 participants, 13 (86%) received the intervention and were able to set one or more ADL goals. There were improvements from baseline in both groups, although overall improvements were greater in the occupational therapy (OT) intervention group. The biggest threat to feasibility was a change in service configuration during the trial, involving additional occupational therapy input, affecting usual care and recruitment. CONCLUSIONS Despite the service reconfiguration, it was feasible to recruit and retain participants, deliver the intervention and collect outcome data that were responsive to change. The choice of primary outcome measure remains unclear. A further powered study is feasible and warranted; however, the design will require careful consideration because of ongoing national changes in service configurations. TRIAL REGISTRATION NUMBER ISRCTN21710246; Results.
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Affiliation(s)
| | - Marion F Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth H Parry
- School of Health Sciences, University of Nottingham, Nottingham, UK
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