Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people

Background. To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture. Methods/Design. Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables. Discussion. Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study. Trial registration. Current Controlled Trials ISRCTN53680197peerReviewe

Tavoitteet nuorten mielenterveyskuntoutuksessa

Abstrakti Johdanto: Tavoitteiden asettaminen on tärkeä osa mielenterveyskuntoutusta. Nuorilla mielenterveyshäiriöt voivat vaikeuttaa kehitystehtävien saavuttamista, joten kuntoutuksen tavoitteiden tulee mukailla niitä. Aiemmat tutkimukset korostavat, että kuntoutuksessa on tärkeää huomioida kuntoutujan henkilökohtaiset tavoitteet yhteiskunnallisten resurssien lisäksi. Tavoite ja menetelmä: Tämän tutkimuksen tavoitteena oli kuvailla nuorten mielenterveyskuntoutuksen tavoitteita ja tämän myötä lisätä ymmärrystä tavoitteiden merkityksestä ja kehittää tavoitteiden asettelua. Tutkimuksen aineistona olivat 18‐29-vuotiaiden nuorten (n = 16) asumiskuntoutuksessa laaditut kuntoutustiedotteet. Aineisto analysoitiin laadullisella sisällön analyysillä. Tulokset: Mielenterveyskuntoutuksen tavoitteiden pääkategoriat olivat: ikätasoiset toiminnalliset roolit, sosiaalinen osallisuus sekä sisäinen resilienssi. Yksilön toimiessa ikätasoisten toiminnallisten rooliensa mukaisesti yksilö kykenee suuntautumaan kehitystehtäviinsä. Sosiaalinen osallisuus on mahdollisuutta osallistua sosiaalisiin ympäristöihin. Sisäinen resilienssi tarkoittaa yksilön kykyä vaikeissa tilanteissa käyttää vahvuuksiaan. Aineistosta nousi esille myös nuoren ja ammattilaisen välinen vuorovaikutussuhde kuntoutusprosessin aikana. Pohdinta: Tässä tutkimuksessa löydetyt pääkategoriat ovat aiemman tutkimustiedon perusteella yhteydessä valtaistumiseen, kuntoutumiseen ja toipumiseen. Tulosten perusteella ammattilaisen ja nuoren välinen vuorovaikutussuhde on tärkeä osa kuntoutusta ja kuntoutujan osallisuutta tavoitteiden asettelussa tulee vahvistaa. Toipumisorientaation laajempi käyttö mielenterveyspalveluissa voisi mahdollistaa tätä kehitystä.Abstract Goals in Adolescents’ Mental Health Rehabilitation Introduction: Goal setting is a central part of mental health rehabilitation. Especially among young people mental health disorders may delay achieving developmental tasks. Goals of rehabilitation should be in concordance with developmental tasks. According to rehabilitation impact studies, it is important to consider the rehabilitees’ goals in addition to the social and financial perspectives. Purpose and method: The purpose of this study was to increase the understanding of goals set in adolescents’ mental health rehabilitation and develop goal setting. The aim of the study was to describe the goals set in adolescent’s mental health rehabilitation. The study participants were rehabilitees between 18‐29 years in residential rehabilitation (n=16) and the data was register information. The analyze method was content analysis. Results: The main categories of goals were: age-level occupational roles, social inclusion and inner resilience. When acting according to the age-level occupational roles, people are pursuing their developmental tasks. Social inclusion is the possibility to participate in the social environment. Inner resilience is a psychological process which helps the individual to cope with difficult situations by using their personal skills. The data shows also the importance of collaborative relationship between the professional and the young person during the process of recovery. Discussion: Prior research shows that the main categories are connected to empowerment, rehabilitation and recovery. It is important to support the collaborative relationship between the professional and the adolescent by increasing methods that supports adolescent’s participation in the process of goal setting. Wider use of recovery orientation in mental health services could support this development

Effects of a Home-Based Physical Rehabilitation Program on Physical Disability After Hip Fracture: A Randomized Controlled Trial

Objective Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture. Design Randomized, controlled, parallel-group trial. Setting Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Participants Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups. Intervention The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care. Measurements Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention. Results In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were −0.4 points (SE 0.5), −1.7 (0.7), and −1.2 (0.7) at 3, 6, and 12 months for ADLs and −1.0 (1.2), −3.2 (1.5), and −2.5 (1.4) for IADLs, correspondingly. Conclusion The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).peerReviewe

Promoting safe walking among older people : the effects of a physical and cognitive training intervention vs. physical training alone on mobility and falls among older community-dwelling men and women (the PASSWORD study) : design and methods of a randomized controlled trial

Background: Safe and stable walking is a complex process involving the interaction of neuromuscular, sensory and cognitive functions. As physical and cognitive functions deteriorate with ageing, training of both functions may have more beneficial effects on walking and falls prevention than either alone. This article describes the study design, recruitment strategies and interventions of the PASSWORD study investigating whether a combination of physical and cognitive training (PTCT) has greater effects on walking speed, dual-task cost in walking speed, fall incidence and executive functions compared to physical training (PT) alone among 70–85-year-old communitydwelling sedentary or at most moderately physically active men and women. Methods: Community-dwelling sedentary or at most moderately physically active, men and women living in the city of Jyväskylä will be recruited and randomized into physical training (PT) and physical and cognitive training (PTCT). The 12-month interventions include supervised training sessions and home exercises. Both groups attend physical training intervention, which follows the current physical activity guidelines. The PTCT group performes also a web-based computer program targeting executive functions. Outcomes will be assessed at baseline and at 6 and 12 months thereafter. Falls data are collected during the interventions and the subsequent one-year follow-up. The primary outcome is 10-m walking speed. Secondary outcomes include 6-min walking distance, dual-task cost in walking speed, fall incidence and executive function assessed with color Stroop and Trail Making A and B tests. Explanatory outcomes include e.g. body composition and bone characteristics, physical performance, physical activity, life-space mobility, fall-related self-efficacy, emotional well-being and personality characteristics. Discussion: The study is designed to capture the additive and possible synergistic effects of physical and cognitive training. When completed, the study will provide new knowledge on the effects of physical and cognitive training on the prevention of walking limitations and rate of falls in older people. The expected results will be of value in informing strategies designed to promote safe walking among older people and may have a significant health and socio-economic impact.peerReviewe

Effects of Physical and Cognitive Training on Gait Speed and Cognition in Older Adults : A Randomized Controlled Trial

Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12‐month physical and cognitive training (PTCT) on gait speed, dual‐task cost in gait speed, and executive functions (EFs) compared to physical training (PT) (ISRCTN52388040). Community‐dwelling older adults, who did not meet physical activity recommendations, were recruited (n=314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2‐3 times weekly) and moderate aerobic activity 150 minutes/week in bouts of >10 minutes. PTCT included the PT and computer training (CT) on EFs 15‐20 minutes, 3‐4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6‐minute walking distance, dual‐task cost in gait speed, and EF (Stroop and Trail Making B‐A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59‐72% in PT and 62‐77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT‐PT, 0.02; 95%CI ‐0.03, 0.08), walking distance (‐3.8; ‐16.9, 9.3) or dual‐task cost (‐0.22; ‐1.74, 1.30). Stroop improvement was greater after PTCT than PT (‐6.9; ‐13.0, ‐0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF’s, complementing physical training with targeted cognitive training provides additional benefit.peerReviewe