Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits

BACKGROUND: Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation. METHODS: Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The pre-discharge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates. RESULTS: Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small sample size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results. CONCLUSION: Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting

Human kallikrein-related peptidase 12 stimulates endothelial cell migration by remodeling the fibronectin matrix

Abstract Kallikrein-related peptidase 12 (KLK12) is a kallikrein family peptidase involved in angiogenesis – a complex biological process in which the sprouting, migration and stabilization of endothelial cells requires extracellular matrix remodeling. To characterize the molecular mechanisms associated with KLK12′s proangiogenic activity, we evaluated its ability to hydrolyze various matrix proteins. Our results show that KLK12 efficiently cleaved the human extracellular matrix proteins fibronectin and tenascin, both of which are involved in the regulation of endothelial cell adhesion and migration. For fibronectin, the major proteolytic product generated by KLK12 was a 29 kDa fragment containing the amino-terminal domain and the first five type I fibronectin-domains, which are essential for regulating fibronectin assembly. We also demonstrated that KLK12-mediated fibronectin proteolysis antagonizes fibronectin polymerization and fibronectin fibril formation by endothelial cells, leading to an increase in cell migration. Furthermore, a polyclonal antibody raised against KLK12′s proteolytic cleavage site on fibronectin prevented the KLK12-dependent inhibition of fibronectin polymerization and the KLK12-mediated pro-migratory effect on endothelial cells. Taken as a whole, our results indicate that KLK12′s proangiogenic effect is mediated through several molecular mechanisms

Reporting of complex interventions in clinical trials : development of a taxonomy to classify and describe fall-prevention interventions

Background: Interventions for preventing falls in older people often involve several components, multidisciplinary teams, and implementation in a variety of settings. We have developed a classification system (taxonomy) to describe interventions used to prevent falls in older people, with the aim of improving the design and reporting of clinical trials of fall-prevention interventions, and synthesis of evidence from these trials. Methods: Thirty three international experts in falls prevention and health services research participated in a series of meetings to develop consensus. Robust techniques were used including literature reviews, expert presentations, and structured consensus workshops moderated by experienced facilitators. The taxonomy was refined using an international test panel of five health care practitioners. We assessed the chance corrected agreement of the final version by comparing taxonomy completion for 10 randomly selected published papers describing a variety of fall prevention interventions. Results: The taxonomy consists of four domains, summarized as the “Approach”, “Base”, “Components” and “Descriptors” of an intervention. Sub-domains include; where participants are identified; the theoretical approach of the intervention; clinical targeting criteria; details on assessments; descriptions of the nature and intensity of interventions. Chance corrected agreement of the final version of the taxonomy was good to excellent for all items. Further independent evaluation of the taxonomy is required. Conclusions: The taxonomy is a useful instrument for characterizing a broad range of interventions used in falls prevention. Investigators are encouraged to use the taxonomy to report their interventions

Ergotherapie: een effectief en goedkoop middel om vallen te voorkomen en ouderen hun zelfstandigheid te laten behouden

Inleiding: Dit artikel beschrijft de effectiviteit van ergotherapie voor zelfstandig wonende ouderen, gebaseerd op resultaten van een systematische review. Methoden: Wij zochten naar relevante literatuur in Cinahl, EMBASE, AMED, Scisearch en het Cochrane Controlled Trials Register (juli 2002), en in MEDLINE (mei 2006). Het zoekresultaat, 21 onderzoeken, bevatte gerandomiseerde gecontroleerde trials (RCT’s), gecontroleerde klinische trials en voor-navergelijkingen. Daarbij waren 13 RCT’s, waarvan er 8 voldeden aan de gestelde eisen voor methodologische kwaliteit. Wij onderscheidden een viertal ergotherapeutische interventies. Voor het samenvoegen van de uitkomsten van de afzonderlijke onderzoeken gebruikten wij de ‘best evidence’-synthese. Een methode die de bewijskracht toetst aan de hand van beslisregels over het gebruikte design, de methodologische kwaliteit, het type uitkomstmaat en statistisch significante uitkomsten. Resultaten: Er is sterk bewijs dat adviezen over hulpmiddelen thuis ouderen effectief helpen hun zelfstandigheid te behouden. Een combinatie van advies en trainen van activiteiten blijkt tevens de kans op vallen te verminderen. Ergotherapie helpt bovendien ook ouderen die geen specifieke medische diagnose hebben bij het verbeteren of behouden van de zelfstandigheid, de sociale participatie en het welbevinden. Onderzoeken naar het effect van ergotherapie die gericht is op de mantelzorger zijn van onvoldoende kwaliteit om uitspraken te kunnen doen over de effectiviteit van deze interventie. Beschouwing: Een aantal systematische reviews met betrekking tot de effectiviteit van ergotherapie bij ouderen bevestigt de gevonden resultaten. Ergotherapie levert een belangrijke bijdrage aan het veilig en zelfstandig thuis functioneren van de oudere mens. Ook onderzoeken naar de kosteneffectiviteit van ergotherapie tonen aan dat deze kosten in de zorg bespaart. (aut.ref.