一项针对体弱老年人的多因素干预措施在依从性较好的人群中的效果是两倍以上：一项随机试验的遵从平均因果效应分析。
A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.
机构信息
The George Institute for Global Health, Sydney Medical School, The University of Sydney.
John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney.
出版信息
J Physiother. 2017 Jan;63(1):40-44. doi: 10.1016/j.jphys.2016.11.007. Epub 2016 Dec 1.
QUESTION
What is the effect of a multifactorial intervention on frailty and mobility in frail older people who comply with their allocated treatment?
DESIGN
Secondary analysis of a randomised, controlled trial to derive an estimate of complier average causal effect (CACE) of treatment.
PARTICIPANTS
A total of 241 frail community-dwelling people aged ≥ 70 years.
INTERVENTION
Intervention participants received a 12-month multidisciplinary intervention targeting frailty, with home exercise as an important component. Control participants received usual care.
OUTCOME MEASURES
Primary outcomes were frailty, assessed using the Cardiovascular Health Study criteria (range 0 to 5 criteria), and mobility measured using the 12-point Short Physical Performance Battery. Outcomes were assessed 12 months after randomisation. The treating physiotherapist evaluated the amount of treatment received on a 5-point scale.
RESULTS
216 participants (90%) completed the study. The median amount of treatment received was 25 to 50% (range 0 to 100). The CACE (ie, the effect of treatment in participants compliant with allocation) was to reduce frailty by 1.0 frailty criterion (95% CI 0.4 to 1.5) and increase mobility by 3.2 points (95% CI 1.8 to 4.6) at 12 months. The mean CACE was substantially larger than the intention-to-treat effect, which was to reduce frailty by 0.4 frailty criteria (95% CI 0.1 to 0.7) and increase mobility by 1.4 points (95% CI 0.8 to 2.1) at 12 months.
CONCLUSION
Overall, compliance was low in this group of frail people. The effect of the treatment on participants who comply with allocated treatment was substantially greater than the effect of allocation on all trial participants.
TRIAL REGISTRATION
Australian and New Zealand Trial Registry ANZCTRN12608000250336. [Fairhall N, Sherrington C, Cameron ID, Kurrle SE, Lord SR, Lockwood K, Herbert RD (2016) A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.Journal of Physiotherapy63: 40-44].
问题
对于遵守分配治疗的虚弱老年人，多因素干预对虚弱和移动性有什么影响？
设计
随机对照试验的二次分析，以得出治疗的遵从平均因果效应（CACE）的估计值。
参与者
总共 241 名年龄≥70 岁的虚弱的社区居住者。
干预措施
干预组参与者接受了为期 12 个月的多学科干预，针对虚弱，家庭运动是一个重要组成部分。对照组参与者接受常规护理。
结果测量
主要结果是使用心血管健康研究标准（范围 0 到 5 个标准）评估的虚弱，以及使用 12 点简短身体表现电池评估的移动性。在随机分组后 12 个月评估结果。治疗物理治疗师根据 5 分制评估治疗的接受程度。
结果
216 名参与者（90％）完成了研究。接受的治疗中位数为 25 ％至 50 ％（范围 0 ％至 100 ％）。CACE（即，符合分配的治疗效果）是在 12 个月时减少 1.0 个虚弱标准（95％CI 0.4 至 1.5）和增加 3.2 点（95％CI 1.8 至 4.6）。平均 CACE 明显大于意向治疗效果，后者是在 12 个月时减少 0.4 个虚弱标准（95％CI 0.1 至 0.7）和增加 1.4 点（95％CI 0.8 至 2.1）。
结论
总体而言，在这群虚弱人群中，依从性较低。治疗对符合分配治疗的参与者的效果明显大于对所有试验参与者的分配效果。
试验注册
澳大利亚和新西兰临床试验注册中心 ANZCTRN12608000250336。[Fairhall N，Sherrington C，Cameron ID，Kurrle SE，Lord SR，Lockwood K，Herbert RD（2016）多因素干预对虚弱的老年人效果是两倍以上，更适合那些符合要求的人：随机试验的遵从性平均因果效应分析。物理治疗杂志 63：40-44]。
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