Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Exp Gerontol. 2018 Nov;113:48-57. doi: 10.1016/j.exger.2018.09.017. Epub 2018 Sep 24.
The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees.
The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding.
During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy.
PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
正在进行的“老年人肌肉减少症和身体虚弱:多组分治疗策略(SPRINTT)”随机对照试验(RCT)正在测试多组分干预措施在预防身体虚弱和肌肉减少症(PF&S)的老年人中移动性残疾的疗效。在这里,我们描述了为 SPRINTT RCT 进行 PF&S 病例发现和候选参与者筛选所遵循的程序。我们还说明了合格筛选者的主要人口统计学和临床特征。
PF&S 的识别基于三个定义要素的共同发生:(1)身体表现下降(定义为短体力量表评分在 3 到 9 之间);(2)根据美国国立卫生研究院基金会发布的标准,肌肉量低;(3)无移动性残疾(定义为能够在 15 分钟内完成 400 米步行测试)。SPRINTT 通过多种方式进行宣传。针对各中心的情况,制定了特定地点的病例发现策略,以适应不同中心的特征和目标人群的获取情况。设计了一个快速的“参与者概况”问卷,以方便 PF&S 病例发现。
在大约 22 个月的时间里,在 17 个 SPRINTT 站点完成了 12358 次预筛选访谈,共进行了 6710 次诊所筛选访问。最终,发现 1566 名候选人符合参加 SPRINTT RCT 的条件。合格的筛选者表现出明显的身体功能障碍和合并症负担。在大多数中心,通过大众媒体进行项目宣传是最有效的病例发现策略。
社区中 PF&S 的病例发现是一项具有挑战性但可行的任务。尽管在日常生活活动中基本能够自理,但患有 PF&S 的老年人仍存在严重的功能障碍和合并症。因此,这部分老年人有很高的残疾和其他不良健康相关事件的风险。成功拦截高危老年人的关键策略应侧重于大众传播方法。