Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (MA, MCG, SLM, YW, LH, LF, YG, UG, ZR, JYW, CKC), Boston, MA; Department of Psychiatry, Harvard Medical School (MA), Boston, MA.
Departments of Physical Medicine, Rehabilitation and Sports Medicine and Physiology and Biophysics, University of Puerto Rico (WF), Río Piedras, Puerto Rico.
Am J Geriatr Psychiatry. 2019 Dec;27(12):1299-1313. doi: 10.1016/j.jagp.2019.08.008. Epub 2019 Aug 13.
To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages.
Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care.
Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019.
English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction.
Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care.
Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0).
Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention.
PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.
测试由准专业人员用四种语言向大多数移民老年人提供的残疾预防干预措施——积极思维-强健体魄（PMSB）的可接受性和有效性。
307 名参与者的随机试验，均衡随机分为干预组和增强常规护理组。
在马萨诸塞州、纽约州、佛罗里达州和波多黎各的社区组织中为少数民族老年人提供服务。数据收集于 2015 年 5 月至 2019 年 3 月期间的基线、2 个月、6 个月和 12 个月。
年龄在 60 岁以上、不寻求残疾预防服务、但根据情绪升高症状和轻度至中度身体功能障碍有资格参加的英语、西班牙语、普通话或粤语成年人。
在 6 个月的时间里，与增强常规护理相比，进行了 10 次认知行为疗法（PM）的个体治疗和 36 次强化锻炼训练（SB）的小组治疗。
可接受性定义为对>50%的治疗方案的满意度和出勤率。有效性通过情绪症状（HSCL-25 和 GAD-7）、功能表现（SPPB）、自我报告的残疾（LLFDI）和残疾天数（WHODAS 2.0）的变化来确定。
大约 77.6%的干预参与者参加了超过一半的 PM 治疗；53.4%的人参加了超过一半的 SB 治疗。6 个月时的意向治疗分析显示干预效果显著：SPPB 和 LLFDI 改善了功能，HSCL-25 降低了情绪症状。12 个月时的意向治疗分析显示，LLFDI 和 HSCL-25 的效果仍然显著，残疾天数（根据 WHODAS 2.0）在干预后 6 个月显著减少。
社区组织中的准专业人员提供的 PMSB 具有良好的可接受性，似乎可以改善功能，并且依从性效益表明依从性是干预反应的一个重要决定因素。
