“行动中”团体运动项目对老年人跌倒和医疗保健利用的潜在长期影响：一项随机对照试验的探索性分析。

Potential long-term impact of "On The Move" group-exercise program on falls and healthcare utilization in older adults: an exploratory analysis of a randomized controlled trial.

机构信息

Department of Physical Therapy, University of Delaware, Newark, DE, USA.

Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.

出版信息

BMC Geriatr. 2020 Mar 16;20(1):105. doi: 10.1186/s12877-020-1506-3.

DOI:10.1186/s12877-020-1506-3

PMID:32178633

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7075006/

Abstract

BACKGROUND

Wellness program participation may reduce the risk of falling, emergency department-use, and hospitalization among older adults. "On the Move" (OTM), a community-based group exercise program focused on the timing and coordination of walking, improved mobility in older adults, but its impact on falls, emergency department-use, and hospitalizations remains unclear. The aim of this preliminary study was to investigate the potential long-term effects that OTM may have on downstream, tertiary outcomes.

METHODS

We conducted a secondary analysis of a cluster-randomized, single-blind intervention trial, which compared two community-based, group exercise programs: OTM and a seated exercise program on strength, endurance, and flexibility (i.e. 'usual-care'). Program classes met for 50 min/session, 2 sessions/week, for 12 weeks. Older adults (≥65 years), with the ability to ambulate independently at ≥0.60 m/s were recruited. Self-reported incidence of falls, emergency department visitation, and hospitalization were assessed using automated monthly phone calls for the year following intervention completion. Participants with ≥1 completed phone call were included in the analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated (reference = usual-care).

RESULTS

Participants (n = 248) were similar on baseline characteristics and number of monthly phone calls completed. Participants in the seated exercise program attended an average of 2.9 more classes (p = .017). Of note, all results were not statistically significant (i.e. 95% CI overlapped a null value of 1.0). However, point estimates suggest OTM participation resulted in a decreased incidence rate of hospitalization compared to usual-care (IRR = 0.88; 95% CI = 0.59-1.32), and the estimates strengthened when controlling for between-group differences in attendance (adjusted IRR = 0.82; 95% CI = 0.56-1.21). Falls and emergency department visit incidence rates were initially greater for OTM participants, but decreased after controlling for attendance (adjusted IRR = 1.08; 95% CI = 0.72-1.62 and adjusted IRR = 0.96; 95% CI = 0.55-1.66, respectively).

CONCLUSION

Compared to a community-based seated group exercise program, participation in OTM may result in a reduced risk of hospitalization. When OTM is adhered to, the risk for falling and hospitalizations are attenuated. However, definitive conclusions cannot be made. Nevertheless, it appears that a larger randomized trial, designed to specifically evaluate the impact of OTM on these downstream health outcomes is warranted.

TRIAL REGISTRATION

Clinical trials.gov (NCT01986647; prospectively registered on November 18, 2013).

摘要

背景

参与健康计划可能会降低老年人跌倒、急诊就诊和住院的风险。“On the Move”（OTM）是一项以步行的时机和协调性为重点的基于社区的团体运动计划，提高了老年人的活动能力，但它对跌倒、急诊就诊和住院的影响仍不清楚。本初步研究的目的是调查 OTM 对下游三级结果可能产生的潜在长期影响。

方法

我们对一项基于群组的、单盲干预试验进行了二次分析，该试验比较了两种基于社区的团体运动计划：OTM 和以力量、耐力和灵活性为重点的坐姿运动计划（即“常规护理”）。课程每节课持续 50 分钟/节，每周 2 节课。招募有能力以≥0.60m/s 的速度独立行走的≥65 岁老年人。使用自动每月电话询问干预完成后一年的跌倒、急诊就诊和住院的自我报告发生率。完成≥1 次电话询问的参与者被纳入分析。计算发病率比（IRR）和 95%置信区间（CI）（参考值=常规护理）。

结果

参与者（n=248）在基线特征和每月完成电话询问次数方面相似。参加坐姿运动计划的参与者平均多上 2.9 节课（p=0.017）。值得注意的是，所有结果均不具有统计学意义（即 95%CI 与 1.0 的零值重叠）。然而，点估计表明，与常规护理相比，OTM 参与降低了住院的发病率（IRR=0.88；95%CI=0.59-1.32），并且当控制组间出勤率差异时，估计值得到加强（调整后的 IRR=0.82；95%CI=0.56-1.21）。OTM 参与者的跌倒和急诊就诊发生率最初较高，但在控制出勤率后下降（调整后的 IRR=1.08；95%CI=0.72-1.62 和调整后的 IRR=0.96；95%CI=0.55-1.66）。