Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Clinical implications of 750 mg, 5-day levofloxacin for the treatment of community-acquired pneumonia.
Adult; Female; Male; Human; Chi Square Test; Funding Source; Retrospective Design; T-Tests; Kaplan-Meier Estimator; Random Assignment; McNemar's Test; Double-Blind Studies; Log-Rank Test; Pneumonia – Drug Therapy; Community-Acquired Infections – Drug Therapy; Ofloxacin – Administration and Dosage
OBJECTIVE: To evaluate the time to symptom resolution and i.v.-to-p.o. transition in community-acquired pneumonia (CAP) patients treated with 750 mg or 500 mg levofloxacin. RESEARCH DESIGN: A retrospective, subset analysis of a multicenter, randomized, double-blind, controlled trial comparing 750 mg levofloxacin for 5 days to 500 mg levofloxacin for 10 days for the treatment of CAP. PATIENTS AND METHODS: A total of 528 CAP patients were included. Baseline symptoms were re-evaluated on Day 3 of therapy, and time to i.v.-to-p.o. transition was recorded for inpatients. RESULTS: For the overall population, 67.4% of patients receiving 750 mg levofloxacin had resolution of fever by Day 3 of therapy, compared to 54.6% of 500 mg treated patients (P = 0.006). Patients who started on 750 mg levofloxacin i.v. (N = 108) transitioned to p.o. in an average of 2.68 days while those starting on 500 mg i.v. (N = 124) transitioned in 2.95 days (P = 0.144). The median time for i.v.-to-p.o. switch was 2.35 days and 2.75 days for patients receiving 750 mg and 500 mg levofloxacin, respectively (P = 0.098, log rank test). By Day 3 of therapy, 68% of patients receiving the 750 mg dose had transitioned from i.v. to p.o. levofloxacin, compared with 61% of the 500 mg group (P = 0.280). The safety profiles were comparable for the two regimens. CONCLUSIONS: The 750 mg levofloxacin dose resulted in a greater proportion of patients with resolution of CAP symptoms by Day 3 when compared with 500 mg therapy. Consequently, the 750 mg regimen trended toward more rapid transition to p.o., potentially resulting in lower overall drug costs. Time to switch from i.v. to p.o. was determined by the investigators' discretion rather than a set protocol. Additionally, length of stay data was not collected in this study, which can significantly impact overall healthcare costs. Further research is required to fully understand the economic impact of the 750 mg, 5-day levofloxacin regimen.
File T M Jr; Milkovich G; Tennenberg AM; Xiang JX; Khashab MM; Zadeikis N
Current Medical Research & Opinion
2004
2004-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1185/030079904x2556" target="_blank" rel="noreferrer noopener">10.1185/030079904x2556</a>
Biomechanical Head-to-Head Comparison of 2 Sutures and the Giftbox Versus Bunnell Techniques for Midsubstance Achilles Tendon Ruptures.
Achilles repair; Achilles rupture; Achilles Tendon – Injuries; Achilles Tendon Rupture – Surgery; Aged; Biomechanics; Data Analysis Software; Human; Orthopedic Fixation Devices; Random Assignment; Randomized Controlled Trials; Reconstructive – Methods; Surgery; Suture Techniques; tendon biomechanics; tendon repair
BACKGROUND: Acute midsubstance Achilles tendon ruptures are a common orthopaedic problem for which the optimal repair technique and suture type remain controversial. Head-to-head comparisons of current fixation constructs are needed to establish which stitch/suture combination is most biomechanically favorable. HYPOTHESIS: Of the tested fixation constructs, Giftbox repairs with Fiberwire will exhibit superior stiffness and strength during biomechanical testing. STUDY DESIGN: Controlled laboratory study. METHODS: Two biomechanical trials were performed, isolating stitch technique and suture type, respectively. In trial 1, 12 transected fresh-frozen cadaveric Achilles tendon pairs were randomized to receive either the Giftbox-modified Krackow or the Bunnell stitch with No. 2 Fiberwire suture. Each repair underwent cyclic loading, oscillating between 10 and 100 N at 2 Hz for 1000 cycles, with repair gapping measured at 500 and 1000 cycles. Load-to-failure testing was then performed, and clinical and catastrophic failure values were recorded. In trial 2, 10 additional paired cadaveric Achilles tendons were randomized to receive a Giftbox repair with either No. 2 Fiberwire or No. 2 Ultrabraid. Testing and data collections protocols in trial 2 replicated those used in trial 1. RESULTS: In trial 1, the Bunnell group had 2 failures during cyclic loading while the Giftbox had no failures. The mean tendon gapping after cyclic loading was significantly lower in the Giftbox repairs (0.13 vs 2.29 mm, P = .02). Giftbox repairs were significantly stiffer than Bunnell (47.5 vs 38.7 N/mm, P = .019) and showed more tendon elongation (5.9 +/- 0.8 vs 4.5 +/- 1.0 mm, P = .012) after 1000 cycles. Mean clinical load to failure was significantly higher for Giftbox repairs (373 vs 285 N, P = .02), while no significant difference in catastrophic load to failure was observed (mean, 379 vs 336 N; P = .61). In trial 2, there were no failures during cyclic loading. The Giftbox + Fiberwire repairs recorded higher clinical load-to-failure values compared with Giftbox + Ultrabraid (mean, 361 vs 239 N; P = .005). No other biomechanical differences were observed in trial 2. CONCLUSION: Simulated early rehabilitation biomechanical testing showed that Giftbox-modified Krackow Achilles repair technique with Fiberwire suture was stronger and more resistant to gap formation at the repair site than combinations that incorporated the Bunnell stitch or Ultrabraid suture. CLINICAL RELEVANCE: A more in-depth understanding of the biomechanical properties of the Giftbox repair will help inform surgical decision making because stronger repairs are less likely to fail during accelerated postoperative rehabilitation.
Van Dyke Rufus O; Chaudhary Sejul A; Gould Gregory; Trimba Roman; Laughlin Richard T
Orthopaedic journal of sports medicine
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2325967117707477" target="_blank" rel="noreferrer noopener">10.1177/2325967117707477</a>
Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.
80 and over; 80 and Over; Adolescence; Adolescent; Adult; Aged; Anatomic Landmarks/anatomy & histology/*diagnostic imaging; Body Regions; Body Regions – Anatomy and Histology; Botulinum Toxins; Botulinum Toxins – Administration and Dosage; Chronic Disease; Female; Human; Humans; Male; Middle Age; Middle Aged; Migraine; Migraine – Drug Therapy; Migraine Disorders/*diagnostic imaging/*drug therapy; Neck Muscles; Neck Muscles – Anatomy and Histology; Neck Muscles – Drug Effects; Neck Muscles/anatomy & histology/*diagnostic imaging/drug effects; Pilot Projects; Pilot Studies; Random Allocation; Random Assignment; Tomography; Type A/*administration & dosage; X-Ray Computed – Methods; X-Ray Computed/methods; Young Adult
BACKGROUND AND OBJECTIVES: While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. METHODS: Anatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius. RESULTS: Median depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols. CONCLUSIONS: Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.
Wu-Fienberg Yuewei; Ansari Hossein; Zardouz Shawn; Narouze Samer; Blaha Taryn; Swanson Marco; Totonchi Ali
Regional anesthesia and pain medicine
2018
2018-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/AAP.0000000000000818" target="_blank" rel="noreferrer noopener">10.1097/AAP.0000000000000818</a>
Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.
*Quality of Life; 80 and over; Activities of Daily Living; Advance Care Planning; Advance Care Planning/*organization & administration; Aged; Case Management – Methods; Chi Square Test; Community-Institutional Relations; Comparative Studies; Decision Making; Descriptive Statistics; Disease Management; Family; Female; Frail Elderly; Geriatric Assessment/methods; Health Promotion; Health Resource Utilization; Health Services for the Aged/organization & administration; Home Care Services/*organization & administration; Human; Humans; Interdisciplinary Communication; Long Term Care; Long-Term Care/*organization & administration; Male; Medicaid – Ohio; Multidisciplinary Care Team; Ohio; Outcomes (Health Care); Palliative Care; Palliative Care/organization & administration; Patient; Physicians; Pilot Projects; Pilot Studies – Ohio; Program Evaluation; Psychological Tests; Quality of Life; Random Assignment; Reference Values; Repeated Measures; Scales; Spiritual Care; T-Tests; Treatment Outcome
The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were \textgreater60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.
Radwany Steven M; Hazelett Susan E; Allen Kyle R; Kropp Denise J; Ertle Denise; Albanese Teresa H; Fosnight Susan M; Moore Pamela S
Population Health Management
2014
2014-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2013.0017" target="_blank" rel="noreferrer noopener">10.1089/pop.2013.0017</a>