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Effects of a high-intensity exercise program on well-being among older people with dementia living in care facilities: a cluster-randomized trial
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
base through discussion and research of complex clinical scenarios. Methods: Students were randomly allocated to groups and required to work with people that they may not have previously worked with on complex case scenarios. Through facilitated discussion the class identified their learning needs and negotiated the allocation of workload across the groups to meet those needs. The goal was for the students to develop a database of resources to support their overseas clinical placement. The soft skills required to achieve this goal were made explicit at each stage and students were asked to reflect on their actions and behaviours in group, plenary and personal study. Students then completed an overseas clinical placement. During a workshop at the end of module, students were asked to reflect on and then document their thoughts on whether the module and experience had changed them in any way. Results: Students reported developing skills that enhance personal and professional development. The main areas identified were enhanced communication skills, a greater appreciation of culture and context in healthcare, developing interpersonal skills that enhance clinical ability, increased self-awareness and confidence, ability to direct own learning and set goals for the future. Conclusion(s): A pedagogy that creates a teaching and learning environment where soft skills development is made explicit as part of the content driven requirements of a module is an effective method of enhancing personal and professional development. Teaching and learning across countries and cultures is a powerful paradigm for facilitating the development of soft skills. Further work is required to examine the role of soft skills in physiotherapy. Implications: Soft skills are associated with success, innovation and leadership. A stronger focus on the development of these skills within pre and post registration education and in the evidence base would enhance the physiotherapy profession. Keywords: Soft skills; Education; Continuing professional development Funding acknowledgements: None. Ethics approval: Approved by Trinity College Dublin Faculty of Health Sciences Research Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.447
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Research Report Platform Presentation Number: RR-PL-3012 Monday 4 May 2015 08:52 Room 300-301 EFFECTS OF A HIGH-INTENSITY EXERCISE PROGRAM ON WELL-BEING AMONG OLDER PEOPLE WITH DEMENTIA LIVING IN CARE FACILITIES: A CLUSTER-RANDOMIZED TRIAL M. Conradsson 1 , Y. Gustafson 1 , H. Holmberg 2 , N. Lindelöf 1,3 , H. Littbrand 1,3 , P. Nordström 1 , E. Rosendahl 1,3 1 Umeå
University, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå, Sweden; 2 Umeå University, Public Health and Clinical Medicine, Umeå, Sweden; 3 Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden Background: The number of people with dementia is growing and the consequences of this progressive disease include psychological aspects such as a decreased wellbeing. Exercise is suggested as a means to improve well-being among older people and a previous randomized controlled trial, the FOPANU Study (the Frail Older People – Activity and Nutrition Study), showed positive effects on well-being among people with dementia. However, these positive results from sub-group analyses need to be strengthened by studies including only people with dementia. Purpose: To evaluate the effects of a high-intensity functional exercise program on well-being, among people with dementia who are living in residential care facilities. Methods: Cluster-randomized controlled study, the Umeå Dementia and Exercise (UMDEX) study. Participants were 186 people with dementia, dependent in ADL, living in residential care facilities, aged 65-105, and with Mini-Mental State Examination scores of 10-26. The High-Intensity Functional Exercise (HIFE) program, consisting of exercises aimed to improve balance, mobility and lower-limb strength performed in high intensity if possible, was compared to a seated control activity program, with sessions for about 45 min, 2–3 times/week for 4 months. Psychological wellbeing was assessed with the Philadelphia Geriatric Center Morale Scale (PGCMS), which ranges 0–17 points and where higher scores indicate greater wellbeing. Assessments were made at baseline, at 4 months (directly after intervention) and 7 months after baseline by blinded assessors. Intentionto-treat analyses were made using linear mixed models. Results: There were no difference in PGCMS scores between the exercise and the control group neither at 4- or 7months follow-up. There was a significant interaction effect of sex at the 7-months follow-up, with a difference between men and women of 2.53 points (p = 0.02) in favour of men.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Additional analysis of the between group effect among men showed a mean difference from baseline to 7 months of 0.58 points among men in exercise group and −1.43 points among men in the control group (p = 0.003). Conclusion(s): A high-intensity exercise program generally seems to have no superior effect on well-being compared to a seated control activity among people with dementia living in care facilities. However among men, the exercise program may be beneficial with respect to well-being, compared to the control activity. Implications: Exercise as a single intervention may not influence well-being among older people with dementia, and an individualized and multifactorial intervention may be needed. In addition, there may be gender differences in the effects of exercise that are important to investigate in future research. Keywords: Exercise; Dementia; Quality of life Funding acknowledgements: Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, Swedish Dementia Association, Promobilia Foundation, Swedish Alzheimer Foundation. Ethics approval: Approval obtained from the Regional Ethical Review Board in Umeå in August 2011 (2011-20531 M). http://dx.doi.org/10.1016/j.physio.2015.03.448 Research Report Poster Presentation Number: RR-PO-20-07-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 THE RELATIONSHIP BETWEEN SELF-REPORTED AND PHYSICAL FUNCTION IN INDIVIDUALS WITH HIP OSTEOARTHRITIS M. Constantinou 1,2 , P. Mills 1,2 , A. Loureiro 1,2 , R. Barrett 1,2 1 Griffith
University, Centre for Musculoskeletal Research, Griffith Health Institute, Gold Coast, Australia; 2 Griffith University, School of Allied Health Sciences, Gold Coast, Australia Background: Osteoarthritis (OA) is a progressive musculoskeletal condition of the whole joint organ, affecting around 8.3% of the population. After the knee, the hip is the second most commonly affected joint, leading to pain and functional limitations in the individual. There is no cure for OA, with current treatment focusing on improving pain and function, and with the end stage result often being total joint replacement. In individuals with hip OA dysfunction is usually assessed using self-reported questionnaires and measures of physical function, which capture different domains. Most measures of functional limitations in hip OA are for those
with end-stage disease, with limited information in the early stages. Understanding the relationship between physical and self-reported function in the early stages of the disease is important in devising early intervention programs to maintain function. Purpose: The main aims of this cross sectional study were to investigate the effect of hip OA on physical function for muscle strength, timed-up-and go (TUG) and timed stair tests (TST) and the relationship between self-reported outcome measures using the Hip Osteoarthritis Outcome Score (HOOS) and the physical function in individuals with early to moderate stages of hip OA. Methods: Participants over the age of 45 years, with early to moderate symptomatic radiographic hip OA were included in the hip OA group, and healthy participants with no hip OA on X-rays were included in the control group. Any other major musculoskeletal conditions, lower limb surgery or neurological conditions excluded participants from either group. Participants completed the HOOS questionnaire, the TUG and TST (timed in seconds) and lower limb muscle isometric maximum voluntary contractions (MVC) assessed using an isokinetic dynamometer. Independent samples ttests analysed any differences between groups and Pearson Correlation coefficients defined the relationships between HOOS and the physical measures in the hip OA group. Results: Twenty-seven participants were included in the control (age 59.0 ± 7.7 years) and 26 in the hip OA (63.0 ± 7.7 years) groups. There was a significant difference between the control and hip OA groups in the TUG and TST (p = 0.00) times and in hip flexor, abductor, knee flexor and extensor MVC (p = 0.001–0.044). There was a strong negative relationship between TUG and HOOS (r = −0.579, p = 0.004) and strong positive relationship between each of hip flexors, abductors, knee flexors, and extensors with HOOS (r = 0.466–0.584, p = 0.002–0.028). Conclusion(s): Individuals with hip OA are experiencing functional limitations in the early to moderate stages of the disease which include TUG, TST and reduced muscle strength. These functional tests have a strong relationship with self-reported HOOS indicating that they may be useful in identifying the level of dysfunction experienced by the individual before the severe stages of hip OA. Future studies to explore tests predictive of hip OA progression would further assist in identifying those likely to require total hip joint replacement. Implications: Information from this study can aid understanding of the relationships between the self-reported questionnaires and physical function in the early to moderate stages of hip OA. Keywords: Osteoarthritis; Hip joint; Function Funding acknowledgements: National Health Medical Research Council Postgraduate Scholarship, Fellowship Funds Incorporated Ltd, Griffith University Areas of Strategic Investment-Chronic Disease Research Grant.
base through discussion and research of complex clinical scenarios. Methods: Students were randomly allocated to groups and required to work with people that they may not have previously worked with on complex case scenarios. Through facilitated discussion the class identified their learning needs and negotiated the allocation of workload across the groups to meet those needs. The goal was for the students to develop a database of resources to support their overseas clinical placement. The soft skills required to achieve this goal were made explicit at each stage and students were asked to reflect on their actions and behaviours in group, plenary and personal study. Students then completed an overseas clinical placement. During a workshop at the end of module, students were asked to reflect on and then document their thoughts on whether the module and experience had changed them in any way. Results: Students reported developing skills that enhance personal and professional development. The main areas identified were enhanced communication skills, a greater appreciation of culture and context in healthcare, developing interpersonal skills that enhance clinical ability, increased self-awareness and confidence, ability to direct own learning and set goals for the future. Conclusion(s): A pedagogy that creates a teaching and learning environment where soft skills development is made explicit as part of the content driven requirements of a module is an effective method of enhancing personal and professional development. Teaching and learning across countries and cultures is a powerful paradigm for facilitating the development of soft skills. Further work is required to examine the role of soft skills in physiotherapy. Implications: Soft skills are associated with success, innovation and leadership. A stronger focus on the development of these skills within pre and post registration education and in the evidence base would enhance the physiotherapy profession. Keywords: Soft skills; Education; Continuing professional development Funding acknowledgements: None. Ethics approval: Approved by Trinity College Dublin Faculty of Health Sciences Research Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.447
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Research Report Platform Presentation Number: RR-PL-3012 Monday 4 May 2015 08:52 Room 300-301 EFFECTS OF A HIGH-INTENSITY EXERCISE PROGRAM ON WELL-BEING AMONG OLDER PEOPLE WITH DEMENTIA LIVING IN CARE FACILITIES: A CLUSTER-RANDOMIZED TRIAL M. Conradsson 1 , Y. Gustafson 1 , H. Holmberg 2 , N. Lindelöf 1,3 , H. Littbrand 1,3 , P. Nordström 1 , E. Rosendahl 1,3 1 Umeå
University, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå, Sweden; 2 Umeå University, Public Health and Clinical Medicine, Umeå, Sweden; 3 Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden Background: The number of people with dementia is growing and the consequences of this progressive disease include psychological aspects such as a decreased wellbeing. Exercise is suggested as a means to improve well-being among older people and a previous randomized controlled trial, the FOPANU Study (the Frail Older People – Activity and Nutrition Study), showed positive effects on well-being among people with dementia. However, these positive results from sub-group analyses need to be strengthened by studies including only people with dementia. Purpose: To evaluate the effects of a high-intensity functional exercise program on well-being, among people with dementia who are living in residential care facilities. Methods: Cluster-randomized controlled study, the Umeå Dementia and Exercise (UMDEX) study. Participants were 186 people with dementia, dependent in ADL, living in residential care facilities, aged 65-105, and with Mini-Mental State Examination scores of 10-26. The High-Intensity Functional Exercise (HIFE) program, consisting of exercises aimed to improve balance, mobility and lower-limb strength performed in high intensity if possible, was compared to a seated control activity program, with sessions for about 45 min, 2–3 times/week for 4 months. Psychological wellbeing was assessed with the Philadelphia Geriatric Center Morale Scale (PGCMS), which ranges 0–17 points and where higher scores indicate greater wellbeing. Assessments were made at baseline, at 4 months (directly after intervention) and 7 months after baseline by blinded assessors. Intentionto-treat analyses were made using linear mixed models. Results: There were no difference in PGCMS scores between the exercise and the control group neither at 4- or 7months follow-up. There was a significant interaction effect of sex at the 7-months follow-up, with a difference between men and women of 2.53 points (p = 0.02) in favour of men.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Additional analysis of the between group effect among men showed a mean difference from baseline to 7 months of 0.58 points among men in exercise group and −1.43 points among men in the control group (p = 0.003). Conclusion(s): A high-intensity exercise program generally seems to have no superior effect on well-being compared to a seated control activity among people with dementia living in care facilities. However among men, the exercise program may be beneficial with respect to well-being, compared to the control activity. Implications: Exercise as a single intervention may not influence well-being among older people with dementia, and an individualized and multifactorial intervention may be needed. In addition, there may be gender differences in the effects of exercise that are important to investigate in future research. Keywords: Exercise; Dementia; Quality of life Funding acknowledgements: Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, Swedish Dementia Association, Promobilia Foundation, Swedish Alzheimer Foundation. Ethics approval: Approval obtained from the Regional Ethical Review Board in Umeå in August 2011 (2011-20531 M). http://dx.doi.org/10.1016/j.physio.2015.03.448 Research Report Poster Presentation Number: RR-PO-20-07-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 THE RELATIONSHIP BETWEEN SELF-REPORTED AND PHYSICAL FUNCTION IN INDIVIDUALS WITH HIP OSTEOARTHRITIS M. Constantinou 1,2 , P. Mills 1,2 , A. Loureiro 1,2 , R. Barrett 1,2 1 Griffith
University, Centre for Musculoskeletal Research, Griffith Health Institute, Gold Coast, Australia; 2 Griffith University, School of Allied Health Sciences, Gold Coast, Australia Background: Osteoarthritis (OA) is a progressive musculoskeletal condition of the whole joint organ, affecting around 8.3% of the population. After the knee, the hip is the second most commonly affected joint, leading to pain and functional limitations in the individual. There is no cure for OA, with current treatment focusing on improving pain and function, and with the end stage result often being total joint replacement. In individuals with hip OA dysfunction is usually assessed using self-reported questionnaires and measures of physical function, which capture different domains. Most measures of functional limitations in hip OA are for those
with end-stage disease, with limited information in the early stages. Understanding the relationship between physical and self-reported function in the early stages of the disease is important in devising early intervention programs to maintain function. Purpose: The main aims of this cross sectional study were to investigate the effect of hip OA on physical function for muscle strength, timed-up-and go (TUG) and timed stair tests (TST) and the relationship between self-reported outcome measures using the Hip Osteoarthritis Outcome Score (HOOS) and the physical function in individuals with early to moderate stages of hip OA. Methods: Participants over the age of 45 years, with early to moderate symptomatic radiographic hip OA were included in the hip OA group, and healthy participants with no hip OA on X-rays were included in the control group. Any other major musculoskeletal conditions, lower limb surgery or neurological conditions excluded participants from either group. Participants completed the HOOS questionnaire, the TUG and TST (timed in seconds) and lower limb muscle isometric maximum voluntary contractions (MVC) assessed using an isokinetic dynamometer. Independent samples ttests analysed any differences between groups and Pearson Correlation coefficients defined the relationships between HOOS and the physical measures in the hip OA group. Results: Twenty-seven participants were included in the control (age 59.0 ± 7.7 years) and 26 in the hip OA (63.0 ± 7.7 years) groups. There was a significant difference between the control and hip OA groups in the TUG and TST (p = 0.00) times and in hip flexor, abductor, knee flexor and extensor MVC (p = 0.001–0.044). There was a strong negative relationship between TUG and HOOS (r = −0.579, p = 0.004) and strong positive relationship between each of hip flexors, abductors, knee flexors, and extensors with HOOS (r = 0.466–0.584, p = 0.002–0.028). Conclusion(s): Individuals with hip OA are experiencing functional limitations in the early to moderate stages of the disease which include TUG, TST and reduced muscle strength. These functional tests have a strong relationship with self-reported HOOS indicating that they may be useful in identifying the level of dysfunction experienced by the individual before the severe stages of hip OA. Future studies to explore tests predictive of hip OA progression would further assist in identifying those likely to require total hip joint replacement. Implications: Information from this study can aid understanding of the relationships between the self-reported questionnaires and physical function in the early to moderate stages of hip OA. Keywords: Osteoarthritis; Hip joint; Function Funding acknowledgements: National Health Medical Research Council Postgraduate Scholarship, Fellowship Funds Incorporated Ltd, Griffith University Areas of Strategic Investment-Chronic Disease Research Grant.