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Efficacy of a Post-Rehabilitation Exercise Intervention

22 aprile 2013 aggiornato da: Alan Jette, Boston University

Background:

Many people who have suffered a hip fracture are discharged from rehabilitation services with significant residual functional limitations and disability. We believe that a home-based exercise program that incorporates cognitive-behavioral techniques to increase exercise adherence and promote the return to daily activities could extend the benefits of formal rehabilitation for patients who have suffered a hip fracture.

Specific Aims:

We will conduct a 5-year multi-site randomized controlled trial in patients who have suffered a recent hip fracture and have completed all rehabilitation services. The specific aim that this project will address is whether:

Participation in the Strong for Life (SFL) program will improve function and disability outcomes in participants 6-months after they are discharged from rehabilitation services.

This study will also investigate the following secondary hypotheses:

  1. Changes in function and disability at 6-month follow-up will be correlated with changes in all three proposed intermediary variables: muscle strength, balance, and self-efficacy.
  2. The SFL program will significantly improve health-related quality of life among participants at 6-month follow-up.
  3. At 9-month follow-up the SFL program will continue to have a significant impact on participants' function and disability compared to the control group.

Target population:

The target population will be people aged 60 years or more who have suffered a recent traumatic hip fracture, have one or more residual functional limitations and have completed all inpatient, outpatient or homecare rehabilitation services.

Intervention:

We will use an enhanced version of the Strong for Life program. This home-based exercise program will include both resistance exercises using Thera-bands that will be shown on a video/DVD and weight-bearing exercises that are progressed using a step and/or a weighted vest. A cognitive-behavioral program that is customized for people recovering from hip fracture is being developed that will focus on promoting exercise adherence, decreasing fear of falling and increasing the return to daily activities in the patient's home and community.

Design:

A randomized controlled clinical trial will be implemented to measure the efficacy of the Strong for Life program. An attention-control intervention will be provided to all participants assigned to the control group. The outcome evaluation points are:

  • T0: baseline, at the point of discharge from formal rehabilitation;
  • T2: 6-month outcome assessment
  • T3: 9-month follow-up

Outcomes:

The primary outcomes will be function measured by both self-report (AM PAC) and physical performance measures (SPPB). Secondary outcomes include disability, self-efficacy, balance, strength, cognition, and reaction time. Adherence to the exercise program and adverse events will also be monitored.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Tipo di studio

Interventistico

Iscrizione (Effettivo)

232

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

  • Stati Uniti
    • Massachusetts
      • Cambridge, Massachusetts, Stati Uniti, 02138
        • Spaulding Rehabilitation Hospital

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

60 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria:

  • Have a primary diagnosis of hip fracture;
  • Aged 60 years and above;
  • Have functional limitation (i.e., as determined by limitation in at least one of 9 functional tasks listed in the SF-36 physical function scale, excluding vigorous activities);
  • Have recently been discharged from rehabilitation services;
  • Be able to understand and communicate in English;
  • Be able to safely and independently stand with or without the aid of a mobility device, without needing any assistance or supervision from another person;
  • Have received written clearance from their primary care physician documenting no contra-indications for participating in the study;
  • Be able to provide written informed consent.

Exclusion Criteria:

  • Have serious cognitive deficits (i.e., a Mini-Mental State Examination score of less than 20)85;
  • Have severe depression (i.e., a score of 20 or greater on the Geriatric Depression Scale)86;
  • Have a terminal illness with survival expected to be less than 1 year;
  • Have significant pulmonary or cardiovascular contraindications or pre-existing conditions that preclude participating in an exercise program;
  • Legally blind;
  • Currently receiving rehabilitation therapy;
  • Live outside of the study's catchment area in the Boston metropolitan area and eastern Massachusetts.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: 1
Comportamentale: Enhanced Strong for Life

The program contains 5 minutes of warm-up, 25 minutes of strengthening, and 5 minutes of cool-down exercises. The SFL program is contained on a 35 minute videotape. Subjects are instructed to increase resistance when they can perform 10 repetitions of a movement pattern without significant fatigue or loss of proper execution. Subjects are instructed to move within a comfortable range of motion.

Participants will be taught the SFL program during two home visits conducted by a physical therapist. On the first visit, the exercise techniques will be taught, modified as needed based on individual needs and practiced as necessary until proper technique is attained. Each participant will be given written guidelines for how to progress resistance of the program, how to modify the exercises and how to complete bimonthly exercise calendars.
Comparatore placebo: cardiovascular education (attention control)
Comportamentale: cardiovascular nutrition education
administered as an attention control intervention using home visits, phone calls and mail-outs of information

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
The specific aim that this project will address is whether: Participation in the SFL program will improve function and disability outcomes in participants 6-months after they are discharged from rehabilitation services.
Lasso di tempo: baseline, 6-month and 9-month follow up
performance based function is assessed using the Short Physical Performance Battery (SPPB) and self-reported function is assessed using the AM-PAC
baseline, 6-month and 9-month follow up

Misure di risultato secondarie

Misura del risultato
Lasso di tempo
Changes in function and disability at 6-month follow-up will be correlated with changes in all three proposed intermediary variables: muscle strength, balance, and self-efficacy.
Lasso di tempo: baseline, 6-month and 9-month follow up
baseline, 6-month and 9-month follow up
At 9-month follow-up the SFL program will continue to have a significant impact on participants' function and disability compared to the control group.
Lasso di tempo: baseline, 6-month and 9-month follow up
baseline, 6-month and 9-month follow up

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Boston University

Collaboratori

National Institute of Nursing Research (NINR)
Spaulding Rehabilitation Hospital

Investigatori

  • Investigatore principale: Alan M Jette, PhD, Health & Disability Research Institute
  • Investigatore principale: Nancy Latham, PhD, Health & Disability Research Institute

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio

1 aprile 2008

Completamento primario (Effettivo)

1 settembre 2012

Completamento dello studio (Effettivo)

1 novembre 2012

Date di iscrizione allo studio

Primo inviato

2 gennaio 2008

Primo inviato che soddisfa i criteri di controllo qualità

11 gennaio 2008

Primo Inserito (Stima)

14 gennaio 2008

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Stima)

23 aprile 2013

Ultimo aggiornamento inviato che soddisfa i criteri QC

22 aprile 2013

Ultimo verificato

1 aprile 2013

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • NINR 1R01NR010815-01A2
  • 1R01NR010815-01A2 (Sovvenzione/contratto NIH degli Stati Uniti)

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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