Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial

Anne-Gabrielle Mittaz Hager, Nicolas Mathieu, Constanze Lenoble-Hoskovec, Jaap Swanenburg, Rob de Bie, Roger Hilfiker, Anne-Gabrielle Mittaz Hager, Nicolas Mathieu, Constanze Lenoble-Hoskovec, Jaap Swanenburg, Rob de Bie, Roger Hilfiker

Abstract

Background: Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence.

Methods: The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up).

Discussion: Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy.

Trial registration: ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Keywords: Exercise-adherence; Falls; Home-based exercises programmes; Older adults; Quality of life.

Conflict of interest statement

Ethics approval and consent to participate

This trial has been approved by the Swiss Ethics Committees on research involving humans (registration number: 2016–00931) on the 28th of July 2016. It is also register in Consent for publication

Not applicable.

Competing interests

AGMH, NM and RH developed the T&E home-based exercise programme. JS, RdB and CHL declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Recommendations for create your home-based exercise-programme
Fig. 2
Fig. 2
Patient Flow. FES-I: Falls Efficacy Scale - International; MMSE: Mini Mental State Examination; OPQOL-3: Older People’s Quality of Life Questionnaire; TUG: Timed Up and Go test; FR: Functional Reach Test; FSBT: Four Stage Balance Test; FTSTS: Five Times Site To Stand test; SMWT: Six Meters Walk Test; BSW: Base of Support Width

References

    1. Pizzigalli L, Filippini A, Ahmaidi S, Jullien H, Rainoldi A. Prevention of falling risk in elderly people: the relevance of muscular strength and symmetry of lower limbs in postural stability. J Strength Cond Res. 2011;25(2):567–574. doi: 10.1519/JSC.0b013e3181d32213.
    1. Stenhagen M, Ekström H, Nordell E, Elmståhl S. Accidental falls, health-related quality of life and life satisfaction: a prospective study of the general elderly population. Arch Gerontol Geriatr. 2014;58(1):95–100. doi: 10.1016/j.archger.2013.07.006.
    1. Palumbo P, Palmerini L, Bandinelli S, Chiari L. Fall risk assessment tools for elderly living in the community: can we do better? PLoS One. 2015;10(12):e0146247. doi: 10.1371/journal.pone.0146247.
    1. Yoshida-Intern S. A global report on falls prevention epidemiology of falls. Geneva: WHO; 2007.
    1. Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing. 2007;36(6):656–662. doi: 10.1093/ageing/afm122.
    1. Hartholt KA, van Beeck EF, Polinder S, van der Velde N, van Lieshout EMM, Panneman MJM, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma. 2011;71(3):748–753. doi: 10.1097/TA.0b013e3181f6f5e5.
    1. Finlayson ML, Peterson EW. Falls, aging, and disability. Phys Med Rehabil Clin North Am. 2010;21(2):357–373. doi: 10.1016/j.pmr.2009.12.003.
    1. Leroy-Calatayud R. Point de mire sur la prévention chez les personnes âgées à partir d’un thème et problème de santé : « Les chutes ». 2007.
    1. Roe B, Howell F, Riniotis K, Beech R, Crome P, Ong BN. Older people and falls: health status, quality of life, lifestyle, care networks, prevention and views on service use following a recent fall. J Clin Nurs. 2009;18(16):2261–2272. doi: 10.1111/j.1365-2702.2008.02747.x.
    1. World Health O . WHO global report on falls prevention in older age. Geneva: World Health Organisation; 2007.
    1. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int. 2010;21(8):1295–1306. doi: 10.1007/s00198-009-1162-0.
    1. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290–295. doi: 10.1136/ip.2005.011015.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;2:CD007146.
    1. Zimmermann-Sloutskis D, Moreau-Gruet F, Zimmerman E. Comparaison de la qualité de vie des personnes âgées vivant à domicile ou en institution. OBSAN. 2012.
    1. Davis JC, Bryan S, Best JR, Li LC, Hsu CL, Gomez C, et al. Mobility predicts change in older adults’ health-related quality of life: evidence from a Vancouver falls prevention prospective cohort study. Health Qual Life Outcomes. 2015;13:101. doi: 10.1186/s12955-015-0299-0.
    1. Eyigor S, Karapolat H, Durmaz B. Effects of a group-based exercise program on the physical performance, muscle strength and quality of life in older women. Arch Gerontol Geriatr. 2007;45(3):259–271. doi: 10.1016/j.archger.2006.12.001.
    1. Iglesias CP, Manca A, Torgerson DJ. The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int. 2009;20(6):869–878. doi: 10.1007/s00198-008-0753-5.
    1. Karinkanta S, Heinonen A, Sievanen H, Uusi-Rasi K, Kannus P. Factors predicting dynamic balance and quality of life in home-dwelling elderly women. Gerontology. 2005;51(2):116–121. doi: 10.1159/000082196.
    1. Ozcan A, Donat H, Gelecek N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health. 2005;5:90. doi: 10.1186/1471-2458-5-90.
    1. Sayer AA, Syddall HE, Martin HJ, Dennison EM, Roberts HC, Cooper C. Is grip strength associated with health-related quality of life? Findings from the Hertfordshire cohort study. Age Ageing. 2006;35(4):409–415. doi: 10.1093/ageing/afl024.
    1. Stathi A, Simey P. Quality of life in the fourth age: exercise experiences of nursing home residents. J Aging Phys Act. 2007;15(3):272–286. doi: 10.1123/japa.15.3.272.
    1. Pernambuco CS, Rodrigues BM, Bezerra JCP, Carrielo A. Fernandes ADdO, Vale RGdS, et al. quality of life, elderly and physical activity. Health. 2012;04(02):88–93. doi: 10.4236/health.2012.42014.
    1. WHO | Physical activity. WHO.
    1. Büla C, Santos-Eggimann B, Seematter-Bagnoud L, Bize R, Mettler D. Promotion de l’activité physique. Projet “Bonnes pratiques de promotion de la santé des personnes âgées” Résumé et recommandations. CHUV Centre d’Observation et d’Analyse du Vieillissement (COAV) 2011.
    1. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–1530. doi: 10.1249/MSS.0b013e3181a0c95c.
    1. Seematter-Bagnoud L, Lenoble-Hoskovec C, Santos-Eggimann B, Büla C. Promotion of exercise in older people: issues and strategies. Rev Med Suisse. 2012;8(348):1453–1457.
    1. Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A. Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95(4):753–69.e3. doi: 10.1016/j.apmr.2013.11.007.
    1. Karlsson MK, Magnusson H, von Schewelov T, Rosengren BE. Prevention of falls in the elderly--a review. Osteoporos Int. 2013;24(3):747–762. doi: 10.1007/s00198-012-2256-7.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.
    1. El-Khoury F, Cassou B, Charles M-A, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f6234.
    1. Langlois F, Vu TTM, Chassé K, Dupuis G, Kergoat M-J, Bherer L. Benefits of physical exercise training on cognition and quality of life in frail older adults. J Gerontol B Psychol Sci Soc Sci. 2013;68(3):400–404. doi: 10.1093/geronb/gbs069.
    1. Cesarec G, Martinec S, Basić I, Jakopić D. Effect of exercises on quality of life in women with osteoporosis and osteopenia. Coll Antropol. 2014;38(1):247–254.
    1. Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O'Loughlin P, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012;345:e4547. doi: 10.1136/bmj.e4547.
    1. Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing. 2010;39(6):681–687. doi: 10.1093/ageing/afq102.
    1. Hill KD, Hunter SW, Batchelor FA, Cavalheri V, Burton E. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: a systematic review and meta-analysis. Maturitas. 2015;82(1):72–84. doi: 10.1016/j.maturitas.2015.04.005.
    1. Cyarto EV, Brown WJ, Marshall AL, Trost SG. Comparative effects of home- and group-based exercise on balance confidence and balance ability in older adults: cluster randomized trial. Gerontology. 2008;54(5):272–280. doi: 10.1159/000155653.
    1. Picorelli AMA, Pereira LSM, Pereira DS, Felício D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother. 2014;60(3):151–156. doi: 10.1016/j.jphys.2014.06.012.
    1. Yardley L, Bishop FL, Beyer N, Hauer K, Kempen GI, Piot-Ziegler C, et al. Older people's views of falls-prevention interventions in six European countries. Gerontologist. 2006;46(5):650–660. doi: 10.1093/geront/46.5.650.
    1. Forkan R, Pumper B, Smyth N, Wirkkala H, Ciol MA, Shumway-Cook A. Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther. 2006;86(3):401–410.
    1. Zijlstra GAR, van Haastregt JCM, van Rossum E, van Eijk JTM, Yardley L, Kempen GIJM. Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc. 2007;55(4):603–615. doi: 10.1111/j.1532-5415.2007.01148.x.
    1. McMahon S, Talley KM, Wyman JF. Practice development section paper 1 older People's perspectives on fall risk and fall prevention programs: a literature review. Int J Older People Nursing. 2011;6(4):289–298. doi: 10.1111/j.1748-3743.2011.00299.x.
    1. Child S, Goodwin V, Garside R, Jones-Hughes T, Boddy K, Stein K. Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies. Implement Sci. 2012;7:91. doi: 10.1186/1748-5908-7-91.
    1. Yardley L, Beyer N, Hauer K, McKee K, Ballinger C, Todd C. Recommendations for promoting the engagement of older people in activities to prevent falls. Qual Saf Health Care. 2007;16(3):230–234. doi: 10.1136/qshc.2006.019802.
    1. Resnick B, Spellbring AM. Understanding what motivates older adults to exercise. J Gerontol Nurs. 2000;26(3):34–42. doi: 10.3928/0098-9134-20000301-08.
    1. Simek EM, McPhate L, Haines TP. Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med. 2012;55(4):262–275. doi: 10.1016/j.ypmed.2012.07.007.
    1. Delbaere K, Valenzuela T, Woodbury A, Davies T, Yeong J, Steffens D, et al. Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the standing tall randomised controlled trial. BMJ Open. 2015;5(10):e009173. doi: 10.1136/bmjopen-2015-009173.
    1. Merchán-Baeza JA, Gonzalez-Sanchez M, Cuesta-Vargas A. Clinical effect size of an educational intervention in the home and compliance with mobile phone-based reminders for people who suffer from stroke: protocol of a randomized controlled trial. JMIR Res Protoc. 2015;4(1):e33. doi: 10.2196/resprot.4034.
    1. Sandlund M, Lindgren H, Pohl P. Towards a Mobile exercise application to prevent falls: a participatory design process. Technology, Rehabilitation and Empowerment of People with Special Needs. 2015. pp. 157–168.
    1. Silveira P, van de Langenberg R, van het Reve E, Daniel F, Casati F, de Bruin ED. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: a phase II preclinical exploratory trial. J Med Internet Res. 2013;15(8):e159. doi: 10.2196/jmir.2579.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Ambrose AF, Cruz L, Paul G. Falls and fractures: a systematic approach to screening and prevention. Maturitas. 2015;82(1):85–93. doi: 10.1016/j.maturitas.2015.06.035.
    1. Gschwind YJ, Eichberg S, Marston HR, Ejupi A, Hd R, Kroll M, et al. ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial. BMC Geriatr. 2014;14:91. doi: 10.1186/1471-2318-14-91.
    1. Vanderbilt U, REDCap . REDCap research electronic data capture. 2016.
    1. Mittaz Hager A-G, Mathieu N, Sattelmayer M, Hilfiker R. Fiabilité inter- et intra-examinateur de deux échelles d’évaluation en vue de la création d’un programme d’exercices à domicile de prévention des chutes pour personnes senior. Neurophysiologie clinique/Clinical neurophysiology. 2009;39(4–5):255.
    1. Brewer MB, Hewstone M. Emotion and motivation: Wiley-Blackwell. 2004.
    1. Mittaz Hager AG, Mathieu N, Hilfiker R. Effects of “Test and Exercise” home-based programm for elderly on falls and on quality of life: a feasabiliy study. Manuscript in preparation. 2017.
    1. Campbell AJ, Robertson MC. Otago exercise programme to prevent falls in older adults. Otago Medical School: University of Otago, NZ; 2003.
    1. Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. Phys Ther. 2013;93(10):1321. doi: 10.2522/ptj.20120286.
    1. Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5–10. doi: 10.1093/ageing/afi218.
    1. Swanenburg J, de Bruin ED, Uebelhart D, Mulder T. Falls prediction in elderly people: a 1-year prospective study. Gait & posture. 2010;31(3):317–321. doi: 10.1016/j.gaitpost.2009.11.013.
    1. Schwenk M, Lauenroth A, Stock C, Moreno RR, Oster P, McHugh G, et al. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol. 2012;12:50. doi: 10.1186/1471-2288-12-50.
    1. Wolf B, Feys H, De W, van der Meer J, Noom M, Aufdemkampe G, et al. Effect of a physical therapeutic intervention for balance problems in the elderly: a single-blind, randomized, controlled multicentre trial. Clin Rehabil. 2001;15(6):624–636. doi: 10.1191/0269215501cr456oa.
    1. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the falls efficacy scale-international (FES-I) Age Ageing. 2005;34(6):614–619. doi: 10.1093/ageing/afi196.
    1. Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, et al. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology. 2011;57(5):462–472.
    1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control . Division of Unintentional Injury Prevention. 2015.
    1. Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896.
    1. Wall JC, Bell C, Campbell S, Davis J. The timed get-up-and-go test revisited: measurement of the component tasks. J Rehabil Res Dev. 2000;37(1):109–113.
    1. Herman T, Giladi N, Hausdorff JM. Properties of the ‘timed up and go’test: more than meets the eye. Gerontology. 2010;57(3):203–210. doi: 10.1159/000314963.
    1. Beauchet O, Fantino B, Allali G, Muir S, Montero-Odasso M, Annweiler C. Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 2011;15(10):933–938. doi: 10.1007/s12603-011-0062-0.
    1. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014;14(1):14. doi: 10.1186/1471-2318-14-14.
    1. Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise-based falls prevention programme. Age Ageing. 2001;30(1):77–83. doi: 10.1093/ageing/30.1.77.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Goldberg A, Chavis M, Watkins J, Wilson T. The five-times-sit-to-stand test: validity, reliability and detectable change in older females. Aging Clin Exp Res. 2012;24(4):339–344. doi: 10.1007/BF03325265.
    1. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008;37(4):430–435. doi: 10.1093/ageing/afn100.
    1. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):M192–M197. doi: 10.1093/geronj/45.6.M192.
    1. Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. J Gerontol. 1992;47(3):M93–M98. doi: 10.1093/geronj/47.3.M93.
    1. Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc. 1992;40(3):203–207. doi: 10.1111/j.1532-5415.1992.tb02068.x.
    1. Bohannon RW. Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997;26(1):15–19. doi: 10.1093/ageing/26.1.15.
    1. Goldberg A, Schepens S. Measurement error and minimum detectable change in 4-meter gait speed in older adults. Aging Clin Exp Res. 2011;23(5–6):406–412. doi: 10.1007/BF03325236.
    1. Rolland YM, Cesari M, Miller ME, Penninx BW, Atkinson HH, Pahor M. Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults. J Am Geriatr Soc. 2004;52(6):972–976. doi: 10.1111/j.1532-5415.2004.52267.x.
    1. Bowling A, Stenner P. Which measure of quality of life performs best in older age? A comparison of the OPQOL, CASP-19 and WHOQOL-OLD. J Epidemiol Community Health. 2011;65(3):273–280. doi: 10.1136/jech.2009.087668.
    1. Mütze T. An introduction to planning and analyzing three-arm trials using the package ThreeArmedTrials. 2016.
    1. Mütze T, Munk A, Friede T. Design and analysis of three-arm trials with negative binomially distributed endpoints. Stat Med. 2016;35(4):505–521. doi: 10.1002/sim.6738.
    1. Mielke M, Munk A, Schacht A. The assessment of non-inferiority in a gold standard design with censored, exponentially distributed endpoints. Stat Med. 2008;27(25):5093–5110. doi: 10.1002/sim.3348.
    1. Mittaz Hager A-G, Nevzati A, Mathieu N, Swanenburg J. Physical activity and risk of falling in elderly: a 1-year prospective study. submitted. 2015.
    1. Swanenburg J, Mittaz Hager AG, Nevzati A, Klipstein A. Identifying fallers and non-fallers with the Maximal Base of support width (BSW): a 1-year prospective study. J Aging Phys Act. 2014;23(2):200–204. doi: 10.1123/japa.2013-0210.
    1. White IR, Horton NJ, Carpenter J, Pocock SJ. Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ. 2011;342:d40. doi: 10.1136/bmj.d40.
    1. Röhmel J, Pigeot I. A comparison of multiple testing procedures for the gold standard non-inferiority trial. J Biopharm Stat. 2010;20(5):911–926. doi: 10.1080/10543401003618942.
    1. Herbison P, Robertson MC, McKenzie JE. Do alternative methods for analysing count data produce similar estimates? Syst Rev. 2015;4(1):163. doi: 10.1186/s13643-015-0144-x.
    1. Robertson MC, Campbell AJ, Herbison P. Statistical analysis of efficacy in falls prevention trials. J Gerontol A Biol Sci Med Sci. 2005;60(4):530–534. doi: 10.1093/gerona/60.4.530.
    1. Kahan BC, Morris TP. Adjusting for multiple prognostic factors in the analysis of randomised trials. BMC Med Res Methodol. 2013;13:99. doi: 10.1186/1471-2288-13-99.
    1. Deri Armstrong C, Hogg WE, Lemelin J, Dahrouge S, Martin C, Viner GS, Saginur R. Home-based intermediate care program vs hospitalization: Cost comparison study. Can Fam Physician. 2008;54(1):66–73.
    1. Haywood K, Marshall S, Fitzpatrick R. Patient participation in the consultation process: a structured review of intervention strategies. Patient Educ Couns. 2006;63(1):12–23. doi: 10.1016/j.pec.2005.10.005.
    1. Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil. 2014;36(6):457–463. doi: 10.3109/09638288.2013.797515.
    1. Coulter A. Engaging patients in healthcare: McGraw-Hill education (UK) 2011.
    1. Fleuren MA, Vrijkotte S, Jans MP, Pin R, van Hespen A, van Meeteren NL, et al. The implementation of the functional task exercise programme for elderly people living at home. BMC Musculoskelet Disord. 2012;13(1):128. doi: 10.1186/1471-2474-13-128.
    1. Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The falls efficacy scale international (FES-I). a comprehensive longitudinal validation study. Age Ageing. 2010;39(2):210–216. doi: 10.1093/ageing/afp225.
    1. Lopez MN, Charter RA, Mostafavi B, Nibut LP, Smith WE. Psychometric properties of the Folstein mini-mental state examination. Assessment. 2005;12(2):137–144. doi: 10.1177/1073191105275412.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere