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Multicomponent Intervention (multicomponent + intervention)
Selected AbstractsA Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic SurgeryJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009R. Sean Morrison MD OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery. DESIGN: Controlled prospective propensity score,matched clinical trial. SETTING: New York City acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty. INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care. MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge. RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03). CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function. [source] Effect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary FindingsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Laura N. Gitlin PhD OBJECTIVES: To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism. DESIGN: Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group. SETTING: Urban, community-living older people. PARTICIPANTS: Three hundred nineteen people aged 70 and older with functional difficulties. INTERVENTION: Occupational therapy and physical therapy sessions involving home modifications, problem solving, and training in energy conservation, safe performance, balance, muscle strength, and fall recovery techniques. MEASUREMENTS: Survival time was number of days between baseline interview and date of death or final interview if date unknown. Control-oriented strategy use was measured using eight items. RESULTS: Intervention participants exhibited a 1% rate of mortality, compared with a 10% rate for no-treatment control participants (P=.003, 95% confidence interval=2.4,15.04%). At baseline, those who subsequently died had more days hospitalized and lower control-oriented strategy use 6 months before study enrollment than survivors. No intervention participants with previous days hospitalized (n=31) died, whereas 21% of control group counterparts did (n=35; P=.001). Although intervention participants with low and high baseline control strategy use had lower mortality risk than control participants, mortality risk was lower for intervention participants with low strategy use at baseline (P=.007). CONCLUSION: An occupational and physical therapy intervention to ameliorate functional difficulties may reduce mortality risk in community-dwelling older people overall and benefit those most compromised. Instruction in control-oriented strategies may account for the intervention's protective effects on survivorship. [source] A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006Laura N. Gitlin PhD OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions. DESIGN: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group. SETTING: Urban community-living older people. PARTICIPANTS: Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living. INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training. MEASUREMENTS: Outcome measures included self-rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted. RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=,0.28,0.00) and activities of daily living (P=.03, 95% CI=,0.24 to ,0.01), with largest reductions in bathing (P=.02, 95% CI=,0.52 to ,0.06) and toileting (P=.049, 95% CI=,0.35,0.00). They also had greater self-efficacy (P=.03, 95% CI=0.02,0.27), less fear of falling (P=.001, 95% CI=0.26,0.96), fewer home hazards (P=.05, 95% CI=,3.06,0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03,0.22). Benefits were sustained at 12 months for most outcomes. CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year. [source] Bone Mineral Density in Postmenopausal Breast Cancer SurvivorsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2001APRN, Janice J. Twiss PhD Purpose The overall purpose of this longitudinal 18-month study was to test the feasibility and effectiveness of a multicomponent intervention for prevention and treatment of osteoporosis. The purpose of this article is to describe the baseline bone mineral density (BMD) findings for 30 postmenopausal women and to compare these BMD findings to time since menopause, body mass index, and tamoxifen use. Data Sources Baseline data of BMD findings for 30 post-menopausal women, who have had a variety of treatments including surgery, adjuvant chemotherapy and or tamoxifen, and are enrolled in the 18-month longitudinal study. A demographic questionnaire and a three day dietary record were used to collect baseline data. Conclusions Eighty percent of the women with breast cancer history had abnormal BMDs at baseline (t-scores below -1.00 SD). Thinner women showed a greater risk for accelerated trabecular bone loss at the spine and hip. Implications for Practice These findings suggest the need for early BMD assessments and for aggressive health promotion intervention strategies that include a multifaceted protocol of drug therapy for bone remodeling, 1500 mg of daily calcium, 400 IU vitamin D and a strength weight training program that is implemented immediately following chemotherapy treatment and menopause in this high risk population of women. [source] An investigation of Detect, Practice, and Repair to remedy math-fact deficits in a group of third-grade studentsPSYCHOLOGY IN THE SCHOOLS, Issue 4 2010Brian C. Poncy A multiple-probe-across-problem-sets (tasks) design was used to evaluate the effects of the Detect, Practice, and Repair (DPR) on multiplication-fact fluency development in seven third-grade students nominated by their teacher as needing remediation. DPR is a multicomponent intervention and begins with a group-administered, metronome-paced assessment used to identify specific facts in need of repair. Next, Cover, Copy, and Compare (CCC) procedures are used to enhance automaticity with those specific facts. Lastly, students complete a 1-min speed drill and self-graph their fluency performance. Results showed large level and trend increases in fact fluency after DPR was applied across all three sets of multiplication problems. Discussion focuses on the importance of developing effective and efficient basic-skill-remediation procedures and directions for future research. © 2010 Wiley Periodicals, Inc. [source] Electronic continuing education in the health professions: An update on evidence from RCTsTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2009CCFP, Margarita Lam-Antoniades MD Abstract Introduction: Demonstrating the effectiveness of the rapidly expanding field of electronic continuing education (e-CE) has important implications for CE in the health professions. This study provides an update on evidence from randomized controlled trials (RCTs) assessing the effectiveness of e-CE in the health professions. Methods: A literature search of RCTs was performed in MEDLINE, EMBASE, and CINAHL from 2004 to 2007. Papers were reviewed separately by 2 of the authors and results were categorized and reviewed according to study comparisons. Results: Fifteen studies met our inclusion criteria. Six compared e-CE to no intervention or placebo. Of these 6 studies, 4 showed a statistically significant advantage of the e-CE intervention and 2 showed no significant effect. Two studies compared e-CE to a lecture. Of these, 1 showed an advantage of e-CE and 1 showed no difference. Two studies compared e-CE to a small-group interactive intervention. In both studies, the e-CE group outperformed the control. Two studies compared a multicomponent e-CE intervention to one based on flat text, and both showed the multicomponent intervention to be more effective. Two of the 15 studies demonstrated a statistically significant effect on practice patterns. Positive effects of e-CE on knowledge were shown to persist for up to 12 months and effects on practice up to 5 months. Discussion: Overall, these studies suggest that multicomponent e-CE interventions can be effective in changing health professionals' practice patterns, and improve their knowledge. E-CE interventions based purely on flat text appear to be of limited effectiveness in changing either knowledge or practice. These results support the use of multicomponent e-CE as a method of CE delivery. [source] Interventions to reduce the burden of caregiving for an adult with dementia: A meta-analysis,RESEARCH IN NURSING & HEALTH, Issue 5 2001Gayle J. Acton Abstract Because of conflicting results, in order to clarify the state of the science it was necessary to do a systematic analysis of the literature on research testing the effect of interventions on the burden of persons caring for family members with dementia. The purpose of this study was to evaluate, using meta-analytic techniques, those intervention strategies (support group, education, psychoeducation, counseling, respite care, and multicomponent) designed to help caregivers cope with the burden of caregiving. Using meta-analytic methods developed by Glass, McGraw, and Smith (1981) and Hedges and Olkin (1985), 24 published research reports testing 27 treatments for caregivers of adults with dementia were synthesized. Overall, the analysis showed that collectively the interventions had no effect on caregiver burden. Only the category of multicomponent interventions significantly reduced caregiver burden. Burden may be too global an outcome to be affected consistently by intervention. Better and more precise measures are needed to evaluate the effects of caregiver interventions properly. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24:349,360, 2001 [source] | ||||||||||