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Shi Y, Stanmore E, McGarrigle L, Todd C. Social-media based Health Education plus Exercise Programme (SHEEP) to improve muscle function among community-dwelling young-old adults with possible sarcopenia in China: A study protocol for intervention development. PLoS One 2024; 19:e0286490. [PMID: 38547178 PMCID: PMC10977808 DOI: 10.1371/journal.pone.0286490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
Possible sarcopenia refers to low muscle strength. Prevalence of possible sarcopenia is estimated to be significantly higher in community-dwelling older adults than that of confirmed or severe sarcopenia. However, there are currently far fewer non-pharmacological intervention strategies for possible sarcopenia than for sarcopenia in the community. Meanwhile, one type of non-pharmacological intervention in sarcopenic area, health education, is under-researched, and older people's awareness about sarcopenia is extremely low, necessitating an immediate dissemination tool for prevention. Social media may be a potential, scalable, low-cost tool for this. This study protocol outlines how a social media-based multicomponent intervention will be co-designed with stakeholders to address this evidence gap. Guided by the Medical Research Council's framework, the proposed research covers two phases that employ a co-design approach to develop a theory-based multicomponent intervention to increase sarcopenia prevention in the community. The participants will be recruited from young-old adults (60~69) with possible sarcopenia in the community of Changsha, China. Maximum sample size will be 45 participants in total, with 18~25 participants in the development phase and 15~20 participants in the pre-test phase. During two rounds of focus groups with older adults, a social-media based intervention strategy will be developed from a theory-based conceptual model and an initial intervention plan formulated by the research group. After this, there will be a three-week pre-test phase, followed by a semi-structured interview to further modify the theory-based conceptual model and the social-media based intervention strategy. The focus of the data analysis will be on thematic analysis of qualitative data primarily derived from the group interview and the semi-structured interview with key stakeholders.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Lewis SR, McGarrigle L, Pritchard MW, Bosco A, Yang Y, Gluchowski A, Sremanakova J, Boulton ER, Gittins M, Spinks A, Rapp K, MacIntyre DE, McClure RJ, Todd C. Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database Syst Rev 2024; 1:CD013789. [PMID: 38180112 PMCID: PMC10767771 DOI: 10.1002/14651858.cd013789.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Around one-third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population-level interventions may be facilitated by different healthcare, social care, and community-level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community-wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low-cost or free gym membership for older adults to encourage increased physical activity). OBJECTIVES To review and synthesise the current evidence on the effects of population-based interventions for preventing falls and fall-related injuries in older people. We defined population-based interventions as community-wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top-up search of CENTRAL, MEDLINE, and Embase in January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped-wedge designs, and controlled non-randomised studies evaluating population-level interventions for preventing falls and fall-related injuries in adults ≥ 60 years of age. Population-based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall-related injuries, number of people experiencing one or more fall-related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health-related quality of life, fall-related mortality, and concerns about falling. MAIN RESULTS We included nine studies: two cluster RCTs and seven non-randomised trials (of which five were controlled before-and-after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free-of-charge daily supplements of calcium carbonate and vitamin D3. Although female residents exposed to this falls prevention programme had fewer fall-related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non-randomised trial designs (which started as low-certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low-certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall-related injuries, but with little or no difference in the number of people having one or more fall-related fractures. In another cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D3 programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall-related injuries. One CITS found no evidence of a difference in the number of people having one or more fall-related fractures. No studies reported adverse events. AUTHORS' CONCLUSIONS Given the very low-certainty evidence, we are unsure whether population-based multicomponent or nutrition and medication interventions are effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population-based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lisa McGarrigle
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alessandro Bosco
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Yang Yang
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Ashley Gluchowski
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- School of Health & Society, University of Salford, Salford, UK
| | - Jana Sremanakova
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Elisabeth R Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Anneliese Spinks
- School of Population Health, University of Queensland, Queensland, Australia
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Chris Todd
- NIHR Applied Research Collaboration Greater Manchester, School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
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Shi Y, Tang Y, Stanmore E, McGarrigle L, Todd C. Non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia: a scoping review. Arch Gerontol Geriatr 2023; 112:105022. [PMID: 37084601 DOI: 10.1016/j.archger.2023.105022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Sarcopenia is a progressive, age-related muscle disease that, if left untreated, imposes significant personal, social, and economic burdens. OBJECTIVE To compile and document the nature and extent of existing studies exploring non-pharmacological interventions as a strategy to prevent or treat possible sarcopenia or sarcopenia in community-dwelling older adults. METHOD Thirteen databases were searched up from January 2010 to March 2023 and filters were limited to English and Chinese language. Studies with older adults (≥60 y) in the community were included. The review was conducted and reported according to the PRISMA-ScR guidance and seven stages of methodology framework. A descriptive synthesis of trial characteristics and effectiveness was conducted. RESULTS A total of 59 studies were included in the analysis. Most studies were RCTs. Few studies enrolled older adults with possible sarcopenia. The 70-79 age group has been studied more than any other age group. Six intervention types were identified, including exercise-only, nutrition-only, health education-only, traditional Chinese medicine-only, multicomponent intervention and control type. Majority of exercise-only interventions received resistance-based exercise. In nutrition-only category, overall food intervention or nutrients intervention was more than dietary pattern. Moreover, exercise plus nutrition was the main sub-type in multicomponent interventions. Health education-only and traditional Chinese medicine-only interventions were less frequently identified. Most studies had high and moderate compliance. CONCLUSION There is evidence for the effectiveness of exercise and exercise plus nutrition interventions in improving muscle strength and physical performance, whereas the effectiveness of other intervention types or their combinations requires additional research. SCOPING REVIEW REGISTRATION Open Science Framework (OSF) Registration DOI 10.17605/OSF.IO/RK3TE.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu province, China.
| | - Yimin Tang
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK.
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; Manchester Institute for Collaborative Research on Ageing, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK.
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; Manchester Institute for Collaborative Research on Ageing, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK.
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; Manchester Institute for Collaborative Research on Ageing, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK.
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Gasteiger N, Dowding D, Norman G, McGarrigle L, Eost-Telling C, Jones D, Vercell A, Ali SM, O'Connor S. Conducting a systematic review and evaluation of commercially available mobile applications (apps) on a health-related topic: the TECH approach and a step-by-step methodological guide. BMJ Open 2023; 13:e073283. [PMID: 37308269 PMCID: PMC10277147 DOI: 10.1136/bmjopen-2023-073283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES To provide an overview of the methodological considerations for conducting commercial smartphone health app reviews (mHealth reviews), with the aim of systematising the process and supporting high-quality evaluations of mHealth apps. DESIGN Synthesis of our research team's experiences of conducting and publishing various reviews of mHealth apps available on app stores and hand-searching the top medical informatics journals (eg, The Lancet Digital Health, npj Digital Medicine, Journal of Biomedical Informatics and the Journal of the American Medical Informatics Association) over the last five years (2018-2022) to identify other app reviews to contribute to the discussion of this method and supporting framework for developing a research (review) question and determining the eligibility criteria. RESULTS We present seven steps to support rigour in conducting reviews of health apps available on the app market: (1) writing a research question or aims, (2) conducting scoping searches and developing the protocol, (3) determining the eligibility criteria using the TECH framework, (4) conducting the final search and screening of health apps, (5) data extraction, (6) quality, functionality and other assessments and (7) analysis and synthesis of findings. We introduce the novel TECH approach to developing review questions and the eligibility criteria, which considers the Target user, Evaluation focus, Connectedness and the Health domain. Patient and public involvement and engagement opportunities are acknowledged, including co-developing the protocol and undertaking quality or usability assessments. CONCLUSION Commercial mHealth app reviews can provide important insights into the health app market, including the availability of apps and their quality and functionality. We have outlined seven key steps for conducting rigorous health app reviews in addition to the TECH acronym, which can support researchers in writing research questions and determining the eligibility criteria. Future work will include a collaborative effort to develop reporting guidelines and a quality appraisal tool to ensure transparency and quality in systematic app reviews.
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Affiliation(s)
- Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Gill Norman
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Lisa McGarrigle
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Charlotte Eost-Telling
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Debra Jones
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Amy Vercell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Syed Mustafa Ali
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Siobhan O'Connor
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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McGarrigle L, Yang Y, Lasrado R, Gittins M, Todd C. A systematic review and meta-analysis of the measurement properties of concerns-about-falling instruments in older people and people at increased risk of falls. Age Ageing 2023; 52:7174131. [PMID: 37211363 DOI: 10.1093/ageing/afad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools. OBJECTIVES To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants. METHODS MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach. RESULTS The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments. CONCLUSION There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.
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Affiliation(s)
- Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
| | - Yang Yang
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
| | - Reena Lasrado
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
| | - Matthew Gittins
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- NIHR Applied Research Collaboration Greater Manchester, The University of Manchester, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Ellmers TJ, Freiberger E, Hauer K, Hogan DB, McGarrigle L, Lim ML, Todd C, Martin F, Delbaere K. Why should clinical practitioners ask about their patients' concerns about falling? Age Ageing 2023; 52:7136743. [PMID: 37097766 DOI: 10.1093/ageing/afad057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 04/26/2023] Open
Abstract
Concerns (or 'fears') about falling (CaF) are common in older adults. As part of the 'World Falls Guidelines Working Group on Concerns about Falling', we recommended that clinicians working in falls prevention services should regularly assess CaF. Here, we expand upon these recommendations and argue that CaF can be both 'adaptive' and 'maladaptive' with respect to falls risk. On the one hand, high CaF can lead to overly cautious or hypervigilant behaviours that increase the risk of falling, and may also cause undue activity restriction ('maladaptive CaF'). But concerns can also encourage individuals to make appropriate modifications to their behaviour to maximise safety ('adaptive CaF'). We discuss this paradox and argue that high CaF-irrespective of whether 'adaptive' or 'maladaptive'-should be considered an indication that 'something is not right', and that is represents an opportunity for clinical engagement. We also highlight how CaF can be maladaptive in terms of inappropriately high confidence about one's balance. We present different routes for clinical intervention based on the types of concerns disclosed.
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Affiliation(s)
- Toby Jack Ellmers
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany
| | - David B Hogan
- Brenda Strafford Centre on Aging, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Mae Ling Lim
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Finbarr Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine King's College London, London, UK
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Medicine & Health, School of Population Health, University of New South Wales, Kensington, NSW, Australia
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Shi Y, Stanmore E, McGarrigle L, Todd C. Non-pharmacological interventions for possible sarcopenia or sarcopenia in community-dwelling older adults: a scoping review protocol. BMJ Open 2023; 13:e067079. [PMID: 36810172 PMCID: PMC9944664 DOI: 10.1136/bmjopen-2022-067079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Early prevention of sarcopenia is a recommendation to reduce morbidity, mortality and improve quality of life. Several non-pharmacological interventions to reduce the risk of sarcopenia in community-dwelling older people have been proposed. Therefore, there is a need to identify the scope and differences of these interventions. This scoping review will summarise the nature and extent of the existing literature that describes and examines non-pharmacological interventions for community-dwelling older adults with possible sarcopenia or sarcopenia. METHODS AND ANALYSIS The seven-stage review methodology framework will be used. Searches will be conducted in the following databases: Embase, Medline, PsycINFO, CINAHL, All EBM Reviews, Web of Science, Scopus, CBM, CNKI, WANFANG and VIP. Grey literature will also be identified from Google scholar. Search dates will be restricted to January 2010 to December 2022, in English and Chinese language only. Screening will be focused on published research, including both quantitative and qualitative study designs, and prospectively registered trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be followed when delineating the search decision process. Findings will be synthesised quantitatively and qualitatively as appropriate and classified using key conceptual categories. We will identify whether studies identified have been included in systematic reviews or meta-analyses, and research gaps and opportunities will be identified and summarised. ETHICS AND DISSEMINATION As this is a review, ethical approval will not be sought. The results will be published in peer-reviewed scientific journals and also disseminated in relevant disease support groups and conferences. The planned scoping review will help us identify the current status of research and gaps in the literature, so as to develop a future research agenda.
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Affiliation(s)
- Ya Shi
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- School of Nursing & School of Public Health, Yangzhou University, Yangzhou, Jiangsu province, China
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Zougar M, Todd C, McGarrigle L, Stanmore E. MIRA Rehab Exergames for Older Male Residents in a Care Home Center in Saudi Arabia: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e39148. [PMID: 36538360 PMCID: PMC9812269 DOI: 10.2196/39148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Physical activity leads to improvements in morbidity, mortality, and quality of life, especially when it is progressive, challenging, and regular. There is strong evidence that strength and balance exercises decrease the risk of falling. However, traditional exercises may be tedious and not very motivating for participants. Exergames have been found to increase engagement and enjoyment for older users. OBJECTIVE This study will conduct a feasibility randomized controlled trial (RCT) on the use of MIRA Rehab Exergames among older male residents in a care home setting in Saudi Arabia. A sample of 30 eligible participants will be recruited to meet feasibility study requirements. METHODS We will recruit 38 residents in the care home who will be randomly allocated to either an intervention or a control group. The intervention participants will perform gamified exercises using the MIRA telerehabilitation platform (30 minutes 3 times per week for 6 weeks). The control group will receive educational advice based on booklets of the Otago exercise program and be encouraged to exercise (30 minutes 3 times per week for 6 weeks). Participants will be assessed at weeks 0, 6, and 12. Assessments will include feasibility measures (eligibility, recruitment and attrition rates, and practicalities of data collection methods) and participant outcome measures (balance, strength, mobility, adherence, quality of life, fear of falling, depression, acceptability, and usability). RESULTS Data collection started in November 2021 and ended in March 2022. The study is currently in the data analysis stage, which commenced in May 2022. The findings from this feasibility RCT will be used to design a definitive RCT to test whether the MIRA Rehab Exergame program benefits older people in Saudi Arabia who may not like participating in traditional exercise programs and may be unwilling or unable to leave their homes. CONCLUSIONS This study will contribute to our understanding of how to recruit in this specific population and provide information to inform the design of a future RCT. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39148.
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Affiliation(s)
- Mohammad Zougar
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Taif University, Taif city, Saudi Arabia
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Emma Stanmore
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
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McGarrigle L, Hunt S. Rehabilitation of short term mechanical circulatory support recipients in the intensive care unit: Optimising the heart transplant candidate. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Bosco A, McGarrigle L, Skelton DA, Laventure R, Townley B, Todd C. Make Movement Your Mission: Evaluation of an online digital health initiative to increase physical activity in older people during the COVID-19 pandemic. Digit Health 2022; 8:20552076221084468. [PMID: 35295764 PMCID: PMC8918976 DOI: 10.1177/20552076221084468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To formatively evaluate the Make Movement Your Mission (MMYM) digital health initiative to promote physical activity (PA) levels and help avert the negative consequences of sedentary behaviours in older adults during the SARS-CoV2 pandemic. Methods Mixed-method study to explore activity levels, changes in physical function and Activities of Daily Living (ADLs), quality-of-life, social engagement, technology use, and accessibility. Survey data were analysed descriptively. Qualitative interviews were analysed using framework analysis. Results Forty-one respondents completed the survey (Mean age 68.4 (8.9) years; 34 Female), 68% aged ≥ 65 years. Average attendance was 14.3 sessions per week (3.5 h). 73% had been with MMYM for >1 year, 90% reported they were engaging in more movement on a typical day, and 75% reported improvement in ability to perform moderate PA. Since starting MMYM, participation in activities targeting strength, balance and flexibility increased (by 48%, 73% and 75%, respectively). 83% met strength and 90% balance PA guidelines for health (≥ 2x per week). Between 18% and 53% of respondents reported improvements in ADLs, 53% reported better quality-of-life, and 28% increased use of the internet. Eight participants were interviewed (Mean age 70.7 (6.7) years; 7 Female). Activity levels were promoted by having direct support from the instructor through Facebook messages pre and post live sessions, having group expectation about quality and level of engagement, having a sense of control and encouragement from others, MMYMs regularity, choice around level of engagement and accessibility. Noticing short-term outcomes in balance and posture helped boost confidence and continued participation. Conclusion Clinical trials need to robustly assess its effectiveness and acceptability.
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Affiliation(s)
- Alessandro Bosco
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lisa McGarrigle
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Dawn A. Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Manchester, UK
| | | | | | - Chris Todd
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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McGarrigle L, Todd C. Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews. J Med Internet Res 2020; 22:e22201. [PMID: 33372894 PMCID: PMC7803474 DOI: 10.2196/22201] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. OBJECTIVE The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. METHODS We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. RESULTS Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. CONCLUSIONS There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support.
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Affiliation(s)
- Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,National Institute for Health Research Applied Research Collaboration-Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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McGarrigle L, Boulton E, Todd C. Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises. BMC Geriatr 2020; 20:483. [PMID: 33208117 PMCID: PMC7673248 DOI: 10.1186/s12877-020-01880-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people. METHODS We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality. RESULTS We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review. CONCLUSIONS Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.
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Affiliation(s)
- Lisa McGarrigle
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
| | - Elisabeth Boulton
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
- National Institute for Health Research, Applied Research Collaboration- Greater Manchester, Manchester, M13 9PL, UK
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McGarrigle L, Boulton E, Sremanakova J, Gittins M, Rapp K, Spinks A, MacIntyre DE, McClure RJ, Todd C. Population-based interventions for preventing falls and fall-related injuries in older people. Hippokratia 2020. [DOI: 10.1002/14651858.cd013789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lisa McGarrigle
- School of Health Sciences, Division of Nursing, Midwifery and Social Work; University of Manchester; Manchester UK
| | - Elisabeth Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social Work; University of Manchester; Manchester UK
| | - Jana Sremanakova
- School of Health Sciences; The University of Manchester, and Manchester Academic Health Science Centre; Manchester UK
| | - Matthew Gittins
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences; University of Manchester; Manchester UK
| | - Kilian Rapp
- Department of Clinical Gerontology; Robert-Bosch-Hospital; Stuttgart Germany
| | | | | | | | - Chris Todd
- School of Health Sciences; University of Manchester; Manchester UK
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McGarrigle L, Rockwood K. The responsiveness of goal attainment scaling using just one goal in controlled clinical trials: an exploratory analysis. J Patient Rep Outcomes 2020; 4:35. [PMID: 32399731 PMCID: PMC7218040 DOI: 10.1186/s41687-020-00196-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Goal Attainment Scaling (GAS) is an individualized outcome measure that allows the setting of personalized treatment goals. We compared the responsiveness of GAS when individuals set only one goal instead of the recommended three or more goals. Methods We conducted exploratory analyses on data from two randomized controlled trials: the Video-Imaging Synthesis of Treating Alzheimer’s Disease (VISTA) (n = 130); and the Mobile Geriatric Assessment Team (MGAT) (n = 265). Independent t-tests and standardized response means (SRMs) were used to assess responsiveness of one- vs. multiple-goal GAS. Results In VISTA, clinician-rated multiple-goal GAS detected higher goal attainment in the intervention group (p = 0.01; SRM = 0.48). One-goal GAS, whether rated by patients or by clinicians, did not detect differences in goal attainment between groups (patient: p = 0.56, SRM = 0.10; clinician: p = 0.10, SRM = 0.29). In MGAT, multiple-goal GAS (outcome goals: p < .001, SRM = 1.29; total goals: p < .001, SRM = 1.52) and one-goal GAS (outcome goals: p < .001, SRM = 0.89; total goals: p < .001, SRM = 0.75), detected significantly higher goal attainment in the intervention group. Conclusion One-goal GAS detected significant change in response to a patient-centred, multi-domain care initiative. As such, in similar contexts, one-goal GAS may be an effective means of optimizing personalization and improving GAS feasibility through reduced administration time. However, it is not yet clear if one-goal GAS is responsive in the context of a pharmacological intervention and further research is recommended.
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Affiliation(s)
- Lisa McGarrigle
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,DGI Clinical Inc., 1730 Market St, Halifax, NS, B3J 3N9, Canada.,School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,DGI Clinical Inc., 1730 Market St, Halifax, NS, B3J 3N9, Canada.,Centre for Health Care of the Elderly, Nova Scotia Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E9, Canada
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15
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McGarrigle L, Squires E, Wallace LMK, Godin J, Gorman M, Rockwood K, Theou O. Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale. Age Ageing 2019; 48:832-837. [PMID: 31579907 DOI: 10.1093/ageing/afz111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. OBJECTIVES To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. DESIGN observational study. SETTING three outpatient geriatric healthcare settings. SUBJECTS patients (n = 132), caregivers (n = 84), clinic nurses (n = 7) and physicians (n = 10). METHODS the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients' health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7-14 days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test-retest and inter-rater reliability. RESULTS mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P < 0.01), nurse (P < 0.001) and physician (P < 0.01) scores. Test-retest reliability was good for patients (ICC = 0.78, [95%CI = 0.67-0.86]) and nurses (ICC = 0.88 [0.80-0.93]). Inter-rater reliability between HCPs was also good (ICC = 0.75 [0.63-0.83]). CONCLUSION the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary.
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Affiliation(s)
- Lisa McGarrigle
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Emma Squires
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
| | - Lindsay M K Wallace
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Mary Gorman
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- St. Martha’s Regional Hospital, Antigonish, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Olga Theou
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
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Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Sazlina SG, Moorhouse P, Fay S, Visvanathan R, Rockwood K. The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty. Can Geriatr J 2019; 22:64-74. [PMID: 31258829 PMCID: PMC6542581 DOI: 10.5770/cgj.22.357] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. Methods In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. Results The final scale incorporated 14 domains, each conceptualized with 3–6 response levels. All domains were rated as “understood well” by most participants (range 64–94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. Conclusions The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada.,National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia
| | - Melissa Andrew
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | | | - Emma Squires
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Lisa McGarrigle
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, NS, Canada.,Department of Emergency Medicine, Division of EMS, Halifax, NS, Canada
| | | | - Judith Godin
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Glen Hougan
- Nova Scotia College of Art and Design University, Halifax, NS, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Lindsay Wallace
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shariff Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Paige Moorhouse
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Sherri Fay
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia.,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Kenneth Rockwood
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
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Rockwood K, Sanon Aigbogun M, Stanley J, Wong H, Dunn T, Chapman CAT, Howlett SE, Miguelez M, McGarrigle L, Baker RA. The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study. J Med Internet Res 2019; 21:e13360. [PMID: 31254339 PMCID: PMC6625216 DOI: 10.2196/13360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In people with dementia, neuropsychiatric symptoms (NPSs), especially agitation, are associated with worse quality of life and caregiver burden. As NPSs may vary with illness severity, knowledge of how people with dementia and their caregivers describe and rate the importance of agitation symptoms can improve the understanding of the clinical meaningfulness of the manifestations of agitation. The internet provides new opportunities to better understand patient experiences, as patients and caregivers increasingly look to Web-based platforms as a means of managing symptoms. OBJECTIVE The aim of this study was to examine Web-based reports from a dementia symptom website to better understand the symptoms of agitation and explore how they are being targeted for monitoring by caregivers of people with dementia. METHODS The Dementia Guide website hosts a Web-based database used by caregivers (97%) and people with dementia (3%). From its 61 dementia symptoms, users can select relevant symptoms that they deem important to monitor or track the effects of treatment. We employed a staging algorithm to determine if individuals had mild cognitive impairment (MCI) or mild, moderate, or severe dementia. Agitation was defined using terms consistent with the International Psychogeriatrics Association's provisional consensus definition. We compared the proportion of people with NPSs and agitation across stages of dementia severity and studied how many agitation-defining descriptors were selected, and how often they occurred, by stage. RESULTS As of March 2017, 4121 people had used the tracking tool, of whom 2577 provided sufficient data to allow disease severity staging. NPSs were tracked by 2127/2577 (82.54%) and agitation by 1898/2577 (73.65%). The proportion in whom agitation was tracked increased with increasing cognitive impairment: 68.5% (491/717) in people with MCI, and 72.50% (754/1040), 73.3% (378/516), and 90.5% (275/304) in mild, moderate, and severe dementia, respectively (χ23=54.9; P<.001). The number of NPS and agitation descriptors selected also increased with severity (median number of NPSs=1, 2, 2, and 3 for MCI, mild, moderate, and severe dementia, respectively, Kruskal-Wallis H Test H3=250.47; P<.001; median number of agitation descriptors=1, 2, 3, and 4, H3=146.11; P<.001). CONCLUSIONS NPSs and agitation are common targets for tracking over the course of dementia and appear more frequently with increasing disease severity. These common and distressing symptoms represent clinically meaningful targets in treating people with dementia.
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Affiliation(s)
- Kenneth Rockwood
- Geriatric Medicine Research Unit, Halifax, NS, Canada.,DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Susan E Howlett
- DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Maia Miguelez
- Otsuka Canada Pharmaceutical Inc, Saint-Laurent, QC, Canada
| | - Lisa McGarrigle
- Geriatric Medicine Research Unit, Halifax, NS, Canada.,DGI Clinical Inc, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ross A Baker
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
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McGarrigle L, Roberts JC, Denne M, Rockwood K. Exploring the responsiveness of goal attainment scaling in relation to number of goals set in a sample of hemophilia-A patients. J Patient Rep Outcomes 2019; 3:20. [PMID: 30931491 PMCID: PMC6441664 DOI: 10.1186/s41687-019-0110-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose Guidelines for the use of goal attainment scaling (GAS) recommend that the patient specify at least three goals. Even so, this may not always be feasible or align with patient preferences. Investigations into the psychometric properties of GAS using three or more goals largely support its reliability, validity, and responsiveness compared with standard measures. As evaluations of responsiveness rely on variability estimates, this metric may be impacted when GAS is based on fewer than three goals. For this reason, we investigated the responsiveness of one- and two-goal GAS. Methods Secondary analyses were conducted on data from a mixed sample of pediatric, adolescent and adult subjects with hemophilia A. The standardized response mean (SRM) and its 95% confidence intervals (CI) were used to assess responsiveness of one- and two-goal GAS at six and twelve weeks. Results Both one-goal and two-goal GAS demonstrated similar responsiveness to change at 6-week (Patient-Rated GAS: one-goal SRM [95% CI] = 0.70 [0.45–1.08], two-goal = 0.96 [0.68–1.30]; Clinician-Rated GAS: one-goal = 1.26 [0.81–1.77], two-goal = 1.01 [0.73–1.32]) and 12-week follow-up (Patient-Rated GAS: one-goal SRM [95% CI] = 1.14 [0.53–1.71], two-goal = 1.35 [0.92–1.82]; Clinician-Rated GAS: one-goal = 1.71 [1.12–2.30], two-goal = 1.48 [1.02–2.02]). Larger SRMs were observed for clinician-rated GAS, but all were within the rubric of a large effect size. Conclusions One-goal GAS is responsive to change in a clinical population. Further research is recommended in a larger sample where responsiveness of one- and multiple-goal GAS can be compared
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Affiliation(s)
- Lisa McGarrigle
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,DGI Clinical Inc, 1730 Market St, Halifax, NS, B3J 3N9, Canada
| | | | | | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada. .,DGI Clinical Inc, 1730 Market St, Halifax, NS, B3J 3N9, Canada. .,Centre for Health Care of the Elderly, Nova Scotia Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E9, Canada.
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Abstract
The Child and Youth Resilience Measure (CYRM) is one of the most popular measures of resilience. In this paper, we investigate the CYRM using Rasch analysis to explore and improve its psychometric properties, leading to a more robust measure of resilience.Cross-sectional data were obtained from a questionnaire administered to n = 408 individuals in Canada aged 11-19 who were participating in the Pathways to Resilience study. Rasch analysis was applied to these data, resulting in the production of a 17-item, 2-subscale CYRM-R, consisting of intra/interpersonal and caregiver resilience subscales. The subscales demonstrated good fit to the Rasch model by satisfying requirements of unidimensionality, good fit statistics and internal reliability, and a lack of item bias and problematic local dependency. The person separation indices also indicated that the subscales had good ability to differentiate between individuals of varying levels of resilience. In sum, the CYRM-R is a 2-subscale, 17-item Rasch-validated measure of resilience with robust psychometric properties. This revised measure is recommended for researchers and practitioners who are interested in measuring resilience across diverse cultures and contexts.
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Affiliation(s)
- Philip Jefferies
- Resilience Research Centre, Dalhousie University, Halifax, Canada
| | - Lisa McGarrigle
- Geriatric Medicine Research Unit, Dalhousie University, Halifax, Canada
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, Canada
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McGarrigle L, Squires E, Wallace L, Gorman M, Rockwood K, Theou O. INVESTIGATING THE PSYCHOMETRIC PROPERTIES OF THE PICTORIAL FIT-FRAIL SCALE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - M Gorman
- St. Martha’s Regional Hospital, Antigonish, Nova Scotia, Canada
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21
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Wallace LM, Squires E, McGarrigle L, Andrew MK, Rockwood K, Theou O. P3‐570: VALIDATING THE PICTORIAL FIT‐FRAIL SCALE (PFFS) IN A MEMORY CLINIC SETTING. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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McGarrigle L, Bradley R, Al-Aloul M, Foden P. The Short Physical Performance Battery (SPPB) as a Stand-Alone Measure of Frailty in Lung Transplant Candidates. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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Newport GR, McKerrow JH, Hedstrom R, Petitt M, McGarrigle L, Barr PJ, Agabian N. Cloning of the proteinase that facilitates infection by schistosome parasites. J Biol Chem 1988; 263:13179-84. [PMID: 3166457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Four cDNA clones encoding a proteinase which facilitates skin invasion by schistosome parasites were isolated by screening a schistosome sporocyst cDNA library, using an oligonucleotide probe containing sequences complementary to predicted 5'-translated regions of its RNA. The amino acid sequence of the enzyme, as deduced from the DNA sequence of the clones, indicates that the enzyme is a serine protease which in many respects is similar to vertebrate pancreatic elastases, although regions outside of the putative active site, binding pocket, and amino-terminal cysteines differ significantly. Regulation of expression of the enzyme occurs at the level of mRNA transcription as well as posttranslationally, the latter involving the processing of a previously unidentified pre-proenzyme (zymogen) sequence. In situ hybridization of the cDNA clones to tissue sections of developing larvae indicates that the enzyme is synthesized within a discrete time frame in specialized cells of the organism.
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Affiliation(s)
- G R Newport
- University of California, School of Public Health, Berkeley 94720
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24
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Newport GR, McKerrow JH, Hedstrom R, Petitt M, McGarrigle L, Barr PJ, Agabian N. Cloning of the proteinase that facilitates infection by schistosome parasites. J Biol Chem 1988. [DOI: 10.1016/s0021-9258(18)37688-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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