Study protocol for a comparative randomized controlled trial of Tai Chi and conventional exercise training on alleviating depression in older insomniacs

Background

Insomnia and depression are prevalent mental disorders that are often comorbid among older adults. Lifestyle intervention strategies incorporating Tai Chi or conventional exercise have been shown to alleviate symptoms of insomnia and depression. However, the comparative efficacy of these exercise modalities in individuals with both disorders has yet to be determined. Therefore, the aim of this study is to examine the efficacy of Tai Chi and conventional exercise for reducing depressive symptoms in older adults with chronic insomnia and depressive symptoms, when compared to a health education control.

Methods

This study is a prospective, assessor-blinded, three-arm, parallel group, randomized controlled trial. Older adults aged ≥60 years with a diagnosis of chronic insomnia and depressive symptoms will be randomly assigned to a Tai Chi, conventional exercise or health education control condition on a 1:1:1 basis. Interventions will last for 3 months, with a 6-month follow-up period. The primary outcome is depressive symptoms, assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes include subjective sleep quality, 7-day actigraphy, 7-day sleep diary, anxiety symptoms, quality of life, medication usage and physical function. All measurements will be conducted at baseline, 3 months and 9 months by outcome assessors who are blinded to group allocation.

Discussion

This study will compare the efficacy of Tai Chi and conventional exercise in improving depression outcomes in older adults with chronic insomnia and depressive symptoms. Our results will shed light on the clinical potential of these interventions for combating insomnia and depression in older adults.

The cost-effectiveness of methadone maintenance

BACKGROUND

Although methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse, many health plans offer little or no access to methadone, and many methadone providers do not comply with treatment guidelines regarding dose, duration of treatment, or provision of ancillary services. Moral and political judgments have helped shape the U.S. treatment system. Evaluations of methadone cost-effectiveness may play a role in changing public policy.

METHOD

Cost-effectiveness analysis is used to compare a change, or changes, in treatment to that of current standard care. The cost of treatment and its effect on outcomes are used to find the incremental cost-effectiveness ratio, and determine whether the change(s) should be adopted. The literature on methadone maintenance is reviewed from an economic perspective, focusing on five policy questions: (1) whether methadone should be a health care benefit; (2) what level of ancillary services is optimal; (3) what methadone dose is appropriate; (4) what length of treatment is appropriate; and (5) whether contingency contracts should be employed.

RESULTS

Expanded access to methadone maintenance has an incremental cost-effectiveness ratio of less than $11,000 per Quality-Adjusted Life Year. This is more cost-effective than many widely used medical therapies, a finding that strongly supports the inclusion of methadone in the formulary of health care plans.Ancillary services have been shown to be an effective part of methadone maintenance therapy, especially during the beginning of a treatment episode, but there is not enough information available to tell whether the optimal amount of services is being used. There is extensive evidence that many treatment programs dispense inadequate doses of methadone. The cost of additional drugs is very small compared to the benefits of an adequate dose. Many methadone programs limit treatment to 6 months or less, but such short episodes are not likely to be cost-effective. The medical model of methadone maintenance may increase the cost-effectiveness of the treatment for long-term patients. Programs that reward patients for negative urinalysis have proven effective at reducing illicit drug use, but their cost-effectiveness will need to be demonstrated before they are widely adopted.

CONCLUSIONS

Cost-effectiveness researchers need to measure substance abuse outcomes in terms of Quality-Adjusted Life Years, as this will make their findings more relevant to the development of treatment policy. It will allow different substance abuse treatments to be compared to each other and to medical care interventions.

Validity of the modified back-saver sit-and-reach test: a comparison with other protocols

PURPOSE

Studies have shown that the classical sit-and-reach (CSR) test, the modified sit-and-reach (MSR), and the newly developed back-saver sit-and-reach (BS) test have poor criterion-related validity in estimating low-back flexibility but yielded moderate criterion-related validity in hamstring flexibility. The V sit-and-reach (VSR) test was found to be practical but the validity has not been established. The purpose of this study was to propose a modified back-saver sit-and-reach (MBS) test, which incorporated all advantages of the various protocols, and to compare the criterion-related validity and reliability of all these tests.

METHODS

158 college students (F = 96, and M = 62; age = 20.77 +/- 2.51) performed CSR, VSR, BS (left and right leg), and MBS (left and right leg) tests in a randomized order. Scores from each test were then correlated with the criterion measures.

RESULTS

For all sit-reach tests, intraclass reliability (single trial) was very high (r = 0.89-0.98). MBS yielded significant and highest r with low-back and hamstring criterion for men (r = 0.47-0.67) and women (r = 0.23-0.54). The low-back and right hamstring validity of MBS for men were significantly (P < 0.01) higher than those from BS and CSR, whereas no differences in criterion-related validity were found between the MBS and other protocols in women. The ratings of perceived comfort among the sit-and-reach protocols were significantly different (P < 0.001) from each other. The rating for MBS was observed the most comfortable test as compared with other protocols.

CONCLUSION

The MBS test is not only a reliable test for hamstring and low-back flexibility, it is also a more practical with improved validity for hamstring and low-back flexibility in men than previous protocols.