Effectiveness of a Multifactorial Intervention on Frailty

Study Overview
=================
Brief Summary
-----------------
Objective: To evaluate the effectiveness of a multifactorial intervention program based on physical activity and diet, memory workshops and review of medication, to modify frailty parameters, muscle strength and physical and cognitive performance in people 65 years or older with a positive screening for frailty. Secondly, to assess changes in falls, hospitalizations, nutritional risk, disability and institutionalization or home-care. Methods: randomized clinical trial with a control group, of one year and a half of follow-up, conducted in eight primary care teams in Barcelona. Individuals to be included are 65 years or older with positive frailty screening, timed get-up-and-go between 10 to 30 seconds, and cognitive Lobo test greater than or equal to 18. 165 patients will be selected in each group (difference to be detected on physical performance (Short physical performance battery (SPPB)): 0.5 units; common Standard Deviation : 1.42, 20% lost to follow-up). Intervention: consists in three different actions on frailty dimensions, applied to each subject in the intervention group, in groups of 15 participants: rehabilitative therapy plus intake of hyperproteic shakes, memory workshop and review of the medication. Evaluations will be blinded and conducted at 0, 3 and 18 months. Analysis of variance for repeated measures to adjust for differences attributable to intervention effect and for potential confounders such as comorbidity, sensory limitations, social risk, other medical or social interventions, among others.

Official Title
-----------------
Effectiveness of a Multifactorial Intervention to Modify Frailty Parameters in Elderly Population

Conditions
-----------------
Frail Elderly, Cognitive Impairment, Dependence

Intervention / Treatment
-----------------
* Other: Multifactorial intervention


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Positive Barber screen Timed get-up-and-go 10 to 20 seconds cognitive Lobo test greater than or equal to 18 Exclusion Criteria: Home Care Institutionalization Conditions not allowing physical exercise

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multifactorial Intervention<br>Intervention consists in three different actions on frailty dimensions, applied to each subject in the intervention group, in groups of 15 participants: rehabilitative therapy plus intake of hyperproteic shakes, memory workshop and review of the medication. | Other: Multifactorial intervention<br>* Intervention consists in three different actions on frailty dimensions, applied to each subject in the intervention group, in groups of 15 participants: rehabilitative therapy and physical exercise plus intake of hyperproteic shakes, memory workshop and review of the medication.<br>* Other names: Multifactorial intervention on frailty dimensions;|
| No Intervention: No intervention<br>Usual care | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Short Physical performance battery at 3 and 18 months | The Short Physical Performance Battery (SPPB) is a standardised assessment tool of lower limb function, testing 3 dimensions: standing balance, walking speed, and chair stands. Each component is scored between 0-4, total score from 0 (poor performance) to 12 (best performance). | 0,3,18 months | 
| Change from Baseline in Muscle strength at 3 and 18 months | Evaluation of upper extremities strength was assessed through the measurement of force with a handgrip dynamometer. Grip strength was evaluated using a portable hand dynamometer (JAMAR®0-90 kg, coding 506320). The participants were seated with their shoulder in a neutral position and their elbow flexed at 90°. Three attempts were performed alternately in each hand; the mean of the three measures was recorded. | 0,3,18 months | 
| Change from Baseline in Cognitive Performance (Barcelona test) at 3 and 18 months | The first neuro-psychometric instrument developed in Spain to measure semi-quantitatively cognitive status in clinical neurology was the Barcelona Test (BT). Shortened version of the BT, named Barcelona Test Review (BTR) had been used for neuropsychological area evaluation in our participants and it takes only 20-30 minutes to administer | 0,3,18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with Falls during follow-up, at 18 months |  | 18 months | 
| Change from Baseline in Functional Capacity at 18 months | Barthel Index Lawton&Brody Index | 18 months | 
| Number of Participants Hospitalized during follow-up, at 18 months |  | 18 months | 
| Number of Participants Institutionalized during follow-up, at 18 months |  | 18 months | 
| Number of Participants included in Home Health care during follow-up, at 18 months |  | 18 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Frail elderly