Clinical trial NCT01593345: Self-management of Chronic Mobility Limitations in MUHC Seniors
Official title: Promotion of Self-management of Chronic Mobility Limitations Among Vulnerable Seniors at the MUHC: Training the New Generation of Canadian Physiotherapists for This Role. Addendum: Planning Physiotherapy Services for Persons Treated at the MUHC for Cancer: A Needs Assessment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Seniors With Mobility Limitations
Keywords: Elderly
mobility limitations
self-management
exercise
Lead sponsor: McGill University
Sponsor class: OTHER
Collaborators: name: Richard and Edith Strauss Foundation of Canada
First posted: 2012-05-08
Enrollment: 60
Sex: ALL
Minimum age (years): 70
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The population is aging and chronic conditions, which are major causes of pain and mobility limitations, are on the rise, however, current access to physiotherapy is difficult. Knowledge on managing disability is substantial, but methods to translate into action are lacking. This project is designed to test a novel method of promoting function in vulnerable seniors and simultaneously develop awareness in the new generation of physiotherapists that they can have a proactive role in health promotion. The investigators are proposing a pilot project targeting both students and patients.

The research question are (1) What are the needs of vulnerable patients at the MUHC? Two groups will be targeted; newly discharged seniors (who will be eligible for an intervention) and cancer outpatients who will be surveyed only);(2) For a senior population at risk for physical deterioration, to what extent is a personalized mentoring approach to optimizing function and preventing disability through developing self-management skills more effective in improving outcomes than the provision of written material covering the same general content? (3) Does a mentoring experience with vulnerable seniors through development and teaching of a self-management program (comprised of education and support) produce meaningful positive changes in future clinicians' knowledge, skills and attitude towards modes of delivering physiotherapy services and promoting self-management in Canadian seniors?

There are two phases to this study: a survey and randomized controlled trial (RCT). The survey phase will identify mobility needs of two groups, newly discharged seniors and cancer outpatients. The needs assessment for newly discharged seniors will identify people eligible for the (RCT) component; the needs assessment for cancer outpatients will inform the development of interventions for this specific group. The RCT component will be piloted for recently discharged community dwelling seniors 70 years and older only.

A sample of 400 seniors recently discharged from the adult, general, hospital sites of the MUHC will be contacted for a needs assessment. From this pool, the investigators anticipate 100 will be eligible and 60 will be randomized, 30 to the mentor intervention and 30 to the control group. Participants will be followed-up for 6 months and assessments will be performed at 2 time points (baseline and 6 months). The main outcome is a standardized response ratio (SRR) estimated across all persons and measures. SRRs will be calculated for three groups of response variables: impairment/mobility measures, quality of life indicators, and health services outcomes.

In parallel, to determine cancer survivor needs, the investigators will contact 600 cancer survivors; as the investigators anticipate 400 will answer the survey. The analysis of this survey will consist of frequency of specific needs by diagnosis and treatment.


Eligibility criteria: Inclusion Criteria:

* community dwelling seniors,
* aged 70 years and older,
* recently discharged from one of the adult general (MGH, RVH, Lachine) hospital sites,
* with anyone of the following mobility limitations:

  1. Limitation in walking more than 1 block
  2. Limitation in going up 1 flight of stairs
  3. Unable to get groceries without help
  4. Unable to do housework (dishes, meals, vacuuming, making bed) without help
  5. Self-rated health fair or poor
  6. Pain
  7. Shortness of breath

Exclusion Criteria:

* seniors discharged with orthopaedic or cardiac surgery, or
* with stroke or myocardial infarction, as formal rehabilitation is part of the usual care plan for these conditions.

Also excluded will be people with dementia as identified on the medical chart.

Primary outcomes:
measure: Brief Pain Questionnaire
timeFrame: 2 time points (baseline and 6 months)
measure: DASH
timeFrame: 2 time points (baseline and 6 months)
measure: LEFS
timeFrame: 2 time points (baseline and 6 months)
measure: RAND-MOS36
timeFrame: 2 time points (baseline and 6 months)
measure: Short Self Efficacy scale
timeFrame: 2 time points (baseline and 6 months)
Secondary outcomes:
measure: Health care utilization
timeFrame: 2 time points (baseline and 6 months)
measure: Medication management
timeFrame: 2 time points (baseline and 6 months)
Other outcomes:
Locations:
city: Montreal
country: Canada
facility: Lachine Hospital
state: Quebec
city: Montreal
country: Canada
facility: Montreal General Hospital
state: Quebec
city: Montreal
country: Canada
facility: Royal Victoria Hospital
state: Quebec
Study officials:
affiliation: McGill University
name: Nancy E Mayo, PhD
role: PRINCIPAL_INVESTIGATOR
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