A mixed-methods feasibility study of a sit-to-stand based exercise programme to maintain knee-extension muscle strength for older patients during hospitalisation

Background.In older patients, hospitalization is associated with a decline in functional performance and loss of muscle strength. Loss of muscle strength and functional performance can be prevented by systematic strength training, but details are lacking regarding the optimal exercise program and dose for older patients. Therefore, our aim was to test the feasibility of a progression model for loaded sit-to-stand training among older hospitalized patients.Methods.This is a prospective cohort study conducted as a feasibility study prior to a full-scale trial. We included twenty-four older patients (≥65 yrs) acutely admitted from their own home to the medical services of the hospital. We developed an 8-level progression model for loaded sit-to-stands, which we named STAND. We used STAND as a model to describe how to perform the sit-to-stand exercise as a strength training exercise aimed at reaching a relative load of 8–12 repetitions maximum (RM) for 8–12 repetitions. Weight could be added by the use of a weight vest when needed. The ability of the patients to reach the intended relative load (8–12 RM), while performing sit-to-stands following the STAND model, was tested once during hospitalization and once following discharge in their own homes. A structured interview including assessment of possible modifiers (cognitive status by the Short Orientation Memory test and mobility by the De Morton Mobility Index) was administered both on admission to the hospital and in the home setting. The STAND model was considered feasible if: (1) 75% of the assessed patients could perform the exercise at a given level of the model reaching 8–12 repetitions at a relative load of 8–12 RM for one set of exercise in the hospital and two sets of exercise at home; (2) no ceiling or floor effect was seen; (3) no indication of adverse events were observed. The outcomes assessed were: level of STAND attained, the number of sets performed, perceived exertion (the Borg scale), and pain (the Verbal Ranking Scale).Results.Twenty-four patients consented to participate. Twenty-three of the patients were tested in the hospital and 19 patients were also tested in their home. All three criteria for feasibility were met: (1) in the hospital, 83% could perform the exercise at a given level of STAND, reaching 8–12 repetitions at 8–12 RM for one set, and 79% could do so for two sets in the home setting; (2) for all assessed patients, a possibility of progression or regression was possible—no ceiling or floor effect was observed; (3) no indication of adverse events (pain) was observed. Also, those that scored higher on the De Morton Mobility Index performed the exercise at higher levels of STAND, whereas performance was independent of cognitive status.Conclusions.We found a simple progression model for loaded sit-to-stands (STAND) feasible in acutely admitted older medical patients (≥65 yrs), based on our pre-specified criteria for feasibility.

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71 Changes in Muscle Strength in Older Patients During Hospitalisation: A Prospective Repeated Measures Cohort Study

Age and Ageing ◽

10.1093/ageing/afz188.02 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i22-i23 ◽

Cited By ~ 1

Author(s):

P Hartley ◽

R Romero-Ortuno ◽

I Wellwood ◽

C Deaton

Keyword(s):

Cohort Study ◽

Muscle Strength ◽

Repeated Measures ◽

Older Patients ◽

Sedentary Time ◽

Knee Extension ◽

Functional Mobility ◽

Repeated Measure ◽

Knee Extension Strength ◽

The Impact

Abstract Introduction Hospital associated deconditioning is a well-established phenomenon. Whilst mechanisms are not well understood, one is thought to be skeletal muscle wasting and/or loss of muscle strength. The primary aim of this study was to investigate changes in knee-extension muscle strength in older patients during and after an acute-hospital admission. We also aimed to explore the potential contributions of frailty, acute-illness severity and sedentary activity, with changes in knee-extension strength. Methods This was a prospective repeated-measures cohort study. Measurements of muscle strength and functional mobility were taken at recruitment, on day 7 of admission (or at discharge if earlier) and again 4-6 weeks post-hospitalisation. During the first 7 days of admission, daily measurements of muscle strength were taken. Results We recruited 70 participants, of which 65 had at least one repeated measure in hospital. Median age was 84 years, and participants participated in the study for a median of 6 days whilst in hospital, on average participants were ‘active’ for less than 4% of the day. Knee-extension strength significantly reduced by approximately 11% during hospitalisation, but no significant changes occurred post-hospitalisation. A repeated-measures mixed model included 292 observations from 62 participants and showed a significant decrease in the reduction in muscle strength as patients' sedentary time decreased on days 2 to 7 of the study. Additionally, the model showed that a higher frailty score, higher baseline knee-extension strength, lower baseline c-reactive protein levels were associated with greater loss in knee-extension strength during hospitalisation. Association between change in functional mobility after hospitalisation and change in knee-extension strength during hospitalisation was non-significant. Conclusion Our findings provide an important link in understanding the mechanisms and relative contributions of risk factors to hospital associated deconditioning. Further research is needed to confirm these findings and examine the impact of reducing sedentary time on muscle strength during and post-hospitalisation.

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Older patients’ use of technology for a post-discharge nutritional intervention – A mixed-methods feasibility study

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2016.10.017 ◽

2017 ◽

Vol 97 ◽

pp. 312-321 ◽

Cited By ~ 11

Author(s):

T. Lindhardt ◽

M.H. Nielsen

Keyword(s):

Mixed Methods ◽

Feasibility Study ◽

Older Patients ◽

Nutritional Intervention ◽

Post Discharge ◽

Use Of Technology

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Exercise for people living with frailty and receiving haemodialysis: a mixed-methods randomised controlled feasibility study

BMJ Open ◽

10.1136/bmjopen-2020-041227 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041227

Author(s):

Hannah M L Young ◽

Daniel S March ◽

Patrick J Highton ◽

Matthew P M Graham-Brown ◽

Darren C Churchward ◽

...

Keyword(s):

Mixed Methods ◽

Feasibility Study ◽

Controlled Trial ◽

Exercise Programme ◽

Exercise Group ◽

Moderate Intensity ◽

Secondary Outcome ◽

Link Type ◽

Patient Reported ◽

Randomised Controlled

ObjectivesFrailty is highly prevalent in haemodialysis (HD) patients, leading to poor outcomes. This study aimed to determine whether a randomised controlled trial (RCT) of intradialytic exercise is feasible for frail HD patients, and explore how the intervention may be tailored to their needs.DesignMixed-methods feasibility.Setting and participantsPrevalent adult HD patients of the CYCLE-HD trial with a Clinical Frailty Scale Score of 4–7 (vulnerable to severely frail) were eligible for the feasibility study.InterventionsParticipants in the exercise group undertook 6 months of three times per week, progressive, moderate intensity intradialytic cycling (IDC).OutcomesPrimary outcomes were related to feasibility. Secondary outcomes were falls incidence measured from baseline to 1 year following intervention completion, and exercise capacity, physical function, physical activity and patient-reported outcomes measured at baseline and 6 months. Acceptability of trial procedures and the intervention were explored via diaries and interviews with n=25 frail HD patients who both participated in (n=13, 52%), and declined (n=12, 48%), the trial.Results124 (30%) patients were eligible, and of these 64 (52%) consented with 51 (80%) subsequently completing a baseline assessment. n=24 (71% male; 59±13 years) dialysed during shifts randomly assigned to exercise and n=27 (81% male; 65±11 years) shifts assigned to usual care. n=6 (12%) were lost to follow-up. The exercise group completed 74% of sessions. 27%–89% of secondary outcome data were missing. Frail HD patients outlined several ways to enhance trial procedures. Maintaining ability to undertake activities of daily living and social participation were outcomes of primary importance. Participants desired a varied exercise programme.ConclusionsA definitive RCT is feasible, however a comprehensive exercise programme may be more efficacious than IDC in this population.Trial registration numbersISRCTN11299707; ISRCTN12840463.

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Effects of lower limb resistance exercise on muscle strength, physical fitness, and metabolism in pre-frail elderly patients: a randomized controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02386-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoxing Lai ◽

Lin Bo ◽

Hongwei Zhu ◽

Baoyu Chen ◽

Zhao Wu ◽

...

Keyword(s):

Muscle Strength ◽

Resistance Exercise ◽

Frail Elderly ◽

Lower Limb ◽

Intervention Group ◽

Control Group ◽

Walking Test ◽

Sit To Stand ◽

Femoris Muscle ◽

Activity Energy

Abstract Background Few studies examined interventions in frail elderly in China, while the awareness of applying interventions to prevent frailty in pre-frail elderly is still lacking. This study aimed to explore the effects of lower limb resistance exercise in pre-frail elderly in China. Methods This was a randomized controlled trial of patients with pre-frailty. The control group received routine care, while the exercise group received a 12-week lower limb resistance exercise based on routine care. The muscle strength in the lower limbs, physical fitness, and energy metabolism of the patients was evaluated at admission and after 12 weeks of intervention. Results A total of 60 pre-frail elderly were included in this study. The patients were divided into the exercise group (n = 30) and control group (n = 30) by random grouping. There were 17 men and 13 women aged 65.3 ± 13.4 in the exercise group, and 15 men and 15 women aged 67.6 ± 11.9 years in the control groups. The Barthel index was 80.3 ± 10.6 and 85.1 ± 11.6, respectively. The characteristics of the two groups were not significantly different before intervention (all p > 0.05). The results of repeated measurement ANOVA showed that there was statistically significant in crossover effect of group * time (all p < 0.05), that is, the differences of quadriceps femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent between the intervention group and the control group changed with time, and the variation ranges were different. The main effects of time were statistically significant (all p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft “up & go” test, daily activity energy expenditure and metabolic equivalent of the intervention group and the control group were significantly different before and after intervention. The main effects of groups were statistically significant (p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, daily activity energy expenditure and metabolic equivalent before and after intervention were significantly different between the intervention group and the control group, while there was no significant differences in 8-ft “up & go” test between groups. Conclusion Lower limb resistance exercise used for the frailty intervention could improve muscle strength, physical fitness, and metabolism in pre-frail elderly. Trial registration ChiCTR, ChiCTR2000031099. Registered 22 March 2020, http://www.chictr.org.cn/edit.aspx?pid=51221&htm=4

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Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study

Physiotherapy Theory and Practice ◽

10.1080/09593985.2021.1952670 ◽

2021 ◽

pp. 1-13

Author(s):

Donald G. Manlapaz ◽

Gisela Sole ◽

Prasath Jayakaran ◽

Cathy M. Chapple

Keyword(s):

Mixed Methods ◽

Knee Osteoarthritis ◽

Feasibility Study ◽

Risk Of Falling

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Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00821-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Caroline B. Hing ◽

Elizabeth Tutton ◽

Toby O. Smith ◽

Molly Glaze ◽

Jamie R. Stokes ◽

...

Keyword(s):

Mixed Methods ◽

External Fixation ◽

Intramedullary Nailing ◽

Feasibility Study ◽

Online Survey ◽

Tibial Fracture ◽

Tibial Fractures ◽

Circular Frame ◽

Pilot Rct ◽

Randomised Controlled

Abstract Background Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. An adequately powered randomised controlled trial (RCT) to determine optimum treatment is required. STIFF-F aimed to assess the feasibility of a multicentre RCT comparing IMN with CFEF for segmental tibial fracture. Methods STIFF-F was a mixed-methods feasibility study comprising a pilot RCT conducted at six UK Major Trauma Centres, qualitative interviews drawing on Phenomenology and an online survey of rehabilitation. The primary outcome was recruitment rate. Patients, 16 years and over, with a segmental tibial fracture (open or closed) deemed suitable for IMN or CFEF were eligible to participate. Randomisation was stratified by site using random permuted blocks of varying sizes. Participant or assessor blinding was not possible. Interviews were undertaken with patients about their experience of injury, treatment, recovery and participation. Staff were interviewed to identify contextual factors affecting trial processes, their experience of recruitment and the treatment pathway. An online survey was developed to understand the rehabilitation context of the treatments. Results Eleven patients were screened and three recruited to the pilot RCT. Nineteen staff and four patients participated in interviews, and 11 physiotherapists responded to the survey. This study found the following: (i) segmental tibial fractures were rarer than anticipated, (ii) the complexity of the injury, study setup times and surgeon treatment preferences impeded recruitment, (iii) recovery from a segmental tibial fracture is challenging, and rehabilitation protocols are inconsistent and (iv) despite the difficulty recruiting, staff valued this research question and strived to find a way forward. Conclusion The proposed multicentre RCT comparing IMN with CFEF is not feasible. This study highlighted the difficulty of recruiting patients to an RCT of a complex rare injury over a short time period. Trial registration The study was registered with the International Standard Randomised Controlled Trials Number Registry: ISRCTN11229660

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