Individually tailored physical and daily activities for residents in nursing home settings : a Scandinavian multi-centre study
Author: Grönstedt, Helena
Date: 2013-05-31
Location: Föreläsningssalen H2 Grön, Alfred Nobels Allé 23, Karolinska Institutet, Campus Huddinge.
Time: 13:00
Department: Inst för neurobiologi, vårdvetenskap och samhälle / Dept of Neurobiology, Care Sciences and Society
Abstract
The overall
purpose
of this thesis was to describe the impact of an individually tailored intervention
programme, in nursing home settings, on physical capacity, degree of dependence in activities of daily
living (ADL), long-term participation in physical
and/or daily activities, and self-rated well-being.
The different
aims
were
to present the rationale and design of the study
to describe the
levels of
physical and cognitive func
tion, dependence in ADL, and degree of well-being of
the participants at baseline,
to investigate the feasibility of measuring muscle strength, mobility, balance function, dependence in
ADL, physical activity level, and cognitive function in elderly nursing home residents, and also to
detect any correlations between these measurements,
to describe the effect of three months of individua
lly tailored physical and daily activities for elderly
nursing home residents on muscle strength, mobility, balance function, fall-related self-efficacy,
dependence in ADL, and physical activity level,
to evaluate the long-term effects,
within and between groups, on well-be
ing, cognitive function, mobility,
dependence in ADL, physical activity level, and di
fferent dimensions of physical function three
months after the intervention was completed
Material and methods: Elderly residents (n=322) from nursing hom es in three Scandinavian countries were randomised to either an Intervention group (IG) or Control Group (CG). The intervention consisted of individually tailored physical and daily activities fo r three months. Reliable a nd valid tests of muscle strength, mobility, balance function, fall-related sel f-efficacy, dependence in ADL, physical activity level, well-being and cognitive function were used. All participants were measured at baseline, after three months of intervention, and after three months of post-training.
Results: The median age of the participants was 85.5 years, and 74% of them were women. The median length of stay was 15 months, 64% were able to walk with or without walking aids, and 60 % were able to rise from a chair once. The measurements seem f easible, and no floor or ceiling effects were detected. Sixty-eight per cent completed between 10 and 13 weeks of intervention with a mean exercise dose of 105 minutes per week. Following intervention, a significant difference was found between groups regarding balance function, transfer ability and phys ical activity level, where the IG had improved while the CG deteriorated. Also, within the IG a significant improvement regarding functional leg muscle strength and walking/wheelchair speed was demonstrated, while the results for balance and dependence in ADL were maintained during the intervention period. Between the 3- and 6-month follow-ups, the test results for functional leg muscle st rength, balance function, physical activity level and the cognitive and social dimensions of ADL deteriorated within the IG. Within the CG, a significant deterioration in balance function, dependence in ADL, and transfer ability, but a significant improvement in physical activity level, were seen between baseline and the 3-month follow-up.
Conclusions: This study demonstrates that balance, transf er ability, and physical activity level can be improved or maintained following 3 months of intervention in nursing home residents. Within the IG, leg muscle strength and walking/wheelchai r speed also improved. However, the effects regarding leg muscle strength, balance function, and physical activity le vel were lost during the post-training period, and dependence in social and cognitive dimensions of ADL deteriorated. The duration and frequency of the intervention and levels of cognition had some impact on the outcome values. Low physical activity level, physical function and dependence in ADL were related to poor well- being, low cognitive function and low fall-related self-efficacy. The instruments used for testing seem to be feasible for elderly nursing home residents.
Material and methods: Elderly residents (n=322) from nursing hom es in three Scandinavian countries were randomised to either an Intervention group (IG) or Control Group (CG). The intervention consisted of individually tailored physical and daily activities fo r three months. Reliable a nd valid tests of muscle strength, mobility, balance function, fall-related sel f-efficacy, dependence in ADL, physical activity level, well-being and cognitive function were used. All participants were measured at baseline, after three months of intervention, and after three months of post-training.
Results: The median age of the participants was 85.5 years, and 74% of them were women. The median length of stay was 15 months, 64% were able to walk with or without walking aids, and 60 % were able to rise from a chair once. The measurements seem f easible, and no floor or ceiling effects were detected. Sixty-eight per cent completed between 10 and 13 weeks of intervention with a mean exercise dose of 105 minutes per week. Following intervention, a significant difference was found between groups regarding balance function, transfer ability and phys ical activity level, where the IG had improved while the CG deteriorated. Also, within the IG a significant improvement regarding functional leg muscle strength and walking/wheelchair speed was demonstrated, while the results for balance and dependence in ADL were maintained during the intervention period. Between the 3- and 6-month follow-ups, the test results for functional leg muscle st rength, balance function, physical activity level and the cognitive and social dimensions of ADL deteriorated within the IG. Within the CG, a significant deterioration in balance function, dependence in ADL, and transfer ability, but a significant improvement in physical activity level, were seen between baseline and the 3-month follow-up.
Conclusions: This study demonstrates that balance, transf er ability, and physical activity level can be improved or maintained following 3 months of intervention in nursing home residents. Within the IG, leg muscle strength and walking/wheelchai r speed also improved. However, the effects regarding leg muscle strength, balance function, and physical activity le vel were lost during the post-training period, and dependence in social and cognitive dimensions of ADL deteriorated. The duration and frequency of the intervention and levels of cognition had some impact on the outcome values. Low physical activity level, physical function and dependence in ADL were related to poor well- being, low cognitive function and low fall-related self-efficacy. The instruments used for testing seem to be feasible for elderly nursing home residents.
List of papers:
I. Frändin K, Borell L, Grönstedt H, Bergland A, Helbostad JL, Puggaard L, Andresen M, Granbo R, Hellström K. A Nordic multi-center study on physical and daily activities for residents in nursing home settings: design of a randomized, controlled trial. Aging Clin Exp Res 2009;21(4-5):314-22.
Pubmed
View record in Web of Science®
II. Bergland A, Narum I, Grönstedt H, Hellström K, Helbostad JL, Puggaard L, Andresen M, Granbo R, Frändin K. Evaluating the feasibility and intercorrelation of measurements on the functioning of residents living in Scandinavian nursing homes. Phys Occup Ther Ger 2010;28(2):154-169.
III. Grönstedt H, Hellström K, Bergland A, Helbostad JL, Puggaard L, Andresen M, Granbo R, Frändin K. Functional level, physical activity and well-being in nursing home residents in three Nordic countries. Aging Clin Exp Res 2011;23(5-6):413-420.
Fulltext (DOI)
Pubmed
IV. Grönstedt H, Frändin K, Bergland A, Helbostad JL, Granbo R, Puggaard L, Andresen M, Hellström K. Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial. Gerontology 2012 Dec 20.
Fulltext (DOI)
Pubmed
V. Grönstedt H, Hellström K, Harms Ringdahl K, Helbostad JL, Bergland A, Andresen M, Puggaard L, Granbo R, Frändin K. Long-term effects of individually tailored physical training and activity in Scandinavian nursing home residents on well-being, cognition and physical function. An RCT. [Manuscript].
I. Frändin K, Borell L, Grönstedt H, Bergland A, Helbostad JL, Puggaard L, Andresen M, Granbo R, Hellström K. A Nordic multi-center study on physical and daily activities for residents in nursing home settings: design of a randomized, controlled trial. Aging Clin Exp Res 2009;21(4-5):314-22.
Pubmed
View record in Web of Science®
II. Bergland A, Narum I, Grönstedt H, Hellström K, Helbostad JL, Puggaard L, Andresen M, Granbo R, Frändin K. Evaluating the feasibility and intercorrelation of measurements on the functioning of residents living in Scandinavian nursing homes. Phys Occup Ther Ger 2010;28(2):154-169.
III. Grönstedt H, Hellström K, Bergland A, Helbostad JL, Puggaard L, Andresen M, Granbo R, Frändin K. Functional level, physical activity and well-being in nursing home residents in three Nordic countries. Aging Clin Exp Res 2011;23(5-6):413-420.
Fulltext (DOI)
Pubmed
IV. Grönstedt H, Frändin K, Bergland A, Helbostad JL, Granbo R, Puggaard L, Andresen M, Hellström K. Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial. Gerontology 2012 Dec 20.
Fulltext (DOI)
Pubmed
V. Grönstedt H, Hellström K, Harms Ringdahl K, Helbostad JL, Bergland A, Andresen M, Puggaard L, Granbo R, Frändin K. Long-term effects of individually tailored physical training and activity in Scandinavian nursing home residents on well-being, cognition and physical function. An RCT. [Manuscript].
Institution: Karolinska Institutet
Supervisor: Frändin, Kerstin
Issue date: 2013-05-06
Rights:
Publication year: 2013
ISBN: 978-91-7549-135-6
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