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Clinical Efficacy of а Medical Centre- and Home-based Cardiac Rehabilitation Program for Patients with Coronary Heart Disease After Coronary Bypass Graft Surgery.
Aronov, D, Bubnova, M, Iosseliani, D, Orekhov, A
Archives of medical research. 2019;(3):122-132
Abstract
BACKGROUND Rehabilitation measures are crucial for maintaining clinical benefits of coronary artery bypass grafting (CABG) surgery. We evaluated the clinical efficacy of a medical centre- and home-based cardiac rehabilitation (CR) for patients after CABG in an out-patient setting. METHODS The study included 36 male patients 3-8 weeks after CABG that were randomly assigned to either study or control group. Patients from the study group performed a 60 min excercise in controlled setting 3 times a week for 4 months followed by home-based excercise later on, while patients from the control group only received a recommendation to perform the excercise at home in an uncontrolled setting. Total duration of the follow-up was 12 months. RESULTS Physical endurance in the study group increased by 32.6% (p <0.05) in comparison to baseline after 4 months, and was maintained at this level after 12 months, while in the control group, an improvement of 9.8% (p <0.05) was observed after 12 months. Moreover, patients from the study group demonstrated a stable level of such risk factors as blood total and low-density lipoprotein cholesterol, while in the control group, these parameters increased by 10.2% (p <0.05) and 15.6% (p <0.05) respectively by the end of follow-up. Controlled medical centre-based exercise resulted in improvement of patients' quality of life and reduction of cardiovascular complications (11.1% against 39.2% in the control group). CONCLUSION The integral (medical centre and home-based) stage III CR program after CABG helped reducing cardiovascular risk factors, and improved clinical parameters and functional capacity of patients.
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The effectiveness of home versus community-based weight control programmes initiated soon after breast cancer diagnosis: a randomised controlled trial.
Harvie, M, Pegington, M, McMullan, D, Bundred, N, Livingstone, K, Campbell, A, Wolstenholme, J, Lovato, E, Campbell, H, Adams, J, et al
British journal of cancer. 2019;(6):443-454
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Abstract
BACKGROUND Breast cancer diagnosis may be a teachable moment for lifestyle behaviour change and to prevent adjuvant therapy associated weight gain. We assessed the acceptability and effectiveness of two weight control programmes initiated soon after breast cancer diagnosis to reduce weight amongst overweight or obese women and prevent gains in normal-weight women. METHODS Overweight or obese (n = 243) and normal weight (n = 166) women were randomised to a three-month unsupervised home (home), a supervised community weight control programme (community) or to standard written advice (control). Primary end points were change in weight and body fat at 12 months. Secondary end points included change in insulin, cardiovascular risk markers, quality of life and cost-effectiveness of the programmes. RESULTS Forty-three percent of eligible women were recruited. Both programmes reduced weight and body fat: home vs. control mean (95% CI); weight -2.3 (-3.5, -1.0) kg, body fat -1.6 (-2.6, -0.7) kg, community vs. control; weight -2.4 (-3.6, -1.1) kg, body fat -1.4 (-2.4, -0.5) kg (all p < 0.001). The community group increased physical activity, reduced insulin, cardiovascular disease risk markers, increased QOL and was cost-effective. CONCLUSIONS The programmes were equally effective for weight control, but the community programme had additional benefits. CLINICAL TRIAL REGISTRATION ISRCTN68576140.
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Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study).
Soukkio, P, Suikkanen, S, Kääriä, S, Kautiainen, H, Sipilä, S, Kukkonen-Harjula, K, Hupli, M
BMC geriatrics. 2018;(1):232
Abstract
BACKGROUND Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. METHODS This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. DISCUSSION Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02305433 , Registered Nov 28, 2014.
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Home-exercise Childhood Obesity Intervention: A Randomized Clinical Trial Comparing Print Versus Web-based (Move It) Platforms.
Bruñó, A, Escobar, P, Cebolla, A, Álvarez-Pitti, J, Guixeres, J, Lurbe, E, Baños, R, Lisón, JF
Journal of pediatric nursing. 2018;:e79-e84
Abstract
PURPOSE To compare the impact of adhering to a Mediterranean diet plus mixed physical exercise program (Move-It) implemented by means of printed instructions or via a web-platform (with or without e-mail support) on body composition, physical fitness, and blood pressure. DESIGN AND METHODS Randomized clinical trial. Fifty-two overweight or obese Spanish children and adolescents were randomly assigned to the print-based (n = 18), Move-It (n = 18), or Move-It plus support (n = 16) intervention groups. Two-way mixed ANOVA tests were used to compare any changes between the groups in terms of percentage body fat, physical fitness (VO2peak), handgrip strength, and systolic and diastolic blood pressure. The measurements were taken before and after a three-month mixed-exercise (aerobic and resistance) and Mediterranean-diet program which was either implemented by means of printed instructions or via a web-platform (with or without e-mail support). RESULTS No statistical differences were found between groups. However, the results highlighted significant improvements in body fat percentage metrics over time for all three groups (print-based: -1.8%, 95%CI -3.3% to -0.3%; Move-It: -1.8%, 95%CI -3.3% to -0.3%; Move-It plus support: -2.0%, 95%CI -3.7% to -0.4%, P < 0.05). We also observed a tendency towards improvement in the VO2peak, handgrip strength, and blood pressure variable values 10 min after the exercise-stress test in these three groups. CONCLUSIONS The program improved the body composition, regardless of the way it is implemented. PRACTICE IMPLICATIONS A mixed physical exercise program lasting for three months, combined with a Mediterranean diet, improves the body composition of children and adolescents with overweight/obesity.
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The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving Home Care: A randomized controlled trial.
Fernández-Barrés, S, García-Barco, M, Basora, J, Martínez, T, Pedret, R, Arija, V, ,
International journal of nursing studies. 2017;:131-141
Abstract
OBJECTIVE To assess the effect of a nutrition education intervention included in the Home Care Program for caregivers to prevent the increasing risk of malnutrition of dependent patients at risk of malnutrition. DESIGN Randomized controlled multicenter trial of 6 months of duration and 12 months follow-up. SETTINGS 10 Primary Care Centers, Spain. PARTICIPANTS Patients enrolled in the Home Care Program between January 2010 and March 2012, who were dependent and at risk of malnutrition, older than 65, and had caregivers (n=190). INTERVENTION The nurses conducted initial educational intervention sessions for caregivers and then monitored at home every month for 6 months. MEASUREMENTS The nutritional status was assessed using the Mini Nutritional Assessment test (primary outcome), diet, anthropometry, and biochemical parameters (albumin, prealbumin, hemoglobin and cholesterol). Other descriptive and outcome measures were recorded: current medical history, Activities of daily living (Barthel test), cognitive state (Pfeiffer test), and mood status (Yesavage test). All the measures were recorded in a schedule of 0-6-12 months. RESULTS 173 individuals participated after exclusions (intervention n=101; control n=72). Mean age was 87.8±8.9years, 68.2% were women. Difference were found between the groups for Mini Nutritional Assessment test score change (repeated measures ANOVA, F=10.1; P<0.001), the intervention improved the Mini Nutritional Assessment test score of the participants in the intervention group. The egg consumption (F=4.1; P=0.018), protein intake (F=3.0; P=0.050), polyunsaturated fatty acid intake (F=5.3; P=0.006), folate (F=3.3; P=0.041) and vitamin E (F=6.4; P=0.002) showed significant group×time interactions. CONCLUSION A nutrition education intervention for caregivers halted the tendency of nutritional decline, and reduced the risk of malnutrition of older dependent patients. TRIAL REGISTRATION Clinical Trial Registration-URL: www.clinicaltrials.gov. Identifier: NCT01360775.
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Preventing weight gain and obesity: indirect effects of the family check-up in early childhood.
Smith, JD, Montaño, Z, Dishion, TJ, Shaw, DS, Wilson, MN
Prevention science : the official journal of the Society for Prevention Research. 2015;(3):408-19
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The early signs of obesity are observable in early childhood. Although the most promising prevention approaches are family-centered, few relevant early prevention programs exist. This study evaluated the effects of an evidence-based, home-visiting intervention, the Family Check-Up (FCU), on the trajectory of children's weight gain. The FCU was designed to prevent the development of behavior problems by improving family management practices; children's weight has not been an explicit target. On the basis of previous research and conceptual models, we hypothesized that intervention effects on parenting practices, specifically caregivers' use of positive behavior support (PBS) strategies in toddlerhood, would mediate improvements in children's weight trajectories. A total of 731 indigent caregiver-child dyads from a multisite randomized intervention trial were examined. Observational assessment of parenting and mealtime behaviors occurred from age 2-5 years. The child's body mass index (BMI) was assessed yearly from age 5-9.5 years. Path analysis with a latent growth model revealed a significant indirect effect of the FCU on the trajectory of BMI in later childhood. Improvements in caregivers' PBS in toddlerhood, which was related to the nutritional quality of the meals caregivers served to the child during the mealtime task, served as the intervening process. Furthermore, findings indicate that the FCU prevents progression to overweight and obese status amongst at-risk children. These study results add to existing evidence that has demonstrated that family-based interventions aimed at improving general family management skills are effective at preventing weight gain. Future directions are discussed.
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Nursing interventions in a telemonitoring program.
Wakefield, BJ, Scherubel, M, Ray, A, Holman, JE
Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2013;(3):160-5
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BACKGROUND The use of telemonitoring of patients with chronic illness in their homes is growing. Current literature does not describe what types of patient problems are addressed by nurses in these programs and what actions are taken in response to identified problems. This study defined and analyzed patient problems and nursing actions delivered in a telemonitoring program focused on chronic disease management. SUBJECTS AND METHODS Data were drawn from a clinical trial that evaluated telemonitoring in patients with comorbid diabetes and hypertension. Using study patient records, patient problems and nursing actions were coded using an inductive approach. RESULTS In total, 2,336 actions were coded for 68 and 65 participants in two intervention groups. The most frequent reasons for contact were reporting information to the primary care provider and lifestyle information related to diabetes and hypertension (e.g., diet, smoking cessation, foot care, and social contacts). The most frequent mode of contact was the study sending a letter to a participant. CONCLUSIONS Detailed descriptions of interventions delivered facilitate analysis of the unique contributions of nurses in the expanding market of telemonitoring, enable identification of the appropriate number and combination of interventions needed to improve outcomes, and make possible more systematic translation of findings to practice. Furthermore, this information can inform calculation of appropriate panel sizes for care managers and the competencies needed to provide this care.
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A randomized trial of single home nursing visits vs office-based care after nursery/maternity discharge: the Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study.
Paul, IM, Beiler, JS, Schaefer, EW, Hollenbeak, CS, Alleman, N, Sturgis, SA, Yu, SM, Camacho, FT, Weisman, CS
Archives of pediatrics & adolescent medicine. 2012;(3):263-70
Abstract
OBJECTIVE To compare office-based care (OBC) with a care model using a home nursing visit (HNV) as the initial postdischarge encounter for "well" breastfeeding newborns and mothers. DESIGN Randomized controlled trial. SETTING A single academic hospital. PARTICIPANTS A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks' gestation. INTERVENTIONS Home nursing visits were scheduled no later than 2 days after discharge; OBC timing was physician determined. OUTCOME MEASURES Mothers completed telephone surveys at 2 weeks, 2 months, and 6 months. The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery. Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration. Maternal mental health, parenting competence, and satisfaction with care outcomes were assessed. Analyses followed an intent-to-treat paradigm. RESULTS At 2 weeks, hospital readmissions and emergency department visits were uncommon, and there were no study group differences in these outcomes or with unplanned outpatient visit frequency. Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group (85.9% vs 78.8%) (P = .002) and were more likely to be breastfeeding at 2 weeks (92.3% vs 88.6%) (P = .04) and 2 months (72.1% vs 66.4%) (P = .05) but not 6 months. No group differences were detected for maternal mental health or satisfaction with care, but HNV group mothers had a greater parenting sense of competence (P < .01 at 2 weeks and 2 months). CONCLUSIONS Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits.
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Exercise intervention in childhood obesity: a randomized controlled trial comparing hospital-versus home-based groups.
Lisón, JF, Real-Montes, JM, Torró, I, Arguisuelas, MD, Alvarez-Pitti, J, Martínez-Gramage, J, Aguilar, F, Lurbe, E
Academic pediatrics. 2012;(4):319-25
Abstract
OBJECTIVE The aim of this study was to compare the effect of a hospital clinic group- versus home-based combined exercise-diet program for the treatment of childhood obesity. METHODS One hundred ten overweight/obese Spanish children and adolescents (6-16 years) in 2 intervention groups (hospital clinic group-based [n = 45] and home-based [n = 41]) and a sex-age-matched control group (n = 24) were randomly assigned to participate in a 6-month combined exercise (aerobic and resistance training) and Mediterranean diet program. Anthropometric values (including body weight, height, body mass index, BMI-Z score, and waist circumference) were measured pre- and postintervention for all the participants. Percentage body fat was also determined with a body fat analyzer (TANITA TBF-410 M). RESULTS Our study showed a significant reduction in percentage body fat and body mass index Z-score among both intervention-group participants (4%, 0.16, hospital clinic group-based; 4.4%, 0.23, home-based; P < .0001). There was also a significant reduction in waist circumference in the home-based group (4.4 cm; P = .019). Attendance rates at intervention sessions were equivalent for both intervention groups (P = .805). CONCLUSIONS The study findings indicate that a simple home-based combined exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents, because it improves body composition, is feasible and can be adopted on a large scale without substantial expenses.
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Effects of a physical activity and nutrition program for seniors on body mass index and waist-to-hip ratio: a randomised controlled trial.
Burke, L, Lee, AH, Pasalich, M, Jancey, J, Kerr, D, Howat, P
Preventive medicine. 2012;(6):397-401
Abstract
OBJECTIVE To investigate whether a home-based program, physical activity and nutrition for seniors (PANS), made positive changes to central obesity, measured by body mass index (BMI) and waist-to-hip ratio (WHR). METHODS A 6-month randomised controlled trial was conducted targeting overweight and sedentary older adults aged 60 to 70 years residing in low to medium socio-economic suburbs within metropolitan Perth. Intervention participants (n=248) received mailed materials and telephone/email support to improve nutrition and physical activity levels. Controls (n=230) received small incentives to complete baseline and post-intervention questionnaires. Both groups reported anthropometric measures following specific written instructions. Generalised estimating equation models were used to assess repeated outcomes of BMI and WHR over both time points. RESULTS 176 intervention and 199 controls (response rate 78.5%) with complete data were available for analysis. After controlling for demographic and other confounding factors, the intervention group demonstrated a small (0.02) but significant reduction in WHR (p=0.03) compared to controls, no apparent change in BMI was evident for both groups. The 0.02 reduction in mean WHR corresponded to a 2.11 cm decrease in waist circumference for a typical hip circumference. CONCLUSION PANS appears to improve the WHR of participants. Changes in BMI might require a longer term intervention to take effect, and/or a follow-up study to confirm its sustainability.