Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial.

BACKGROUND: Little evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls. OBJECTIVE: To compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality. DESIGN: Randomised experimental trial. SETTING: A 3000-bed medical centre in northern Taiwan. PARTICIPANTS: Patients with hip fracture aged 60 years or older (N=299). METHOD: Patients were randomly assigned to three groups: comprehensive care (n=99), interdisciplinary care (n=101), and usual care (control) (n=99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients' self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission. RESULTS: The comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up. CONCLUSION: Comprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care.

Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status.

OBJECTIVES: The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge. DESIGN: A secondary analysis of data from a randomized controlled trial with 24-month follow-up. SETTING: A 3000-bed medical center in northern Taiwan. PARTICIPANTS: Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group. INTERVENTIONS: The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation. MEASUREMENTS: Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression. RESULTS: Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered. CONCLUSIONS: An in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.

Sedative music facilitates deep sleep in young adults.

OBJECTIVES: To investigate the effect of sedative music on the different stages of the sleep cycle in young adults with various sleep latencies by using polysomnography (PSG). DESIGN: Prospective, randomized, controlled, crossover study. SETTING: Sleep center of a teaching hospital. PARTICIPANTS: Young adults with different sleep latencies. Poor sleepers (Pittsburgh Sleep Quality Index score ≥5) were excluded. INTERVENTIONS: Each participant stayed one night in the sleep center for adaptation and on each of the following two nights was assigned to (1) music and (2) control (without music) conditions in random order. In the music condition, sedative music composed by certified music therapists was played on a compact disc player for the first hour the participant was in bed. OUTCOME MEASURES: Sleep measures recorded with PSG, including sleep latency and durations of sleep stages. RESULTS: Twenty-four young adults (mean±standard deviation, 24.5±2.6 years) participated. They were classified into the short sleep latency (SL) group if the baseline SL of the adaptation night was shorter than 10 minutes or into the long SL group if the baseline SL was 10 minutes or longer. Sedative music did not alter the SL in either group. Sedative music reduced stage II sleep in both SL groups (main effect of music, p=0.03; interaction effect, p=0.87) but increased the duration of deep sleep (stages III and IV) only in the long SL group (main effect of music, p=0.15; interaction effect, p=0.02). CONCLUSIONS: In participants with long SL, sedative music improved the quality of sleep by prolonging the duration of deep sleep. This effect provides an alternative and noninvasive way to improve sleep in selected persons experiencing sleep problems.

Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

BACKGROUND: Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. METHODS: A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. RESULTS: Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. CONCLUSIONS: Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial.

BACKGROUND: Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention, early rehabilitation, and supported discharge. However, no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture. OBJECTIVES: To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life (HRQoL) for elderly patients with hip fracture. DESIGN: Randomised controlled trial. SETTINGS: A 3000-bed medical centre in northern Taiwan. PARTICIPANTS: Patients with hip fracture (N=299) were randomised into three groups: subacute care (n=101), comprehensive care (n=99), and usual care (n=99). METHODS: Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning. Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls. Usual care included only 1-2 in-hospital rehabilitation sessions, discharge planning without environmental assessment, no geriatric consultation, and no in-home rehabilitation. HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1, 3, 6, and 12 months after discharge. RESULTS: Participants in the comprehensive care group improved more in physical function, role physical, general health and mental health than those in the usual care group. The subacute care group had greater improvement in physical function, role physical, vitality, and social function than the usual care group. The intervention effects for both comprehensive and subacute care increased over time, specifically from 6 months after hip fracture onward, and reached a maximum at 12 months following discharge. CONCLUSIONS: Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programmes with Chinese/Taiwanese immigrant populations.

Immediate effects of ischemic compression on neck function in patients with cervicogenic cephalic syndrome.

OBJECTIVE: Cervicogenic cephalic syndrome (CCS), a group of diseases, consists of cervicogenic headache and dizziness. These symptoms may cause loss of physical function compared with other headache and dizziness disorders. The purpose of this case-control study was to assess the clinical effects of ischemic compression (IC) in patients with CCS. METHODS: Twenty-seven subjects with chronic neck pain (persisting for >3 months) and 26 healthy volunteers were examined. Subjects with organic lesion of the ear, nose, throat, eye, or central nervous system were excluded. The CCS group received IC over the maximal tender points of the origin of the posterior nuchal muscle. Sensory organization test (SOT) scores, cervical range of motion (ROM), and isometric strength of neck were measured before IC and after IC. RESULTS: The ROM of the cervical spine increased in all directions after IC (P < .0083) in the CCS group, and isometric strength in the CCS group rose in all directions after IC (P = .000). There was a significant difference in ankle strategy score under the sway-referenced vision and fixed support condition (P = .003) between the control group and CCS before IC. The ankle strategy score of the CCS group improved substantially after IC under eyes closed and sway-referenced support conditions (P = .003). The visual and vestibular ratios in the CCS group also increased after IC (P = .006 and P = .002, respectively). CONCLUSIONS: The findings of this study showed that ROM of the cervical spine and isometric strength increased in all directions, and the SOT scores showed increased postural stability under conditions with swayed reference support after IC in the CCS group. The ratios for vestibular and visual function also increased after IC in the CCS group.

Does different exercise have the same effect of health promotion for the elderly? Comparison of training-specific effect of Tai Chi and swimming on motor control.

It remains unclear whether Tai Chi Chuan (TCC) instead of swimming yields a training-specific effect on dynamic balance. The objective of the present study is to test if the practice of TCC provides a distinctive benefit of balance in the elderly. The participants in TCC (n = 32) and swimming groups (n = 20) practiced regular swimming and TCC respectively for at least 3 years before the recruitment. Thirty-four healthy and active elderly volunteers were also recruited as the control group. To evaluate balance, we used SMART Balance Master that yields balance parameters including maximal stability, center-of-pressure velocity, and percentage ankle strategy obtained under six different balance conditions. We evaluated eye-hand coordination by measuring the movement time required to accurately point from one target to the next. In the most challenging balance conditions, the TCC group performed significantly better than the swimming and control groups. In eye-hand coordination tasks, both the TCC and swimming groups yielded significantly shorter movement time compared with the control group; however, no significant difference was observed between them. We concluded that both TCC and swimming improve eye-hand coordination in the elderly. However, TCC yields a better training effect on dynamic balance.

Is Tai Chi Chuan effective in improving lower limb response time to prevent backward falls in the elderly?

To evaluate the training effect of Tai Chi Chuan (TCC) in postural control and backward fall prevention in the elderly, balance assessment and visually guided lower limb response time were analyzed in a case-control study conducted in a community setting. Thirty-one elderly subjects (mean age: 68.2 +/- 6.8 years) participated in the TCC group, 30 community-dwelling elderly subjects with matched age and body composition served as the elderly control group, with 13 young adults (mean age: 27.5 +/- 3.8 years) serving as young controls. The TCC group had practiced TCC regularly five times per week, for over 30 min per day for at least 4 years. Lower limb response time were measured using a computerized dance machine that we developed, which contains two blocks during testing: single and dual feet. The motor planning of the latter is more complex than the former. Postural control was assessed by computerized posturography (Smart Balance Master). Compared to the elderly controls, the TCC group demonstrated significantly better balance performance in sway-referenced support, which is more challenging. Moreover, the TCC group had better dual feet response than the elderly controls in the forward-backward, forward-right and forward-left directions. Practicing TCC may improve motor responses and postural control in the elderly, particularly in more challenging situations. Subjects showed better postural responses to unexpected perturbation in the forward-backward and forward-sideways direction than sideways or backward-sideways directions, which may have clinical relevance.

Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis.

OBJECTIVE: To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA). DESIGN: Randomized, double-blinded, placebo-controlled and before-after trial. SETTING: Rehabilitation clinic in a tertiary hospital. PARTICIPANTS: Eligible patients (N=50) (mean age+/-SD, 66.0+/-8.6 y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects. INTERVENTIONS: Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale. RESULTS: Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30 degrees/s (P=.007) and 60 degrees/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05 Nm/kg vs -.09 Nm/kg at 60 degrees/s, P=.038) and week 12 (30 degrees/s, .09 Nm/kg vs .04 Nm/kg, P=.044; 60 degrees/s, .17 Nm/kg vs .02 Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group. CONCLUSIONS: Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.

Eye-hand coordination of elderly people who practice Tai Chi Chuan.

BACKGROUND/PURPOSE: The objective of this study was to evaluate the effect of motor control from Tai Chi Chuan (TCC) on eye-hand coordination in the elderly. METHODS: Forty-two elderly people were recruited into this study. People in the TCC group (n = 22) had been practicing TCC regularly for more than 3 years. The control group (n = 20) comprised healthy and active elderly people. Subjects were asked to stroke target sensors in a test device with computer recording. There were three different target sensor sizes (1 cm, 1.5 cm and 2 cm in diameter) for different tests. For each target stroking, the following were recorded and calculated: start and end positions, duration of movement, pause time, peak velocity, and the time to reach peak velocity. RESULTS: The TCC group showed significantly better results in decrease of displacement (p = 0.003), movement time (p = 0.002), pause time (p < 0.001), number of submovements (p = 0.001), and better skewness coefficients (p < 0.001) than the control group. However, the difference in the peak velocity of the TCC and control groups did not reach statistical significance (p = 0.026). CONCLUSION: The elderly TCC group had better results on the eye-hand coordination test than the control elderly group.

The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners.

The objective of this study was to compare cardiorespiratory responses to exercise among older Qigong participants, Tai Chi Chuan (TCC) practitioners and normal sedentary controls during cycle ergometry. Thirty-six community-dwelling men with a mean age of 59.1 +/- 6.6 years participated in this study. Each group (Qigong, TCC and control) included 12 subjects with matched age and body size. The Qigong group practiced Qigong regularly for 2.3 +/- 1.5 years; the TCC group practiced Yang TCC for 4.7 +/- 2.3 years. Heart rate (HR) responses were measured during the practice of Qigong and TCC. Additionally, breath-by-breath measurement of cardiorespiratory function was performed during the incremental exercise of leg cycling. The mean HR during Qigong and TCC practice was 91 +/- 5 bpm and 129 +/- 7 bpm, respectively. At the peak exercise and the ventilatory threshold (VeT), TCC group displayed highest oxygen uptake (VO2), O2 pulse and work rate among the three groups. The Qigong group also showed higher oxygen uptake and O2 pulse than the control group. At the same relative exercise intensity, the Qigong group had the highest tidal volume among the three groups. In conclusion, Qigong and TCC show a beneficial effect to aerobic capacity in older individuals, but TCC displays a better training effect than Qigong due to its higher exercise intensity. However, Qigong can enhance breathing efficiency during exercise due to the training effect of diaphragmatic breathing.