Plain English Summary
Background and study aims
Falls are one of the leading causes of death and injury in people over the age of 65. Studies have shown that getting more exercise can help to lower the risk of falls by improving balance, coordination and strength. Many older people find it difficult to get enough exercise, and so actively encouraging and promoting regular participation in physical activity (PA) is especially important. Being able to safely move around outside the home (mobility) is important part of long-term independence in old age. Musculoskeletal disorders (problems with the muscles and/or joints because of injury or long-term illnesses such as arthritis) are increasingly common in adults over 60. Studies have shown that when a person is hospitalized because of a musculoskeletal disorder affecting their legs and/or back, they can become very inactive during their hospital stay. This can lead to problems “getting back into” physical activity and causes mobility issues in the future. There is currently a lack of evidence about the effectiveness of combining physical activity promotion programs (to encourage people to become more active) with rehabilitative exercise training (exercises designed to help restore movement) among older adults who have been recently discharged from the hospital. The aim of this study is to find out whether a home-based physical activity promotion program can help improve the level of physical activity and mobility in older adults who are recovering from a musculoskeletal disorder affecting the legs or back.
Who can participate?
Adults over 60 years old who do not live in nursing homes and have been admitted to and discharged from hospital because of a musculoskeletal disorder affecting their legs or back.
What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group continue to receive their usual care, and do not take part in any extra exercise for the 6 month study period. Those in the second group also continue to receive their usual care however they also take part in the personalised home-based rehabilitation program for 6 months. This program is given by a trained physiotherapist, and involves a combination of counselling and leg exercises which get progressively harder. At the start of the study and then again after 3, 6 and 12 months, all participants have their level of physical activity measured using an accelerometer (device to measure how much they move) and complete a number of questionnaires in order to assess their mobility, independence and mental faculties.
What are the possible benefits and risks of participating?
All participants benefit from receiving information about their physical performance, and participants who receive the personalized rehabilitation program my benefit from improved mobility. There is a small risk that participants may fall or become injured during exercise.
Where is the study run from?
Palokka Health Centre and Kyllö Health Centre in Jyväskylä (Finalnd)
When is the study starting and how long is it expected to run for?
February 2016 to February 2018
Who is funding the study?
1. National Institute for Health and Welfare (Finland)
2. Social Insurance Institution of Finland (Finland)
3. Ministry of Social Affairs and Health (Finland)
Who is the main contact?
1. Professor Riku Nikander (scientific)
2. Mrs Katri Turunen (public)
Trial website
Contact information
Type
Scientific
Primary contact
Prof Riku Nikander
ORCID ID
http://orcid.org/0000-0002-2072-0510
Contact details
GeroCenter Foundation for Aging Research and Development
Rautpohjankatu 8
Jyväskylä
FI-40700
Finland
Type
Public
Additional contact
Mrs Katri Turunen
ORCID ID
http://orcid.org/0000-0001-6529-1046
Contact details
GeroCenter Foundation for Aging Research and Development
Rautpohjankatu 8
Jyväskylä
FI-40700
Finland
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
N/A
Study information
Scientific title
Program to Promote Physical Activity and mobility recovery in older people hospitalized for musculoskeletal disorders: A single-centre randomized controlled trial
Acronym
ProPA
Study hypothesis
The 6-month individually targeted multi-component intervention will increase the level of physical activity and restores mobility of older adults compared to controls receiving standard/usual care.
Ethics approval
The Ethics Committee of the Central Finland Health Care District, 03/02/2015, ref: 3U/2014
Study design
Single-centre randomized controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Home
Trial type
Treatment
Patient information sheet
Condition
Musculoskeletal disorders in lower extremities or back
Intervention
Participants are randomly allocated to one of two groups.
Intervention group: Participants receive standard/usual care, as well as an individually targeted multi-component home-based program that aims to increase physical activity and restore mobility. The six-month intervention comprises goal-directed physical activity promotion (counselling and management sessions for physical activity promotion and mobility goal attainment), progressive lower extremity physical exercise program, and supported physical and social activity sessions. The intervention will start at home following hospital discharge, baseline measurements and randomization. It will be coordinated and delivered by a physiotherapist and supported by of a lay volunteer person.
Control group: Participants continue to receive standard/usual care, and are instructed to follow the instructions provided by the Health Centre-Hospital. Total duration of the intervention is six months.
Participants in both groups will be followed up for 12 months after baseline.
Intervention type
Behavioural
Phase
Drug names
Primary outcome measure
1. Level of physical activity and inactivity is objectively assessed using the accelerometer at baseline, 3 and 6 months
2. Level of physical activity is measured using validated self-reporting questionnaires at baseline, 3, 6 and 12 months
3. Mobility is assessed using the Short Physical Performance Battery and self-reporting at baseline, 3, 6 and 12 months
Secondary outcome measures
1. Life space mobility is assessed by Birmingham Life-Space Assessment (LSA) at baseline, 3, 6 and 12 months
2. Social participation and autonomy is assessed using the Impact on Participation and Autonomy (IPA) questionnaire at baseline, 6 and 12 months
3. Fear of falling assessed using the Falls Efficacy Scale International (FES) questionnaire at baseline, 3, 6 and 12 months
4. Pain is assessed using the modified Brief Pain Inventory at baseline, 3, 6 and 12 months
5. Depressive mood assessed is measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) at baseline, 3, 6 and 12 months
6. Perceived barriers to indoor and outdoor physical activity is assessed using checklists for perceived environmental barriers to outdoor mobility (PENBOM; 15 items) and perceived environmental facilitators for outdoor mobility (PENFOM; 16 items) as well as self-reporting at baseline, 3, 6 and 12 months
7. Memory are assessed using Mini-Mental State Examination (MMSE) at baseline, 3, 6 and 12 months
8. Executive function is assessed using the Trail Making test at baseline, 3, 6 and 12 months
9. Use of formal and informal care is assessed through self-reporting (formal health care will be varified from the registers of Health Centre-Hosptials) at 3, 6 and 12 months
9. Hand grip strength from the dominant hand with a hand-held dynamometer at baseline, 3, 6 and 12 months
Overall trial start date
01/02/2016
Overall trial end date
28/02/2018
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Aged 60 years and over
2. Community-dwelling
3. Admitted and thereafter discharged to home from Health Centre-Hospital because of musculoskeletal disorder, such as orthopedic surgery of lower extremity (i.e. hip fracture, joint replacement) or some other musculoskeletal event or condition of lower extremity or back (i.e. fall, aggravated arthritis, osteoporotic fracture and/or back pain)
Participant type
Patient
Age group
Senior
Gender
Both
Target number of participants
We will recruit 60 participants per group, i.e. in total 120 participants.
Total final enrolment
117
Participant exclusion criteria
1. Living in an institution
2. Confined to bed at time of recruitment
3. Severe memory problems (mini-mental state examination (MMSE) less than 21
4. Severe cardiovascular or pulmonary disease
5. Severe progressive disease (i.e., neoplasm, ALS, Parkinson disease).
6. Alcoholism
7. Unwillingness to participate
Recruitment start date
01/02/2016
Recruitment end date
31/10/2017
Locations
Countries of recruitment
Finland
Trial participating centre
Palokka Health Centre
Ritopohjantie 25
Jyväskylä
40270
Finland
Trial participating centre
Kyllö Health Centre
Keskussairaalantie 20
Jyväskylä
40620
Finland
Funders
Funder type
Government
Funder name
National Institute for Health and Welfare
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Social Insurance Institution of Finland
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Ministry of Social Affairs and Health (for Kuopio University Hospital Catchment Area)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Results will be published in peer-reviewed international scientific journals prioritizing open access series.
IPD sharing statement
The datasets generated and/or analyzed during the present study are not available as they contain information that could compromise research participant privacy/consent (the tightened privacy policy in EU). The main results will be published by the research group.
Intention to publish date
30/10/2019
Participant level data
Not expected to be available
Basic results (scientific)
Publication list
2020 results in https://pubmed.ncbi.nlm.nih.gov/31964174 (added 07/04/2020)