Journal Appraisal -Janel

8/16/2019 Journal Appraisal -Janel

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Janelcris G. EnriquezCommunity Clerk August 2014

JOURNALAPPRAISA

L

COMMUNITYMEDICINE


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Community-ase! Grou"E#ercise Im"ro$es

%alance an! Re!uces&alls in At-ris' Ol!er

Peo"le

a randomized controlled trial


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• O%JEC(I)E*

To determine weter !"rti#i!"tion

in " weekly grou! e$er#ise!rogr"mme wit "n#ill"ry omee$er#ises o%er one ye"r im!ro%es

&"l"n#e' mus#le strengt' re"#tiontime' !ysi#"l (un#tioning' e"ltst"tus "nd !re%ents ("lls in "t)risk

#ommunity)dwelling older !eo!le*

• +ESIGN+

A r"ndomi,ed #ontrolled tri"l


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SE((ING AN+ SU%JEC(S

Te su&-e#ts were dr"wn (rom.01 !eo!le "ged ./ ye"rs "ndolder wo "ttended one o( 24

gener"l !r"#ti#e #lini#s or two"#ute os!it"l !ysioter"!yde!"rtments in out estern

ydney' Austr"li"*


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SE((ING AN+ SU%JEC(S

• #reening "ssessments+ –"n in"&ility to st"nd (rom " 4/ #m

ig #"ir in less t"n 2 se#onds

–" need to ste! to m"int"in &"l"n#ewen !er(orming " ne"r)t"ndem&"l"n#e test

– in"&ility to #"t# " rod dro!!ed(rom "&o%e te "nd witin 300millise#onds*


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IN(ER)EN(ION

• u&-e#ts r"ndomised to teinter%ention "rm "ttended " weeklystru#tured e$er#ise grou! run in "

#ommunity setting* An "##reditede$er#ise instru#tor tr"ined to !ro%idete s"me !rogr"mme led e"# #l"ss*

• Te #l"ss #ontent w"s designed &y "!ysioter"!ist to s!e#i5#"lly "ddress!ysi#"l ("lls risk ("#tors*


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IN(ER)EN(ION

• 6un#tion"l e$er#ises –sit to st"nd !r"#ti#e

–weigt tr"ns(eren#e

– re"#ing were "n im!ort"nt !"rt o(te grou! e$er#ise*

– Tere w"s " 10)minute #ool downwere te !"rti#i!"nts !er(ormedgentle stret#es "nd ten in "se"ted !osition !r"#ti#ed

rel"$"tion "nd #ontrolled


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RESUL(S

• At aseline ot, rou"s ere ellmatc,e! in t,eir ",ysical "er/ormance0,ealt, an! acti$ity le$els.

•

At retest0 t,e e#ercise rou" "er/orme!sini1cantly etter t,an t,e controls int,ree o/ si# alance measures2.

• 3it,in t,e 45-mont, trial "erio!0 t,e

rate o/ /alls in t,e inter$ention rou"as 678 loer t,an t,at o/ t,e controlrou" 9IRR:7.;70 ;?7.


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CONCLUSION

• Tese 5ndings indi#"te t"t!"rti#i!"tion in " weekly grou!e$er#ise !rogr"mme wit "n#ill"ryome e$er#ises #"n im!ro%e &"l"n#e"nd redu#e te r"te o( ("lling in "t)risk #ommunity dwelling older

!eo!le*


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CRI(ICAL APPRAISAL

7rim"ry 8"lidity

9uidelines+ :Yes;No<


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Was the assignment of patients to

treatment randomized?

ES.


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Were all patients who entered the trial properlyaccounted for and attributed at its conclusion?

ES.


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Were all patients who entered the trial properlyaccounted for and attributed at its conclusion?

es0 "atients ere "ro"erly

accounte!0 an! attriute!.


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Was follow-up complete? Dropouts,withdrawals

es0 all "atients t,at "artici"ate! int,e stu!y /olloe! u" t,rou,out t,e

!uration o/ t,e stu!y.(,ere as B it,!raals /rom e#ercise

rou" ,ile ; on control rou".


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Were patients analyzed in the groupsto which they were randomized?

es0 t,e "artici"ants ereanalyze! it,in t,e rou"s

to ,ic, t,ey areran!omize!.


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CRI(ICAL APPRAISAL

e#ond"ry 8"lidity

9uidelines


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Were patients, their clinicians, andstudy personnel “blind” to treatment?

es0 (,ree assessors lin! totreatment status a!ministere!

t,e ",ysical "er/ormance an!eneral ,ealt, measureassessments.


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Were the groups similar at the startof the trial?

es0 t,e aselinec,aracteristics o/ eac,

rou" ere similar at t,estart o/ t,e trial.


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Aside from the experimental interention,were the groups treated e!ually?

es0 all "atients recei$e!t,e a""ro"riate treatment.


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"# $%& #$'D( )A*"D?

ES.

(,e "rimary $ali!ity ui!equestions as ell as t,e secon!ary$ali!ity ui!e questions ere

ansere! ell.


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OU(COE

EDERCISE GROUP)S. CON(ROL

GROUP

OU(COE

RIS O& OU(COE

:=< :)<

(reate!9@ " & :aF9a@

Control9D@ # d D :cF9c!@

(reate!9@ >3 ? : H>F9H>B@ :

7.0 .

: H>F9H>B@ :7.


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E#"erimental E$ent Rate 9EER@

• A me"sure o( ow o(ten " !"rti#ul"r st"tisti#"le%ent :su# "s res!onse to " drug< o##urs witinte e$!eriment"l grou! :non)#ontrol grou!< o( "ne$!eriment

• In te tre"tment grou!' num&er o( !"tients wit:=< out#ome di%ided &y tot"l num&er o( !"tients

No 7$s wit out#ome @ "

Tot"l no o( !"tients :"=&<

EEB E$er#ise grou! 0*22


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Control E$ent Rate 9CER

• A me"sure o( ow o(ten " !"rti#ul"r st"tisti#"le%ent :su# "s res!onse to " drug< o##urs witinte s#ienti5# #ontrol grou! o( "n e$!eriment*

• In te #ontrol grou!' num&er o( !"tients wit :=<

out#ome di%ided &y tot"l num&er o( !"tients

No o( 7Fs wit out#ome @ &

Tot"l no o( !"tients :&=d<

CEB Control grou! 0*30


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o lare as

t,e treatment

eKect


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Relati$e Ris' or Ris'Ratio 9RR@

• te risk o( te out#ome o##urring inte inter%ention grou! #om!"redwit te #ontrol grou!*

• BB @ EEB;CEB

• BB :E$er#ise grou! %s* #ontrol grou!<@ 0*22;0*33 @ 0*>>


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Asolute Ris' Re!uction9ARR@

• !ecrease in ris' o/ a i$en acti$ity 9ortreatment@ in relation to a control acti$ity.

• Bisk o( te out#ome in te #ontrol grou! risk o(te out#ome in te tre"tment grou!*

• ARR 9E#ercise rou" $s. control rou"@ :CER-EER:

0*22)0*33 @ 0*011

• Te "&solute &ene5t o( tre"tment is " 11Gredu#tion in te out#ome (or e$er#ise grou! %s*#ontrol grou!*


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o lare as t,e treatmenteKect

• T"ke te in%erse o( te ABB wi# tells us tenum&er o( !"tients t"t weHd need to tre"t wit tee$!eriment"l ter"!y in order to !re%ent one"ddition"l &"d e%ent*

• Numer Nee!e! to treat 9NN(@ 9e#ercise rou"$s. control rou"@ : 4 F ARR : 4F7.744 :


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+A $%& '*$ .& A//*"&D $0 1(/A$"&$ +A&?

ES.


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W&& A** +*""+A**( "1/0$A$0'$+01 +0#"D&&D?

es0 all rele$ant outcomesere consi!ere!.

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Journal Appraisal -Janel