Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial


Autoři: Leanne Hassett aff001;  Maayken van den Berg aff003;  Richard I. Lindley aff005;  Maria Crotty aff003;  Annie McCluskey aff002;  Hidde P. van der Ploeg aff007;  Stuart T. Smith aff009;  Karl Schurr aff006;  Kirsten Howard aff008;  Maree L. Hackett aff010;  Maggie Killington aff003;  Bert Bongers aff012;  Leanne Togher aff002;  Daniel Treacy aff001;  Simone Dorsch aff006;  Siobhan Wong aff001;  Katharine Scrivener aff006;  Sakina Chagpar aff001;  Heather Weber aff003;  Marina Pinheiro aff001;  Stephane Heritier aff018;  Catherine Sherrington aff001
Působiště autorů: Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia aff001;  School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia aff002;  Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia aff003;  Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia aff004;  Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia aff005;  StrokeEd Collaboration, Sydney, New South Wales, Australia aff006;  Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands aff007;  School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia aff008;  School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia aff009;  The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia aff010;  Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom aff011;  Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, New South Wales, Australia aff012;  Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia aff013;  Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia aff014;  School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia aff015;  Physiotherapy Department and Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia aff016;  Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia aff017;  Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia aff018
Vyšlo v časopise: Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial. PLoS Med 17(2): e32767. doi:10.1371/journal.pmed.1003029
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003029

Souhrn

Background

Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation.

Methods and findings

We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0–3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0–3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference −0.2, 95% CI −2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%–19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes.

Conclusions

In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted.

Trial registration

The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628

Klíčová slova:

Consumer electronics – Inpatients – Measurement equipment – Medical devices and equipment – Neurorehabilitation – Physical activity – Rehabilitation medicine – Virtual reality


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