Loss of mobility is predictive of a loss of autonomy and is often the first sign of functional decline. Loss of mobility is also associated with poor perceived quality of life, depressive symptoms, high risk of adverse events such as falls and fractures, to an increased risk to input in institution and mortality's increase. Consequences and frequency of loss of mobility make essential its identification, evaluation and the practice of preventive measures in primary care. The implementation of effective interventions in primary care to prevent or delay the loss of mobility is a public health priority. PRISME-3P program aims to develop and evaluate a dedicated care pathway, in primary care, based on a personalized multimodal intervention: screening, support combining physician, teaching exercises by a specialized Monitor in Adapted Physical Activities (MAPA) and nutritional counseling.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
39
PRISM-3P program will consist on a visit in the geriatric centre: * Consultation with the geriatrician to rule a condition associated with loss of mobility and not known until now. * Perform a nutritional assessment by a dietician followed by appropriate care management. * Educational activity based on exercises and physical activity and balance: MAPA teaches exercises to develop strength and balance; gives tips to increase time spent on non-sedentary activities and enhance endurance followed by a monthly phone coaching. * At 3 months, in case of no improvement of the SPPB score of 1 point, a training of 10 weeks with two sessions per week will be perform by the MAPA individually or in small patients groups; * Implementation of a information exchange processing (mail, phone and book binding) between the various stakeholders.
Service de Médecine Gériatrique. Groupement Hospitalier Sud. Hospices Civils de Lyon.
Pierre-Bénite, France
Change in Short Physical Performance Battery (SPPB) score
Consists in estimating three components: 1. walking, 2. muscular strength and endurance, and 3. balance through short physical exercises (walk on a defined distance, get up from a chair, keep a position up). A score from 1 to 3 for each of the components marks a very low feature of lower limbs. This feature is considered low of 4 in 6, moderated by 7 in 9 and high of 10 in 12.
Time frame: from baseline at 6 months
Evolution of the Short Physical Performance Battery (SPPB) score
Consists in estimating three components: 1.walking, 2.muscular strength and endurance, and 3. balance through short physical exercises (walk on a defined distance, get up from a chair, keep a position up). A score from 1 to 3 for each of the components marks a very low feature of lower limbs. This feature is considered low of 4 in 6, moderated by 7 in 9 and high of 10 in 12.
Time frame: Baseline, 3 months (for interventional arm), 6 months and 12 months
Assessment of functional disability by questionnaires
Functional disability refers to limitations in performing in dependent living tasks, which are often further divided into activities of daily living (ADLs), which include basic activities of hygiene and personal care, and instrumental activities of daily living (IADLs), which include basic activities necessary to reside in the community, such as shopping, managing finances, housekeeping, and meal preparation
Time frame: Baseline, 6 months and 12 months
Assessment of Quality of Life by questionnaire
The Quality of Life is assessed with the 12-Item Short Form Health Survey (SF-12). The SF-12 is a multipurpose short form survey with 12 questions which were combined, scored, and weighted to create two scales that provide glimpses into mental and physical functioning and overall health-related-quality of life
Time frame: baseline, 6 months and 12 months
Number of falls
Data will be collected by the geriatrician from the patient's medical records
Time frame: Baseline, 6 months and 12 months
Number of hospitalization
Data will be collected by the geriatrician from the patient's medical records
Time frame: Baseline, 6 months and 12 months
Assessment of the Physical Activity by questionnaire
Using the Physical Activity Scale for the Elderly (PASE) auto-questionnaire which is designed to assess the duration, frequency, exertion level, and amount of physical activity undertaken over a seven day period.
Time frame: baseline, 6 months and 12 months
Assessment of sedentary time by questionnaire
Using self-report sedentary behavior questionnaire based on the Gardiner questionnaire to assess time spent in behaviors common among older adults: watching television, computer use, reading, socializing, transport and hobbies, and a summary measure (total sedentary time)
Time frame: baseline, 6 months and 12 months
Assessment of weight loss
weight in kilograms
Time frame: baseline, 6 months and 12 months
Body Mass Index (BMI)
calculating the BMI in kg/m\^2
Time frame: baseline, 6 months and 12 months
Assessment of nutritional status using MNA scale
Using the Mini Nutritional Assessment (MNA) scale which consists of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment.
Time frame: baseline, 3 months (for interventional arm depending on the SPPB score), 6 months and 12 months
Rate of study participation
Time frame: Baseline
Monitoring of detailed physical activity performed by patients with diaries outlining the exercise sessions .
Patient adherence to the multimodal intervention. Monitoring of detailed physical activity performed by patients. Patients were also asked to complete diaries outlining the exercise sessions.
Time frame: at the end of the multimodal intervention (3 months)
Monitoring of detailed physical activity performed by patients with MAPA assessment.
Patient adherence to the multimodal intervention. Monitoring of detailed physical activity performed by patients. Patients MAPA assessment.
Time frame: at the end of the multimodal intervention (3 months)
Rate of compliant General practitioners (GP) associated to the study
Time frame: at 12 months
Assessment of psychological factors using GDS-4 scale associated with a loss of mobility
Using a short Geriatric Depression Scale (GDS-4). The GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults.
Time frame: baseline, 6 and 12 months
Assessment of social factors associated with a loss of mobility
Using the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) score which is related to several socioeconomic indicators (occupation, education, and employment status), to health-related behaviors (smoking and health care use), and morbidity (self-perceived health, dental health, obesity, and diabetes).
Time frame: baseline
Assessment of comorbidities using the index of Charlson
Using the index of Charlson which included a closed list of 19 diseases, grouped into 4 subgroups different weighting.
Time frame: baseline
Description of concomitant medications
List of active drugs and psychotropic
Time frame: baseline
Type of diagnoses for unknown diseases following the dedicated geriatric consultation.
Description of pathologies possibly associated with a symptomatic loss of mobility.
Time frame: baseline
Percentage of diagnoses for unknown diseases following the dedicated geriatric consultation.
Description of pathologies possibly associated with a symptomatic loss of mobility.
Time frame: baseline
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