A multimodal and multidisciplinary program to prevent loss of mobility in patients aged over 70\u2009years: study protocol of a multicenter cluster randomized study in primary care (the PRISME-3P study)

Sofia Perrotin,Thomas Gilbert,Marc Bonnefoy,Laurent Villeneuve,Sylvie Bin-Dorel,Laurent Letrilliart,Amna Klich,Marine Dupuis

doi:10.1186/s12877-019-1059-5

Sofia Perrotin, Thomas Gilbert + Show 6 more

Open Access

https://doi.org/10.1186/s12877-019-1059-5

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Journal: BMC Geriatrics	Publication Date: Feb 19, 2019
Citations: 2	License type: open-access

Affiliation: Hôpital Lyon Sud, Hospices Civils de Lyon

Abstract

BackgroundReduced mobility is the first sign of functional decline and can lead to dependency in elderly people. Screening for the risk of mobility limitation in this population is an important public health issue to prevent further disabilities. Despite the current lack of guidelines, primary care healthcare providers may have a central role to play in this type of screening. Multi-domain physical exercise interventions in older persons have shown some efficacy/effectiveness on frailty status, yet, to the best of our knowledge, no published study has focused on patients screened in primary care.MethodThe PRISME-3P study is a national, interventional, multicenter, cluster randomized trial. Patients over 70 years of age will be systematically screened by their general practitioner (GP) on the basis of clinical criteria of mobility limitation. To avoid contamination bias, the unit of randomization will be the GP practice. In the intervention group, patients will consult a geriatrician and a dietician, and will receive a physical training program from a personal trainer who will demonstrate the exercises and provide follow-up coaching. The control group will receive standard care. The primary outcome will be the change in Short Physical Performance Battery (SPPB) scores between inclusion and 6-months follow-up.DiscussionWe expect an improvement of the SPPB between inclusion and 6 months of follow-up.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02847871, 27 July 2016).

Highlights

Reduced mobility is the first sign of functional decline and can lead to dependency in elderly people
We expect an improvement of the Short Physical Performance Battery (SPPB) between inclusion and 6 months of follow-up
Loss of muscle mass causes a reduced muscle strength and a decrease of maximal oxygen uptake [5]; this leads to a mobility limitation [6] and a vicious circle is established as this in turn leads to loss of muscle mass [7]

Summary

Introduction

Reduced mobility is the first sign of functional decline and can lead to dependency in elderly people. Mobility limitation is common in older adults, almost 30% in those aged over 65 years [8, 9], and the most frequently used method in the literature to measure this has been the Perrotin et al BMC Geriatrics (2019) 19:48 ability to rise from a chair, walking speed, or capacity to walk 400 m [10, 11] It is predictive of dependence and the first sign of functional decline [10, 12], which increases the likelihood of depression [13], risk of falls and fractures [14], institutionalization [15] and mortality [16], and lowers quality of life. Fried et al have defined frailty as a clinical syndrome in which three or more of the following criteria are present: unintentional weight loss (10 lbs. in past year), self-reported exhaustion, weakness (grip strength), slow walking speed and low physical activity [7]

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