Protocol for a randomised controlled trial of a primary care intervention to Reverse Frailty and Enhance Resilience through Exercise and dietary protein Education (REFEREE) in community-dwelling adults aged 65 and over.

John Travers,John Langan,Éidin Ní Shé,Sebastian Vencken,Dermot Power,Diarmuid O'Shea,Roman Romero-Ortuno,Joanne Mckiernan,Jude Mcentire,Christopher Mcdermott,Marie-Therese Cooney,Andrew W Murphy,Darren Mccormack,Patrick J Murphy,Peter Doran,Fergal Macnamara

doi:10.12688/hrbopenres.13188.2

Abstract

Introduction: Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. Methods: This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to 'intervention' or 'usual care'. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. Discussion: The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. Trial registration: ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.

Highlights

Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice
Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion
We offered an exercise intervention to reverse frailty and build resilience in primary care consultations

Summary

21 Dec 2020

Study objective Primary objective To measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS), muscle-mass, as a result of an optimised exercise and dietary intervention versus usual care among community-dwelling adults aged 65 and over whose baseline clinical frailty (CFS) is not worse than mild. We hypothesise that participants on resistance exercise regime and with guidance on dietary protein will have a higher SHARE-FI score than patients without this intervention This outcome will be analysed as a difference in means between treatment arms using a linear mixed effects model, with arm allocation, SHARE-FI at baseline and age included as fixed effects and GP practice included as a random effect. Reporting guidelines Harvard Dataverse: SPIRIT checklist for ‘Protocol for a randomised controlled trial of a primary care intervention to Reverse Frailty and Enhance Resilience through Exercise and dietary protein Education (REFEREE) in community-dwelling adults aged 65 and over’.

12. Travers J: Primary care exercise intervention to reverse frailty

16. Bryman A

23. Travers J