Home-based Group Research Articles

Early home-based group education to support informed decision-making among patients with end-stage renal disease: a multi-centre randomized controlled trial.

The aim was to test the effectiveness of early home-based group education on knowledge and communication about renal replacement therapy (RRT). We conducted a randomized controlled trial using a cross-over design among 80 end-stage renal disease (ESRD) patients. Between T0 and T1 (weeks 1-4) Group 1 received the intervention and Group 2 received standard care. Between T1 and T2 (weeks 5-8) Group 1 received standard care and Group 2 received the intervention. The intervention was a group education session on RRT options held in the patient's home given by social workers. Patients invited members from their social network to attend. Self-report questionnaires were used at T0, T1 and T2 to measure patients' knowledge and communication, and concepts from the Theory of Planned Behaviour such as attitude. Comparable questionnaires were completed pre-post intervention by 229 attendees. Primary RRT was registered up to 2 years post-intervention. Multilevel linear modelling was used to analyse patient data and paired t-tests for attendee data. Statistically significant increases in the primary targets knowledge and communication were found among patients and attendees after receiving the intervention. The intervention also had a significant effect in increasing positive attitude toward living donation and haemodialysis. Of the 80 participants, 49 underwent RRT during follow-up. Of these, 34 underwent a living donor kidney transplant, of which 22 were pre-emptive. Early home-based group education supports informed decision-making regarding primary RRT for ESRD patients and their social networks and may remove barriers to pre-emptive transplantation.

Effects of pharmacist-led patient education on diabetes-related knowledge and medication adherence: A home-based study

Objective: Patient education is key to the management of acute and chronic conditions. However, the majority of such educational interventions have been reported from health-care settings. In contrast, this study aims to evaluate whether a home-based intervention can result in better understanding about type 2 diabetes mellitus and can increase adherence to prescribed medications. Method: A non-clinical randomised controlled trial was conducted whereby participants received a home-based educational intervention through a registered pharmacist. A total of 150 patients were randomly assigned to two groups (75 patients in each arm). Diabetes knowledge and medication adherence were measured by means of the 14-item Michigan Diabetes Knowledge Test and the 8-item Morisky Medication Adherence Scale, respectively. Results: No significant differences were observed in either group for demographic variables. There was, however, a significant increase in the participants’ levels of knowledge about type 2 diabetes mellitus and medication adherence in the home-based intervention group at the completion of the intervention ( p < .001). Significantly lower HbA1c levels were also observed among the home-based intervention group following the intervention ( p < .001). Conclusion: A pharmacist-led home-based intervention can significantly increase disease-related knowledge and medication adherence in patients with type 2 diabetes mellitus. Home-based interventional programmes offer a promising method of patient education and counselling.

Passive movement and active exercise for very young infants with congenital heart disease: a study protocol for a randomized controlled trial.

BackgroundDelayed motor development is reported in patients with congenital heart disease (CHD). Exercise is widely used to facilitate motor development and improve motor ability. Exercise for adolescents and adults with CHD has been extensively studied. However, the evidence of exercise for infants with CHD is sparse. This study aims to identify the effect of passive movement and active exercise on motor development within very young CHD infants with cardiac catheterization.Methods/DesignA prospective and randomized controlled trial will be conducted in very young CHD infants with cardiac catheterization. A total of 147 infants with CHD will be randomized by a 1:1:1 allocation ratio by computer to an exercise intervention group, a home-based intervention group and a control group. The exercise intervention group will receive passive movement and active exercise from experienced physiotherapists in pediatrics three times a week for 12 weeks. The home-based intervention group will receive passive movement and active exercise from their parents or caregivers at home three times a week for 12 weeks. The control group will receive follow up only. The follow-up duration is 20 months. The primary outcome measures are the motor quotient measured by the Peabody Developmental Motor Scales-II. The secondary outcome measures are the Ross score, ventricular function, bone quality, body length, weight, head circumference, upper arm circumference, and adverse events.DiscussionThis study has several important features, including the randomization process, the long follow-up duration, the control group, and the large sample size. The aim of this study is to determine whether 12-week passive movement and active exercise promotes motor development and produces other beneficial effects for very young CHD infants with cardiac catheterization. Therefore, this study will contribute new knowledge regarding the rehabilitation program in very young CHD infants with cardiac catheterization.Trial registrationCurrent Controlled Trials ChiCTR-IOR-15005909 (January 31, 2015).

Psychological effects of calisthenic exercises on neuroinflammatory and rheumatic diseases.

The aim of this study was to evaluate the effects of calisthenic exercises on psychological status in patients with ankylosing spondylitis (AS) and multiple sclerosis (MS). This study comprised 40patients diagnosed with AS randomized into two exercise groups (group1 =hospital-based, group2 = home-based) and 40patients diagnosed with MS randomized into two exercise groups (group1 =hospital-based, group2 =home-based). The exercise programme was completed by 73participants (hospital-based= 34, home-based= 39). Mean age was 33.75 ± 5.77years. After the 8-week exercise programme in the AS group, the home-based exercise group showed significant improvements in erythrocyte sedimentation rates (ESR). The hospital-based exercise group showed significant improvements in terms of the Bath AS Metrology Index (BASMI) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A) scores. After the 8-week exercise programme in the MS group, the home-based and hospital-based exercise groups showed significant improvements in terms of the 10-m walking test, Berg Balance Scale (BBS), HADS-A, and MS international Quality of Life (MusiQoL) scores. There was a significant improvement in the hospital-based and a significant deterioration in the home-based MS patients according to HADS-Depression (HADS-D) score. The positive effects of exercises on neurologic and rheumatic chronic inflammatory processes associated with disability should not be underestimated.

EPHECT I: European household survey on domestic use of consumer products and development of worst-case scenarios for daily use

Consumer products are frequently and regularly used in the domestic environment. Realistic estimates for product use are required for exposure modelling and health risk assessment. This paper provides significant data that can be used as input for such modelling studies. A European survey was conducted, within the framework of the DG Sanco-funded EPHECT project, on the household use of 15 consumer products. These products are all-purpose cleaners, kitchen cleaners, floor cleaners, glass and window cleaners, bathroom cleaners, furniture and floor polish products, combustible air fresheners, spray air fresheners, electric air fresheners, passive air fresheners, coating products for leather and textiles, hair styling products, spray deodorants and perfumes. The analysis of the results from the household survey (1st phase) focused on identifying consumer behaviour patterns (selection criteria, frequency of use, quantities, period of use and ventilation conditions during product use). This can provide valuable input to modelling studies, as this information is not reported in the open literature. The above results were further analysed (2nd phase), to provide the basis for the development of ‘most representative worst-case scenarios’ regarding the use of the 15 products by home-based population groups (housekeepers and retired people), in four geographical regions in Europe. These scenarios will be used for the exposure and health risk assessment within the EPHECT project. To the best of our knowledge, it is the first time that daily worst-case scenarios are presented in the scientific published literature concerning the use of a wide range of 15 consumer products across Europe.

Effect of video game commercial on short term balance training in Thai elderly

Background: Fall is one of the leading causes to incapability of individuals over the age of 65 years old and commonly used as an indicator to reveal the ability to control balance. Consequence of falls can lead to fractures, activity avoidance, health decline, disability, fear of falling and hospitalization. Numbers of research reported that the most effective fall-prevention programs involved a variety of tasks which challenge balance, such as multisensory balance training and a training program done by a game console or video games. Purpose:The objectives of this studywere to compare the effect of video game commercial exercise and home based exercise on short-term effect in improving balance in the elderly. Methods: Forty-eight healthy elderly, age 65–80 years were included. Participants were randomized into a video game based exercise (Wii) group (n= 24) and a home based exercise group (n= 24). The Wii group was set at Phra Nung Kloa hospital elderly club and received video game exercise 30-45minutes per day, 3 days a week, for 4 weeks. The home based group was received self-monitored exercise for 30minutes, 3 times a week, for 4 weeks. The home based group was reminded about the exercises by the researcher via telephone twice a week and also received a handbook to prevent fall. Berg Balance Scale (BBS), Fullerton Advance Balance Scale (FAB), and Functional Reach Test (FRT) were evaluated at the beginning of training, the end of week 1, 2, 3 and at the completed of the training on week 4. Results: Repeated two way ANOVA showed no significantly different reach distance (FRT) when compared Wii group and home base group at the end of week 4 (p= 0.144). Both groups showed significantly improved reach distance (FRT) started at the end of week 1, score of FAB and BBS at the end of week 2 and 3 respectively (p< 0.05). No significantly different between groups in BBS and FAB was found. Conclusion(s): Video game based exercise and home based exercise improved balance in the elderly demonstrating by increased scores of BBS, FAB and reach distance (FRT) after 4 weeks training, indicating improvement of balance and implied the reduction of risks of fall in the elderly. Implications: A minimal of 3 weeks training of video game based or a home based exercise especially lower limb muscles strengthening have potential to improve balance in elderly.

Long-term Exercise Adherence After High-intensity Interval Training in Cardiac Rehabilitation: A Randomized Study.

Exercise adherence in general is reported to be problematic after cardiac rehabilitation. Additionally, vigorous exercise is associated with impaired exercise adherence. As high-intensity interval training (HIT) is frequently used as a therapy to patients with coronary artery disease in cardiac rehabilitation, the objective was to assess long-term exercise adherence following an HIT cardiac rehabilitation programme. A multicentre randomized study was carried out. Eligible participants were adults who had previously attended a 12-week HIT cardiac rehabilitation programme, as either a home-based or hospital-based HIT (treadmill exercise or group exercise). The primary outcome was change in peak oxygen uptake; secondary outcomes were self-reported and objectively measured physical activity. Out of 83 eligible participants, 76 were available for assessment (68 men/8 women, mean age 59 (8) years) at a one-year follow-up. Peak oxygen uptake was significantly elevated above baseline values, (treadmill exercise: 35.8 (6.4) vs. 37.4 (7.4) ml kg(-1) min(-1) , group exercise: 32.7 (6.5) vs. 34.1 (5.8) ml kg(-1) min(-1) and home-based exercise: 34.5 (4.9) vs. 36.7 (5.8) ml kg(-1) min(-1) at baseline and follow-up, respectively), with no significant differences between groups. The majority of the participants (>90%) met the recommended daily level of 30 minutes of moderate physical activity. The home-based group showed a strong trend towards increased physical activity compared with the hospital-based groups. The results from this study have shown that both home-based and hospital-based HIT in cardiac rehabilitation induce promising long-term exercise adherence, with maintenance of peak oxygen uptake significantly above baseline values at a one-year follow-up. The implication for physiotherapy practice is that HIT in cardiac rehabilitation induces satisfactory long-term exercise adherence.

Perception of sex workers of Lucknow City, Uttar Pradesh, India towards sexually transmitted infections.

The prevention, control, and management of sexually transmitted infections/reproductive tract infection (STI/RTI) are well-recognized cost-effective strategies for controlling the spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). A cross-sectional descriptive study was done over a period of 1 year to assess the prevalence of STI, knowledge level about STI, and the STI-HIV link among the female sex workers (FSWs) of Lucknow city, Uttar Pradesh, India along with their biosocial characteristics. Most of the FSWs were illiterate, married, Hindus, and belonged to general category. The prevalence rates of STI among street-based and home-based FSWs were 50.6% and 29.8%, respectively. Knowledge about the role of condom in prevention of STI and the STI-HIV link was significantly less among home-based FSWs than those who are street-based. There is a great lack in the awareness among FSWs regarding STI and their prevention. Behavior change communication (BCC) and advocacy strategy were developed, especially for the home-based group, to strengthen their knowledge regarding the STI-HIV link.

A Home-Based Walking Program Improves Erectile Dysfunction in Men With an Acute Myocardial Infarction

The purpose of this study was to evaluate the influence of a home-based walking program on erectile function and the relation between functional capacity and erectile dysfunction (ED) in patients with recent myocardial infarctions. Patients with acute myocardial infarctions deemed to be at low cardiovascular risk were randomized into 2 groups: (1) a home-based walking group (n = 41), instructed to participate in a progressive outdoor walking program, and (2) a control group (n = 45), receiving usual care. Functional capacity was determined by the 6-minute walk test and evaluation of sexual function by the International Index of Erectile Function questionnaire; the 2 tests were performed at hospital discharge and 30 days later. In the overall cohort, 84% of patients reported previous ED at hospital discharge. After 30 days, ED had increased by 9% in the control group in relation to baseline (p = 0.08). However, the home-based walking group had a significant decrease of 71% in reported ED (p <0.0001). The 6-minute walk distance was statistically significant higher in the home-based walking group compared with the control group (p = 0.01). There was a significant negative correlation between 6-minute walk distance and ED 30 days after hospital discharge (r = -0.71, p <0.01). In conclusion, an unsupervised home-based progressive walking program led to significant improvements in functional capacity in men at low cardiovascular risk after recent acute myocardial infarctions. In addition, this intervention demonstrated a link between functional capacity and exercise training and erectile function improvement.

Comparaison de la réhabilitation respiratoire de patients atteints de BPCO en centre et à domicile

There are few data showing how pulmonary rehabilitation (PR) for COPD patients carried out at home impacts on health-related quality of life (HRQL). The aim of this study was to determine if PR conducted at home improves quality of life. We compared the results of home-based PR versus PR performed in an outpatient center. The outcomes were the HRQL measured by the Saint-George's Hospital questionnaire and the 6-minute walk test distance (6MWT). Fifty-six COPD patients were included for PR either at home (n=27) or in the outpatient center (n=29) depending on distance from the center and patients preference. The two groups were similar for sex, age, BMI, lung function, and initial peak oxygen uptake. 6MWT showed a similar non-significant improvement in both groups after PR (+12±46m in home-based PR,+13±34m in outpatient center). HRQL was significantly improved in the home-based group in 2 domains: "Activity" (-8.6±6.4 vs -0.7±17.7, P<0.05), "Impact" (-8.4±6.5 vs 1.6±11.7, P<0.001) and total score (-8.2±4.0 vs 0.0±8.8, P<0.001). Pulmonary rehabilitation at home is associated with improvements in health-related quality of life, and thus can be considered where availability of treatment in specialized centers is limited.

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease.

Home-based exercise has been shown to provide benefits in terms of physical capacity in the general population, but has been scarcely investigated in patients with chronic kidney disease (CKD). To evaluate the impact of a home-based aerobic training on the cardiopulmonary and functional capacities of overweight non-dialysis-dependent patients with CKD (NDD-CKD). Twenty-nine sedentary patients (55.1 ± 11.6 years, BMI = 31.2 ± 6.1 kg/m(2), eGFR = 26.9 ± 17.4 mL/min/1.73 m(2)) were randomly assigned to a home-based exercise group (n = 14) or to a control group (n = 15) that remained without performing exercise. Aerobic training was performed three times per week for 12 weeks. A cardiopulmonary exercise test, functional capacity and clinical parameters were evaluated. A significant increase, ranging from 8.3 to 17 %, was observed in the cardiopulmonary capacity parameters, such as maximal ventilation (p = 0.005), VO2peak (p = 0.049), ventilatory threshold (p = 0.040) and respiratory compensation point (p < 0.001), of the exercise group. A simultaneous improvement in the functional capacity tests [6-min walk test (p < 0.001), time up and go test (p < 0.001), arm curl test (p < 0.001), sit and stand test (p < 0.001), 2-min step test (p < 0.001) and back scratch test (p = 0.042)] was also found in patients who were submitted to the exercise. Exercised patients experienced a decrease in systolic and diastolic blood pressure, average 10.6 % (p < 0.001) and 9.2 % (p = 0.007), respectively, and a trend toward improved renal function (p = 0.1). No change in any parameter was found in the control group during the follow-up. The home-based aerobic exercise program was feasible, safe and effective for the improvement in the cardiopulmonary and functional capacities of overweight NDD-CKD patients.

Lower back injuries in rowing are responsible for more time loss from training in National level rowers compared to International level rowers. For rib stress fractures International rowers are more at risk

Introduction: Rowing injuries are common, with lower back injuries having the highest incidence. This study was to investigate the major rowing injuries seen at a single high performance rowing sports program over a 5 year training period and establish if any relationship exists between these injuries and the level of competition that the rower is partaking in.

Improving core stability: Targeting success with core strengthening programs

Introduction: Poor dynamic core stability is implicated in the development of low back pain and lower limb injuries. Core strengtheningprograms are used to treat these conditions however the therapeutic outcomes are unpredictable. Sources of variability may be the method of program delivery (supervised or homebased), adherence and type of exercises (static endurance versus dynamic stability). The aim of this study was to investigate the contribution of method of delivery, adherence and exercise selection on static endurance and dynamic stability outcomes of a core -strengthening program. Methods: This was a randomised controlled trial with participants allocated to one of three groups: 8-week supervised core-strengthening program, an identical program delivered as a home-based program or a control group. Primary outcomes weremeasures of lumbo-pelvic dynamic stability (Sahrmann test), dynamic postural stability (Star Excursion Balance Test [SEBT] in posterior-lateral [PL], posterior-medial [PM] and anterior directions) and static core stability (side-bridge, flexor endurance and Sorensen tests). Secondary outcomes included measures of adherence to the program and perceived difficulty of exercises. Analysis of covariancewasperformedon the change frombaseline formeasures of static and dynamic core stability. In the home-based group regression analysis was used to determine the effect of adherence to specific exercises on core stability outcomes. Results: Seventy-eight participants were recruited (n=26 per group). The supervised program produced superior results to other groups on all measures of static and dynamic stability, with greatest improvement in the flexor endurance and Sahrmann tests (ES 2.35, p=0.0001 and ES 2.06, p=0.0001). The home-based program produced significant improvements compared to the control group in all static tests, but not in most dynamic tests (Sahrmann: ES 0.34, p=0.09, SEBT PL: ES 0.24, p=0.08, SEBT PM: ES 0.36). Overall adherence was similar in both intervention groups (∼80%) however strong correlations with improvements in dynamic stability occurred in the supervised group only. In the home-based group greater perceived difficulty of dynamic stability exercises was strongly negatively correlated to adherence to those exercises (r=−0.50, p=0.01). Hierarchical regression analysis demonstrated completion of dynamic stability exercises predicted 52%of the variance in measures of dynamic stability (beta =0.80, p=0.0001). Discussion: Supervised programs provide greater improvements in static endurance anddynamic core strength than the same program delivered in a home-based environment. Home-based programs produce poorer outcomes particularly for measures of dynamic core stability and this is related to poor adherence to, and greater perceived difficulty of, exercises targeting dynamic stability.

Effectiveness, Usability, and Cost-Benefit of a Virtual Reality–Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial

ObjectivesFirst, to evaluate the clinical effectiveness of a virtual reality (VR)–based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program; second, to compare the subjective experiences; and third, to contrast the costs of both programs. DesignSingle-blind, randomized, controlled trial. SettingNeurorehabilitation unit. ParticipantsChronic outpatients with stroke (N=30) with residual hemiparesis. InterventionsTwenty 45-minute training sessions with the telerehabilitation system, conducted 3 times a week, in the clinic or in the home. Main Outcome MeasuresFirst, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment), and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences. Third, cost (in dollars). ResultsSignificant improvement in both groups (in-clinic group [control] and a home-based telerehabilitation group) from the initial to the final assessment in the Berg Balance Scale (ηp2=.68; P=.001), in the balance (ηp2=.24; P=.006) and gait (ηp2=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (control: χ2=15.0; P=.002; experimental: χ2=21.9; P=.001). No significant differences were found between the groups in any balance scale or in the feedback questionnaires. With regard to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ($654.72 per person). ConclusionsFirst, VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions, both complemented with a conventional therapy program; second, the usability of and motivation to use the 2 interventions can be similar; and third, telerehabilitation interventions can involve savings that vary depending on each scenario.

The efficacy of a supervised and a home-based core strengthening programme in adults with poor core stability: a three-arm randomised controlled trial

BackgroundPoor core stability is linked to a range of musculoskeletal pathologies and core-strengthening programmes are widely used as treatment. Treatment outcomes, however, are highly variable, which may be related to...

Multi-site videoconferencing for home-based education of older people with chronic conditions: the Telehealth Literacy Project

We examined the acceptability of multi-site videoconferencing as a method of providing group education to older people in their homes. There were 9 groups comprising 52 participants (mean age 73 years) with an average of four chronic conditions. Tablet computers or PCs were installed in participant’s homes and connected to the Internet by the National Broadband Network (high-speed broad band network) or by the 4G wireless network. A health literacy and self-management programme was delivered by videoconference for 5 weeks. Participants were able to view and interact with all group members and the facilitator on their devices. During the study, 44 group videoconferences were conducted. Evaluation included 16 semi-structured interviews, 3 focus groups and a journal detailing project implementation. The participants reported enjoying home-based group education by videoconference and found the technology easy to use. Using home-based groups via videoconference was acceptable for providing group education, and considered particularly valuable for people living alone and/or with limited mobility. Audio difficulties were the most commonly reported problem. Participants connected with 4G experienced more problems (audio and visual) than participants on the National Broadband Network and those living in multi-dwelling residences reported more problems than those living in single-dwelling residences. Older people with little computer experience can be supported to use telehealth equipment. Telehealth has the potential to improve access to education about chronic disease self-management.

Home-based group education on renal replacement therapy for patients with end-stage renal disease: A multi-center randomized controlled trial

Fatigue affects at least half of patients who are on hemodialysis (HD) with considerable repercussions on their functioning, quality of life, and clinical outcomes.This study assessed the feasibility, acceptability, and potential benefits of a cognitive behavioral therapy intervention for renal fatigue (BReF intervention).This was a feasibility randomized controlled trial of the BReF intervention vs. waiting-list control. Outcomes included recruitment, retention, and adherence rates. Exploratory estimates of treatment effect were computed. The statistician was blinded to allocation.Twenty-four prevalent HD patients experiencing clinical levels of fatigue were individually randomized (1:1) to BReF (N = 12) or waiting-list control arms (N = 12). Fifty-three (16.6%; 95% CI = 12.7–21.1) of 320 patients approached consented and completed the screening questionnaire. It was necessary to approach 13 patients for screening for every one patient randomized. The rate of retention at follow-up was 75% (95% CI = 53.29–90.23). Moderate to large treatment effects were observed in favor of BReF on fatigue severity, fatigue-related functional impairment, depression, and anxiety (standardized mean difference [SMD]g = 0.81; SMDg = 0.93; SMDg = 0.38; SMDg = 0.42, respectively) but not sleep quality (SMDg = −0.31). No trial adverse events occurred.There was promising evidence in support of the need and benefits of a cognitive behavioral therapy-based intervention for fatigue in HD. However, uptake was low, possibly as a result of an already high treatment burden in this setting. Considerations on the context of delivery are necessary before pursuing a definitive trial.

Home-Based Pulmonary Rehabilitation for Subjects With COPD: A Randomized Study.

The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test. Twenty-nine subjects with COPD (FEV1 = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV1 = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise. The 2 groups were similar regarding age, FEV1, and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P < .05) and 316.6 ± 81.8 m in the endurance test (P < .05) and decreased by > 4 units in all SGRQ domains. The control group showed no difference in any variable. This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.

Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India--study protocol and intervention adaptation of a randomised control trial.

BackgroundThe World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic.Methods/DesignThis study protocol describes a study that is a randomised, controlled, non-superiority trial. Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. The randomisation list will be generated using a computerized random number generator and opaque sealed envelopes with group allocation will be prepared. Randomization of the study participants will occur after the first clinical encounter with the doctor. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study this study protocol describes is to evaluate the efficacy of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10–14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This resulted in an optimized, tailor-made intervention and in the development of the pictorial instruction sheet with a guide on how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion.DiscussionIn this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10–14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor.Trial registrationClinicaltrials.gov NCT01827995. Registered 04 May 2013.

Home-Based Group Education On Renal Replacement Therapy For Patients With End-Stage Renal Disease: A Multi-Center Randomized Controlled Trial.

Aim: In this study we investigated the effectiveness of a home-based group education programme about renal replacement therapy (RRT) in patients with end-stage renal failure. Methods: In a randomised controlled trial in 4 hospitals, 40 patients received the intervention and 40 patients received standard care. We additionally recruited 310 members of the patients' social network (attendees). The intervention consisted of group education about RRT held in the patient's home, moderated by medical social workers specialized in nephrology and transplantation. Both patients and attendees completed self-report measures prior to and after the intervention. Concepts measured were knowledge, communication, self-efficacy, anticipated affect, subjective and moral norm, and attitude toward communication and RRT options. Mixed modelling was used to analyse patient data (effect sizes are reported using Cohen's d) and paired t-tests for attendee data. Results:In the intervention group significant increases were observed in knowledge (d=1.1; p<.001), communication (d=0.2; p=.13), attitude toward haemodialysis (d=0.5; p=.01), and subjective and moral norm (d=0.5; p=.02). In the control group there were no significant changes observed in these outcomes respectively (d=0.2; p=.13; d=0.0; p=.99; d=-.03; p=.85; d=-0.3; p=.14). For anticipated affect there was no change in the intervention group (d=-0.1; p=.65) while the controls showed a significant decrease (d=0.6; p=.003). There were also significant increases among attendees in knowledge (p<.001) and communication (p<.001). There was no significant impact of the intervention on self-efficacy and attitude toward communication, living donation, peritoneal dialysis and deceased donor transplant. Conclusion: Early, out-reaching, group education supports informed decision-making regarding primary treatment for end-stage renal disease. If patients and members of their social network are better informed in this early phase they may be more likely to pursue pre-emptive kidney transplantation as first form of RRT.