Home-based Intervention Program Research Articles

Effect of individualized home-based intervention program in preterm infants at 35-36 weeks gestational age using prechtl’s general movement assessment: a pre-post experimental study

Background: Preterm birth associated with various abnormalities can have a detrimental impact on an infant’s developmental outcome which marks the need of a landmark tool to detect an abnormality at an early age and incorporate specific intervention strategies. Positive effects of intervention on developmental outcomes have been noted, however tailored home-based intervention programs on developmental enhancements are essential. Purpose: To evaluate the impact of Individualized Home Based Developmental Program on the neurodevelopmental outcome of preterm infants using Prechtl’s General Movement Assessment. Methodology: Ninety preterm infants admitted to the NICU (Neonatal Intensive Care Unit)of a tertiary care hospital in Tertiary care hospital at Belagavi, Karnataka, India. The study was carried out for a duration of 12 months. Participants were conveniently selected from a population-based sample from May 2018 to March 2019. Based on the inclusion criteria of the study, these infants were screened for the movement trajectories on Prechtl’s GMA at 3-36- and 38-40-weeksGA(Gestational Age) respectively. Out of the 90 infants, 19 infants showing abnormal movement trajectories were recruited for individualized home-based developmental program for a duration of 12 weeks followed by re-evaluation at 3 months post term age. Results: The results were statistically significant (p<0.001) with 14 out of 19 infants exhibiting 70% improvement with normal Fidgety movements at 3 months post term age. Conclusion: IHBP delivered for 12 weeks was found to be effective in promoting developmental outcome in preterm infants. KEY WORDS: Preterm infants, Prechtl’s General Movement Assessment, home-based early intervention.

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

BackgroundTongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults.ObjectiveThe purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults.MethodsWe developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention.ResultsOf the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed.ConclusionsSwallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted.International Registered Report Identifier (IRRID)RR2-10.2196/19585

Suicide Gatekeeping: An Important Potential Role for Early Childhood Home Visitors

Parents of young children with disabilities may experience high levels of stress and psychological distress that may put them at higher risk for experiencing suicidality. Thus, early childhood home visitors (e.g., professionals who work for home-based early intervention programs) may serve as important gatekeepers for identifying and referring parents who are experiencing psychological distress, including suicidal thoughts. However, most early childhood home visitors do not receive training on identifying or intervening with distressed and potentially suicidal caregivers. Therefore, early childhood home visitors would benefit from acquiring evidence-based, accessible strategies for identifying and responding to caregivers who they know or suspect are experiencing suicidal thoughts—a class of knowledge and skills that can be obtained through “suicide gatekeeper” training. In this article, we provide evidence-based information about suicide risk among parents of young children with disabilities, the intervention of suicide gatekeeping, and how suicide gatekeeping can be incorporated into the early childhood home visitor role.

Use of the portage curriculum to impact child and parent outcome in an early intervention program in Lebanon

ABSTRACT The purpose of this study, that took place in Lebanon, is to investigate the effectiveness of Portage, a home-based early intervention program for children with special needs. The sample consisted of 16 children (eight male and eight female) whose ages ranged between 1 and 3 years. Participants were provided with home-based services by a Portage home-visitor for a period of six months. Data were collected before and after the intervention. Participants’ progress was evaluated in five developmental areas: communication, social-emotional, exploration, purposeful-motor activity, and sensory organization. Parents’ satisfaction with the program’s provisions was also examined. The results revealed significant differences in the participants’ pre and post ratings, indicating improvement in the children’s functional skills in all developmental areas. Also, parents’ interviews revealed satisfaction with the program’s services. In sum, Portage seems to be a promising home-based intervention, but further research is needed before making any claims about its wider potential.

Development and Validation of a Comprehensive Neuropsychological and Language Rehabilitation for Stroke Survivors: A Home-Based Caregiver-Delivered Intervention Program.

Context:Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery.Aims:To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS.Methods and Material:A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs.Results:All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001).Conclusions:This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.

Rationale and protocol of the StayFitLonger study: a multicentre trial to measure efficacy and adherence of a home-based computerised multidomain intervention in healthy older adults

BackgroundIn older adults, multidomain training that includes physical and cognitive activities has been associated with improvement of physical and cognitive health. The goal of the multisite StayFitLonger study is to assess a home-based computerised training programme, which combines physical exercises, stimulating cognitive activities and virtual coaching.MethodsOne hundred twenty-eight cognitively healthy older adults will be recruited from the community in Switzerland, Canada and Belgium. The study will comprise (1) a 26-week double-blind randomized controlled efficacy trial and (2) a 22-week pragmatic adherence sub-study. In the efficacy trial, participants will be randomly assigned to an experimental or an active control intervention. In the experimental intervention, participants will use the StayFitLonger programme, which is computerised on a tablet and provides content that combines physical activities with a focus on strength and balance, as well as divided attention, problem solving and memory training. Outcomes will be measured before and after 26 weeks of training. The primary efficacy outcome will be performance on the “Timed-Up & Go” test. Secondary outcomes will include measures of frailty, cognition, mood, fear of falling, quality of life, and activities of daily living. Age, sex, education, baseline cognition, expectation, and adherence will be used as moderators of efficacy. Following the 26-week efficacy trial, all participants will use the experimental programme meaning that participants in the control group will ‘cross over’ to receive the StayFitLonger programme for 22 weeks. Adherence will be measured in both groups based on dose, volume and frequency of use. In addition, participants’ perception of the programme and its functionalities will be characterised through usability, acceptability and user experience.DiscussionThis study will determine the efficacy, adherence and participants’ perception of a home-based multidomain intervention programme and its functionalities. This will allow for further development and possible commercialization of a scientifically validated training programme.Trial registrationClinicalTrials.gov, NCT04237519 Registered on January 22, 2020 - Retrospectively registered.

South Korean Study to Prevent Cognitive Impairment and Protect Brain Health Through Lifestyle Intervention in At-Risk Elderly People: Protocol of a Multicenter, Randomized Controlled Feasibility Trial.

Background and PurposeThe prevalence of dementia is increasing in South Korea. Multidomain interventions may be useful for preventing dementia. Such programs need to be disseminated to elderly Koreans throughout the country. We have developed programs of the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), which consists of a facility-based multidomain intervention (FMI) program and a home-based multidomain intervention (HMI) program suitable for elderly Koreans. We aim to determine the feasibility of the SUPERBRAIN programs before a large-scale randomized controlled trial.MethodsWe will recruit 150 participants among those without dementia aged 60–79 years with at least 1 modifiable dementia risk factor. They will be randomly assigned in a 1:1:1 ratio to the FMI, HMI, and the waiting-list control arm. The 6-month multidomain intervention consists of management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement programs. The primary outcomes are adherence and retention rates and changes in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to the study end. The main secondary outcomes are disability, depressive symptoms, quality of life, vascular risk factors, physical performance, nutritional assessment, and motivation questionnaire. There will be an exploratory evaluation of neurotrophic, neurodegeneration, and neuroinflammation factors, microbiome, telomere length, electroencephalography, and neuroimaging measures.ConclusionsThe results obtained will provide information on the applicability of these multidomain intervention programs to at-risk elderly people.

Effectiveness of home-based rehabilitation program in minimizing disability and secondary falls after a hip fracture: Protocol for a randomized controlled trial

IntroductionHip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population. Methods and analysisThe study will be an open label, simple randomized controlled trial at a single hospital. The two arms will be equally allocated on a 1:1 ratio into intervention and control groups. The control arm will receive the usual standard postoperative rehabilitation. The intervention group will receive an extended home-based rehabilitation program twice a week continued for 3 months (12 weeks) after discharge. The Primary outcome of the study is occurrence of falls. Falls will be measured at 3, 6, 12, and 24 months by research-assistant follow-up telephone calls for both the groups. Mobility-related disability will be measured with a self-reported test at every routine follow-up for up to two years using a performance-based short battery tool. Negative binomial regression model will be used to compare number of falls in both the groups by computing incidence ratio rates. Ethics and disseminationApproval for the conduction of this study has been taken from the Ethical Review Committee (ERC) of the institution. Evidences which will be obtained from this study will facilitate to propose changes in existing guidelines and policies for treating fall and hip fracture patients.Trial registrationThis trial is registered on clinicaltrials.gov ID: NCT04108793.

Effects of a home-based nursing intervention programme among adolescents with type 1 diabetes.

To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus. After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home. A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study. This study was conducted in İzmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements. At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels. The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents. The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.

Abstract P152: A Personalised Home-Based Physical Activity Intervention for Chronic Heart Failure: Do Physiological Changes Correspond with Patient Experiences?

Background: Referrals to physical activity and exercise programmes for patients with heart failure is suboptimal with high dropout rates in hospital-based programmes. Home-based programmes have gained popularity and help address this issue. The aim of the present study was to explore patients’ experiences of participating in a personalised homebased physical activity intervention programme and to explore whether experiences corresponded with physiological changes post intervention. Methods: Twenty patients (68±7 years) with chronic heart failure (13±11 years) due to reduced ejection fraction underwent a 12-week personalised home-based physical activity programme. This involved increasing daily pedometer step count by 2000 steps from baseline. Patients completed exercise, cardiac function and quality of life tests pre-post intervention. Sixteen of the 20 patients attended one of three focus group discussions to provide their views around the decision to participate in the programme and their experience of the programme when enrolled. Results: Seventeen patients (85%) completed the intervention, and 15 patients achieved the daily target step count which increased from baseline to 3 weeks by 2546 (5108±3064 to 7654±3849, p=0.03), and maintained until week 12 (9022±3942). On completion of the intervention, quality of life improved by 15% (26±18 vs. 22±19), cardiac index and stroke volume increased by 11% and 19% respectively (6.8±1.5 vs. 7.6±2.0 L/min/m2; and 127 ± 34 vs 151 ± 34, P=0.05). Workload and O2 consumption at anaerobic threshold increased by 16% (49±16 vs. 59±14 watts, p=0.01) and 10% (11.5±2.9 vs 12.8±2.2 ml/kg/min). Thematic analyses identified 10 themes influencing participation and maintenance. These included patient’s fear of engaging in physical activity, family influences on engagement with physical activity, support from clinicians and research staff, and increased confidence as a result of participating in a personalised programme. Conclusion: A personalised home-based physical activity intervention programme is feasible and for patients with stable chronic heart failure and led to improved quality of life and submaximal exercise capacity. However, qualitative findings suggest that outcomes are likely to be contingent on personalised feedback and support from suitably trained team members to increase confidence and self-efficacy, family support, and endorsement of the programme from a clinician.

Effectiveness of home based intervention program in reducing mortality of hip fracture patients: A non-randomized controlled trial

PurposeThe study was done to investigate whether a postoperative intervention program is effective in reducing mortality and improving mobility in two comparative hip fracture patients over one year postoperatively. MethodsA non-randomized controlled trial study with an intervention group of hip fracture patients and historical control group with 12 months follow up.One hundred twenty four admitted hip fracture patients to the Trauma Unit of Assiut University Hospitals, aged 50 years and older were included from 1st July to 31st December 2014. They were divided into 64 and 60 patients as intervention and control groups respectively. Weight, height and bone mineral density were measured and baseline characteristics were taken. The intervention was a postoperative care program in the form of education sessions with an explanatory leaflet on discharge for nutrition and physical exercise program at home. Follow up phone calls were done at 3 months, 6 months and one year postoperatively by one assessor. Physical mobility was assessed by 24 items Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC). ResultsMortality was significantly higher in the control group, WOMAC score was significantly better among intervention group through follow up. By multivariate Cox survival analysis, advancing age, no intervention, osteoporosis, postoperative complications, chest infections and heart attacks were significant predictors for mortality. ConclusionA significant improvement in mobility and reduction of mortality was achieved by application of a postoperative care program that could be incorporated into the hip fracture patients' care pathway.

【論文摘要】Effects of Early Intervention for Preterm Infants: Outcomes of Motor Function, Lung Function and Health-Related Quality of Life during School Age

Background and Purpose: Infants born preterm are at risk for neurodevelopmental disorders and adverse long-term health outcomes. Previous studies have shown short-term and mid-term effects of early intervention for preterm children. However, very limited research has investigated the long-term effects. Our research team previously conducted a randomized control trial to examine the effects of two comprehensive early intervention programs: clinicalbased intervention program (CBIP) and home-based intervention program (HBIP) compared to usual care program (UCP) on very low birth weight (VLBW) preterm infants. The purpose of the present study was to examine the long-term effects of these early interventions programs on preterm children’s motor function, lung function and health-related quality of life (HRQoL) during school age. Methods: Thirty-nine preterm children (10 UCP, 14 CBIP, 15 HBIP) and 13 full-term children who participated in our previous intervention study were recruited at 10-11 years of age. Children’s motor function was examined using Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Lung function was measured by pulmonary function test with a computerized spirometer. HRQoL was measured by parental reports of Pediatric Quality of Life Inventory. One-way analysis of variance and Kruskal-Wallis test were conducted for normally distributed and non-normally distributed outcomes, respectively, to investigate the differences among 4 groups of children. Results: Compared to full-term peers, preterm children in the UCP group demonstrated significantly poorer motor function, indicated by lower scores of upper limb coordination (p = 0.002), body coordination (p = 0.04) and total motor composite (p = 0.04). They also showed lower forced expiratory volume (p = 0.008) and lower forced vital capacity (p = 0.04). While preterm children in the HBIP group showed comparable outcomes with term children, children in the CBIP group had significantly poorer performance in upper limb coordination (p = 0.002) than full-term peers did. All children were reported to have comparable HRQoL. Conclusion: Our study shows positive effects of early intervention on motor function and lung function of preterm children during school age. Furthermore, home-based early intervention appears to be more beneficial than clinical-based program for the long-term outcomes of preterm children. Clinical Relevance: Early intervention programs for preterm infants should be provided with comprehensive child-, parent-, and dyad-focused services to enhance long-term outcomes.

Associations between feeding practices and growth and neurodevelopmental outcomes at 36\xa0months among children living in low- and low-middle income countries who participated in the BRAIN-HIT trial

BackgroundFeeding practices over the first several years of a child’s life can critically influence development. The purpose of this study was to examine associations between feeding practices and growth and neurodevelopmental outcomes at 36 months of age among children from low- and low-middle-income countries (LMIC).MethodsWe conducted a secondary analysis using data collected from children in India, Pakistan, and Zambia who were enrolled in a randomized controlled trial of a home-based early development intervention program called Brain Research to Ameliorate Impaired Neurodevelopment Home-based Intervention Trial. Qualitative dietary data collected at 36 months was used to assess the modified Minimum Acceptable Diet (mMAD), a measure based on a core indicator developed by the World Health Organization to measure whether young children receive the minimum number of meals recommended and adequate diversity of major food groups in their diet. Regression models were used to assess cross-sectional associations between diet and growth indices, including Z-scores for height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), head circumference (HCZ), and Bayley Scales of Infant Development II mental and psychomotor developmental measures at 36 months of age.ResultsOf 371 children, 174 (47%) consumed the mMAD, with significantly higher mean adjusted WHZ than those who did not meet mMAD (0.20 vs − 0.08, p = 0.05). Egg consumption was found to be significantly associated with a decreased risk of wasting [adjusted RR (95% CI): 0.37 (0.15, 0.89), p = 0.03]. HCZ at 36 months did not differ significantly for children who did and did not receive the mMAD.ConclusionMeeting the mMAD was associated with better weight-for-height outcomes at 36 months in children in these three LMIC, highlighting the importance of adequate food quantity and quality.Trial registrationNCT00639184 registered on March 20, 2008.

Blood Profiles among Female Undergraduate in Iraq After a 12-Weeks Home-based Intervention Program

The aim of this study is to investigate whether a 12-weeks home-based intervention program could improve blood profiles among female students in Iraq. A 12-week home-based intervention which consisted of physical activity and dietary awareness program was carried out at home. The subjects were 44 sedentary undergraduate female students from Soran University, Iraqi. Both experimental and control groups (n=22 in each group) completed practical tests at baseline pre-test, post-test1, and post-test2, but only the experimental group participants received the 12-weeks intervention program. The blood profiles measured were blood pressure, blood cholesterol, and blood glucose. Results showed that the experimental group demonstrated improvement in diastolic systolic blood pressure after undergone 6 weeks post-test intervention program. The reported f value was (F(2, 84)=-6.636, p=.047, η2=0.091). Significant blood profiles results were reported for diastolic blood pressure and blood glucose. However, the significant results were only reported after the subjects had undergone the 12-weeks intervention program. The reported f values were (F(2, 84)=-7.000, p=.007, ?2=0.163) and (F(2, 84)=-16.182, p=.003, η2=0.188), respectively. As the conclusion, a home-based physical activity and dietary intervention program can positively influence sedentary undergraduate female students’ blood profiles and the benefits can be achieved as early as after 6-weeks.

Effects of a Home-based Programme on Physical Activity among Undergraduate Female Students in Iraq

The study aimed to evaluate the effect of home-based programme to improve physical activity among undergraduate female students in Iraq. The participants were Iraqi sedentary undergraduate female students (N=44) who were assigned to two groups consisted of experimental group (N=22) and control group (N=22) respectively. The experimental group received a 12-week home based intervention programme which focuses on PA, while the control group were maintaining their usual life. Measurements for all the variables were taken prior to the intervention (pre-test), at week 6 (post-test1), and after 12 weeks (post-test2). The results of Mixed between-within subjects analysis of variance shows a statistically significant between the mean test scores in the pre-test, post-test1, and post-test2 measurements of PA in the experimental group. This study provided evidence that home-based intervention programme which focused on physical activity had a significant effect on improving physical activity.

Effects of Home-Based Intervention Program to Prevent Child Abuse for Parents: A Meta Analysis

Purpose This study was done to conduct a meta-analysis of articles describing randomized controlled trials which showed substantiated effects for home-based child abuse prevention programs for all parents. Methods The articles regarding child abuse prevention programs for parents were investigated using the systematic review method. A literature search was conducted in PubMed, CINAHL, PsycINFO, Cochrane central library, Eric, and RISS on material published. Article searches and quality appraisal through RoB (Risk of Bias) yielded 14 records. Results The total random effect size was 0.344 (Parents outcome, 0.333; Child outcome, 0.310; Environment, 0.275). The home based intervention for parents was effective for prevention of potential child abuse. Conclusion This study supports the effectiveness of health care professional directing child abuse prevention programs for all parents whose children are in the early years of life including during the period of pregnancy. Key words: 아동학대; 메타분석; 부모 Key words: Child abuse; Meta-analysis; Parents

Impact of a lay-led home-based intervention programme on quality of life in community-dwelling pre-frail and frail older adults: a randomized controlled trial

BackgroundDue to the demographic ageing process and the increasing number of pre-frail and frail individuals, new lifestyle interventions to enhance the quality of life (QoL) in community-dwelling older adults are necessary. Therefore, we performed a randomised controlled trial (RCT) to compare effects of a lay-led home-based physical and nutritional intervention programme with social support alone on different QoL domains in community-dwelling pre-frail and frail older adults.MethodsIn this analysis within a RCT (12 weeks), lay volunteers visited one-on-one pre-frail or frail older adults at home twice a week. Participants in the physical training and nutritional intervention (PTN) group performed six strength exercises and discussed main nutritional issues during each visit. The social support (SOSU) group received home visits twice a week for social exchanges. The QoL was assessed with the WHOQOL-BREF and the WHOQOL-OLD instruments. Analyses of covariance (ANCOVA) were used to examine differences between groups with baseline values as the covariate. Changes within groups were assessed with paired t-tests.ResultsEighty participants (n = 39 in the PTN group and n = 41 in the SOSU group) were included. No significant differences were found between the two groups except in past, present and future activities domain [β = 3.66 (95% confidence interval 0.13 to 7.18)] in favour of the PTN group. However, there was some evidence of greater within group improvements in the PTN group particularly in overall QoL, social relations and social participation. In the SOSU group, no significant effect was observed in any QoL domain.ConclusionA combination of a home-based physical and nutritional intervention was not more effective compared to social support alone, on QoL in community-dwelling pre-frail and frail older adults. However, the small but significant improvement within the PTN group suggests that a home-based physical and nutritional intervention delivered by volunteers may influence the QoL in a positive way.Trial registrationThe study protocol was registered on 6 November 2013 at ClinicalTrials.gov (identifier: NCT01991639).

Outcomes in a group of 7–8-year-old children in a developmental-based intervention in autism spectrum disorder

Healthy parent-child interaction is essential for child development. Parents play a central role in the acquisition of social and communicative skills, both in typical and atypical children. Increased support for parent-mediated intervention in autism has been demonstrated. Developmental approaches for ASD are based in establishing strong interpersonal relationships through natural play to foster developmental capacities. This work reports outcomes from an intensive approach based on a developmental, individual difference, home-based intervention program with children with severe ASD. Parents were trained with DIR approach by a specialist. An individual intensive rehabilitation program was set up for each child and implemented at school, home and rehabilitation center. The intervention program also focused on semi-structured activities to promote problem solving, and meliorate sensory dysfunction. Standardized scales were administered pre– and post-intervention, with ABC). The Childhood Autism Rating Scale (CARS), the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales.ResultsBefore initiating the intervention all children presented severe difficulties in communication, social interaction, lack of language, and gestures of communication, auto– and hetero-aggressive behaviors. After 6 months, children showed significant changes in mean scores for emotional functioning, communication, and daily living skills and diminution of aggressive behaviors. The present results provide strong support for the effectiveness of a developmental-based intervention, specifically in the domains of social skills behavior, social responsiveness, in a group of children with severe autism. These results highlight the positive effects of a rehabilitative approach that works in harmony with the family, school and professional team.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior.

BackgroundThe limited or uncertain access to adequate food in elderly people includes not only economic restrictions but also inability of food utilization due to functional or cognitive impairment, health problems, and illiteracy.ObjectiveThe aim of this work is to present the protocol of the randomized controlled trial Saúde.Come Senior, an educational and motivational television (TV)-based intervention to promote healthy lifestyles and decrease food insecurity in elderly people.MethodsA randomized controlled study will be conducted in subjects aged 60 years and older with food insecurity, identified at 17 primary care centers in the Lisboa e Vale do Tejo health region in Lisbon, Portugal. The primary outcome will be the changes in participants’ food insecurity score (evaluated by the Household Food Insecurity Scale) at 3 months. Change in other outcomes will be assessed (dietary habits, nutritional status, physical activity, health status, and clinical outcomes). Subjects will be followed over 6 months; the intervention will last 3 months. Data collection will be performed at 3 different time points (baseline, end of intervention at 3 months, and follow-up at 6 months). The intervention is based on an interactive TV app with an educational and motivational program specifically developed for the elderly that has weekly themes and includes daily content in video format: (1) nutrition and diet tips for healthy eating, (2) healthy, easy to cook and low-cost recipes, and (3) physical exercise programs. Furthermore, brief reminders on health behaviors will also be broadcasted through the TV app. The total duration of the study will be 6 months. The intervention is considered to be effective and meaningful if 50% of the individuals in the experimental group have a decrease of 1 point in the food insecurity score, all the remaining being unchanged. We expect to include and randomize 282 (141 experimental and 141 control) elderly with food insecurity. We will recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282).ResultsThe randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017.ConclusionsThis study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way.

Effectiveness of a Home-Based Eccentric-Exercise Program on the Torque-Angle Relationship of the Shoulder External Rotators: A Pilot Study.

The role of the rotator cuff is to provide dynamic stability to the glenohumeral joint. Human and animal studies have identified sarcomerogenesis as an outcome of eccentric training indicated by more torque generation with the muscle in a lengthened position. The authors hypothesized that a home-based eccentric-exercise program could increase the shoulder external rotators' eccentric strength at terminal internal rotation (IR). Prospective case series. Clinical laboratory and home exercising. 10 healthy subjects (age 30 ± 10 y). All participants performed 2 eccentric exercises targeting the posterior shoulder for 6 wk using a home-based intervention program using side-lying external rotation (ER) and horizontal abduction. Dynamic eccentric shoulder strength measured at 60°/s through a 100° arc divided into 4 equal 25° arcs (ER 50-25°, ER 25-0°, IR 0-25°, IR 25-50°) to measure angular impulse to represent the work performed. In addition, isometric shoulder ER was measured at 5 points throughout the arc of motion (45° IR, 30° IR, 15° IR, 0°, and 15° ER). Comparison of isometric and dynamic strength from pre- to posttesting was evaluated with a repeated-measure ANOVA using time and arc or positions as within factors. The isometric force measures revealed no significant differences between the 5 positions (P = .56). Analysis of the dynamic eccentric data revealed a significant difference between arcs (P = .02). The percentage-change score of the arc of IR 25-50° was found to be significantly greater than that of the arc of IR 0-25° (P = .007). After eccentric training the only arc of motion that had a positive improvement in the capacity to absorb eccentric loads was the arc of motion that represented eccentric contractions at the longest muscle length.