Rural Community-dwelling Adults Research Articles

Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial

BackgroundChronic low back pain (CLBP) is a common health problem in rural Nigeria but access to rehabilitation is limited. Current clinical guidelines unanimously recommend patient education (PE) including instruction on self‐management, and exercises as frontline interventions for CLBP. However, the specific content of these interventions and how they are best delivered remain to be well-described, particularly for low-resource communities. This study determined the effectiveness of PE plus motor control exercise (MCE) compared with either therapy alone among rural community-dwelling adults with CLBP.MethodsA single-blind, three-arm parallel-group, randomised clinical trial including 120 adult rural dwellers (mean [SD] age, 46.0 [14.7] years) with CLBP assigned to PE plus MCE group (n = 40), PE group (n = 40), and MCE group (n = 40) was conducted. The PE was administered once weekly and the MCE twice weekly. Each group also received stretching and aerobic exercises twice weekly. All interventions were administered for 8 weeks. Blinded assessments for pain intensity and disability level as primary outcomes, and quality of life, global perceived recovery, fear-avoidance beliefs, pain catastrophising, back pain consequences belief and pain medication use as secondary outcomes were conducted at baseline, 8-week (immediately after intervention) and 20-week follow-ups.ResultsAll the groups showed significant improvements in all the primary and secondary outcomes evaluated over time. Compared with PE alone, the PE plus MCE showed a significantly greater reduction in pain intensity by an additional –1.15 (95% confidence interval [CI], –2.04 to –0.25) points at the 8-week follow-up and –1.25 (95% CI, –2.14 to –0.35) points at the 20-week follow-up. For disability level, both PE plus MCE and MCE alone showed a significantly greater improvement compared with PE alone by an additional –5.04% (95% CI, –9.57 to –0.52) and 5.68% (95% CI, 1.15 to 10.2) points, respectively, at the 8-week follow-up, and –5.96% (95% CI, –9.84 to –2.07) and 6.57% (95% CI, 2.69 to 10.4) points, respectively, at the 20-week follow-up. For the secondary outcomes, at the 8-week follow-up, PE plus MCE showed a significantly greater reduction in fear-avoidance beliefs about physical activity compared with either therapy alone, and a significantly greater reduction in pain medication use compared with PE alone. However, compared with PE plus MCE, PE alone showed a significantly greater reduction in pain catastrophising at all follow-up time points, and a significantly greater improvement in back pain consequences belief at the 20-week follow-up. Additionally, PE alone compared with MCE alone showed a significantly greater improvement in back pain consequences belief at all follow-up time points. No significant between-group difference was found for other secondary outcomes.ConclusionsAmong rural community-dwelling adults with CLBP, PE plus MCE led to greater short-term improvements in pain and disability compared with PE alone, although all intervention strategies were associated with improvements in these outcomes. This trial provides additional support for combining PE with MCE, as recommended in current clinical guidelines, to promote self-management and reduce the burden of CLBP in low-resource rural communities.Trial registrationClinicalTrials.gov (NCT03393104), Registered on 08/01/2018.

<p>Prevalence of Sarcopenia in Community-Dwelling Older Adults According to Simplified Algorithms for Sarcopenia Consensus Based on Asian Working Group for Sarcopenia</p>

PurposeThis study sought to identify the prevalence of sarcopenia in community-dwelling Korean older adults and validate two simplified diagnostic algorithms based on the Asian Working Group for Sarcopenia (AWGS) algorithm for identifying sarcopenia.Patients and MethodsPatients (n = 338) aged ≥65 years participated in this cross-sectional study. Muscle strength was measured by hand grip strength, physical performance by gait speed, and muscle mass by the skeletal muscle mass index (SMI). Sarcopenia was assessed using the AWGS-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the AWGS-recommended algorithm using the chi-square test, and the sensitivity and specificity were obtained.ResultsSarcopenia prevalence, determined using the AWGS-recommended algorithm, was 40.3% and 41.3% in men and women, respectively. The overall prevalence of sarcopenia was 41.0% by the AWGS-recommended algorithm, 37.6% by algorithm A, and 37.6% by algorithm B; 111 participants were diagnosed with sarcopenia using all three methods (p = 0.157).ConclusionWe established sarcopenia prevalence among rural community-dwelling adults in Korea and confirmed that the simplified algorithms were suitable for the identification of sarcopenia in rural community-dwelling older adults in Korea. Further studies are needed to assess whether these simplified algorithms are applicable to older Asian adults with functional and/or cognitive impairment and nursing home residents.

Chronic stress and age-related pattern of blood pressure: A cross-sectional study in rural China.

Chronic stress is a risk factor for hypertension in adults. However, there is conflicting evidence for older adults. We hypothesized that age-related arterial stiffening, which leads to a lower blood pressure (especially diastolic blood pressure [DBP]), is more pronounced among older adults with high vs low stress. The objectives of this study were (a) to investigate age-related trends in systolic and DBPs among adults in rural Fujian, China, and (b) to examine differences in age-related blood pressure trends according to levels of stress by using Epstein-Barr virus (EBV) antibody titer as a marker of chronic stress status. We collected cross-sectional data from 764 rural community-dwelling adults in rural Fujian, China (mean age = 59.4). Participants were categorized into high and low stress groups by median split of EBV antibody titer. A least-squares regression analysis was used to investigate the association between age and blood pressures. We observed an inverted U-shaped association between age and DBP, while there was a linear association between age and systolic blood pressure in the overall sample. When stratified by stress, the inverted U-shaped associations with age (both systolic and DBPs) were seen only among those with high stress; DBP peaked at the age of ~68 years, and the declining trend later in life was more clearly observed among those with high chronic stress. Decrease of DBP was more pronounced among older adults with high vs low chronic stress in rural China.

A lifestyle intervention supported by mobile health technologies to improve the cardiometabolic risk profile of individuals at risk for cardiovascular disease and type 2 diabetes: study rationale and protocol.

BackgroundMetabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes. Regular exercise improves the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation practices remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes.Methods/DesignAdults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol.DiscussionThis study tested the effects of a prescriptive exercise intervention alone, versus one supported by mobile health technology on cardiometabolic risk factors. The intervention was designed to be translated into clinical or community-based programming. Results will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time; particularly in rural communities.Trial registrationClinical trials registration: NCT01944124

A preliminary study of symptomatic fatigue in rural older adults.

The purpose of this study was to evaluate the prevalence of symptomatic fatigue and its relation to physical function and self-perceived health in a sample of older, rural community-dwelling adults with commonly-used clinical fatigue scales. This is an exploratory, descriptive study of 30 subjects from 4 rural counties. All subjects were 70+ years of age and had no recent history of hospitalization. Subjects were assessed in their homes and completed a standard test of physical function, twelve functional assessment instruments, and two commonly-used clinical fatigue scales: the Fatigue Severity Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Depending on the fatigue instrument and criteria used, 23-47% of subjects exhibited symptomatic fatigue. Regardless of the scale, fatigue was associated with several negative consequences: decreased physical function performance, lower morale, and reduced physical composite scores on the Short Form-36 quality of life questionnaire. Of note, these differences remained significant even after accounting for depression scale scores. In addition, fatigue was associated with a greater incidence of risk for malnutrition. Together, these findings suggest that symptomatic fatigue may be quite prevalent in older individuals in rural settings, and warrants further consideration when presented in the clinical setting, as it may be associated with several negative health outcomes.

P4-085: Serum uric acid and cognitive function in rural community-dwelling adults

P4-085: Serum uric acid and cognitive function in rural community-dwelling adults