Six-month Intervention Research Articles

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial

ObjectivePricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Design and methodsCost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. ResultsAt three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. ConclusionsA 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention.The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901.

Effects of aerobic exercise on home-based sleep among overweight and obese men with chronic insomnia symptoms: a randomized controlled trial

ObjectiveTo determine the effect of a six-month aerobic exercise program on home-based sleep quality among overweight and obese men with chronic insomnia symptoms. MethodsParticipants were 45 Finnish men (93% had body mass index ≥25) aged 30–65 years, with chronic (≥3 months) insomnia symptoms as classified by the DSM-IV criteria. Participants were randomized into an exercise (n = 24) or control group (n = 21). The exercise group received six-month aerobic exercise intervention with one to five sessions per week of 30–60 minutes duration. The control group was instructed to maintain habitual lifestyle behaviors during the study period. Seven-night home sleep was measured with a piezoelectric bed sensor and sleep diary. Other assessments included the modified Basic Nordic Sleep Questionnaire, a health and behavior questionnaire, physical activity and diet diaries, anthropometry, fat mass, and physical fitness. Analysis of covariance controlling for baseline values, and repeated-measures analysis of variance were implemented for time-by-group comparisons and within-group comparisons, respectively. ResultsAt six months, the exercise group showed reduced objective sleep onset latency (p = 0.010) and lowered frequency of difficulty initiating sleep (p = 0.021) than controls. Although a time-by-group difference was not significant, exercisers showed shorter objective wake after sleep onset (p = 0.004), reduced subjective nocturnal awakenings (p = 0.010), improved objective sleep efficiency (p < 0.001), and improved morning-rated subjective sleep quality (p = 0.042) at six months than baseline. ConclusionsA six-month aerobic exercise can improve sleep, mainly by mitigating difficulty of initiating sleep among overweight and obese men with chronic insomnia symptoms.

Testing social-cognitive mediators for objective estimates of physical activity from the Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN) study

Objective: More evidence from prospective studies is needed to determine ‘if’ and ‘how’ social cognitive constructs mediate behaviour change. In a longitudinal study, we aimed to examine potential social cognitive mediators of objectively measured physical activity (PA) behaviour among people with type 2 diabetes (T2D) who participated in a six-month PA intervention. Methods: All participants from the proven effective Healthy Eating and Active Living for Diabetes in Primary Care Networks trial were included for this secondary analysis. Change in pedometer-derived daily step counts (baseline to six months) was the outcome of interest. Primary constructs of interest were from Social Cognitive Theory, however constructs from and Theory of Planned Behaviour were also tested in a mediating variable framework using a product-of-coefficients test. Results: The sample (N = 198) had a mean age of 59.5 (SD 8.3) years, haemoglobin A1c 6.8% (SD 1.1), 50% women, BMI 33.6 kg/m2 (SD 6.5), systolic pressure 125.6 mmHg (SD 16.2) and average daily steps were 5879 (SD 3130). Daily pedometer-determined steps increased for the intervention group compared to usual care control at six-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p = .002). There was a significant action theory test effect for ‘planning’ (A = .21, SE = .10, p = .037), and significant conceptual theory test results for ‘subjective norms’ (B = 657, SE = 312, p = .037) and ‘cons’ (B = −664, SE = 270, p = .015). None of the constructs satisfied the criteria for mediation. Conclusions: We were unable to account for the effect of a pedometer-based PA intervention for people with T2D through our examination of mediators. Our findings are inconsistent with some literature concerning PA interventions in diabetes; this may be due to variability in measures used or in study populations.

Air-abrasive debridement with glycine powder versus manual debridement and chlorhexidine administration for the maintenance of peri-implant health status: a six-month randomized clinical trial.

This single-masked, randomized and six-month clinical intervention trial including two study groups was planned to evaluate the efficacy of maintenance treatment with glycine powder on the periodontal health of peri-implant tissues. A total of 46 patients with partial or total edentulism, carrying a total of 88 implants, were assigned either to an air abrasive with the glycine powder treatment group (AAD) or to a manual debridement and clorexidine administration treatment group (MDA). Clinical data were collected before treatment and at 3 and 6 months after the treatment. Plaque index (PI), bleeding index (BOP), probing depth (PD), clinical attachment level (CAL) and bleeding score (BS) were analysed. After 3 months, AAD treatment statistically significantly improved BS (P < 0.05); at 6 months, AAD treatment statistically significantly improved indexes PD, PI, BOP and BS (P < 0.05). In addition, the AAD treatment proved to be more effective than MDA in maintaining the peri-implant health of PD at three and 6 months, and of PI at 6 months (P < 0.05). There were no significant changes of CAL in both groups, and all the indexes remained within the physiological levels. Within the limits of the study, treatment with glycine seems appropriate in the maintenance of peri-implant health and more effective than the traditional treatment with plastic curette and chlorhexidine.

A Pilot Study of Parent Mentors for Early Childhood Obesity.

Objective. To assess the feasibility of a parent mentor model of intervention for early childhood obesity using positive deviance-based methods to inform the intervention. Methods. In this pilot, randomized clinical trial, parent-child dyads (age: 2–5) with children whose body mass index (BMI) was ≥95th percentile were randomized to parent mentor intervention or community health worker comparison. The child's height and weight were measured at baseline, after the six-month intervention, and six months after the intervention. Feasibility outcomes were recruitment, participation, and retention. The primary clinical outcome was BMI z-score change. Results. Sixty participants were enrolled, and forty-eight completed the six-month intervention. At baseline, the BMI z-score in the parent mentor group was 2.63 (SD = 0.65) and in the community health worker group it was 2.61 (SD = 0.89). For change in BMI z-score over time, there was no difference by randomization group at the end of the intervention: −0.02 (95% CI: −0.26, 0.22). At the end of the intervention, the BMI z-score for the parent mentor group was 2.48 (SD = 0.58) and for the community health worker group it was 2.45 (SD = 0.91), both reduced from baseline, p < 0.001. Conclusion. The model of a parent mentor clinical trial is feasible, and both randomized groups experienced small, sustained effects on adiposity in an obese, Hispanic population.

Simplified Tai Chi Program Training versus Traditional Tai Chi on the Functional Movement Screening in Older Adults.

Background. The present study aimed to evaluate and compare the effect of two different types of Tai Chi programs on the Functional Movement Screening (FMS) in older adults. Methods. Ninety older adults (65.5 ± 4.6 years old) who met the eligibility criteria were randomized into three different groups based on a ratio of 1 : 1 : 1: a traditional Tai Chi exercise (TTC), a simplified Tai Chi exercise (TCRT), or a control group (routine activity). The FMS consisted of the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg rise, trunk stability push-up, and rotatory stability, which was used to measure physical function before the present study and after six months of Tai Chi interventions. Results. Seventy-nine participants completed the present study (control = 27, TTC = 23, and TCRT = 29). Significant improvement on the FMS tests between the baseline and after the six-month intervention was observed in both Tai Chi programs, whereas no significant improvement was observed in the control group. In addition, participants in the TCRT group demonstrated greater improvement than those in the TTC group. Conclusions. The TCRT is more effective in improving the physical function in older adults when compared to the traditional Tai Chi modality, particularly for improving balance.

Evaluation of a Nutrition Intervention through a School-Based Food Garden to Improve Dietary Consumption, Habits and Practices in Children from the Third to Fifth Grade in Chile

Objective: Use a school-based food garden as an instrument to improve healthy dietary consumption, habits, and practices among children from the third to fifth grade in public schools in Chile. Design: Quasi-experimental, six-month intervention with an evaluation of dietary consumption, habits, and practices and use of the school-based food garden among the 3rd to 5th grade students. Setting: Two municipal schools in a low-middle income district in Santiago de Chile; one with a school garden intervention and a control school without a garden. Subjects: 155 third to fifth grade children, 63 in the intervention school and 92 in the control school (average age 10 years old, 58% boys). Results: In the intervened school, there was a significant improvement in the children’s dietary habits, such as peeling and slicing fruit (p Conclusions: The school-based food garden was effective in achieving change in dietary habits and practices among the third to fifth grade children. The project should be carried out for a longer period of time, so that the changes will be reflected in the students’ food consumption and nutritional status.

Feasibility and acceptability of Facebook for health promotion among people with serious mental illness

ObjectiveElevated obesity rates are a major contributor to the significantly reduced life expectancy impacting people with serious mental illness. With over 1.5 billion Facebook users worldwide, this platform may afford opportunities for reaching individuals with serious mental illness outside professional settings and fostering social support for adopting healthier behaviors. In this mixed methods pilot study, we explored the feasibility and acceptability of using Facebook to support a group lifestyle intervention for weight loss among obese adults with serious mental illness.MethodsNine of eleven participants enrolled in a six-month lifestyle intervention delivered through a community mental health center agreed to join a private Facebook group to support their healthy eating and exercise goals. We measured participants’ use of the Facebook group and collected post-intervention feasibility and acceptability questionnaires followed by in-depth qualitative interviews to elicit participants’ perspectives and recommendations for improving the use of Facebook.ResultsOf 188 posts to the Facebook group, the majority (79%) were from participants compared to study staff (21%). Participants also posted 186 comments, 299 likes, and recorded 1316 page views. Participants were positive about opportunities to interact and support each other outside group sessions, found content posted by other participants to be helpful, and indicated that the Facebook group was safe to use. Participants provided constructive feedback, including recommendations for more detailed instructions for accessing the group and posting content, finding ways to encourage more interaction within the group, and tips for responding to notifications or alerts directly from the Facebook website.ConclusionsThese findings suggest that Facebook may be feasible for supporting health promotion efforts targeting people with serious mental illness. Participants provided valuable feedback that can inform the use of Facebook for future health promotion efforts targeting this high-risk group.

Reduction of sitting time has a positive effect on the decrease of insulin resistance in patients with non-alcoholic fatty liver disease.

IntroductionNon-alcoholic fatty liver disease (NAFLD) affects a large part of the human population. One of the major environmental factors associated with the risk of NAFLD is the lack of physical activity.AimTo compare the level of physical activity and the insulin resistance in NAFLD patients.Material and methodsThirty patients with NAFLD underwent a six-month dietary intervention based on the principles of classical dietetics. Data about diet and physical activity was based on 72-hour nutrition diaries and International Physical Activity Questionnaire (IPAQ). Standard blood biochemical analyses were carried out before and after diet at the University Hospital Laboratory.ResultsThe study showed that total physical activity and physical activity in leisure time are negatively correlated with insulin resistance (HOMA-IR) (p < 0.05). Insulin (p < 0.05), body weight (p < 0.05), and waist-hip ratio (WHR) (p < 0.05) were also negatively correlated with physical activity in free time. In addition, we noticed a positive correlation between sitting time and the risk of insulin resistance, in the case of HOMA-IR and insulin concentration (p < 0.05).ConclusionsDietary intervention and a physical activity plan are important factors in the treatment of non-alcoholic fatty liver disease. Taking regular exercise increases insulin sensitivity and prevents further development of the disease. It seems that diet and physical activity are not the only one risk factors of NAFLD. Our study reveals that the reduction of sitting time has a positive effect on the level of insulin and it reduces insulin resistance in patients with NAFLD.

The Effects of Psychological Skills Training on Mental Toughness and Psychological Well-Being of Student-Athletes

This study examined the effects of a psychological skills intervention (PST) designed to enhance the mental toughness and psychological well-being of student-athlete rowers (N = 16). Within this context, PWB was conceptualized by an amalgamation of the following psychological constructs; self-esteem, perceived self-efficacy, positive affect and dispositional optimism. Progress was examined at three times evenly dispersed over the course of the six-month intervention, pre-, mid- and post-intervention. The intervention was solution-focused and informed by Dweck’s (2009) theory of a growth mindset and Goldberg’s (1998) psychological strategies to develop mental toughness. The study design was a 2 (group) × 3 (time) two-way MANOVA with repeated measures on one factor (time). Various measures of mental toughness and positive psychological constructs were utilised. Over the course of the intervention, MT significantly improved, in addition to perceived self-efficacy, self-esteem and positive affect. Positive significant relationships were observed between components of MT and each of the positive measures; which lends support to the conceptualization of MT as a positive psychological construct which fosters positive psychological states (Clough & Strycharczyk, 2012). Further research is warranted to examine the development of MT on negative psychological constructs.

Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial.

The recently developed Healthy Beverage Index (HBI) was designed to evaluate overall beverage intake quality (including total fluid consumption and beverage calories), yet no known intervention studies have assessed longitudinal changes to the HBI. The objective of this investigation was to assess changes in HBI scores in response to a sugar-sweetened beverage (SSB) reduction trial as compared to a physical activity comparison group. Participants were enrolled into a six-month, community-based, controlled behavioral trial and randomized into either a SSB reduction group (SIPsmartER) or a physical activity group (MoveMore). Correlations and multilevel mixed-effects linear regression with intention-to-treat analyses are presented. Total HBI score significantly increased for SIPsmartER (n = 149) (mean increase = 7.5 points (5.4, 9.7), p ≤ 0.001) and MoveMore (n = 143) (mean increase = 3.4 points (1.6, 5.2), p ≤ 0.001) participants, with a significant between group effect (p ≤ 0.05), over the six-month intervention. Other significant changes in HBI components for SIPsmartER included increased SSB and total beverage calorie scores, and decreased low-fat milk and diet soda scores. Changes in total HBI scores were significantly correlated with changes in total Healthy Eating Index-2010 scores (r = 0.15, p ≤ 0.01). Our findings suggest that individual HBI component scores, beyond the SSB component, are influenced by intervention strategies that primarily focus on SSB reduction.

Managing Medication Adherence in Elderly Hypertensive Patients Through Pharmacist Home Visits.

The purpose of the Managing Your Blood Pressure program was to reduce health disparities in blood pressure (BP) control by improving medication adherence in a cohort of geriatric African-Americans with hypertension (HTN). The program was implemented using a quasi-experimental pre- and postintervention study design that utilized a pharmacist home-based model and follow-up educational phone calls to impact BP over a six-month period. Home visits occurred in participants' residences, and phone calls occurred at program headquarters at Texas Southern University (Houston, Texas). The primary outcome measure was BP control rate, and secondary outcome measures were knowledge of HTN, medication adherence, and use of a BP monitor. At six months, 306 of the 431 patients recruited completed all phases of the program (two in-home consultations and biweekly telephone consultations). At the end of the six-month intervention period, the reduction in mean systolic BP was statistically significant (baseline 140 mmHg vs. six months 137 mmHg; P < 0.049). No difference in mean diastolic BP pre- and postintervention was found. The percent of patients with controlled BP improved from 46.7% to 49.5%; P = 0.34. Medication adherence, self-monitoring of BP, and knowledge of HTN were significantly improved from baseline to postintervention. Pharmacist-led interventions in the home were effective in improving BP control and medication adherence. Further programs are needed to address uncontrolled HTN in this vulnerable population.

A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States.

Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity.

Did you get your shots? Experimental evidence on the role of reminders

Many families fail to vaccinate their children despite the supply of these services at no cost. This study tests whether personal reminders can increase demand for vaccination. A field experiment was conducted in rural Guatemala in which timely reminders were provided to families whose children were due for a vaccine. The six-month intervention increased the probability of vaccination completion by 2.2 percentage points among all children in treatment communities. Moreover, for children in treatment communities who were due to receive a vaccine, and whose parents were expected to be reminded about that due date, the probability of vaccination completion increased by 4.6 percentage points. The cost of an additional child with complete vaccination due to the intervention is estimated at about $7.50.

Metabolites of arachidonic acid and linoleic acid in early stages of non-alcoholic fatty liver disease—A pilot study

BackgroundNonalcoholic fatty liver disease (NAFLD) is a spectrum of liver conditions related to fat infiltration. The role of liver triacylglycerol accumulation in NAFLD is not fully understood. MethodsTwenty-four patients, 12 in the first and 12 in the second stage of NAFLD, were prospectively enrolled in this study. Biochemical parameters and eicosanoids (HETE and HODE) were compared between the first and the second stage of hepatic steatosis and the effect of a 6-month dietary intervention on these parameters was evaluated. Eicosanoid profiles were extracted from 0.5ml of plasma using solid-phase extraction RP-18 SPE columns. The HPLC separations were performed on a 1260 liquid chromatograph. ResultsPatients with stage I NAFLD had a significantly higher level of HDL cholesterol and a lower level of 5-HETE. Patients with grade II steatosis had higher concentrations of 9-HODE. Following the six-month dietary intervention, hepatic steatosis resolved completely in all patients. This resulted in a significant decrease in the concentrations of all eicosanoids (LX4, 16-HETE, 13-HODE, 9-HODE, 15-HETE, 12-HETE, 5-oxoETE, 5-HETE) and key biochemical parameters (BMI, insulin, HOMA-IR, liver enzymes). ConclusionA significant reduction in the analyzed eicosanoids and a parallel reduction in fatty liver confirmed the usefulness of HETE and HODE in the assessment of NAFLD.

The effects of music composition as a classroom activity on engagement in music education and academic and music achievement: A quasi-experimental study

The present study aims to contribute to the understanding of the effects of music education, in particular music composition as a classroom activity for fifth- and sixth-graders. The intervention (experimental condition) focused on a three-step-model for music composition, based on the Cultural Historical Activity Theory of education, and has been compared with a teacher-centered approach mainly based on students’ reproduction of music (control condition). Results indicated that after the six-month intervention period, students in the experimental group were more engaged in music education compared to students in the control group. The research did not show a statistical difference in learning outcomes with regard to intelligence, academic achievement and music achievement, although the students of the experimental group performed better with regard to reading comprehension than their counterparts in the control group. The authors conclude that music composition as a classroom activity is feasible and useful in elementary schools.

Effects of a DVD-delivered exercise intervention on physical function in older adults with multiple sclerosis: A pilot randomized controlled trial.

BackgroundOlder adults with multiple sclerosis (MS) exhibit disease-related impairments such as compromised strength, balance, mobility, coordination, and quality of life (QOL). Exercise training as an intervention to reverse these conditions in older adults with MS is limited.ObjectiveThe objective of this pilot trial was to examine the effects of a DVD exercise intervention targeting flexibility, strength, and balance in older adults with MS in order to generate effect sizes to power a larger trial.MethodsParticipants were randomly assigned to a six-month DVD exercise intervention (n = 24) or a healthy aging DVD control condition (n = 24). Measures of physical function, physical activity, sedentary behavior, QOL and program satisfaction were assessed at baseline and at follow-up.ResultsThe DVD exercise intervention was well received with no adverse events. Effects sizes ranged from small to modest reflecting improved function, increased physical activity, decreased sitting time, and improved QOL in the intervention condition compared to the control condition.ConclusionThis pilot randomized controlled trial suggests that older adults with MS are receptive to an exercise program via DVD, and the program results in modest but potentially important improvements in function and physical activity.

Entering the Historical Problem Space: Whole-Class Text-Based Discussion in History Class

Background/ContextThe Common Core State Standards reveals how little we understand about the components of effective discussion-based instruction in disciplinary history. Although the case for classroom discussion as a core method for subject matter learning stands on stable theoretical and empirical ground, to date, none of the research on classroom discussion has examined whole-class text-based discussion in secondary history classrooms.PurposeThis study explored how teachers and students in five 11th-grade classrooms participated in whole-class discussion, using intervention materials designed to promote text-based disciplinary discussion. Analysis of videotaped instruction sought to (a) determine the degree to which the instructional materials fostered disciplinary discussion about texts, and (b) analyze teacher talk moves that characterized effective facilitation of such discussions.Research DesignThis qualitative study was embedded in a larger quasi-experimental curricular intervention that found treatment effects on factual recall, historical thinking, and general reading comprehension. In this paper, we analyze classroom videos from five treatment classrooms taken over the course of the six-month intervention. Each teacher was videotaped once per week, for a total of 20 videotaped lessons per teacher.Findings/ResultsAnalyses showed that disciplinary discussion was surprisingly rare, and discussion that promoted historical understanding even rarer. Discussions that were most successful in deepening students’ historical understanding were characterized by talk moves that drew students’ attention to the text, and that stabilized the historical content.Conclusions/RecommendationsThe study has implications for teacher preparation focused on implementation of Common Core State Standards as well as for teacher training in do-main-specific core practices.

A cluster randomised feasibility trial evaluating six-month nutritional interventions in the treatment of malnutrition in care home-dwelling adults: recruitment, data collection and protocol.

BackgroundProtein energy malnutrition predisposes individuals to disease, delays recovery from illness and reduces quality of life. Care home residents are especially vulnerable, with an estimated 30%–42% at risk. There is no internationally agreed protocol for the nutritional treatment of malnutrition in the care home setting. Widely used techniques include food-based intervention and/or the use of prescribed oral nutritional supplements, but a trial comparing the efficacy of interventions is necessary. In order to define outcomes and optimise the design for an adequately powered, low risk of bias cluster randomised controlled trial, a feasibility trial with 6-month intervention is being run, to assess protocol procedures, recruitment and retention rates, consent processes and resident and staff acceptability.MethodsTrial recruitment began in September 2013 and concluded in December 2013. Six privately run care homes in Solihull, England, were selected to establish feasibility within different care home types. Residents with or at risk of malnutrition with no existing dietetic intervention in place were considered for receipt of the allocated intervention. Randomisation took place at the care home level, using a computer-generated random number list to allocate each home to either a dietetic intervention arm (food-based or prescribed supplements) or the standard care arm, continued for 6 months. Dietetic intervention aimed to increase daily calorie intake by 600 kcal and protein by 20–25 g.ResultsThe primary outcomes will be trial feasibility and acceptability of trial design and allocated interventions. A range of outcome assessments and data collection tools will be evaluated for feasibility, including change in nutrient intake, anthropometric parameters and patient-centric measures, such as quality of life and self-perceived appetite.ConclusionsThe complexities inherent in care home research has resulted in the under representation of this population in research trials. The results of this feasibility trial will be used to inform the development and design of a future cluster randomised controlled trial to compare food-based intervention with prescribed oral nutritional supplements (ONS) in the treatment of malnutrition within the care home population.Trial registrationCurrent Controlled Trials ISRCTN38047922 Electronic supplementary materialThe online version of this article (doi:10.1186/2055-5784-1-3) contains supplementary material, which is available to authorized users.

Exercise for Mild Balance Dysfunction: Research into Practice.

The objective of this study was to determine whether improved balance outcomes achieved in a randomized controlled trial (RCT) using balance screening to identify mild balance dysfunction and home exercises could be translated into community settings. Community-dwelling people aged over 65 who expressed concerns about their balance, had less than two falls in the preceding 12 months, and who had mild balance impairment on screening were given an individualized home-based balance and strengthening exercise program with intermittent home-visit support by a physiotherapist. Of 71 participants assessed (mean age 77.3 years, 76% female), 58 (82%) completed the six-month intervention. Twenty six percent of participants regained balance performance within normal limits--similar to those achieved in the previous RCT. Successful results from a previous RCT were able to be translated into community settings, with a similar magnitude of effect on balance and mobility.