Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents

Authors

  • John F. Schnelle PhD,

    1. UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California;
    2. Veterans Affairs (VA) Greater Los Angeles Healthcare System, Sepulveda Geriatric Research, Education and Clinical Center, Los Angeles, California;
    3. UCLA/Los Angeles Jewish Home for the Aging, Borun Center, Reseda, California;
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  • Cathy A. Alessi MD,

    1. UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California;
    2. Veterans Affairs (VA) Greater Los Angeles Healthcare System, Sepulveda Geriatric Research, Education and Clinical Center, Los Angeles, California;
    3. UCLA/Los Angeles Jewish Home for the Aging, Borun Center, Reseda, California;
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  • Sandra F. Simmons PhD,

    1. UCLA/Los Angeles Jewish Home for the Aging, Borun Center, Reseda, California;
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  • Nahla R. Al-Samarrai MS,

    1. UCLA/Los Angeles Jewish Home for the Aging, Borun Center, Reseda, California;
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  • John C. Beck MD,

    1. UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California;
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  • Joseph G. Ouslander MD

    1. Emory University, Division of Geriatric Medicine and Gerontology, Wesley Woods Center, Atlanta, Georgia; and
    2. Atlanta VA Rehabilitation Research and Development Center, Atlanta, Georgia.
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Address correspondence to John F. Schnelle, PhD, UCLA/Jewish Home Borun Center, 7150 Tampa Avenue, Reseda, CA 91335. E-mail: jschnell@ucla.edu

Abstract

OBJECTIVES: To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention.

DESIGN: Randomized controlled trial with blinded assessments of outcomes at three points over 8 months.

SETTING: Four nursing homes.

PARTICIPANTS: Two hundred fifty-six incontinent residents.

INTERVENTION: Research staff provided the intervention, which integrated incontinence care and exercise every 2 hours from 8:00 a.m. to 4:00 p.m. 5 days a week.

MEASUREMENTS: Average and maximum distance walked or wheeled, level of assistance required to stand, maximum pounds lifted by arms, fecal and urinary incontinence frequency, and time required to implement intervention.

RESULTS: Intervention residents maintained or improved performance whereas the control group's performance declined on 14 of 15 outcome measures. Repeated measures analysis of variance group-by-time significance levels ranged from P < .0001 to .05. The mean time required to implement the intervention each time care was provided was 20.7 ± 7.2 minutes. We estimate that a work assignment of approximately five residents to one aide would be necessary to provide this intervention.

CONCLUSIONS: The incontinence care and exercise intervention resulted in significant improvement for most residents, and most who could be reliably interviewed expressed a preference for such care. Fundamental changes in the staffing of most nursing homes will be necessary to translate efficacious clinical interventions into everyday practice.

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