journal appraisal -janel
TRANSCRIPT
-
8/16/2019 Journal Appraisal -Janel
1/33
Janelcris G. EnriquezCommunity Clerk August 2014
JOURNALAPPRAISA
L
COMMUNITYMEDICINE
-
8/16/2019 Journal Appraisal -Janel
2/33
Community-ase! Grou"E#ercise Im"ro$es
%alance an! Re!uces&alls in At-ris' Ol!er
Peo"le
a randomized controlled trial
-
8/16/2019 Journal Appraisal -Janel
3/33
• O%JEC(I)E*
To determine weter !"rti#i!"tion
in " weekly grou! e$er#ise!rogr"mme wit "n#ill"ry omee$er#ises o%er one ye"r im!ro%es
&"l"n#e' mus#le strengt' re"#tiontime' !ysi#"l (un#tioning' e"ltst"tus "nd !re%ents ("lls in "t)risk
#ommunity)dwelling older !eo!le*
• +ESIGN+
A r"ndomi,ed #ontrolled tri"l
-
8/16/2019 Journal Appraisal -Janel
4/33
SE((ING AN+ SU%JEC(S
Te su&-e#ts were dr"wn (rom.01 !eo!le "ged ./ ye"rs "ndolder wo "ttended one o( 24
gener"l !r"#ti#e #lini#s or two"#ute os!it"l !ysioter"!yde!"rtments in out estern
ydney' Austr"li"*
-
8/16/2019 Journal Appraisal -Janel
5/33
SE((ING AN+ SU%JEC(S
• #reening "ssessments+ –"n in"&ility to st"nd (rom " 4/ #m
ig #"ir in less t"n 2 se#onds
–" need to ste! to m"int"in &"l"n#ewen !er(orming " ne"r)t"ndem&"l"n#e test
– in"&ility to #"t# " rod dro!!ed(rom "&o%e te "nd witin 300millise#onds*
-
8/16/2019 Journal Appraisal -Janel
6/33
IN(ER)EN(ION
• u&-e#ts r"ndomised to teinter%ention "rm "ttended " weeklystru#tured e$er#ise grou! run in "
#ommunity setting* An "##reditede$er#ise instru#tor tr"ined to !ro%idete s"me !rogr"mme led e"# #l"ss*
• Te #l"ss #ontent w"s designed &y "!ysioter"!ist to s!e#i5#"lly "ddress!ysi#"l ("lls risk ("#tors*
-
8/16/2019 Journal Appraisal -Janel
7/33
IN(ER)EN(ION
• 6un#tion"l e$er#ises –sit to st"nd !r"#ti#e
–weigt tr"ns(eren#e
– re"#ing were "n im!ort"nt !"rt o(te grou! e$er#ise*
– Tere w"s " 10)minute #ool downwere te !"rti#i!"nts !er(ormedgentle stret#es "nd ten in "se"ted !osition !r"#ti#ed
rel"$"tion "nd #ontrolled
-
8/16/2019 Journal Appraisal -Janel
8/33
RESUL(S
• At aseline ot, rou"s ere ellmatc,e! in t,eir ",ysical "er/ormance0,ealt, an! acti$ity le$els.
•
At retest0 t,e e#ercise rou" "er/orme!sini1cantly etter t,an t,e controls int,ree o/ si# alance measures2.
• 3it,in t,e 45-mont, trial "erio!0 t,e
rate o/ /alls in t,e inter$ention rou"as 678 loer t,an t,at o/ t,e controlrou" 9IRR:7.;70 ;?7.
-
8/16/2019 Journal Appraisal -Janel
9/33
-
8/16/2019 Journal Appraisal -Janel
10/33
-
8/16/2019 Journal Appraisal -Janel
11/33
CONCLUSION
• Tese 5ndings indi#"te t"t!"rti#i!"tion in " weekly grou!e$er#ise !rogr"mme wit "n#ill"ryome e$er#ises #"n im!ro%e &"l"n#e"nd redu#e te r"te o( ("lling in "t)risk #ommunity dwelling older
!eo!le*
-
8/16/2019 Journal Appraisal -Janel
12/33
CRI(ICAL APPRAISAL
7rim"ry 8"lidity
9uidelines+ :Yes;No<
-
8/16/2019 Journal Appraisal -Janel
13/33
Was the assignment of patients to
treatment randomized?
ES.
-
8/16/2019 Journal Appraisal -Janel
14/33
Were all patients who entered the trial properlyaccounted for and attributed at its conclusion?
ES.
-
8/16/2019 Journal Appraisal -Janel
15/33
Were all patients who entered the trial properlyaccounted for and attributed at its conclusion?
es0 "atients ere "ro"erly
accounte!0 an! attriute!.
-
8/16/2019 Journal Appraisal -Janel
16/33
Was follow-up complete? Dropouts,withdrawals
es0 all "atients t,at "artici"ate! int,e stu!y /olloe! u" t,rou,out t,e
!uration o/ t,e stu!y.(,ere as B it,!raals /rom e#ercise
rou" ,ile ; on control rou".
-
8/16/2019 Journal Appraisal -Janel
17/33
Were patients analyzed in the groupsto which they were randomized?
es0 t,e "artici"ants ereanalyze! it,in t,e rou"s
to ,ic, t,ey areran!omize!.
-
8/16/2019 Journal Appraisal -Janel
18/33
CRI(ICAL APPRAISAL
e#ond"ry 8"lidity
9uidelines
-
8/16/2019 Journal Appraisal -Janel
19/33
Were patients, their clinicians, andstudy personnel “blind” to treatment?
es0 (,ree assessors lin! totreatment status a!ministere!
t,e ",ysical "er/ormance an!eneral ,ealt, measureassessments.
-
8/16/2019 Journal Appraisal -Janel
20/33
Were the groups similar at the startof the trial?
es0 t,e aselinec,aracteristics o/ eac,
rou" ere similar at t,estart o/ t,e trial.
-
8/16/2019 Journal Appraisal -Janel
21/33
-
8/16/2019 Journal Appraisal -Janel
22/33
Aside from the experimental interention,were the groups treated e!ually?
es0 all "atients recei$e!t,e a""ro"riate treatment.
-
8/16/2019 Journal Appraisal -Janel
23/33
"# $%& #$'D( )A*"D?
ES.
(,e "rimary $ali!ity ui!equestions as ell as t,e secon!ary$ali!ity ui!e questions ere
ansere! ell.
-
8/16/2019 Journal Appraisal -Janel
24/33
-
8/16/2019 Journal Appraisal -Janel
25/33
OU(COE
EDERCISE GROUP)S. CON(ROL
GROUP
OU(COE
RIS O& OU(COE
:=< :)<
(reate!9@ " & :aF9a@
Control9D@ # d D :cF9c!@
(reate!9@ >3 ? : H>F9H>B@ :
7.0 .
: H>F9H>B@ :7.
-
8/16/2019 Journal Appraisal -Janel
26/33
E#"erimental E$ent Rate 9EER@
• A me"sure o( ow o(ten " !"rti#ul"r st"tisti#"le%ent :su# "s res!onse to " drug< o##urs witinte e$!eriment"l grou! :non)#ontrol grou!< o( "ne$!eriment
• In te tre"tment grou!' num&er o( !"tients wit:=< out#ome di%ided &y tot"l num&er o( !"tients
No 7$s wit out#ome @ "
Tot"l no o( !"tients :"=&<
EEB E$er#ise grou! 0*22
-
8/16/2019 Journal Appraisal -Janel
27/33
Control E$ent Rate 9CER
• A me"sure o( ow o(ten " !"rti#ul"r st"tisti#"le%ent :su# "s res!onse to " drug< o##urs witinte s#ienti5# #ontrol grou! o( "n e$!eriment*
• In te #ontrol grou!' num&er o( !"tients wit :=<
out#ome di%ided &y tot"l num&er o( !"tients
No o( 7Fs wit out#ome @ &
Tot"l no o( !"tients :&=d<
CEB Control grou! 0*30
-
8/16/2019 Journal Appraisal -Janel
28/33
o lare as
t,e treatment
eKect
-
8/16/2019 Journal Appraisal -Janel
29/33
Relati$e Ris' or Ris'Ratio 9RR@
• te risk o( te out#ome o##urring inte inter%ention grou! #om!"redwit te #ontrol grou!*
• BB @ EEB;CEB
• BB :E$er#ise grou! %s* #ontrol grou!<@ 0*22;0*33 @ 0*>>
-
8/16/2019 Journal Appraisal -Janel
30/33
Asolute Ris' Re!uction9ARR@
• !ecrease in ris' o/ a i$en acti$ity 9ortreatment@ in relation to a control acti$ity.
• Bisk o( te out#ome in te #ontrol grou! risk o(te out#ome in te tre"tment grou!*
• ARR 9E#ercise rou" $s. control rou"@ :CER-EER:
0*22)0*33 @ 0*011
• Te "&solute &ene5t o( tre"tment is " 11Gredu#tion in te out#ome (or e$er#ise grou! %s*#ontrol grou!*
-
8/16/2019 Journal Appraisal -Janel
31/33
o lare as t,e treatmenteKect
• T"ke te in%erse o( te ABB wi# tells us tenum&er o( !"tients t"t weHd need to tre"t wit tee$!eriment"l ter"!y in order to !re%ent one"ddition"l &"d e%ent*
• Numer Nee!e! to treat 9NN(@ 9e#ercise rou"$s. control rou"@ : 4 F ARR : 4F7.744 :
-
8/16/2019 Journal Appraisal -Janel
32/33
+A $%& '*$ .& A//*"&D $0 1(/A$"&$ +A&?
ES.
-
8/16/2019 Journal Appraisal -Janel
33/33
W&& A** +*""+A**( "1/0$A$0'$+01 +0#"D&&D?
es0 all rele$ant outcomesere consi!ere!.