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Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents
Author(s) -
Schnelle John F.,
Alessi Cathy A.,
Simmons Sandra F.,
AlSamarrai Nahla R.,
Beck John C.,
Ouslander Joseph G.
Publication year - 2002
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1046/j.1532-5415.2002.50401.x
Subject(s) - medicine , staffing , randomized controlled trial , physical therapy , urinary incontinence , intervention (counseling) , psychological intervention , repeated measures design , clinical trial , nursing homes , nursing , gerontological nursing , surgery , statistics , mathematics
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.