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Published (Version of record)CC BY V4.0, Open Access
Published (Version of record)CC BY V4.0, Open
Journal article
Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial
PLoS Medicine, Vol.17(2), pp.1-24
18/02/2020
PMCID: PMC7028259
PMID: 32069288
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Abstract
We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0–3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0–3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference −0.2, 95% CI −2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%–19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes.
Details
- Title
- Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial
- Creators
- Leanne Hassett - University of SydneyMaayken van den Berg - Flinders UniversityRichard I Lindley - University of SydneyMaria Crotty - Flinders UniversityAnnie McCluskey - University of SydneyHidde P van der Ploeg - Vrije Universiteit AmsterdamStuart T Smith - Southern Cross UniversityKarl Schurr - StrokeEd CollaborationKirsten Howard - University of SydneyMaree L Hackett - University of New South WalesMaggie Killington - Flinders UniversityBert Bongers - University of Technology SydneyLeanne Togher - University of SydneyDaniel Treacy - University of SydneySimone Dorsch - StrokeEd CollaborationSiobhan Wong - University of SydneyKatharine Scrivener - StrokeEd CollaborationSakina Chagpar - University of SydneyHeather Weber - Flinders UniversityMarina Pinheiro - University of SydneyStephane Heritier - Monash UniversityCatherine Sherrington - University of Sydney
- Publication Details
- PLoS Medicine, Vol.17(2), pp.1-24
- Publisher
- Public Library of Science; United States
- Grant note
- This work was supported by an Australian National Health and Medical Research Council Project Grant (APP1063751). CS receives salary funding from an Australian National Health and Medical Research Council Fellowship.
- Identifiers
- 991012925687702368
- Copyright
- Copyright: © 2020 Hassett et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
- Academic Unit
- School of Health and Human Sciences; Faculty of Health
- Language
- English
- Resource Type
- Journal article