Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial
Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health c...
Published in: | Journal of the American Medical Directors Association |
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2021
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ftunivhelsihelda:oai:helda.helsinki.fi:10138/332479 2024-01-07T09:44:31+01:00 Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial Suikkanen, Sara A. Soukkio, Paula K. Aartolahti, Eeva M. Kautiainen, Hannu Kääriä, Sanna Hupli, Markku T. Sipilä, Sarianna Pitkälä, Kaisu Kukkonen- Harjula, Katriina HYKS erva South Carelia Social and Health care District Eksote Clinicum Department of General Practice and Primary Health Care Helsinki University Hospital Area Teachers' Academy 2021-07-17T22:33:20Z 7 application/pdf http://hdl.handle.net/10138/332479 eng eng EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC 10.1016/j.jamda.2020.06.005 Suikkanen , S A , Soukkio , P K , Aartolahti , E M , Kautiainen , H , Kääriä , S , Hupli , M T , Sipilä , S , Pitkälä , K & Kukkonen- Harjula , K 2021 , ' Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial ' , Journal of the American Medical Directors Association , vol. 22 , no. 4 , pp. 773-779 . https://doi.org/10.1016/j.jamda.2020.06.005 ORCID: /0000-0001-9659-6985/work/95495713 2a79fbaa-e3d6-4a43-b24f-b7b6a08f18b3 http://hdl.handle.net/10138/332479 000637317600011 cc_by_nc_nd openAccess info:eu-repo/semantics/openAccess 3121 General medicine internal medicine and other clinical medicine Article acceptedVersion 2021 ftunivhelsihelda 2023-12-14T00:01:40Z Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17. Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group Conclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months. (c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. ... Article in Journal/Newspaper karelia* HELDA – University of Helsinki Open Repository Journal of the American Medical Directors Association 22 4 773 779 |
institution |
Open Polar |
collection |
HELDA – University of Helsinki Open Repository |
op_collection_id |
ftunivhelsihelda |
language |
English |
topic |
3121 General medicine internal medicine and other clinical medicine |
spellingShingle |
3121 General medicine internal medicine and other clinical medicine Suikkanen, Sara A. Soukkio, Paula K. Aartolahti, Eeva M. Kautiainen, Hannu Kääriä, Sanna Hupli, Markku T. Sipilä, Sarianna Pitkälä, Kaisu Kukkonen- Harjula, Katriina Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
topic_facet |
3121 General medicine internal medicine and other clinical medicine |
description |
Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17. Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group Conclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months. (c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine. ... |
author2 |
HYKS erva South Carelia Social and Health care District Eksote Clinicum Department of General Practice and Primary Health Care Helsinki University Hospital Area Teachers' Academy |
format |
Article in Journal/Newspaper |
author |
Suikkanen, Sara A. Soukkio, Paula K. Aartolahti, Eeva M. Kautiainen, Hannu Kääriä, Sanna Hupli, Markku T. Sipilä, Sarianna Pitkälä, Kaisu Kukkonen- Harjula, Katriina |
author_facet |
Suikkanen, Sara A. Soukkio, Paula K. Aartolahti, Eeva M. Kautiainen, Hannu Kääriä, Sanna Hupli, Markku T. Sipilä, Sarianna Pitkälä, Kaisu Kukkonen- Harjula, Katriina |
author_sort |
Suikkanen, Sara A. |
title |
Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
title_short |
Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
title_full |
Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
title_fullStr |
Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
title_full_unstemmed |
Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial |
title_sort |
effects of home-based physical exercise on days at home and cost-effectiveness in pre-frail and frail persons : randomized controlled trial |
publisher |
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC |
publishDate |
2021 |
url |
http://hdl.handle.net/10138/332479 |
genre |
karelia* |
genre_facet |
karelia* |
op_relation |
10.1016/j.jamda.2020.06.005 Suikkanen , S A , Soukkio , P K , Aartolahti , E M , Kautiainen , H , Kääriä , S , Hupli , M T , Sipilä , S , Pitkälä , K & Kukkonen- Harjula , K 2021 , ' Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons : Randomized Controlled Trial ' , Journal of the American Medical Directors Association , vol. 22 , no. 4 , pp. 773-779 . https://doi.org/10.1016/j.jamda.2020.06.005 ORCID: /0000-0001-9659-6985/work/95495713 2a79fbaa-e3d6-4a43-b24f-b7b6a08f18b3 http://hdl.handle.net/10138/332479 000637317600011 |
op_rights |
cc_by_nc_nd openAccess info:eu-repo/semantics/openAccess |
container_title |
Journal of the American Medical Directors Association |
container_volume |
22 |
container_issue |
4 |
container_start_page |
773 |
op_container_end_page |
779 |
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1787425918402166784 |