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

doi:10.1046/j.1532-5415.2002.50401.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 50 Issue 9, Pages 1476 - 1483

Published Online: 17 Oct 2002

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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

John F. Schnelle, PhD,* ^† ^‡ Cathy A. Alessi, MD,* ^† ^‡ Sandra F. Simmons, PhD, ^‡ Nahla R. Al-Samarrai, MS, ^‡ John C. Beck, MD,* and Joseph G. Ouslander, MD ^§ ^‖

*UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California; ^† Veterans Affairs (VA) Greater Los Angeles Healthcare System, Sepulveda Geriatric Research, Education and Clinical Center, Los Angeles, California; ^‡ UCLA/Los Angeles Jewish Home for the Aging, Borun Center, Reseda, California; ^§ Emory University, Division of Geriatric Medicine and Gerontology, Wesley Woods Center, Atlanta, Georgia; and ^‖ Atlanta VA Rehabilitation Research and Development Center, Atlanta, Georgia.

Address correspondence to John F. Schnelle, PhD, UCLA/Jewish Home Borun Center, 7150 Tampa Avenue, Reseda, CA 91335. E-mail: jschnell@ucla.edu

KEYWORDS

practice guidelines • dissemination barriers • labor requirements

J Am Geriatr Soc 50:1476–1483, 2002.

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.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1046/j.1532-5415.2002.50401.x About DOI