Optimizing a complex intervention for community-dwelling frail older adults: A factorial randomized trial within the multiphase optimization strategy framework

IF 7.1 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2025-08-06 DOI:10.1016/j.ijnurstu.2025.105181

Xuemei Sun , Yinyan Gao , Jinlu Song , Wenqi Liu , Linqi Li , Hui Sun , Weiru Zhang , Irene X.Y. Wu

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引用次数: 0

Abstract

Background

The effectiveness of resistance exercise in improving frailty among community-dwelling frail older adults has been well-proved. However, poor adherence has threatened its effectiveness.

Objective

To optimize a previously developed complex intervention to enhance its efficiency and disseminability.

Design

2 × 2 × 2 full factorial randomized trial.

Settings

This study was conducted at five community health service centers in Hunan Province, China.

Participants

A total of 114 pre-frail or frail community-dwelling older adults.

Methods

Participants were randomly assigned to one of eight intervention groups (corresponding to all possible combinations of the three implementation components of goal setting, feedback and reinforcement guidance) to receive a 12-week intervention, with all receiving the core intervention (group elastic-band resistance exercise and community education). Outcomes were measured at baseline, 6 weeks, and 12 weeks. Primary outcomes included frailty and resistance exercise adherence. Mean difference (MD) and 95 % confidence interval (CI) were calculated to estimate effectiveness using a linear mixed-effects model. Intervention costs were assessed from the viewpoint of service providers (community organizations and research teams).

Results

The goal-setting on group exhibited statistical significance in improving frailty (week 6: MD: − 0.25, 95 % CI: − 0.47 to − 0.02) and resistance exercises adherence (week 6: MD: 6.37, 95 % CI: 2.40 to 10.30; week 12: MD: 6.42, 95 % CI: 2.45 to 10.40). No statistically significant differences were found among the other implementation component groups. Compared to other implementation components, goal setting demonstrated superior implementation. The total intervention cost was 41,072.00 Chinese yuan, among which the goal-setting was 4560.00 Chinese yuan.

Conclusion

The optimized intervention identified in this study, which combines group elastic-band resistance exercise with community-based education and goal-setting, is expected to facilitate the delivery of an efficient, effective, and disseminable intervention for frail older adults in community settings.

Registration

chictr.org.cn (No. ChiCTR2300070392). Registration date: 11 April, 2023. First recruitment date: 21 April, 2023.

查看原文本刊更多论文

优化社区居住体弱老年人的复杂干预：一项多阶段优化策略框架内的因子随机试验

背景：阻力运动在改善社区居住体弱老年人体质方面的有效性已得到充分证明。然而，依从性差已经威胁到其有效性。目的对已有的复杂干预措施进行优化，提高其有效性和可推广性。设计2 × 2 × 2全因子随机试验。本研究在中国湖南省的五个社区卫生服务中心进行。参与者共114名体弱或体弱的社区老年人。方法将参与者随机分为8个干预组（对应于目标设定、反馈和强化指导三个实施组件的所有可能组合），接受为期12周的干预，所有干预均接受核心干预（团体弹性带阻力运动和社区教育）。在基线、6周和12周时测量结果。主要结局包括虚弱和抵抗性运动坚持。使用线性混合效应模型计算平均差（MD）和95%置信区间（CI）来估计有效性。从服务提供者（社区组织和研究团队）的角度评估干预成本。结果目标设定组在改善虚弱（第6周：MD: - 0.25, 95% CI: - 0.47 ~ - 0.02）和阻力运动依从性(第6周：MD: 6.37, 95% CI: 2.40 ~ 10.30；第12周：MD: 6.42, 95% CI: 2.45 - 10.40)。在其他实施成分组之间没有发现统计学上的显著差异。与其他实施要素相比，目标设定的实施效果更好。干预总成本为41,072.00元，其中目标设定成本为4560.00元。结论本研究确定的优化干预措施，将团体弹性带阻力运动与社区教育和目标设定相结合，有望促进社区环境中体弱老年人的高效，有效和可推广的干预措施。ChiCTR2300070392)。报名日期：2023年4月11日。首次招聘日期：2023年4月21日。

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).