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Loss of mobility is predictive of a loss of autonomy and is often the first sign of functional decline. Loss of mobility is also associated with poor perceived quality of life, depressive symptoms, high risk of adverse events such as falls and fractures, to an increased risk to input in institution and mortality's increase.
Consequences and frequency of loss of mobility make essential its identification, evaluation and the practice of preventive measures in primary care.
The implementation of effective interventions in primary care to prevent or delay the loss of mobility is a public health priority.
PRISME-3P program aims to develop and evaluate a dedicated care pathway, in primary care, based on a personalized multimodal intervention: screening, support combining physician, teaching exercises by a specialized Monitor in Adapted Physical Activities (MAPA) and nutritional counseling.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Multimodal Intervention | Other | The multimodal intervention on mobility will consist of the implementation of a care pathway dedicated in primary care. It will include awareness and training of general practitioners for easy identification, a care associating a dedicated geriatric consultation to rule out underlying pathology, teaching exercises by MAPA (+/- taken care in the presence of MAPA) and nutritional counseling by a dietician. Close collaboration between general practitioners, geriatrician, MAPA and dietician will be established. |
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| Non interventional | No Intervention | Patients received treatment as part of their standard care: at the discretion of the general practitioner patients |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PRISME-3P program | Behavioral | PRISM-3P program will consist on a visit in the geriatric centre:
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| Measure | Description | Time Frame |
|---|---|---|
| Change in Short Physical Performance Battery (SPPB) score | Consists in estimating three components: 1. walking, 2. muscular strength and endurance, and 3. balance through short physical exercises (walk on a defined distance, get up from a chair, keep a position up). A score from 1 to 3 for each of the components marks a very low feature of lower limbs. This feature is considered low of 4 in 6, moderated by 7 in 9 and high of 10 in 12. | from baseline at 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Evolution of the Short Physical Performance Battery (SPPB) score | Consists in estimating three components: 1.walking, 2.muscular strength and endurance, and 3. balance through short physical exercises (walk on a defined distance, get up from a chair, keep a position up). A score from 1 to 3 for each of the components marks a very low feature of lower limbs. This feature is considered low of 4 in 6, moderated by 7 in 9 and high of 10 in 12. |
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Inclusion Criteria:
Aged > 70 years
With at least 2 of the following signs:
Short Physical Performance Battery score < 10
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marc BONNEFOY, Pr | Hospices Civils de Lyon | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Service de Médecine Gériatrique. Groupement Hospitalier Sud. Hospices Civils de Lyon. | Pierre-Bénite | 69310 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30782118 | Result | Perrotin S, Gilbert T, Dupuis M, Villeneuve L, Bin-Dorel S, Klich A, Letrilliart L, Bonnefoy M. A multimodal and multidisciplinary program to prevent loss of mobility in patients aged over 70 years: study protocol of a multicenter cluster randomized study in primary care (the PRISME-3P study). BMC Geriatr. 2019 Feb 19;19(1):48. doi: 10.1186/s12877-019-1059-5. |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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|
| Baseline, 3 months (for interventional arm), 6 months and 12 months |
| Assessment of functional disability by questionnaires | Functional disability refers to limitations in performing in dependent living tasks, which are often further divided into activities of daily living (ADLs), which include basic activities of hygiene and personal care, and instrumental activities of daily living (IADLs), which include basic activities necessary to reside in the community, such as shopping, managing finances, housekeeping, and meal preparation | Baseline, 6 months and 12 months |
| Assessment of Quality of Life by questionnaire | The Quality of Life is assessed with the 12-Item Short Form Health Survey (SF-12). The SF-12 is a multipurpose short form survey with 12 questions which were combined, scored, and weighted to create two scales that provide glimpses into mental and physical functioning and overall health-related-quality of life | baseline, 6 months and 12 months |
| Number of falls | Data will be collected by the geriatrician from the patient's medical records | Baseline, 6 months and 12 months |
| Number of hospitalization | Data will be collected by the geriatrician from the patient's medical records | Baseline, 6 months and 12 months |
| Assessment of the Physical Activity by questionnaire | Using the Physical Activity Scale for the Elderly (PASE) auto-questionnaire which is designed to assess the duration, frequency, exertion level, and amount of physical activity undertaken over a seven day period. | baseline, 6 months and 12 months |
| Assessment of sedentary time by questionnaire | Using self-report sedentary behavior questionnaire based on the Gardiner questionnaire to assess time spent in behaviors common among older adults: watching television, computer use, reading, socializing, transport and hobbies, and a summary measure (total sedentary time) | baseline, 6 months and 12 months |
| Assessment of weight loss | weight in kilograms | baseline, 6 months and 12 months |
| Body Mass Index (BMI) | calculating the BMI in kg/m^2 | baseline, 6 months and 12 months |
| Assessment of nutritional status using MNA scale | Using the Mini Nutritional Assessment (MNA) scale which consists of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment. | baseline, 3 months (for interventional arm depending on the SPPB score), 6 months and 12 months |
| Rate of study participation | Baseline |
| Monitoring of detailed physical activity performed by patients with diaries outlining the exercise sessions . | Patient adherence to the multimodal intervention. Monitoring of detailed physical activity performed by patients. Patients were also asked to complete diaries outlining the exercise sessions. | at the end of the multimodal intervention (3 months) |
| Monitoring of detailed physical activity performed by patients with MAPA assessment. | Patient adherence to the multimodal intervention. Monitoring of detailed physical activity performed by patients. Patients MAPA assessment. | at the end of the multimodal intervention (3 months) |
| Rate of compliant General practitioners (GP) associated to the study | at 12 months |
| Assessment of psychological factors using GDS-4 scale associated with a loss of mobility | Using a short Geriatric Depression Scale (GDS-4). The GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults. | baseline, 6 and 12 months |
| Assessment of social factors associated with a loss of mobility | Using the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) score which is related to several socioeconomic indicators (occupation, education, and employment status), to health-related behaviors (smoking and health care use), and morbidity (self-perceived health, dental health, obesity, and diabetes). | baseline |
| Assessment of comorbidities using the index of Charlson | Using the index of Charlson which included a closed list of 19 diseases, grouped into 4 subgroups different weighting. | baseline |
| Description of concomitant medications | List of active drugs and psychotropic | baseline |
| Type of diagnoses for unknown diseases following the dedicated geriatric consultation. | Description of pathologies possibly associated with a symptomatic loss of mobility. | baseline |
| Percentage of diagnoses for unknown diseases following the dedicated geriatric consultation. | Description of pathologies possibly associated with a symptomatic loss of mobility. | baseline |