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A ‘Case-Mix’ Approach to Understand Adherence Trajectories for a Falls Prevention Exercise Intervention: A Longitudinal Cohort Study Publisher Pubmed



Davis JC1, 2 ; Khan K2, 3 ; Mansournia MA4, 5 ; Khosravi A6 ; Rhodes RE7 ; Chan P2, 3, 4, 8 ; Zhao M3, 4, 8 ; Jehu DA2, 8, 9 ; Parmar N10 ; Liuambrose T2, 8, 9
Authors
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Authors Affiliations
  1. 1. Faculty of Management, University of British Columbia – Okanagan, Social and Economic Change Laboratory, Kelowna, BC, Canada
  2. 2. Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
  3. 3. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  4. 4. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
  7. 7. Behavioural Medicine Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
  8. 8. Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  9. 9. Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
  10. 10. Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

Source: Maturitas Published:2021


Abstract

Objective: We identified adherence-based case-mixes from participants’ longitudinal adherence to falls prevention exercise interventions over 12 months. Second, we identified modifiable baseline predictors (cognition, mobility and functional status) based on participants' case-mix adherence trajectories. Study design and outcome measures: This study was a 12-month longitudinal secondary analysis of data from 172 participants who received the Otago Exercise Program (OEP) in a randomized controlled trial. Adherence to the OEP was ascertained monthly via self-report. Case-mixes, groups of individuals who followed similar adherence trajectories, were visually defined using 12-month longitudinal trajectories; we used latent class growth modeling. Baseline predictors of adherence were examined for the following categories: 1) cognition, 2) mobility and 3) functional status. Results: Four distinct case-mixes were identified. The “non-adherent” case-mix (18 %) was distinguished by a non-adherent and decreasing adherence trajectory over time. The “low adherence” case-mix (45 %) did not have complete adherence or consistent adherence over the 12-month follow-up. The “moderate adherence” case-mix (27 %) was characterized by a stable (i.e., non-variable) adherence trajectory with a slightly increasing pattern at midpoint. The “high adherence” case-mix (10 %) demonstrated consistent and high adherence over the 12-month follow-up. For individuals with “moderate adherence”, the Digit Symbol Substitution Test (DSST) significantly predicted adherence (relative risk ratio (RRR) = 1.12 (0.95 CI: 1.0–1.26); p = 0.049). For individuals with “high adherence”, the Digits Forward minus Digits Backward (RRR = 0.43 (0.95 CI: 0.23−0.79); p = 0.002) and Instrumental Activities of Daily Living (RRR = 0.36 (0.95 CI: 0.16−0.81); p = 0.01) significantly predicted adherence. Conclusions: Cognitive profile and activities of daily living at baseline may predict the longitudinal pattern of adherence. © 2021 Elsevier B.V.
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