Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents
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John F Schnelle1, Cathy A Alessi, Sandra F Simmons
1UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California 91335, USA. jschnell@ucla.edu
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.
