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      An evaluation of the effectiveness of a multi-modal intervention in frail and pre-frail older people with type 2 diabetes - the MID-Frail study: study protocol for a randomised controlled trial

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          Abstract

          Background

          Diabetes, a highly prevalent, chronic disease, is associated with increasing frailty and functional decline in older people, with concomitant personal, social, and public health implications. We describe the rationale and methods of the multi-modal intervention in diabetes in frailty (MID-Frail) study.

          Methods/Design

          The MID-Frail study is an open, randomised, multicentre study, with random allocation by clusters (each trial site) to a usual care group or an intervention group. A total of 1,718 subjects will be randomised with each site enrolling on average 14 or 15 subjects. The primary objective of the study is to evaluate, in comparison with usual clinical practice, the effectiveness of a multi-modal intervention (specific clinical targets, education, diet, and resistance training exercise) in frail and pre-frail subjects aged ≥70 years with type 2 diabetes in terms of the difference in function 2 years post-randomisation. Difference in function will be measured by changes in a summary ordinal score on the short physical performance battery (SPPB) of at least one point. Secondary outcomes include daily activities, economic evaluation, and quality of life.

          Discussion

          The MID-Frail study will provide evidence on the clinical, functional, social, and economic impact of a multi-modal approach in frail and pre-frail older people with type 2 diabetes.

          Trial registration

          ClinicalTrials.gov: NCT01654341.

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          Most cited references17

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          Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

          Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.
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            Frailty in older adults: evidence for a phenotype

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              Methodological bias in cluster randomised trials

              Background Cluster randomised trials can be susceptible to a range of methodological problems. These problems are not commonly recognised by many researchers. In this paper we discuss the issues that can lead to bias in cluster trials. Methods We used a sample of cluster randomised trials from a recent review and from a systematic review of hip protectors. We compared the mean age of participants between intervention groups in a sample of 'good' cluster trials with a sample of potentially biased trials. We also compared the effect sizes, in a funnel plot, between hip protector trials that used individual randomisation compared with those that used cluster randomisation. Results There is a tendency for cluster trials, with evidence methodological biases, to also show an age imbalance between treatment groups. In a funnel plot we show that all cluster trials show a large positive effect of hip protectors whilst individually randomised trials show a range of positive and negative effects, suggesting that cluster trials may be producing a biased estimate of effect. Conclusion Methodological biases in the design and execution of cluster randomised trials is frequent. Some of these biases associated with the use of cluster designs can be avoided through careful attention to the design of cluster trials. Firstly, if possible, individual allocation should be used. Secondly, if cluster allocation is required, then ideally participants should be identified before random allocation of the clusters. Third, if prior identification is not possible, then an independent recruiter should be used to recruit participants.
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                Author and article information

                Journal
                Trials
                Trials
                Trials
                BioMed Central
                1745-6215
                2014
                24 January 2014
                : 15
                : 34
                Affiliations
                [1 ]Division of Geriatrics, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Getafe, Spain
                [2 ]Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5 28905, Getafe, Spain
                [3 ]Institute of Primary Care and Public Health, School of Medicine, Cardiff University and Memory Team, Cardiff and Vale University Health Board, Cardiff CF14 4YS, UK
                [4 ]Institute of Translation, Innovation, Methodology and Engagement (TIME), South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
                [5 ]University of Ulm, Institue of Epidemiology, Albert-Einstein-Allee 41, 89081 Ulm, Germany
                [6 ]Department of Health Sciences, Public University of Navarre, Campus of Tudela 31500 Tudela, Spain
                [7 ]Niche Science & Technology, Unit 26, Falstaff House, Bardolph Road, Richmond, TW9 2LH, UK
                [8 ]Institute of Diabetes for Older People (IDOP), University of Bedfordshire, Putteridge Bury Campus, Hitchin Road, Luton, Bedfordshire LU2 8LE, UK
                Author notes
                on behalf of the MID-Frail Consortium
                Article
                1745-6215-15-34
                10.1186/1745-6215-15-34
                3917538
                24456998
                44120aed-ab17-423a-ba2c-34f6ac83a91c
                Copyright © 2014 Rodríguez-Mañas et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 April 2013
                : 11 December 2013
                Categories
                Study Protocol

                Medicine
                frail,multi-modal intervention,pre-frail,type 2 diabetes
                Medicine
                frail, multi-modal intervention, pre-frail, type 2 diabetes

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