Viewing Study NCT04072185



Ignite Creation Date: 2024-05-06 @ 1:37 PM
Last Modification Date: 2024-10-26 @ 1:17 PM
Study NCT ID: NCT04072185
Status: UNKNOWN
Last Update Posted: 2019-08-28
First Post: 2019-07-19

Brief Title: PHYSICAL ACTIVITY AS A MEASURE OF IMPROVING THE EMOTIONAL STATE AND SOCIALIZATION IN THE ELDERLY
Sponsor: Fundacio dInvestigacio en Atencio Primaria Jordi Gol i Gurina
Organization: Fundacio dInvestigacio en Atencio Primaria Jordi Gol i Gurina

Study Overview

Official Title: CHANGES IN THE EMOTIONAL STATE QUALITY OF LIFE AND SOCIAL SUPPORT AFTER A PROGRAM OF PHYSICAL ACTIVITY IN THE ELDERLY PEOPLE RANDOMIZED MULTI-CENTER CLINICAL TRIAL
Status: UNKNOWN
Status Verified Date: 2019-08
Last Known Status: ACTIVE_NOT_RECRUITING
Delayed Posting: No
If Stopped, Why?: Not Stopped
Has Expanded Access: False
If Expanded Access, NCT#: N/A
Has Expanded Access, NCT# Status: N/A
Acronym: None
Brief Summary: Background Social isolation loneliness and anxiety-depressive states are emerging health conditions in the elderly of our society This situation is related to higher morbidity and mortality There is a growing need to determine effective interventions that address these situations since sometimes pharmacological options are limited in these patients Physical activity AF and social relationships in the elderly are linked to physical and mental health Being able to do some physical or recreational activity will help them face this stage of life with more optimism and relate to others in a healthy and independent way however few studies have evaluated their effectiveness in our territory

Objectives To evaluate whether a 4 month AF group program and the visit to know socio-cultural entities improve the emotional social and quality of life situation in a sample of people over 64 years of age with anxiety depression social isolation or solitude And measure whether adherence to AF and the linkage to sociocultural entities is maintained after the intervention has taken place
Methodology

Design Multicentre randomized two-group clinical trial of 1 year follow-up Study population Patients over 64 years of age assigned to primary care teams EAP from different locations Sant Joan de Vilatorrada Súria and Manresa 2

Inclusion criteria To meet criteria of depression or anxiety at the time of the study score 12 on the Beck Depression Scale and or score 10 on the GAD-7 Scale General Anxiety Disorder and that Present a score 32 on the steps of DUKE-UNC-11

A randomization of between 44 and 56 patients will be performed at each participant EAP Half will be allocated to the control group GC and half to the intervention group GI

The intervention group will participate in a group AF program for 4 months It will consist of 60 minutes of walking sessions 2 days a week Also once a month coinciding with the walk you will visit some sociocultural municipal equipment to promote a community connection

Main measures Response to the intervention or clinical remission of depression Escalera de Beck and or anxiety Escala GAD-7 improvement of social support DUKE-UNC and quality of life EuroQol Secondary measures Adherence to the AF VREM questionnaire Spanish Reduced Version of the Minnesota Free Time Questionnaire in Minnesota and linkage to sociocultural entities once the intervention has been completed The assessments will be made at 0 4 8 and 12 months
Detailed Description: BACKGROUND AND CURRENT STATUS OF THE SUBJECT

In our society thanks to medicine and development the proportion of the elderly population tends to increase every year The percentage of people over 64 years of age in 2017 in Spain was 188 and is expected to continue to increase to 346 in 2066 according to the National Statistics Institute projection 1

Social isolation loneliness and anxiety-depressive states are emerging health conditions in the elderly in our society As much in adult population as in old population noninstitutionalized it has been verified that to have little social support is related to a worse mental health According to the European Health Survey in Spain carried out by the Ministry of Health Consumption and Social Welfare of 2017 the prevalence of depression and chronic anxiety were in subjects of 65-74 years of 1064 and 825 from 75 to 84 years of 1373 and 949 and over 85 years of 1136 and 668 2 This situation is related to higher morbidity and mortality There is a growing need to determine effective interventions that address these conditions since sometimes pharmacological options are limited in these patients

For decades it has been known that social relationships are linked to physical and mental health A satisfying social network promotes healthy behaviors and habits Social support especially protects the elderly from loneliness 3 and from depression 4 In particular it can have a beneficial impact on mental health problems and psychological distress among older adults 5

Also AF in the elderly has multiple advantages not only at the physical level but also at the emotional level 6-8 several studies show that physical or leisure activities reduce loneliness 9 depression 10- 14 anxiety 15 and are associated with better mental health 16 17 According to Guszkowska 18 the AFs benefits of anxiety depression and irritability are especially high in those who start from high levels of anxiety and depression The type of AF that causes major improvements is those based on cyclical aerobic activities walking swimming or cycling from moderate to low intensity This statement is aligned with the position of the American College of Sports Medicine which recommends AF for the larger populations and affirms that regular AF can minimize the physiological and psychological effects of a sedentary lifestyle time that increases the expectations of life 19 and the quality of life 20 Being able to do some physical or recreational activity will help them face this stage of life with more optimism and relate to others in a healthy and independent way 21 however few studies in our territory have evaluated their effectiveness

HYPOTHESIS

The AF improves the emotional social and quality of life situation in subjects over 64 years of age with problems of anxiety depression social isolation or loneliness
The intervention group remains more active than the control group
The intervention favors maintaining the AF for a long period
The intervention group is more linked to sociocultural entities than the control group

TARGETS

Main objective

-To evaluate if the AF improves the emotional social and quality of life situation in a sample of people over 64 years of age with problems of anxiety depression and little social social support

Secondary goals

Evaluate whether the intervention of an AF program for 4 months keeps improving the emotional social and quality of life situation in a sample of people over 64 years of age with anxiety depression social isolation or loneliness at 8 and 12 months of the intervention
Measure if the adherence to the AF is maintained after the intervention has taken place at 8 and 12 months
Measure if the link to sociocultural entities is created and maintained once the intervention has been carried out at 4 8 and 12 months
Evaluate the satisfaction of the users after the intervention at 4 months

METHODOLOGY Design Multicentre randomized two-group clinical trial of 1 year follow-up Study population Patients over 64 years of age assigned to primary care teams EAP from different locations Sant Joan de Vilatorrada 12721 assigned Súria 8956 assigned Manresa 2 23351 assigned With this representativeness of territories patients living in urban semi-urban and rural areas will be able to study Subsequently the participation of other SAP teams will be attempted

Inclusion criteria Meet the criteria of depression or anxiety at the time of the study score 12 on the Beck Depression Scale BDI-II and or score 10 on the GAD-7 Scale General Anxiety Disorder and that they score 32 on the back of DUKE-UNC-11 Possibility to follow a year by the same primary care team At least read and write Spanish or Catalan

Exclusion criteria Diagnosis of dementia or moderate cognitive impairment Greater depression BECK scale score 28 Dependency disorders due to abuse of alcohol or other drugs You are receiving some psychological therapy from the Center for Reference Mental Health Physical illness at an advanced stage Present any physical mental or temporary limitations to be able to walk 1 hour a day two days a week That they have not signed the informed consent

Show and recruitment Each participating Primary Care Team EAP will be randomized between 44 and 56 patients Half will be allocated to the control group GC and half to the intervention group GI The recruitment will be consecutive in each EAP

The professionals participating in the study will consult the database of the Computerized Clinical History of Catalonia ECAP through the consultation form of their quotas Dbsform in order to obtain the lists of patients that meet the inclusion criteria have the active diagnosis of depression or anxiety and have little social support Subsequently your doctor or nurse will make the selection of the patients and will contact them to offer them the possibility to participate in the study and in case they accept they will be grouped in their CAP to explain In detail study and sign informed consent an interview will be followed and the questionnaires will be administered to assess whether they meet the inclusion criteria They will finally be assigned to Control group or intervention randomly and anonymously using a statistical program

Sample size The sample size for independent groups was estimated capable of detecting differences of two points in the average score of the Depression of Beck and GAD-7 and 7 points in the scale of social support of DUKE-UNC-11 A control has been assigned for each case assuming a statistical power of 80 with a confidence interval of 95 Between 146 and 162 patients would be needed and for reasons of convenience three groups of 50 patients each will form in each EAP 25 of which will be in the intervention groups and 25 in the control units

Variables and measurement methods

Variables main results

1 Clinical remission of depression and or response to the intervention once the intervention has been completed at 4 months after the start of the study Clinical remission is considered Beck scale score BDI-II 12 points Riedel 2010 and response to the intervention reduction of the basal score The Beck Depression Inventory is an auto-applied questionnaire of 21 items with four response alternatives sorted according to the severity of the symptoms it refers to range 0 to 3 range score from 0 to 63 scale The version adapted to Spanish by Sanz 2003 will be used
2 Remission of the anxiety clinic and or response to the intervention once the intervention has been completed at 4 months after the start of the study Clinical remission is considered scaling of the GAD-7 scale General Anxiety Disorder 10 points and response to the intervention reduction of the score compared to basal The GAD-7 scale is simple and self-administrable it has 7 items of anxiety symptoms on a Likert scale on the presence of the symptom in the last two weeks nothing at all several days more than half of the days and almost every day that score from 0 to 3 where the maximum score is 21 A score greater than or equal to 10 is indicative of anxiety disorders achieving a sensitivity of 89 and a specificity of 82 This scale has been validated in Spanish by García-Campayo 2010
3 Improvement of social support once the intervention has finished 4 months after the start of the study Social support improvement is considered a decrease in the score in the DUKE-UNC-11 social support questionnaire with respect to the basal and good social support with a score 32 points This instrument was designed to measure functional social support perceived by Broadhead and validated for the Spanish population by Bellón et al 1996 This is a self-administered 11 item instrument uses a Likert type response scale with scores from 1 to 5 stands out for its simplicity and brevity evaluates the perceived social support evaluates the confidential social support possibility of have people to communicate and affective social support demonstrations of love affection and empathy In the Spanish version a cut-off point was chosen in the 15th percentile which corresponds to a score 32 to divide the subjects into two groups normal or low support
4 Improved quality of life once the intervention has been completed at 4 months after the start of the study Quality of life improvement is considered a decrease in the score in the EuroQol questionnaire EQ-5D with respect to basal

Secondary result variables

1 Clinical remission of depression and or response to the intervention at 8 and 12 months
2 Clinical remission of anxiety and or response to the intervention at 8 and 12 months
3 Improvement of the situation social perception DUKE-UNC Social Welfare Questionnaire at 8 and 12 months
4 Improved quality of life measured through EuroQol EQ-5D at 8 and 12 months
5 Result variables that measure feasibility in the intervention group

Satisfaction with the intervention A patient satisfaction survey will be carried out at the end of the intervention with 5 items and Likert scale of 4 categories
Adherence to the intervention for each GI patient the number of sessions attended will be collected A variable of adherence to the intervention will be calculated attend 75 or more of the sessions attend less
Adherence to AF post intervention through the VREM Questionnaire Reduced Spanish version of the AF time questionnaire in Minnesota The assessments will be made at 0 4 8 and 12 months
6 Linking to sociocultural entities once the intervention has been completed The assessments will be made at 0 4 8 and 12 months

Variables that can act as confusers or modifiers of the effect

1 Pharmacological treatment The DDD defined daily dose must be calculated for each active ingredient in the follow-up period taking into account the number of days the dose provided and the route of administration of the drug The active principles that will be registered will be those belonging to the following groups antidepressants anxiolytics
2 Participation in other mental health therapies taught by a psychologist psychiatrist Patients included in the therapies of the reference mental health centers will be excluded
3 Prior participation in some AF activity on a regular basis yes no Socio-demographic variables Sex age marital status live life yes no educational level without studies incomplete primary full primary high school higher education Reference primary care team rural assigned to a doctors office semi-urban assigned to an AP center in a population 15000 inhabitants urban assigned to an AP center with a population of 15000 or more

Intervention

The intervention group will participate in a group AF program for 4 months It will consist of 60 minutes of walking sessions 2 days a week The sessions will be directed by two referents of each CAP which will carry an application to the mobile type STRAVA to control the distances recurred from each session Also once a month coinciding with the walk you will visit some sociocultural municipal equipment to promote a community connection

Data collection

In the field work different groups of professionals participate

Professional recruiters doctor and or nurse to which the patient is assigned
Researcher in charge of the random allocation of patients not linked to any EAP Perform the random assignment once all the patients required in each team have consented to participate
Evaluators carry out baseline interviews at 4 8 and 12 months without knowing which group the patient belongs to
Professionals that will accompany the walks two for each EAP
Professionals from sociocultural centers

The external evaluator will be in charge of collecting the results of the self-administered scales previously mentioned in paper These stairs will be in a unique place that only this reviewer will have access to They will be read with automatic reading with the identifier of the survey using the Teleform Elite v 82 reading software

DATA ANALYSIS

Initially the sociodemographic characteristics of the two groups will be described For the description of qualitative variables percentages and for quantitative standard averages and averages ranges and 25-75 percentiles will be used

Previous to the intervention baseline scores on the selected scales after randomization of the patients will be compared to verify that there are no significant differences After the intervention the average scores of the different scales in both groups will be compared independently and for the different periods of post-intervention time using the Student test for matched samples in case of normality adjustment or the Mann-Whitney U if the distribution was not normal A secondary analysis through multiple regression will be carried out including sociodemographic and confusing variables for the variable of clinical remission of depression Yes No Yes Beck scale 12 for the clinical remission variable of anxiety Yes No Yes GAD-7 10 and for the social support variable Yes no Yes DUKE-UNC-11 32

The results showing differences with a p 005 will be considered significant For statistical analysis it was used in program SPSS v 18

ETHICAL CONSIDERATIONS

In accordance with Law 142007 of July 3 of biomedical and human rights research BOE of July 4 2007 all recruited patients will be informed verbally and in writing of the objectives methodology tests and interventions that can be received if they participate in the study It will be included to those who sign informed consent in writing The document will be written in a language that the patient can understand The protocol has been approved by the Ethical Committee of Clinical Investigation of the JGol Idiap The researchers undertake to maintain the confidentiality of the data If the effectiveness of the intervention is shown the control group will receive the same group intervention once the study has finished

Study Oversight

Has Oversight DMC: None
Is a FDA Regulated Drug?: False
Is a FDA Regulated Device?: False
Is an Unapproved Device?: None
Is a PPSD?: None
Is a US Export?: None
Is an FDA AA801 Violation?: None