An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial
Notice bibliographique
Résumé
BACKGROUND: In the United States, over 60% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. OBJECTIVE: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. METHODS: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. RESULTS: At 12 months, 76.1% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm × timepoint interaction: b=0.76, 95% CI 0.14-1.37; P=.02; 12-month ∆d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. CONCLUSIONS: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients' physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25175.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».