Contextualizing, promoting, and estimating longitudinal changes of mobility outcomes in older adults
Notice bibliographique
Résumé
The world population is aging. This phenomenon is accompanied by an increase in the number of disabilities, morbidity, and mortality. Mobility limitations are the second most prevalent type of disability in Canada, affecting individuals, society, and the health care system. Yet, it is understudied. Therefore, the goal of this thesis is to contribute evidence towards the contextualization, promotion, and estimation of longitudinal changes of mobility outcomes in older adults. To achieve this overall goal, this thesis entailed five distinct components. The aim of Manuscript 1, entitled "Heterogeneity in the course of age-related mobility limitations. Trajectories from the NuAge Study", was to identify the course of five mobility indicators over three years as well as clusters of declining outcomes in 1,793 healthy seniors. Participants were stratified by age and sex. This study identified great heterogeneity in the development of mobility limitations. For instance, seniors did not deteriorate in all five indicators at the same time. Instead, they were more likely to deteriorate in 3-4 outcomes according to their age group. In addition, muscle strength and capacity to move from sitting to standing were the most common declining outcomes. This work is in preparation to be submitted to the New England Journal of Medicine. In Manuscript 2, entitled "Identifying mobility needs among vulnerable seniors: Can we use patients' own perception?", a survey of 103 vulnerable seniors, suggested that self-rated health could be used to identify seniors in need of further rehabilitation services upon hospital discharge. This study has been accepted for publication by the Canadian Geriatrics Journal. The aim of Manuscript 3, entitled "Managing Mobility Outcomes in Vulnerable Seniors (MMOVeS): A Randomized Controlled Pilot Study", was to estimate whether a 6-month individualized self-management home exercise program (MMOVES) was more effective than exercise information in improving mobility-related outcomes of vulnerable seniors. 60 participants were randomized. Findings suggested that participants receiving the MMOVES program had 3 times greater odds of improving mobility outcomes. In addition, Number Needed to Treat (NNT) indicated that 4 individuals need to be treated with this program for one person to achieve a positive result. This study has been accepted for publication by the Clinical Rehabilitation Journal. Despite its potential for efficacy, the MMOVES will only be sustainable if it is adopted by future clinicians. In Manuscript 4 (Future professionals' behavior and intentions towards self-management support), the MMOVeS program was disseminated through educational and practical modules among future clinicians. Two focus groups indicated that knowledge and skills regarding the use of self-management improved; however, intention to adopt such an approach remained low. This study has been published by Physiotherapy Canada. Manuscript 5, entitled "Challenges of measuring mobility outcomes for RCTs of seniors: Composite Change Matrix (CCM) as a potential solution", presented the CCM as a method to combine two mobility outcomes while still conforming to the CONSORT guidelines. Combined outcomes were categorized by changes based on the minimal important changes (MIC). CCM results were reported as Odds Ratio and NNT, which are more meaningful estimates for clinical decision making. Another benefit of the CCM is that any two outcomes with known MIC can be used. This study has been submitted to the Journal of Clinical Epidemiology. The field of rehabilitation research is full of opportunities for advancement of methods, interventions, and outcomes. The novel work presented in this thesis illustrates some of these opportunities and challenges. In addition, different components of this thesis can be used to inform different rehabilitation practice settings.
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 source (Gemma direct ou Codex distillé), 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 ».