Effectiveness of Exercise in Older Adults Discharged From the <scp>ER</scp> After Minor Injuries: The <scp>CEDeComS</scp> Stepped‐Wedge Trial
Bibliographic record
Abstract
BACKGROUND: Older adults consulting Emergency Departments (EDs) for minor injuries are at risk for new functional impairments in the 6 months following their injuries. OBJECTIVE: To compare the effects of exercise programs versus usual ED practices on functional status and physical performance at 3-6 months in at-risk older adults with minor injuries. DESIGN AND SETTINGS: Stepped-wedge randomized trial in six Canadian EDs from 2017 to 2020. Participants aged ≥ 65 years were screened for low, moderate, or high risk of functional decline and assessed three times: baseline at ED, 3 and 6 months. INTERVENTION AND MEASURES: Multicomponent (flexibility, balance, strengthening, aerobic) and risk-level adapted exercise programs targeting moderate- and high-risk patients, 3×/week for 12 weeks, at home or in community groups. CONTROL: Usual ED care. MEASURES: Functional decline was defined as a 2/28-point loss from baseline on the Older Americans Resources and Services (OARS) scale. Basic physical performance (leg strength, balance, walking speed) was measured using the Short Physical Performance Battery (SPPB) test. Generalized linear mixed log-binomial regressions were used to examine the effects of the intervention on outcomes compared to usual ED care, stratified by risk level. RESULTS: The intervention and control phases included 277 and 205 moderate-risk individuals, and 249 and 128 high-risk individuals, respectively. Among moderate-risk individuals, functional loss in intervention participants at 3 months was half that of controls: 12% [95% CI: 8%-17%] vs. 25% [95% CI: 18%-34%], RR: 0.48 [0.26, 0.90]. CONCLUSION: 12-week multicomponent exercises implemented early after minor injuries are associated with lower proportions of functional decline at 3 months in moderate-risk seniors and may help those at high risk recover some physical performance. TRIAL REGISTRATION: ClinicalTrials.gov, ID Cedecoms NCT03991598.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".