Contextualizing, promoting, and estimating longitudinal changes of mobility outcomes in older adults
Bibliographic record
Abstract
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.
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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 | 0.009 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".