Differences of expected intervention effects between participant-led and facilitator-led preventive care services in Japan.

Shan Yun, Risa Takashima, Kazuki Yoshida, Daisuke Sawamura, Takao Inoue, Shinya Sakai
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Abstract

Objective: To examine the effect of different management methods on the effectiveness of care preventive programmes for community-dwelling older adults.

Methods: This study comprised two facilitator-led (FL) and one participant-led (PL) preventive care classes in Japan. All participants received the intervention for approximately 12 weeks. Functional assessments, occupational dysfunctions, and subjective health were measured before and after the interventions. A two-way mixed design analysis of covariance (ANCOVA) was adopted to examine the effect of the interventions, adjusted for previous experiences with preventive care services. The level of significance was set at P < 0.05.

Results: Fourteen participants in the PL group (76.64 ± 6.48 years, 92.9% women) and 29 participants in the FL group (76.55 ± 5.75 years, 75.9% women) were included in the statistical analysis. ANCOVA showed significant group × time interaction effects in the Five Times Sit-to-Stand Test (FTSST), the Timed Up & Go (TUG), occupational deprivation of the Classification and Assessment of Occupational Dysfunction Scale, and self-rated health. Simple main effect tests showed that the TUG decreased significantly in the PL group, while occupational deprivation and self-rated health scores improved significantly. In contrast, FTSST scores significantly improved in the FL group.

Conclusion: PL-type management may be more appropriate for preventing social isolation and withdrawal, while FL-type management may be more appropriate for preventing physical frailty. Selecting not only adequate programmes but also an appropriate management type that matches the service purpose can help provide more effective care preventive services.

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日本参与者主导和促进者主导的预防保健服务预期干预效果的差异。
目的:探讨不同管理方法对社区居住老年人护理预防方案效果的影响。方法:本研究包括2个以辅导员为主导(FL)和1个以参与者为主导(PL)的日本预防保健班。所有参与者都接受了大约12周的干预。在干预前后测量功能评估、职业功能障碍和主观健康状况。采用双向混合设计协方差分析(ANCOVA)来检验干预措施的效果,并根据先前的预防保健服务经验进行调整。结果:PL组14例(76.64±6.48岁,女性92.9%),FL组29例(76.55±5.75岁,女性75.9%)纳入统计学分析。ANCOVA结果显示,在五次坐立测试(FTSST)、定时起跳测试(TUG)、职业剥夺职业功能障碍分类与评估量表、健康自评量表中存在显著的组时间交互作用。简单主效应检验显示,职业剥夺组的TUG显著降低,职业剥夺和自评健康得分显著提高。相比之下,FL组的FTSST评分显著提高。结论:pl型管理可能更适合于预防社会隔离和退缩,fl型管理可能更适合于预防身体虚弱。不仅选择适当的方案,而且选择与服务目的相匹配的适当管理类型,有助于提供更有效的保健预防服务。
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