Michael LaMantia in the Annals of Internal Medicine

Congratulations to Associate Professor of Medicine Michael LaMantia, MD, MPH and his colleagues who recently published the results of a large randomized study of in-home occupational therapy for patients with Alzheimer's Disease.

Callahan CM, Boustani MA, Schmid AA, LaMantia MA, Austrom MG, Miller DK, et al. Targeting Functional Decline in Alzheimer Disease: A Randomized Trial. Ann Intern Med. [Epub ahead of print 22 November 2016] doi: 10.7326/M16-0830
Background: Alzheimer disease results in progressive functional decline, leading to loss of independence.

Objective: To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline.

Design: Randomized, controlled clinical trial. (ClinicalTrial.gov: NCT01314950)

Setting: Urban public health system.

Patients: 180 community-dwelling participants with Alzheimer disease and their informal caregivers.

Intervention: All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years.

Measurements: The primary outcome measure was the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL); performance-based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM).

Results: At baseline, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, −5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values.

Limitation: The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention.

Conclusion:We could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline.

Primary Funding Source: National Institute on Aging.

Clinical Research Oriented Workshop (CROW) Meeting: Nov 11, 2016

Present:   Juvena Hitt, Kairn Kelley, Mike Lamantia, Gail Rose, Liliane Savard, Connie van Eeghen

Start Up: Can’t get the FRED screen to work… again…  Sylvie fixed it!

1.                   Liliane Savard: Combined Section Meeting of the APTA (Physical Therapist Association) in February 2017, for a workshop. She is presenting current literature on motor learning in autism to an audience of physical therapists. She is hoping to translate current evidence from research to support PT's practice with this clinical group. This will be a broad audience with 200 people, mostly clinical but some research.

a.       Liliane is interested in developing ways to assist children with autism using motor learning principles.  Research on her approach is limited prior to 2012 and exploding since then.

                                                   i.      She is writing a scoping literature review and has had some challenges

                                                 ii.      Request: look at the presentation and evaluate how well it fits together

b.       Lots of great information

                                                   i.      Select what the audience will remember

                                                 ii.      Identify the evidence that will assist them

                                               iii.      Select the theory that supports the evidence

                                               iv.      Consider a case study to hang it together

c.       Next step: return next week for final presentation!

2.                   Next Workshop Meeting(s): Fridays, 2:00 p.m. – 3:15 p.m., at Given Courtyard South Level 4 until end of Dec.   

a.       Nov 18: Liliane: finished presentation

b.       Nov 25: Canceled

c.       Dec 2: Book club – read it all!

d.       Dec 9: Marianne’s data

e.       Dec 16: Nancy Gell’s manuscript

f.        Future topics:

a.       Juvena: protocol development

b.       Book club discussion of "Weapons of Math Destruction" by Cathy O'Neil, Introduction and Chapter 1 (pgs 1-30)

c.       LaMantia: predictors of successful R01 applications: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155060

Recorder: Connie van Eeghen

Science Network TV

Greetings from Colorado Springs and the North American Primary Care Research Group meetings.  I met an interesting researcher named Ronny Gunnarsson. Ronny wrote a free on-line textbook of research methods in Swedish that he is now translating into English.

http://science-network.tv/

I don't know why it is called "TV", but the content looks good.

Ben Littenberg

John Ware will be speaking Nov 17

The legendary John E. Ware,Jr., PhD, inventor of the SF-36 series of Patient-Reported Outcomes Measures, will be speaking at UVM on “Advances in Methods for Monitoring Patient-reported Outcomes.”

November 17th at Surgery Grand Rounds from 7:30 - 8:30 a.m. in the Davis Auditorium

Clinical Research Oriented Workshop (CROW) Meeting: Nov 4, 2016

Present:   Marianne Burke, Nancy Gell, Juvena Hitt, Kairn Kelley, Mike Lamantia, Ben Littenberg, Gail Rose, Adam Sprouse-Blum, Connie van Eeghen

Start Up: What are we doing to avoid watching pre-election news?  Watch Canadian news, try to stand back and analyze how people use information, watch Vox, watch science news, hide from all of it…

1.                   Marianne Burke’s update on her study: generating follow up visits for the same problem outcome variable (within 90 days)

a.       The other variable/primary outcome: days to resolution of the skin problem (this powered the study)

b.       This new variable (FUVRTSP outcome variable – see above) does not exist yet.  Ingredients:

                                                   i.      Have you had any other visits for the same problem (gathered during consent call) (Y/N)

1.       If yes, how many appointments have you had (numappts)    

c.       How to generate the new outcome variable

                                                   i.      Gen na = 0

                                                 ii.      Replace na = na + numappts if numappts < .

                                               iii.      Replace na = na + numappts60 if num appts60 < .

                                               iv.      Replace na = na + numappts90 if num appts90 < .

d.       Was the number of total return visits the same in the control group and the intervention group? (The research question) is answered by this new variable “na” for use in this study.

e.       What if they are different?  Assume that for “group,” active = 1 and control = 0.  We think that group may affect na.  If length of observations (lobs) interact with both group and na, lobs may be a confounder.

                                                   i.      Reg na group (a linear regression on a dichotomous variable is the same as a t-test)

                                                 ii.      Reg na group lobs

f.        Measure effective of length of observation (90 days) only

g.       Also, analyze the data on use of the intervention during and after the study

2.                   Next Workshop Meeting(s): Fridays, 2:00 p.m. – 3:15 p.m., at Given Courtyard South Level 4 until end of Dec.   

a.       Nov 11: Liliane: presentation for conference on motor learning in autism (no Marianne) (invite Deborah Hirtz MD; no Ben; no Marianne)

b.       Nov 18: (no Ben, no Juvena, no Kairn) Connie’s manuscript or other contributor?

c.       Nov 25: Canceled

d.       Dec 2: Book club – read it all!

e.       Dec 9: Marianne’s data

f.        Future topics:

a.       Juvena: protocol development

b.       Book club discussion of "Weapons of Math Destruction" by Cathy O'Neil, Introduction and Chapter 1 (pgs 1-30)

Recorder: Connie van Eeghen