Download the Toolkit - Brookdale Center for Healthy Aging

BROOKDALE
DEMONSTRATION
INITIATIVE IN
HEALTHY URBAN
AGING:
BRIDGING THE
DIVIDE BETWEEN
PUBLIC HEALTH &
HEALTHY AGING
PREPARED FOR:
THE COMMISIONER
NEW YORK CITY
DEPARTMENT FOR
THE AGING
EVIDENCE-BASED
TOOLKIT:
Program
Summaries and
Implementation
Guide
LILLIAM BARRIOS-PAOLI
COMMISSIONER
APRIL 2010
FUNDING PROVIDED BY:
OFFICE OF THE MAYOR
CITY OF NEW YORK
MICHAEL R. BLOOMBERG
MAYOR
CREATED BY:
THE BROOKDALE
CENTER FOR HEALTHY
AGING & LONGEVITY
OF HUNTER COLLEGE/
CUNY
1
About Brookdale
Brookdale Center for Healthy Aging & Longevity of Hunter College is a
multi-disciplinary center of excellence dedicated to the advancement
of successful aging and longevity through research, education, and
evaluation of evidence-based models of practice and policy.
Founded in 1974 by Dr. Rose Dobrof of the Hunter College School of Social Work, The
Brookdale Center for Healthy Aging & Longevity of Hunter College (formerly Brookdale
Center on Aging) was one of the country's first multi-disciplinary academic gerontology
centers. For over three decades, the Center has taken the lead in identifying the needs of
older New Yorkers, developing programs to make New York a better place to grow old,
training professionals and paraprofessionals who serve the elderly, and championing both
the elderly and policies to promote successful aging. Brookdale Center now serves as a
critical bridge between gerontological education, research, policy, practice and advocacy,
and is recognized nationally today as a major center of excellence.
Acknowledgments
We are grateful to the many people whose insights and contributions have informed the
development of this toolkit.
First and foremost, this toolkit would not have been possible had it not been for the support and
leadership of the Department of the Aging (DFTA): Lilliam Barrios-Paoli, Commissioner; Sally J.
Renfro, First Deputy Commissioner; Caryn Resnick, Deputy Commissioner; Angeles Pai, Deputy
Commissioner, Michael Bosnick, Assistant Commissioner; Marah Rhoades, Assistant Commissioner;
and dedicated staff members Jackie Berman, Joyce Chin, Sabrina Ramos, Maeve Rullo, and Ishrat
Taleb.
Special thanks to DFTA in providing us with information regarding their existing health promotion
programs that have been developed to assist older New Yorkers.
We appreciate the cooperation of evidence-based study authors and program implementation staff
who were instrumental with their cooperation and assistance in providing information regarding
aspects of program implementation and descriptions of program costs.
We wish to thank the leadership of Hunter College for their support: President Jennifer J. Raab;
Provost and Vice President for Academic Affairs Vita Rabinowitz; Dean of the School of Social Work,
Jacqueline B. Mondros; Dean of the School of Nursing, Kristine M. Gebbie, and Dean of the School of
Public Health, Kenneth Olden.
This toolkit would not have been possible without the tireless and invaluable contributions of
members of the Brookdale Center for Healthy Aging & Longevity, Hunter College, including (in
alphabetical order): William T. Gallo, Nuzhat Mirza, Carmen Morano, and Milagro Ruiz.
Funding for this project was provided by the Mayor’s Office and administered by the New York City
Department for the Aging.
Toolkit Authors: Dana Friedman; Matthew Caron; Lauren Evans; Adriana Valencia; Nina S. Parikh;
and Marianne C. Fahs.
TOOLKIT TABLE OF CONTENTS
User’s Guide for Evidence-Based Toolkit ......................................................................... i
Toolkit Section  Program Summaries & Implementation Guide
Program Summaries of Selected Evidence-Based Arthritis Programs .........Tab 1
Comparison Chart of Evidence-Based Arthritis Programs and Existing DFTA Projects
Arthritis Foundation Exercise Program (AFEP) .............................................................................. 1
ESCAPE-knee pain ....................................................................................................................................... 3
Fit and Strong ................................................................................................................................................ 5
Hop with the Hip .......................................................................................................................................... 7
Program Summaries of Selected Evidence-Based Cancer Programs.............Tab 2
Comparison Chart of Evidence-Based Cancer Programs and Existing DFTA Projects
Learn Share and Live Program ............................................................................................................... 9
Screen for Life ............................................................................................................................................... 11
Tepeyac Project ............................................................................................................................................ 13
Program Summaries of Selected Evidence-Based Depression Programs ...Tab 3
Comparison Chart of Evidence-Based Depression Programs and Existing DFTA Projects
Healthy Identifying Depression, Empowering Activities for Seniors (Healthy IDEAS).... 15
Improving Mood Promoting Access to Collaborative Care Treatment (IMPACT).............. 17
Life Review Therapy ................................................................................................................................... 19
Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) ................................. 21
Psycho geriatric Assessment and Treatment in City Housing (PATCH) ................................ 23
Program Summaries of Selected Evidence-Based Diabetes Programs .........Tab 4
Comparison Chart of Evidence-Based Diabetes Interventions and Existing DFTA Projects
Diabetes Education & Prevention with a Lifestyle Intervention Offered at YMCA (DEPLOY) .... 25
Diabetes Health Connection .................................................................................................................... 27
Diabetes Prevention Program (DPP) ................................................................................................... 29
Group Lifestyle Balance (GLB)................................................................................................................ 31
Healthy Changes ........................................................................................................................................... 33
Look After Yourself (LAY) ........................................................................................................................ 35
Look AHEAD (Action for Health in Diabetes) ................................................................................... 37
New Leaf… Choices for Healthy Living with Diabetes ................................................................... 39
Seniors Taking Charge of Diabetes! ...................................................................................................... 41
Starr County Border Health Initiative ................................................................................................. 43
Program Summaries of Selected Evidence-Based Falls Programs .................Tab 5
Comparison Chart of Evidence-Based Falls Interventions and Existing DFTA Projects
A Matter of Balance/Volunteer Lay Leader Model ......................................................................... 45
EnhanceFitness............................................................................................................................................. 47
Falls Management Exercise (FaME) ..................................................................................................... 49
NoFalls ............................................................................................................................................................. 51
Step by Step.................................................................................................................................................... 53
Stepping On .................................................................................................................................................... 55
Strategies and Actions for Independent Living (SAIL).................................................................. 57
Tai Chi: Moving for Better Balance ....................................................................................................... 59
Program Summaries of Selected Evidence-Based Heart Disease Programs..... Tab 6
Comparison Chart of Evidence-Based Heart Disease Programs and Existing DFTA Projects
Airdie Community Hypertension Awareness & Management Program (A-CHAMP) ........ 61
Eat Better Move More ................................................................................................................................ 63
Health for Your Heart (Salud Por Tu Corazón) ................................................................................ 65
Prime Time Sister CirclesTM ..................................................................................................................... 67
Project Joy ....................................................................................................................................................... 69
Selected Evidence-Based Obesity Programs ............................................................Tab 7
Comparison Chart of Evidence-Based Obesity Programs and Existing DFTA Projects
With cross references to above program summaries for DEPLOY, DPP, GLB, and Eat
Better Move More, which are appropriate for obesity .................................................................. 71
Implementation Guide .......................................................................................................Tab 8
Introduction to the Implementation Guide ....................................................................................... 73
Implementation Guides for Selected Evidence-Based Arthritis Programs
Implementation Sheet for AFEP ....................................................................................................... 75
Implementation Sheet for ESCAPE-knee pain ............................................................................. 77
Implementation & Cost Sheet for Fit and Strong ....................................................................... 79
Implementation & Cost Sheet for Hop with the Hip ................................................................. 81
Implementation Guide for Selected Evidence-Based Cancer Program
Implementation & Cost Sheet for Learn Share and Live ......................................................... 83
Implementation Guide for Selected Evidence-Based Depression Programs
Implementation & Cost Sheet for Healthy IDEAS ...................................................................... 85
Implementation & Cost Sheet for IMPACT ................................................................................... 87
Implementation Sheet for Life Review Therapy ........................................................................ 89
Implementation & Cost Sheet for PEARLS .................................................................................... 91
Implementation & Cost Sheet for PATCH ...................................................................................... 93
Implementation Guide for Selected Evidence-Based Diabetes Programs
Implementation Sheet for GLB .......................................................................................................... 95
Implementation & Cost Sheet for Seniors Taking Charge of Diabetes! ............................. 97
Implementation & Cost Sheet for Starr County Border Health Initiative ......................... 99
Implementation Guide for Selected Evidence-Based Falls Programs
Implementation & Cost Sheet for A Matter of Balance/Volunteer Lay Leader Model ....... 101
Implementation & Cost Sheet for EnhanceFitness ................................................................. 103
Implementation Sheet for FaME .................................................................................................... 105
Implementation & Cost Sheet for Stepping On ........................................................................ 107
Implementation Sheet for SAIL ...................................................................................................... 109
Implementation & Cost Sheet for Tai Chi: Moving for Better Balance ............................ 111
Implementation Guide for Selected Evidence-Based Heart Disease Programs
Implementation & Cost Sheet for Health for Your Heart (Salud Por Tu Corazón) ............113
Implementation & Cost Sheet for Project Joy ........................................................................... 115
References...............................................................................................................................Tab 9
Appendices ........................................................................................................................ Tab 10
Appendix 1: Evidence-Based Program Logistics Survey
Appendix 2: Evidence-Based Program Cost Sheet
Toolkit Section  Condition-Specific Instruments Section
See supplemental toolkit binders
Toolkit Section  Cross-Cutting Instruments Section
See supplemental toolkit binders
ToC
USER’S GUIDE FOR EVIDENCE-BASED TOOLKIT
Purpose
 According to the Centers for Disease Control and Prevention, the 7 leading preventable chronic
conditions among older Americans are:
 Arthritis
 Cancer
 Depression
 Diabetes
 Falls
 Heart disease
 Obesity
 In partnership with the NYC Department for the Aging (DFTA), the Brookdale Center for Healthy
Aging & Longevity of Hunter College/CUNY (Brookdale) has organized this compendium of selected
evidence-based programs targeting prevention and management of these chronic conditions among
community-based older adults.
 These programs are termed evidence-based in that their effectiveness in producing significant health
outcomes has been rigorously studied and documented in peer-reviewed scholarly literature.
 Brookdale has utilized the following methodology in selecting the evidence-based programs
described in this toolkit:
1. A systematic review of research studies supporting over 100 evidence-based programs
targeting the CDC’s leading 7 preventable chronic conditions was conducted. These programs
were selected based on two main criteria: a) programs used scientific study designs (such as
randomized-controlled trials) to demonstrate statistically significant health outcomes, and b)
programs were primarily tested using older adults as study participants.
2. These programs were reviewed again and limited to 49 community-based interventions that
can feasibly be implemented in non-clinical community settings, including the NYC senior
centers that DFTA serves. Factors that were considered in determining the feasibility of
program implementation included program duration and senior center staffing.
3. Finally, outreach to program staff to obtain implementation materials to be shared with DFTA
resulted in the inclusion of 35 programs* in this toolkit.
 There is growing recognition among policy makers and public health leaders in the field of aging that
building evidence for community-based models of healthy and productive urban aging is key in
promoting health in far-reaching, cost-effective ways.
 It is hoped that by disseminating information on the targeted interventions described in this toolkit
throughout NYC senior centers, NYC DFTA will substantially reduce rates of chronic disease among
older New Yorkers.
*This toolkit includes two types of programs – research programs that have been tested in controlled settings, and implementation programs that have been
replicated outside of the original research settings.
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USER’S GUIDE FOR EVIDENCE-BASED TOOLKIT
Instructions
 The toolkit has 3 main color-coded sections:
1. Program Summaries and Implementation Guide
2. Condition-Specific Instruments
3. Cross-Cutting Instruments
 The Program Summaries and Implementation Guide  presents program details (overview,
outcomes, implications), implementation guidelines (fidelity, replicability, sustainability), and costs of
each evidence-based program, arranged alphabetically and by condition (Arthritis to Obesity).
 The Condition-Specific Instruments Section  provides the scales that can be used when
implementing the condition-specific programs described in the Program Summaries and
Implementation Guide . This section has also been arranged alphabetically.
 For instruments that can be used for multiple conditions, you may refer to the Cross-Cutting
Instruments Section .
 Refer to the toolkit flowchart below for an illustration of how to use this toolkit.
ii
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COMPARISON CHART OF EVIDENCE-BASED ARTHRITIS PROGRAMS
Program Name
Program Elements
Arthritis Foundation
Exercise Program
(AFEP)
Group-based exercise program
that includes health education
segments and behavioral
strategies to promote physical
activity between classes.
Group/
Individual
Group
Time
(meetings, duration)
Meets twice weekly for 1
hour per session for 8
weeks
Staff
Requirements
Instructors are required to:
• Undergo day-long AFEP
training taught by Arthritis
Foundation Master Trainer
• Receive CPR and first aid
training
• Complete two AFEP programs
and submit necessary
paperwork to Arthritis
Foundation
Instructors must have the following
educational background:
• Associate or baccalaureate
degree in exercise or related
health field or equivalent
exercise training and
certification preferred
• Knowledge of arthritis disease
processes, principles of arthritis
exercise, etc.
• Competence in demonstrating
exercises
Enabling SelfManagement and
Coping with Arthritic
Knee Pain through
Exercise (ESCAPEknee pain)
Rehabilitation program that
combines group discussion on
specific topics regarding selfmanagement and coping, with
an individualized, progressive
exercise regimen
Group and
individual
components
Meets twice weekly for
1 hour per session for
6 weeks
• Instructors undergo program
training, but do not need to have
PT background
• Training involves program
education using an instructor
manual, as well as program
observation
Space
Requirements
Equipment
Requirements
Room should:
• Be large enough for
easy movement and
space for assistive
devices (i.e.,
walkers, crutches,
etc.)
• Have adequate
acoustics and
lighting
• Be free of clutter
• Be carpeted or have
mats for floor
exercises
Sturdy chairs that do
not slide easily and
are of different
heights, some with
arms
Gym or hallway
• Exercise equipment
(i.e., steps, rocker or
wobble board,
soccer ball, static
bike)
• Chair
• Table
• Mat
ToC
Program Name
Fit & Strong
Hop with the Hip
Program Elements
Group/
Individual
Time
Staff
Requirements
Space
Requirements
Equipment
Requirements
(meetings, duration)
• Group and facility-based
exercise training program and
group problem-solving
sessions followed by homebased adherence
• Sessions focus on range of
motion, resistance training,
aerobic walking, and group
problem solving sessions
regarding self-efficacy for
exercise and exercise
adherence
• Participants develop
individualized postintervention exercise plan and
log their progress through
participating in aerobic activity
(usually walking) for 3
days/week for a total of 30
min/day, and participants
keep a log of their progress
Group
Meets 3 times weekly
for 90 minutes per
session for 8 weeks
• Requires national certification
(10 types are available)
• Instructor may be PT, PT aide,
or recreational aide
• Instructors attend an eight-hour
training to obtain certification
Large indoor space
for arm stretching,
fitness walking
• Fitness equipment
that are provided at
instructor training
session (i.e.,
adjustable ankle cut
weight, resistance
bands with foam
rubber handles)
• Floor mats
• Music player
Group exercise program that
involves strength training and
lifestyle advice for older adults
with osteoarthritis of the hip
Group
Meets once a week for
1 hour for 8 weeks
Instructors must have a
background in PT or OT
Gym (12-person
maximum capacity)
Fitness equipment
(i.e., leg press, leg
raise, sitting rotation,
pull down equipment,
treadmill, pulleys,
Bowflex, or
comparable
equipment)
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EXISTING ARTHRITIS HEALTH PROMOTION PROJECT AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. This program has its own curriculum with a set number of training topics. All necessary equipment and forms are
provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Stay Well
Exercise
Classes
Program Elements
• Geared for all seniors, ranging
from the fit to those with
disabilities
• Led by senior volunteers.
• Includes aerobic exercises as
well as routines designed to
enhance balance, build muscle
strength (with the use of stretch
bands) and aid in the
performance of everyday
activities
• Classes end with stress
reduction exercises to help
seniors ease the tensions of
everyday living
Group/
Individual
Group
Time
Staff
(meetings, duration)
(paid, volunteer)
1 hour per week
Center /site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on site. Once
training is completed,
the HPS monitors
senior volunteers and
classes on an on-going
basis
Space
Requirement
Room large enough for
all participants to
complete all exercise
movements
Equipment
Training materials,
certificates, Tee
shirts, stretch bands,
balls, volunteers
buttons, sign-in
sheets and envelopes
provided by HPS
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ARTHRITIS
Arthritis Foundation Exercise Program (AFEP)
PROGRAM OVERVIEW
PRIMARY CONTACT
Jenni Albright, Acting Project
Coordinator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.arthritis.org/chapters/newyork/exercise-program.php
PRINT MATERIALS
Program brochure is available. Training
manual is only available to individuals
who attend the training.
ACCESS ON WEBSITE
Training manual is only available to
individuals who attend the training.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English, Spanish
PROGRAM TYPE
An eight-week group-based program (twice weekly sessions) to
promote self-management through exercise for sedentary adults
with arthritis.
PROGRAM DESCRIPTION
Duration: 8 weeks
Type: Group-based exercise program administered twice weekly for
an hour that includes health education segments and behavioral
strategies to promote physical activity between classes.
Aim: Promote arthritis self-management through exercise;
developed by the Arthritis Foundation in 1987 (revised in 1999).
OUTCOMES
This program reduced pain by 24% and fatigue by 28%, while
improving arthritis management self-efficacy by 3%.
Those who attended a majority of the classes showed:
• 27% reduction in pain
• 35% reduction in fatigue
• 25% reduction in stiffness
• 14% improvement in timed 10-lb lift performance test scores
• 15% improvement in chair stands performance test scores
• 4% improvement in arthritis self-efficacy
Over time (6 months post-intervention), participants:
• Maintained improvements in symptoms
• However, function and self-efficacy for exercise declined over
time
IMPLICATIONS
•
•
This program is safe for sedentary older individuals with
arthritis intending to start exercising without exacerbating their
symptoms.
If arthritic adults attend a majority of PACE classes, they may
expect improvements in symptoms, self-efficacy for arthritis
management, and upper and lower extremity function.
Implementation
Toolkit – Page 1
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ARTHRITIS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
18 sites in urban and rural counties
across North Carolina
REFERENCE
Boutaugh (2003)
Callahan et al. (2008)
Sample size/characteristics: 346 adults
Demographics: Adults aged 18+ were included and mean age of
respondents was 70; 90% were female; 75% were White.
Inclusion criteria: Self-reported arthritis; currently exercising 3 times a
week for 20 minutes/session limited in normal activities due to arthritis or
joint symptoms
Comparison Groups:
Intervention group vs. control group that received the intervention on a
delayed basis.
Instruments/Measures:
•
•
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
Chronic conditions were assessed using a modification of the
American Academy of Orthopedic Surgeons Musculoskeletal
Outcomes Data Evaluation and Management System list of
comorbidities.
Pain, stiffness, and fatigue (symptoms of arthritis) were
measured using a Visual Analog Scale (VAS).
Self-reported function was assessed using the disability scale
of the 8-item Health Assessment Questionnaire (HAQ).
Participants completed 5 performance-based tests of physical
function: timed 10-pound lifts, timed chair stands, timed 360degree turn, speed of gait, and 6-minute walk.
Physical activity was assessed for type of activity, frequency,
and duration over the past 7 days using the Physical Activity
Scale for the Elderly (PASE).
LIMITATIONS
•
COSTS
Not available
•
Nonprobability sampling causes participant bias toward selfselection
Almost one-third of the participants did not complete at least
half of the PACE classes
Toolkit – Page 2
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ARTHRITIS
Enabling Self-Management and Coping with Arthritic Knee Pain
through Exercise (ESCAPE-knee pain)
PROGRAM OVERVIEW
PRIMARY CONTACT
Mike Hurley, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.kcl.a.uk/content/1/c6/04/79/67/es
capeprogramme.pdf
A six-week (12 sessions) exercise program for adults with knee
pain that can be delivered in a group-based format. Includes an
emphasis on coping strategies.
PROGRAM DESCRIPTION
Duration: 6 weeks
Type: Rehabilitation program
Aim: Combined discussion on specific topics regarding selfmanagement and coping, with an individualized, progressive
exercise regimen.
Program consisted of 12 PT-supervised sessions offered twice
weekly and involved exercise and education on self-management
and active coping strategies.
OUTCOMES
This program reduced pain by 21% and improved self-reported
health status by 7%, irrespective of program format (group or
individual).
PRINT MATERIALS
Program handbook is available in print.
ACCESS ON WEBSITE
Not applicable
IMPLICATIONS
ESCAPE-knee pain provides a safe, relatively brief intervention for
chronic knee pain that is equally effective whether delivered to
individuals or groups of participants.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 3
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ARTHRITIS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
54 inner-city primary care practices in
London, UK
Sample size/characteristics: 418 adults
Inclusion criteria: Reported mild, moderate, or severe knee pain for over
six months
Demographics:
• Adults aged 50+ were included and mean age for the usual care
group was 67, 66 for individual rehab, and 68 for group rehab.
• Sample was predominantly female: ratio of females to males was
96:44 for usual care, 104:42 for individual rehab, and 94:38 for
group rehab.
Comparison Groups:
Individual rehabilitation and group rehabilitation groups vs. usual primary
care control group.
Instruments/Measures:
•
REFERENCE
Hurley et al. (2007)
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
•
Physical functioning, pain, and stiffness were measured using
subscales of the WOMAC.
Objective functional performance was assessed by taking the
aggregated functional performance time of 4 common
activities of daily living.
Anxiety and depression were measured using the Hospital
Anxiety and Depression Scale (HADS).
Self-reported health status was measured by the EuroQol,
which was converted into quality-adjusted life years based on
utility weights collected in a UK general population sample
and a condition-specific patient preference health-related
quality of life questionnaire (McMaster Toronto Arthritis
[MACTAR]).
LIMITATIONS
Not applicable
Not available
Toolkit – Page 4
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ARTHRITIS
Fit & Strong
PROGRAM OVERVIEW
PRIMARY CONTACT
An 8-week group-based multi-component intervention for older
adults with arthritis. Exercise includes range of motion, resistance
training, and aerobic walking. Can be taught by certified exercise
therapists or physical therapists.
SECONDARY CONTACT
PROGRAM DESCRIPTION
Susan Hughes, Professor, University
of Illinois at Chicago
[email protected]
Pankaja Desai, Project Manager
[email protected]
WEBSITE
www.fitandstrong.org
Duration: 8 weeks
Type: Group and facility-based multiple-component training
program followed by home-based adherence
Aim: 2 PT's lead 90-min sessions three times a week on range of
motion, resistance training, aerobic walking (60 min) and group
problem solving sessions regarding self-efficacy for exercise and
exercise adherence (30 min)
Staff ask all participants to develop an individualized postintervention exercise plan that incorporates strength training and
aerobic activity (usually walking) for at least 3 days per week for a
total of 30 min per day, and participants keep a log of their progress.
OUTCOMES
•
PRINT MATERIALS
Instructor manual is available.
ACCESS ON WEBSITE
•
Not applicable
Improved exercise self-efficacy (5% at 2 months, 1% at 6
months), exercise adherence by 49% (at 2 months), and
functional exercise capacity by 13% (at 2 months).
Reduced lower extremity stiffness (16% at 2 months, 13% at 6
months) and pain by 14% (at 2 months).
IMPLICATIONS
•
ASSOCIATED CONDITIONS
Not applicable
•
This low cost intervention efficiently targets older adults who
are at substantial risk of developing disability and significantly
reduces their arthritis pain and stiffness, necessary precursors
of functional independence.
This program is safe to replicate with this target group.
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 5
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ARTHRITIS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Random controlled trial
Sample size/characteristics: 150 community-dwelling older adults
Demographics: Aged 60+; females represented 81.0% of the treatment
group and 87.1% of the controls; Whites accounted for 84.6% of the
treatment group and 78.6% of controls.
Inclusion criteria: Reported knee OA.
Comparison Groups:
STUDY/INTERVENTION LOCATION
Several different senior centers and
senior housing residences in Chicago,
IL
Functioning in training program participants vs. wait list control group.
Instruments/Measures:
•
•
REFERENCE
Hughes et al. (2004)
Hughes et al. (2006)
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
•
LIMITATIONS
•
COSTS
See COST SHEET
The 10-item Short Portable Mental Status Questionnaire
(SPMSQ) was used to screen for presence of moderate to
severe cognitive impairment.
Self-efficacy for arthritis self-management (exercise, pain, and
other symptoms) were measured by using three subscales of
efficacy for arthritis self-management scale developed by
Lorig and colleagues.
Two scales developed by McAuley and colleagues were used
to measure self-efficacy for exercise adherence.
The Timed-Stands Test was used to assess lower extremity
muscle strength and endurance.
The 6-min walk test was used to measure functional exercise
capacity.
The WOMAC was used to examine lower extremity pain,
stiffness, and physical function.
•
•
Study design makes it impossible to conclude whether all
three components of the intervention (flexibility, aerobic
walking, and strength training) are necessary to attain the
reported results.
Attrition from posttest measurement was higher among control
group participants.
It was not possible to blind participants in an exercise trial as
to their treatment status; therefore, some of the self-reported
outcomes may have reflected respondent bias.
Toolkit – Page 6
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ARTHRITIS
Hop with the Hip
PROGRAM OVERVIEW
An eight-week group exercise program for adults with adults that
emphasizes strength training.
PRIMARY CONTACT
Erwin Tak, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
PROGRAM DESCRIPTION
Duration: 8 weeks
Type: Group exercise program
Aim: 1-hour weekly sessions of strength training and lifestyle advice
for older adults with OA of the hip
OUTCOMES
WEBSITE
Not available
This program reduced pain by 8% and self-reported disability by
29%, while improving hip function by 6% and performanceby 10%,
without affecting quality of life or BMI.
IMPLICATIONS
Study fulfilled a need for older adults with hip OA and provides
evidence of the benefit of exercise in the management of hip OA.
PRINT MATERIALS
Materials are available in Dutch, by
request from author.
ACCESS ON WEBSITE
Not applicable
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 7
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ARTHRITIS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Random controlled trial
STUDY/INTERVENTION LOCATION
Amersterdam, The Netherlands
Sample size/characteristics: 109 independent adults
Demographics:
• Adults aged 55+ were included, and mean age of experimental
group was 67.4 and control was 68.9.
• Females represented 29% of experimental group and 35% of
controls.
Inclusion criteria: Clinically-diagnosed OA.
Comparison Groups:
Experimental vs. control groups.
Instruments/Measures:
•
REFERENCE
•
•
Tak et al. (2005)
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
Subjects rated tolerance and severity of pain in the past
month on a 10-cm visual analog scale (VAS).
The Harris Hip Score (HHS) assessed hip function.
Activity restriction was measured as the time (in seconds) it
took to perform 4 functional tasks: 20 m walking with a turn
halfway, the timed Up and Go test, ascending and descending
stairs, and reaching for toes in a sitting position.
Self-reported activity restrictions were assessed using the
Groningen Activity Restriction Scale (GARS) and the Sickness
Impact Profile (SIP).
QOL was measured using a subject-rated generic QOL on a
10-cm VAS and a sum score for 7 questions regarding
physical and psychological functioning, evaluation of own
health, and happiness/satisfaction in last month.
LIMITATIONS
COSTS
Researchers did not meet the target of 140 patients at the start of
the study, which affected its statistical power.
See COST SHEET
Toolkit – Page 8
ToC
COMPARISON CHART OF EVIDENCE-BASED CANCER PROGRAMS
Program
Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Learn Share and
Live Program
• Community-based breast cancer
education program that utilizes an
existing informal network for lowincome urban elderly
• Healthcare professionals train
team leaders through short
lectures followed by discussion or
other interactive activities.
• These leaders of lower-income
adult housing complexes train lay
community women who, in turn,
pass along information and
support for breast cancer control
activities among their peers.
Group
One-day group
lecture,
discussion, and
interactive
activities
Instructors must be trained
facilitators in order to
administer the program
Space for 25-30 participants
Music player
Screen for Life
National
Colorectal Cancer
Action Campaign
National multi-year media campaign
developed by the CDC and Centers
for Medicare and Medicaid Services
to promote colorectal cancer
education and screening among
adults aged 50+
Group
National multiyear media
campaign
Staff are needed to
coordinate distribution of
media materials
Not applicable
Media materials
Tepeyac Project
• Church-based health promotion
project aimed at increasing breast
cancer screening rates
• Promotoras, or peer counselors,
deliver bimonthly breast-health
education lectures and conduct 13 group discussions with
members of four Catholic
churches
Group
Meets twice a
month
Promotoras (peer
counselors) deliver
bimonthly breast-health
education lectures and
conduct 1-3 group
discussions with members
of four Catholic churches.
Space for group discussions
• Chairs for group
discussions
• Access to insurance
claim information
ToC
EXISTING CANCER HEALTH PROMOTION PROJECT AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. This program has its own curriculum with a set number of training topics. All necessary equipment and forms are
provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Save a Life
Campaign
Program Elements
• Senior volunteers are trained to
speak to their peers, family and
friends about a variety of
important health topics.
• Volunteers are provided with key
talking points so they are able to
share their information with
others.
• Previous years focused on
colon-rectal cancer and the
importance of a colonoscopy,
and osteoporosis/bone density
testing.
• This year targets glaucoma,
coupled with message of having
a complete eye exam.
Group/
Individual
Group/ one-on-one
encounters
Time
Staff
(meetings, duration)
(paid, volunteer)
5-15 minute presentations
Training open to all
Health Promotion
Volunteers. Specific
workshops and also
training by Health
Promotion Staff (HPS)
on site.
Space
Requirement
Private room for group
presentations
Equipment
Training materials,
volunteer buttons,
educational materials,
sign –in sheets,
envelopes.
ToC
CANCER
Learn Share and Live Program
PROGRAM OVERVIEW
PRIMARY CONTACT
Marian Robinson, Health
Educator/Ciommunity Liaison
[email protected]
SECONDARY CONTACT
A one-day educational group-based intervention to promote
breast cancer screening. Utilizes peer support and informal
networks. Tailored to low-income African American women aged
55+.
PROGRAM DESCRIPTION
Duration: One day
Not applicable
Type: Community-based breast cancer education program
Aim: Program is implemented via an existing informal network for
low-income urban elderly.
Healthcare professionals train team leaders through short lectures
followed by discussion or other interactive activities.
These leaders of lower-income adult complexes train lay community
WEBSITE
www.clemson.edu/fyd/learn_share_live. women who, in turn, pass along information and support for breast
cancer control activities among their peers.
htm
OUTCOMES
This program improved breast cancer knowledge by 31% among its
participants. By taking part in the program, participants learned that
younger women are not at greater risk for developing breast cancer,
PRINT MATERIALS
Health history activity, program postcard, and 18% found out that a mammogram can detect a breast lump
before it is big enough to feel.
and program abstract are available.
ACCESS ON WEBSITE
Program description is available on
website.
IMPLICATIONS
This is an effective program for promoting breast cancer screening
among older, urban, primarily minority women.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 9
ToC
CANCER
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Not available
Sample size/characteristics: 80 African American women
Demographics: Women aged 55+ were included and 15.8% were aged
55-64 while 21.4% were 65+
Inclusion criteria: Live in subsidized complexes for older adults
Comparison Groups:
The program was implemented at index (year 1) and replication (year 2)
sites.
STUDY/INTERVENTION LOCATION
St. Louis, MO
Instruments/Measures:
•
•
REFERENCE
Skinner et al. (1998)
Pre and post-tests were administered to assess participant
knowledge and perceptions before and after the program.
At the end of the program, steering committees were asked to
provide suggestions for subsequent follow-up activities to
promote screening.
LIMITATIONS
Not applicable
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
See COST SHEET
Toolkit – Page 10
ToC
CANCER
Screen for Life National Colorectal Cancer Action Campaign
PROGRAM OVERVIEW
PRIMARY CONTACT
Ann Ward, Principal Investigator
[email protected]
SECONDARY CONTACT
Eugene Lengerich, Principal
Investigator
[email protected]
WEBSITE
www.cdc.gov/cancer/colorectal/sfl/
A social marketing/awareness campaign to promote colorectal
cancer education and screening among adults aged 50+ in
community-based organizations.
PROGRAM DESCRIPTION
Duration: Mult-year
Type: Media campaign
Aim: National multi-year media campaign developed by the CDC
and Centers for Medicare and Medicaid Services to promote
colorectal cancer education and screening among adults aged 50+
OUTCOMES
This study demonstrates that over time, community cancer
coalitions may increase the local dissemination of material from a
national media campaign.
IMPLICATIONS
PRINT MATERIALS
Media campaign materials (i.e,
brochures, fact sheets, posters, and print
ads) are available in print.
Community cancer coalitions can increase the local dissemination of
material from a national media campaign in rural Appalachia.
ACCESS ON WEBSITE
Materials are available on the program
website.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English, Spanish
PROGRAM TYPE
Implementation
Toolkit – Page 11
ToC
CANCER
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Community health
intervention/Awareness campaign
Sample size/characteristics: 168 community organizations from nine
counties
Demographics: Adults aged 65+ accounted for 16% of organizations in
the coalition arm and 16.5% of the noncoalition arm.
Comparison Groups:
Compared organizations that had linkages to cancer coalitions (the
coalition arm) vs. without linkages (noncoalition arm)
STUDY/INTERVENTION LOCATION
Northern Appalachia, NY and PA
REFERENCE
Ward et al. (2006)
Instruments/Measures:
Community organizations’ participation and interest levels in
disseminating the materials to their clients and employees were
assessed using bimonthly phone calls with university investigators
and weekly calls and monthly meetings with field staff members
were used to communicate with coalitions and project leaders..
LIMITATIONS
•
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
•
•
Participation rate was relatively low: 29% participation in the
coalition arm and 8% in the noncoalition arm
Distribution of materials tends to be impersonal, as it was in
the noncoalition arm
Short duration of the study, which limited the time to work
closely with the coalitions
Different individuals in the organization may have responded
to the initial and follow-up surveys differently, but the research
protocol did not require the same person to respond to each
survey
Limited generalizability given that the study was conducted in
rural Appalachian counties in PA and NY only
COSTS
Not available
Toolkit – Page 12
ToC
CANCER
Tepeyac Project
PROGRAM OVERVIEW
PRIMARY CONTACT
Angela Sauia, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.clinicatepeyac.org
A church-based group intervention to promote breast cancer
screening among Hispanic women. Utilizes culturally-tailored print
materials and promotoras (peer counselors).
PROGRAM DESCRIPTION
Duration: Four years
Type: Church-based health promotion project
Aim: Programs aimed to increase breast cancer screening rates
among insured Latinas in Colorado.
Printed intervention involved culturally-tailored education packages
mailed to 209 Colorado Catholic churches.
Promotoras (peer counselors) delivered bimonthly breast-health
education lectures and conducted 1-3 group discussions with
members of four Catholic churches.
OUTCOMES
PRINT MATERIALS
Brochure, planning guide, and sample
church letter are available.
ACCESS ON WEBSITE
Materials are available on the program
website.
Promotora participants increased their biennial mammograms by
2%, while women exposed to the printed intervention did not change
the frequency of their screenings.
IMPLICATIONS
For insured Latinas, personally delivering church-based education
through peer counselors appears to be a better breast-health
promotion method than mailing printed educational materials to
churches.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English, Spanish
PROGRAM TYPE
Research
Toolkit – Page 13
ToC
CANCER
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Community health
intervention/Awareness campaign
STUDY/INTERVENTION LOCATION
Colorado
Sample size/characteristics: 8,439 Latina women. Racial/ethnic
background of participants was identified based on the enrollment
databases of Medicaid and Medicare fee for service (FFS) groups.
Demographics:
• Women aged 50-69 were included and respondents aged 60-64
represented 28% of those in the printed and promotora
interventions, while ages 65-69 accounted for 27% of the printed
and 22% of the promotora group.
• Latinas can be of any race - 11% of respondents identified
themselves as Latinas and 90% were White.
Inclusion criteria: Enrolled in Medicare, Medicaid or select HMO's.
Instruments/measures: Insurance claims were assessed to determine
mammography use and rates.
Comparison Groups:
REFERENCE
Sauia et al. (2007)
Printed intervention vs. promotora intervention
Instruments/Measures:
Not applicable
LIMITATIONS
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
•
•
Although the interventions were based in churches, outcomes
were measured in neighborhoods, with the assumption that a
church intervention will diffuse into the community
Because this was a pilot project, financial and feasibility
constraints limited to four the number of churches in the
Promotora Intervention.
The fact that the churches were not randomly chosen, but
were selected by community-based partner and the
promotoras, presents a potential selection bias./
COSTS
Not available
Toolkit – Page 14
ToC
COMPARISON CHART OF EVIDENCE-BASED DEPRESSION PROGRAMS
Program Name
Program Elements
Healthy Identifying
Depression,
Empowering
Activities for Seniors
(Healthy IDEAS)
• Community-based
intervention designed to
detect and reduce the
severity of depressive
symptoms among older
adults with chronic health
conditions and functional
limitations through existing
community-based case
management services
• Provides participants and
their caregivers with
education about depression
treatment and self-care, and
active assistance in
obtaining further treatment
Group/
Individual
Individual
Time
(meetings,
duration)
Staff
Requirements
At least 3
face-to-face
visits and 3-6
telephone
contacts, over
a 3-6-month
period
• Staff need to attend pre-service training
sessions about depression and program
delivery, as well as in-service and follow-up
training to address real-world challenges in
working with depressed older adults
• Staff training consists of 14-20 hrs of group
training by behavioral health specialist using
a training DVD
• Staff may have various academic
backgrounds - BSW/MSW, RN, and Case
Managers with varying experience have been
trained
• Program must be delivered by established
case management services staff with up to 3
in-person contacts over 3 months
Space
Requirements
Equipment
Requirements
None
None
ToC
Program Name
Program Elements
Improving Mood
Promoting Access to
Collaborative Care
Treatment (IMPACT)
• Collaborative care program
involving a Depression Care
Manager (DCM), who
collaborates with a Team
Psychiatrist and Primary
Care Physician
• DCM follows the depressed
client's care and treatment
on an ongoing basis
• Participants electing Problem
Solving Therapy (PST)
receive 6-8 sessions of brief
psychotherapy by DCM
Group/
Individual
Individual
Time
(meetings,
duration)
Staff
Requirements
3-6 months of
phone
contacts every
two weeks
during
intensive
phase and
once a month
until
symptoms are
stable
Several training options available for clinicians
and organizations:
• Staff can take part in a 10-module online
training program based on program's 2-day
training conference
• Training consists of 15 hours of content that
includes audio-annotated PowerPoint
lectures, case studies, streaming video and
more. The training program is free; however,
a small fee is charged if continuing education
credit is desired or an in-person training as
well
• PST is available online or through program's
in-person training. Once training is complete,
IMPACT will connect agencies with a certified
PST trainer who provides case supervision to
complete certification as a PST practitioner
Required background for Depression Care
Manager:
• Degree in Nursing, Social Work, Marriage
and Family Therapy or Psychology.
• Minimum 2 years clinical experience in a
Relevant setting
Required background for Consulting
Psychiatrist:
• Licensed, preferably board certified
Space
Requirements
• Private
room/space for
consultation
• 2 chairs
Equipment
Requirements
• Phone
• Computer to track
client needs,
schedules, and
progress
ToC
Group/
Individual
Program Name
Program Elements
Life Review Therapy
• Group sessions tailored to
focus on a particular life
period (i.e., childhood,
adolescence, adulthood) with
questions designed to
prompt specific memories
• Seeks to improve mood,
decrease depressive
symptoms and
hopelessness, and increase
life satisfaction
Group
Program to
Encourage Active,
Rewarding Lives for
Seniors (PEARLS)
Home counseling sessions and
phone contacts for older adults
receiving home-based services
from community service
agencies
Individual
Psycho geriatric
Assessment and
Treatment in City
Housing (PATCH)
• Individual-based program
targeting mentally ill elderly
residing in urban public
housing developments
• Trains building staff to
identify elderly at-risk for
mental disorder, referral to
psychiatric RN, and homebased evaluation or
treatment
• Patients are seen an
average 5 times, with 1-hr
initial assessments and 30minute follow-up contacts
Individual
Time
(meetings,
duration)
Staff
Requirements
Meets once a
week for 1
hour for 8
weeks
Clinical psychologist or individual trained in life
review therapy can administer the program
Meets 8 times
for 50 minutes
each (with 3-6
phone
contacts) for
19 weeks
Staff are required to attend a 2-day training to
administer the program. Training is designed to
equip all members of a PEARLS team – both
counselors and administrators – to implement
the program successfully in their organization
Meets 5 times
for 1 hour
each (with 30minute followup contacts)
for 26 months
• Project nurse must have an RN degree,
experience in psychogeriatric nursing, and
knowledge and comfort with addressing coexisting medical, social, psychiatric
symptoms
• Building staff members take part in a
structured educational program of monthly
presentations led by a staff nurse. Program
consists of 7 1-hour teaching modules
enabling housing staff to better understand
and recognize individuals with mental
disorders and to refer residents who may
need mental health services.
Space
Requirements
Equipment
Requirements
Space for face-toface therapy
• Tape recorder
• Chronometer
• Table
Clinical psychology degree is recommended
•
•
Sessions are
conducted at the
client's home
Counselors have
workstations
Computer/laptop
None
• Phone
• Beeper
ToC
COMPARISON CHART OF EXISTING DEPRESSION HEALTH PROMOTION PROJECTS AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. These programs have their own curricula with a set number of training topics. All necessary equipment and forms are
provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Program Elements
Group/
Individual
Stay Well
Exercise
Classes
• Geared for all seniors, ranging
from the fit to those with
disabilities.
• Led by senior volunteers.
• Includes aerobic exercises as
well as routines designed to
enhance balance, build muscle
strength (with the use of stretch
bands) and aid in the
performance of everyday
activities.
• Classes end with stress
reduction exercises to help
seniors ease the tensions of
everyday living.
Group
Alert & Alive
Discussion
Groups
• Senior volunteers conduct
mental wellness discussion
groups.
• Participants support each other
by sharing experiences that
celebrate their lives and the
ways they are dealing with the
realities of aging.
Group
Time
Staff
(meetings, duration)
(paid, volunteer)
1 hour per week
1 hour every two weeks
Space
Requirement
Equipment
Center /site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on site. Once
training is completed,
the HPS monitors
senior
volunteers/classes on
on-going basis.
Room large enough for
all participants to
complete all exercise
movements
Training materials,
certificates, Tee
shirts, stretch bands,
balls, volunteers
buttons, sign-in
sheets and envelopes
provided by HPS
Center /site identifies
suitable candidates.
HPS implements
training on site. Once
training is completed,
the HPS monitors
volunteers/activity on an
on-going basis.
Private room for
discussion if available.
Training materials,
volunteer buttons,
tote bags, sign-in
sheets, envelopes,
provided by HPS
ToC
DFTA
Program
Name
Partner to
Partner
Program Elements
• Based upon the concept that it
is easier to talk with someone
whose life experiences are
similar to one’s own.
• Trained senior volunteers act as
receptive listeners to their peers
and bring attentive and
supportive communication skills
to their private one-on-one
conversations.
• As aging and life issues are
raised, the trained Partner
provides a sure sense of
support and understanding, and
when requested, advice or
referral information.
Group/
Individual
One –on-one
encounters
Time
Staff
(meetings, duration)
(paid, volunteer)
10- 15 minute sessions
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on site. Once
training is completed,
HPS meets with
volunteers on an ongoing basis
Space
Requirement
None
Equipment
Training materials,
certificates, tote
bags, volunteer
buttons, sign-in
sheets, envelopes,
volunteer buttons,
provided by HPS
ToC
DEPRESSION
Healthy Identifying Depression, Empowering Activities for Seniors
(Healthy IDEAS)
PROGRAM OVERVIEW
PRIMARY CONTACT
Nancy Morrow-Howell
morrow-howell@wustledu
(713) 798-3850
SECONDARY CONTACT
Nancy Wilson
[email protected]
(713) 798-3850
WEBSITE
www.careforelders.org/healthyideas
PRINT MATERIALS
Addressing Depression in Older Adults
Replication and Technical Assistance
Information Handout
Self-Assisting Readiness for
Implementing Healthy IDEAS
(Identifying Depression, Empowering
Activities for Seniors) Handout
Healthy IDEAS Replication Report
3 to 6 month intervention where depression screening and
management is incorporated into existing case management
services for older adults. Delivered by employees of community
service agencies to individual clients.
PROGRAM DESCRIPTION
Duration: Three-to-six months
Type: Community-based intervention
Aim: Designed to detect and reduce the severity of depressive
symptoms among older adults with chronic health conditions and
functional limitations through existing community-based case
management services.
Participants and their caregivers are provided with education about
depression treatment and self-care, and active assistance in
obtaining further treatment. Participants also receive coaching and
support as they engage in behavioral activation. Typically involves
at least three face-to-face visits and three to six telephone contacts.
OUTCOMES
Program reduced depression, while improving participants' general
health status, social and physical activation, and the use of mental
health service
At 6 month follow-up, program showed:
• 39% reduction in depression severity
ACCESS ON WEBSITE
• 25% increase in the number of participants indicating they
Organizational readiness, selfknew how to get help for depression
assessment tools, replication guidance,
• 29% increase in the number of participants reporting reduced
case studies and technical assistance, is
available at the Care for Elders website
pain
www.careforelders.org/healthyideas
• 31% increase in the number of participants reporting little or
no interference of their physical or emotional health with their
ASSOCIATED CONDITIONS
social activities
Not applicable
LANGUAGES
English
PROGRAM TYPE
IMPLICATIONS
Non speciality providers can be trained to successfully implement
an evidence-based self-management intervention for depression
with frail, high-risk, and diverse older adults.
Implementation
Toolkit – Page 15
ToC
DEPRESSION
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
Sample size/characteristics: 94 participants
Demographics: Older adults aged 60+, 79% women, 44% Hispanic
Inclusion criteria: Aged 60+ residing within community and receiving
services at one of the participating community-based agencies. Ability to
understand and communicate verbally, be cognitively intact, and score
greater than 5 on the Geriatric Depression Scale-15 item (GDS-15).
Comparison Groups:
STUDY/INTERVENTION LOCATION
Harris County, Texas.
Not applicable. Study did not have a control group. All eligible participants
(n=94) were able to participate in the study and were not randomized to
treatment or control group
Instruments/Measures:
•
•
REFERENCE
Quijano, et al (2007)
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
COSTS
See COST SHEET
•
Depression severity assessed by the Geriatric Depression Scale15 item (GDS-15)
Cognitive impairment measured by the 6-item Mini Mental State
Exam
Quality of life measured by 3 items (general health perception,
bodily pain, and social function) selected from the Medical
Outcomes Study Short Form-36
Medical and mental health utilization assessed by four items
selected from the Depression PORT II study (a) whether the client
has had contact with a medical provider, (b) whether he or she
discussed depression with a medical provider, (c) whether he or
she was given a prescription for antidepressant medication, and
(d) whether he or she had contact with a mental health
professional
Level of social and physical activity measured by 2 items (a selfreport measure of frequency and duration of physical activity)
selected from the Community Healthy Activities Model Program for
Seniors (CHAMPS)
Knowledge about depression self-management were assessed by
four questions (how to identify symptoms of depression, how to
make an appointment, what to do if depression symptoms
increase, and whether increasing activity will improve depression)
selected from the depression self-efficacy portion of a measure
used to assess collaborative interventions for chronic illness
(Cretin, Shortell, & Keeler, 2004)
LIMITATIONS
•
•
•
Lack of generalizability
Bias caused by attrition
Lack of control group
Toolkit – Page 16
ToC
DEPRESSION
Improving Mood Promoting Access to Collaborative Care
Treatment (IMPACT)
PROGRAM OVERVIEW
PRIMARY CONTACT
12-month program conducted by depression care managers with
specialized training in the treatment of depression. Education,
problem-solving treatment, and support for antidepressant
medication management in collaboration with primary care
physician is provided to individual clients.
SECONDARY CONTACT
PROGRAM DESCRIPTION
Jürgen Unützer, MD, MPH
[email protected]
(206) 685-7095
Diane Powers
[email protected]
(206) 685-7095
WEBSITE
www.impact-uw.org
PRINT MATERIALS
*IMPACT Team Building Worksheet
*IMPACT Planning Implemenation
Toolkit: Needs Assessment, Planning
Grid, Fidelity Measure Worksheet
*IMPACT Training Manual
ACCESS ON WEBSITE
Web cast and free interactive webbased trainings are available to
implementers at program website
www.impact-uw.org
ASSOCIATED CONDITIONS
Arthritis, Diabetes
Duration: 12 months
Type: Collaborative/stepped care disease management program
Aim: To obtain a 50% reduction in depression symptoms within 1012 weeks.
Collaborative care provided by Depression Care Manager (DCM),
Team Psychiatrist and Primary Care Physician. Once participants
have started treatment, Depression Care Manager (DCM) follows up
in person or by phone approximately every two weeks during
intensive phase and approximately monthly until symptoms are
stable. Participants electing Problem Solving Therapy (PST) receive
six to eight sessions of brief psychotherapy by DCM.
OUTCOMES
Program reduced depression and health related functional
impairment, while increasing rates of treatment response.
Program showed:
• 49% reduction of major depression at 6 months
• 24% reduction in health related functional impairment at 12
months
• 45% of participants reported a 50% or greater reduction of
depression symptoms at 12 months
IMPLICATIONS
Program appears to be feasible and significantly more effective than
usual care
LANGUAGES
English, Spanish
PROGRAM TYPE
Implementation
Toolkit – Page 17
ToC
DEPRESSION
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
Sample size/characteristics: 1,801 older adults selected from 18 primary
care clinics, randomly assigned to IMPACT intervention (n=906) or to
usual care (n=895)
Demographics: Mean age 71.2 (s.d.. 7.5 years) 65% were women, 23%
were from ethnic minority groups (12 % African American, 8 % Latino, 3%
other)
Inclusion criteria: Older adults aged 60+, who planned to use one of the
participating primary care clinics as the main source of general medical
care, and a diagnosis of current major depression or dysthymia disorder
according to the Structured Clinical Interview for DSM-IV (SCID).
* 18 Primary Care Clinics within
Washington, California, Texas, Indiana
Comparison Groups:
and North Carolina
Intervention patients having access to IMPACT depression care manager
were compared to usual care group receiving primary care or specialty
mental health care
REFERENCE
Unutzer et al. (2002)
Instruments/Measures:
•
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
•
•
COSTS
See COST SHEET
Severity of depressive symptoms assessed using the
Symptom Check List 20 (SCL-20)
Diagnosis of major depression or dysthymia measured by the
Structured Clinical Interview for DSM-IV (SCID)
Health-related functional impairment measured by an Index
developed from the Sheehan Disability Scale that
incorporates impairments in work, family, and other social
functioning
Health services use was assessed by The Cornell Services
Index
Patient Health Questionnaire 9 and a web-based clinical
information system was used to monitor patient response
treatment for up to 12 months
LIMITATIONS
•
•
•
Study design may have biased program's comparisons in
favor of the usual care group.
Underestimation of the effectiveness of the intervention
compared with usual care outside a research setting.
Reliance on self-reports of chronic medical conditions and
antidepressant and psychotherapy use.
Toolkit – Page 18
ToC
DEPRESSION
Life Review Therapy
PROGRAM OVERVIEW
PRIMARY CONTACT
Juan Pedro Serrano
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
An 8-week group program for older adults with depression. The
program encourages participants to practice retrieving
autobiographical memories.
PROGRAM DESCRIPTION
Duration: 8 week program
Type: Interventional
Aim: Seeks to improve the mood state, as reflected in decreased
depressive symptoms, decreased hopelessness, and increased life
satisfaction among older adults with depressive symptomatology by
examining the effects of autobiographical retrieval practice.
Entails focusing on a particular life period each week-childhood,
adolescence, adulthood, and summary and answering 14 tailored
questions designed to prompt specific memories.
OUTCOMES
PRINT MATERIALS
Life Review Specific Positive Events
Protocol Handout
ACCESS ON WEBSITE
Not applicable
Program decreased number of participants meeting criteria of major
depression, as well as hopelessness, while increasing life
satisfaction.
Program showed:
• 25% decrease in the number of participants suffering from
major depression
• 32% reduction in hopelessness
• 44% increase in life satisfaction
IMPLICATIONS
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
Practice in autobiographical memory for specific events may be
among the components of life review that account for its
effectiveness and could be a useful tool in psychotherapy with older
adults.
Spanish, English
PROGRAM TYPE
Research
Toolkit – Page 19
ToC
DEPRESSION
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 43 older adults
Demographics: Older adults aged 65-93. 33 were women and 10 were
men.
Inclusion criteria: Clinically significant symptoms of depression, no
evidence of dementia, and could not be receiving pharmacological
treatment for depression
Comparison Groups:
STUDY/INTERVENTION LOCATION
Albacete, Spain
Intervention group received the life review intervention while continuing
with social services. Control group received social services as usual.
Instruments/Measures:
•
•
REFERENCE
Serrano et al. (2004)
•
LIMITATIONS
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
Depression was measured by the 20-item self-report scale,
Center for Epidemiologic Studies Depression Scale (CES-D)
Life satisfaction was measured by the Life Satisfaction Index
A (LSIA)
Hopelessness was measured by the Beck Hopelessness
Scale (BHS).
•
•
•
No placebo control groups in which participants received the
same amount of attention from the therapist but not the
autobiographical retrieval practice.
Prompting questions during the intervention primarily targeted
positive memories
No follow-up to learn how long the changes maintained.
Sample size was small
Not all respondents had major depressive disorder, but did
have significant depressive symptoms.
COSTS
Not available
Toolkit – Page 20
ToC
DEPRESSION
Program to Encourage Active, Rewarding Lives for Seniors
(PEARLS)
PROGRAM OVERVIEW
PRIMARY CONTACT
Paul Ciechanowski, MD, MPH
[email protected]
(206) 685-7285
SECONDARY CONTACT
Sheryl Schwartz
[email protected]
(206) 685-7285
WEBSITE
www.pearlsprogram.org/
PRINT MATERIALS
PEARLS Toolkit/Manual
An individual-based, 19 week intervention for older adults with
minor depression. Consisting of eight 50-minute in-home
counseling sessions with a trained social service worker followed
by 3-6 subsequent telephone contacts. Program helps
participants recognize symptoms of depression, meet their
recommended levels of social and physical activity, and identify
and participate in personally pleasurable activities, complemented
with telephone support calls.
PROGRAM DESCRIPTION
Duration: 19 weeks
Type: Home-based, time-limited depression treatment program
Aim: To reduce symptoms of depression and improve healthrelated quality of life. Offered to older adults receiving home-based
services from community service agencies and who have minor
depression or dysthymia.
Consists of eight 50-minute in-home counseling sessions with a
trained social service worker followed by 3-6 subsequent telephone
contacts. The Patient Health Questionnaire 9 (PHQ-9) is
administered at the beginning of session to track depression
change.
OUTCOMES
ASSOCIATED CONDITIONS
Program reduced depression among participants.
Program showed:
• 54% of participants reported a decrease in depressive
symptoms at 6 months, while 43% participants reported a
decrease at 12 months
• 36% of participants were more likely to achieve complete
remission from depression at 12 months
• Overall, greater health-related quality -of-life improvements in
functional and emotional well-being.
LANGUAGES
IMPLICATIONS
ACCESS ON WEBSITE
Please visit program website at
www.pearlsprogram.org/ for electronic
PEARLS Toolkit/Manual and training
information
Not applicable
English
PROGRAM TYPE
Program was found to significantly reduce depressive symptoms
and improve health status in chronically medically ill older adults
with minor depression and dysthymia.
Implementation
Toolkit – Page 21
ToC
DEPRESSION
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
Metropolitan Seattle, Washington
area.
Sample size/characteristics: 138 participants
Demographics: Older adults 60+, 79% women, 42% belonged to a
racial/ethnic minority (36% African American , 4% Asian American, 1%
Hispanic , and 1% American Indian)
Inclusion criteria: Aged 60+, receiving services from senior services
agencies or living in senior publics housing with DSM-IV minor depression
or dysthymia diagnostic criteria.
Comparison Groups:
Intervention group received problem-solving therapy by PEARLS
therapists while control group received no additional services, but letters
sent to their regular physicians and social workers reporting their
depression diagnosis with recommendations to cont
Instruments/Measures:
•
REFERENCE
Ciechanowski et al (2004)
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
Depression was assessed using the Hopkins Symptoms
Checklist ( HSCL-20) derived from the revised HSCL-90
Health related quality of life in functional, physical, social and
emotional well-being domains was assessed at baseline and
12 months using the Functional Assessment of Cancer
Therapy Scale-General (FACT-G)
Health care utilization was assessed using the Cornell
Services Index
7 NEO neuroticism scale items were administered at baseline,
since neuroticism predicts persistence of depression in
primary care and an increased risk for late-life depression
associated with disability
LIMITATIONS
COSTS
See COST SHEET
•
•
•
The sample size was moderate and limited to 1 urban
geographical area.
Study did not have access to automated health care records,
relying instead on self-reported medical comorbidty and health
care utilization, which is susceptible to social desirability and
recall biases.
Study has unequal baseline proportions of dysthymia and
minor depression, with intervention participants having a
greater proportion of dysthymia at baseline compared with
usual care participants.
Toolkit – Page 22
ToC
DEPRESSION
Psycho geriatric Assessment and Treatment in City Housing
(PATCH)
PROGRAM OVERVIEW
PRIMARY CONTACT
Peter V. Rabins, MD, MPH
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
PRINT MATERIALS
*PATCH Educational Modules
Individual-based, 26 month intervention applied in urban public
housing developments where building staff are trained to identify
seniors at risk for psychiatric disorders. Residents are then
screened by a psychiatric nurse, and treatment is provided in
residents’ homes as necessary.
PROGRAM DESCRIPTION
Duration: 26 months
Type: Treatment model that combines principles of the Assertive
Community Treatment and Gatekeeper models.
Aim: Intervention targeted mentally ill elderly persons living in urban
public housing developments with the aim of reducing psychiatric
symptoms among elderly residents needing care and enabling them
to remain in public housing.
Intervention's three core elements, include (1) Training of building
staff (manager, social workers, groundskeepers, and janitors) to
identify those at risk for psychiatric disorder (2) Identification and
subsequent referral of potential cases by workers to a psychiatric
nurse (3) Psychiatric evaluation and treatment in the residents'
homes. Patients are seen an average of 5 times, with most initial
assessments taking 1 hour and follow-up contacts averaging 30
minutes
OUTCOMES
ACCESS ON WEBSITE
Program decreased depressive symptoms and psychiatrics
symptoms among participants suffering from psychiatric conditions.
Program showed:
• 8% reduction in depressive symptoms
• 34% reduction in psychiatric symptoms
ASSOCIATED CONDITIONS
IMPLICATIONS
Not applicable
Not applicable
LANGUAGES
PATCH intervention was more effective than usual care in reducing
psychiatrics symptoms in persons with psychiatric disorders and
those with elevated levels of psychiatric symptoms
English
PROGRAM TYPE
Implementation
Toolkit – Page 23
ToC
DEPRESSION
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
6 urban public housing sites for older
adults in Baltimore, MD.
Sample size/characteristics: 945 older adults
Demographics: Older adults 60+. Within intervention group , 77% were
women, 89.2% were African-American,10.8% non-black. Within control
group, 73% were women and 96.4 were African-American and 3.6 were
non-black.
Inclusion criteria: All subjects aged 60+, who screened positive (scored 5
or more on the General Health Questionnaire, 17 or less on the MiniMental State Examination, or a score of 2 or more on the CAGE
questionnaire were included as well as a 10% random sample of those
who screened negative were selected.
Comparison Groups:
Among the 6 sites, residents in 3 buildings were randomized to receive the
PATCH model intervention and residents in the remaining 3 buildings were
randomized to receive usual care.
REFERENCE
Rabins, et al (2000)
Instruments/Measures:
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
LIMITATIONS
•
COSTS
Psychiatric symptoms and behavioral disorders were
measured by the Brief Psychiatric Rating Scale (BPRS)
Changes in mood and measurement of depressive symptoms
were assessed by the Montgomery-Asberg Depression Rating
Scale (MADRS)
Composite measure entitled undesirable moves, included
subjects who were evicted or who moved from the building to
a nursing home or to a board and care home during the study
•
Lack of a single standardized treatment as the independent
variable
Use of non-treated comparison group
See COST SHEET
Toolkit – Page 24
ToC
COMPARISON CHART OF EVIDENCE-BASED DIABETES PROGRAMS
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Program Name
Program Elements
Diabetes Education &
Prevention with a
Lifestyle Intervention
Offered at the YMCA
(DEPLOY)
Group-based intensive lifestyle
intervention which adapts the
Diabetes Prevention
Program (DPP) to YMCA's.
Group
Meets once a
week for 1 hour
for 16 weeks
• The intervention was originally
implemented by trained YMCA
wellness instructors
• Instructors are required to attend
a two-day training
Space for 8-12
participants to participate
in group exercise
• Exercise equipment
(provided by YMCA)
• Instruments to
measure body
weight, blood
pressure, HbA1c
levels, total
cholesterol, and
HDL-cholesterol
• Chairs for group
meetings
Diabetes Health
Connection
Tailored CD-ROM intervention
with one-on-one counseling
and follow-up telephone
support that emphasizes
participant choice in physical
activity selection
Individual
Entails only
two sessions:
for baseline
and follow-up
assessment
Staff may have diverse
educational backgrounds (e.g.,
OT, public health), but all receive
training to become health
coaches. This training focuses on
motivational interviewing, mock
patient interactions, and
"shadowing."
Space for individuals to
use computer (i.e.,
computer room)
• Computer
• Program CD
• Telephone
Diabetes Prevention
Program (DPP)
• Curriculum-based intensive
lifestyle intervention taught
by case managers on a oneto-one basis
• Aims to reduce weight by 7%
and promote at least 150
minutes of weekly physical
activity
Individual
Meets for 16
sessions for 24
weeks
This intervention is taught by
trained case-managers; no
educational background is
specified
Space for one-on-one
discussions.
Equipment to measure
Hba1c level
*This program is a model
evidence-based diabetes
program upon which
other programs have
been adapted
ToC
COMPARISON CHART OF EVIDENCE-BASED DIABETES PROGRAMS
Program Name
Group Lifestyle
Balance (GLB)
Program Elements
Group/
Individual
Time
Staff
Requirements
(meetings,
duration)
Meets for 12
sessions for 12
weeks
Space
Requirements
Equipment
Requirements
• Intervention addressing safe
weight loss and physical
activity
• Shortens the 16-session
Diabetes Prevention
Program (DPP) to 12
sessions, and is delivered by
two trained "preventionists" - one dietician and one
exercise specialist
Group
Healthy ChangesTM
by NCOA
Group-based educational
program on topics of diabetes,
nutrition and physical activity,
with a secondary aim of
providing social support
Group
Meets for 26
sessions
lasting 90
minutes each
This intervention is taught by
trained group facilitators; no
educational background is
specified
Space for group sessions
None
Look After Yourself
(LAY)
Structured group-based
educational program that
promotes diabetes selfmanagement through
education and motivational
components necessary for
behavior change
Group
Meets one a
week for 2
hours per
session for 8
weeks
This intervention is delivered by
nurses specializing in diabetes,
who are trained to conduct the
intervention
Space for group sessions
Equipment to measure
Hba1c levels and BMI
•
•
Originally implemented by
one dietician and one
exercise specialist, although
any health professional may
implement this program
Health care professionals
must attend a 2-day training
at the University of Pittsburgh
Medical Center
•
•
Room with table and
chairs
Private area for
weigh-in's
• Calorie/fat-tracking
book
• Pedometer
• Measuring
cups/spoons
• Scale
ToC
COMPARISON CHART OF EVIDENCE-BASED DIABETES PROGRAMS
Group/
Individual
Time
(meetings,
duration)
Program Name
Program Elements
Look AHEAD (Action
for Health in
Diabetes)
• Intensive lifestyle
intervention involving group
and individual meetings led
by intervention teams
consisting of dieticians,
psychologists, and exercise
specialists
• Adaptation of the Diabetes
Prevention Program, or
DPP, with the goal of 7%
weight loss in the first year
through reduced caloric
intake and physical activity of
175 minutes per week
Group and
individual
components
Year-long
program that
involves 3
group and 1
individual
meetings
during months
1-6, and 1
group session
every 2 weeks
and 1
individual
session during
months 7-12
New Leaf. . . Choices
for Healthy Living
with Diabetes
Group and individual-based
program tailored to African
Americans that uses
community diabetes advisors
to emphasize physical activity,
healthy diet, and diabetes selfcare.
Group and
individual
components
Year-long
program that
involves 2-3
hours of
individual
counseling, 4.5
hours of group
counseling,
and 2 hours of
telephone
contact.
Staff
Requirements
Space
Requirements
Equipment
Requirements
This intervention is implemented
by a team of diverse
professionals - dieticians,
psychologists, and exercise
specialists.
Space for group and
individual sessions,
as well as fitness
test
Equipment to
measure heart rate,
respriatory rate, blood
pressure, HbA1c
levels, fasting serum
glucose, total serum
cholesterol and
triglycerides, and HDL
and LDL cholesterol
The individual-based clinic
component is led by a health
counselor, and the group-based
community component is led by a
community diabetes advisor (CDA)
who is a nonprofessional peer
counselor. When this program
was first studied, CDAs were
African American women with type
2 diabetes, who had a general
knowledge of diabetes, and who
received training on how to
conduct the New Leaf program
Space for group and
individual sessions, as
well as exercise session
• Equipment to
measure fitness
(Caltrac
accelerometer),
weight, glycosylated
hemoglobin, and
blood lipids
• Fitness equipment
(i.e., treadmill)
• Telephone for
counseling
ToC
COMPARISON CHART OF EVIDENCE-BASED DIABETES PROGRAMS
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Seniors Taking
Charge of Diabetes!
• Community-based
intervention that focuses on
improving daily adherence to
diabetes self-management
behaviors, glucose control,
and physical activities
• Incorporates daily meal
planning and interactive
games
Group
Meets for 8
sessions over
4 months., with
8 additional
sessions on
increasing
intake of fruits
and vegetables
This intervention is delivered by
trained group leaders; no
educational background is
specified
Space for lectures, food
demonstrations, and
chair exercises
• Food for
demonstrations
• Ball and bands for
chair exercises
Starr County Border
Health Initiative
• Education and support group
intervention tailored to
Mexican culture
• Involves 3 months of weekly
instructional sessions on
nutrition, self-monitoring of
blood glucose, exercise, and
other self-care topics, and 6
months of biweekly support
group sessions to promote
behavior changes.
• Participants are
accompanied to sessions by
a family member or friend
Group
Meets for 52
contact hours
for 12 months,
including 3
months of
weekly
educational
sessions and 6
months of
biweekly
support group
sessions
• This intervention is implemented
by a team of dieticians, nurses,
and community health workers
• Trainers are not required to be
certified diabetes educators
• Community health workers are
trained to provide logistical
support
• Room with table and
chairs for 15
participants
• Access to kitchen
preferred
• DVD or VCR
• Pedometers
(provided by
program staff)
• Glucometers
(provided by
program staff)
ToC
EXISTING DIABETES HEALTH PROMOTION PROJECT AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. This program has its own curriculum with a set number of training topics. All necessary equipment and forms are
provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Know Your
Numbers
Program Elements
• Senior volunteers are trained to
help their peers understand the
implications of their blood
pressure readings, as well as the
results of their glucose and
cholesterol tests.
• The training curriculum has been
revised to make it more userfriendly for prospective
volunteers.
• Plans are to mail a flyer
announcing the availability of this
program in mid- January.
Group/
Individual
Group/ On-on-one
encounters
Time
Staff
(meetings, duration)
(paid, volunteer)
5-15 minute presentations
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) conducts training
on site. Once training is
completed, HPS meets
with volunteers on an
on-going basis.
Space
Requirement
Private room for group
presentations
Equipment
Training materials,
certificates, tote bags,
volunteer buttons,
educational materials,
sign-in sheets, and
envelopes, provided
by HPS
ToC
DIABETES
Diabetes Education & Prevention with a Lifestyle Intervention
Offered at the YMCA (DEPLOY)
PROGRAM OVERVIEW
PRIMARY CONTACT
Ronald T. Ackermann, MD, MPH
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
PRINT MATERIALS
A 16-session group-based intensive lifestyle intervention for
obese adults with diabetes risk factors. The curriculum is based
on the Diabetes Prevention Program, and is delivered by trained
YMCA wellness instructors. The program aims to reduce weight
through improved diet and exercise.
PROGRAM DESCRIPTION
Duration: 16 sessions over 16 weeks
Type: A group-based intensive lifestyle intervention, involving
groups of 8-12 people
Aim: To adapt the Diabetes Prevention Program (DPP) for wider
dissemination using the YMCA network and wellness instructors.
Following the core training, participants are encouraged to meet
twice weekly at their preferred community location to exercise.
OUTCOMES
•
•
This program reduced weight by an average of 6%, and
improved cholesterol (-22mg/dl), although changes in blood
pressure were not significant.
Weight loss and reduction in cholesterol were sustained at the
12 to 14 month follow-up.
The curriculum, as well as information
on trainings, will be available through the IMPLICATIONS
Centers for Disease Control (CDC) in
There are approximately 2,500 YMCA facilities serving 10,000 rural,
Spring 2010.
suburban and urban communities in the U.S. This study points to
feasibility of nationwide dissemination of a beneficial and costACCESS ON WEBSITE
effective
approach to diabetes prevention.
Not applicable
ASSOCIATED CONDITIONS
Obesity Pre-Diabetes
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 25
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Pilot randomized controlled trial
STUDY/INTERVENTION LOCATION
Two semi-urban YMCA facilities in
Indianapolis IN
REFERENCE
Ackermann and Morero (2007); Finch
et al. (2009); Ackermann et al (2008)
Am J Prev Med.
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
Sample size/characteristics: 92 participants
Demographics: controls were more often women (61% vs. 50%) and of
nonwhite race (29% vs. 7%). The mean age in the intervention group was
56.5 (s.d. 9.7), and 50% of participants in the intervention group were
women, 2% Hispanic, 4% African American, 93% white, and 2% other.
Inclusion criteria: BMI ≥ 24; ≥2 diabetes risk factors; and random
capillary blood glucose of 110–199 mg/dL.
Comparison Groups:
Participants in the intervention group were compared to a control condition
that received approximately 5 minutes of advice, supplemented by the
National Diabetes Education Program's Small Steps Big Rewards to
Prevent Diabetes materials.
Instruments/Measures:
After 6 and 12 months.
• Body weight
• Blood pressure
• HbA1c
• Total cholesterol, and HDL-cholesterol
LIMITATIONS
•
•
•
Pilot study; significant differences at baseline between control
and intervention groups.
Participants in the intervention group only attended
approximately 57% of all possible classes.
With only 2 matched YMCA sites, it was not possible to adjust
for clustering by intervention site.
COSTS
Not available
Toolkit – Page 26
ToC
DIABETES
Diabetes Health Connection
PROGRAM OVERVIEW
PRIMARY CONTACT
D.K. King, M.S., OTR
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
A 2-session CD-ROM-based physical activity intervention for
adults with diabetes. This intervention involves two one-on-one
sessions combined with telephone support. The program assists
participants in designing a physical activity plan that emphasizes
participant choice in activity selection.
PROGRAM DESCRIPTION
Duration: On-on-one sessions conducted at baseline and two
months
Type: CD-ROM-based intervention to improve physical activity
Aim: Tailored CD ROM intervention with one-on-one counseling
and follow-up telephone support that emphasized participant choice
in physical activity selection
OUTCOMES
•
•
•
PRINT MATERIALS
A CD-ROM of the intervention is
provided. No additional print materials
are required.
ACCESS ON WEBSITE
Not applicable
This intervention improved moderate intensity physical activity
and strength training.
Proportion engaging in moderate intensity physical activity
increased by 33%.
Strength training as measured by kcals/kg/hr increased by
227%.
IMPLICATIONS
A computerized assisted program with health coaching can be used
to assist adults with type 2 diabetes to develop a physical activity
plan combining aerobic and strength training.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 27
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
Adults recruited from 42 primary care
physicians in Denver metropolitan
area
REFERENCE
King et al. (2006)
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
Sample/study characteristics: 335 adults randomized to a computerassisted tailored self-management intervention (n=174) or to a health risk
appraisal with feedback control group (n=161).
Demographics: Mean age was approximately 61 for both groups (s.d.
11.3). 76.5% were white, and 17.8% were Hispanic. 50.2% in both groups
were female.
Inclusion criteria:
Participants were at least 25 years of age and had diagnosed type 2
diabetes for 6 months or more; able to read and write in English; and able
to perform moderate level physical activity.
Comparison Groups:
Participants in the comparison condition completed an interactive
computerized health risk appraisal at baseline and received feedback and
brief generic health counseling. At the 2 month follow-up visit, they
discussed their diet and physical activity goa
Instruments/Measures:
•
CHAMPS questionnaire to measure physical activity at
baseline and 2 months.
LIMITATIONS
•
•
Reliance on self-report.
Inability to measure whether results will extend beyond 2
months.
COSTS
Not available
Toolkit – Page 28
ToC
DIABETES
Diabetes Prevention Program (DPP)
PROGRAM OVERVIEW
PRIMARY CONTACT
DPP Coordinating Center
George Washington University
Biostatistics Center
6110 Executive Blvd.
Suite 750
Rockville, MD 20852
An intensive lifestyle intervention program for obese adults with
pre-diabetes. 16 sessions are delivered over 6-months by a case
manager on a one-on-one basis. The sessions focus on reducing
weight through improved diet and exercise.
PROGRAM DESCRIPTION
Not applicable
Duration: 16 sessions within a 24-week period. Participants were
evaluated for an average of 2.8 years following the intervention.
Type: Individual-based intensive lifestyle intervention
Aim: 16-lesson curriculum taught by case managers on a one-onone basis. The goals of the intervention were 7% weight loss and at
least 150 minutes of physical activity per week.
WEBSITE
OUTCOMES
SECONDARY CONTACT
http://www.bsc.gwu.edu/dpp/index.htm
lvdoc
This intervention decreased weight, decreased caloric intake and fat
intake, improved blood glucose, and reduced the incidence of
diabetes.
In the lifestyle intervention group:
PRINT MATERIALS
• 50% achieved weight loss of at least 7% of body weight, and
Print materials can be requested through
74% met the goal of 150 minutes of physical activity per week.
the Diabetes Prevention Program
• Normal fasting glucose values improved in the first year.
Coordinating Center, or they may be
• Daily energy intake decreased by a mean of 450 kcal.
downloaded directly from the website.
• Average fat intake decreased by 7% of total fat intake.
ACCESS ON WEBSITE
• Incidence of diabetes decreased by 58%.
Chapters from the curriculum are
available as pdfs on the study repository
website
IMPLICATIONS
http://www.bsc.gwu.edu/dpp/index.htmlv
• Diabetes can be prevented or controlled in those with
doc.
impaired glucose tolerance using intensive lifestyle
intervention or metformin.
• The lifestyle intervention was more effective than metformin.
ASSOCIATED CONDITIONS
Obesity Pre-Diabetes
LANGUAGES
English and Spanish
PROGRAM TYPE
Research
Toolkit – Page 29
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized Controlled Trial
STUDY/INTERVENTION LOCATION
US
Sample size/characteristics: 3,234 adults with diabetes attending one of
27 clinical centers.
Demographics: 67.7% were women. 54.7% were white, 19.9% were
African American, 15.7% were Hispanic, 5.3% were American Indian, and
4.4% were Asian. Mean age was approximately 50.6 (s.d. 10.7).
Inclusion criteria: at least 25 years of age; BMI of 24 or higher; impaired
glucose tolerance.
Comparison Groups:
Participants in the intensive lifestyle intervention also received a placebo,
and were compared to those receiving standard recommendations plus
metformin, and to participants receiving standard lifestyle
recommendations plus placebo.
Instruments/Measures:
REFERENCE
Diabetes Prevention Program
Research Group (2002); Wylie-Rosett
et al. (2006) for cost effectiveness.
•
•
•
HbA1c
Self-reported physical activity using the Modifiable Activity
Questionnaire.
Dietary intake using modified version of Block food-frequency
questionnaire.
LIMITATIONS
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Toolkit – Page 30
ToC
DIABETES
Group Lifestyle Balance (GLB)
PRIMARY CONTACT
M. Kaye Kramer, DrPH, MPH, BSN,
CCRC
Director, Diabetes Prevention Support
Center
University of Pittsburgh Diabetes
Institute
[email protected]
SECONDARY CONTACT
Miriam Seidel, MS, RD, LDN
[email protected]
WEBSITE
PROGRAM OVERVIEW
A 12-session group-based intensive lifestyle intervention for
obese adults with components of the metabolic syndrome. The
curriculum is based on the Diabetes Prevention Program. Trained
“preventionists” deliver the program which emphasizes weight
loss through improved diet and exercise.
PROGRAM DESCRIPTION
Duration: 12 sessions over 12 weeks
Type: A group-based, intensive lifestyle intervention
Aim: Intervention addressing safe weight loss and physical activity.
The 16 session Diabetes Prevention Program (DPP) was shortened
to 12 sessions over 12 weeks. The goals remained 7% weight loss,
and weekly physical activity of 150 min. Intervention was delivered
by two trained "preventionists" -- one dietician and one exercise
specialist.
https://diabetesprevention.upmc.com/d
iabetesPrevention_Contact.htm
OUTCOMES
This intervention reduced weight, abdominal obesity, and
PRINT MATERIALS
hypertension. Changes in blood lipids were not significant, and
In order to receive the curriculum, health blood glucose increased.
care professionals must attend a 2-day
• Nearly half lost at least 5% and one third lost at least 7% of
training at the University of Pittsburgh
their body weight.
Medical Center.
• 88% maintained weight loss at 6 months.
ACCESS ON WEBSITE
• Proportion with abdominal obesity decreased over time (90%
Information for health care professionals
at baseline, 82% at 3 months and 68% at 6 months).
interested in the 2-day trainings is
• Proportion with hypertension decreased over time (68% at
available through the following website:
baseline, 58% at 3 months and 48% at 6 months).
https://diabetesprevention.upmc.com/dia
• Proportion with glucose greater than or equal to 100 mg/dl
betesPrevention_ProfessionalServices.h
tm
increased over time (42% at baseline, 51% at 3 months and
61% at 6 months).
ASSOCIATED CONDITIONS
Obesity Pre-Diabetes
LANGUAGES
English
PROGRAM TYPE
IMPLICATIONS
•
•
One of the first studies attempting to translate the DPP to an
urban medically underserved community.
One of the few studies demonstrating sustained
improvements in weight loss and reduction in components of
metabolic syndrome in a community setting.
Research
Toolkit – Page 31
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION LOCATION
Sample size/characteristics: Residents from 11 targeted neighborhoods
were screened for metabolic syndrome (n=573) and n=185 eligible
participants were invited. Of these, n=88 took part in the intervention.
Demographics: Mean age was 54 years (s.d. 10.5). 84.1% were female,
and 74.7% white.
Inclusion criteria: BMI ≥ 25; had physician's consent to exercise; and at
least 3 of 5 components of the metabolic syndrome.
REFERENCE
LIMITATIONS
STUDY/INTERVENTION DESIGN
One group pre-post study design
Community-based recruitment in 11
Comparison Groups:
medically underserved neighborhoods in Not applicable
Pittsburgh, PA (flyers were posted in
Instruments/Measures:
churches, physicians offices, worksites
and storefronts, and ads were placed in
• Clinical endpoints: height, weight, waist circumference, blood
newspapers)
pressure, blood glucose, triglycerides, and HDL cholesterol.
The authors note that the information collected on physical
activity and dietary intake was not used due to inaccuracies.
Seidel et al. (2008)
•
•
•
Lack of accuracy in self-reporting of physical activity and food
consumption.
Study was underpowered to detect certain differences.
Lack of Randomized Controlled Trial design.
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
Not available
Toolkit – Page 32
ToC
DIABETES
Healthy Changes™ by NCOA
PROGRAM OVERVIEW
PRIMARY CONTACT
Julie Kosteas, Senior Program
Associate, Center for Healthy Aging
c/o National Council on Aging
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
http://www.healthyagingprograms.org/
content.asp?sectionid=30&ElementID
=11
PRINT MATERIALS
A 26-session group-based educational program for adults with
diabetes. The intervention is delivered by trained leaders, and
emphasizes education, motivation, goal-setting, social support,
and making connections to community resources.
PROGRAM DESCRIPTION
Duration: 26 sessions lasting approximately 90 minutes each
Type: Group-based educational intervention
Aim: To provide education on the topics of diabetes, nutrition and
physical activity, and to provide social support.
OUTCOMES
Not applicable
IMPLICATIONS
This link has all of the information
necessary to replicate Healthy Changes
• Appropriate for use in community settings such as senior
http://www.healthyagingprograms.org/res
centers, community centers,congregate meal sites, and
ources/MP_HealthyChanges.pdf
churches.
Cambios Saludables (the Spanish
version) is also available online
http://www.healthyagingprograms.com/co
ntent.asp?sectionid=30&ElementID=239
Provided in electronic format are: - User
Manual for group leaders (English);
Background information (English); - User
manual (Spanish)
ACCESS ON WEBSITE
Note: toolkit available at NCOA website
http://www.healthyagingprograms.org/co
ntent.asp?sectionid=68
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English and Spanish
PROGRAM TYPE
Implementation
Toolkit – Page 33
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Not applicable
Not Applicable
Comparison Groups:
Not applicable
Instruments/Measures:
•
STUDY/INTERVENTION LOCATION
•
Not applicable
•
REFERENCE
NCOA.
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
Demographic variables and self-reported measures of BMI,
body weight and height.
Behavioral endpoints including a general measure of eating
patterns and physical activity. The items were taken from the
9-item Summary of Diabetes Self-Care Activities (SDSCA), as
well as additional items from Kate Lorig's Stanford Patient
Education Exercise Behavior questionnaire.
Quality of Life was measured using the National Health
Interview Survey Self-Rated Health single item asking
respondents to rate their perceived general health.
Psychosocial outcomes were measured using Kate Lorig's
Stanford Patient Education Research Center Self Efficacy for
Diabetes measure.
Use of community resources/patient empowerment was
measured using the Chronic Illness Resources Survey.
LIMITATIONS
Not applicable
COSTS
Not available
Toolkit – Page 34
ToC
DIABETES
Look After Yourself (LAY)
PROGRAM OVERVIEW
PRIMARY CONTACT
Professor Helen Cooper
Department of Community and Child
Health
Faculty of Health and Social Care,
University of Chester
[email protected]
SECONDARY CONTACT
Not available
An 8-session group-based intervention for adults with diabetes
delivered by trained diabetes nurses. The program uses a
structured empowerment-based approach.
Prior to implementing this program please contact Professor
Helen Cooper for permission (see information at left).
PROGRAM DESCRIPTION
Duration: Two-hour sessions once per week for eight weeks
Type: A structured group-based educational program
Aim: To promote diabetes self-management through education plus
motivational components necessary for behavior change.
OUTCOMES
WEBSITE
Not applicable
PRINT MATERIALS
Provided in electronic format is the
"Teaching Pack" for group facilitators.
ACCESS ON WEBSITE
Not applicable
This intervention improved self-monitoring activity, as well as
psychological attitudes and attitudes toward treatment effectiveness.
However the effect on blood glucose, diet, exercise, and BMI was
not significant.
• Self-monitoring significantly increased at 12 months (+25% ).
• Psychological attitudes improved at 6 months (+2%) and at 12
months (+2%).
• Attitudes toward treatment effectiveness improved at 6
months (+.3% ).
IMPLICATIONS
•
•
The intervention was inexpensive and highly adaptable to
real-world settings.
Demonstrates the importance of improving other outcomes,
not just clinical markers such as HbA1c.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 35
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized Controlled Trial
STUDY/INTERVENTION LOCATION
3 hospital diabetes outpatient clinics in
UK
Sample size/characteristics: n=89 were randomized (n=53 to the
educational group and n=59 to the usual care group).
Demographics: Participants ranged in age from 35-73, with a mean age
of 59. 56% were male.
Inclusion criteria: Patients were 21-75 years old, with diagnosed type 2
diabetes for at least 1 year, and were connected to the healthcare system.
Comparison Groups:
The comparison group received usual care.
Instruments/Measures:
•
•
•
REFERENCE
Cooper et al. (2008)
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
Clinical measures: HbA1c, BMI, and drug treatment.
Diabetes integration questionnaire to assess attitudes
regarding diabetes and its treatment.
Personal models of diabetes questionnaire to assess beliefs
about treatment effectiveness, seriousness and personal
control.
Summary of diabetes self-care activities questionnaire to
assess exercise, diet and self-monitoring.
Focus groups to assess the educational process and real-life
effects of the intervention.
LIMITATIONS
Selection bias -- may have drawn patients who were more compliant
and more willing to change behavior.
COSTS
Not available
Toolkit – Page 36
ToC
DIABETES
Look AHEAD (Action for Health in Diabetes)
PROGRAM OVERVIEW
PRIMARY CONTACT
Mark Espeland, PhD
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
https://www.lookaheadtrial.org/public/h
ome.cfm
A one-year intensive lifestyle intervention for obese adults with
diabetes. The intervention is based on the Diabetes Prevention
Program and involves both group and individual meetings to
encourage weight loss through improved diet and exercise. The
intervention is led by teams consisting of dieticians, psychologists
and exercise specialists.
PROGRAM DESCRIPTION
Duration: One year. During Months 1-6, participants met in three
group sessions and one individual session per month. During
Months 7-12, participants met in group sessions every other week
and had one individual session per month.
Type: An intensive lifestyle intervention (a modification of the
Diabetes Prevention Program, or DPP) involving group and
individual meetings led by intervention teams consisting of
dieticians, psychologists, and exercise specialists.
Aim: Goal of 7% weight loss in first year through reduced caloric
intake and physical activity of 175 minutes per week.
OUTCOMES
Obesity
This intervention reduced weight, reduced waist circumference,
increased physical activity and fitness, improved blood glucose,
decreased blood pressure, and reduced the proportion with
metabolic syndrome.
• In the intervention group:
• 55% met the goal of >7% weight loss and 38% met the goal of
>10% weight loss.
• Waist circumference decreased by 6 cm.
• Fitness improved by 16%.
• HbA1c decreased by .64% and fasting glucose decreased by
22 mg/dl.
• The proportion of participants with metabolic syndrome
decreased by 15%.
• Blood pressure decreased -- mean systolic by -7 mmHg and
diastolic by -3 mmHg.
LANGUAGES
IMPLICATIONS
PRINT MATERIALS
Print materials may be accessed
through the website.
ACCESS ON WEBSITE
Intervention materials and handouts are
available electronically at this website:
https://www.lookaheadtrial.org/public/ds
pMaterials.cfm
ASSOCIATED CONDITIONS
English
PROGRAM TYPE
Research
•
•
Clinically important weight loss and improvement in CVD risk
factors is possible in adults with type 2 diabetes using
intensive lifestyle intervention.
This is the first large clinical trial to compare an intensive
lifestyle intervention to a support and education group.
Toolkit – Page 37
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized Controlled Trial
STUDY/INTERVENTION LOCATION
16 centers in the U.S.
Sample size/characteristics: 5,145 individuals aged 45-74 were
assigned to the Intensive Lifestyle Intervention (ILI) (n=2,570) or to the
Diabetes Support and Education (DSE) (n=2,575) comparison group.
Demographics: In the ILI group, 59.3% were women; 63.1% were white,
15.5% were African American, 5.1% were American Indian, 1.1% were
Asian, 13.2% were Hispanic, and 1.9% were other. Mean age was 58.6
(s.d. 6.8).
Inclusion criteria: Adults with type 2 diabetes between the ages of 45
and 74; BMI > 25 or BMI > 27 if taking insulin; HbA1c < 11%; blood
pressure < 160 systolic, and < 100 diastolic mmHg; triglycerides <600
mg/dl; and adequate performance on physical activity assessment.
Comparison Groups:
REFERENCE
Look AHEAD Research Group (2007)
one year results; Look AHEAD
Research Group (2003) study design.
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
The intervention group was compared to a diabetes support and education
condition. This condition received the same pre-randomization diabetes
session as the intervention group, in addition to three additional group
sessions throughout the year involving
Instruments/Measures:
•
•
•
Weight, height, prescriptions, self-reported incidence of
myocardial infarction, stroke, transient ischemic event,
percutaneous transluminal coronary angioplasty, or coronary
artery bypass graft.
Fitness using a submaximal exercise test.
HbA1c, fasting serum glucose, total serum cholesterol and
triglycerides, and HDL and LDL cholesterol, and blood
pressure.
LIMITATIONS
COSTS
Not available
Several additional years of data will be needed to determine
whether weight loss is maintained and to determine its effect on
CVD risk factors, and to determine whether these changes will
result in decreased risk for cardiovascular events.
Toolkit – Page 38
ToC
DIABETES
New Leaf. . . Choices for Healthy Living with Diabetes
PROGRAM OVERVIEW
PRIMARY CONTACT
Tarisha Cockrell
CDC Wisewoman Program
[email protected]
SECONDARY CONTACT
A one-year intervention for African Americans with diabetes. The
intervention involves a clinic-based individual component plus a
peer educator component taught by “CDAs” or community
diabetes advisors. The intervention emphasizes physical activity,
diet and diabetes care.
PROGRAM DESCRIPTION
Duration: One year. Involves 2-3 hours of individual counseling, 4.5
hours of group counseling, and 2 hours of telephone contact.
Type: A clinic-based individual component plus peer educator
component (led by CDAs or community diabetes advisors)
Aim: The intervention was tailored to African Americans. It
emphasized 1) physical activity of moderate intensity 30 minutes a
WEBSITE
day, 2) a dietary component to decrease total and saturated fat
intake and to improve control and distribution of carbohydrate
http://www.centertrt.org/index.cfm?fa=wwinterventions.i intake, and 3) a diabetes care component addressing various
ntervention&intervention=newleaf&pag aspects of diabetes self-care.
e=intent
Thomas C. Keyserling, MD, MPH
[email protected]
PRINT MATERIALS
Print materials may be accessed
through the website.
Provided in electronic format are:
- two documents providing an overview
of the New Leaf program.
ACCESS ON WEBSITE
Program materials are available through
the following website:
http://www.centertrt.org/index.cfm?fa=wwinterventions.int
ervention&intervention=newleaf&page=i
ntent
OUTCOMES
This intervention improved physical activity and diabetes health
knowledge, although there was no impact on blood lipids, weight,
mental well-being, or blood glucose.
• Physical activity, as measured by accelerometer, increased by
15%.
• Diabetes health knowledge improved by 15%.
IMPLICATIONS
New Leaf is associated with modest enhancement in physical
activity among overweight sedentary older African American women
with type 2 diabetes.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 39
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized Controlled Trial
STUDY/INTERVENTION LOCATION
Primary care practices in central North
Carolina.
Sample size/characteristics: n=200 were randomized to clinic+peer
educator intervention (n=67), clinic only intervention (n=66), or to minimal
intervention (n=67).
Demographics: African American women; overall mean age was 58.5
years.
Inclusion criteria: African American women ≥ 40 years of age with type 2
diabetes onset at ≥ 20 years of age with no history of ketoacidosis.
Comparison Groups:
Participants in the clinic+peer educator group were compared to a clinic
only group and to a minimal intervention group.
Instruments/Measures:
•
•
REFERENCE
•
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Physical activity was measured using a Caltrac
accelerometer.
Dietary intake was measured using a series of three 24-hour
recall telephone-administered calls using the Minnesota
Nutrition Data System.
Weight, glycosylated hemoglobin, and blood lipids.
Diabetes Knowledge Scale.
Diabetes health status instrument which included items from
two validated scales -- Mental Well-Being and Social WellBeing.
LIMITATIONS
•
•
Authors do not believe results on dietary intake to be valid
because of inaccuracies and underreporting of dietary intake
observed.
Caltrac may have underestimated physical activity, although
this bias is consistent across groups.
Toolkit – Page 40
ToC
DIABETES
Seniors Taking Charge of Diabetes!
PROGRAM OVERVIEW
PRIMARY CONTACT
Mary Ann Johnson, PhD
[email protected]
SECONDARY CONTACT
A group-based educational intervention for older adults with
diabetes (8 sessions delivered over 4 months). The sessions
focus on improving daily adherence to diabetes self-management
behaviors, glucose control, and physical activity. The intervention
incorporates daily meal planning and interactive games.
PROGRAM DESCRIPTION
http://livewellagewell.info/study/materi
als.htm
Duration: Eight sessions delivered over four months. Some also
attended eight additional sessions on increasing intake of fruits and
vegetables. All 16 sessions included physical activity.
Type: A statewide community-based intervention based on the
Health Belief Model and National Standards for Diabetes SelfManagement.
Aim: This intervention focused on improving daily adherence to
diabetes self-management behaviors, glucose control, and physical
activities. The intervention incorporated daily meal planning and
interactive games.
PRINT MATERIALS
OUTCOMES
Not applicable
WEBSITE
Not applicable
This intervention improved several behaviors related to diabetes
self-management, and reduced blood glucose.
The following improved by approximately 1 day per week:
• Number of days in the past week followed a healthy eating
plan
• Followed an eating plan prescribed by a doctor
• Ate five or more fruits and vegetables per day
• Spaced carbohydrates evenly
• Checked feet, tested blood sugar as recommended by a
doctor, and inspected insides of shoes.
• HbA1c decreased for the whole sample by .25% and for those
with baseline HbA1c levels of > 8.0% the mean decrease of
1.15% was clinically significant.
LANGUAGES
IMPLICATIONS
Print materials may be accessed
through the website.
Provided in electronic format are:
- User manual for group leaders
- Bingo games
- Bingo pieces
ACCESS ON WEBSITE
Intervention materials are available
through the following website:
http://livewellagewell.info/study/materials
.htm
ASSOCIATED CONDITIONS
English
PROGRAM TYPE
A low cost, low-intensity intervention can be implemented in senior
centers to improve self-management behaviors, and HbA1c.
Implementation
Toolkit – Page 41
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
STUDY/INTERVENTION LOCATION
39 senior centers in Georgia
Sample size/characteristics: 851 seniors enrolled in the study, and 351
of these had diabetes. 261 completed the pretest and HbA1c, and 144
completed the pretest, HbA1c and post-test.
Demographics: The mean age was 74, 84% were female, 42% were
white, and 52% were black.
Inclusion criteria: Adults attending senior centers, mainly for congregate
meals, who received clearance from a physician to participate.
Homebound elders were excluded, as were those who were unable to
understand informed consent, answer pre- and post-test questions, or
participate in the intervention.
Comparison Groups:
This study used a convenience sample and compared people who
received the pre-test only to those who completed the pre-test,
intervention and post-test.
Instruments/Measures:
REFERENCE
Pre-and post-test questionnaires/measures:
• Diet and health practices related to diabetes were assessed
with 12 questions from the Summary of Diabetes Self-Care
Activities.
• HbA1c.
IMPLEMENTATION
LIMITATIONS
Speer et al. (2007)
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
•
Additional research is needed to determine the factors critical
to the success of the intervention and to evaluate whether the
same results would be obtained in other sub-populations.
Contamination: many participants also took other health
education classes.
COSTS
See COST SHEET
Toolkit – Page 42
ToC
DIABETES
Starr County Border Health Initiative
PROGRAM OVERVIEW
PRIMARY CONTACT
Sharon A. Brown, RN, PhD, FAAN
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
A group-based intervention for adults with diabetes, tailored to
Mexican-American culture (52 contact hours over 12 months).
The intervention emphasizes nutrition, self-monitoring of blood
glucose, exercise, and other self-care topics.
PROGRAM DESCRIPTION
Duration: 52 contact hours over 12 months
Type: Education and support group intervention tailored to Mexican
culture
Aim: The intervention involved 3 months of weekly instructional
sessions on nutrition, self-monitoring of blood glucose, exercise,
and other self-care topics and 6 months of biweekly support group
sessions to promote behavior changes. Participants were
accompanied by family member or friend.
OUTCOMES
•
PRINT MATERIALS
Provided in electronic format is the
Intervention Manual for group leaders.
Set of seven DVDs to accompany the
curriculum is available for $35, in English
or Spanish, by contacting Dr. Sharon
Brown.
ACCESS ON WEBSITE
Not applicable
•
•
•
This intervention lowered blood glucose and improved
diabetes knowledge.
At 6 months, the mean HbA1c decreased by 1.01%.
Fasting blood glucose decreased from baseline to 6 months
by 28 mg/dl.
Diabetes knowledge improved by 14% from baseline to 3
months.
IMPLICATIONS
Demonstrates that behavioral intervention that is tailored to adults
with low resources, low literacy, and Mexican culture can be
effective.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English or Spanish
PROGRAM TYPE
Research
Toolkit – Page 43
ToC
DIABETES
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
Starr County Texas (on border with
Mexico)
REFERENCE
Brown et al. (2002)
Sample size/characteristics: Mexican Americans n=126 participated in
the treatment group and n=126 participated in the wait-list control group.
Demographics: Mexican American. In the intervention group, 60% were
female. The mean age was 54.7 (s.d. 8.2) with a range of 35-71.
Inclusion criteria: Participants had a diagnosis of type 2 diabetes, were
between 35 and 70 years of age, and had type 2 diabetes diagnosis after
35 years of age.
Comparison Groups:
Participants were compared to a wait-list control group.
Instruments/Measures:
•
•
•
Diabetes-related knowledge and health beliefs.
Language-based acculturation determined at baseline.
Weight, height, BMI, 10-hour fasting blood glucose, HbA1c,
cholesterol, and prebreakfast and supper blood glucose 3
times per week using a home monitoring device.
LIMITATIONS
None identified
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
See COST SHEET
Toolkit – Page 44
ToC
COMPARISON CHART OF EVIDENCE-BASED FALLS PROGRAMS
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
A Matter of
Balance/Volunteer
Lay Leader Model
Community-based structured
group intervention which aims
to reduce fear of falling and
associated restrictions in
activity levels among older
adults
Group
Meets twice
weekly for 2
hours per
session for 4
weeks
• Master Trainers attend a training
and teach coaches (volunteers or
paid staff), who then teach the
classes
• No educational requirements are
necessary
Space for chairs set up
in a circle for 8-12
participants
• Chairs
• DVD player
• 2 DVD's (provided
by the program)
EnhanceFitness
Community-based group
exercise program that
emphasizes moderate intensity
aerobic conditioning, strength
training, flexibility, and balance
exercises
Group
Meets three
times weekly
for 1 hour per
session for 6
months
Instructors are required to:
Indoor space for
participants to extend
arms
•
•
•
•
•
•
• Be certified in American Council
on Exercise (ACE) or American
College of Sports Medicine
(ACSM), a nationally-recognized
fitness program, or have a related
college degree (exercise science,
physiology, or PT)
• Obtain current first aid and CPR
certification
• Have experience teaching older
adult group exercise classes
• Have 2 months of experience
teaching an EnhanceFitness class
Fitness equipment
Armless chairs
CD player and CDs
Stopwatch
Cone
Tape measure
ToC
Program Name
Falls Management
Exercise (FaME)
NoFalls
Program Elements
Group/
Individual
• Group exercise classes and
home-based exercises that
are individually-tailored and
focused on ‘righting’ or
‘correcting’ the necessary
skills to avoid a fall
• Focuses on dynamic
balance, strength, bone,
endurance, flexibility, gait
and functional skills, and
backward-chaining and
functional floor exercises.
• Home exercises are aimed
at reducing asymmetry in
strength of lower limbs
Group
• Group-based exercise, home
hazard management, and
vision improvement aimed at
improving flexibility, leg
strength, and balance
• Involves participant eye care
referrals for those whose
vision tests below
predetermined criteria and
who are not receiving
corrective treatment
Group
Time
(meetings,
duration)
Staff
Requirements
Group and
home exercise
sessions
conducted
twice weekly
for 36 weeks.
Each group
session lasts
one hour and
home
exercises are
performed
twice weekly
for 20-40
minutes each
Instructors are required to obtain:
• Level 4 National Vocational
Qualifications (NVQ)-level training
• Post-Qualifying Endorsed training
with the Chartered Society of
Physiotherapists
Meets once
weekly for 1
hour per
session for 15
weeks
Instructors must be trained exercise
professionals
Space
Requirements
Equipment
Requirements
Space for 20 participants
• Chairs for balance
exercises
• Mats for floorwork
• Therabands
• Ankle/free weights
• Steps
• Space for group
exercise sessions
• Home modifications
are conducted in
seniors' homes
• Chairs
• Vision test chart
Several educational requirements
exist for the various staff members
in this program, including Postural
Stability Instructors, exercise
instructors, leisure managers,
physiotherapists, OTs,
therapy/rehab/support works, and
health managers
ToC
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Step by Step
• Falls awareness campaign,
individual risk assessments,
and suggestions for
individuals to report
concerns to primary care
physicians.
• Aims to raise awareness of
evidence-based fall
prevention programming in
senior centers by enhancing
knowledge and behaviors of
staff and members, and by
enhancing relationships
between senior centers and
relevant local clinicians
Group and
individual
components
7-week period
at a predetermined
community
venue,
followed by a
follow-up
home visit
within 6 weeks
of the final
program
session
Instructors must be trained in
program delivery
Space for group and
individual sessions
Chairs
Stepping On
• Multifaceted communitybased program using a
small-group learning
environment
• Aims to improve fall selfefficacy, encourage
behavioral change, and
reduce falls
• Focuses on improving lowerlimb balance and strength,
promoting home and
environmental and
behavioral safety,
encouraging regular visual
screening and correcting
visial impairments, and
encouraging medication
review
Group
Meets once
weekly for 1
hour per
session for 7
weeks, with a
follow-up
occupational
therapy home
visit
Community Class Leaders are
required to:
• receive 3-year certification after
being trained in the program
• conduct at least one Stepping On
class yearly
• provide evidence of providing
classes on an ongoing basis in
order to be re-certified after 3
years
Master Trainers must be healthcare
professionals (RN, NP, PA, OT, PT)
with knowledge of falls prevention
Space for 12 participants
to perform strengthening
exercises
• Display table
• Ankle weights
ToC
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Strategies and
Actions for
Independent Living
(SAIL)
• Nurse-designed multifactorial
falls prevention program
delivered by community
health workers to older adult
clients receiving community
home support services
• Uses a checklist and action
plan to reduce falls and fallrelated injuries through
education, routine exercise,
environmental modification,
and physical and
occupational therapy
Group
6-month
program
• Trainers need to undergo program
training
• Trainers must be qualified health
professionals who have worked in
home support services for older
adults (i.e., PT, OT, RN, MSW)
• Most of the program
is delivered in homes
of older adults
• Also requires training
space for 20
facilitators, home
health professionals,
and community health
workers
• Fall surveillance and
risk screening tools
• Access to Excel
spreadsheet
• Laptop projector for
trainings
Tai Chi: Moving for
Better Balance
Community-based fall
prevention program focusing
on the use of Tai Chi to
prevent falls
Group
Meets once
weekly for 1
hour per
session for 12
weeks
• Instructors are required to attend
a 1-2 day training by Oregon
Research Institute trainers to
obtain certification
• No educational requirements
Space for 15 participants
• Chairs
• DVD player (optional)
• Attendance sheet
ToC
EXISTING FALLS HEALTH PROMOTION PROJECT AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. This program has its own curriculum with a set number of training topics. All necessary equipment and forms are
provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Stay Well
Exercise
Classes
Program Elements
• Geared for all seniors, ranging
from the fit to those with
disabilities
• Led by senior volunteers.
• Includes aerobic exercises as
well as routines designed to
enhance balance, build muscle
strength (with the use of stretch
bands) and aid in the
performance of everyday
activities
• Classes end with stress
reduction exercises to help
seniors ease the tensions of
everyday living
Group/
Individual
Group
Time
Staff
(meetings, duration)
(paid, volunteer)
1 hour per week
Center /site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on site. Once
training is completed,
the HPS monitors
senior volunteers and
classes on an on-going
basis
Space
Requirement
Room large enough for
all participants to
complete all exercise
movements
Equipment
Training materials,
certificates, Tee
shirts, stretch bands,
balls, volunteers
buttons, sign-in
sheets and envelopes
provided by HPS
ToC
FALLS
A Matter of Balance/Volunteer Lay Leader Model
PROGRAM OVERVIEW
PRIMARY CONTACT
Patti League, Wellness Specialist
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
A four-week (twice weekly sessions) community-based structured
group cognitive behavioral intervention to reduce fear of falling
and promote activity among older adults.
PROGRAM DESCRIPTION
Duration: 4 weeks
Type: Community-based structured group intervention
Aim: Eight 2-hour sessions scheduled twice a week aimed at
reducing fear of falling and associated restrictions in activity levels
among older adults
OUTCOMES
www.mainehealth.org/pfha
This program produced the following changes:
www.mainehealth.org/mh_body.cfm?id
• Improved levels of intended activity by 5%
=432
• Improved mobility control by 7%
www.bu.edu/hdr/products/balance/ma
• Improved falls efficacy by 6%
nual.html
• Improved perceived falls management (7% at 6 wks, 3% at 6
mths, and 12% at 12 mths.
However, the program did not affect the number of fallers, or the
number of falls, at any study period (6 wks, 6 mths, or 12 mths).
PRINT MATERIALS
Informational video, packet, Master
Trainer brochure, participant survey,
IMPLICATIONS
replication report, and sample exercises Short-term changes can be achieved in maladaptive attitudes and
are available in print.
beliefs about falling and in activity levels and functioning.
ACCESS ON WEBSITE
Materials are available on program
website.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 45
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 434 older adults
Demographics: Aged 60+; 89.6% were female; 90.8% were White.
Inclusion criteria: Living in 40 senior housing sites in the Boston
metropolitan area; reported fear of falling and associated activity
restriction; absence of any major physical or health condition that would
preclude participation in the intervention.
Comparison Groups:
STUDY/INTERVENTION LOCATION
40 senior housing sites in Boston, MA
Intervention group vs. social contact control
Instruments/Measures:
•
•
•
REFERENCE
Tennstedt et al. (1998)
LIMITATIONS
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
The Falls Efficacy Scale was used to measure fear of falling.
The abbreviated Sickness Impact Profile (SIP) assessed
changes in participants' behavior due to health problems.
The Intended Activity scale, developed for this study, asked
subjects to rate how sure they are that they will perform
various activities in the coming week.
•
Used self-report to collect data on numbers of falls for
intervals ranging from 6 weeks to 12 months, and therefore,
the number of falls in this study might have been
underreported.
The one-session attention control condition did not make it
possible to control entirely for the effect of social contact on
attitudinal and behavioral changes in the intervention group. In
other words, it is possible that the supportive atmosphere and
interaction of the group intervention contributed to the
observed changes in fears about falling.
COSTS
See COST SHEET
Toolkit – Page 46
ToC
FALLS
EnhanceFitness
PROGRAM OVERVIEW
PRIMARY CONTACT
Brenda Barkey, National Program
Coordinator
[email protected]
SECONDARY CONTACT
Susan Snyder, Vice President
[email protected]
WEBSITE
www.projectenhance.org/admin_enha
ncefitness.html
PRINT MATERIALS
Training materials are available to
licensed affiliates.
ACCESS ON WEBSITE
Implementation steps presentation is
available on the program website.
A group exercise program (three times per week for 60 minutes)
for older adults. Emphasizes moderate intensity aerobic
conditioning, strength training, flexibility and balance exercises.
PROGRAM DESCRIPTION
Duration: 6 months
Type: Community-based group exercise program
Aim: Supervised classes that meet three times per week for 1 hour;
classes emphasize moderate intensity aerobic conditioning, strength
training, flexibility, and balance exercises.
OUTCOMES
This program improved fitness test performance for all participants,
irrespective of their initial test scores. It also improved self-rated
health for all participants.
• Improved strength as measured by two functional tests:
• Increased scores on chair stands test by 43% at 4 mths, 48%
at 8 months.
• Increased scores on arm curl test by 11% at 4 mths, 6% at 8
mths
• Improved flexibility by 9% at 4 mths.
• Improved functional mobility (13% at 4 and 8 mths)
• Improved self-rated health by 5% at 8 mths.
IMPLICATIONS
Older adults can maintain and/or improve physical function through
participation in EnhanceFitness
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 47
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
STUDY/INTERVENTION LOCATION
WA, TX, ME, MI, CA, Washington,
D.C., GA, NY, and SC
Sample size/characteristics: 2,889 older adults
Demographics:
• Mean age of respondents was 75.5 years.
• 80.5% were female.
• The sample included 1,844 Whites, 219 Blacks, 209 Asians, 117
Hispanics, and 418 Others. 82 participants elected not to report
their ethnic group affiliation.
Comparison Groups:
Initial performance was compared to age- and gender-based norms to
classify participants as within or at
or above normal limits (WNL and BNL)
Instruments/Measures:
•
REFERENCE
Belza et al. (2006)
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
The Functional Fitness Test was used as a performance
measurement which measures strength (arm curl, 30-second
chair stand), flexibility (chair sit-and-reach, back scratch),
endurance (six-minute walk, two-minute step test), and
functional mobility (eight foot up-and-go).
The Short Form-12 (SF-12) Health Survey summary scores
for the physical component summary (PCS-12) and mental
component summary (MCS-12) were used as measures of
perceived health status.
LIMITATIONS
•
•
See COST SHEET
•
•
•
Results are susceptible to biases associated with
observational studies: bias related to loss to follow-up data
(testing nonparticipation) and selection bias (recruitment was
not population-based).
Uncertainty as to the generalizability of the findings to those
older adults who are less functional, as the current study
involved primarily higher functioning older adults living in the
community.
Blind assessments were not conducted, and as such there
might be concern about internal validity.
The use of an instructor to administer the performance tests
may have a biasing effect.
The full benefits of the program were not measured as EF has
an aerobic component, yet an aerobic measure was not
included.
Toolkit – Page 48
ToC
FALLS
Falls Management Exercise (FaME)
PROGRAM OVERVIEW
PRIMARY CONTACT
Dawn Skelton, Reader in Aging and
Health, Glasgow Caledonian
University & Coordinator of ProFaNE
(Prevention of Falls Network Europe)
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.laterlifetraining.co.uk
A program for community-dwelling older adults that emphasizes
balance, strength, endurance, flexibility, and other skills to avoid a
fall for use in a group setting, as well individualized home
exercises. Tailored to women.
PROGRAM DESCRIPTION
Duration: 36 weeks
Type: Individualized and tailored group and home exercise
intervention.
Aim: Group exercise classes that are balance-specific, individuallytailored and targeted for training on dynamic balance, strength,
bone, endurance, flexibility, gait and functional skills, and aimed at
‘righting’ or ‘correcting’ skills to avoid a fall, backward-chaining and
functional floor exercises.
Home exercises, 20–40 minutes in duration and performed twice a
week, that are aimed at reducing asymmetry in strength of the lower
limbs.
OUTCOMES
PRINT MATERIALS
Falls diary card is available in print.
ACCESS ON WEBSITE
Not applicable
This program reduced number of falls by 31% and the number of
fallers by 30%.
IMPLICATIONS
Tailored, balance-specific group and home exercise can prevent
falls in people at high risk.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 49
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 81 independent-living, community-dwelling
women
Demographics: Age 65+ and mean age was 72.8.
Inclusion criteria: History of three or more falls in the previous year; had
known medical reasons for falls.
Comparison Groups:
Intervention vs. control groups.
STUDY/INTERVENTION LOCATION
Manchester, United Kingdom
Instruments/Measures:
Subjects were asked to record falls in daily falls diaries that were
returned to investigators for examination every two weeks.
LIMITATIONS
Not applicable
REFERENCE
Skelton (2005)
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
Not available
Toolkit – Page 50
ToC
FALLS
NoFalls
PROGRAM OVERVIEW
PRIMARY CONTACT
Lesley Day, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.monash.edu.au/muarc/projects/n
ofalls
PRINT MATERIALS
Program manual and falls diary are
available in print.
ACCESS ON WEBSITE
Program materials may be purchased
from the program website.
Intervention to reduce risk of falling among community-dwelling
older adults. Involves group-based exercise (weekly class for 1hour for 15 weeks), home hazard management, and vision
correction for those with uncorrected visual impairment.
PROGRAM DESCRIPTION
Duration: 15 weeks
Type: Group-based exercise, home hazard management, and
vision improvement
Aim: Group-based exercise intervention involves a weekly exercise
class of one hour for 15 weeks, supplemented by daily home
exercises that are designed by a physiotherapist to improve
flexibility, leg strength, and balance.
Home hazards are removed or modified either by the participants
themselves or via the City of Whitehorse's home maintenance
program.
Participants are referred to their regular eye care provider, general
practitioner, or local optometrist, to whom the vision assessment
results are given If their vision tests below predetermined criteria
and if he or she is not already receiving treatment for the problem
identified.
OUTCOMES
•
•
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Participants who received the combined intervention
(exercise, home hazard management, vision improvement)
saw a 14% reduction in falls
Participants who received the exercise program improved
their balance.
IMPLICATIONS
•
•
Group-based exercise was the most potent single intervention
tested, and the reduction in falls among this group seems to
have been associated with improved balance.
Falls can be further reduced by the addition of home hazard
management or reduced vision management, or both of
these.
Toolkit – Page 51
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 1,090 Australian-born independent-living
older adults
Demographics: Adults aged 70-84; 59.8% were women.
Inclusion criteria: Living at home.
Comparison Groups:
STUDY/INTERVENTION LOCATION
Whitehorse, an urban community in
Melbourne, Australia
Eight groups were compared -- exercise, home hazard management,
vision improvement, exercise + home hazard management, exercise +
vision, vision + home hazard management, all three interventions, and no
intervention.
Instruments/Measures:
Participants reported falls using a monthly postcard calendar system
to record daily falls outcome.
LIMITATIONS
REFERENCE
Day et al. (2002)
•
•
Participants were not blinded to group assignment, so the
possibility of differences in self reporting bias exists.
Participants differed somewhat from the general older
population living at home, so the findings lacked
generalizability to the general population.
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Toolkit – Page 52
ToC
FALLS
Step by Step
PROGRAM OVERVIEW
PRIMARY CONTACT
Dorothy Baker, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.fallprevention.org
A 7-week intervention at senior centers, complemented by a
home risk assessment to reduce risk of falls. Involves group
classes, social marketing, screening, and provision of instructions
for risk reduction.
PROGRAM DESCRIPTION
Duration: 7 weeks
Type: Consciousness-raising educational pieces and individual
assessments on personal risk factors
Aim: Includes posters, print media, closed-circuit television, group
classes, and screenings at health fairs, followed by individual
assessments on personal risk factors, instructions on risk reduction,
and suggestions for reporting concerns to primary care physicians.
Aims to embed evidence-based fall prevention programming in
senior centers by enhancing knowledge and behaviors of staff and
members, and by enhancing relationships between senior centers
and relevant local clinicians.
OUTCOMES
PRINT MATERIALS
This program increased the proportion of older adults at senior
centers scheduling individual fall risk assessments by 4% within the
first 18 months of its operation.
ACCESS ON WEBSITE
IMPLICATIONS
Training manual must be purchased
from website.
Training manual must be purchased
from website.
ASSOCIATED CONDITIONS
Not applicable
•
•
The challenges of integrating evidence-based fall-prevention
programming into existing senior center services can be
negotiated by collaboration among senior center
administrators, health providers, the center membership, and
researchers.
Senior centers may be important venues to reach older adults
with fall prevention programming.
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 53
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
STUDY/INTERVENTION LOCATION
Nine senior centers in New Haven, CT
Sample size/characteristics: Intervention took place within nine senior
centers serving an estimated 11,700 older adults (20-325 a day).
Inclusion criteria: Sought senior centers with active administrators and
diverse membership to participate in the project. All centers were located
in towns with a relatively high older adults population.
Demographics: Six of the centers served predominantly White suburban
communities, two served urban Hispanic communities, and one served an
urban Black community.
Comparison Groups:
Not applicable
Instruments/Measures:
A tabulation of participants' monthly reports were used to measure
individual scheduling of fall risk assessment.
REFERENCE
Baker, et al. (2007)
*Program was adapted by Tinetti et al.
(2008)
LIMITATIONS
Not applicable
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Toolkit – Page 54
ToC
FALLS
Stepping On
PROGRAM OVERVIEW
PRIMARY CONTACT
Jill Ballard or Jana Mahoney at
[email protected] or
[email protected]
61-2-9351-9372
SECONDARY CONTACT
Lindy Clemson, Principal Investigator
[email protected]
61-2-9351-9372
WEBSITE
Not available
A 7-week program with 2-hour educational and exercise sessions
conducted in small groups on a weekly basis, complemented by a
home risk assessment to reduce risk of falling. Involves exercise
and encourages visual screening and medication review.
PROGRAM DESCRIPTION
Duration: 7 weeks
Type: Multifaceted community-based program using a small-group
learning environment
Aim: Program aims to improve fall self-efficacy, encourage
behavioral change, and reduce falls. Key aspects of the program
are improving lower-limb balance and strength, improving home and
community environmental and behavioral safety, encouraging
regular visual screening, making adaptations to low vision, and
encouraging medication review.
OUTCOMES
•
•
PRINT MATERIALS
Training manual is available in print.
ACCESS ON WEBSITE
Not applicable
This program reduced falls by 31% (for males in particular)
and improved falls efficacy by 7%.
It also increased protective behavioral practices among
participants.
IMPLICATIONS
Stepping On offers a successful fall-prevention option using
cognitive-behavioral learning in a small group environment.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 55
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 310 community residents
Demographics: Aged 70+, 74% women in both intervention and control
groups
Inclusion criteria: Men and women aged 70+ and older who had had a
fall in the previous year or were concerned about falling.
Comparison Groups:
STUDY/INTERVENTION LOCATION
Sydney, Australia
Intervention group vs. control group that received up to two social visits
from an occupational therapy student
Instruments/Measures:
•
•
REFERENCE
Clemson et al. (2004)
*Stepping On is currently being
adapted by the University of
Wisconsin.
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
•
•
•
•
COSTS
See COST SHEET
Functional measure of mobility and balance were assessed by
the Get-up and Go Test
Balance with eyes open and closed was measured by the
Rhomberg test
Perception of health across mental and physical health
domain was measured by the Short Form (SF-36) Health
Survey
Confidence in avoiding falls when performing basic activities
of daily living was assessed by the Modified Falls-Efficacy
Scale (MFES)
Efficacy beliefs over a more a wider range of functional tasks
were assessed by Mobility Efficacy Scale (MES)
Identification of which aspects of daily lives are troubling were
measured by the Physical Activity Scale for the Elderly
(PASE) and the Worry scale
Falls Behavioral (FaB) Scale for older people was developed
specifically for this study to evaluate behavioral factors that
could potentially protect against falling.
LIMITATIONS
The study was not designed to detect an effect in subgroups, and
therefore such results should be interpreted with caution.
Toolkit – Page 56
ToC
FALLS
Strategies and Actions for Independent Living (SAIL)
PROGRAM OVERVIEW
PRIMARY CONTACT
Vicky Scott, Senior Advisor, Falls &
Injury Prevention
[email protected]
604-587-7850 ext. 4846
SECONDARY CONTACT
A 6-month intervention to reduce risk of falling among
homebound adults. The group-based intervention is delivered by
community health workers, and involves exercise, modification of
the home environment, and action planning.
PROGRAM DESCRIPTION
Duration: 6 months
Type: Nurse-designed multifactorial intervention for homebound
older adults delivered by community health workers (CHWs)
Aim: One-day training session for CHWs (falls overview, proven
fall-prevention strategies, and use of the Falls Prevention Checklist
and Action Plan), followed by six months of evidence-based
interventions with home support clients using the Falls Prevention
WEBSITE
Checklist and Action Plan. Aims to reduce falls and fall-related
www.injuryresearch.bc.ca/categorypag injuries among adult clients receiving community home support
es.aspx?catid=1&subcatid=7
services.
Sepia Sharma, Regional Coordinator,
Fall & Injury Prevention
[email protected]
604-587-7850 ext. 4846
OUTCOMES
PRINT MATERIALS
This program reduced falls by 43% (by 44% for frequent fallers) and
fall-related fractures by 86%.
Training materials are currently available
IMPLICATIONS
only for use in British Columbia and
have not been adapted for use outside
• Intervention is an effective and inexpensive falls prevention
of the province.
strategy for frail recipients of home support services.
ACCESS ON WEBSITE
Not applicable
•
Home care nurses can become facilitators and trainers in
assisting CHWs to conduct first-level risk detection for falls,
respond to falls assessment needs, and provide ongoing
quality assurance and evaluation of such efforts.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
Toolkit – Page 57
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
STUDY/INTERVENTION LOCATION
British Columbia, Canada
Sample size/characteristics: 51 community health workers, and 70 home
support clients
Demographics: community health workers: Aged 20 -62, 98% women,
home support clients: Aged 47-100, 79% female
Inclusion criteria: CHWs participation included having at least two
eligible clients with whom the workers could apply their training. Home
support clients needed to be ambulatory, receiving publicly funded home
support services, and able to complete pre and posttests
Comparison Groups:
Not applicable
Instruments/Measures:
•
REFERENCE
•
Scott (2006)
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
SAIL training for (CHWs) was evaluated using a questionnaire
and knowledge test administered before and after the 7-hour
session.
Falls Prevention Checklist and Action Plan (C&A) were
measured in two areas: frequency of reported fall risk and
ranking of the risks according to whether actions were taken
to reduce risk.
Pretest and Posttest measures collected information on prior
falls.
LIMITATIONS
Without randomization of participants and a large sample size,
caution must be used in generalizing these findings to the broader
population of CHWs and home support clients.
COSTS
Not available
Toolkit – Page 58
ToC
FALLS
Tai Chi: Moving for Better Balance
PROGRAM OVERVIEW
PRIMARY CONTACT
Fuzhong Li, Research Scientist
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
www.healthyaging.ori.org/taichidis/taic
hidis.html
PRINT MATERIALS
Training booklet and implementation
plan/steps are available in print.
ACCESS ON WEBSITE
Materials and informational videos are
also available on program website.
A 12-week community-based program (twice weekly) for older
adults that involves tai chi exercise in a group setting for falls
prevention.
PROGRAM DESCRIPTION
Duration: 12 weeks
Type: Community-based fall prevention program developed for use
in community based organizations such as senior centers.
Aim: Twice-weekly 1-hour classes that includes warm-up exercises
(5-10 min), practice of individual forms of the 8-form tai chi program
(40-45 min), and cool-down exercises (5 min). Copies of the
videotape or DVD and user's guidebook are distributed to all
participants.
OUTCOMES
This program reduced falls by 29%, number of fallers by 28%, and
recurrent falls by 55%. It also improved performance on several
physical performance measures.
Specifically, the program produced the following changes among
participants:
• Improved function reach scores by 6.4%
• Improved up and go test scores by 3.1%
• Improved chair stand test scores by 5%
• Improved 50-foot speeded walk test scores by 5%
IMPLICATIONS
•
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
•
Evidence-based tai chi programs, such as Tai Chi- Moving for
Better Balance can be implemented in urban and rural
community settings.
Program indicated it has good reach, an excellent adoption
rate, and good program fidelity and maintenance.
English
PROGRAM TYPE
Implementation
Toolkit – Page 59
ToC
FALLS
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
Sample size/characteristics: 140 physically inactive, community-dwelling
adults
Demographics: Aged 70 to 92, 85.7% women, 95.7% White.
Inclusion criteria: Aged 60+, physically mobile, and without severe
mental deficits
Comparison Groups:
Intervention group vs. usual care
STUDY/INTERVENTION LOCATION
Portland, OR
Instruments/Measures:
•
•
REFERENCE
•
Li et al. (2005)
The primary outcome measure of falls was assessed using fall
counts, recorded by each participant in a daily ‘‘fall calendar.’’
Physical performance and quality-of-life were measured by
functional reach test, up and go test, time to rise from a chair,
the 50-foot speed walk, and the Short-form 12-item Physical
and Mental Health Summary Scale (SF-12).
Fear of falling was assessed by the Survey of Activities and
Fear of Falling in the Elderly (SAFFE).
LIMITATIONS
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
Although the program results were promising, continued
efforts are needed to address several translation,
implementation, and evaluation issues, such as the
implementation of the program in diverse community setting
and the long-term effects of the intervention falls.
Other needs include measuring program sustainability, at both
the services provider level and by the instructors, and
conducting cost-benefit, cost-utility, or cost-effectiveness
analyses of the program.
COSTS
See COST SHEET
Toolkit – Page 60
ToC
COMPARISON CHART OF EVIDENCE-BASED HEART DISEASE PROGRAMS
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Airdrie Community
Hypertension
Awareness &
Managemt Program
(A-CHAMP)
• Community-based blood pressure
awareness program that aims to
improve awareness and
management of hypertension
• Consists of training sessions on
hypertension and other modifiable
cardiovascular risk factors;
instructions on how to interpret
blood pressure information; and
screening sessions and hands-on
training in blood pressure
measurement using an automated
BpTRU device
Group
Meets twice
weekly for 2
hours per
session for 4-6
months
Instructors must be health
professionals such as RNs, nurse
educators, MDs, or pharmacists to
deliver the program
Indoor space for
group sessions
• Chairs
• Automated BpTRU
device to provide
demonstrations
• Computer and
database to record
changes in antihypertensive
therapy between
initial and final
assessments
Eat Better Move More
• Integrated nutrition and exercise
program that consists of mini-talks
and group nutrition and physical
activity sessions
• Encourages participants to record
their food choices and number of
steps taken each day as a review
of each week’s nutrition and
physical activity mini-talks.
Group
Meets 12 times
for 30-minute
mini-talks and
twice-weekly
group nutrition
and physical
activity sessions
• Facilitator or leader guides
sessions and activities. While
nutritionists or RDs are ideal
facilitators, PTs and certified
fitness professionals may also
lead the program
• Staff or volunteers help to collect
Tips & Tasks sheets and
encourage participants to set
individual step goals
• If Tips & Tasks data are used to
show improvements, additional
help may be needed to collect
and analyze records at the start
of each session
Indoor space for minitalks, and group
nutrition and physical
activity sessions
None
ToC
Program Name
Program Elements
Group/
Individual
Time
(meetings,
duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Health for Your Heart
(Salud Por Tu Corazón)
• Community-based outreach
program delivered by
community health workers to
aimed at reducing
cardiovascular disease among
Latinos.
• Also includes home risk
assessments, phone contacts,
and provider referrals for health
screenings
Group
6-month
program that
includes 8 2hour group
sessions for 2-3
months, followed
by home risk
assessments,
phone contacts,
and referrals to
health care
providers for
health
screenings
• Instructors attend a 5-8 day
training in Su Corazon Su Vida
curriculum taught by
experienced community health
workers
• Instructors need a minimum
high-school education
Space for 15-20
participants
Equipment/materials
to measure blood
pressure, BMI, and
waist circumference
Prime Time Sister
CirclesTM (PTSC)
• Curriculum-based group health
intervention tailored to African
American women
• Targets cardiovascular risk
factors through discussions of
spirituality, self-esteem, and
self-prioritiziation
Group
Meets once
weekly for 90
minutes per
session for 10
weeks
• Instructors are trained in
program delivery.
• No educational requirements are
needed to become an instructor
Indoor meeting room
for 8-13 participants
• Chairs for group
discussions
• Projector for
presentations
Project Joy
• Church-based nutrition and
physical activity program
tailored to African American
churgoing women
• Consists of group education
and discussion sessions,
nutrition education modules
(i.e., cooking demonstration),
and physical exercise
Group
Meets once
weekly for 90
minutes per
session for 20
weeks
Instructors must obtain CPR
certification in order to
administer the program
Indoor meeting room
and space for exercises
•
•
•
•
Portable scale
LCD projector
Computer
CD/MP3 player and
music
ToC
COMPARISON CHART OF EXISTING HEART DISEASE HEALTH PROMOTION PROJECTS AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. Each of these programs, with the exception of the Big Apple Senior Strollers, has its own curriculum with a set number of
training topics. All necessary equipment and forms are provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Program Elements
Group/
Individual
Time
Staff
(meetings, duration)
(paid, volunteer)
Keep on Track
Blood
Pressure
Monitoring
Program
• Senior volunteers are trained to
measure the blood pressure of
their peers.
• Adhering to a training manual
and protocol revised by
DOH&MH, the volunteers offer
basic counseling which helps
participants understand the
significance of their readings.
• Participants with questions about
their readings are advised to
check with their doctor.
Group
1.5 hours every two
weeks
Big Apple
Senior
Strollers
Walking
Clubs
• Strollers count the number of
steps they take during each
walk using pedometers.
• Clubs are presented with
certificates listing total number
of steps accumulated by all
members every October.
Group
Once a week or more
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on-site. Once
training is completed,
the HPS monitors
volunteers/activity on
an on-going basis.
Center/site selects
suitable volunteers
Space
Requirement
Private space when
available. Room for
blood pressure
measurers and clerical
team.
Walking Route decided
by volunteers
Equipment
Training materials,
certificates, tote bags,
blood pressure
machines, large cuffs,
volunteer buttons,
sign in sheets,
envelopes,
Participant and
Tracking cards, ,
supplied by HPS
Educational materials,
volunteer buttons,
pedometers,
sign-in sheets,
envelopes,
provided by HPS
ToC
DFTA
Program
Name
Know Your
Numbers
Program Elements
• Senior volunteers are trained to
help their peers understand the
implications of their blood
pressure readings, as well as
the results of their glucose and
cholesterol tests.
• The training curriculum has
been revised to make it more
user-friendly for prospective
volunteers.
• Plans are to mail a flyer
announcing the availability of
this program in mid- January.
Group/
Individual
Group/ On-on-one
encounters
Time
Staff
(meetings, duration)
(paid, volunteer)
5-15 minute presentations
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) conducts training
on site. Once training is
completed, the HPS
meets with volunteers
on an on-going basis.
Space
Requirement
Private room for group
presentations
Equipment
Training materials,
certificates, tote bags,
volunteer buttons,
educational materials,
sign-in sheets, and
envelopes, provided by
HPS
ToC
HEART DISEASE
Airdrie Community Hypertension Awareness & Managemt
Program (A-CHAMP)
PROGRAM OVERVIEW
PRIMARY CONTACT
Charlotte Jones, Principal Investigator
[email protected]
SECONDARY CONTACT
Not appllicable
WEBSITE
www.libin.ucalgary.ca/documents/cha
mp/Champ_Airdrie.pdf
Community-based screening sessions and education for older
adults provided in a group setting over 4-6 months. Two-hour
training session designed to raise awareness and management
of hypertension and other modifiable cardiovascular disease risk
factors.
PROGRAM DESCRIPTION
Duration: 4-6 months
Type: Community-based blood pressure (BP) program for older
adults
Aim: Aims to improve awareness and management of hypertension;
includes two 2-hour training sessions on hypertension and other
modifiable cardiovascular risk factors; instructions on how to
interpret blood pressure information; and screening sessions and
hands-on training in blood pressure measurement using an
automated BpTRU device
OUTCOMES
•
PRINT MATERIALS
Program information and presentation
are available.
•
•
ACCESS ON WEBSITE
Materials are available on the website.
IMPLICATIONS
•
ASSOCIATED CONDITIONS
Not applicable
This program reduced BP by 11% and improved adherence to
diet and exercise recommendations by 41%.
It also produced a 20% increase in medication use among
those with diabetes and a 15% among those without diabetes.
46% and 60% of participants with and without diabetes,
respectively, reached BP targets by participating in the
program.
•
A-CHAMP raised awareness, and identified and managed
seniors with hypertension.
This program was effective and feasible in improving
awareness and control of hypertension.
LANGUAGES
English
PROGRAM TYPE
Research
Toolkit – Page 61
ToC
HEART DISEASE
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
Sample size/characteristics: 406 residents of Airdrie
Demographics: Aged 65+; 54% were female.
Inclusion criteria: Individuals whose family physician and pharmacy were
located in city of Airdrie.
Comparison Groups:
Not applicable
Instruments/Measures:
STUDY/INTERVENTION LOCATION
•
Airdrie, Alberta, Canada
REFERENCE
•
Jones et al. (2007)
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
The primary outcome was feasibility of the program, defined
as a minimum of 30% of Airdrie seniors attending at least one
of the sessions held between September and November 2005
and, for subjects identified with elevated BP at these
sessions, a minimum of 30% assessed by a pharmacist
and/or physician.
Secondary outcomes included the change in systolic BP
between the first session and the final follow-up session (held
in March 2006), as well as pharmacy database-documented
change in antihypertensive therapy between initial and final
assessments.
LIMITATIONS
•
•
•
Study design was uncontrolled, and inferences on causality
need to be made with caution
Very short-term (4-6 months) BP end points
There were barriers to participant identification and
subsequent management
COSTS
Not available
Toolkit – Page 62
ToC
HEART DISEASE
Eat Better Move More
PROGRAM OVERVIEW
PRIMARY CONTACT
Nancy Wellman, Principal Investigator
[email protected]
SECONDARY CONTACT
Not applicable
WEBSITE
Not available
A six-month group intervention for older adults that integrates
nutrition and physical activity education. Also encourages walking
through step-counting activities.
PROGRAM DESCRIPTION
Duration: 6 months
Type: Integrated nutrition and exercise program
Aim: Encourages older adults, to live longer, healthier lives by being
physically active, eating nutritious diets, obtaining preventive
screenings, and making healthful choices such as not smoking.
Includes 12 weekly sessions incorporating mini-talks (up to 30 min each)
and twice-weekly activities for group nutrition and physical activity
sessions, as well as “Tips & Tasks” sheets, in which participants checked
off food choices and recorded the number of steps taken each day to
briefly review the week’s nutrition and physical activity mini-talks.
OUTCOMES
PRINT MATERIALS
Guidebook is available in print.
ACCESS ON WEBSITE
Not applicable
ASSOCIATED CONDITIONS
Obesity
LANGUAGES
English
PROGRAM TYPE
Research
This program improved diet and increased physical activity among
participants.
• 73% reported an advancement of at least one nutrition stage
of change
• 75% reported an advancement of at least one physical activity
stage of change
• 24% reported improved health status.
• 31% increased their daily intake of fruit
• 37% increased their daily intake of vegetables
• 33% increased their daily intake of fiber
• 35% increased number of daily steps taken
• 45% increased number of blocks walked
• 24% increased number of stairs climbed
• 9% increased number of days walked
• Program improved Timed Up and Go scores by 9.4%
• Program satisfaction was 99%.
IMPLICATIONS
•
•
This easy-to-implement program improves diets and activity
levels.
Program has been tested in a variety of community sites
nationwide that serve diverse older populations, including
members of racial/ethnic minority groups.
Toolkit – Page 63
ToC
HEART DISEASE
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design
Sample size/characteristics: 999 older volunteer participants
Demographics: Adults aged 60+; 82% women; 25% AA, 4% Latino, 6%
Native American, and 7% Asian.
Inclusion criteria: Able to walk with/without assistive devices; can
complete a consent form.
Comparison Groups:
STUDY/INTERVENTION LOCATION
PA, CA, OK, MI, IL, FL, MA, WA, WI,
VA
REFERENCE
Wellman et al. (2007)
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Not applicable
Instruments/Measures:
•
•
•
•
•
Functional ability measured using Nutrition Screening Initiative
Checklist (10-item screening tool with questions on
illnesses/diseases, appetite, tooth loss/mouth pain, economic
hardship, involuntary weight loss/gain, and functional
limitations).
Nutrition and health questionnaire was adapted from
Performance Outcomes Measures Project Congregate Meals
Survey.
Physical activity (PA) questionnaire included Modified Baecke
Questionnaire for Older Adults, which assesses household
and leisure activities.
Functional ability was quantified using the Timed Up and Go
test, which has been shown to be correlated with risk of
falling.
Nutrition and PA questionnaires included a “stage-of-change”
question; participants selected from 5 statements reflecting
stages of change: precontemplation, contemplation,
preparation, action, and maintenance.
LIMITATIONS
•
•
•
•
Completion rates differed significantly according to site
All of the participants were self-selected volunteers
There were no control groups in this demonstration project
As a result of the extensive and time-consuming data
collection process associated with the project, the
implementation costs incurred at the 10 study sites are not
representative of actual program costs.
Toolkit – Page 64
ToC
HEART DISEASE
Health for Your Heart (Salud Por Tu Corazón)
PROGRAM OVERVIEW
PRIMARY CONTACT
Hector Balcázar, Regional Dean,
Professor, UT School of Public Health,
El Paso Regional Campus
[email protected]
SECONDARY CONTACT
Not appllicable
WEBSITE
Not available
A 6-month community-based educational program consisting of 8
group sessions; delivered by promotores de salud (community
health workers) to raise awareness of cardiovascular disease.
Tailored to Hispanics.
PROGRAM DESCRIPTION
Duration: 6 months
Type: Community-based outreach program
Aim: Aimed at reducing the burden of morbidity and mortality
associated with cardiovascular disease among Latinos.
Includes a series of educational sessions from the NHLBI hearthealth curriculum called Your Heart, Your Life.
Promotores de salud (community health workers) deliver 7 of 8
curriculum lessons in 2-hour sessions within a 2-3-month period,
conduct risk assessments through home visits and phone contacts,
and provide educational sessions and referrals to health care
providers for health screenings.
OUTCOMES
PRINT MATERIALS
Training materials are available.
•
•
ACCESS ON WEBSITE
Not applicable
•
This program increased heart-healthy behaviors by 18% and
referrals for blood pressure and cholesterol screenings.
Promotores referred 74% of participants to health care
providers for blood pressure screening and 81% for blood
cholesterol screening.
96% expressed a very high level of satisfaction with the
program.
IMPLICATIONS
ASSOCIATED CONDITIONS
•
Not applicable
LANGUAGES
English, Spanish
PROGRAM TYPE
Implementation
•
•
The community outreach model worked well in the seven pilot
programs because of the successes of the promotores and
the support of the community-based organizations.
Successes of this program stemmed in part from the train-thetrainer approach.
Promotoria, as implemented in this program, has the potential
to be integrated with a medical model of patient care for
primary, secondary, and tertiary prevention.
Toolkit – Page 65
ToC
HEART DISEASE
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
One group pre-post study design (pilot
study)
Sample size/characteristics: 223 participating Latino families (320
individual family members) of various ages
Demographics: Most promotores were women aged 20-67; the average
age was 41.
Comparison Groups:
Not applicable
STUDY/INTERVENTION LOCATION
7 sites in California, Illinois, New
Mexico, Texas, and Rhode Island.
Instruments/Measures:
•
•
REFERENCE
Balcazar et al. (2005)
Changes in heart-healthy behaviors among family contact
persons were assessed using a 35-item self-report survey
with a 4-point scale for assessing family habits, which
included items on the frequency with which families engaged
in exercise and eating a low-sodium diet.
To evaluate the extent to which the program effected change
in awareness, knowledge, and behavior, data were collected
using an evaluation tool called ¡Cuéntamelo! (Tell Me About
It!).
LIMITATIONS
Not applicable
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
COSTS
See COST SHEET
Toolkit – Page 66
ToC
HEART DISEASE
Prime Time Sister CirclesTM (PTSC)
PROGRAM OVERVIEW
PRIMARY CONTACT
Marilyn Gaston & Gayle Porter, CoPrincipal Investigators
[email protected]
[email protected]
SECONDARY CONTACT
Not appllicable
WEBSITE
http://gastonandporter.org/sistercircles/sister-circles.html
PRINT MATERIALS
Program packet is available.
ACCESS ON WEBSITE
Training manual must be purchased
from website.
ASSOCIATED CONDITIONS
Not applicable
LANGUAGES
English
PROGRAM TYPE
Implementation
A 10-week curriculum-based, structured culture- and genderspecific group health intervention in which 8-13 women meet for
90 minutes/session with peers to improve physical activity and
diet and reduce stress. Tailored to African American women.
PROGRAM DESCRIPTION
Duration: 10 weeks
Type: Curriculum-based, structured culture- and gender-specific
group health intervention.
Aim: Assist mid-life African-American (AA) women to decrease the
major risk factors of physical inactivity, poor nutrition, and stress
which contribute to CVD by having 8-13 women meet for 90
minutes/session with mid-life AA women who have with group
facilitation experience, to discuss spirituality, self-esteem, prioritizing
themselves first, stress, nutrition and exercise, CVD, and diabetes.
OUTCOMES
This program improved diet, exercise, stress management, and selfefficacy.
• Increased participation in aerobic exercise by 52% at 10
weeks, 30% at 6 months, and 69% at 12 months.
• Increased consumption of nutritious foods by 20% from
baseline to 10 weeks.
• Increased the proportion reporting an overall change in diet to
prevent disease - 63% of participants at 10 weeks, 98% at 6
months, and 100% at 12 months.
• Increased the proportion using stress management strategies
- 63% at 10 weeks and 66% at 12 months.
• Increased screenings - 60% increased annual mammograms
and 54% increased in blood pressure checks.
• 83.7% felt that positive changes could be maintained over
their lifetime.
• Participants developed more positive attitudes about their
ability to control their health outcomes since participating in
the program - 87% reported this at 10 wks, 77% at 6 mths,
and 84% at 12 mths.
IMPLICATIONS
This study demonstrates the effectiveness of PTSC in modifying
health-related knowledge, attitudes and certain high-risk behaviors
in mid-life African-American women.
Toolkit – Page 67
ToC
HEART DISEASE
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Nonrandomized trial with
contemporary controls
Sample size/characteristics: 134 African-American women
Demographics: Women older than 35 were included and mean age was
54.4.
Comparison Groups:
Intervention vs. control groups
STUDY/INTERVENTION LOCATION
11 sites in Illinois, Washington, DC,
Florida, and Maryland. Sites included
four churches, a state health
education center, a mental health
center, a community center, a
hospital, a feminist bookstore, a
predominantly African-American
college and a social club.
REFERENCE
Gaston et al. (2007)
Instruments/Measures:
•
•
•
•
•
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
Not available
COSTS
Not available
Perception of overall health was assessed using a single item
Likert rating of participants' health in comparison to other
women their age.
A 13-item instrument, adapted from a 2002 AARP survey, was
given to assess health and wellness (self-care) behavior such
as checking blood pressure, eating healthily, managing stress,
and discussing health improvements with others.
A 19-item nutrition measure was used as a pre-/postmeasure
of the women's daily or weekly nutritious foods and eating
habits.
The women were given a seven-item inventory to rate the
level of importance they placed on engaging in selected
health-related behaviors.
Focus groups were held with the participants of two of the
PTSC groups to obtain some in-depth qualitative data in
selected areas of concern such as barriers to completing
goals.
LIMITATIONS
•
•
•
Generalizability of the study's findings may be limited because
of the small sample sizes and the nonrandom nature of the
women's recruitment and assignment to the intervention and
comparison groups
Given that the participants were mostly college-educated,
middle-income women, these findings may not be
generalization to less-educated, poor women
Use of self-report data, which are always susceptible to social
desirability bias.
Toolkit – Page 68
ToC
HEART DISEASE
Project Joy
PROGRAM OVERVIEW
PRIMARY CONTACT
Lisa Yanek, Project Director
[email protected]
SECONDARY CONTACT
Not appllicable
WEBSITE
Not available
A 20-week church-based nutrition (cooking) and physical activity
(30 minute exercise classes) intervention held weekly in groups to
reduce cardiovascular risk. Facilitated by health educators and
church lay leaders. Tailored to African American women.
PROGRAM DESCRIPTION
Duration: 20 weeks
Type: Church-based nutrition and physical activity (PA) program
Aim: Reduce cardiovascular risk in urban communities where most
AA women are regular churchgoers by having group sessions, led
by female AA health educators, begin with a weigh-in and group
discussion, followed by a 30- to 45-minute nutrition education
module that included a taste test or cooking demonstration, and 30
minutes of moderate intensity aerobic activity. Lay leaders offer
weekly sessions after the first 20 weeks are over.
OUTCOMES
PRINT MATERIALS
Session presentation, handout,
questionnaire, and program CD are
available.
ACCESS ON WEBSITE
Not applicable
ASSOCIATED CONDITIONS
This intervention reduced weight by 1 lb, waist circumference by
nearly 1 inch, blood pressure by about 2 mmHg, and improved diet
among participants. Moreover, women who lost about 20 lbs had
even larger, clinically meaningful changes in risk outcomes.
• Reduced dietary energy intake by 117 kcal
• Reduced dietary total fat intake by 8 g
• Reduced sodium intake by 145 mg
• Women in the intervention groups who lost an average 20 lbs
a year were more likely to lose even more weight (nearly 20
lbs) one year post-intervention.
IMPLICATIONS
•
Not applicable
LANGUAGES
English
PROGRAM TYPE
•
Intervention participants achieved clinically important
improvements in cardiovascular disease risk profiles one year
after program initiation, which did not occur in the self-help
group.
Church-based interventions can significantly benefit the
cardiovascular health of African American women.
Implementation
Toolkit – Page 69
ToC
HEART DISEASE
Study/Intervention Methodology
STUDY/INTERVENTION METHODS
STUDY/INTERVENTION DESIGN
Randomized controlled trial
STUDY/INTERVENTION LOCATION
16 churches in Baltimore, MD
Sample size/characteristics: 529 AA women
Demographics: Women aged 40+ were included and mean age was
53.1.
Inclusion criteria: Not pregnant or planning in the coming year; had not
had myocardial infarction or stroke in the past 6 mths; had not felt chest
pain or angina requiring use of nitroglycerine in the past 6 mths; did not
have cancer currently under treatment; not undergoing renal dialysis; able
to obtain permission to participate in program from physicians.
Comparison Groups:
Standard behavioral group intervention, standard intervention
supplemented with spiritual strategies, or self-help strategies (control
group).
Instruments/Measures:
•
REFERENCE
Yanek et al. (2001)
IMPLEMENTATION
(FIDELITY, MODIFICATIONS,
SUSTAINABILITY)
See IMPLEMENTATION SHEET
•
•
•
•
•
•
•
COSTS
•
See COST SHEET
•
Weight measured using calibrated digital scale with participant
wearing light indoor clothing and no shoes.
Height measured with set square against a straight wall.
BMI calculated as weight (kg) divided by height (m)2.
Bioelectrical impedance used to assess % total body fat
based on resistance and reactance measurements.
Waist circumference measured using guidelines of the
National Obesity Expert Panel Report.
Blood pressure (BP) measured with mercury
sphygmomanometer.
Total cholesterol, HDL cholesterol, triglycerides, and glucose
measured via blood samples.
Block Food Questionnaire administered to assess dietary
nutrient intake.
Smoking status was self-reported and verified by measured
exhaled carbon monoxide using a Vitalograph EC50 CO
monitor.
PA assessed using Yale PA Survey, from which energy
expenditure was calculated.
LIMITATIONS
Not applicable
Toolkit – Page 70
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COMPARISON CHART OF EVIDENCE-BASED OBESITY PROGRAMS
Program Name
Group/
Time
Program Elements Individual (meetings, duration)
Diabetes Education &
Prevention with a
Lifestyle Intervention
Offered at the YMCA
(DEPLOY)
Group-based intensive
lifestyle intervention which
adapts the Diabetes
Prevention Program
(DPP) to YMCA's.
Group
Meets once a week for 1
hour for 16 weeks
• The intervention was originally
implemented by trained
YMCA wellness instructors
• Participants are also
encouraged to meet twice
weekly outside of class to
exercise, at a community
facility such as a YMCA
Space for 8-12
participants to participate
in group exercise
• Exercise
equipment
(provided by
YMCA)
• Instruments to
measure body
weight, blood
pressure, HbA1c
levels, total
cholesterol, and
HDL-cholesterol
• Chairs for group
meetings
Diabetes Prevention
Program (DPP)
• Curriculum-based
intensive lifestyle
intervention taught by
case managers on a oneto-one basis
• Aims to reduce weight by
7% and promote at least
150 minutes of weekly
physical activity
Individual
Meets for 16 sessions for
24 weeks
• This intervention is taught by
trained case-managers.
• No educational background is
specified
Space for one-on-one
discussions.
Equipment to
measure Hba1c
level
*This program is a model
evidence-based diabetes
program upon which
other programs have
been adapted
Staff
Requirements
Space
Requirements
Equipment
Requirements
ToC
Program Name
Group/
Time
Program Elements Individual (meetings, duration)
Staff
Requirements
Space
Requirements
Equipment
Requirements
Eat Better Move More
• Integrated nutrition and
exercise program that
consists of mini-talks and
group nutrition and
physical activity sessions
• Encourages participants
to record their food
choices and number of
steps taken each day as
a review of each week’s
nutrition and physical
activity mini-talks.
Group
Meets 12 times for 30minute mini-talks and
twice-weekly group
nutrition and physical
activity sessions
• Facilitator or leader guides
sessions and activities. While
nutritionists or RDs are ideal
facilitators, PTs and certified
fitness professionals may also
lead the program
• Staff or volunteers help to
collect Tips & Tasks sheets
and encourage participants to
set individual step goals
• If Tips & Tasks data are used
to show improvements,
additional help may be
needed to collect and analyze
records at the start of each
session
Indoor space for minitalks, and group nutrition
and physical activity
sessions
None
Group Lifestyle
Balance (GLB)
• Intervention addressing
safe weight loss and
physical activity
• Shortens the 16-session
Diabetes Prevention
Program (DPP) to 12
sessions, and is delivered
by two trained
"preventionists" -- one
dietician and one exercise
specialist
Group
Meets for 12 sessions for
12 weeks
• Originally implemented by one
dietician and one exercise
specialist, although any health
professional may implement
this program
• Health care professionals
must attend a 2-day training
at the University of Pittsburgh
Medical Center
• Room with table and
chairs
• Private area for weighin's
• Calorie/fattracking book
• Pedometer
• Measuring
cups/spoons
• Scale
ToC
COMPARISON CHART OF EXISTING OBESITY HEALTH PROMOTION PROJECTS AT NYC DFTA
DFTA's Health Promotion Services (HPS) Unit trains senior volunteers to lead health activities at their senior centers and other sites. Each site has the responsibility of selecting appropriate
volunteers and then the Health Promotion staff conducts the training on- site. Each of these programs, with the exception of the Big Apple Senior Strollers, has its own curriculum with a set number of
training topics. All necessary equipment and forms are provided by DFTA. Once in place, staff monitors the activity on a regular basis to ensure that all program guidelines are adhered to.
DFTA
Program
Name
Program Elements
Group/
Individual
Time
Staff
(meetings, duration)
(paid, volunteer)
Keep on Track
Blood
Pressure
Monitoring
Program
• Senior volunteers are trained to
measure the blood pressure of
their peers.
• Adhering to a training manual
and protocol revised by
DOH&MH, the volunteers offer
basic counseling which helps
participants understand the
significance of their readings.
• Participants with questions about
their readings are advised to
check with their doctor.
Group
1.5 hours every two
weeks
Big Apple
Senior
Strollers
Walking
Clubs
• Strollers count the number of
steps they take during each
walk using pedometers.
• Clubs are presented with
certificates listing total number
of steps accumulated by all
members every October.
Group
Once a week or more
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) implements
training on-site. Once
training is completed,
the HPS monitors
volunteers/activity on
an on-going basis.
Center/site selects
suitable volunteers
Space
Requirement
Private space when
available. Room for
blood pressure
measurers and clerical
team.
Walking Route decided
by volunteers
Equipment
Training materials,
certificates, tote bags,
blood pressure
machines, large cuffs,
volunteer buttons,
sign in sheets,
envelopes,
Participant and
Tracking cards, ,
supplied by HPS
Educational
materials, volunteer
buttons, pedometers,
sign-in sheets,
envelopes,
provided by HPS
ToC
DFTA
Program
Name
Know Your
Numbers
Program Elements
• Senior volunteers are trained to
help their peers understand the
implications of their blood
pressure readings, as well as
the results of their glucose and
cholesterol tests.
• The training curriculum has
been revised to make it more
user-friendly for prospective
volunteers.
• Plans are to mail a flyer
announcing the availability of
this program in mid- January.
Group/
Individual
Group/ On-on-one
encounters
Time
Staff
(meetings, duration)
(paid, volunteer)
5-15 minute presentations
Center/site identifies
suitable candidates.
Health Promotion Staff
(HPS) conducts training
on site. Once training is
completed, the HPS
meets with volunteers
on an on-going basis.
Space
Requirement
Private room for group
presentations
Equipment
Training materials,
certificates, tote bags,
volunteer buttons,
educational materials,
sign-in sheets, and
envelopes, provided by
HPS
ToC
EVIDENCE-BASED OBESITY PROGRAMS
You may consult the Program Summaries for the following evidence-based programs that
would be appropriate for adults with obesity:
Condition
Program Name
Diabetes
Diabetes Education & Prevention with a Lifestyle Intervention Offered at the
YMCA (DEPLOY)
Heart Disease
Eat Better Move More
Diabetes
Diabetes Prevention Program (DPP)
Diabetes
Group Lifestyle Balance (GLB)
Toolkit – Page 71
Toolkit – Page 72
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INTRODUCTION TO THE IMPLEMENTATION GUIDE
Outreach to program directors, principal investigators, and project staff associated with the
evidence-based programs described in this toolkit was conducted in mid-March to obtain
information regarding program implementation in community settings. Program staff were
allotted five weeks to respond to a six-item survey covering topics related to program fidelity,
replicability, and sustainability.
Detailed cost information was requested (e.g., personnel cost breakdown including position, annual
salary, percent time/FTE, program salary, and salary sub-total); supplies/expendable equipment
cost breakdown (including items, unit costs, quantities, and supplies sub-total); and nonexpendable equipment cost breakdown (including items, unit costs, quantities, and non-expendable
equipment sub-total) to understand the associated expenses to implement selected programs (see
Appendices for a copy of the Evidence-Based Program Logistics Survey and Cost Sheet).
The survey was e-mailed directly to the Project Director or other program staff of 34* programs.
After 10 days, a reminder e-mail was sent to respondents who had yet to reply to our initial inquiry.
The response rate was 52.9%.
The following summaries report practical implementation information and related costs for the 18
programs who responded, with information derived from publicly available sources for 3 additional
programs.
*Please note that while 35 programs have been included in this toolkit, the Diabetes Priority Program was not contacted to complete the
survey and cost sheet because this program serves as a model program upon which many of the other evidence-based diabetes programs
have been based.
Toolkit – Page 73
Toolkit – Page 74
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Staff
Requirements
Arthritis Foundation Exercise Program (AFEP)
Certification
Instructors are required to:
• Undergo day-long AFEP training taught by
Arthritis Foundation Master Trainer
• Receive CPR and first aid training
• Complete two AFEP programs and submit
necessary paperwork to Arthritis Foundation
Arthritis
Education
• Associate or baccalaureate degree in exercise
or related health field or equivalent exercise
training and certification preferred
• Knowledge of arthritis disease processes,
principles of arthritis exercise, etc.
• Competence in demonstrating exercises
Program Fidelity
Quality
Assurance
Instructors are trained by Arthritis Foundation Master Trainers
Space
Maintenance
Resources
Room should:
• Be large enough for easy movement and
space for assistive devices (i.e., walkers,
crutches, etc.)
• Have adequate acoustics and lighting
• Be free of clutter
• Be carpeted or have mats for floor exercises
Equipment
Sturdy chairs that do not slide easily and are of
different heights, some with arms
Funding
Implementation Notes
Sustainability
The source of this implementation information is Ellen Schneider of the UNC Institute on Aging.
Toolkit – Page 75
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Arthritis Foundation Exercise Program (AFEP)
Project Cost Information is not available
Toolkit – Page 76
Arthritis
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Staff
Requirements
Enabling Self-Management and Coping with Arthritic Knee Pain
Through Exercise (ESCAPE-knee pain)
Certification
Program training involves program education
using an instructor manual, as well as program
observation
Arthritis
Education
Instructors undergo program training, but do
not need to have PT background
Program Fidelity
Quality
Assurance
• Instructors are provided with education and booklet, and observe course being run by Master
Trainers
• Instructors are observed when delivering the program
Maintenance
Resources
Gym or hallway
Space
Funding
Equipment
• Exercise equipment (i.e., steps, rocker or
wobble board, soccer ball, static bike)
• Chair
• Table
• Mat
UK charity body (Arthritis Research UK)
Sustainability
Review session is provided 4 months after the
program ends to reinforce messages
Implementation Notes
Toolkit – Page 77
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Enabling Self-Management and Coping with Arthritic Knee Pain
Through Exercise (ESCAPE-knee pain)
Project Cost Information is not available
Toolkit – Page 78
Arthritis
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Staff
Requirements
Fit and Strong
Arthritis
Certification
• National certification is required; 10 types
are available nationwide
• Instructors may be physical therapists (PTs),
PT aides, or recreational aides
• Instructors are required to attend an 8-hour
training
None required
Education
Program Fidelity
Quality
Assurance
Master Trainer visits the class at week 3 or 4 and meets with instructor
Space
Maintenance
Resources
Large indoor space for arm stretching, fitness
walking
Funding
• Federal grants
• Future state Administration on Aging (AOA)
initiatives
Equipment
• Fitness equipment that are provided at
instructor training session (i.e., adjustable
ankle cut weight, resistance bands with foam
rubber handles)
• Floor mats
• Music player
Sustainability
Program to be included in future AOA initiative
and possible partnerships with providers
Implementation Notes
Toolkit – Page 79
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Fit and Strong
Arthritis
Project Cost Information
Duration
8 weeks
Program Characteristics
Sessions
24
Participants
15
Personnel Costs
Title
Not available
Salary
% Time
Offering Cost
$9,070
Fringe Rate %
$
Item Description
Ankle weights
Exercise bands
Participant manuals
Exercise mats
CD player and exercise music
Unit Cost
Quantity
Total
$22
$5
$30
$40
$85
15
15
15
15
1
$330
$75
$450
$600
$85
Expendable Equipment/Supplies
Item Description
Copies of recruitment materials
Copies of program materials for participants
Consultants
Unit Cost
Quantity
Total
$20
$30
2
15
$40
$450
Description
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$605
$1,540
$490
$3,840
Cost
Certified exercise instructor. 8-hour instructor training, 48 hours to conduct Fit
and Strong , 8 hours to develop negotiated adherence contracts = 64 hours
(@$30/hour) = 2 iterations @ $1,920
$3,840
Other Costs
Description
$3,200
Cost
License fee for lead site. Training, access to interactive website for outcomes
and attendance tracking, instructor hotline, and fidelity site visits from Fit and
Strong team
Annual renewal fee for lead site.
Toolkit – Page 80
$3,000
$200
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Staff
Requirements
Hop with the Hip
None
Arthritis
Certification
Quality
Assurance
Space
Gym (12-person maximum capacity)
Resources
Instructors must have a background in PT or OT
Program Fidelity
None
Maintenance
Education
Funding
Research fund - Netherlands
Equipment
Fitness equipment (i.e., leg press, leg raise,
sitting rotation, pull down equipment, treadmill,
pulleys, Bowflex, or comparable equipment)
Sustainability
Program participants have been recruited from
provider groups, home care agencies, or other
sources
Implementation Notes
Toolkit – Page 81
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Hop with the Hip
Arthritis
Project Cost Information
Duration
8 weeks
Program Characteristics
Sessions
9
Participants
12
Personnel Costs
Title
Not available
Salary
% Time
Offering Cost
$1,889
Fringe Rate %
$
Item Description
Program instruction guidelines
Manual for physical therapist
Unit Cost
Quantity
Total
$34
$67
2
1
$68
$67
Expendable Equipment/Supplies
Item Description
Exercise manuals for participants
Consultants
Unit Cost
Quantity
Total
$33.75
12
$405
Description
Cost
Not available
$
Description
Cost
Other Costs
Participant recruitment.
$1,349
Toolkit – Page 82
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$157
$135
$405
$0
$1,349
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Staff
Requirements
Learn Share and Live
Cancer
Certification
Instructors must be trained facilitators
Program Fidelity
Quality
Assurance
None
Space
Resources
Space for 25-30 participants
Maintenance
None required
Education
Funding
Grants and research funds
Music player
Equipment
Sustainability
Program has been adapted by community-based
organizations (i.e., Cooperative Extension)
Implementation Notes
Toolkit – Page 83
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Learn Share and Live
Cancer
Project Cost Information
Duration
varies
Program Characteristics
Sessions
varies
Personnel Costs
Participants
50
Offering Cost
$11,900
Title
Salary
% Time
Fringe Rate %
Total
Project Coordinator
$38,000
0.25
0.11
$10,545
Unit Cost
Quantity
Total
$85
$7
3
50
$255
$350
Non-Expendable Equipment
Item Description
Breast models
Breast beads
Expendable Equipment/Supplies
Item Description
Notebooks
DVD's
Consultants
Unit Cost
Quantity
Total
$6
$6
50
50
$300
$300
Description
Cost
Trainers. Provide facilitation.
$150
Description
Cost
Not available
$
Other Costs
Toolkit – Page 84
Cost/Person
$238
$10,545
$605
$600
$150
$0
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Staff Requirements
Healthy IDEAS (Identifying Depression Empowering Activities
for Seniors)
Certification
• Pre-service training about depression and
program delivery
• In-service and follow-up training to address
real-world challenges in working with
depressed older adults
• 14-20 hours of group training by behavioral
health specialist using a training DVD
• Program must be delivered by established
case management services staff with up to 3
in-person contacts over 3 months
Depression
Education
Instructors may have various educational
backgrounds - BSW or MSW, nurses, and case
managers with varying experience have been
trained
Program Fidelity
Quality
Assurance
• Trainers are observed after pre-service training using a Staff Skills Checklist
• Follow-up coaching/training to build confidence in staff, address questions or barriers that staff
are encountering, and prevent “drift” in staff skills
Resources
None
Space
Funding
None
Maintenance
• Older Americans Act case management
programs through Area Agencies on Aging
• Older Americans Act Family Caregiver
Support Programs through state and local
agencies
• Medicaid home and community-based
services case management programs
• State-funded case management
• United Way nonprofit case management
programs
• SAMHSA mental health funding to states
Equipment
Sustainability
• Agencies wishing to implement the program
receive a toolkit that guides them in
establishing partnerships with key mental
health providers
• Program supervisors become certified after
they implement the program so they can
train new staff
Implementation Notes
Toolkit – Page 85
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Healthy IDEAS (Identifying Depression Empowering Activities
for Seniors)
Project Cost Information
Duration
Program Characteristics
Sessions
Participants
Offering Cost
$5,119
Personnel Costs
Title
Not available
Salary
% Time
Fringe Rate %
$
Item Description
Binder of materials for staff
Client education materials (per participant)
Unit Cost
Quantity
Total
30$
$1
1
1
$30
$1
Expendable Equipment/Supplies
Not available
Consultants
Unit Cost
Quantity
$
$0
Cost
Behavioral health provider/educator @ $75/hour for 2 – 3 hours (2.5 hours on
average)
Clinical coach. Reinforce staff skills in program delivery (includes meetings with
staff and supervisors for follow-up training and individual support, 8-12 hours
extra for agencies without clinical expertise or partnerships with mental health
providers); includes round-trip travel from Houston, lodging, meals to train 25
case managers. $1,000 @ $100/hour for 10 hours and $900 travel.
$188
$0
$2,088
$3,000
Cost
Toolkit – Page 86
$31
$1,900
Other Costs
Healthy IDEAS program fee and technical assistance package
$0
Total
Description
Description
Cost/Person
Total
$0
Non-Expendable Equipment
Item Description
Depression
$3,000
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Improving Mood Promoting Access to Collaborative Care
Treatment (IMPACT)
Certification
Staff Requirements
• 10-module training program in IMPACT care
that is based on the program’s two-day
training conference is available online.
• Program covers 15 hours of content that
includes audio-annotated PowerPoint
lectures, case studies, streaming video and
more. The training program is free; however,
a small fee is charged if you want continuing
education credit.
• PST is available online or through program's
in-person training. Once training is
complete, IMPACT will connect agencies with
a certified PST trainer who provides case
supervision to complete certification as a PST
practitioner
Depression
Education
Required background for Depression Care
Manager:
• Degree in Nursing, Social Work, Marriage And
Family Therapy or Psychology.
• Minimum 2 years clinical experience in a
Relevant setting
Required background for Consulting
Psychiatrist:
• Licensed, preferably board certified
Program Fidelity
Quality Assurance
• Fidelity Scale is available on line at http://impact-uw.org/implementation/planning.html
• In addition to implementing the key components, we encourage providers and organizations
implementing or adapting IMPACT to measure the effectiveness of their program to convince
themselves that they are achieving their goals. Below are the quality indicators that we
recommend. The goal for indicators 1-5 should be to implement them with at least 75% of
eligible patients. The goal for indicator 6 should be to achieve this with at least 50% of eligible
patients.
1. Depression screening
4. Measurement of treatment outcomes
2. Diagnosis (PHQ-9)
5. Adjustment of treatment based on outcome
3. Initiation of treatment
6. Symptom reduction (PHQ-9)
Space
Maintenance
Resources
• Private room/space for consultation
• 2 chairs
Funding
Federal funding for original project
None
Equipment
Sustainability
Implemented with federal funding throughout
country, including New York City
Implementation Notes
The source of this Cost Sheet information is the IMPACT program website.
Toolkit – Page 87
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Improving Mood Promoting Access to Collaborative Care
Treatment (IMPACT)
Project Cost Information
Duration
Program Characteristics
Sessions
Participants
Offering Cost
$7,050
Personnel Costs
Title
Not available
Salary
% Time
Fringe Rate %
$
Not available
Unit Cost
Quantity
$
Item Description
Not available
Consultants
Unit Cost
Quantity
$
$0
Cost
IMPACT Implentation Center consultation. Consultation and technical
assistance via telephone/e-mail in the adaptation of IMPACT for various
settings, design of the program, and implementation planning. Rate: $150/hour
(assumption for this cost sheet is 3 hours)
IMPACT training by 1-2 Implementation Center staff members. 1-2 day training
meeting. Rate: $500/day for travel to and from training location + $750 for each
training day (assumption for this cost sheet is 2 days of training)
Booster training. Additional training on specific topics (i.e., grief and
bereavement, etc.) can be offered via webinar. The number, content, and
duration would be mutually agreed upon. Rate: $150/hour of trainer time +
$25/hour per webinar connect
Problem-solving treatment (PST) training. Trainees are paired with certified
PST trainer who listens to audio recordings of selected PST sessions with
patients and gives feedback to trainers prior to the next session. Typically takes
3-6 sessions for trainers to be certified. Rate: $150/hour of supervision,
typically 1-1.5 hours of listening time."
Post-Implementation consultation and technical assistance. Rate $150/hour,
assumption is 3 hours.
Program evaluation. Provided by Dr. Unutzer and implementation center team.
Rate $150/hour, assumption is 3 hours.
$450
$4,550
$475
$225
$450
$450
$2,500
Cost
Toolkit – Page 88
$0
$2,500
Other Costs
Care Management Tracking System. Web-based tracking tool to assist with
tracking of care management.
$0
Total
Description
Description
$0
Total
$0
Expendable Equipment/Supplies
Cost/Person
Total
$0
Non-Expendable Equipment
Item Description
Depression
$2,500
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Staff
Requirements
Life Review Therapy
Depression
Certification
Instructors must be clinical psychologists
and/or trained in life review therapy
Quality
Assurance
Space
Resources
Space for face-to-face therapy
Maintenance
Clinical psychology degree is recommended
Program Fidelity
None
Federal grants
Education
• Tape recorder
• Chronometer
• Table
Funding
Equipment
Sustainability
Implementation Notes
Toolkit – Page 89
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Life Review Therapy
Depression
Project Cost Information is not available
Toolkit – Page 90
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Staff
Requirements
Program to Encourage Actove, Rewarding Lives for Seniors
(PEARLS)
Certification
Staff are required to attend a 2-day training to
administer the program.
Depression
Education
None required
Training is designed to equip all members of a
PEARLS team – both counselors and
administrators – to implement the program
successfully in their organization.
Program Fidelity
Quality
Assurance
Agencies wishing to use the program are encouraged to use the PEARLS fidelity instrument
Space
Maintenance
Resources
• Sessions are conducted at the client's home
• Counselors have workstations
Funding
• County levy money
• State discretionary money (Senior Services
Act)
• State Medicaid money
Computer/laptop
Equipment
Sustainability
• Program has partnered with communitybased organizations
• Program relies on county funding
Implementation Notes
Seattle's Aging & Disability Services contracts with agencies who provide counseling and psychiatric
supervision services. Personnel costs cited in this cost sheet were based on a community-based
organization's staff salaries, which are generally higher than that of PEARLS counselors.
Toolkit – Page 91
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Program to Encourage Actove, Rewarding Lives for Seniors
(PEARLS)
Project Cost Information
Duration
19 weeks
Depression
Program Characteristics
Sessions
8
Personnel Costs
Participants
88
Offering Cost
$90,548
Title
Salary
% Time
Fringe Rate %
Total
PEARLS counselor
PEARLS counselor
PEARLS counselor
PEARLS counselor
PEARLS counselor
$11,495
$11,495
$11,495
$15,105
$16,675
1
1
1
1
1
0.1925
0.1925
0.1925
0.32
0.32
$13,708
$13,708
$13,708
$19,938
$22,010
Non-Expendable Equipment
Item Description
Not available
Unit Cost
Quantity
$
Item Description
Not available
Consultants
Unit Cost
Quantity
$
Description
$83,072
$0
Total
$0
Expendable Equipment/Supplies
Cost/Person
$1,029
$0
Total
$0
$4,048
Cost
Psychiatric supervision. Psychiatrist provides supervision to PEARLS
counselors twice a month
$4,048
Other Costs
Description
$3,429
Cost
Mileage reimbursement.
Database fees.
$1,449
$1980
Toolkit – Page 92
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Staff
Requirements
Psychogeriatric Assessment and Treatment in Congregate
Housing (PATCH)
Certification
• Building staff members take part in a
structured educational program of monthly
presentations led by a staff nurse.
• Program consists of 7 1-hour teaching modules
enabling housing staff to better understand and
recognize individuals with mental disorders
and to refer residents who may need mental
health services.
Depression
Education
Project nurse must have:
• Nursing degree with experience in
psychogeriatric nursing
• Knowledge and comfort with addressing coexisting medical, social, and psychiatric
symptoms
Program Fidelity
Quality
Assurance
Training manuals are constructed to ensure that all program providers adhere to certain training
protocol
Maintenance
Resources
None
Space
Funding
• Phone
• Beeper
State funds (Baltimore Mental Health Systems)
Equipment
Sustainability
Program relies on direct government or
foundation support
Implementation Notes
Toolkit – Page 93
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Psychogeriatric Assessment and Treatment in Congregate
Housing (PATCH)
Project Cost Information
Duration
52 weeks
Program Characteristics
Sessions
Participants
Offering Cost
$46955
Personnel Costs
Title
Nurse
Psychiatrist
Social worker
Salary
% Time
Fringe Rate %
Total
$65000
$140000
$63700
.017
0.10
0.5
0
$1,105
$14,000
$31,850
Non-Expendable Equipment
Item Description
Not available
Unit Cost
Quantity
$
Not available
Consultants
Unit Cost
Quantity
$
$0
Cost
Not available
$
Description
Cost
Not available
$
Toolkit – Page 94
$46,955
$0
$0
Total
Description
Other Costs
Cost/Person
#DIV/0!
Total
$0
Expendable Equipment/Supplies
Item Description
Depression
$0
$0
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Staff
Requirements
Group Lifestyle Balance
Diabetes
Certification
Instructors are required to attend a two-day
training
Quality
Assurance
Space
• Room with table and chairs
• Private area for weigh-in's
Resources
Minimum BA in health or related field (i.e., RN,
RD, exercise, or health education)
Program Fidelity
None
Maintenance
Education
Funding
•
•
•
•
Federal (Department of Defense)
Equipment
Calorie/fat-tracking book
Pedometer
Measuring cups/spoons
Scale
Sustainability
• Program has partnered with communitybased organizations such as the YMCA,
primary care physicians, health plans,
hospitals, and work sites
• Program training has been offered as a
graduate-level course at the University of
Pittsburgh
Implementation Notes
The University of Pittsburgh Diabetes Institute only provides program training as part of ongoing research
projects
Toolkit – Page 95
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Group Lifestyle Balance
Diabetes
Project Cost Information is not available
Toolkit – Page 96
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Staff
Requirements
Seniors Taking Charge of their Diabetes
Certification
Program training
None required
Quality
Assurance
Space
Resources
Space for lectures, food demonstrations, and
chair exercises
Maintenance
Education
Program Fidelity
None
State funds
Diabetes
Funding
Equipment
• Food for demonstrations
• Ball and bands for chair exercises
Sustainability
Program materials are publicly accessible for
anyone in the state and anyone with internet
access to use
Implementation Notes
Toolkit – Page 97
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Seniors Taking Charge of their Diabetes
Project Cost Information
Duration
16-32 weeks
Diabetes
Program Characteristics
Sessions
8
Personnel Costs
Participants
25
Offering Cost
$5,110
Title
Salary
% Time
Fringe Rate %
Total
Educator
$40,000
.05
0
$2,000
Non-Expendable Equipment
Item Description
Exercise bands
Unit Cost
Quantity
Total
$2
25
$50
Expendable Equipment/Supplies
Item Description
Food for demonstration
Handouts
Evaluation handouts
Consultants
Unit Cost
Quantity
Total
$20
$10
$2
8
25
25
$160
$250
$50
Description
Cost/Person
$204
$2,000
$50
$460
$2,600
Cost
Trainer. Provides program training; includes travel/lodging @ $600/day,
honorarium= $2000 for first day, $1000 for additional days, ongoing
consultation if desired on program evaluation @ $200/hour
$2,600
Other Costs
$0
Description
Cost
Not available
$
Toolkit – Page 98
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Staff
Requirements
Starr County Border Health Initiative
Extended version of the program (12 months)
Certification
• Trainers are not required to be certified
diabetes educators
• Community health workers are trained to
provide logistical support
Quality
Assurance
Space
Resources
• Room with table and chairs for 15
participants
• Access to kitchen preferred
Maintenance
Education
Trainers are typically nurses or dietitians
Program Fidelity
Random visits by research staff
Funding
Diabetes
Federal (National Institutes of Health)
Equipment
• DVD or VCR
• Pedometers (provided by program staff)
• Glucometers (provided by program staff)
Sustainability
Program components have been disseminated
by nurses and dietitians in clinics and healthcare
agencies
Implementation Notes
Program was originally designed for Spanish- speaking Mexican Americans, so it is not appropriate to
deliver it for non-Spanish speakers or other Hispanic groups at this time.
This program has also been piloted as a six month intervention. However, the long-term efficacy of the
twelve month program is greater than the shorter version, hence its inclusion.
Toolkit – Page 99
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Starr County Border Health Initiative
Extended version of the program (12 months)
Project Cost Information
Duration
48 weeks
Program Characteristics
Sessions
26
Participants
10
Personnel Costs
Title
Not available
Diabetes
Salary
% Time
Offering Cost
$13,760
Fringe Rate %
$
Item Description
Computer for downloading glucometer data
TV/DVD combo unit
Videotapes
Unit Cost
Quantity
Total
$1,500
$400
$5
1
1
7
$1,500
$400
$35
Expendable Equipment/Supplies
Item Description
Glucometers
Glucometer strips - 25 strips per person per
week for 12 months for 13 people
Pedometers
Snacks for each session
Consultants
Unit Cost
Quantity
Total
$25
$1
13
3900
$325
$,3900
$25
$25
20
26
Description
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$1,376
$500
$650
$1,935
$5,375
$6,450
Cost
Nurses. Provide intervention sessions @ $50/hour for 52 hours
Dietitians. Provide nutrition aspects of intervention sessions @ $50/hour for 52
hours
Community health workers. Set-up, reminder calls, food preparation,
transportation
$2,600
$2,600
$,1250
Other Costs
Description
$
Cost
Lab work to measure outcomes.
$Not available
Toolkit – Page 100
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Staff
Requirements
A Matter of Balance/Volunteer Lay Leader Model
Certification
Master Trainers attend a training and teach
coaches (volunteers or paid staff), who then
teach the classes
None required
Falls
Education
Program Fidelity
Quality
Assurance
• Master Trainers (MTs) provide an 8-hour training session to coaches
• Coaches are observed by MTs for one of the four first sessions
• Coaches are paired with more experienced coaches, mentored by MTs
Space
Maintenance
Resources
Space for chairs set up in a circle for 8-12
participants
Funding
• Area Agencies on Aging
• Department of Health
• Private grants
Equipment
• DVD player
• 2 DVD's (provided by the program)
Sustainability
There is an ongoing search for partnerships with
this program
Implementation Notes
Sessions 1 & 3 can also be held in a room for 14 with a TV and DVD player
Toolkit – Page 101
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A Matter of Balance/Volunteer Lay Leader Model
Project Cost Information
Duration
4 weeks
Program Characteristics
Sessions
8
Participants
0
Personnel Costs
Title
Not available
Falls
Salary
% Time
Offering Cost
$2,066
Fringe Rate %
$
Item Description
Not available
Unit Cost
Quantity
$
Item Description
Coach manuals
Participant workbooks
Refreshments for coach training
Refreshments for participants
Consultants
Unit Cost
Quantity
Total
$20
$13
$5
$5
2
12
2
12
$40
$156
$10
$60
Description
$0
Total
$0
Expendable Equipment/Supplies
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$172
$266
$1,500
Cost
Master trainer. Program coordinator/Master trainer - training fee includes
program DVD and CD that sites can make copies of
$1,500
Other Costs
Description
$300
Cost
Staff mileage reimbursement.
Materials shipping/postage.
Combined
cost of $300
Toolkit – Page 102
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Staff
Requirements
EnhanceFitness
Falls
Certification
Instructors are required to:
• Be certified in American Council on Exercise
(ACE) or American College of Sports Medicine
(ACSM), a nationally-recognized fitness
program, or have a related college degree
(exercise science, physiology, or PT)
• Obtain current first aid and CPR certification
Master Trainer (MT) contacts instructors 1-2 times in the first month
MT observes instructor's class on monthly and annual basis
Instructor completes a self-assessment form and MTs fill out an instructor review form
Instructors attend annual workshops for ongoing assistance and mainetnace of fidelity
Space
Resources
Indoor space for participants to extend arms
Maintenance
• Experience with teaching older adult group
exercise classes
• 2 months of experience teaching an
EnhanceFitness class
Program Fidelity
Quality
Assurance
•
•
•
•
Education
Funding
• Older Americans Act funding through state
units on aging and Are Agencies on Aging
• CDC Arthritis Program funding through state
Department of Health
• Local foundations
• Private fitness clubs and YMCA's
• Periodic grant funding by university investig
•
•
•
•
•
•
Equipment
Fitness equipment
Armless chairs
CD player and CDs
Stopwatch
Cone
Tape measure
Sustainability
• There are 450 EnhanceFitness sites
nationwide
• Program has partnered with healthcare
groups, foundations, Area Agencies on Aging,
and community-based organizations
Implementation Notes
Toolkit – Page 103
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EnhanceFitness
Falls
Project Cost Information
Duration
24 weeks
Program Characteristics
Sessions
72
Personnel Costs
Participants
21
Offering Cost
$26,437
Title
Salary
% Time
Fringe Rate %
Total
Site coordinator
$37,440
.05
Non-Expendable Equipment
0.25
$2,340
Item Description
Unit Cost
Quantity
Total
$32
$10
$5
$40
$125
21
1
1
1
1
$672
$10
$5
$40
$125
Soft wrist and ankle weights (including shipping)
Stopwatch
Tape measure
CD player and CD's
Storage cart for weights
Expendable Equipment/Supplies
Item Description
Mailing participant intake forms, attendance logs,
and fitness checks to EF administrative offices
Printing program forms, ie. Participant Intake
Forms, Attendance, FitnessChecks as well as
training materials such as manuals
Unit Cost
Quantity
Total
$125
1
$125
$5
12
Cost/Person
$1,259
$2,340
$852
$185
$60
Consultants
$17,000
Description
Cost
Fitness instructor. Teaches EnhanceFitness classes, 3 1-hour classes/week with
an additional hour for setting up and taking down class equipment; i.e. weights,
chairs. Salary varies by region, $20/hour is salary used herein..
EF trainer of instructors. Given the number of potential sites in NYC, it is
recommended that a Trainer be hired to be able to train Instructors as needed; to
have a local person to provide technical assistance to Instructors; and to conduct
fidelity monitoring. If there isn’yt a local trainer, a trainer would be brought in
from another location and additional expenses for travel would be added.
$4,000
$13,000
Other Costs
Description
$6,060
Cost
Trainer travel expenses. Airfare ($500), meals ($75), hotel ($320) and travel
($125) per Trainer, two for Trainer and/or Instructor training and one for
administrative training.
Licensing/Training Fee--Year One only and training could include up to 15
Instructors. 12 hours training of no more than 12 instructors on class protocols,
inc. exercises, data collection, and fidelity monitoring; Instructor and
Coordinator training manuals, listing on EF website; technical support, and
program data entry and reports. This assumes one organization will manage all
EF sites. (An additional $1,000/organization is required if necessary. Not
included in the costs listed herein)
Toolkit – Page 104
$3,060
$3,000
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Staff
Requirements
Falls Management Exercise (FaME)
Falls
Certification
Instructors need to obtain:
• Level 4 National Vocational Qualifications
(NVQ)-level training
• Post-Qualifying Endorsed training Status
with the Chartered Society of
Physiotherapists
Education
Several educational requirements exist for the
various staff members in this program, including
Postural Stability Instructors, exercise
instructors, leisure managers, physiotherapists,
ocuppational therapists,
therapy/rehabilitation/support workers, and
health managers
Program Fidelity
Quality
Assurance
• Two Internal Verifiers ensure fidelity
• University of Derby also provides external verification of fidelity
Space
•
•
•
•
•
Maintenance
Resources
Space for 20 participants
•
•
•
•
Funding
National Health Service – United Kingdom
Local Council
Acute Trusts
Funding is not uniform across the UK
Equipment
Chairs for balance exercises
Mats for floorwork
Therabands
Ankle/free weights
Steps
Sustainability
Funding by Health Trusts and Councils ensures
sustainability by requiring the program to meet
targets on accident prevention and include older
adults in active lifestyles
Implementation Notes
Toolkit – Page 105
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Falls Management Exercise (FaME)
Falls
Project Cost Information is not available
Toolkit – Page 106
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Staff
Requirements
Stepping On
Falls
Certification
Community Class Leaders are required to:
• receive 3-year certification after being
trained in the program
• conduct at least one Stepping On class yearly
• provide evidence of providing classes on an
ongoing basis in order to be re-certified after
3 years
Education
Master Trainers must be healthcare
professionals (RN, NP, PA, OT, PT) with
knowledge of falls prevention
Quality Assurance
Program Fidelity
•Community Class Leaders are monitored by Master Trainers (MTs), and get re-certified after a
refresher course
•Agencies implementing the program must: (1) use training materials provided by the program; (2)
be given oversight by MTs; (3) provide yearly report to the Wisconsin Partnership for Healthy
Aging (WPHA) with listing of leaders, training dates, and number of classes led by each leader
• In addition, fidelity monitoring includes: (1) Direct observation; (2) Observe via videotape or
Skype; (3) Administer knowledge quizzes at leader training; (4) Review of Participant; and (5)
Leader ratings of classes
Space
Equipment
• Display table
• Ankle weights for class
Resources
Space for 12 participants to perform
strengthening exercises
Funding
Maintenance
• Centers for Disease Control and Prevention
(CDC)
• Administration on Aging (AoA)
• Wisconsin Department of Health Services
Sustainability
• Widely disseminated falls program in WI with
over 30 sites providing workshops.
• Have collaborated with other states to
implement the program.
• Local and federal funding
• Local and national collaborative partnerships
for dissemination of Stepping-On
Implementation Notes
This implementation information has been derived from personal communications with the Wisconsin
Partnership for Healthy Aging (WPHA).
Toolkit – Page 107
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Stepping On
Falls
Project Cost Information
Duration
Program Characteristics
Sessions
Participants
Offering Cost
$5,540
Personnel Costs
Title
Not available
Salary
% Time
Fringe Rate %
$
Item Description
Leader manuals for class
Display Table
Ankle weights for class
Unit Cost
Quantity
Total
$95
$200
$7.5
2
1
12
$190
$200
$90
Expendable Equipment/Supplies
Item Description
Printing handouts exercise manual (including
labor)
Snacks
Consultants
Unit Cost
Quantity
Total
$2
15
$30
$10
8
Description
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$80
$480
$110
$3,950
Cost
Master trainer. Trainees come to Wisconsin - 3 day training for Leaders /4 day
training for Master Trainers
Leader training = $1,400 per person if sending two or more persons $1000.00
per person
Master Trainer training (one additional day added to leader training) =
Lead trainer.
Peer trainer. Older adult peer co-leader attending with leader
Other Costs
Description
$2,050
$1,400
$500
Cost
Licensure. $500/year up to 10 classess; $1,000/year 11-30 classes
Toolkit – Page 108
$1,000
$1,000
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Staff
Requirements
Strategies and Actions for Independent Living (SAIL)
Certification
Falls
Education
Program training
Instructors must be qualified health
professionals who have worked in home
support services for older adults (i.e., PT, OT,
RN, MSW)
Program Fidelity
Quality
Assurance
Master Trainers attend and mentor new trainers and community health workers
Space
Maintenance
Resources
• Most of the program is delivered in homes of
older adults
• Training space for 20 facilitators, home
health professionals, and community health
workers
Funding
• Research grant from Vancouver Foundation
of the Medical Services Association and
British Columbia Ministry of Health
• In-kind funding from British Columbia Health
Authorities
• Provincial funding from Fraser Health
Equipment
• Fall surveillance and risk screening tools
• Access to Excel spreadsheet
• Laptop projector for trainings
Sustainability
• Since the program is designed to be integrated
into existing home care services, it uses
existing resources and does not require
anything additional besides a realignment of
staff time
• Steering committee has been set up to address
gaps in program delivery and sustainability
Implementation Notes
While this program can be modified based on client needs, and has been modified for assisted living
residences (Promoting Active Living program), it is only designed for home support services for older
adults.
Fraser Health Authority of British Columbia was unable to provide costs since the program serves as an
add-on to existing home care services, whose costs vary by region.
Toolkit – Page 109
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Strategies and Actions for Independent Living (SAIL)
Project Cost Information is not available
Toolkit – Page 110
Falls
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Staff
Requirements
Tai Chi: Moving for Better Balance
Falls
Certification
Instructors are required to attend a 1-2 day
training by Oregon Research Institute
None required
Education
Program Fidelity
Quality
Assurance
Instructors are observed by Master-level instructors
Space
Equipment
• Chairs
• DVD player (optional)
• Attendance sheet
Maintenance
Resources
Space for 15 participants
Funding
Federal – Centers for Disease Control &
Prevention
Sustainability
Program has partnered with local senior service
providers (i.e., senior centers, meal sites) is
recommended
Implementation Notes
Program has been adapted for adults who use special equipment, i.e., walkers, wheelchairs.
Costs elements that have not been specified in the Cost Sheet include personnel (salary rate unknown) and
materials (class size unknown).
Toolkit – Page 111
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Tai Chi: Moving for Better Balance
Project Cost Information
Duration
12 weeks
Program Characteristics
Sessions
24
Participants
10
Personnel Costs
Title
Not available
Falls
Salary
% Time
Offering Cost
$10,549
Fringe Rate %
$
Item Description
CD player
Unit Cost
Quantity
Total
$25
1
$25
Expendable Equipment/Supplies
Item Description
User's guide and workbook for instructors
User's guide for participants
Consultants
Unit Cost
Quantity
Total
$15
$8
1
10
$15
$80
Description
$0
Total
$0
Non-Expendable Equipment
Cost/Person
$1,055
$25
$95
$10,429
Cost
Fuzhong Li. Provides instructor training; cost includes round-trip airfare from
Oregon, travel reimbursement, lodgingq
Master-level trainer. Instructor @ $35/hour, two 2-hour sessions/week
Other Costs
Description
$3,149
$7,280
Cost
Room rental. Costs not available
$
Toolkit – Page 112
$0
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Staff
Requirements
Health for Your Heart (Salud Por Tu Corazón)
Certification
Instructors are required to attend a 5-8 day
training in Su Corazón Su Vida curriculum
delivered by experienced community health
workers
Heart disease
Education
Minimum high school education
Program Fidelity
Quality
Assurance
Instructors are mentored and observed by experienced community health workers
Space
Equipment
Maintenance
Resources
Space for 15-20 participants
Funding
Equipment/materials to measure blood
pressure, body mass index, and waist
circumference
• Federal funding through the National Heart,
Lung, and Blood Institute and National
Center on Minority Health and Health
Disparities of the National Institutes of
Health, and Health Resources and Services
Administration
• Metropolitan Life
Sustainability
• Fund depletion following program
completion has been an ongoing issue.
Therefore, community partnerships are
essential
Implementation Notes
Toolkit – Page 113
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Health for Your Heart (Salud Por Tu Corazón)
Project Cost Information
Duration
16 weeks
Heart disease
Program Characteristics
Sessions
10 (8 + 2 follow-up)
Personnel Costs
Participants
100
Offering Cost
$64,700
Title
Salary
% Time
Fringe Rate %
Total
Community health worker
Community health worker
Project coordinator
$25,000
$25,000
$30,000
0.5
0.5
0.5
0.26
0.26
0.26,
$15,750
$15,750
$18,900
Non-Expendable Equipment
Item Description
Not available
Unit Cost
Quantity
$
Item Description
Su Corazón Su Vida materials
Training materials
Incentives for participants
Consultants
Unit Cost
Quantity
Total
$50
$1,500
$25
100
1
100
$5,000
$1,500
$2,500
Description
$50,400
$0
Total
$0
Expendable Equipment/Supplies
Cost/Person
$647
$9,000
$5,000
Cost
Promotora trainee. Training for one week - stipend plus travel
Other Costs
$5,000
Description
Cost
Room rental
$300
Toolkit – Page 114
$300
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Staff
Requirements
Project Joy
Heart disease
Certification
Instructors must obtain CPR certification in
order to administer the program
None required
Education
Program Fidelity
Quality
Assurance
Instructors are observed by Master Trainers
Space
Maintenance
Resources
Indoor meeting room and space for exercises
Funding
Federal funding through the Centers for
Disease Control & Prevention
•
•
•
•
Equipment
Portable scale
LCD projector
Computer
CD/MP3 player and music
Sustainability
Program has partnered with local churches
Implementation Notes
Toolkit – Page 115
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Project Joy
Heart disease
Project Cost Information
Duration
20 weeks
Program Characteristics
Sessions
20
Personnel Costs
Participants
75
Offering Cost
$36,215
Title
Salary
% Time
Fringe Rate %
Total
Health educator - note: rates
are based on 1996 estimates
Health educator - note: rates
are based on 1996 estimates
$14,000
1
0.28
$17,920
$14,000
1
0.28
Not available
$0
Unit Cost
Quantity
$
Educational materials (rate for color
photocopies)
Total
$0
Expendable Equipment/Supplies
Item Description
$35,840
$17,920
Non-Expendable Equipment
Item Description
Cost/Person
$483
Unit Cost
Quantity
Total
$5
75
$375
Consultants
$375
$0
Description
Cost
Not available
$
Description
Cost
Not available
$
Other Costs
Toolkit – Page 116
$0
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REFERENCES
ARTHRITIS
Arthritis Foundation Exercise Program (AFEP)
Boutaugh, M. (2003). Arthritis Foundation community-based physical activity programs:
Effectiveness and implementation issues. Arthritis & Rheumatism (Arthritis Care &
Research), 49(3), 463–470.
Callahan, L.F., Mielenz, T., Freburger, J., Shreffler, J., Hootman, J., Brady, T., Buysse, K., &
Schwartz, T. (2008). A randomized controlled trial of the People With Arthritis Can
Exercise Program: Symptoms, function, physical activity, and psychosocial outcomes.
Arthritis & Rheumatism (Arthritis Care & Research), 59(1), 92–101.
Enabling Self-Management and Coping with Arthritic Knee Pain Through Exercise
(ESCAPE-knee pain)
Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H.,
Dieppe, P. A., & Reeves, B. C. (2007). Clinical effectiveness of a rehabilitation program
integrating exercise, self-management, and active coping strategies for chronic knee pain: A
cluster randomized trial. Arthritis & Rheumatism (Arthritis Care & Research), 57(7), 1211–
1219.
Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H.,
Dieppe, P. A., & Reeves, B. C. (2007). Enabling Self-Management and Coping with Arthritic
Knee Pain through Exercise (ESCAPE-knee pain). Arthritis & Rheumatism (Arthritis Care &
Research), 57(7), 1211-1219.
Fit & Strong
Hughes, S.L., Seymour, R.B, Campbell, R., Huber, G., Pollak. N., Sharma, L., & Desai, P. (2006).
Long-term impact of Fit and Strong! on older adults with osteoarthritis. The Gerontologist,
46(6), 801-814.
Hughes, S.L., Seymour, R.B., Campbell, R., Pollak, N., Huber, G., & Sharma, L. (2004). Impact
of the Fit and Strong intervention on older adults with osteoarthritis. The Gerontologist,
44(2), 217–228.
Seymour, R.B., Hughes, S.L., R.B, Campbell, Huber, G., & Desai, P. (2009). Comparison of two
methods of conducting the Fit and Strong! program. Arthritis & Rheumatism (Arthritis Care
& Research), 61(7), 876-884.
Hop with the Hip
Tak, E., Staats, P., Van Hespen, A., & Hopman-Rock, M. (2005). The effects of an exercise
program for older adults with osteoarthritis of the hip. Journal of Rheumatology. 32(6),
1106-1113.
CANCER
Learn Share and Live Program
Skinner, C.S., Arfken, C.L., & Waterman, B. (2000). Outcomes of the Learn Share & Live
Breast Cancer Education Program for older urban women. American Journal of Public
Health, 90(8), 1229-1234.
Skinner, C.S., Sykes, R.K., Monsees, B.S., Andriole, D.A., Arfken, C.L., & Fisher, E.B. (1998).
Learn, Share, and Live: Breast cancer education for older, urban minority women. Health
Education & Behavior, 25(1), 60-78
Screen for Life National Colorectal Cancer Action Campaign
Ward, A.J., Kluhsman, B.C., Lengerich, E.J., & Piccinin, A.M. (2006). The impact of cancer
coalitions on the dissemination of colorectal cancer materials to community organizations
in rural Appalachia. Preventing Chronic Disease Public Health Research, Practice, and Policy,
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Tepeyac Project
Sauaia, A., Min, S., Lack, D., Apodaca, C., Osuna, D., Stowe, A., McGinnis, G.F., Latts, L.M., &
Byers, T. (2007). Church-based breast cancer screening education: Impact of two
approaches on Latinas enrolled in public and private health insurance plans. Preventing
Chronic Disease Public Health Research, Practice, and Policy, 4(4), 1-10.
DEPRESSION
Healthy Identifying Depression, Empowering Activities for Seniors (Healthy IDEAS)
Quijano, L.M., Stanley, M.A., Petersen N.J., Casado, B.L., Steinberg E.H., Cully J.A., & Wilson,
N.L. (2007). Healthy IDEAS: A depression intervention delivered by community-based case
managers serving older adults. Journal of Applied Gerontology, 26(2), 139-156.
Improving Mood Promoting Access to Collaborative Care Treatment (IMPACT)
Arean, P., Hegel, M., Vannoy, S., Fan, M.Y., & Unutzer, J. (2008). Effectiveness of problemsolving therapy for older, primary care patients with depression: Results from the IMPACT
project. The Gerontologist, 48(3), 311-323.
Hunkeler, E., Katon, W., Tang, L., Williams, Jr., J., Kroenke, K., Lin E., Harpole, L., Arean, P.,
Levine, S., Grypma, L., Hargreaves, W., & Unutzer, J. (2006). Long-term outcomes from the
IMPACT randomized trial for depressed elderly patients in primary care. BMJ, 332: 259263.
Unutzer, J., Katon, W., Callahan, C., Williams, Jr., J., Hunkeler, E., Harpole, L., Hoffing, M.,
Della-Penna, R.D., Hitchcock, N. P., Lin, E., Arean, P., Hegel, M., Tang, L., Belin, T., Oishi, S., &
Langston, C. (2002). Collaborative care management of late-life depression in the primary
care setting. JAMA, 288(22), 2846-2845.
Life Review Therapy
Serrano, J.P., Latorre, J.M., Gatz, M., & Montanes, J. (2004). Life review therapy: Using
autobiographical retrieval practice for older adults with depressive symptomatology.
Psychology and Aging, 19(2), 272-277.
Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)
Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz S., Williams, B. Diehr., P., Kulzer, J.,
Gray, S., Collier, C., & LoGerfo, J. (2004). Community-integrated home-based depression
treatment in older adults, a randomized controlled trial. JAMA, 291(13), 1569-1577.
Psycho geriatric Assessment and Treatment in City Housing (PATCH)
Rabins, P.V., Black, B.S., Roca, R., German, P., McGuire, M., Robbins, B., Rye, R., & Brant, L.
(2000). Effectiveness of a nurse-based outreach program for identifying and treating
psychiatric illness in the elderly. JAMA, 283(21), 2802-2809.
DIABETES
Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA
(DEPLOY)
Ackermann, R.T., Finch, E.A., Brizendine, E., Zhou, H., & Marrero, D.G. (2008). Translating
the Diabetes Prevention Program into the community: The DEPLOY pilot study. American
Journal of Preventive Medicine, 35(4), 357–363.
Ackermann, R.T. & Marrero, D.G. (2007). Adapting the Diabetes Prevention Program
lifestyle intervention for delivery in the community. The YMCA model. The Diabetes
Educator, 33(1), 69-78.
Finch, E.A., Kelly, M.S., Marrero, D.G. & Ackermann, R.T. (2009). Training YMCA wellness
instructors to deliver an adapted version of the Diabetes Prevention Program lifestyle
intervention. The Diabetes Educator, 35(2), 224-232.
Diabetes Health Connection
Glasgow, R.E., Nelson, C.C., Strycker, L.A. & King, D.K. (2006). Using RE-AIM metrics to
evaluate diabetes self-management support interventions. American Journal of Preventive
Medicine, 30(1) 67-73.
King, D.K., Estabrooks, P.A., Strycker, L.A., Toobert, D.J., Bull, S.S. & Glasgow, R.E. (2006).
Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management
intervention. Annals of Behavioral Medicine, 31(2), 28–137.
Diabetes Prevention Program (DPP)
Knowler, W.C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker, E.A. &
Nathan, D.M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. New England Journal of Medicine, 346(6), 393-403.
The Diabetes Prevention Program Research Group. (1999). The Diabetes Prevention
Program: Design and methods for a clinic trial in the prevention of type 2 diabetes.
Diabetes Care, 22(44), 623-634.
Wylie-Rosett, J., Herman, W.H. & Goldberg, R.B. (2006). Lifestyle intervention to prevent
diabetes: Intensive AND cost-effective. Current Opinion in Lipidology Nutrition and
Metabolism, 17, 37-44.
Group Lifestyle Balance (GLB)
Seidel, M. C., Powell, R.O., Zgibor, J.C., Siminerio, L.M., & Piatt, G.A. (2008). Translating the
Diabetes Prevention Program into an urban medically underserved community: A
nonrandomized prospective intervention study. Diabetes Care, 31(4), 684–689.
Healthy ChangesTM by NCOA
Elders in Action. (2007). Healthy Changes: A community-based diabetes education and
support program. Healthy Changes Replication Report, 1-25.
National Council on Aging. (2006). Center for Healthy Aging model health programs for
communities. Using the evidence base to promote healthy aging: The Administration on
Aging’s evidence-based prevention programs for the elderly initiative. Evidence-Based
Health Promotion Series, 3, 1-5.
Look After Yourself (LAY)
Cooper, H., Booth, K. & Gill, G. (2008). A trial of empowerment-based education in type 2
diabetes—Global rather than glycaemic benefits. Diabetes Research and Clinical Practice,
82, 165-171.
Look AHEAD (Action for Health in Diabetes)
Ryan, D.H., Espeland, M.A., Foster, G.D., Haffner, S.M., Hubbard, V.S., Johnson, K.C., Kahn, S.E.,
Knowler, W.C., & Yanovski, S.Z. (2003). Look AHEAD (Action for Health in Diabetes):
Design and methods for a clinical trial of weight loss for the prevention of cardiovascular
disease in type 2 diabetes. Controlled Clinical Trials, 24, 610–628.
The Look AHEAD Research Group. (2007). Reduction in weight and cardiovascular disease
risk factors in individuals with type 2 diabetes: One-year results of the Look AHEAD trial.
Diabetes Care, 30(6), 1374–1383.
New Leaf … Choices for Healthy Living with Diabetes
Keyserling, T.C., Ammerman, A.S., Samuel-Hodge, Ingram, A.F., Skelly, A.H., Elasy, T.A.,
Johnston, L.F., Cole, A.S. & Henríquez-Roldán, C.F. (2000). A diabetes management
program for African American women with type 2 diabetes. The Diabetes Educator, 26(5),
796-805.
Keyserling, T.C., Samuel-Hodge, C.D., Ammerman, A.S., Ainsworth, B.E., Henríquez-Roldán,
C.F., Elasy, T.A., Skelly, A.H., Johnston, L.F., & Bangdiwala, S.I. (2002). A randomized trial of
an intervention to improve self-care behaviors of African-American women with type 2
diabetes: Impact on physical activity. Diabetes Care, 25(9), 1576–1583.
Seniors Taking Charge of Diabetes!
Speer, E.M., Reddy, S., Lommel, T.S., Fischer, J.G., Stephens, H., Park, S. & Johnson, M.A.
(2008). Diabetes self-management behaviors and Alc improved following a communitybased intervention in older adults in Georgia senior centers. Journal of Nutrition for the
Elderly, 27(1/2), 179-200.
Starr County Border Health Initiative
Brown, S.A., Garcia, A.A., Kouzekanani , K., & Hanis, G.L. (2002). Culturally competent
diabetes self-management education for Mexican Americans: The Starr County Border
Health Initiative. Diabetes Care, 25(2), 259–268.
FALLS
A Matter of Balance/Volunteer Lay Leader Model
Tennstedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L., & Jette, A. (1998). A
randomized, controlled trial of a group intervention to reduce fear of falling and associated
activity restriction in older adults. Journal of Gerontology: Psychological Sciences, 53B(6),
384-392.
van Haastregt, J.C.M., Zijlstra, G.A.R., van Rossum, E., van Eijk, J.T.M, de Witte, L.P., &
Kempen, G.I.J.M. (2007). Feasibility of a cognitive behavioral group intervention to reduce
fear of falling and associated avoidance of activity in community-living older people: A
process evaluation. BMC Health Services Research, 7(156), 1-9.
Zijlstra, G.A.R., Tennstedt, S.L., van Haastregt, J.C.M., van Eijk, J.T.M., & Kempen, G.I.J.M.
(2006). Reducing fear of falling and avoidance of activity in elderly persons: The
development of a Dutch version of an American intervention. Patient Education and
Counseling, 62, 220-227.
EnhanceFitness
Belza, B., Shumway-Cook, A., Phelan, E.A., Williams, B., Snyder, S.J., & LoGerfo, J.P. (2006).
The effects of a community-based exercise program on function and health in older adults:
The EnhanceFitness Program. Journal of Applied Gerontology, 25(4), 291-306.
Wallace, J.I., Buchner, D.M., Grothaus, L., Leveille, S., Tyll., L., LaCroix, A.Z., & Wagner, E.H.
(1998). Implementation and effectiveness of a community-based health promotion
program of older adults. The Journals of Gerontology: Medical Sciences, 53A(4), M301M306.
Falls Management Exercise (FaME)
Skelton, D., Dinan, S., Campbell, M., & Rutherford, O. (2005). Tailored group exercise (Falls
Management Exercise — FaME) reduces falls in community-dwelling older frequent fallers
(an RCT). Age and Ageing, 34(6), 636-639.
NoFalls
Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer H., & & Lord, S. (2002). Randomized
factorial trial of falls prevention among older people living in their own homes. BMJ, 325, 16.
Step by Step
Baker, D.I., Gottschalk, M., & Bianco, L.M. (2007). Step by Step: Integrating evidence-based
fall-risk management into senior centers. The Gerontologist, 47(4), 548–554.
Stepping On
Clemson, L., Cumming., R.G., Kendig, H., Swann, M., Heard, R., & Taylor, K. (2004). The
effectiveness of a community-based program for reducing the incidence of falls in the
elderly: A randomized trial. JAGS, 52(9), 1487-1494.
Strategies and Actions for Independent Living (SAIL)
Scott, V.J., Votova, K., & Callagher, E. (2006). Falls prevention training for community
health workers:. Strategies and Actions for Independent Living (SAIL). Journal of
Gerontological Nursing, 32(10), 48-56.
Tai Chi: Moving for Better Balance
Li, F., Harmer, P., Fisher, J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N.L. (2005).
Tai chi and fall reductions in older adults: A randomized controlled trial. Journal of
Gerontology: Medical Sciences, 60A(2), 187-194.
HEART DISEASE
Airdie Community Hypertension Awareness and Management Program (A-CHAMP)
Jones, C., Simpson, S.H., Mitchell, D., Haggarty, S., Campbell, N., Then, K., Lewanczuk, R.Z.,
Sebaldt, R.J., Farrell, B., Dolovich, L., Kaczorowski, J., & Chambers, L.W. (2008). Enhancing
hypertension awareness and management in the elderly: Lessons learned from the Airdrie
Community Hypertension Awareness and Management Program (A-CHAMP). The
Canadian Journal of Cardiology, 24(7), 561-567.
Eat Better Move More
Wellman, N.S., Kamp, B., Kirk-Sanchez, N.J., & Johnson, P.M. (2007). Eat Better & Move
More: A community-based program designed to improve diets and increase physical
activity among older Americans. American Journal of Public Health, 97(4), 710-717.
Health for Your Heart (Salud Por Tu Corazón)
Balcázar, H., Alvarado, M., Hollen, M.L., Gonzalez-Cruz, Y., & Pedregón, V. (2005).
Evaluation of Salud Para Su Corazón (Health for Your Heart) — National Council of La Raza
Promotora Outreach Program. Preventing Chronic Disease Public Health Research, Practice,
and Policy, 2(3), 1-9. URL: http://www.cdc.gov/pcd/issues/2005/
Prime Time Sister CirclesTM
Gaston, M.H., Porter, G.K. & Thomas, V.G. (2007). Prime Time Sister CirclesTM: Evaluating a
gender-specific, culturally relevant health intervention to decrease major risk factors in
mid-life African-American women. Journal of the National Medical Association, 99(4), 428438.
Project Joy
Yanek, L.R., Becker, D.M., Moy, T.F., Gittelsohn, J., & Koffman, D.M. (2001). Project Joy:
Faith-based cardiovascular health promotion for African American women. Public Health
Reports, 116(S1), 68-81.
OBESITY
For the evidence-based program references for obesity, please refer to the citations
listed above for the following programs:
Condition
Diabetes
Diabetes
Heart Disease
Diabetes
Program Name
Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA
(DEPLOY)
Diabetes Prevention Program (DPP)
Eat Better Move More
Group Lifestyle Balance (GLB)
APPENDICES
ToC
APPENDIX 1:
Evidence-Based
Program Logistics
Survey
ToC
EVIDENCE-BASED PROGRAM LOGISTICS SURVEY
PROGRAM NAME:
RESPONDENT NAME:
TITLE:
Funding
1.
What is the funding source used to implement your program (e.g., local agency, foundation, federal grant)?
Resources
2.
What types of resources are required for implementing your program?
a. Space requirements
b. Equipment/material requirements
Certification/Educational Background
3a.
If appropriate, do trainers need to obtain special certification to implement your program?
** If trainers are not required for your program, SKIP TO QUESTION 4 on next page
□ Yes □ No If so, please explain below.
3b.
Do trainers need to have specific educational background/experience to implement your program?
(i.e., MSW, RN, PT, etc.)
□ Yes □ No If so, please specify below.
1
ToC
Fidelity
4.
Are any specific arrangements made to ensure program fidelity? For instance, do Master Trainers attend
program sessions to observe whether the program is implemented per original specifications?
□ Yes □ No If so, please explain below.
Replicability and Modifications (if any)
5a.
Can your program be replicated in any community setting? □ Yes □ No
** If the answer to item 5a (above) was NO:
5b.
Are there any suggested modifications that need to be made for community settings to implement your
program? □ Yes □ No If so, what would these modifications entail?
Sustainability
6.
Does your program have any elements used to ensure its sustainability? For example, does your program
partner with community-based organizations or healthcare providers/networks to facilitate ongoing or
continuous implementation of the program? □ Yes □ No If so, please explain.
Finally, would you please provide us with contact information in case we have questions about your responses?
Phone:
Email:
THANK YOU!
2
ToC
APPENDIX 2:
Evidence-Based
Program Cost Sheet
ToC
Evidence-Based Program Cost Sheet
Program Name:
Does this budget worksheet describe a/an:
Annual program
Single offering
Program Duration (weeks)
Number of Sessions
If this is an annual budget, how many offerings/programs are run annually?
On average, how many participants take part in each program offering?
PERSONNEL
For each staff member WORKING DIRECTLY ON THE PROGRAM, list each position, annual salary and percent time devoted to program (FTE).
This does not include contracted personnel providinf services for the intervention.
Position/Title
Annual
Salary
Percent
Time (FTE)
Program
Salary
1
X
"="
$0
2
X
"="
$0
3
X
"="
$0
4
X
"="
$0
5
X
"="
$0
6
X
"="
$0
SALARY SUB-TOTAL
$0
FRINGE BENEFITS
For each staff member listed above, please provide the fringe benefit rate used for that position.Please keep in mind that staff at various
levels may have different fringe benefit rates. The position/titles and salaries from above will self-populate the table below.
Position/Title (Self-Populating)
Fringe
Benefit
Program
Salary
Program
Fringe
1 0
X
$0
"="
$0
2 0
X
$0
"="
$0
3 0
X
$0
"="
$0
4 0
X
$0
"="
$0
5 0
X
$0
"="
$0
6 0
X
$0
"="
$0
FRINGE SUB-TOTAL
$0
ToC
NON-EXPENDABLE EQUIPMENT
List NON-EXPENDABLE items related to the program intervention in the spaces below. NON-EXPENDABLE equipment is usually defined as
tangible property having a useful life of 2 or more years. Single, or short-term, use items should be listed under EXPENDABLE ITEMS below.
Construction costs are not to be included. Please describe each item fully.
Items
Unit Cost
Quantity
1
X
"="
$0
2
X
"="
$0
3
X
"="
$0
4
X
"="
$0
5
X
"="
$0
NON-EXP SUB-TOTAL
$0
SUPPLIES/EXPENDABLE EQUIPMENT
List EXPENDABLE items related to the program intervention by type (training materials, postage, copies, etc.) in the spaces below.
EXPENDABLE items are those items consumed during the course of a program. Please describe each item fully.
Items
Unit Cost
Quantity
1
X
"="
$0
2
X
"="
$0
3
X
"="
$0
4
X
"="
$0
5
X
"="
$0
6
X
"="
$0
7
X
"="
$0
8
X
"="
$0
SUPPLIES SUB-TOTAL
$0
ToC
CONSULTANTS/CONTRACTUAL
For each consultant/contractor provide a description of services provided. If additional costs are included in the consultant's fee
(travel, lodging, etc.) please include that in the total cost of that contractor's services. This would also include students or others
that are paid but not considered employees.
Consultant/Contractor
Details of Service Provided
Total Cost
1
2
3
4
5
CONSULTANT SUB-TOTAL
$0
OTHER COSTS
Specify
Details of Service Provided
Total Cost
1
2
3
4
5
OTHER SUB-TOTAL
ORGANIZATIONAL INDIRECT COSTS
Specify if indirect rate is a federally negotiated rate and oversite organization (DHHS, etc.)
Federal Agency or Source of Indirect Rate
Indirect Rate
Personnel
Fringe
Non-Exp
Supplies
Consult
Other
TOTAL
$0
$0
$0
$0
$0
$0
$0
$0
BROOKDALE
DEMONSTRATION
INITIATIVE IN
HEALTHY URBAN
AGING:
BRIDGING THE
DIVIDE BETWEEN
PUBLIC HEALTH &
HEALTHY AGING
EVIDENCE-BASED
TOOLKIT:
Condition-Specific
Instruments
PREPARED FOR:
THE COMMISIONER
NEW YORK CITY
DEPARTMENT FOR
THE AGING
LILLIAM BARRIOS-PAOLI
COMMISSIONER
APRIL 2010
FUNDING PROVIDED BY:
OFFICE OF THE MAYOR
CITY OF NEW YORK
MICHAEL R. BLOOMBERG
MAYOR
CREATED BY:
THE BROOKDALE
CENTER FOR HEALTHY
AGING & LONGEVITY
OF HUNTER COLLEGE/
CUNY
2
Arthritis-Specific
Instruments
•Tab 1
Cancer-Specific
Instruments
•Tab 2
Depression-Specific
Instruments
•Tab 3
Diabetes-Specific
Instruments
•Tab 4
Falls-Specific
Instruments
•Tab 5
Heart DiseaseSpecific
Instruments
•Tab 6
Obesity-Specific
Instruments
•Tab 7
INSTRUMENT GUIDE FOR ARTHRITIS-SPECIFIC PROGRAMS
Instruments preceded by an asterisk (*) and bolded are common to a number of conditions
and can be found in the Cross-Cutting Instruments Guide
Important Note: While rigorous research was conducted to provide readers with all of the instrumentation
for implementing the programs outlined in this toolkit, for a limited number of programs, instrumentation
was not available for public use. Therefore, interested parties are encouraged to contact selected programs to
obtain permission for instruments not included here.
Instrument
Program
•
*6-Minute Walk Test
•
•
Arthritis Self-Efficacy Scale
English & Spanish versions
•
Arthritis Foundation Exercise Program (AFEP)
Enabling Self-Management and Coping with
Arthritic Knee Pain through Exercise (ESCAPE-knee
pain)
Fit and Strong
Fit and Strong
* Center for Epidemiologic Studies
Depression (CES-D) Scale
•
* Community Health Activities Model
Program for Seniors (CHAMPS) Physical
Activity Questionnaire
English & Spanish versions, including
manual and scoring guide
•
Fit and Strong
•
ESCAPE-knee pain
EuroQol (EQ-5D)
Including user’s guide
Gait Speed Test
•
Groningen Activity Restriction Scale
•
Geri-AIMS Pain Scale
Harris Hip Score (HHS)
Including instrument overview
Health Assessment Questionnaire (HAQ)-8
English & Spanish versions
Helplessness Subscale of the Rheumatology
Attitudes Index
Hospital Anxiety and Depression Scale
(HADS)
McMaster Toronto Arthritis Quality of Life
Questionnaire (MACTAR)
•
•
•
•
•
•
AFEP
AFEP
Fit and Strong
Hop with the Hip
Hop with the Hip
AFEP
AFEP
ESCAPE-knee pain
ESCAPE-knee pain
Instrument
*Physical Activity Scale for the Elderly
(PASE)
Rheumatoid Arthritis Self-Efficacy (RASE)
Scale
Rheumatology Attitudes Index (RAI)
Self-Efficacy for Exercise Adherence Scale
Self-Efficacy for Physical Activity (SEPA)
Scale
Short Portable Mental Status Questionnaire
(SPSMQ)
Program
•
•
•
•
•
•
* Sickness Impact Profile (SIP)
•
Timed 10-Pound Lifts
•
Timed 360-Degree Turn
•
Timed Up and Go Test
•
Timed Chair Stand Test
Visual Analog Scale (VAS)
Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC)
Including instrument overview and scoring
guide
•
•
•
•
•
•
AFEP
AFEP
AFEP
Fit and Strong
AFEP
Fit and Strong
Hop with the Hip
AFEP
AFEP
AFEP
Fit and Strong
Hop with the Hip
AFEP
Hop with the Hip
ESCAPE-knee pain
Fit and Strong
Back
ToC
Arthritis Self-Efficacy
For each of the following questions, please circle the number that corresponds to how certain you are
that you can do the following tasks regularly at the present time.
Self-Efficacy Pain Scale (may be combined with Other Symptoms Scale)
1. How certain are you that you can
decrease your pain quite a bit?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
2. How certain are you that you can
continue most of your daily
activities?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
3. How certain are you that you can
keep arthritis pain from interfering
with your sleep?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
4. How certain are you that you can
that you can make a small-tomoderate reduction in your arthritis
pain by using methods other than
taking extra medication?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
5. How certain are you that you can
make a large reduction in your
arthritis pain by using methods other
than taking extra medication?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
Self-Efficacy Function Scale
1. How certain are you that you can
walk 100 feet on flat ground in 20
seconds?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
2. How certain are you that you can
that you can walk 10 steps
downstairs in 7 seconds?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
3. How certain are you that you can get
out of an armless chair quickly,
without using your hands for
support?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
4. How certain are you that you can
very
______________________________
|
|
|
|
|
|
|
|
|
|
very
1
button and unbutton 3 medium-size
buttons in a row in 12 seconds?
uncertain 1
2
3
4
5
6
7
8
9 10 certain
5. How certain are you that you can cut
2 bite-size pieces of meat with a
knife and fork in 8 seconds?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
6. How certain are you that you can
turn an outdoor faucet all the way on
and all the way off?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
7. How certain are you that you can
scratch your upper back with both
your right and left hands?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
8. How certain are you that you can get
in and out of the passenger side of a
car without assistance from another
person and without physical aids?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
9. How certain are you that you can put
on a long-sleeve front-opening shirt
or blouse (without buttoning) in 8
seconds?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
Self-Efficacy Other Symptoms Scale (may be combined with Pain Scale)
1. How certain are you that you can
control your fatigue?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
2. How certain are you that you can
regulate your activity so as to be
active without aggravating your
arthritis?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
3. How certain are you that you can do
something to help yourself feel better
if you are feeling blue?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
4. As compared with other people with
arthritis like yours, how certain are
you that you can manage arthritis
pain during your daily activities?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
5. How certain are you that you can
manage your arthritis symptoms so
that you can do the things you enjoy
doing?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
6. How certain are you that you can
deal with the frustration of arthritis?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
2
Characteristics
Mean
N=95 (T)
N=49 (C)
Standard
Deviation
N=95 (T)
N=49 (C)
Internal Consistency
Reliability
N=97
Test-Retest
Reliability
N=91
2.14 (T)
1.79 (C)
.75
.87
7.33 (T)
6.79 (C)
2.02 (T)
2.25 (C)
.90
.85
5.56 (T)
4.92 (C)
2.16 (T)
2.06 (C)
.87
.90
Scale
No. of
items
Observed
Range
SE Pain
5
1-10
5.20 (T)
4.82 (C)
SE Function
9
1-10
SE Other
Symptoms
6
1-10
Source of Psychometric Data
Stanford Arthritis Self-Management Study. Psychometrics reported in: Lorig K, Chastain RL, Ung E,
Shoor S, & Holman HR: Development and evaluation of a scale to measure self-efficacy in people with
arthritis. Arthritis and Rheumatism, 32, 1, 1989, pp. 37-44.
Scoring
The score for each item is the number circled. If two consecutive numbers are circled, code the lower
number (less self-efficacy). If the numbers are not consecutive, do not score the item. The score for the
scale is the mean of the items. If more than 25% of the items are missing, do not score the scale.
Comments
The original response categories for these scales were 10-100, with “moderately certain” place midway
between “very uncertain” and “very certain”. We found that subjects tended to circle the phrases rather
than the numbers, and there was some confusion about whether “moderate” was truly in the middle for
all people, so we dropped “moderately” from the scales. Data above have been adjusted to reflect the
1-10 response categories that we use now. The Self-Efficacy Function Scale should be scored
separately, but Self-Efficacy Pain and Self-Efficacy Other Symptoms may be combined.
There are 2 ways to format these items. We use the format above, because it takes up less room on
the questionnaire. The other is shown on the web page.
References
Lorig K, Chastain RL, Ung E, Shoor S, & Holman HR: Development and evaluation of a scale to
measure self-efficacy in people with arthritis. Arthritis and Rheumatism, 32, 1, 1989, pp. 37-44.
3
Current 8-item scale:
1. How certain are you that you can
decrease your pain quite a bit?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
2. How certain are you that you can
keep your arthritis or fibromyalgia
pain from interfering with your sleep?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
3. How certain are you that you can
keep your arthritis or fibromyalgia
pain from interfering with the things
you want to do?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
4. How certain are you that you can
regulate your activity so as to be
active without aggravating your
arthritis or fibromyalgia?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
5. How certain are you that you can
keep the fatigue caused by your
arthritis or fibromyalgia from
interfering with the things you want
to do?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
6. How certain are you that you can do
something to help yourself feel better
if you are feeling blue?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
7. As compared with other people with
arthritis or fibromyalgia like yours,
how certain are you that you can
manage pain during your daily
activities?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
8. How certain are you that you can
deal with the frustration of arthritis or
fibromyalgia?
______________________________
very |
|
|
|
|
|
|
|
|
| very
uncertain 1 2 3 4 5 6 7 8 9 10 certain
Scoring
The score for each item is the number circled. If two consecutive numbers are circled, code the lower
number (less self-efficacy). If the numbers are not consecutive, do not score the item. The score for the
scale is the mean of the eight items. If more than two items are missing, do not score the scale.
Characteristics
Tested on 175 subjects with arthritis.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
8
1-10
5.53
2.20
.92
NA
4
Source of Psychometric Data
Stanford Arthritis Self-Management Study participants. Unpublished.
Comments
This is the scale we use in our current studies, as it is much less burdensome for subjects than the
original 3 scales with 20 total items. We have not included function items because we also use the
HAQ and there is a high correlation between the SE function scale and the HAQ disability scale. There
are 2 ways to format these items. We use the format above, because it takes up less room on the
questionnaire. The other is shown on the web site (address below). This scale is available in Spanish.
References
Lorig K, Chastain RL, Ung E, Shoor S, & Holman HR: Development and evaluation of a scale to
measure self-efficacy in people with arthritis. Arthritis and Rheumatism, 32, 1, 1989, pp. 37-44 (original
scales).
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
5
Back
ToC
Spanish Arthritis Self-Efficacy
En las siguientes preguntas nos gustaría saber cómo le afecta el dolor de artritis y qué piensa Ud. de
sus habilidades para controlar su artritis. En cada una de las siguientes escalas, por favor marque el
número que mejor corresponda a su nivel de seguridad de que puede realizar en este momento las
siguientes tareas.
1. ¿Qué tan seguro se siente Ud. de
poder reducir bastante su dolor?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
2. ¿Qué tan seguro se siente Ud. de
poder evitar que el dolor de la artritis
interfiera con su sueño?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
3. ¿Qué tan seguro se siente Ud. de
poder evitar que el dolor de la artritis
interfiera con las cosas que quiere
hacer?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
4. ¿Qué tan seguro se siente Ud. de
poder regular su actividad para
mantenerse activo sin empeorar
(agravar) su artritis?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
5. ¿Qué tan seguro se siente Ud. de
poder evitar que la fatiga (el
cansancio), debido a su artritis,
interfiera con las cosas que quiere
hacer?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
6. ¿Qué tan seguro se siente Ud. de
poder ayudarse a sí mismo a
sentirse mejor si se siente triste?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
7. Comparándose con otras personas
con artritis como la suya, ¿qué tan
seguro se siente Ud. de poder
sobrellevar el dolor de artritis
durante sus actividades diarias?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
8. ¿Qué tan seguro se siente Ud. de
poder sobrellevar la frustración
debido a su artritis?
______________________________
muy |
|
|
|
|
|
|
|
|
| muy
inseguro(a) 1 2 3 4 5 6 7 8 9 10 seguro(a)
Scoring
The score for each item is the number circled. If two consecutive numbers are circled, code the lower
number (less self-efficacy). If the numbers are not consecutive, do not score the item. The score for the
scale is the mean of the eight items. If more than two items are missing, do not score the scale.
Characteristics
Tested on 272 Spanish-speaking subjects. N=25 for test-retest.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
8
1-10
5.9
2.1
.92
.69
Source of Psychometric Data
Stanford Spanish Outcome Measures Study. Results reported in: González V, Stewart A, Ritter P, Lorig
K, Translation and validation of arthritis outcome measures into Spanish. Arthritis and Rheumatism,
38(10),1995, pp.1429-1446.
Comments
There are 2 ways to format these items. We use the format above, because it takes up less room on
the questionnaire. The other is shown on the web page.
References
González V, Stewart A, Ritter P, Lorig K, Translation and validation of arthritis outcome measures into
Spanish. Arthritis and Rheumatism, 38(10),1995, pp.1429-1446.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
Back
ToC
Table of contents
1. INTRODUCTION........................................................................................................... 3
EUROQOL GROUP .......................................................................................................... 3
EQ-5D ........................................................................................................................... 4
WHAT IS A HEALTH STATE?.............................................................................................. 7
VERSIONS OF EQ-5D...................................................................................................... 8
2. SCORING THE EQ-5D DESCRIPTIVE SYSTEM ........................................................ 9
3. SCORING THE EQ VAS............................................................................................. 10
4. CONVERTING EQ-5D STATES TO A SINGLE SUMMARY INDEX ......................... 11
5. ORGANISING EQ-5D DATA ...................................................................................... 12
6. PRESENTING EQ-5D RESULTS ............................................................................... 13
HEALTH PROFILES ......................................................................................................... 13
EQ VAS ....................................................................................................................... 15
EQ-5D INDEX ............................................................................................................... 16
7. EQ-5D: FREQUENTLY ASKED QUESTIONS........................................................... 19
8. ADDITIONAL INFORMATION.................................................................................... 22
Version 2.0
February 2009
Web: www.euroqol.org
Email: [email protected]
1. Introduction
This guide has been developed in order to give users basic information on how to
use EQ-5D. Topics include administering the instrument, setting up a database for
data collected using EQ-5D as well as information about how to present the results.
Also included are some frequently asked questions dealing with common issues
regarding the use of EQ-5D and a list of currently available EuroQol Group products.
EuroQol Group
• The EuroQol Group is a network of international multidisciplinary researchers
devoted to the measurement of health status. Established in 1987, the EuroQol
Group originally consisted of researchers from Europe, but nowadays includes
members from North America, Asia, Africa, Australia, and New Zealand. The
Group is responsible for the development of EQ-5D, a preference based measure
of health status that is now widely used in clinical trials, observational studies and
other health surveys.
•
The EuroQol Group has been holding annual scientific meetings since its
inception in 1987.
•
The EuroQol Group can be justifiably proud of its collective scientific
achievements over the last 20 years. Research areas include: valuation, EQ-5D
use in clinical studies and in population surveys, experimentation with the EQ-5D
descriptive system, computerized applications, interpretation of EQ-5D ratings
and the role of EQ-5D in measuring social inequalities in self-reported health.
•
The EuroQol Group’s website (www.euroqol.org) contains detailed information
about EQ-5D, guidance for users, a list of available language versions, EQ-5D
references and contact details.
3
EQ-5D
EQ-5D is a standardised measure of health status developed by the EuroQol Group
in order to provide a simple, generic measure of health for clinical and economic
appraisal1. Applicable to a wide range of health conditions and treatments, it provides
a simple descriptive profile and a single index value for health status that can be
used in the clinical and economic evaluation of health care as well as in population
health surveys (Figure 1).
EQ-5D is designed for self-completion by respondents and is ideally suited for use in
postal surveys, in clinics, and in face-to-face interviews. It is cognitively
undemanding, taking only a few minutes to complete. Instructions to respondents are
included in the questionnaire.
EQ-5D essentially consists of 2 pages - the EQ-5D descriptive system (page 2) and
the EQ visual analogue scale (EQ VAS) (page 3). The EQ-5D descriptive system
comprises the following 5 dimensions: mobility, self-care, usual activities,
pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems,
some problems, severe problems. The respondent is asked to indicate his/her health
state by ticking (or placing a cross) in the box against the most appropriate statement
in each of the 5 dimensions. This decision results in a 1-digit number expressing the
level selected for that dimension. The digits for 5 dimensions can be combined in a 5digit number describing the respondent’s health state. It should be noted that the
numerals 1-3 have no arithmetic properties and should not be used as a
cardinal score.
The EQ VAS records the respondent’s self-rated health on a vertical, visual analogue
scale where the endpoints are labelled ‘Best imaginable health state’ and ‘Worst
imaginable health state’. This information can be used as a quantitative measure of
health outcome as judged by the individual respondents.
1
EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health
Policy 1990;16:199-208
4
Figure 1: EQ-5D (UK English version)
By placing a tick in one box in each group below, please indicate which statements
best describe your own health state today.
Mobility
I have no problems in walking about
‰
I have some problems in walking about
I am confined to bed
‰
‰
Self-Care
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
‰
‰
‰
Usual Activities (e.g. work, study, housework, family or
leisure activities)
I have no problems with performing my usual activities
I have some problems with performing my usual activities
I am unable to perform my usual activities
‰
‰
‰
Pain/Discomfort
I have no pain or discomfort
I have moderate pain or discomfort
‰
‰
I have extreme pain or discomfort
‰
Anxiety/Depression
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed
‰
‰
‰
5
Best
imaginable
health state
100
To help people say how good or bad a health state
is, we have drawn a scale (rather like a
thermometer) on which the best state you can
imagine is marked 100 and the worst state you can
9 0
imagine is marked 0.
We would like you to indicate on this scale how
8 0
good or bad your own health is today, in your
opinion. Please do this by drawing a line from the
box below to whichever point on the scale
7 0
indicates how good or bad your health state is
today.
6 0
Your own
health state
today
5 0
4 0
3 0
2 0
1 0
0
Worst
imaginable
health state
6
What is a health state?
Each of the 5 dimensions comprising the EQ-5D descriptive system is divided into 3
levels of perceived problems:
Level 1: indicating no problem
Level 2: indicating some problems
Level 3: indicating extreme problems
A unique health state is defined by combining 1 level from each of the 5 dimensions.
Anxiety /
Depression
Pain /
Discomfort
Mobility
Health
state
Self-Care
UsualActivities
Activity
Usual
A total of 243 possible health states is defined in this way. Each state is referred to in
terms of a 5 digit code. For example, state 11111 indicates no problems on any of
the 5 dimensions, while state 11223 indicates no problems with mobility and self
care, some problems with performing usual activities, moderate pain or discomfort
and extreme anxiety or depression.
Note: Two further states (unconscious and death) are included in the full set of 245
EQ-5D health states, but information on these states is not collected via self-report.
7
Versions of EQ-5D
EQ-5D in different languages
Currently there are more than 100 translated versions of EQ-5D. If you want to know
if there is an EQ-5D version appropriate for your country, please consult the website.
All translations/adaptations of EQ-5D are produced using a standardised translation
protocol that conforms to internationally recognized guidelines. These guidelines aim
to ensure semantic and conceptual equivalence and involve a forward/backward
translation process and lay panel assessment. Only the EuroQol Group Executive
Office can give permission for a translation to be performed and translations can only
be stamped as official if they are performed in cooperation with EuroQol Group
reviewers.
Alternative modes of administration
EQ-5D was primarily designed for self-completion by the patient or respondent.
However EQ-5D self-report data can also be collected using the following alternative
modes of administration:
(i) Face-to-face
(ii) Self-completion in the presence of an interviewer
(iii) Telephone interview
(iv) Interactive Voice Response (IVR) versions (available through a preferred vendor
- Perceptive Informatics)
(v) Proxy (asking the proxy to rate how he or she, (i.e. the proxy), would rate the
subject’s health)
8
2. Scoring the EQ-5D descriptive system
The EQ-5D descriptive system should be scored as follows:
Levels of perceived
problems are coded
By placing a tick in one box in each group, please indicate which
whic h
statements best describe your health today.
as follows:
‰
9
Mobility
I have no problems in walking about
I have some problems in walking about
I am confined to bed
‰
‰
‰
Self-Care
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
‰
‰
‰
‰
Level 2
‰
9
is coded
‰
‰
as a ‘2’
‰
‰
‰
Level 3
Pain/Discomfort
I have no pain or discomfort
I have moderate pain or discomfort
I have extreme pain or discomfort
‰
‰
‰
‰
‰
9
is coded
Anxiety/Depression
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed
‰
‰
‰
Usual Activities (e.g. work, study, housework, family or
leisure
activities)
I have some
problems with performing my usual activities
II have
no
usual activities
activities
have no problems
problems with
with performing
performing my
my usual
housework,
family ormy
leisure
I(e.g.
havework,
somestudy,
problems
with performing
usualactivities)
activities
I am unable to perform my usual activities
‰
‰
Level 1
is coded
as a ‘1’
as a ‘3’
NB: There should be
only one response
for each dimension.
This example identifies the state 11232.
Missing values can be coded as ‘9’.
Ambiguous values (e.g. 2 boxes are ticked for a single dimension) should be treated
as missing values.
9
3. Scoring the EQ VAS
The EQ VAS should be scored as follows:
To help people say how good or bad a health state is,
we have drawn a scale (rather like a thermometer) on
which the best state you can imagine is marked 100 and
the worst state you can imagine is marked 0.
We would like you to indicate on this scale how good
or bad your own health is today, in your opinion. Please
do this by drawing a line from the box below to
whichever point on the scale indicates how good or bad
your health state is today.
Your own
health state
today
Best
imaginable
health state
100
9
0
8
0
7
0
6
0
5
0
4
0
3
0
2 0
8 0
7
0
6
0
8
0
7
0
6
0
1 0
0
Worst
imaginable
health state
For example this
response should
be coded as 77
Even though the
line does not cross
the VAS this
response can still
be scored by
drawing a
horizontal line from
the end point of
the response to
the VAS. In this
example the
response should
be coded as 77
Missing values should be coded as ‘999’.
Ambiguous values (e.g. the line crosses the VAS twice) should be treated as missing
values.
10
4. Converting EQ-5D states to a single summary index
EQ-5D health states, defined by the EQ-5D descriptive system, may be converted
into a single summary index by applying a formula that essentially attaches values
(also called weights) to each of the levels in each dimension. The index can be
calculated by deducting the appropriate weights from 1, the value for full health (i.e.
state 11111). Information in this format is useful, for example, in cost utility analysis.
Value sets have been derived for EQ-5D in several countries using the EQ-5D visual
analogue scale (EQ-5D VAS) valuation technique or the time trade-off (TTO)
valuation technique. The list of currently available value sets with the number of
respondents and valuation technique applied is presented in table 1. Most of the EQ5D value sets have been obtained using a representative sample of the general
population, thereby ensuring that they represent the societal perspective. For anyone
working with EQ-5D data, an essential guide to the Group’s available value sets can
be found in: EuroQol Group Monograph series: Volume 2: EQ-5D value sets:
inventory, comparative review and user guide, recently published by Springer (see
section 8 for more information).
Table 1: List of available value sets (references available on the website)
Country
Belgium
Denmark
Denmark
Europe
Finland
Germany
Germany
Japan
Netherlands
New Zealand
Slovenia
Spain
Spain
UK
UK
US
Zimbabwe
N
Valuation method
722
1686
1332
8709
1634
339
339
621
309
1360
733
300
1000
3395
3395
4048
2440
EQ-5D VAS
EQ-5D VAS
TTO
EQ-5D VAS
EQ-5D VAS
EQ-5D VAS
TTO
TTO
TTO
EQ-5D VAS
EQ-5D VAS
EQ-5D VAS
TTO
EQ-5D VAS
TTO
TTO
TTO
Documents containing the scoring algorithms, information on the valuation studies,
tables of values for all 243 health states and SPSS and SAS syntax files can be
ordered from the EuroQol Executive Office ([email protected]).
11
5. Organising EQ-5D data
Data collected using EQ-5D can be entered in a database according to the following
schema:
Variable
ID
COUNTRY YEAR MOBILITY
name
patient ID
1=No
Variable
Problems,
description number
2=Some
problems,
3=Extreme
problems,
9=Missing
value
Data row 1
Data row 2
1001
1002
Variable
STATE
name
Variable
description
Data row 1
Data row 2
21221
21111
UK
UK
EQ_VAS
999=
Missing
value
80
90
2006
2006
SELFCARE
1=No
Problems,
2=Some
problems,
3=Extreme
problems,
9=Missing
value
ACTIVITY
1=No
Problems,
2=Some
problems,
3=Extreme
problems,
9=Missing
value
PAIN
1=No
Problems,
2=Some
problems,
3=Extreme
problems,
9=Missing
value
ANXIETY
1=No
Problems,
2=Some
problems,
3=Extreme
problems,
9=Missing
value
1
1
2
1
2
1
1
1
2
1
SEX
1=male,
2=female,
9=Missing
value
AGE
999=
Missing
value
1
2
EDU
1=low,
2=medium,
3=high,
9=Missing
value
43
24
METHOD
0=postal,
1=interview,
2=telephone,
9=Missing
value
1
2
SOC_ECON
1=employed,
2=retired,
…..,
9=Missing
value
0
0
NB: The variable names are just examples. However, the variables for the 5 dimensions of
the EQ-5D descriptive system should be named 'mobility', 'selfcare', 'activity', 'pain', and
'anxiety'. If they are given different names the syntax codes containing the value sets that
are distributed by the EuroQol Group will not work properly.
12
1
4
6. Presenting EQ-5D results
Data collected using EQ-5D can be presented in various ways. A basic subdivision
can be made according to the structure of the EQ-5D:
1. Presenting results from the descriptive system as a health profile
2. Presenting results of the EQ VAS as a measure of overall self-rated health status
3. Presenting results from the descriptive system as a weighted index
However, the way results are presented is partly determined by what message you,
as a researcher, wish to convey to your audience.
Health profiles
One way of presenting data as a health profile is by making a table with the
frequency or the proportion of reported problems for each level for each dimension.
These tables can be broken down to include the proportions per subgroup, such as
age, before vs. after treatment, treatment vs. comparator, etc.
Sometimes it is more convenient to dichotomise the EQ-5D levels into 'no problems'
(i.e. level 1) and 'problems' (i.e. levels 2 and 3), thereby changing the profile into
frequencies of reported problems. This can be the case, for example, in a general
population survey where the numbers of reported level 3 problems are very low.
Tables 2 and 3 are examples of how to present EQ-5D data in tabulated form. The
data for the tables originates from a general population survey in the UK2.
2
Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United
Kingdom national questionnaire survey Bmj 1998;316 (7133): 736-41.
13
Table 2: Proportion of levels 1, 2 and 3 by dimension and by age group
EQ-5D DIMENSION
Level 1
MOBILITY
Level 2
Level 3
Level 1
SELF-CARE
Level 2
Level 3
Level 1
USUAL
Level 2
ACTIVITIES
Level 3
Level 1
PAIN /
DISCOMFORT Level 2
Level 3
Level 1
ANXIETY /
DEPRESSION Level 2
Level 3
18-29
95.4
4.6
0.0
99.1
0.9
0.0
93.3
6.3
0.4
83.9
15.8
0.3
86.5
12.6
0.9
AGE GROUPS
40-49
50-59
60-69
89.7
78.1
70.7
9.9
21.9
29.3
0.4
0.0
0.0
95.8
94.8
94.3
4.0
5.2
5.5
0.2
0.0
0.2
89.2
78.1
75.3
9.4
18.8
21.6
1.5
3.0
3.1
74.1
56.3
53.8
22.8
38.1
40.6
3.1
5.6
5.6
81.3
72.8
72.0
16.9
24.4
25.1
1.8
2.8
2.9
30-39
92.2
7.6
0.1
98.4
1.5
0.1
91.4
7.9
0.7
80.7
17.7
1.6
82.6
16.4
1.0
70-79
60.2
39.8
0.0
92.6
7.1
0.2
73.7
22.1
4.2
44.0
48.4
7.6
74.7
22.6
2.7
80+
43.3
56.7
0.0
83.7
15.6
0.7
56.0
38.3
5.7
39.7
49.6
10.6
75.2
24.1
0.7
TOTAL
81.6
18.3
0.1
95.7
4.1
0.1
83.7
14.2
2.1
67.0
29.2
3.8
79.1
19.1
1.8
80+
61
81
119
23
80
62
56
86
107
35
TOTAL
2770
625
3251
144
2842
553
2275
1120
2684
711
Table 3: Frequency of reported problems by dimension and age group
EQ-5D DIMENSION
No problems
MOBILITY
Problems
No problems
SELF-CARE
Problems
USUAL
No problems
ACTIVITIES
Problems
PAIN /
No problems
DISCOMFORT Problems
ANXIETY /
No problems
DEPRESSION Problems
18-29
643
31
668
6
629
45
566
108
583
91
30-39
631
53
673
11
625
59
552
132
565
119
AGE GROUPS
40-49 50-59 60-69
489
362
339
56
101
140
522
439
452
23
24
27
486
362
361
59
101
118
404
261
258
141
202
221
443
337
345
102
126
134
70-79
246
162
378
30
301
107
179
229
305
103
In addition to presenting the results in tabulated form, you can also use graphical
presentations. Two or 3 dimensional bar charts can be used to summarise the results
in 1 graph, (see figure 2). Figure 2 shows the sum of the proportion of reported level
2 and level 3 problems for each of the 5 EQ-5D dimensions for 3 distinct age groups.
Older people reported more problems on all dimensions but the effect of age was
strongest for mobility and weakest for anxiety/depression.
14
Figure 2: Profile of the population (% reporting problem)
70
60
50
40
18-39 yrs
40-59 yrs
30
60+ yrs
20
10
0
Mobility
Self care
Usual act
Pain/Disc
Anx/Depr
EQ VAS
In order to present all aspects of the EQ VAS data, you should present both a
measure of the central tendency and a measure of dispersion. This could be the
mean values and the standard deviation or, if the data is skewed, the median values
and the 25th and 75th percentiles. An example is presented in table 4. The data for
the table originates from a general population survey in the UK3.
Table 4: EQ VAS values by age – mean + standard deviation and median +
percentiles
EQ VAS
Mean
- Std dev
Median
- 25th
- 75th
18-29
87.0
13.8
90
80
98
30-39
86.2
14.6
90
80
95
AGE GROUPS
40-49
50-59
60-69
85.1
81.3
79.8
15.5
46.8
17.5
90
86
85
80
70
70
95
95
93
70-79
75.3
18.5
80
65
90
80+
72.5
18.2
75
60
88
TOTAL
82.8
23.1
90
75
95
You can present a graphical representation of the data by using bar charts, line
charts, or both (see figure 3). Figure 3 shows the mean EQ VAS ratings reported by
3
Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United
Kingdom national questionnaire survey Bmj 1998;316 (7133): 736-41.
15
men, women and both for 7 distinct age groups. The mean EQ VAS ratings are seen
to decrease with increasing age. Also, men of all age groups reported higher EQ
VAS ratings than women.
Figure 3: Mean population EQ VAS ratings by age group and sex
100
EQ VAS
90
80
Men
Women
Total
70
60
50
18-29
30-39
40-49
50-59
60-69
70-79
80+
age (yrs)
EQ-5D index
Information about the EQ-5D index can be presented in much the same way as the
EQ VAS data. This means that for the index, you can present both a measure of the
central tendency and a measure of dispersion. This could be the mean values and
the standard deviation (or standard error). If the data is skewed, the median values
and the 25th and 75th percentiles could be presented. Tables 5 and 6 and figures 4
and 5 contain 2 examples of how to present EQ-5D index results. Table 5 and figure
4 present the results from a study where the effect of a treatment on health status is
investigated. Table 6 and figure 5 show results for a patient population and 3
subgroups (the tables and figures are based on hypothetical data and for illustration
purposes only).
16
Table 5: EQ-5D index values
before and after treatment
– mean + standard deviation
and median + percentiles
EQ-5D
index
Mean
- Std error
Median
- 25th
- 75th
before
treatment
0.59
0.012
0.60
0.50
0.70
after
treatment
0.76
0.015
0.70
0.65
0.80
120
110
Figure 4: EQ-5D index values before and after
treatment ─ mean values and 95% confidence intervals
1.00
0.90
0.80
0.70
Utility
0.60
N
0.50
0.40
0.30
0.20
0.10
0.00
17
before
treatment
after
treatment
Table 6: EQ-5D index values of the total patient population and the 3 subgroups –
mean + standard deviation and median + percentiles
EQ-5Dindex
Mean
- Std error
Median
- 25th
- 75th
All
patients
0.66
0.010
0.55
0.50
0.70
Subgroup
1
0.45
0.013
0.40
0.30
0.50
Subgroup
2
0.55
0.015
0.55
0.50
0.60
Subgroup
3
0.90
0.010
0.95
0.80
1.00
N
300
100
75
125
Figure 5: EQ-5D index values of the total patient population and the 3 subgroups –
mean values and 95% confidence intervals
1.00
0.90
0.80
0.70
Utility
0.60
0.50
0.40
0.30
0.20
0.10
0.00
All patients
Subgroup 1
18
Subgroup 2
Subgroup 3
7. EQ-5D: Frequently asked questions
For what period of time does EQ-5D record health status?
Self-reported health status captured by EQ-5D relates to the respondent’s situation at
the time of completion. No attempt is made to summarise the recalled health status
over the preceding days or weeks, although EQ-5D has been tested in recall mode.
An early decision taken by the EuroQol Group determined that health status
measurement ought to apply to the respondent’s immediate situation - hence the
focus on ‘your own health state today’.
General population value sets vs patient population value sets
If you want to undertake a utility analysis you will need to use a value set. Generally
speaking utility analysis requires a general population-based value set (as opposed
to a patient-based set). The rationale behind this is that the values are supposed to
reflect the preferences of local taxpayers and potential receivers of healthcare.
Additionally, patients tend to rate their health states higher than the general
population because of coping etc, often underestimating their need for healthcare.
The EQ-5D value sets are therefore based on the values of the general population.
Difference between the EQ-5D descriptive system and the EQ VAS
The descriptive system can be represented as a health state, e.g. health state 11212
represents a patient who indicates some problems on the usual activities and
anxiety/depression dimensions. These health states can be converted to a single
index value using (one of) the available EQ-5D value sets. These value sets have
been derived using VAS or TTO valuation techniques, and reflect the opinion of the
general population. The EQ VAS scores are patient-based and are therefore not
representative of the general population. The EQ VAS self-rating records the
respondent’s own assessment of their health status. The EQ VAS scores however
are anchored on 100 = best imaginable health and 0 = worst imaginable health,
whereas the value sets are anchored on 11111 = 1 and dead = 0 and can therefore
be used in QALY calculations.
19
Difference between the VAS and TTO techniques
The difference between the value sets based on TTO and those based on VAS is
that the techniques used for the elicitation of the values on which the models are
based differ. In the TTO task, respondents are asked, for example, to imagine they
live in a health state (e.g. 22222) for 10 years and then asked to specify the amount
of time they are willing to give up to live in full health instead (i.e. 11111). For
example, someone might find 8 years in 11111 equivalent to 10 years in 22222. The
VAS technique on the other hand, asks people to indicate where, on a vertical
thermometer-like scale ranging from best imaginable health to worst imaginable
health, they think a health state should be positioned.
Multinational clinical trials
Information relating to EQ-5D health states gathered in the context of multinational
trials may be converted into a single summary index using one of the available EQ5D value sets. There are different options available to do this using appropriate value
sets-however the choice depends on the context in which the information will be used
by researchers or decision makers. In cases where data from an international trial
are to be used to inform decision makers in a specific country, it seems reasonable to
expect decision makers to be interested primarily in value sets that reflect the values
for EQ-5D health states in that specific country. So for example, if applications for
reimbursement of a drug are rolled out from country to country, country-specific value
sets should be applied and reported in each pharmaco-economic report. This is no
different from the requirement to use country-specific costs. In the absence of a
country-specific value set, the researcher should select another set of values for a
population that most closely approximates that country. Sometimes however,
information about utilities is required to inform researchers or decision makers in an
international context. In these instances, 1 value set applied over all EQ-5D health
states data is probably more appropriate.
The decision about which value set to use will also depend on whether the relevant
decision making body in each country specifies any requirements or preferences in
regard to the methodology used in different contexts (e.g. TTO, standard gamble
(SG), VAS or discrete choice modelling (DCM)). These guidelines are the topic of an
international ongoing debate but the EuroQol Group website is planning to provide a
summary of health care decision-making bodies internationally, and their stated
requirements regarding the valuation of health states.
20
Detailed information regarding the valuation protocols, guidelines on which value set
to use and tables of all available value sets has recently been published by Springer
in: EuroQol Group Monograph series: Volume 2: EQ-5D value sets: inventory,
comparative review and user guide’ (see section 8 for more information). Chapter 4
by Nancy Devlin and David Parkin will be of special interest to researchers pondering
the issue of which value set to use.
Can I use only the EQ-5D descriptive system or only the EQ VAS?
We cannot advise this. EQ-5D is a 2-part instrument so if you only use 1 part you
cannot claim to have used EQ-5D in your publications.
How long should the EQ VAS be?
Officially, for paper versions, the EQ VAS scale should be 20cms. All methodological
and developmental work has been carried using this length. To ensure that you print
the correct length, make sure your paper size is set at A4 and the box in your printing
instructions labelled ‘scale to paper size’ is set at ‘no scaling’.
Can I publish our study using EQ-5D?
Yes, you are free to publish your results. If you are reproducing the EQ-5D in an
appendix we request that you use the sample version of EQ-5D and that the
following text is included in the footer: © 1990 EuroQol Group. EQ-5D™ is a trade
mark of the EuroQol Group.
21
8. Additional information
Key EuroQol Group references
1. The EuroQol Group (1990). EuroQol-a new facility for the measurement of
health-related quality of life. Health Policy 16(3):199-208.
2. Brooks R (1996). EuroQol: the current state of play. Health Policy 37(1):53-72.
3. Dolan P (1997). Modeling valuations for EuroQol health states. Med Care
35(11):1095-108.
4. Roset M, Badia X, Mayo NE (1999). Sample size calculations in studies using the
EuroQol 5D. Qual Life Res 8(6):539-49.
5. Greiner W, Weijnen T, Nieuwenhuizen M, et al. (2003). A single European
currency for EQ-5D health states. Results from a six country study. Eur J Health
Econ; 4(3):222-231.
6. Shaw JW, Johnson JA, Coons SJ (2005). US valuation of the EQ-5D health
states: development and testing of the D1 valuation model. Med Care; 43(3):
203-220.
Referring to the EQ-5D instrument in publications
When publishing results obtained with the EQ-5D, the following references can be
used:
1. The EuroQol Group (1990). EuroQol-a new facility for the measurement of
health-related quality of life. Health Policy 16(3):199-208.
2. Brooks R (1996). EuroQol: the current state of play. Health Policy 37(1):53-72.
If you used a value set in your study you can also include a reference to the
publication regarding that value set. The appropriate references for the value sets
can be found in the EQ-5D Value Sets Monograph and in the value set summary
documents that can be ordered from the EuroQol Executive Office.
Products available from the EuroQol Executive Office
EQ-5D language versions (self-report and alternative modes of self-report)
All self-report and alternative modes of self-report versions in different languages
must be obtained exclusively from the EuroQol Executive Office. Normally only the
language(s) appropriate to the country where the research request originates will be
supplied. Licensing fees are determined by the EuroQol Executive Office on the
basis of information provided by the user. Whether a fee is appropriate depends
upon the type of study, size and/or number of patients/respondents and requested
languages.
22
The Measurement and valuation of health status using EQ-5D: A European
perspective. Eds Brooks R, Rabin R, de Charro F. Kluwer Acacemic Publishers,
2005
This book reports on the results of the European Union-funded EQ-net project which
furthered the development of EQ-5D in the key areas of valuation, application and
translation. The book can be obtained from Springer at www.springeronline.com at a
cost of €107.95.
Measuring self-reported population health: An international perspective based
on EQ-5D. Eds Szende A, Williams A. EuroQol Group Monographs Volume 1.
SpringMed publishing, 2004.
This booklet provides population reference data for a number of different countries
and is available on request from the EuroQol Executive Office.
EQ-5D concepts and methods: a developmental history. Eds Kind P, Brooks R,
Rabin R. Springer, 2005.
This book is a collection of papers representing the collective intellectual enterprise
of the EuroQol Group and can be obtained from Springer at www.springeronline.com
at a cost of € 85.00.
EQ-5D value sets: Inventory, comparative review and user guide. Eds. Szende
A, Oppe M, Devlin N. EuroQol Group Monographs Volume 2. Springer, 2006.
This book provides an essential guide to the use of the EuroQol Group’s value sets
for anyone working with EQ-5D data and can be obtained from Springer at
www.springeronline.com at a cost of € 49.95.
Future developments
Since 2002, the EuroQol Group Foundation has provided modest funding for EuroQol
Group members to carry out innovative EQ-5D-related research. Since 2004, the
Group has been establishing specific task forces to:
•
Investigate the use of EQ-5D in different disease areas
•
Develop a 5-level version of EQ-5D
•
Explore different valuation methodologies for valuing EQ-5D health states
23
•
Develop an EQ-5D version for young people and children in different
languages
•
Investigate the use of EQ-5D in population health
•
Explore the use of electronic versions of EQ-5D in pc and web-based
applications as well as palm pilots and (in the future) cell phones. This task
force will also investigate the eliciting of values via the computer
Please check the EuroQol Group website for up-to-date information on the availability
of current and future EuroQol Group products.
Contact information:
For more information please look at the EuroQol Group website at www.euroqol.org
or e-mail us at [email protected]
Acknowledgements:
Part of this user guide was taken from and is based on the UK user guide that was
developed by Professor Paul Kind from York University, UK in 1998.
24
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ToC
GAIT SPEED TEST
Equipment needed:
• Masking tape or paper tape (4 pieces).
• Tape measure (English or metric)
• Stopwatch.
Setup:
• Decide on length of gait test distance, acceleration zone and deceleration zone based on
space availability. Be sure to have unobstructed floor space.
• Using masking tape or paper tape mark a start line on the floor (line#1).
• Measure an acceleration zone of 1 step to 3 meters based on available space and place a
piece of tape at this distance on the floor (line#2).
• Measure the test distance of 10 ft etc and place a piece of tape on the floor (line#3).
• Measure a deceleration zone of 1 step to 3 meters and place a piece of tape at this
distance on the floor (line#4).
Measuring comfortable gait speed:
Start position: Patient/client stands behind the start line.
Instructions given:
• Ask patient to walk at a comfortable pace from before the start line (line#1) to the end
line (line#4).
Measurement:
• Using a stopwatch, time from when the patient’s leading limb (toe) crosses the test
distance line (line #2) until the leading limb crosses the end test distance line (line#3). Be
sure patient does not stop at line #3, patient should walk to line #4 to insure deceleration
does not occur in the test distance.
Calculation: Comfortable gait speed = test distance/time to complete test distance.
Measuring fast gait speed: Same as cgs except for the instructions given to the patient.
• Ask patient to walk as fast as you safely can from before the start line (line#1) to the end
line (line#4).
Measurement and calculation are the same as cgs.
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GERI-AIMS PAIN SCALE
The following questions concern the amount of pain you are currently experiencing in your hips
and/or knees. For each situation, please indicate the amount of pain you recently experienced
using the following scale: None, Mild, Moderate, Severe, Extreme. CIRCLE ONE NUMBER
ONLY.
QUESTION: How much pain do you have?
None
Mild
Moderate
Severe
Extreme
1
2
3
4
1
2
3
4
0
1
2
3
4
0
1
2
3
4
0
1
2
3
4
14. Walking on a flat surface
0
15. Going up or down stairs
0
16. At night while in bed
17. Sitting or lying
18. Standing upright
The following questions concern the amount of joint stiffness (not pain) you are currently
experiencing in your hips and/or knees. Stiffness is a sensation of restriction or slowness in the
ease with which you move your joints. CIRCLE ONE NUMBER ONLY.
None
Mild
Moderate
Severe
Extreme
19. How severe is your stiffness after first waking in the morning?
0
1
2
3
4
20. How severe is your stiffness after sitting, lying, or resting later in the day?
0
1
2
3
4
21. During the past month, how often have you had to take medication for your arthritis?
Always .............................................................................................1
Very often ........................................................................................2
Fairly often ......................................................................................3
Sometimes ........................................................................................4
Almost never ....................................................................................5
Never
...............................................................................................
These questions are about how you feel and how things have been with you during the past
month. For each question, please circle one number for each question that comes closest to
the way you have been feeling
How much time during the past 4 weeks…
22. Did you feel worn out?
0
1
None of
A little
the time of the time
2
Some of
the time
3
A good bit
of the time
4
Most of
the time
5
All of
the time
2
Some of
the time
3
A good bit
of the time
4
Most of
the time
5
All of
the time
2
Some of
the time
3
A good bit
of the time
4
Most of
the time
5
All of
the time
23. Did you have a lot of energy?
0
1
None of
A little
the time of the time
24. Did you feel tired?
0
1
None of
A little
the time of the time
25. Did you have enough energy to do the things you wanted to do?
0
1
None of
A little
the time of the time
2
Some of
the time
3
A good bit
of the time
4
Most of
the time
5
All of
the time
3
A good bit
of the time
4
Most of
the time
5
All of
the time
26. Did you feel full of pep?
0
1
None of
A little
the time of the time
2
Some of
the time
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The Groningen Activity Restriction Scale (GARS)
Overview: The Groningen Activity Restriction Scale (GARS) is general disease independent instrument for
measuring disability. It can be used to monitor a patient over time and to identify potential interventions. The
authors are from the University of Groningen in The Netherlands.
Statements about Activities of Daily Living (ADL) - Can you fully independently:
(1) dress yourself?
(2) get in and out of bed?
(3) stand up from sitting in a chair?
(4) wash your face and hands?
(5) wash and dry your whole body?
(6) get on and off the toilet?
(7) feed yourself?
(8) get around in the house (if necessary with a cane)?
(9) go up and down the stairs?
(10) walk outdoors (if necessary with a cane)?
(11) take care of your feet and toenails?
Statements about Instrumental Activities of Daily Living (IADL) - Can you fully independently:
(12) prepare breakfast or lunch?
(13) prepare dinner?
(14) do "light" household activities (for example dusting and tidying up)?
(15) do "heavy" household activities (for example mopping cleaning the windows and vacuuming)?
(16) wash and iron your clothes?
(17) make the beds?
(18) do the shopping?
Response (based on what the patient is able to do)
Points
Yes I can do it fully independently without any difficulty
1
Yes I can do it fully independently but with some difficulty
2
Yes I can do it fully independently but with great difficulty
3
No I cannot do it fully independently. I can only do it with
someone's help.
4
No I cannot do it at all. I need complete help.
4
where:
• The point assignment for needing complete help was originally 5 points but was switched to 4
becaue only a few patients selected this response. There may be an argument to keep it at 5 points.
• The response is based on what the patient is able to do rather than what s/he usually does.
total score = SUM(points for all 18 items)
Interpretation:
• minimum score: 18
• maximum score: 72
• The higher the score the greater the disability.
References:
Suurmeijer TBPM Doeglas DM et al. The Groningen Activity Restriction Scale for measuring disability: Its
utility in international comparisons. Am J Public Health. 1994; 84: 1270-1273 (Table 1 page 1271).
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Hip ID:
Study Hip:
Left
Right
Examination Date (MM/DD/YY):
Subject Initials: |____|____|____|
Medical Record Number:
Harris Hip Score
Interval:
/
/
______________
Harris Hip Score
Pain (check one)
None or ignores it (44)
Slight, occasional, no compromise in activities (40)
Mild pain, no effect on average activities, rarely moderate
pain with unusual activity; may take aspirin (30)
Moderate Pain, tolerable but makes concession to pain.
Some limitation of ordinary activity or work. May require
Occasional pain medication stronger than aspirin (20)
Marked pain, serious limitation of activities (10)
Totally disabled, crippled, pain in bed, bedridden (0)
Limp
None (11)
Slight (8)
Moderate (5)
Severe (0)
Support
None (11)
Cane for long walks (7)
Cane most of time (5)
One crutch (3)
Two canes (2)
Two crutches or not able to walk (0)
Distance Walked
Unlimited (11)
Six blocks (8)
Two or three blocks (5)
Indoors only (2)
Bed and chair only (0)
Sitting
Comfortably in ordinary chair for one hour (5)
On a high chair for 30 minutes (3)
Unable to sit comfortably in any chair (0)
Enter public transportation
Yes (1)
No (0)
Stairs
Normally without using a railing (4)
Normally using a railing (2)
In any manner (1)
Unable to do stairs (0)
Put on Shoes and Socks
With ease (4)
With difficulty (2)
Unable (0)
Absence of Deformity (All yes = 4; Less than 4 =0)
Less than 30° fixed flexion contracture
Less than 10° fixed abduction
Less than 10° fixed internal rotation in extension
Limb length discrepancy less than 3.2 cm
Yes
Yes
Yes
Yes
Range of Motion (*indicates normal)
Flexion (*140°)
________
Abduction (*40°)
________
Adduction (*40°)
________
External Rotation (*40°) ________
Internal Rotation (*40°) ________
Range of Motion Scale
211° - 300° (5)
61° - 100 (2)
161° - 210° (4)
101° - 160° (3)
31° - 60° (1)
0° - 30° (0)
Range of Motion Score ____________
Total Harris Hip Score ____________
No
No
No
No
Explaining the use of the Harris Hip Questionnaire
By Thomas J. Blumenfeld, MD.
The old adage, there is no such thing as a stupid question, may at times be sorely tested. I have
wondered about this as I have come to the end of asking many of you about how your hip is doing,
just prior to the physical exam. Those of you who have had your hip replaced know that, at each
follow-up visit, a standard set of questions is asked. You are asked questions such as if you have
any hip pain, how far you can walk whether you can put on your own shoes and socks, even if you
can use public transportation. To date, no one has asked why we ask these questions, or what their
relevance is.
The answers to these questions form the basis for the Harris Hip Score (HHS1~ Developed by Dr.
William Harris, a prominent orthopaedist in Massachusetts, the HHS is a tool for the evaluation of
how a patient is doing after their hip is replaced. Based on a total of 100 points possible, each
question is awarded a certain number of points based on how it is answered. Questions are further
grouped into categories. The first category is pain. For example, if you
have no pain in your hip you get 44 points, slight pain 40 points, down to 0 points for disabling
pain. The second category is function. If you have no limp, do not use a walking aid, and can walk
more than six blocks, you get 33 points; less if you were to use a cane, or walk only two blocks,
etc. The third category, functional activities, consists of questions about how you climb stairs, put
on shoes, length of time you can sit in a chair, and if you can use public
transportation. Finally, the physical exam results are tabulated, and based on your range of motion,
up to 9 points awarded.
The score is reported as 90-100 for excellent results, 80-90 being good, 70-79 fair, 60-69 poor, and
below 60 a failed result. Using the HHS, results of hip replacements can be compared across the
country in an objective fashion. In the clinic, the HHS allows us to rapidly get a feel for how you are
doing after surgery.
The HHS, being an objective tool, has one shortcoming. The score does not allow for individual
differences based on age, health, or other personal issues that may affect the total score. How
might this occur?
Let us imagine that one of you finds the idea of walking six blocks as appealing as root canal
surgery, or you can only walk two blocks because of asthma, not because of your hip. You would
only get five out of a possible eleven points. Then let's say that you use a cane for balance when
you walk. You would get seven out of a possible eleven points. If you use a railing to go up stairs
(and I expect that many of you do for safety alone), you only get two out of the possible 4 points.
This would mean that the best HHS you could get would be an 88, which is a good result. You
however may feel that because you have no pain and can do what you wish, that you have an
excellent result from you hip replacement. We here would agree.
The above example highlights a key point, that while the HHS is an objective tool, it must be
interpreted by a subjective individual, namely your doctor. While we take some comfort when you
have a high score, and tend to be concerned when the score is low, there are many variables that
affect the total score. The HHS, without the clinical acumen to use it appropriately, is only a
number.
In summary, the HHS is a tool that allows us to find out how you are doing after your hip
replacement. We keep all of your scores enabling us to follow you along as you and your hip pass
the years together. We hope to have many chances to ask questions of you that may at times seem
stupid, but are quite important to you and your hip's health and good function.
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Stanford HAQ 8-Item Disability Scale
Please check ( ) the one best answer for your abilities.
Without
ANY
difficulty
With
SOME
difficulty
With
MUCH
difficulty
UNABLE
to do
1. Dress yourself, including tying
shoelaces and doing buttons? .......................... R
R
R
R
2. Get in and out of bed? ..................................... R
R
R
R
3. Lift a full cup or glass to your mouth? .............. R
R
R
R
4. Walk outdoors on flat ground? ......................... R
R
R
R
5. Wash and dry your entire body? ...................... R
R
R
R
R
R
R
R
7. Turn faucets on and off?................................... R
R
R
R
At this moment, are you able to:
6. Bend down to pick up clothing from the floor?
8. Get in and out of a car? ....................................
Scoring
Score the number circled for each item. If more than one consecutive number is circled for one item,
code the higher number (more difficulty). If responses are not consecutive, code as blank. The
disability index is the mean of the eight items. If more than 2 items are blank, do not score the index.
Characteristics
Tested on 611 subjects with chronic disease.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
1
0-1.88
0.384
0.409
.85
NA
Source of Psychometric Data
Stanford/Garfield Kaiser Chronic Disease Dissemination Study. Psychometrics reported in: Lorig KR,
Sobel, DS, Ritter PL, Laurent, D, Hobbs, M. Effect of a self-management program on patients with
chronic disease. Effective Clinical Practice, 4, 2001,pp. 256-262.
Comments
This is a short version of the 22-item disability scale in the Stanford Health Assessment Questionnaire.
The 8-item scale was originally developed in Spanish. We have replaced the numbers with check
boxes on the print version. It should be noted that the items have been chosen as they represent use of
every major joint in the body. While closely related to an ADL scale this is not an ADL scale but rather a
disability scale. This scale is available in Spanish.
References
Lorig KR, Sobel, DS, Ritter PL, Laurent, D, Hobbs, M. Effect of a self-management program on patients
with chronic disease. Effective Clinical Practice, 4, 2001,pp. 256-262.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
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Stanford Spanish HAQ 8-Item Disability Scale
Por favor marque la respuesta que mejor describa sus habilidades usuales (comunes) durante la
semana pasada.
Sin
ninguna
dificultad
Con
alguna
dificultad
Con
mucha
dificultad
No
puedo
hacerlo
1. Vestirse, incluyendo amarrarse los
zapatos y abrocharse (abotonarse)? ................ R
R
R
R
2. Acostarse y levantarse de la cama?................. R
R
R
R
3. Levantar hasta su boca una taza
o vaso lleno? .................................................... R
R
R
R
4. Caminar al aire libre en terreno plano? ........... R
R
R
R
5. Bañarse y secarse todo el cuerpo? ................. R
R
R
R
R
R
R
R
7. Abrir y cerrar las llaves del agua (los grifos)?... R
R
R
R
¿Actualmente puede Ud:
6. Agacharse para recoger ropa del piso?
8. Subir y bajar del auto (carro)? ..........................
Scoring
Score the number circled for each item. If more than one consecutive number is circled for one item,
code the higher number (more difficulty). If responses are not consecutive, code as blank. The
disability index is the mean of the eight items. If more than 2 items are blank, do not score the index.
Characteristics
Tested on 272 Spanish-speaking subjects with arthritis. N=25 for test-retest.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
8
0-3
1.7
.8
.89
.87
Source of Psychometric Data
The Stanford Spanish Arthritis Self-Management Study (Programa de Manejo Personal de la Artritis).
The psychometrics were done on the original 20-item Spanish scale, resulting in this version.
Psychometrics reported in: González V, Stewart A, Ritter P, Lorig K, Translation and validation of
arthritis outcome measures into Spanish. Arthritis and Rheumatism, 38(10),1995, pp.1429-1446.
Comments
This is a modified version of the 20-item Spanish disability scale which we translated and back
translated from the Stanford Health Assessment Questionnaire. We have replaced the
numbers with check boxes on the print version. It should be noted that the items have been
chosen as they represent use of every major joint in the body. While closely related to an ADL
scale this is not an ADL scale but rather a disability scale.
References
González V, Stewart A, Ritter P, Lorig K, Translation and validation of arthritis outcome measures into
Spanish. Arthritis and Rheumatism, 38(10),1995, pp.1429-1446.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
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Rheumatology Attitudes Index (RAI)
The statements below concern your personal beliefs. Please check the number beside each
statement that best describes how you feel.
Do not
Strongly
Disagree agree or Agree
disagree
disagree
a. My condition is controlling my life
Strongly
agree
b. I would feel helpless if I couldn’t rely on other
people for help with my condition
…
…
…
…
…
…
…
…
…
…
c. No matter what I do, or how hard I try, I just
can’t seem to get relief from my pain
…
…
…
…
…
d. I am NOT coping effectively with my condition
…
…
…
…
…
…
…
…
…
…
1
1
1
1
e. It seems as though fate and other factors
beyond my control affect my condition
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
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Hospital Anxiety and Depression Scale (HADS)
Reference: Zigmond and Snaith (1983)
Patients are asked to choose one response from the four given for each
interview. They should give an immediate response and be dissuaded
from thinking too long about their answers. The questions relating to
anxiety are marked "A", and to depression "D". The score for each answer
is given in the right column. Instruct the patient to answer how it currently
describes their feelings.
A I feel tense or 'wound up':
Most of the time
3
A lot of the time
2
From time to time, occasionally
1
Not at all
0
D I still enjoy the things I used to enjoy:
A
Definitely as much
0
Not quite so much
1
Only a little
2
Hardly at all
3
I get a sort of frightened feeling as if something awful is about to
happen:
Very definitely and quite badly
3
Yes, but not too badly
2
A little, but it doesn't worry me
1
Not at all
0
D I can laugh and see the funny side of things:
As much as I always could
0
Not quite so much now
1
Definitely not so much now
2
Not at all
3
A Worrying thoughts go through my mind:
A great deal of the time
3
A lot of the time
2
From time to time, but not too often
1
Only occasionally
0
D I feel cheerful:
Not at all
3
Not often
2
Sometimes
1
Most of the time
0
A I can sit at ease and feel relaxed:
Definitely
0
Usually
1
Not Often
2
Not at all
3
D I feel as if I am slowed down:
Nearly all the time
3
Very often
2
Sometimes
1
Not at all
0
A I get a sort of frightened feeling like 'butterflies' in the stomach:
Not at all
0
Occasionally
1
Quite Often
2
Very Often
3
D I have lost interest in my appearance:
Definitely
3
I don't take as much care as I should
2
I may not take quite as much care
1
I take just as much care as ever
0
A I feel restless as I have to be on the move:
Very much indeed
3
Quite a lot
2
Not very much
1
Not at all
0
D I look forward with enjoyment to things:
As much as I ever did
0
Rather less than I used to
1
Definitely less than I used to
2
Hardly at all
3
A I get sudden feelings of panic:
Very often indeed
3
Quite often
2
Not very often
1
Not at all
0
D I can enjoy a good book or radio or TV program:
Often
0
Sometimes
1
Not often
2
Very seldom
3
Scoring (add the As = Anxiety. Add the Ds = Depression).
The norms below will give you an idea of the level of Anxiety and
Depression.
0-7 = Normal
8-10 = Borderline abnormal
11-21 = Abnormal
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MODIFIED MACTAR BASELINE
INTERVIEWER NOTE:
When the question ends with "…" read the response categories
provided, otherwise wait for a spontaneous response form the
respondent for all questions. Circle the number of the response.
INTERVIEWER START TIME:
__________ A.M.
P.M.
SECTION A: This section contains some question about your general health.
1. Over the last weeks how would you say your overall health has been? Would you say your
overall health has been…
1. Very good
2. Pretty good
3. Not too good
2. a. Do you think your arthritis limits your ability to carry out activities you did before you
had arthritis?
INTERVIEWER NOTE: See Probe
1. No
2. Yes
b. Please tell me which activities are affected.
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
______________________________
[
]
INTERVIEWER NOTE: In order to elicit as comprehensive a list of activities affected by
respondent's arthritis as possible, please read each probe to all
respondents. Record each new activity in Q 2b and indicate a probed
response with a "P" and the probe number. e.g., "P 3" would indicate
a response to the leisure activity probe.
PROBE: Does your arthritis limit…
(1) any (other) activities around the house such as cooking,
housework, etc.
(2) any activity related to dressing such as doing up buttons, pulling
sweater over head, etc.
(3) any (other) activities at your work (outside the house)?
(4) any (other) leisure activities. Either athletic such as bowling,
swimming, golf, etc. or non-athletic such as needlework,
woodwork, etc.?
(5) any (other) social activities such as visiting, playing cards, going
to church, etc.?
INTERVIEWER NOTE: To rank the list of activities in order of importance to the respondent
follow the steps below.
2. c. Which of these activities would you most like to be able to do without the pain or
discomfort of your arthritis?
INTERVIEWER NOTE: Please show and read the list to the respondent. Place a "1" in the box
next to the selected activity.
2. d. After _______________ (read ACTIVITY "1") which activity would you next most like
to be able to do without the pain and discomfort of your arthritis?
INTERVIEWER NOTE: Please show and read the list to the respondent again, do not read
activity "1". Place a "2" in the box beside the selected activity.
2. e. After _______________ (read ACTIVITY "1" and ACTIVITY "2") which activity would
you next like to be able to do without the pain and discomfort of your arthritis?
INTERVIEWER NOTE: Please show the list to the respondent. Read the remaining activities,
do not read activities "1" and "2". Place a "3" in the box beside the
selected activity. Continue in this manner until all the activities have
been ranked.
3. a. In general, how satisfying do you find the way you've been spending your life? For
example, over the last 2 weeks would you call your life…
1. Completely satisfying
2. Pretty satisfying
3. Not very satisfying
GO TO Q 4
b. Is your life not completely satisfying because of your arthritis?
1. No
2. Yes
4. a. How would you say your overall physical functioning has been? For example, over the
last 2 weeks would you call your physical function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
GO TO Q 5
b. Is your physical function not as good as it might be because of your arthritis?
2. No
2. Yes
5. a. How would you say your overall social functioning has been over the last 2 weeks?…
(such as your ability to work, to have friends, and to get along with you family). Would
you call your social function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
GO TO Q 6
b. Is your social function not as good as it might be because of your arthritis?
1. No
2. Yes
6. a. How would you say your overall emotional functioning has been over the last 2
weeks?… (such as your ability to remain in good spirits most of the time, and to be
usually happy). Would you call your emotional function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
SKIP PART B
b. Is your overall emotional function not as good as it might be because of your arthritis?
1. No
2. Yes
MODIFIED MACTAR FOLLOW-UP
INTERVIEWER NOTE:
When the question ends with "…" read the response categories
provided, otherwise wait for a spontaneous response from the
respondent for all questions. Circle the number of the response.
INTERVIEWER START TIME:
__________ A.M.
P.M.
SECTION A: This section contains some question about your general health.
1. Over the last 2 weeks how would you say your overall health has been? Would you say your
overall health has been…
1. Very good
2. Pretty good
3. Not too good
b. Have you noticed any change in your arthritis since we talked during the first interview?
1. No
2. Yes
GO TO Q 2
c. Has your arthritis improved or got worse?
1. Improved
2. Got worse
d. Please describe how your arthritis has changed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
e. Compared to how your arthritis was during the 2 weeks before you began taking the new
medication, how much better or worse overall has your arthritis been? (Circle one.)
-3
-2
-1
0
+1
+2
+3
A great
deal worse
Moderately
worse
Slightly
worse
No
change
Slightly
better
Moderately
better
A great deal
better
2. You may remember the first time we talked you said your arthritis limited your ability to
carry out some activities. (INTERVIEWER NOTE: For a to j read and insert the activities
elicited at baseline).
a. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2b
Has this improved or got worse?
1. Improved
2. Got worse
b. Have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2c
Has this improved or got worse?
1. Improved
2. Got worse
c. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2d
Has this improved or got worse?
1. Improved
2. Got worse
d. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2e
Has this improved or got worse?
1. Improved
2. Got worse
e. Have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
Has this improved or got worse?
1. Improved
2. Got worse
GO TO Q 2f
f. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2g
Has this improved or got worse?
1. Improved
2. Got worse
g. Have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2h
Has this improved or got worse?
1. Improved
2. Got worse
h. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2i
Has this improved or got worse?
1. Improved
2. Got worse
i. Have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
GO TO Q 2j
Has this improved or got worse?
1. Improved
2. Got worse
j. Since the first interview have you noticed any change in your ability to…
____________________________________________________________________
1. No
2. Yes
Has this improved or got worse?
1. Improved
2. Got worse
3. a. In general, how satisfying do you find the way you've been spending your life? For
example, over the last 2 weeks would you call your life…
1. Completely satisfying
2. Pretty satisfying
3. Not very satisfying
GO TO Q 3c
b. Is your life not completely satisfying because of your arthritis?
1. No
2. Yes
c. How satisfying do you find the way you are spending your life since we last talked,
would you say it has improved, got worse, or not changed?
1. Improved
2. Got worse
3. Not changed
4. a. How would you say your overall physical functioning has been? For example, over the
last 2 weeks would you call your physical function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
GO TO Q 4c
b. Is your physical function not as good as it might be because of your arthritis?
1. No
2. Yes
c. Has your physical function improved, got worse, or not changed since we last talked?
1. Improved
2. Got worse
3. Not changed
5. a. How would you say your overall social functioning has been over the last 2 weeks?…
(such as your ability to work, to have friends, and to get along with your family). Would
you call your social function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
GO TO Q 5c
b. Is your social function not as good as it might be because of your arthritis?
1. No
2. Yes
c. Has your social function improved, got worse, or not changed since the first interview?
1. Improved
2. Got worse
3. Not changed
6. a. How would you say your overall emotional functioning has been over the last 2
weeks?… (such as your ability to remain in good spirits most of the time, and to be
usually happy). Would you call your emotional function…
1.
2.
3.
4.
5.
Good
Good to fair
Fair
Fair to poor
Poor
GO TO Q 6c
b. Is your overall emotional function not as good as it might be because of your arthritis?
1. No
2. Yes
c. Has your emotional function improved, got worse, or not changed since we last talked?
1. Improved
2. Got worse
3. Not changed
MACTAR SCORING GUIDELINES
SUMMARY
The Modified Mactar [McMaster (Mac) Toronto Arthritis] Questionnaire was developed
from the original Mactar [J Rheumatol 1987;14(3):446-451] and consists of two
components:
1.
A "priority function questionnaire designed to identify individual disabilities due to
arthritis" and their "relative importance to the patient". The patient is asked the following
questions, "Please tell me which activities are affected by your arthritis." To ensure the
patient realized that we are interested in all activities including mobility, self-care, work
and leisure, the interviewer described this "menu" and provided a standardized
explanation with examples of what is meant by each of these. The patient is then asked
to add any activities in each of these areas not already listed and to be as specific as
possible in describing which activities are affected. Following this, the rank order of
these activities is elicited using the following wording: "Which of these activities would
you most like to be able to do?" Further questions are asked to determine the rank order
of the other disabilities mentioned.
2.
Four global questions (original questionnaire) eliciting information on physical, social
and emotional functions, each scored on a five-point scale. If a less than perfect score is
elicited for any of these functions, a further question is asked to determine the association
of these difficulties with arthritis, i.e., " Is your physical function not as good as it might
be because of arthritis?" For both components, patients are questioned over a two-week
period. The modified Mactar takes 5 to 10 minutes to administer, depending on the
number of activities in the priority function section.
The follow-up or post-treatment section consists of change questions for both the priority
function and conventional components. The patient is questioned as follow: "Have you
noticed any change in your arthritis since the first interview?"; "Since the first interview,
have you noticed any changes in your ability to walk?", etc. If the response is positive, a
further question is asked as follows: "Has this improved or gotten worse?".
SCORING THE MACTAR
Priority Function Section
This section does not receive a score at baseline: a direct change score is computed at
follow-up. Scoring of the Mactar can be computed using different methods. Weights can be
given to the priority problems depending on the rank order of these problems by the patient. It is
possible to select the top five problems (if the patient has at least five problems) or the top three
problems. If the top five problems are selected, the problem ranked No. 1 will be given a score
of 5, the problem ranked No. 2 will be assigned a score of 4, and similarly weights 3, 2, 1 for the
problems ranked Nos. 3, 4, 5.
The top five problems elicited from and ranked by a hypothetical patient are shown in
column 1 of Table 1. In order to avoid problems with negative signs, all change scores will be
positive as follows: worse = 1, no change = 2, improved = 3. Walking is ranked No. 1;
therefore, it received a weight of 5.
TABLE 1
Problems
Standing
Dressing
Walking
Driving
Socializing
Rank by Patient
2
3
1
4
5
Weights
4
3
5
2
1
Worse
No Change
2
Improved
3
2
2
3
The score can be computed as follows:
Sum of [weight x change score]
Denote S5R as score ranked for top 5 problems
For example given in table 1 S5R = 5(2) + 4(2) + 3(3) + 2(2) + 1(3) = 34
The maximum possible score for S5R using this weighting is 45. The minimum score is
15. This allows for a change score to vary over 30 between interview 1 and 2. If fewer than 5
problems are identified, it is possible to compute S5R for the smaller set by using dummy
problems for the missing ones and scoring them as no change (i.e. 2).
Equal weights can also be assigned to the activities in the previous example as outlined in
Table 2:
TABLE 2
Problems
Standing
Dressing
Walking
Driving
Socializing
Rank by Patient
2
3
1
4
5
Weights
1
1
1
1
1
Worse
No Change
2
Improved
3
2
2
3
The score can be computed as follows:
S5E = equal scores for top 5 problems
Sum of [weight x change score]
S5E = 1(2) + 1(3) + 1(2) + 1(2) + 1(3) = 12
The maximum possible score for S5E using the previous example is 15. The minimum
score is 5, thus permitting a change score to vary over 10 units between interview 1 and 2. If
fewer than 5 problems are identified, it is possible to compute S5E for the smaller set by using
dummy problems for the missing ones and scoring them as no change (i.e. 2).
Conventional Questions
In order to maintain consistency with the priority function component, the scores
assigned to the conventional questions must again be reversed.
TABLE 3: Scoring Scheme for Baseline Conventional Questions
Question Number
1
2a
3a
3b
4a, 5a and 6a
4b, 5b and 6b
Response #
1
2
3
1
2
1
2
3
1
2
1
2
3
4
5
1
2
Responses
Very good
Pretty good
Not too good
No
Yes
Completely satisfying
Pretty satisfying
Not very satisfying
No
Yes
Good
Good to fair
Fair
Fair to poor
Poor
No
Yes
Score
3
2
1
1
0
3
2
1
1
0
5
4
3
2
1
1
0
Using these guidelines it is possible to compute a best and worst score for the physical,
social and emotional components of the conventional section of the questionnaire at
baseline:
best possible baseline score = 26; worst possible baseline score = 5
TABLE 4: Scoring Scheme for Post-Treatment Follow-up Questionnaire
Question
1a
1b
1c
1e
2a to 2j
3a
3b
3c
4a, 5a and 6a
4b, 5b and 6b
4c, 5c and 6c
Response #
1
2
3
1
2
1
2
-3
-2
-1
0
+1
+2
+3
2&1
2&2
1
1
2
3
1
2
1
2
3
1
2
3
4
5
1
2
1
2
3
Responses
Very good
Pretty good
Not too good
No
Yes
Improved
Got worse
A great deal better
Moderately better
Slightly better
No change
Slightly worse
Moderately worse
A great deal worse
Yes and Improved
Yes and Got worse
No
Completely satisfying
Pretty satisfying
Not very satisfying
No
Yes
Improved
Got worse
No change
Good
Good to fair
Fair
Fair to poor
Poor
No
Yes
Improved
Got worse
No change
Score
3
2
1
2
0
3
1
7
6
5
4
3
2
1
3
1
2
3
2
1
1
0
3
1
2
5
4
3
2
1
1
0
3
1
2
Using these guidelines it is possible to compute a best and worst score for the physical,
social and emotional components of the conventional section of the questionnaire at posttreatment follow-up:
best possible post-treatment score = 47; worst possible post-treatment score = 11
References
Tugwell P, Bombardier C, Buchanan WW, Goldsmith C, Grace E & Hanna B. The MACTAR
patient preference disability questionnaire – An individualized functional priority
approach for assessing improvement in physical disability in clinical trials in rheumatoid
arthritis. J Rheumatol 1987;14:446-451.
Verhoeven AC Boers M & van der Linden S. Validity of the MACTAR questionnaire as a
functional index in a rheumatoid arthritis clinical trial. J Rheumatol 2000;27:2801-9.
Clinch JJ, Tugwell P, Wells G & Shea B. An individualized functional priority approach to the
assessment of health-related quality of life in rheumatology. J Rheumatol 2001;28:44551.
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Rheumatoid Arthritis Self-Efficacy (RASE) Scale
We are interested in finding out what things you believe you could do to help you with your
arthritis. We want to know what you think you could do, even if you are not actually doing it at
the moment. Please check one column for each question.
Do you believe you could do these things to
help you with your arthritis?
Strongly
disagree
Disagree
Do not
agree or
disagree
Agree
Strongly
agree
a. I believe I could use relaxation
techniques to help with pain
…
…
…
…
…
b. I believe I could think about something
else to help with pain
…
…
…
…
…
…
…
…
…
…
d. I believe I could think positively to help
with pain
…
…
…
…
…
e. I believe I could avoid doing things
that cause pain
…
…
…
…
…
…
…
…
…
…
g. I believe I could have a hot drink
before bed, to improve my sleep
…
…
…
…
…
h. I believe I could use relaxation before
bed, to improve my sleep
…
…
…
…
…
I believe I could pace myself and take
my arthritis into account to help deal
with tiredness
…
…
…
…
…
I believe I could accept fatigue as part
of my arthritis
…
…
…
…
…
…
…
…
…
…
I believe I could ask for help to deal
with the difficulties of doing everyday
tasks
…
…
…
…
…
m. I believe I could do exercises to deal
with the difficulty of doing everyday
tasks
…
…
…
…
…
c. I believe I could use my joints
carefully (joint protection) to help with
pain
f.
i.
j.
I believe I could wind down and relax
before going to bed, to improve my
sleep
k. I believe I could use gadgets to help
with mobility, household tasks or
personal care
l.
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
Do you believe you could do these things to
help you with your arthritis?
Strongly
disagree
Disagree
Do not
agree or
disagree
Agree
Strongly
agree
…
…
…
…
…
o. I believe I could educate my family
and friends about my arthritis to help
with the strains that arthritis can make
on relationships
…
…
…
…
…
p. I believe I could explain to friends and
family when I do or do not need help
…
…
…
…
…
q. I believe I could discuss any problems
with my partner or family
…
…
…
…
…
r.
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
u. I believe I could use relaxation to deal
with worries
…
…
…
…
…
v. I believe I could allocate time for
relaxation
…
…
…
…
…
w. I believe I could use a relaxation tape
or instructions to help me relax
…
…
…
…
…
x. I believe I could use regular exercise
…
…
…
…
…
…
…
…
4
…
4
…
z. I believe I could manage my
medication, knowing how and when to
take it
…
…
…
…
…
aa. I believe I could look out for and avoid
side-effects of my medication
…
…
…
…
…
bb. I believe I could seek help with
persistent side effects
…
…
…
…
…
n. I believe I could plan or prioritize my
day to deal with difficulties of doing
everyday tasks
1
I believe I could make time for leisure
activities, hobbies or socializing
s. I believe I could save energy for
leisure activities, hobbies or
socializing
t.
I believe I could focus on the positive
when I am feeling down
1
1
1
1
1
1
1
1
1
1
y. I believe I could be aware of my limits
in exercise
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
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Rheumatology Attitudes Index (RAI)
The statements below concern your personal beliefs. Please check the number beside each
statement that best describes how you feel.
Do not
Strongly
Disagree agree or Agree
disagree
disagree
a. My condition is controlling my life
b. I would feel helpless if I couldn’t rely on other
people for help with my condition


c. No matter what I do, or how hard I try, I just
can’t seem to get relief from my pain
d. I am NOT coping effectively with my condition
e. It seems as though fate and other factors
beyond my control affect my condition
1


2



1

2

1


1

1
3



3
2

2

2
Strongly
agree
4



4

5
3

4

5
3

4

5
3
4
5
5
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SELF-EFFICACY FOR EXERCISE ADHERENCE
We would like to know how confident you are in doing certain activities. We want you to answer
based on your current level of ability (how you feel at the present time). For each of the
following questions, please circle the number that indicates your confidence that you can do the
activities regularly.
On a scale of 1 to 10, how confident are you that you can do exercises for flexibility and range
of motion 3 to 4 times per week? A few examples of flexibility exercises include stretching
exercises, Tai Chi, and yoga.
Not at all 1
Confident
2
3
4
5
6
7
8
9
10 Totally
confident
On a scale of 1 to 10, how confident are you that you can do exercises for muscle strength 3 to
4 times per week? Examples of exercises for muscle strength include using weights, elastic
exercise bands, or weight machines.
Not at all 1
Confident
2
3
4
5
6
7
8
9
10 Totally
confident
On a scale of 1-10, how confident are you that you can do exercises such as aerobics, walking,
biking or swimming – physical activity that makes your heart beat faster and makes you breathe
hard or make you sweat?
Not at all 1
Confident
2
3
4
5
6
7
8
9
10 Totally
confident
On a scale of 1 to 10, how confident are you that you can exercise without causing yourself pain
or other symptoms?
Not at all 1
Confident
2
3
4
5
6
7
8
9
10 Totally
confident
Physical activities are activities where you move and increase your heart rate above its resting
rate, whether you do them for pleasure, work, or transportation.
Examples of physical activity intensity levels:
Description of intensity levels
Possible examples of light activities for
some people may include:
Light activities
• Your heart beats slightly faster than
normal
• You can talk and sing
•
•
•
Walking leisurely
Stretching
Vacuuming or light yard work
Moderate Activities
• Your heart beats faster than normal
• You can talk but not sing
•
•
•
•
•
•
•
Brisk walking
Aerobics Class
Strength training
Swimming
Stair machine
Jogging or running
Tennis, racquetball, pickle ball or
badminton
Vigorous Activities
• Your heart rate increases a lot
• You can’t talk, or your talking is broken
up by large breaths
Does this accurately describe you?
I rarely or never do any physical activities…………………………….Yes
 No
I do some light or moderate physical activities,
but not every week……………………………………………………….Yes
I do some light physical activity every week……….……………........Yes
 No
I do moderate physical activity every week………………….………..Yes
 No
 No
I do 30 minutes or more per day of moderate physical activity, 5 or more days per
week.….…………………………Yes
 No
I do vigorous physical activities every week, but for less than 5 days per week or less than 20 minutes
at a time. ………………………………………………………Yes  No
I do 20 minutes or more per day of vigorous physical activities, 3 or more days per week.
……….Yes
 No
I do activities to increase muscle strength, such as lifting weights or calisthenics, once a week or more.
………………………..Yes  No
I do activities to improve flexibility, such as stretching or yoga, once a week or more. .
……Yes
 No
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Self-Efficacy for Physical Activity (SEPA) Scale
Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any
other activity in which the exertion is at least as intense as these activities.
For each item, check the box that indicates how confident you are that you could be physically active in each
of the following situations:
a. When I am tired
Not at all
confident
Slightly
confident
Moderately
confident
Very
confident
Extremely
confident
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
1
b. When I am in a bad mood
2
1
c. When I feel I don’t have time
2
1
d. When I am on vacation
2
1
e. When it is raining or snowing
2
1
2
1
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
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THE SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE (SPMSQ)
Question
Response
Incorrect
Responses
1. What are the date, month, and year?
2. What is the day of the week?
3. What is the name of this place?
4. What is your phone number?
5. How old are you?
6. When were you born?
7. Who is the current president?
8. Who was the president before him?
9. What was your mother's maiden name?
10. Can you count backward from 20 by 3's?
SCORING:*
0-2 errors: normal mental functioning
3-4 errors: mild cognitive impairment
5-7 errors: moderate cognitive impairment
8 or more errors: severe cognitive impairment
*One more error is allowed in the scoring if a patient has had a grade school
education or less.
*One less error is allowed if the patient has had education beyond the high
school level.
Source: Pfeiffer, E. (1975). A short portable mental status questionnaire for the
assessment of organic brain deficit in elderly patients. Journal of American Geriatrics
Society. 23, 433-41.
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Timed 10 Pound Lifts
1. Have the participant stand in front of a table with a basket containing a 10 pound weight.
2. The participant is allowed to use both upper extremities.
3. Instruct the participant using the following script:
“On the word “go,” lift up the basket and raise it to chin level, then lower it to your
belly button as quickly as you can. At the end, place the basket back on the table.
Ready, go.”
4. Begin timing the participant as you say “go” and end timing when the participant has placed
the basket back on the table. Record the time below to the nearest hundredth of a second.
Also indicate whether the participant had any pain during the test.
5. If the participant was successful with the single lift, have the participant do another single lift.
6. Instruct the participant using the following script:
“On the word “go,” lift up the basket and raise it to chin level, then lower it to your
belly button as quickly as you can. At the end, place the basket back on the table.
Ready, go.”
7. Record the time below to the nearest hundredth of a second and indicate whether the
participant had any pain during the test.
8. If the participant was successful with both single 10 pound lifts, then have him/her repeat this
3 times.
9. Instruct the participant using the following script:
“On the word “go,” lift up the basket and raise it to chin level, then lower it to your
belly button, 3 times, as quickly as you can. At the end, place the basket back on
the table. Ready, go.” (Note: It is OK to count as the subject performs the lifts)
10. Begin timing the participant as you say “go” and end timing when the participant has placed
the basket back on the table. Record the time below to the nearest hundredth of a second
and indicate whether the participant had any pain during the test.
TIMED 10 POUND LIFTS
TIME
INCREASE IN
PAIN DURING TEST?
Single Lift
‰ NO
‰ YES
Single Lift
‰ NO
‰ YES
Three Lifts
‰ NO
‰ YES
11. If the participant is unable to complete all three lifts, record the number of lifts completed and the time
it took.
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Timed 360° Turn Test
1. This test can be performed with an assistive device.
2. Ask the participant to stand with arms at his/her side and feet comfortably apart and pointed
straight ahead. If the participant uses an assistive device, he/she may hold onto the device.
3. Instruct the participant using the following script:
“When I say go, I want you to turn to your right at your normal pace making sure to
go in a complete circle and making sure you end up with your feet facing straight
ahead.”
4. Ask the participant to perform a practice trial.
5. Then instruct the participant using the following script:
“ I want you to start when I say go and turn to your right at your normal pace. Ready,
go.”
6. The participant’s feet can be together or apart at the end of the turn, but they should both be
facing forward. If one or both feet end up greater than 45 degrees rotated to the left or right,
redo the trial.
7. Record the time, to the nearest hundredth of a second, it took to complete the turn and
indicate whether the participant had any pain during the test.
8. Repeat the test having the participant initiating the turn toward the left.
9. Instruct the participant using the following script:
“ I want you to start when I say go and turn to your left at your normal pace. Ready,
go.”
10. Have the participant do a second trial to the right and a second trial to the left.
Timed 360° Turn
Time for
Turn (R)
Increase in
Pain?
Increase in
Pain?
Time for
Turn (L)
TRIAL 1
‰ NO
‰ YES
‰ NO
‰ YES
TRIAL 2
‰ NO
‰ YES
‰ NO
‰ YES
Did participant use an assistive device?
‰
‰
NO
YES
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Timed chair stand test
Critical issues
No previous international recommendations for standardized protocol exist
Exclusion criteria
Equipment
Stopwatch
Armless chair (height: 45 cm) with straight back
Procedure
Participant should be sitting on the chair with his/her feet on the
floor.
Participant is asked to rise from the chair without the help of
his/her arms.
The success is recorded. If successful, the participant can
proceed to the next step of chair rises.
Participant is asked to sit down again, with feet on the floor.
Participant is asked to rise from the chair without the help of
his/her arms (arms folded across chest), 10 times.
Time to complete 10 rises is recorded. If the person cannot
complete 10 rises, the number of completed rises is recorded.
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ToC
Timed “Up and Go”*
Directions:
The timed “Up and Go” test measures, in seconds, the time taken by an individual to stand up
from a standard arm chair (approximate seat height of 46 cm, arm height 65 cm), walk a distance
of 3 meters (approximately 10 feet), turn, walk back to the chair, and sit down. The subject wears
their regular footwear and uses their customary walking aid (none, cane, walker). No physical
assistance is given. They start with their back against the chair, their arms resting on the
armrests, and their walking aid at hand. They are instructed that, on the word “go” they are to get
up and walk at a comfortable and safe pace to a line on the floor 3 meters away, turn, return to
the chair and sit down again. The subject walks through the test once before being timed in order
to become familiar with the test. Either a stopwatch or a wristwatch with a second hand can be
used to time the trial.
Instructions to the patient:
“When I say ‘go’ I want you to stand up and walk to the line, turn and then walk back to the
chair and sit down again. Walk at your normal pace.”
Variations:
You may have the patient walk at a fast pace to see how quickly they can ambulate. Also you
could have them turn to the left and to the right to test any differences.
*Podsiadlo D, Richardson S. The timed “up and go”: a test of basic functional mobility for frail
elderly persons. JAGS 1991; 39: 142-148.
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Patient Name: ______________________________________________________________ Date: ________________________
Visual Analog Scale (VAS)*
No
pain
Pain as bad
as it could
possibly be
*A 10-cm baseline is recommended for VAS scales.
From: Acute Pain Management: Operative or Medical Procedures and Trauma, Clinical Practice Guideline No. 1. AHCPR Publication
No. 92-0032; February 1992. Agency for Healthcare Research & Quality, Rockville, MD; pages 116-117.
Visual Analog Scale
NO
PAIN
WORST
PAIN
Directions: Ask the patient to indicate on the line where the pain is in relation to the two
extremes. Measure from the left hand side to the mark.
From Stratton Hill C. Guidelines for Treatment of Cancer Pain: The Revised Pocket Edition of the Final Report of the Texas Cancer
Council's Workgroup on Pain Control in Cancer Patients, 2nd Edition; pages 61-63. Copyright 1997, Texas Cancer Council.
Reprinted with permission. www.texascancercouncil.org.
A7012-AS-1
Appendix II • Health Status Assessment Instruments in Common Use
385
WESTERN ONTARIO AND McMASTER UNIVERSITIES OSTEOARTHRITIS
INDEX (WOMAC)-VA3.0
ToC
Courtesy of the originator.
Back
Source:
J Rheumatol 15:1833-1840,1988.
Contact Address:
Telephone:
Fax:
Dr. Nicholas Bellamy
Division of Rheumatology
Victoria Hospital
EO. Box 5375
London, Ontario
Canada N6A 4G5
519-667-6815
519-667-6687
INSTRUCTIONS TO PATIENTS
In Sections A, B, and C questions will be asked in the following format and you should give your answers by
putting an "X" on the horizontal line.
NOTE:
1.
If you put your "X" at the left-hand end of the line, i.e.,
NO I---~Ir-----------------------i EXTREME
PAIN
PAIN
then you are indicating that you have no pain.
2.
If you place your "X" at the right-hand end of the line, i.e.,
P~~ r----------------------~~--~I ~!JfEME
then you are indicating that your pain is extreme.
3.
Please Note:
a) that the further to the right-hand end you place your "X" the more pain you are experiencing.
b) that the further to the left-hand end you place your "X" the less pain you are experiencing.
c) Please do not place your "X" outside the end markers.
You will be asked to indicate on this type of scale the amount of pain, stiffness, or disability you are experiencing.
please remember the further you place your "X" to the right, the more pain, stiffness, or disability you are
indicating that you experience.
WOMAC Continued
386
Appendix II • Health Status Assessment Instruments in Common Use
Section A
INSTRUCTIONS TO PATIENTS
The following questions concern the amount of pain you are currently experiencing due to arthritis in your hips
and/or knees. For each situation please enter the amount of pain recently experienced (please mark your answers
with an "X").
QUESTION: How much pain do you have?
~
____________________________________________________
~I
EXTREME
PAIN
r---------------------------------------------------------~I EXTREME
PAIN
~--------------------------------------------------------~I
EXTREME
PAIN
EXTREME
PAIN
r---------------------------------------------------------~I EXTREME
PAIN
Section B
INSTRUCTIONS TO PATIENTS
The following questions concern the amount of joint stiffness (not pain) you are currently experiencing in your
hips and/or knees. Stiffness is a sensation of restriction or slowness in the ease with which you move your joints
(please mark your answers with an "X").
1.
How severe is your stiffness after first wakening in the morning?
NO
EXTREME
STIFFNESS
STIFFNESS
2. How severe is your stiffness after sitting, lying or resting later in the day?
NO
I
STIFFNESS IEXTREME
STIFFNESS
WOMAC Continued
Appendix II • Health Status Assessment Instruments in Common Use
387
Section C INSTRUCTIONS TO PATIENTS The following questions concern your physical function. By this we mean your ability to move around and to
look after yourself. For each of the following activities, please indicate the degree of difficulty you are currently
experiencing due to arthritis in your hips and/or knees (please mark your answers with an "X").
QUESTION: What degree of difficulty do you have with:
1.
Descending stairs.
NO
~~
____________________________________________________4EXTREME
DIFFICULTY
DIFFICULTY
2. Ascending stairs. NO
r-----------------------------------------------------~
DIFFICUlTY EXTREME DIFFICULTY
3. Rising from sitting. NO
~----------------------------------------------------__4
EXTREME NO
r-----------------------------------------------------~
EXTREME DIFFICULTY DIFFICUlTY
4. Standing. DIFFICULTY DIFFICULTY
S. Bending to floor. NO
DIFFICULTY ~-------------------------------------------------------11
EXTREME
DIFFICULTY
6. Walking on flat. r-____________________________________________________--1EXTREME NO
DIFFICULTY 7.
DIFFICULTY
Getting in/out of car.
NO r-____________________________________________________
~EXTREME
DIFFICULTY
DIFFICULTY
8. Going shopping. NO
DIFFICUlTY ~----------------------------------------------------~EXTREME DIFFICULTY
9. Putting on socks/stockings. NO
DIFFICULTY r-----------------------------------------------------~
EXTREME DIFFICUlTY
10. Rising from bed.
NO
DIFFICULTY ~----------------------------------------------------__4
EXTREME
DIFFICULTY
11. Taking off socks/stockings.
NO r-----------------------------------------------------__4 EXTREME
DIFFICULTY DIFFICULTY
12. Lying in bed.
NO
DIFFICULTY ~----------------------------------------------------__4
EXTREME
DIFFICULTY
WOMAC Continued
388
Appendix II • Health Status Assessment Instruments in Common Use
13.
Getting in/out of bath.
NO
DIFFICUUY
14.
Sitting.
NO
DIFFICULTY
15.
I
I
I
I
EXTREME
DIFFICULTY
Heavy domestic duties.
NO
DIFFICULTY
17.
EXTREME
DIFFICULTY
Getting on/off toilet.
NO
DIFFICULTY
16.
EXTREME
DIFFICULTY
EXTREME
DIFFICULTY
Light domestic duties.
NO
DIFFICULTY
I
I EXTREME
. DIFFICULTY
WOMAC
The WOMAC (Western Ontario and McMaster Universities) Index of Osteoarthritis
Overview:
The WOMAC (Westren Ontario and McMaster Universities) index is used to assess patients with
osteoarthritis of the hip or knee using 24 parameters. It can be used to monitor the course of the disease or
to determine the effectiveness of anti-rheumatic medications.
Pain:
(1) walking
(2) stair climbing
(3) nocturnal
(4) rest
(5) weight bearing
Stiffness:
(1) morning stiffness
(2) stiffness occurring later in the day
Physical function:
(1) descending stairs
(2) ascending stairs
(3) rising from sitting
(4) standing
(5) bending to floor
(6) walking on flat
(7) getting in or out of car
(8) going shopping
(9) putting on socks
(10) rising from bed
(11) taking off socks
(12) lying in bed
(13) sitting
(14) sitting
(15) getting on or off toilet
(16) heavy domestic duties
(17) light domestic duties
While the index was being developed performance of social functions and the status of emotional function
were also included. These were not included in the final instrument.
Social function:
(1) leisure activities
(2) community events
(3) church attendance
(4) with spouse
(5) with family
(6) with friends
(7) with others
Emotional function:
(1) anxiety
(2) irritability
(3) frustration
(4) depression
(5) relaxation
(6) insomnia
(7) boredom
(8) loneliness
(9) stress
(10) well-being
Scoring and Interpretation
Response
Points
none
0
slight
1
moderate
2
severe
3
extreme
4
Alternatively a visual analogue scale (VAS) may be used ranging from 0 to 10.
score =
= SUM(points for relevant items)
average score =
= (total score) / (number of items)
Interpretation:
• minimum total score: 0
• maximum total score: 96
• minimum pain subscore: 0
• maximum pain subscore: 20
• minimum stiffness subscore: 0
• maximum stiffness subscore: 8
• minimum physical function subscore: 0
• maximum physical function subscore: 68
References:
Bellamy N Buchanan WW et al. Validation study of WOMAC: A health status instrument for
measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients
with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15: 1833-1840.
Bellamy N. Pain assessment in osteoarthritis: Experience with the WOMAC osteoarthritis index.
Semin Arthritis Rheumatism. 1989; 18 (supplement 2): 14-17.
Bellamy N Kean WF et al. Double blind randomized controlled trial of sodium meclofenamate
(Meclomen) and diclofenac soidum (Voltaren): Post validation reapplication of the WOMAC
osteoarthritis index. J Rheumatol. 1992; 19: 153-159.
Hawker G Melfi C et al. Comparison of a generic (SF-36) and a disease specific (WOMAC)
instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995; 22:
1193-1196.
Lequesne M. Indices of severity and disease activity for osteoarthritis. Seminars in Arthritis and
Rheumatism. 1991; 20 (supplement 2): 48-54.
Stucki G Sangha O et al. Comparison of WOMAC (Western Ontario and McMaster Universities)
osteoarthritis index and a self-report format of the self-administered Lequesne-Algofunctional index
in patients with knee and hip osteoarthritis. Osteoarthritis and Cartilage. 1998; 6: 79-86.
ToC
INSTRUMENT GUIDE FOR CANCER-SPECIFIC PROGRAMS
Please note that there are no instruments for the evidence-based cancer programs
included this toolkit.
INSTRUMENT GUIDE FOR DEPRESSION-SPECIFIC PROGRAMS
Instruments preceded by an asterisk (*) and bolded are common to a number of
conditions and can be found in the Cross-Cutting Instruments Guide
Important Note: While rigorous research was conducted to provide readers with all of the instrumentation
for implementing the programs outlined in this toolkit, for a limited number of programs, instrumentation
was not available for public use. Therefore, interested parties are encouraged to contact selected program 1s
to obtain permission for instruments not included here.
Instrument
Brief Psychiatric Rating Scale (BPRS)
CAGE Questionnaire
* Center for Epidemiologic Studies Depression
(CES-D) Scale
* Community Health Activities Model Program for
Seniors (CHAMPS) Physical Activity Questionnaire
English & Spanish versions, including manual and
scoring guide
Psycho geriatric Assessment and Treatment
in City Housing (PATCH)
PATCH
Life Review Therapy
Healthy Identifying Depression Empowering
Activities for Seniors
(Healthy IDEAS)
Life Satisfaction Index A
Life Review Therapy
Functional Assessment of Cancer Therapy ScaleGeneral (FACT-G1)
PEARLS
Geriatric Depression Scale-15 (GDS-15)
Mini-Mental State Examination (MMSE)
Montgomery - Asberg Depression Rating Scale
(MADRS)
Patient Health Questionnaire (PHQ-9)
Sheehan Disability Scale
* Short Form-36 Health Survey (SF-36)
Including scoring guide
1
Program
Healthy IDEAS
Healthy IDEAS
PATCH
PATCH
Improving Mood-Promoting Access to
Collaborative Treatment (IMPACT)
IMPACT
Healthy IDEAS
Readers interested in using the scoring sheet for the FACT-G instrument may visit http://www.facit.org/.
Back
ToC
Brief Psychiatric Rating Scale (BPRS)
Expanded Version (4.0)
Introduction
This section reproduces an interview schedule, symptom definitions, and specific anchor
points for rating symptoms on the BPRS. Clinicians intending to use the BPRS should
also consult the detailed guidelines for administration contained in the reference below.
Scale Items and Anchor Points
Rate items 1-14 on the basis of individual's self-report. Note items 7, 12 and 13 are also
rated on the basis of observed behaviour. Items 15-24 are rated on the basis of
observed behaviour and speech.
1. Somatic Concern
Degree of concern over present bodily health. Rate the degree to which physical health
is perceived as a problem by the individual, whether complaints have realistic bases or
not. Somatic delusions should be rated in the severe range with or without somatic
concern. Note: be sure to assess the degree of impairment due to somatic concerns only
and not other symptoms, e.g., depression. In addition, if the individual rates 6 or 7 due to
somatic delusions, then you must rate Unusual Thought Content at least 4 or above.
2 Very mild Occasional somatic concerns that tend to be kept to self.
3 Mild Occasional somatic concerns that tend to be voiced to others (e.g., family,
doctor).
4 Moderate Frequent expressions of somatic concern or exaggerations of existing ills
OR some preoccupation, but no impairment in functioning. Not delusional.
5 Moderately severe Frequent expressions of somatic concern or exaggerations of
existing ills OR some preoccupation and moderate impairment of functioning. Not
delusional.
6 Severe Preoccupation with somatic complaints with much impairment in functioning
OR somatic delusions without acting on them or disclosing to others.
7 Extremely severe Preoccupation with somatic complaints with severe impairment in
functioning OR somatic delusions that tend to be acted on or disclosed to others.
"Have you been concerned about your physical health?" "Have you had any physical
illness or seen a medical doctor lately? (What does your doctor say is wrong? How
serious is it?)"
"Has anything changed regarding your appearance?"
"Has it interfered with your ability to perform your usual activities and/or work?"
"Did you ever feel that parts of your body had changed or stopped working?"
[If individual reports any somatic concerns/delusions, ask the following]:
"How often are you concerned about [use individual's description]?"
"Have you expressed any of these concerns to others?"
2. Anxiety
Reported apprehension, tension, fear, panic or worry. Rate only the individual's
statements - not observed anxiety which is rated under Tension.
2 Very mild Reports some discomfort due to worry OR infrequent worries that occur
more than usual for most normal individuals.
3 Mild Worried frequently but can readily turn attention to other things.
4 Moderate Worried most of the time and cannot turn attention to other things easily but
no impairment in functioning OR occasional anxiety with autonomic accompaniment but
no impairment in functioning.
5 Moderately Severe Frequent, but not daily, periods of anxiety with autonomic
accompaniment OR some areas of functioning are disrupted by anxiety or worry.
6 Severe Anxiety with autonomic accompaniment daily but not persisting throughout the
day OR many areas of functioning are disrupted by anxiety or constant worry.
7 Extremely Severe Anxiety with autonomic accompaniment persisting throughout the
day OR most areas of functioning are disrupted by anxiety or constant worry.
"Have you been worried a lot during [mention time frame]? Have you been nervous or
apprehensive? (What do you worry about?)"
"Are you concerned about anything? How about finances or the future?"
"When you are feeling nervous, do your palms sweat or does your heart beat fast (or
shortness of breath, trembling, choking)?"
[If individual reports anxiety or autonomic accompaniment, ask the following]:
"How much of the time have you been [use individual's description]?"
"Has it interfered with your ability to perform your usual activities/work?"
3. Depression
Include sadness, unhappiness, anhedonia and preoccupation with depressing topics
(can't attend to TV or conversations due to depression), hopeless, loss of self-esteem
(dissatisfied or disgusted with self or feelings of worthlessness). Do not include
vegetative symptoms, e.g., motor retardation, early waking or the amotivation that
accompanies the deficit syndrome.
2 Very mild Occasionally feels sad, unhappy or depressed.
3 Mild Frequently feels sad or unhappy but can readily turn attention to other things.
4 Moderate Frequent periods of feeling very sad, unhappy, moderately depressed, but
able to function with extra effort.
5 Moderately Severe Frequent, but not daily, periods of deep depression OR some
areas of functioning are disrupted by depression.
6 Severe Deeply depressed daily but not persisting throughout the day OR many areas
of functioning are disrupted by depression.
7 Extremely Severe Deeply depressed daily OR most areas of functioning are disrupted
by depression.
"How has your mood been recently? Have you felt depressed (sad, down, unhappy, as if
you didn't care)?"
"Are you able to switch your attention to more pleasant topics when you want to?"
"Do you find that you have lost interest in or get less pleasure from things you used to
enjoy, like family, friends, hobbies, watching TV, eating?"
[If individual reports feelings of depression, ask the following]:
"How long do these feelings last?" "Has it interfered with your ability to perform your
usual activities?"
4. Suicidality
Expressed desire, intent, or actions to harm or kill self.
2 Very mild Occasional feelings of being tired of living. No overt suicidal thoughts.
3 Mild Occasional suicidal thoughts without intent or specific plan OR he/she feels they
would be better off dead.
4 Moderate Suicidal thoughts frequent without intent or plan.
5 Moderately Severe Many fantasies of suicide by various methods. May seriously
consider making an attempt with specific time and plan OR impulsive suicide attempt
using non-lethal method or in full view of potential saviours.
6 Severe Clearly wants to kill self. Searches for appropriate means and time, OR
potentially serious suicide attempt with individual knowledge of possible rescue.
7 Extremely Severe Specific suicidal plan and intent (e.g., "as soon as ________ I will
do it by doing X"), OR suicide attempt characterised by plan individual thought was lethal
or attempt in secluded environment.
"Have you felt that life wasn't worth living? Have you thought about harming or killing
yourself? Have you felt tired of living or as though you would be better off dead? Have
you ever felt like ending it all?"
[If individual reports suicidal ideation, ask the following]:
"How often have you thought about [use individual's description]?"
"Did you (Do you) have a specific plan?"
5. Guilt
Overconcern or remorse for past behaviour. Rate only individual's statements, do not
infer guilt feelings from depression, anxiety, or neurotic defences. Note: if the individual
rates 6 or 7 due to delusions of guilt, then you must rate Unusual Thought Content at
least 4 or above, depending on level of preoccupation and impairment.
2 Very mild Concerned about having failed someone, or at something, but not
preoccupied. Can shift thoughts to other matters easily.
3 Mild Concerned about having failed someone, or at something, with some
preoccupation. Tends to voice guilt to others.
4 Moderate Disproportionate preoccupation with guilt, having done wrong, injured others
by doing or failing to do something, but can readily turn attention to other things.
5 Moderately Severe Preoccupation with guilt, having failed someone or at something,
can turn attention to other things, but only with great effort. Not delusional.
6 Severe Delusional guilt OR unreasonable self-reproach very out of proportion to
circumstances. Moderate preoccupation present.
7 Extremely Severe Delusional guilt OR unreasonable self-reproach grossly out of
proportion to circumstances. Individual is very preoccupied with guilt and is likely to
disclose to others or act on delusions.
"Is there anything you feel guilty about? Have you been thinking about past problems?"
"Do you tend to blame yourself for things that have happened?"
"Have you done anything you're still ashamed of?"
[If individual reports guilt/remorse/delusions, ask the following]:
"How often have you been thinking about [use individual's description]?"
"Have you disclosed your feelings of guilt to others?"
6. Hostility
Animosity, contempt, belligerence, threats, arguments, tantrums, property destruction,
fights, and any other expression of hostile attitudes or actions. Do not infer hostility from
neurotic defences, anxiety or somatic complaints. Do not include incidents of appropriate
anger or obvious self-defence.
2 Very mild Irritable or grumpy, but not overtly expressed.
3 Mild Argumentative or sarcastic.
4 Moderate Overtly angry on several occasions OR yelled at others excessively.
5 Moderately Severe Has threatened, slammed about or thrown things.
6 Severe Has assaulted others but with no harm likely, e.g., slapped or pushed, OR
destroyed property, e.g., knocked over furniture, broken windows.
7 Extremely Severe Has attacked others with definite possibility of harming them or with
actual harm, e.g., assault with hammer or weapon.
"How have you been getting along with people (family, co-workers, etc.)?"
"Have you been irritable or grumpy lately? (How do you show it? Do you keep it to
yourself?"
"Were you ever so irritable that you would shout at people or start fights or arguments?
(Have you found yourself yelling at people you didn't know?)"
"Have you hit anyone recently?"
7. Elevated Mood
A pervasive, sustained and exaggerated feeling of well-being, cheerfulness, euphoria
(implying a pathological mood), optimism that is out of proportion to the circumstances.
Do not infer elation from increased activity or from grandiose statements alone.
2 Very mild Seems to be very happy, cheerful without much reason.
3 Mild Some unaccountable feelings of well-being that persist.
4 Moderate Reports excessive or unrealistic feelings of well-being, cheerfulness,
confidence or optimism inappropriate to circumstances, some of the time. May frequently
joke, smile, be giddy, or overly enthusiastic OR few instances of marked elevated mood
with euphoria.
5 Moderately Severe Reports excessive or unrealistic feelings of well-being, confidence
or optimism inappropriate to circumstances, much of the time. May describe feeling `on
top of the world', `like everything is falling into place', or `better than ever before', OR
several instances of marked elevated mood with euphoria.
6 Severe Reports many instances of marked elevated mood with euphoria OR mood
definitely elevated almost constantly throughout interview and inappropriate to content.
7 Extremely Severe Individual reports being elated or appears almost intoxicated,
laughing, joking, giggling, constantly euphoric, feeling invulnerable, all inappropriate to
immediate circumstances.
"Have you felt so good or high that other people thought that you were not your normal
self?" "Have you been feeling cheerful and `on top of the world' without any reason?"
[If individual reports elevated mood/euphoria, ask the following]:
"Did it seem like more than just feeling good?"
"How long did that last?"
8. Grandiosity
Exaggerated self-opinion, self-enhancing conviction of special abilities or powers or
identity as someone rich or famous. Rate only individual's statements about himself, not
his/her demeanour. Note: if the individual rates 6 or 7 due to grandiose delusions, you
must rate Unusual Thought Content at least 4 or above.
2 Very mild Feels great and denies obvious problems, but not unrealistic.
3 Mild Exaggerated self-opinion beyond abilities and training.
4 Moderate Inappropriate boastfulness, e.g., claims to be brilliant, insightful or gifted
beyond realistic proportions, but rarely self-discloses or acts on these inflated selfconcepts. Does not claim that grandiose accomplishments have actually occurred.
5 Moderately Severe Same as 4 but often self-discloses and acts on these grandiose
ideas. May have doubts about the reality of the grandiose ideas. Not delusional.
6 Severe Delusional - claims to have special powers like ESP, to have millions of
dollars, invented new machines, worked at jobs when it is known that he/she was never
employed in these capacities, be Jesus Christ, or the Prime Minister. Individual may not
be very preoccupied.
7 Extremely Severe Delusional - same as 6 but individual seems very preoccupied and
tends to disclose or act on grandiose delusions.
"Is there anything special about you? Do you have any special abilities or powers? Have
you thought that you might be somebody rich or famous?"
[If the individual reports any grandiose ideas/delusions, ask the following]:
"How often have you been thinking about [use individuals description]? Have you told
anyone about what you have been thinking? Have you acted on any of these ideas?"
9. Suspiciousness
Expressed or apparent belief that other persons have acted maliciously or with
discriminatory intent. Include persecution by supernatural or other non-human agencies
(e.g., the devil). Note: ratings of 3 or above should also be rated under Unusual Thought
Content.
2 Very mild Seems on guard. Reluctant to respond to some `personal' questions.
Reports being overly self-conscious in public.
3 Mild Describes incidents in which others have harmed or wanted to harm him/her that
sound plausible. Individual feels as if others are watching, laughing or criticising him/her
in public, but this occurs only occasionally or rarely. Little or no preoccupation.
4 Moderate Says other persons are talking about him/her maliciously, have negative
intentions or may harm him/her. Beyond the likelihood of plausibility, but not delusional.
Incidents of suspected persecution occur occasionally (less than once per week) with
some preoccupation.
5 Moderately Severe Same as 4, but incidents occur frequently, such as more than
once per week. Individual is moderately preoccupied with ideas of persecution OR
individual reports persecutory delusions expressed with much doubt (e.g., partial
delusion).
6 Severe Delusional - speaks of Mafia plots, the FBI or others poisoning his/her food,
persecution by supernatural forces.
7 Extremely Severe Same as 6, but the beliefs are bizarre or more preoccupying.
Individual tends to disclose or act on persecutory delusions.
"Do you ever feel uncomfortable in public? Does it seem as though others are watching
you? Are you concerned about anyone's intentions toward you? Is anyone going out of
their way to give you a hard time, or trying to hurt you? Do you feel in any danger?"
[If individual reports any persecutory ideas/delusions, ask the following]:
"How often have you been concerned that [use individual's description]? Have you told
anyone about these experiences?"
10. Hallucinations
Reports of perceptual experiences in the absence of relevant external stimuli. When
rating degree to which functioning is disrupted by hallucinations, include preoccupation
with the content and experience of the hallucinations, as well as functioning disrupted by
acting out on the hallucinatory content (e.g., engaging in deviant behaviour due to
command hallucinations). Include thoughts aloud (`gedenkenlautwerden') or
pseudohallucinations (e.g., hears a voice inside head) if a voice quality is present.
2 Very mild While resting or going to sleep, sees visions, smells odours or hears voices,
sounds, or whispers in the absence of external stimulation, but no impairment in
functioning.
3 Mild While in a clear state of consciousness, hears a voice calling the individual's
name, experiences non-verbal auditory hallucinations (e.g., sounds or whispers),
formless visual hallucinations or has sensory experiences in the presence of a modalityrelevant stimulus (e.g., visual illusions) infrequently (e.g., 1-2 times per week) and with
no functional impairment.
4 Moderate Occasional verbal, visual, gustatory, olfactory or tactile hallucinations with
no functional impairment OR non-verbal auditory hallucinations/visual illusions more
than infrequently or with impairment.
5 Moderately Severe Experiences daily hallucinations OR some areas of functioning
are disrupted by hallucinations.
6 Severe Experiences verbal or visual hallucinations several times a day OR many
areas of functioning are disrupted by these hallucinations.
7 Extremely Severe Persistent verbal or visual hallucinations throughout the day OR
most areas of functioning are disrupted by these hallucinations.
"Do you ever seem to hear your name being called?"
"Have you heard any sounds or people talking to you or about you when there has been
nobody around?
[If hears voices]:
"What does the voice/voices say? Did it have a voice quality?"
"Do you ever have visions or see things that others do not see? What about smell
odours that others do not smell?"
[If the individual reports hallucinations, ask the following]:
"Have these experiences interfered with your ability to perform your usual
activities/work? How do you explain them? How often do they occur?"
11. Unusual thought content
Unusual, odd, strange, or bizarre thought content. Rate the degree of unusualness, not
the degree of disorganisation of speech. Delusions are patently absurd, clearly false or
bizarre ideas that are expressed with full conviction. Consider the individual to have full
conviction if he/she has acted as though the delusional belief was true. Ideas of
reference/persecution can be differentiated from delusions in that ideas are expressed
with much doubt and contain more elements of reality. Include thought insertion,
withdrawal and broadcast. Include grandiose, somatic and persecutory delusions even if
rated elsewhere. Note: if Somatic Concern, Guilt, Suspiciousness or Grandiosity are
rated 6 or 7 due to delusions, then Unusual Thought Content must be rated 4 or above.
2 Very mild Ideas of reference (people may stare or may laugh at him), ideas of
persecution (people may mistreat him). Unusual beliefs in psychic powers, spirits, UFOs,
or unrealistic beliefs in one's own abilities. Not strongly held. Some doubt.
3 Mild Same as 2, but degree of reality distortion is more severe as indicated by highly
unusual ideas or greater conviction. Content may be typical of delusions (even bizarre),
but without full conviction. The delusion does not seem to have fully formed, but is
considered as one possible explanation for an unusual experience.
4 Moderate Delusion present but no preoccupation or functional impairment. May be an
encapsulated delusion or a firmly endorsed absurd belief about past delusional
circumstances.
5 Moderately Severe Full delusion(s) present with some preoccupation OR some areas
of functioning disrupted by delusional thinking.
6 Severe Full delusion(s) present with much preoccupation OR many areas of
functioning are disrupted by delusional thinking.
7 Extremely Severe Full delusion(s) present with almost total preoccupation OR most
areas of functioning disrupted by delusional thinking.
"Have you been receiving any special messages from people or from the way things are
arranged around you? Have you seen any references to yourself on TV or in the
newspapers?"
"Can anyone read your mind?"
"Do you have a special relationship with God?"
"Is anything like electricity, X-rays, or radio waves affecting you?"
"Are thoughts put into your head that are not your own?"
"Have you felt that you were under the control of another person or force?"
[If individual reports any odd ideas/delusions, ask the following]:
"How often do you think about [use individual's description]?"
"Have you told anyone about these experiences? How do you explain the things that
have been happening [specify]?"
Rate items 12-13 on the basis of individual's self-report and observed behaviour.
12. Bizarre behaviour
Reports of behaviours which are odd, unusual, or psychotically criminal. Not limited to
interview period. Include inappropriate sexual behaviour and inappropriate affect.
2 Very mild Slightly odd or eccentric public behaviour, e.g., occasionally giggles to self,
fails to make appropriate eye contact, that does not seem to attract the attention of
others OR unusual behaviour conducted in private, e.g., innocuous rituals, that would
not attract the attention of others.
3 Mild Noticeably peculiar public behaviour, e.g., inappropriately loud talking, makes
inappropriate eye contact, OR private behaviour that occasionally, but not always,
attracts the attention of others, e.g., hoards food, conducts unusual rituals, wears gloves
indoors.
4 Moderate Clearly bizarre behaviour that attracts or would attract (if done privately) the
attention or concern of others, but with no corrective intervention necessary. Behaviour
occurs occasionally, e.g., fixated staring into space for several minutes, talks back to
voices once, inappropriate giggling/laughter on 1-2 occasions, talking loudly to self.
5 Moderately Severe Clearly bizarre behaviour that attracts or would attract (if done
privately) the attention of others or the authorities, e.g., fixated staring in a socially
disruptive way, frequent inappropriate giggling/laughter, occasionally responds to voices,
or eats non-foods.
6 Severe Bizarre behaviour that attracts attention of others and intervention by
authorities, e.g., directing traffic, public nudity, staring into space for long periods,
carrying on a conversation with hallucinations, frequent inappropriate giggling/laughter.
7 Extremely Severe Serious crimes committed in a bizarre way that attract the attention
of others and the control of authorities, e.g., sets fires and stares at flames OR almost
constant bizarre behaviour, e.g., inappropriate giggling/laughter, responds only to
hallucinations and cannot be engaged in interaction.
"Have you done anything that has attracted the attention of others?"
"Have you done anything that could have gotten you into trouble with the police?"
"Have you done anything that seemed unusual or disturbing to others?"
13. Self-neglect
Hygiene, appearance, or eating behaviour below usual expectations, below socially
acceptable standards or life threatening.
2 Very mild Hygiene/appearance slightly below usual community standards, e.g., shirt
out of pants, buttons unbuttoned, shoe laces untied, but no social or medical
consequences.
3 Mild Hygiene/appearance occasionally below usual community standards, e.g.,
irregular bathing, clothing is stained, hair uncombed, occasionally skips an important
meal. No social or medical consequences.
4 Moderate Hygiene/appearance is noticeably below usual community standards, e.g.,
fails to bathe or change clothes, clothing very soiled, hair unkempt, needs prompting,
noticeable by others OR irregular eating and drinking with minimal medical concerns and
consequences.
5 Moderately Severe Several areas of hygiene/appearance are below usual community
standards OR poor grooming draws criticism by others and requires regular prompting.
Eating or hydration are irregular and poor, causing some medical problems.
6 Severe Many areas of hygiene/appearance are below usual community standards,
does not always bathe or change clothes even if prompted. Poor grooming has caused
social ostracism at school/residence/work, or required intervention. Eating erratic and
poor, may require medical intervention.
7 Extremely Severe Most areas of hygiene/appearance/nutrition are extremely poor and
easily noticed as below usual community standards OR hygiene/appearance/nutrition
require urgent and immediate medical intervention.
"How has your grooming been lately? How often do you change your clothes? How often
do you take showers? Has anyone (parents/staff) complained about your grooming or
dress? Do you eat regular meals?"
14. Disorientation
Does not comprehend situations or communications, such as questions asked during the
entire BPRS interview. Confusion regarding person, place, or time. Do not rate if
incorrect responses are due to delusions.
2 Very mild Seems muddled or mildly confused 1-2 times during interview. Oriented to
person, place and time.
3 Mild Occasionally muddled or mildly confused 3-4 times during interview. Minor
inaccuracies in person, place, or time, e.g., date off by more than 2 days, or gives wrong
division of hospital or community centre.
4 Moderate Frequently confused during interview. Minor inaccuracies in person, place,
or time are noted, as in 3 above. In addition, may have difficulty remembering general
information, e.g., name of Prime Minister.
5 Moderately Severe Markedly confused during interview, or to person, place, or time.
Significant inaccuracies are noted, e.g., date off by more than one week, or cannot give
correct name of hospital. Has difficulty remembering personal information, e.g., where
he/she was born or recognising familiar people.
6 Severe Disoriented as to person, place, or time, e.g., cannot give correct month and
year. Disoriented in 2 out of 3 spheres.
7 Extremely Severe Grossly disoriented as to person, place, or time, e.g., cannot give
name or age. Disoriented in all three spheres.
"May I ask you some standard questions we ask everybody?"
"How old are you? What is the date [allow 2 days]"
"What is this place called? What year were you born? Who is the Prime Minister?"
Rate items 15-24 on the basis of observed behaviour and speech.
15 Conceptual disorganisation
Degree to which speech is confused, disconnected, vague or disorganised. Rate
tangentiality, circumstantiality, sudden topic shifts, incoherence, derailment, blocking,
neologisms, and other speech disorders. Do not rate content of speech.
2 Very mild Peculiar use of words or rambling but speech is comprehensible.
3 Mild Speech a bit hard to understand or make sense of due to tangentiality,
circumstantiality, or sudden topic shifts.
4 Moderate Speech difficult to understand due to tangentiality, circumstantiality,
idiosyncratic speech, or topic shifts on many occasions OR 1-2 instances of incoherent
phrases.
5 Moderately Severe Speech difficult to understand due to circumstantiality,
tangentiality, neologisms, blocking or topic shifts most of the time, OR 3-5 instances of
incoherent phrases.
6 Severe Speech is incomprehensible due to severe impairment most of the time. Many
BPRS items cannot be rated by self-report alone.
7 Extremely Severe Speech is incomprehensible throughout interview.
16. Blunted affect
Restricted range in emotional expressiveness of face, voice, and gestures. Marked
indifference or flatness even when discussing distressing topics. In the case of euphoric
or dysphoric individuals, rate Blunted Affect if a flat quality is also clearly present.
2 Very mild Emotional range is slightly subdued or reserved but displays appropriate
facial expressions and tone of voice that are within normal limits.
3 Mild Emotional range overall is diminished, subdued or reserved, without many
spontaneous and appropriate emotional responses. Voice tone is slightly monotonous.
4 Moderate Emotional range is noticeably diminished, individual doesn't show emotion,
smile or react to distressing topics except infrequently. Voice tone is monotonous or
there is noticeable decrease in spontaneous movements. Displays of emotion or
gestures are usually followed by a return to flattened affect.
5 Moderately Severe Emotional range very diminished, individual doesn't show
emotion, smile, or react to distressing topics except minimally, few gestures, facial
expression does not change very often. Voice tone is monotonous much of the time.
6 Severe Very little emotional range or expression. Mechanical in speech and gestures
most of the time. Unchanging facial expression. Voice tone is monotonous most of the
time.
7 Extremely Severe Virtually no emotional range or expressiveness, stiff movements.
Voice tone is monotonous all of the time.
Use the following probes at end of interview to assess emotional responsivity:
"Have you heard any good jokes lately? Would you like to hear a joke?"
17. Emotional withdrawal
Deficiency in individual's ability to relate emotionally during interview situation. Use your
own feeling as to the presence of an `invisible barrier' between individual and
interviewer. Include withdrawal apparently due to psychotic processes.
2 Very mild Lack of emotional involvement shown by occasional failure to make
reciprocal comments, appearing preoccupied, or smiling in a stilted manner, but
spontaneously engages the interviewer most of the time.
3 Mild Lack of emotional involvement shown by noticeable failure to make reciprocal
comments, appearing preoccupied, or lacking in warmth, but responds to interviewer
when approached.
4 Moderate Emotional contact not present much of the interview because individual
does not elaborate responses, fails to make eye contact, doesn't seem to care if
interviewer is listening, or may be preoccupied with psychotic material.
5 Moderately Severe Same as 4 but emotional contact not present most of the
interview.
6 Severe Actively avoids emotional participation. Frequently unresponsive or responds
with yes/no answers (not solely due to persecutory delusions). Responds with only
minimal affect.
7 Extremely Severe Consistently avoids emotional participation. Unresponsive or
responds with yes/no answers (not solely due to persecutory delusions). May leave
during interview or just not respond at all.
18. Motor retardation
Reduction in energy level evidenced by slowed movements and speech, reduced body
tone, decreased number of spontaneous body movements. Rate on the basis of
observed behaviour of the individual only. Do not rate on the basis of individual's
subjective impression of his own energy level. Rate regardless of medication effects.
2 Very mild Slightly slowed or reduced movements or speech compared to most people.
3 Mild Noticeably slowed or reduced movements or speech compared to most people.
4 Moderate Large reduction or slowness in movements or speech.
5 Moderately Severe Seldom moves or speaks spontaneously OR very mechanical or
stiff movements
6 Severe Does not move or speak unless prodded or urged.
7 Extremely Severe Frozen, catatonic.
19. Tension
Observable physical and motor manifestations of tension, `nervousness' and agitation.
Self-reported experiences of tension should be rated under the item on anxiety. Do not
rate if restlessness is solely akathisia, but do rate if akathisia is exacerbated by tension.
2 Very mild More fidgety than most but within normal range. A few transient signs of
tension, e.g., picking at fingernails, foot wagging, scratching scalp several times or finger
tapping.
3 Mild Same as 2, but with more frequent or exaggerated signs of tension.
4 Moderate Many and frequent signs of motor tension with one or more signs
sometimes occurring simultaneously, e.g., wagging one's foot while wringing hands
together. There are times when no signs of tension are present.
5 Moderately Severe Many and frequent signs of motor tension with one or more signs
often occurring sim ultaneously. There are still rare times when no signs of tension are
present.
6 Severe Same as 5, but signs of tension are continuous.
7 Extremely Severe Multiple motor manifestations of tension are continuously present,
e.g., continuous pacing and hand wringing.
20. Unco-operativeness
Resistance and lack of willingness to co-operate with the interview. The uncooperativeness might result from suspiciousness. Rate only unco-operativeness in
relation to the interview, not behaviours involving peers and relatives.
2 Very mild Shows non-verbal signs of reluctance, but does not complain or argue.
3 Mild Gripes or tries to avoid complying, but goes ahead without argument.
4 Moderate Verbally resists but eventually complies after questions are rephrased or
repeated.
5 Moderately Severe Same as 4, but some information necessary for accurate ratings
is withheld.
6 Severe Refuses to co-operate with interview, but remains in interview situation.
7 Extremely Severe Same as 6, with active efforts to escape the interview
21. Excitement
Heightened emotional tone or increased emotional reactivity to interviewer or topics
being discussed, as evidenced by increased intensity of facial expressions, voice tone,
expressive gestures or increase in speech quantity and speed.
2 Very mild Subtle and fleeting or questionable increase in emotional intensity. For
example, at times seems keyed-up or overly alert.
3 Mild Subtle but persistent increase in emotional intensity. For example, lively use of
gestures and variation in voice tone.
4 Moderate Definite but occasional increase in emotional intensity. For example, reacts
to interviewer or topics that are discussed with noticeable emotional intensity. Some
pressured speech.
5 Moderately Severe Definite and persistent increase in emotional intensity. For
example, reacts to many stimuli, whether relevant or not, with considerable emotional
intensity. Frequent pressured speech.
6 Severe Marked increase in emotional intensity. For example, reacts to most stimuli
with inappropriate emotional intensity. Has difficulty settling down or staying on task.
Often restless, impulsive, or speech is often pressured.
7 Extremely Severe Marked and persistent increase in emotional intensity. Reacts to all
stimuli with inappropriate intensity, impulsiveness. Cannot settle down or stay on task.
Very restless and impulsive most of the time. Constant pressured speech.
22. Distractibility
Degree to which observed sequences of speech and actions are interrupted by stimuli
unrelated to the interview. Distractibility is rated when the individual shows a change in
the focus of attention as characterised by a pause in speech or a marked shift in gaze.
Individual's attention may be drawn to noise in adjoining room, books on a shelf,
interviewer's clothing, etc. Do not rate circumstantiality, tangentiality or flight of ideas.
Also, do not rate rumination with delusional material. Rate even if the distracting stimulus
cannot be identified.
2 Very mild Generally can focus on interviewer's questions with only 1 distraction or
inappropriate shift of attention of brief duration.
3 Mild Individual shifts focus of attention to matters unrelated to the interview 2-3 times.
4 Moderate Often responsive to irrelevant stimuli in the room, e.g., averts gaze from the
interviewer.
5 Moderately Severe Same as above, but now distractibility clearly interferes with the
flow of the interview.
6 Severe Extremely difficult to conduct interview or pursue a topic due to preoccupation
with irrelevant stimuli.
7 Extremely Severe Impossible to conduct interview due to preoccupation with
irrelevant stimuli.
23. Motor hyperactivity
Increase in energy level evidenced in more frequent movement and/or rapid speech. Do
not rate if restlessness is due to akathisia.
2 Very mild Some restlessness, difficulty sitting still, lively facial expressions, or
somewhat talkative
3 Mild Occasionally very restless, definite increase in motor activity, lively gestures, 1-3
brief instances of pressured speech.
4 Moderate Very restless, fidgety, excessive facial expressions, or non-productive and
repetitious motor movements. Much pressured speech, up to one-third of the interview.
5 Moderately Severe Frequently restless, fidgety. Many instances of excessive nonproductive and repetitious motor movements. On the move most of the time. Frequent
pressured speech, difficult to interrupt. Rises on 1-2 occasions to pace.
6 Severe Excessive motor activity, restlessness, fidgety, loud tapping, noisy, etc.,
throughout most of the interview. Speech can only be interrupted with much effort. Rises
on 3-4 occasions to pace.
7 Extremely Severe Constant excessive motor activity throughout entire interview, e.g.,
constant pacing, constant pressured speech with no pauses, individual can only be
interrupted briefly and only small amounts of relevant information can be obtained
24. Mannerisms and posturing
Unusual and bizarre behaviour, stylised movements or acts, or any postures which are
clearly uncomfortable or inappropriate. Exclude obvious manifestations of medication
side effects. Do not include nervous mannerisms that are not odd or unusual.
2 Very mild Eccentric or odd mannerisms or activity that ordinary persons would have
difficulty explaining, e.g., grimacing, picking. Observed once for a brief period.
3 Mild Same as 2, but occurring on two occasions of brief duration.
4 Moderate Mannerisms or posturing, e.g., stylised movements or acts, rocking,
nodding, rubbing, or grimacing, observed on several occasions for brief periods or
infrequently but very odd. For example, uncomfortable posture maintained for 5 seconds
more than twice.
5 Moderately Severe Same as 4, but occurring often, or several examples of very odd
mannerisms or posturing that are idiosyncratic to the individual.
6 Severe Frequent stereotyped behaviour, assumes and maintains uncomfortable or
inappropriate postures, intense rocking, smearing, strange rituals or foetal posturing.
Individual can interact with people and the environment for brief periods despite these
behaviours.
7 Extremely Severe Same as 6, but individual cannot interact with people or the
environment due to these behaviours.
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CAGE Questionnaire
1. Have you ever felt you should Cut down on your drinking?
_____ Yes
_____ No
2. Have people Annoyed you by criticizing your drinking?
_____ Yes
_____ No
3. Have you ever felt bad or Guilty about your drinking?
_____ Yes
_____ No
4. Have you ever had a drink first thing in the morning to steady your nerves or to
get rid of a hangover (Eye opener)?
_____ Yes
_____ No
********************************************************************************************
Scoring:
Item responses on the CAGE are scored 0 or 1, with a higher score an indication
of alcohol problems. A total score of 2 or greater is considered clinically
significant.
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Life Satisfaction Index A (LSIA; Adams, 1969)
Here are some statements about life in general that people feel different ways
about. Read each statement on the list and indicate on the left the number that
best describes how you feel about the statement.
1= Agree
2= Disagree
3= Unsure
1.
___ As I get older, things seem better than I thought they would be.
2.
___ I have gotten more of the breaks in life than most of the people that I know.
3.
___ This is the dreariest time of my life.
4.
___ I am just as happy as when I was younger.
5.
___ My life could be happier than it is now.
6.
___ These are the best years of my life
7.
___ Most of the things I do are boring or monotonous.
8.
9.
___ I expect some interesting and some pleasant things to happen to me in the
future.
___ The things I do are as interesting to me as they ever were.
10. ___ I feel old and somewhat tired.
11. ___ As I look back on my life, I am fairly well satisfied.
12. ___ I would not change my past life even if I could
13. ___ Compared to other people my age, I make a good appearance.
14. ___ I have made plans for things I’ll be doing in a month or a year from now.
15. ___ When I think back over my life, I didn’t get most of the important things I
wanted.
16. ___ Compared to other people, I get down in the dumps too often.
17. ___ I got pretty much what I expected out of life.;
18. ___ In spite of what some people say, the lot of the average man is getting worse,
not better.
Scoring Guide
LSIA Adams (1969) uses Wood’s scoring method (Wood, Wylie, & Sheafor,
1969). Method assigns 2 points fro positive answers, 0 for negative answers, and
1 for “don’t know” answers, provide a range of 0 to 36, with the highest scores
indicating the greatest satisfaction.
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Geriatric Depression Scale -15 (GDS-15)
Choose the best answer for how you have felt over the past week:
1
Are you basically satisfied with you life?
Yes
No
2
Have you dropped many of your activities and
interests?
Yes
No
3
Do you feel that your life is empty?
Yes
No
4
Do you often get bored?
Yes
No
5
Are you in good sprits most of the time?
Yes
No
6
Are you afraid that something bad is going to
happen to you?
Yes
No
7
Do you feel happy most of the time?
Yes
No
8
Do you often feel helpless?
Yes
No
9
Do you prefer to stay at home, rather than going
out and doing new things?
Yes
No
10
Do you feel you have more problems with memory
than most?
Yes
No
11
Do you think is it wonderful to be alive now?
Yes
No
12
Do you feel pretty worthless the way you are now?
Yes
No
13
Do you feel full of energy?
Yes
No
14
Do you feel that your situation is hopeless?
Yes
No
15
Do you think that most people are better off than
you are?
Yes
No
Answers in bold indicate depression. Although differing sensitivities and specificities
have been obtained across studies, for clinical purposes a score >5 bold answers is
suggestive of depression and should warrant a follow-up interview.
This instrument, and other versions of the GDS in multiple translations, are in the public
domain and can be found at: ww.stanford.edu?~yesavage/DGS.html
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FACT-G (Version 4)
Below is a list of statements that other people with your illness have said are important. Please circle
or mark one number per line to indicate your response as it applies to the past 7 days.
PHYSICAL WELL-BEING
Not
at all
A little
bit
Somewhat
Quite
a bit
Very
much
GP1
I have a lack of energy .......................................................
0
1
2
3
4
GP2
I have nausea ......................................................................
0
1
2
3
4
GP3
Because of my physical condition, I have trouble
meeting the needs of my family .........................................
0
1
2
3
4
GP4
I have pain ..........................................................................
0
1
2
3
4
GP5
I am bothered by side effects of treatment .........................
0
1
2
3
4
GP6
I feel ill ...............................................................................
0
1
2
3
4
GP7
I am forced to spend time in bed ........................................
0
1
2
3
4
Not
at all
A little
bit
Somewhat
Quite
a bit
Very
much
SOCIAL/FAMILY WELL-BEING
GS1
I feel close to my friends ....................................................
0
1
2
3
4
GS2
I get emotional support from my family ............................
0
1
2
3
4
GS3
I get support from my friends.............................................
0
1
2
3
4
GS4
My family has accepted my illness ....................................
0
1
2
3
4
GS5
I am satisfied with family communication about my
illness..................................................................................
0
1
2
3
4
I feel close to my partner (or the person who is my main
support) ..............................................................................
0
1
2
3
4
0
1
2
3
4
GS6
Q1
Regardless of your current level of sexual activity, please
answer the following question. If you prefer not to answer it,
please mark this box
and go to the next section.
GS7
I am satisfied with my sex life ............................................
English (Universal)
Copyright 1987, 1997
16 November 2007
Page 1 of 2
FACT-G (Version 4)
Please circle or mark one number per line to indicate your response as it applies to the past 7
days.
EMOTIONAL WELL-BEING
Not
at all
A little
bit
Somewhat
Quite
a bit
Very
much
GE1
I feel sad ..............................................................................
0
1
2
3
4
GE2
I am satisfied with how I am coping with my illness..........
0
1
2
3
4
GE3
I am losing hope in the fight against my illness..................
0
1
2
3
4
GE4
I feel nervous.......................................................................
0
1
2
3
4
GE5
I worry about dying .............................................................
0
1
2
3
4
GE6
I worry that my condition will get worse ............................
0
1
2
3
4
Not
at all
A little
bit
Somewhat
Quite
a bit
Very
much
FUNCTIONAL WELL-BEING
GF1
I am able to work (include work at home) ..........................
0
1
2
3
4
GF2
My work (include work at home) is fulfilling.....................
0
1
2
3
4
GF3
I am able to enjoy life..........................................................
0
1
2
3
4
GF4
I have accepted my illness...................................................
0
1
2
3
4
GF5
I am sleeping well ...............................................................
0
1
2
3
4
GF6
I am enjoying the things I usually do for fun ......................
0
1
2
3
4
GF7
I am content with the quality of my life right now..............
0
1
2
3
4
English (Universal)
Copyright 1987, 1997
16 November 2007
Page 2 of 2
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Mini-Mental State Examination (MMSE)
Patient’s Name:
Date:
Instructions: Ask the questions in the order listed. Score one point for each correct
response within each question or activity.
Maximum Patient’s
Questions
Score
Score
5
“What is the year? Season? Date? Day of the week? Month?”
5
“Where are we now: State? County? Town/city? Hospital? Floor?”
3
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient’s response is
used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials: ___________
5
“I would like you to count backward from 100 by sevens.” (93, 86, 79,
72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
3
“Earlier I told you the names of three things. Can you tell me what those
were?”
2
Show the patient two simple objects, such as a wristwatch and a pencil,
and ask the patient to name them.
1
“Repeat the phrase: ‘No ifs, ands, or buts.’”
3
“Take the paper in your right hand, fold it in half, and put it on the floor.”
(The examiner gives the patient a piece of blank paper.)
1
“Please read this and do what it says.” (Written instruction is “Close
your eyes.”)
1
“Make up and write a sentence about anything.” (This sentence must
contain a noun and a verb.)
“Please copy this picture.” (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
1
30
TOTAL
(Adapted from Rovner & Folstein, 1987)
1
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
Instructions for administration and scoring of the MMSE
Orientation (10 points):
• Ask for the date. Then specifically ask for parts omitted (e.g., "Can you also tell me what season it
is?"). One point for each correct answer.
• Ask in turn, "Can you tell me the name of this hospital (town, county, etc.)?" One point for each
correct answer.
Registration (3 points):
• Say the names of three unrelated objects clearly and slowly, allowing approximately one second for
each. After you have said all three, ask the patient to repeat them. The number of objects the
patient names correctly upon the first repetition determines the score (0-3). If the patient does not
repeat all three objects the first time, continue saying the names until the patient is able to repeat all
three items, up to six trials. Record the number of trials it takes for the patient to learn the words. If
the patient does not eventually learn all three, recall cannot be meaningfully tested.
• After completing this task, tell the patient, "Try to remember the words, as I will ask for them in a
little while."
Attention and Calculation (5 points):
• Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93,
86, 79, 72, 65). Score the total number of correct answers.
• If the patient cannot or will not perform the subtraction task, ask the patient to spell the word "world"
backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3).
Recall (3 points):
• Ask the patient if he or she can recall the three words you previously asked him or her to
remember. Score the total number of correct answers (0-3).
Language and Praxis (9 points):
• Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score
one point for each correct naming (0-2).
• Repetition: Ask the patient to repeat the sentence after you ("No ifs, ands, or buts."). Allow only one
trial. Score 0 or 1.
• 3-Stage Command: Give the patient a piece of blank paper and say, "Take this paper in your right
hand, fold it in half, and put it on the floor." Score one point for each part of the command correctly
executed.
• Reading: On a blank piece of paper print the sentence, "Close your eyes," in letters large enough
for the patient to see clearly. Ask the patient to read the sentence and do what it says. Score one
point only if the patient actually closes his or her eyes. This is not a test of memory, so you may
prompt the patient to "do what it says" after the patient reads the sentence.
• Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do
not dictate a sentence; it should be written spontaneously. The sentence must contain a subject
and a verb and make sense. Correct grammar and punctuation are not necessary.
• Copying: Show the patient the picture of two intersecting pentagons and ask the patient to copy the
figure exactly as it is. All ten angles must be present and two must intersect to score one point.
Ignore tremor and rotation.
(Folstein, Folstein & McHugh, 1975)
2
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
Interpretation of the MMSE
Method
Score
Single Cutoff
<24
Abnormal
<21
Increased odds of dementia
>25
Decreased odds of dementia
21
Abnormal for 8th grade education
<23
Abnormal for high school education
<24
Abnormal for college education
Range
Education
Severity
Interpretation
24-30
No cognitive impairment
18-23
Mild cognitive impairment
0-17
Severe cognitive impairment
Sources:
•
•
•
•
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state
examination by age and educational level. JAMA. 1993;269(18):2386-2391.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state
of patients for the clinician. J Psychiatr Res. 1975;12:189-198.
Rovner BW, Folstein MF. Mini-mental state exam in clinical practice. Hosp Pract. 1987;22(1A):99, 103, 106,
110.
Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc.
1992;40(9):922-935.
3
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
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Montgomery-Åsberg Depression Rating Scale (MADRS)
Montgomery-Åsberg Depression Rating Scale
(MADRS)
Please visit us at www.lundbeck.com/cnsforum
1
Montgomery-Åsberg Depression Rating Scale (MADRS)
1. Apparent sadness
Representing despondency, gloom and despair (more than just ordinary transient low spirits),
reflected in speech, facial expression, and posture. Rate by depth and inability to brighten up.
0 = No sadness.
2 = Looks dispirited but does brighten up without difficulty.
4 = Appears sad and unhappy most of the time.
6 = Looks miserable all the time. Extremely despondent
2. Reported sadness
Representing reports of depressed mood, regardless of whether it is reflected in appearance or not.
Includes low spirits, despondency or the feeling of being beyond help and without hope.
0 = Occasional s adness in keeping with the circumstances.
2 = Sad or low but brightens up without difficulty.
4 = Pervasive feelings of sadness or gloominess. The mood is still influenced by external
circumstances.
6 = Continuous or unvarying sadness, misery or despondency.
Please visit us at www.lundbeck.com/cnsforum
2
Montgomery-Åsberg Depression Rating Scale (MADRS)
3. Inner tension
Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to
either panic, dread or anguish. Rate according to intensity, frequency, duration a nd the extent of
reassurance called for.
0 = Placid. Only fleeting inner tension.
2 = Occasional feelings of edginess and ill-defined discomfort.
4 = Continuous feelings of inner tension or intermittent panic which the patient c an only master
with some difficulty.
6 = Unrelenting dread or anguish. Overwhelming panic.
4. Reduced sleep
Representing the experience of reduced duration or depth of sleep compared to the subject's own
normal pattern when well.
0 = Sleeps as normal.
2 = Slight difficulty dropping off to sleep or slightly reduced, light or fitful sleep.
4 = Moderate stiffness and resistance
6 = Sleep reduced or broken by at least 2 hours.
Please visit us at www.lundbeck.com/cnsforum
3
Montgomery-Åsberg Depression Rating Scale (MADRS)
5. Reduced appetite
Representing the feeling of a loss of appetite compared with when-well. Rate by loss of desire for food
or the need to force oneself to eat.
0 = Normal or increased appetite.
2 = Slightly reduced appetite.
4 = No appetite. Food is tasteless.
6 = Needs persuasion to eat at all.
6. Concentration difficulties
Representing difficulties in collecting one's thoughts mounting to an incapacitating lack of
concentration. Rate accordin g to intensity, frequency, and degree of incapacity produced.
0 = No difficulties in concentrating.
2 = Occasional difficulties in collecting one's thoughts.
4 = Difficulties in concentrating and sustaining thought which reduced ability to read or hold a
conversation.
6 = Unable to read or converse without great difficulty.
Please visit us at www.lundbeck.com/cnsforum
4
Montgomery-Åsberg Depression Rating Scale (MADRS)
7. Lassitude
Representing difficulty in getting started or slowness in initiating and performing everyday activities.
0 = Hardly any difficulty in getting started. No sluggishness.
2 = Difficulties in starting activities.
4 = Difficulties in starting simple routine activities which are carried out with effort.
6 = Complete lassitude. Unable to do anything without help.
8. Inability to feel
Representing the subjective experience of reduced interest in the surroundings, or activities that
normally give pleasure. The ability to react with adequate emotion to circumstances or people is
reduced.
0 = Normal interest in the surroundings and in other people.
2 = Reduced ability to enjoy usual interests.
4 = Loss of interest in the surroundings. Loss of feelings for friends and acquaintances.
6 = The experience of being emotionally paralysed, inability to feel anger, grief or pleasure and
a complete or even painful failure to feel for close relatives and friends.
Please visit us at www.lundbeck.com/cnsforum
5
Montgomery-Åsberg Depression Rating Scale (MADRS)
9. Pessimistic thoughts
Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin.
0 = No pessimistic thoughts.
2 = Fluctuating ideas of failure, self-reproach or self- depreciation.
4 = Persistent self-accusations, or definite but still rational ideas of guilt or sin. Increasingly
pessimistic about the future.
6 = Delusions of ruin, remorse or irredeemable sin. Self- accusations which are absurd and
unshakable.
10. Suicidal thoughts
Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal
thoughts, and preparations for suicide. Suicide attempts should not in themselves influence the rating.
0 = Enjoys life or takes it as it comes.
2 = Weary of life. Only fleeting suicidal thoughts.
4 = Probably better off dead. Suicidal thoughts are common, and suicide is considered as a
possible solution, but without specific plans or intenstion.
6 = Explicit plans for suicide when there is an opportunity. Active preparations for suicide.
Please visit us at www.lundbeck.com/cnsforum
6
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PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
DATE:
NAME:
Over the last 2 weeks, how often have you been
bothered by any of the following problems?
(use "ⁿ" to indicate your answer)
More than Nearly
half the every day
days
Not at all
Several
days
1. Little interest or pleasure in doing things
0
1
2
3
2. Feeling down, depressed, or hopeless
0
1
2
3
3. Trouble falling or staying asleep, or sleeping too much
0
1
2
3
4. Feeling tired or having little energy
0
1
2
3
5. Poor appetite or overeating
0
1
2
3
6. Feeling bad about yourself or that you are a failure or
have let yourself or your family down
0
1
2
3
7. Trouble concentrating on things, such as reading the
newspaper or watching television
0
1
2
3
8. Moving or speaking so slowly that other people could
have noticed. Or the opposite being so figety or
restless that you have been moving around a lot more
than usual
0
1
2
3
9. Thoughts that you would be better off dead, or of
hurting yourself
0
1
2
3
add columns
+
+
(Healthcare professional: For interpretation of TOTAL, TOTAL:
please refer to accompanying scoring card).
10. If you checked off any problems, how difficult
have these problems made it for you to do
your work, take care of things at home, or get
along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD© is a trademark of Pfizer Inc.
A2663B 10-04-2005
PHQ-9 Patient Depression Questionnaire
For initial diagnosis:
1.
Patient completes PHQ-9 Quick Depression Assessment.
2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive
disorder. Add score to determine severity.
Consider Major Depressive Disorder
- if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)
Consider Other Depressive Disorder
- if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2)
Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician,
and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood
the questionnaire, as well as other relevant information from the patient.
Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social,
occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a
history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the
biological cause of the depressive symptoms.
To monitor severity over time for newly diagnosed patients or patients in current treatment for
depression:
1.
Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at
home and bring them in at their next appointment for scoring or they may complete the
questionnaire during each scheduled appointment.
2.
Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3
3.
Add together column scores to get a TOTAL score.
4.
Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score.
5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of
response, as well as guiding treatment intervention.
Scoring: add up all checked boxes on PHQ-9
For every 3 Not at all = 0; Several days = 1;
More than half the days = 2; Nearly every day = 3
Interpretation of Total Score
Total Score
1-4
5-9
10-14
15-19
20-27
Depression Severity
Minimal depression
Mild depression
Moderate depression
Moderately severe depression
Severe depression
PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a
trademark of Pfizer Inc.
A2662B 10-04-2005
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INSTRUMENT GUIDE FOR DIABETES-SPECIFIC PROGRAMS
Instruments preceded by an asterisk (*) and bolded are common to a number of conditions
and can be found in the Cross-Cutting Instruments Guide
Important Note: While rigorous research was conducted to provide readers with all of the instrumentation for
implementing the programs outlined in this toolkit, for a limited number of programs, instrumentation was not
available for public use. Therefore, interested parties are encouraged to contact selected programs to obtain
permission for instruments not included here.
Instrument
Chronic Illness Resources Survey
* Community Health Activities Model Program for
Seniors (CHAMPS) Physical Activity Questionnaire
English & Spanish versions, including manual and
scoring guide
Program
• Healthy Changes™
• Diabetes Health Connection
Diabetes Integration Questionnaire (ATT39)
• Look After Yourself (LAY)
Diabetes Knowledge (SKILLD) 1 Scale
• New Leaf
Diabetes Knowledge Questionnaire
English & Spanish versions
* Fat-Related Diet Habits Questionnaire 2
Measurement of Beliefs of Diabetic Patients
English & Spanish versions
Modifiable Activity Questionnaire
National Health Interview Survey (NHIS)
Item on self-rated health
Personal Models of Diabetes Questionnaire (Updated
2001 version)
Including scoring guide
Stanford Patient Education Exercise Behaviors
Questionnaire
Stanford Patient Education Research Center Self
Efficacy for Diabetes Measure
Summary of Diabetes Self-Care Activities (SDSCA)
• Starr County Border Health Initiative
• Diabetes Prevention Program (DPP)
• New Leaf
• Starr County Border Health Initiative
• DPP
• Healthy Changes™
• LAY
• Healthy Changes™
• Healthy Changes™
• Healthy Changes™
• LAY
• New Leaf
• Seniors Taking Charge of Diabetes!
Please note that we are recommending the SKILLD measure as a substitute measure for the diabetes knowledge
measure used in the New Leaf program because that measure is not currently available.
1
2 Please note that we are recommending the Fat-Related Diet Habits Questionnaire as a substitute measure for the DPP
and New Leaf Interventions. The measure used by the study authors in those two interventions to assess diet would be
overly burdensome to administer.
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Diabetes Integration Questionnaire (ATT39)
INSTRUCTIONS: This form contains 19 questions to see how you feel about diabetes and its effect on your
life. The are no ‘right’ or ‘wrong’ answers because everyone has the right to his or her own views. Please do not
spend too long on each question. There are 5 possible answers to choose from:
I DISAGREE
COMPLETELY
(DC)
or
I DISAGREE
(D)
or
I DON’T
KNOW
(?)
or
I AGREE
(A)
or
I AGREE
COMPLETELY
(AC)
For each question, circle the ONE answer that is right for you. Give your first, natural answer as it occurs to
you.
1.
If I did not have
diabetes I think I
would be quite a
different person
2.
I dislike being
referred to as ‘A
DIABETIC’
3.
Diabetes is the worst
thing that has ever
happened to me
4.
5.
6.
7.
8.
9.
Most people would
find it difficult to
adjust to having
diabetes
I often feel
embarrased about
having diabetes
There is not much I
seem to be able to do
to control my
diabetes
There is little hope of
leadinga normal life
with diabetes
The proper control of
diabetes involves a
lot of sacrifice and
inconvenience
I try not to let people
know about my
diabetes
I disagree
completely
I disagree
I don’t
know
I agree
I agree
completely
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
10.
11.
12.
13.
14.
15.
I disagree
completely
I disagree
I don’t
know
I agree
I agree
completely
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
Having diabetes over
a long period changes
the personality
DC
D
?
A
AC
I often find it difficult
to decide whether I
feel sick or well
DC
D
?
A
AC
Diabetes is not really
a problem because it
can be controlled
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
DC
D
?
A
AC
Being told you have
diabetes is like being
sentences to a
lifetime of illness
My diabeteic diet
does not really spoil
my social life
In general, doctors
need to be a lot more
sympathetic in their
treatment of people
with diabetes
16.
There is really
nothing you can do if
you have diabetes
17.
There is no-one I feel
I can talk to openly
about my diabetes
18.
I believe I have
adjusted well to
having diabetes
19.
I often think it is
unfair that I should
have diabetes when
other people are so
healthy
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Diabetes Knowledge Questionnaire: English & Spanish
Errata
Garcı́a AA, Villagomez, ET, Brown SA, Kouzekanani K, Hanis CL: The Starr County Diabetes Education Study: development
of the Spanish-language diabetes knowledge questionnaire. Diabetes Care 24:16 –21, 2001
In the APPENDIX of the above article, errors appeared that were introduced at the composition stage. The corrected Diabetes
Knowledge Questionnaire appears below.
APPENDIX—24-Item Diabetes Knowledge Questionnaire and Correct Responses
CUESTIONAIRIO DE CONOCIMIENTO DE LA DIABETES
DIABETES KNOWLEDGE QUESTIONNAIRE
Item
#
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
7.
7.
8.
8.
9.
9.
10.
10.
11.
11.
12.
12.
13.
13.
14.
14.
15.
15.
16.
16.
17.
17.
18.
18.
19.
19.
20.
20.
21.
21.
22.
22.
23.
23.
24.
24.
Preguntas
Questions
Sı́
Yes
El comer mucha azúcar y otras comidas dulces es una causa de la diabetes.
Eating too much sugar and other sweet foods is a cause of diabetes.
La causa común de la diabetes es la falta de insulina efectiva en el cuerpo.
The usual cause of diabetes is lack of effective insulin in the body.
La diabetes es causada porque los riñones no pueden mantener el azúcar fuera de la orina.
Diabetes is caused by failure of the kidneys to keep sugar out of the urine.
Los riñones producen la insulina.
Kidneys produce insulin.
En la diabetes que no se está tratando, la cantidad de azúcar en la sangre usualmente sube.
In untreated diabetes, the amount of sugar in the blood usually increases.
Si yo soy diabético, mis hijos tendrán más riesgo de ser diabéticos.
If I am diabetic, my children have a higher chance of being diabetic.
Se puede curar la diabetes.
Diabetes can be cured.
Un nivel de azúcar de 210 en prueba de sangre hecha en ayunas es muy alto.
A fasting blood sugar level of 210 is too high.
La mejor manera de checar mi diabetes es haciendo pruebas de orina.
The best way to check my diabetes is by testing my urine.
El ejercicio regular aumentará la necesidad de insulina u otro medicamento para la diabetes.
Regular exercise will increase the need for insulin or other diabetic medication.
Hay dos tipos principales de diabetes: tipo 1 (dependiente de insulina) y tipo 2 (no-dependiente
de insulina).
There are two main types of diabetes: type 1 (insulin-dependent) and type 2 (non-insulin dependent).
Una reacción de insulina es causada por mucha comida.
An insulin reaction is caused by too much food.
La medicina es más importante que la dieta y el ejercicio para controlar mi diabetes.
Medication is more important than diet and exercise to control my diabetes.
La diabetes frecuentemente causa mala circulación.
Diabetes often causes poor circulation.
Cortaduras y rasguños cicatrizan más despacio en diabéticos.
Cuts and abrasions on diabetics heal more slowly.
Los diabéticos deberı́an poner cuidado extra al cortarse las uñas de los dedos de los pies.
Diabetics should take extra care when cutting their toenails.
Una persona con diabetes deberı́a limpiar una cortadura con yodo y alcohol.
A person with diabetes should cleanse a cut with iodine and alcohol.
La manera en que preparo mi comida es igual de importante que las comidas que como.
The way I prepare my food is as important as the foods I eat.
La diabetes puede dañar mis riñones.
Diabetes can damage my kidneys.
La diabetes puede causar que no sienta en mis manos, dedos y pies.
Diabetes can cause loss of feeling in my hands, fingers, and feet.
El temblar y sudar son señales de azúcar alta en la sangre.
Shaking and sweating are signs of high blood sugar.
El orinar seguido y la sed son señales de azúcar baja en la sangre.
Frequent urination and thirst are signs of low blood sugar.
Los calcetines y las medias elásticas apretadas no son malos para los diabéticos.
Tight elastic hose or socks are not bad for diabetics.
Una dieta diabética consiste principalmente de comidas especiales.
A diabetic diet consists mostly of special foods.
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
No
No
No sé
I don’t know
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√ ⫽ correct answer
972
DIABETES CARE, VOLUME 24, NUMBER 5, MAY 2001
Errata
Phillips LS, Grunberger G, Miller E, Patwardhan R, Rappaport EB, Salzman A, for the Rosiglitazone Clinical Trials Study
Group: Once- and twice-daily dosing with rosiglitazone improves glycemic control in patients with type 2 diabetes. Diabetes
Care 24:308-315, 2001
The first complete sentence in column 2 on page 309 should state: “LDL cholesterol concentrations were estimated using the
Friedewald equation (11) when triglycerides were ⱕ400 mg/dl.” In line 4, “⬎400 mg/dl” was corrected to “ⱕ400 mg/dl.”
In lines 12 and 20 in column 1 of Table 2 on page 312, “Baseline triglycerides ⱕ5.17 mmol/l” should state “Baseline triglycerides
ⱕ2.26 mmol/l.”
The first sentence of paragraph 2 in column 1 on page 312 should state: “In general, the rosiglitazone treatment groups
demonstrated small but significant increases in triglyceride levels, with greater increases observed in patients with baseline levels
ⱕ2.26 mmol/l (200 mg/dl); however, these changes were not dosage related.”
In the same paragraph, the third sentence should state: “In patients with baseline triglyceride levels 2.26 mmol/l, no change was
significant in any treatment group (Table 2).” In both sentences, “5.17 mmol/l” was corrected to “2.26 mmol/l.”
The third complete sentence of column 3 on page 310 should state: “In comparison with placebo, there were small but statistically
significant increases in the rosiglitazone 2 mg b.i.d., 8 mg o.d., and 4 mg b.i.d. treatment groups.” In line 14, the first mention of
“4 mg b.i.d.” was corrected to “2 mg b.i.d.”
Crook MA, Pickup JC, Lumb PJ, Georgino F, Webb DJ, Fuller JH, The EURODIAB IDDM Complications Study Group:
Relationship between plasma sialic acid concentration and microvascular and macrovascular complications in type 1
diabetes: the EURODIAB Complications Study. Diabetes Care 24:316 –322, 2001
The authors of the above article wish to note that Dr. Francesco Giorgino’s name was inadvertently misspelled and that his affiliation
should read Istituto di Clinica Medica, Endocrinologia e Malattie Metaboliche, Bari, Italy.
DIABETES CARE, VOLUME 24, NUMBER 5, MAY 2001
973
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Rothman R., Malone R, Bryant B, et al. The Spoken Knowledge in Low-literacy Patients with Diabetes.
Diabetes Educator. 2005;31(2):215-224.
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Modifiable Activity Questionnaire.
Medicine & Science in Sports & Exercise. A Collection of Physical Activity Questionnaires for Health-Related
Researc. 29(6) Supplement:73-78, June 1997.
2
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NHIS
Self-Rated Health
In general, would you say your health is:............................................(Circle one)
Excellent...............................1
Very good .............................2
Good ....................................3
Fair .......................................4
Poor......................................5
Scoring
Score the number circled. If two consecutive numbers are circled, choose the higher number (worse
health); if two non-consecutive numbers are circled, do not score. The score is the value of this single
item only. A higher score indicates poorer health.
Characteristics
Tested on 1,129 subjects with chronic disease. N=51 for test-retest.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
1
1-5
3.29
.91
—
.92
Source of Psychometric Data
Stanford Chronic Disease Self-Management Study. Psychometrics reported in Lorig K, Stewart A,
Ritter P, González V, Laurent D, & Lynch J, Outcome Measures for Health Education and other Health
Care Interventions. Thousand Oaks CA: Sage Publications, 1996, p.25.
Comments
This item is used in the National Health Interview Survey. In a number of studies self-rated health has
been found to be an excellent predictor of future health. This scale available in Spanish.
References
Idler EL, & Angel RJ, Self-rated health and mortality in the NHANES-I epidemiologic follow-up study.
American Journal of Public Health, 80, 1990, pp.446-452.
Schoenfeld DE, Malmrose LC, Blazer DG, Gold DT, & Seeman TE, Self-rated health and mortality in
the high-functioning elderly: A closer look at healthy individuals; MacArthur Field Study of Successful
Aging. Journal of Gerontology: Medical Sciences, 49, 1994, pp.M109-M115.
U.S. Bureau of the Census, National Health Interview Survey. Washington DC: U.S. Dept. of
Commerce, 1985.
Ware JE Jr, Nelson EC, Sherbourne CD, & Stewart AL, Preliminary tests of a 6-item general health
survey: A patient application; in AL Stewart & JE Ware Jr (Eds), Measuring Functioning and WellBeing: The Medical Outcomes Study Approach, Durham NC: Duke University Press, 1992, pp.291-303.
Wolinsky FD, & Johnson RJ, Perceived health status and mortality among older men and women.
Journal of Gerontology: Social Sciences, 47, 1992, pp.S304-S312.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
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Exercise Behaviors
During the past week, even if it was not a typical week for you, how much total time (for the entire
week) did you spend on each of the following? (Please circle one number for each question.)
less than
30 min/wk
30-60
min/wk
1. Stretching or strengthening exercises
(range of motion, using weights, etc.) ................0
1
2
3
4
2. Walk for exercise ...............................................0
1
2
3
4
3. Swimming or aquatic exercise ...........................0
1
2
3
4
4. Bicycling (including stationary
exercise bikes) ...................................................0
1
2
3
4
5. Other aerobic exercise equipment
(Stairmaster, rowing, skiing machine, etc.) ........0
1
2
3
4
1
2
3
4
none
1-3 hrs more than
per week 3 hrs/wk
6. Other aerobic exercise
Specify_________________________ .............0
Scoring
Code each item as the number circled, then covert as follows. If two consecutive numbers are circled,
code the lower number (less exercise). If two non-consecutive numbers are circled, do not score the
item. For "Other aerobic", try to fit the type of exercise into the existing aerobic categories (i.e., treadmill
as "other aerobic equipment”), otherwise leave as "other aerobic" (i.e., "dancing"). However, if exercise
that is not aerobic, such as yoga or weight training, do not score as aerobic. Yoga, weight training, tai
chi, etc., should be scored as "stretching or strengthening".
Each category is converted to the number of minutes below. Time spent in stretching or strengthening
is the value for item 1. Time spent in aerobic exercise is the sum of the values for items 2 through 6.
None
Less than 30
minutes/week
30-60
minutes/week
1-3
hours/week
More that 3
hours/week
0
15
45
120
180
Characteristics
Stretching/strengthening (minutes/week) tested on 1,127 subjects with chronic disease. N=51 for testretest.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
1
0-180
40.1
54.8
—
.56
Aerobic exercise (minutes/week) tested on 1,130 subjects with chronic disease. M=51 for test-retest.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
5
0-540
90.6
90.9
—
.72
Source of Psychometric Data
Stanford Chronic Disease Self-Management Study. Psychometrics reported in: Lorig K, Stewart A,
Ritter P, González V, Laurent D, & Lynch J, Outcome Measures for Health Education and other Health
Care Interventions. Thousand Oaks CA: Sage Publications, 1996, pp.25,37-38.
Comments
We have used this scale to measure both aerobic and a combination of stretching strengthening
exercise for many years. This scale available in Spanish.
References
Lorig K, Stewart A, Ritter P, González V, Laurent D, & Lynch J, Outcome Measures for Health
Education and other Health Care Interventions. Thousand Oaks CA: Sage Publications, 1996,
pp.25,37-38.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
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Self-Efficacy for Diabetes
We would like to know how confident you are in doing certain activities. For each of the following
questions, please choose the number that corresponds to your confidence that you can do the tasks
regularly at the present time.
1. How confident do you feel that you
can eat your meals every 4 to 5
hours every day, including breakfast
every day?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
2. How confident do you feel that you
can follow your diet when you have
to prepare or share food with other
people who do not have diabetes?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
3. How confident do you feel that you
can choose the appropriate foods to
eat when you are hungry (for
example, snacks)?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
4. How confident do you feel that you
can exercise 15 to 30 minutes, 4 to 5
times a week?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
5. How confident do you feel that you
can do something to prevent your
blood sugar level from dropping
when you exercise?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
6. How confident do you feel that you
know what to do when your blood
sugar level goes higher or lower than
it should be?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
7. How confident do you feel that you
can judge when the changes in your
illness mean you should visit the
doctor?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
8. How confident do you feel that you
can control your diabetes so that it
does not interfere with the things you
want to do?
______________________________
not at all |
|
|
|
|
|
|
|
|
| totally
confident 1 2 3 4 5 6 7 8 9 10 confident
1
Scoring
The score for each item is the number circled. If two consecutive numbers are circled, code the lower
number (less self-efficacy). If the numbers are not consecutive, do not score the item. The score for the
scale is the mean of the six items. If more than two items are missing, do not score the scale. Higher
number indicates higher self-efficacy.
Characteristics
Tested on 186 subjects with diabetes.
.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
8
1-10
6.87
1.76
.828
NA
Source of Psychometric Data
Stanford English Diabetes Self-Management study, ongoing.
Comments
This 8-item scale was originally developed and tested in Spanish for the Diabetes Self-Management
study. For internet studies, we add radio buttons below each number. There is another way that we use
to format these items, which takes up less space on a questionnaire, shown also in the PDF document.
This scale is available in Spanish.
References
Unpublished.
This scale is free to use without permission
Stanford Patient Education Research Center
1000 Welch Road, Suite 204
Palo Alto CA 94304
(650) 723-7935
(650) 725-9422 Fax
[email protected]
http://patienteducation.stanford.edu
Funded by the National Institute of Nursing Research (NINR)
2
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INSTRUMENT GUIDE FOR FALLS-SPECIFIC PROGRAMS
Instruments preceded by an asterisk (*) and bolded are common to a number of
conditions and can be found in the Cross-Cutting Instruments Guide
Important Note: While rigorous research was conducted to provide readers with all of the instrumentation
for implementing the programs outlined in this toolkit, for a limited number of programs, instrumentation
was not available for public use. Therefore, interested parties are encouraged to contact selected programs to
obtain permission for instruments not included here.
Instrument
Program
*6-Minute Walk Test
•
Berg Balance Scale
•
Dynamic Gait Index
•
Functional Reach test
•
*Physical Activity Scale for the Elderly (PASE)
•
* Center for Epidemiologic Studies-Depression
(CES-D) Scale
Falls Efficacy Scale
Modified Falls Efficacy Scale (MFES)
Short Form-12 Health Survey (SF-12)
Short Form-20 Health Survey (SF-20)
* Short Form-36 Health Survey (SF-36)
Including scoring guide
* Sickness Impact Profile (SIP)
Survey of Activities and Fear of Falling in the
Elderly (SAFFE)
Timed Chair Stand Test
Timed Up and Go test
•
•
•
•
•
•
•
•
•
•
•
•
•
EnhanceFitness
Tai Chi: Moving for Better Balance
EnhanceFitness
Tai Chi: Moving for Better Balance
A Matter of Balance/Volunteer Lay-Leader
Model
Tai Chi: Moving for Better Balance
Stepping On
Stepping On
EnhanceFitness
Tai Chi: Moving for Better Balance
A Matter of Balance/Volunteer Lay-Leader
Model
EnhanceFitness
Stepping On
A Matter of Balance/Volunteer Lay-Leader
Model
Tai Chi: Moving for Better Balance
EnhanceFitness
Stepping On
Tai Chi: Moving for Better Balance
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Berg Balance Scale
Description:
14-item scale designed to measure balance of the older adult in a clinical setting.
Equipment needed: Ruler
2 standard chairs (one with arm rests, one without)
Footstool or step
Stopwatch or wristwatch
15 ft walkway
Completion:
Time:
15-20 minutes
Scoring:
A five-point ordinal scale, ranging from 0-4. “0” indicates the
lowest level of function and “4” the highest level of function.
Total Score = 28
Interpretation:
41-56 = low fall risk
21-40 = medium fall risk
0 –20 = high fall risk
< 36 fall risk close to 100%
Berg Balance Scale
Name: __________________________________
Date: ___________________
Location: ________________________________ Rater: ___________________
ITEM DESCRIPTION
SCORE (0-4)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
________
________
________
________
________
________
________
________
________
________
________
________
________
________
Sitting to standing
Standing unsupported
Sitting unsupported
Standing to sitting
Transfers
Standing with eyes closed
Standing with feet together
Reaching forward with outstretched arm
Retrieving object from floor
Turning to look behind
Turning 360 degrees
Placing alternate foot on stool
Standing with one foot in front
Standing on one foot
Total
________
GENERAL INSTRUCTIONS
Please document each task and/or give instructions as written. When scoring, please record the
lowest response category that applies for each item.
In most items, the subject is asked to maintain a given position for a specific time. Progressively
more points are deducted if the time or distance requirements are note met, if the subject’s
performance warrants supervision, or if the subject touches an external support or receives
assistance from the examiner. Subject should understand that they must maintain their balance
while attempting the tasks. The choices of which leg to stand on or how far to reach are left to
the subject. Poor judgment will adversely influence the performance and the scoring.
Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other
indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either
a step or a stool of average step height may be used for item # 12.
Berg Balance Scale
1.
SITTING TO STANDING
INSTRUCTIONS: Please stand up. Try not to use your hand for support.
( )4
able to stand without using hands and stabilize independently
( )3
able to stand independently using hands
( )2
able to stand using hands after several tries
( )1
needs minimal aid to stand or stabilize
( )0
needs moderate or maximal assist to stand
2.
STANDING UNSUPPORTED
INSTRUCTIONS: Please stand for two minutes without holding on.
( )4
able to stand safely for 2 minutes
( )3
able to stand 2 minutes with supervision
( )2
able to stand 30 seconds unsupported
( )1
needs several tries to stand 30 seconds unsupported
( )0
unable to stand 30 seconds unsupported
If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4.
3.
SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL
INSTRUCTIONS: Please sit with arms folded for 2 minutes.
( )4
able to sit safely and securely for 2 minutes
( )3
able to sit 2 minutes under supervision
( )2
able to able to sit 30 seconds
( )1
able to sit 10 seconds
( )0
unable to sit without support 10 seconds
4.
STANDING TO SITTING
INSTRUCTIONS: Please sit down.
( )4
sits safely with minimal use of hands
( )3
controls descent by using hands
( )2
uses back of legs against chair to control descent
( )1
sits independently but has uncontrolled descent
( )0
needs assist to sit
5.
TRANSFERS
INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way
toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.
( )4
able to transfer safely with minor use of hands
( )3
able to transfer safely definite need of hands
( )2
able to transfer with verbal cuing and/or supervision
( )1
needs one person to assist
( )0
needs two people to assist or supervise to be safe
6.
STANDING UNSUPPORTED WITH EYES CLOSED
INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.
( )4
able to stand 10 seconds safely
( )3
able to stand 10 seconds with supervision
( )2
able to stand 3 seconds
( )1
unable to keep eyes closed 3 seconds but stays safely
( )0
needs help to keep from falling
7.
STANDING UNSUPPORTED WITH FEET TOGETHER
INSTRUCTIONS: Place your feet together and stand without holding on.
( )4
able to place feet together independently and stand 1 minute safely
( )3
able to place feet together independently and stand 1 minute with supervision
( )2
able to place feet together independently but unable to hold for 30 seconds
( )1
needs help to attain position but able to stand 15 seconds feet together
( )0
needs help to attain position and unable to hold for 15 seconds
Berg Balance Scale continued…..
8.
REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING
INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler
at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded
measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask
subject to use both arms when reaching to avoid rotation of the trunk.)
( )4
can reach forward confidently 25 cm (10 inches)
( )3
can reach forward 12 cm (5 inches)
( )2
can reach forward 5 cm (2 inches)
( )1
reaches forward but needs supervision
( )0
loses balance while trying/requires external support
9.
PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION
INSTRUCTIONS: Pick up the shoe/slipper, which is place in front of your feet.
( )4
able to pick up slipper safely and easily
( )3
able to pick up slipper but needs supervision
( )2
unable to pick up but reaches 2-5 cm(1-2 inches) from slipper and keeps balance
independently
( )1
unable to pick up and needs supervision while trying
( )0
unable to try/needs assist to keep from losing balance or falling
TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING
INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. Examiner may pick an
object to look at directly behind the subject to encourage a better twist turn.
( )4
looks behind from both sides and weight shifts well
( )3
looks behind one side only other side shows less weight shift
( )2
turns sideways only but maintains balance
( )1
needs supervision when turning
( )0
needs assist to keep from losing balance or falling
10.
11.
TURN 360 DEGREES
INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
( )4
able to turn 360 degrees safely in 4 seconds or less
( )3
able to turn 360 degrees safely one side only 4 seconds or less
( )2
able to turn 360 degrees safely but slowly
( )1
needs close supervision or verbal cuing
( )0
needs assistance while turning
12.
PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED
INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touch the step/stool four times.
( )4
able to stand independently and safely and complete 8 steps in 20 seconds
( )3
able to stand independently and complete 8 steps in > 20 seconds
( )2
able to complete 4 steps without aid with supervision
( )1
able to complete > 2 steps needs minimal assist
( )0
needs assistance to keep from falling/unable to try
13.
STANDING UNSUPPORTED ONE FOOT IN FRONT
INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot
place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other
foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should
approximate the subject’s normal stride width.)
( )4
able to place foot tandem independently and hold 30 seconds
( )3
able to foot ahead independently and hold 30 seconds
( )2
able to take small step independently and hold 30 seconds
( )1
needs help to step but can hold 15 seconds
( )0
loses balance while stepping or standing
14.
STANDING ON ONE LEG
INSTRUCTIONS: Stand on one leg as long as you can without holding on.
( )4
able to lift leg independently and hold > 10 seconds
( )3
able to lift leg independently and hold 5-10 seconds
( )2
able to lift leg independently and hold ≥ 3 seconds
( )1
tries to lift leg unable to hold 3 seconds but remains standing independently.
( )0
unable to try of needs assist to prevent fall
(
) TOTAL SCORE (Maximum = 56)
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Dynamic Gait Index*
Description:
Developed to assess the likelihood of falling in older adults.
This scale was designed to test eight facets of gait.
Equipment needed: Box (Shoebox)
Cones (2)
Stairs
Completion:
Time:
15 minutes
Scoring:
A four-point ordinal scale, ranging from 0-3. “0” indicates the
lowest level of function and “3” the highest level of function.
Total Score = 24
Interpretation:
< 19 = predictive of falls in the elderly
> 22 = safe ambulators
*Shumway-Cook A, Woollacott M. Motor Control Theory and Applications, Williams and
Wilkins Baltimore, 1995: 323-324
Dynamic Gait Index
1. Gait level surface _____
Instructions: Walk at your normal speed from here to the next mark (20’)
Grading: Mark the lowest category that applies.
(3) Normal: Walks 20’, no assistive devices, good sped, no evidence for imbalance, normal gait pattern
(2) Mild Impairment: Walks 20’, uses assistive devices, slower speed, mild gait deviations.
(1) Moderate Impairment: Walks 20’, slow speed, abnormal gait pattern, evidence for imbalance.
(0) Severe Impairment: Cannot walk 20’ without assistance, severe gait deviations or imbalance.
2. Change in gait speed _____
Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for 5’).
When I tell you “slow,” walk as slowly as you can (for 5’).
Grading: Mark the lowest category that applies.
(3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a
significant difference in walking speeds between normal, fast and slow speeds.
(2) Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or not gait deviations but
unable to achieve a significant change in velocity, or uses an assistive device.
(1) Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed
with significant gait deviations, or changes speed but has significant gait deviations, or changes speed but
loses balance but is able to recover and continue walking.
(0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.
3. Gait with horizontal head turns _____
Instructions: Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but
turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and
turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight,
but return your head to the center.
Grading: Mark the lowest category that applies.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to
smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers
but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers
outside 15” path, loses balance, stops, reaches for wall.
4. Gait with vertical head turns _____
Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip
your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down.
Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the
center.
Grading: Mark the lowest category that applies.
(3) Normal: Performs head turns smoothly with no change in gait.
(2) Mild Impairment: Performs head turns smoothly with slight change in gait
velocity, i.e., minor disruption to smooth gait path or uses walking aid.
(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers
but recovers, can continue to walk.
(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers
outside 15” path, loses balance, stops, reaches for wall.
Dynamic Gait Index continued….
5. Gait and pivot turn _____
Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to
face the opposite direction and stop.
Grading: Mark the lowest category that applies.
(3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.
(2) Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance.
(1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance
following turn and stop.
(0) Severe Impairment: Cannot turn safely, requires assistance to turn and stop.
6. Step over obstacle ____
Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it,
and keep walking.
Grading: Mark the lowest category that applies.
(3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.
(2)Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box
safely.
(1) Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal cueing.
(0) Severe Impairment: Cannot perform without assistance.
7. Step around obstacles _____
Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the
right side of it. When you come to the second cone (6’ past first cone), walk around it to the left.
Grading: Mark the lowest category that applies.
(3)Normal: Is able to walk around cones safely without changing gait speed; no evidence of
imbalance.
(2) Mild Impairment: Is able to step around both cones, but must slow down and
adjust steps to clear cones.
(1) Moderate Impairment: Is able to clear cones but must significantly slow, speed to accomplish task, or
requires verbal cueing.
(0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance.
8. Steps _____
Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn
around and walk down.
Grading: Mark the lowest category that applies.
(3) Normal: Alternating feet, no rail.
(2) Mild Impairment: Alternating feet, must use rail.
(1) Moderate Impairment: Two feet to a stair, must use rail.
(0) Severe Impairment: Cannot do safely.
TOTAL SCORE: ______
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Falls Efficacy Scale
Name_________________________________
Date__________________________________
On a scale from 1 to 10, with 1 being very confident and 10 being not confident at all,
how confident are you that you do the following activities without falling?
Activity
Score
1 very confident
10 not confident at all
Take a bath or shower
Reach into cabinets or closets
Walk around the house
Prepare meals not requiring carrying
heavy or hot objects
Get in and out of bed
Answer the door or telephone
Get in and out of a chair
Getting dressed and undressed
Personal grooming (i.e. washing
your face)
Getting on and off of the toilet
Total Score
A total score of greater than 70 indicates that the person has a fear of falling
Source: Tinetti, M., Richman, D., Powell, L. (1990). Falls Efficacy as a Measure of Fear of Falling.
Journal of Gerontology. 45;239
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Functional Reach Test
The Functional Reach Test is a single item test
developed as a quick screen for balance
problems in older adults.
Interpretation:
A score of 6 or less indicates a significant increased
risk for falls.
A score between 6-10 inches indicates a moderate
risk for falls.
Age related norms for the functional reach test:
Age
20-40yrs
41-69yrs
70-87
Men
(in inches)
16.7 ± 1.9
14.9 ± 2.2
13.2 ± 1.6
Women
(in inches)
14.6 ± 2.2
13.8 ± 2.2
10.5 ± 3.5
Requirements:
The patient must be able to stand independently for at least 30 seconds without
support, and be able to flex the shoulder to at least 90 degrees.
Equipment and Set up:
A yard stick is attached to a wall at about shoulder height. The patient is positioned in
front of this so that upon flexing the shoulder to 90 degrees, an initial reading on the
yard stick can be taken. The examiner takes a position 5-10 feet away from the patient,
viewing the patient from the side.
Instructions:
Position the patient close to the wall so that they may reach forward along the length of
the yardstick. The patient is instructed stand with feet shoulder distance apart then
make a fist and raise the arm up so that it's parallel to the floor. At this time the
examiner takes an initial reading on the yard stick, usually spotting the knuckle of the
third metacarpal. The patient is instructed to reach forward along the yardstick without
moving the feet. Any reaching strategy is allowed but the hand should remain in a fist.
The therapist takes a reading on the yardstick of the farthest reach attained by the
patient without taking a step. The initial reading is subtracted from the final to obtain the
functional reach score.
References:
Duncan, PW, Weiner DK, Chadler J, Studenske S. Functional reach: A new clinical measure of balance. J Gerontol. 1990;
45:M192.
Duncan, PW, et al: Functional reach: Predictive validity in a sample of elderly male veterans. J Gerontol. 1992; 47:M93.
Mann, GC, et al: Functional reach and single leg stance in patients with peripheral vestibular disorders. J Vestib Res. 1996; 6:343.
Weiner, DK, et al: Does functional reach improve with rehabilitation. Arch Phys Med Rehab. 1993; 74:796.
This and other balance tests can be found at AROM.COM ~ the web address for physical therapy
www.arom.com
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Modified Falls Efficacy Scale*
Administration:
The Modified Falls Efficacy Scale (mFES) can be self-administered or administered via personal
or telephone interview. Larger typeset should be used for self-administration, while an enlarged
version of the rating scale on an index card will facilitate in-person interviews. Regardless of
method of administration, each respondent should be queried concerning their understanding of
instructions, and probed regarding difficulty answering specific items.
Instructions to Participants:
Subjects are asked, “How confident/sure are you that you do each of the activities without
falling?”
Instructions for Scoring:
The mFES scale is a visual analog scale in which items are scored from 0 to 10, with 0 meaning
“not confident/not sure at all,” 5 being “fairly confident/fairly sure,” and 10 being “completely
confident/completely sure.” Total the ratings (possible range = 0 – 140) and divide by 14 to get
each subject’s mFES score. Scores of < 8 indicate fear of falling, 8 or greater indicate lack of
fear.
*Hill KD, Schwarz JA, Kalogeropolous AJ, Gibson, SJ. Fear of Falling Revisited. Arch Phys
Med Rehabil. 1996;77:1025-1029.
-1-
Modified Falls Efficacy Scale*
Instructions: For each statement circle the level of confidence expressed, using the code below.
0= No confidence at all to 10 = Extreme confidence
How confident are you that you can...
1.
Get dressed and undressed
0
1
2
3
4
5
6
7
8
9
10
2.
Prepare a simple meal
0
1
2
3
4
5
6
7
8
9
10
3.
Take a bath or a shower
0
1
2
3
4
5
6
7
8
9
10
4.
Get in/out of a chair
0
1
2
3
4
5
6
7
8
9
10
5.
Get in/out of bed
0
1
2
3
4
5
6
7
8
9
10
6.
Answer the door or telephone
0
1
2
3
4
5
6
7
8
9
10
7.
Walk around the inside of your house
0
1
2
3
4
5
6
7
8
9
10
8.
Reach into cabinets or closets
0
1
2
3
4
5
6
7
8
9
10
9.
Light housekeeping
0
1
2
3
4
5
6
7
8
9
10
10.
Simple shopping
0
1
2
3
4
5
6
7
8
9
10
11.
Using public transportation
0
1
2
3
4
5
6
7
8
9
10
12.
Crossing roads
0
1
2
3
4
5
6
7
8
9
10
13.
Light gardening or hanging out the washing
0
1
2
3
4
5
6
7
8
9
10
14.
Using front or rear steps at home
0
1
2
3
4
5
6
7
8
9
10
…..without falling?
Score = Total _____/14 = ______
*Modified from Hill KD, Schwarz JA, Kalogeropolous AJ, Gibson, SJ. Fear of Falling Revisited. Arch Phys Med Rehabil. 1996;77:1025-1029
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SF-12
1. In general, would you say your health is…
Excellent. . . . . . . . . . . . .. .. .. . . . . . . . 1
Very Good . . . . . .. .. . . . . . . . . . . . . .. . 2
Good . . . . . .. . . . . . . .. . . . . . . .. . . . . 3
Fair . . . . . . .. . . .. . .. .. . . . . . . . . . . . . 4
Poor . . . . .. . . .. . .. . . .. . . . . . .. . . . . . 5
2. The following questions are about activities you might do during a typical day. Does your health now limit you in
these activities? If so, how much?
Yes,
limited a
lot
Yes,
limited a
little
No, not
limited at
all
1
1
2
2
3
3
a. Moderate activities, such as moving
a table, pushing a vacuum cleaner,
bowling, or playing golf?
b. Climbing several flights of stairs?
3. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other
daily activities as a result of your physical health?
a. Accomplished less than you would
like?
b. Were limited in the kind of work or
other daily activities?
All of the
time
Most of the
time
Some of
the time
A little of
the time
None of
the time
1
2
3
4
5
1
2
3
4
5
4. During the past 4 weeks, how much of the time have you had any of the following problems with your work or other
daily activities as a result of any emotional problems (such as depressed or anxious)?
a. Accomplished less than you would
like?
b. Were limited in the kind of work or
other daily activities?
All of the
time
Most of the
time
Some of
the time
A little of
the time
None of
the time
1
2
3
4
5
1
2
3
4
5
5. During the past 4 weeks, how did pain interfere with your normal work (including both work outside the home and
housework)?
Not at all . . . . . . . . . . . . . . . . . . . . 1
A little bit,. . . . . . . . . . . . . . . . . . .2
Moderately . . . . . . . . . . . . . . . . . . 3
Quite a bit. . . . . . . . . . . . . . . . . . . .4
Extremely.. . . . . . . . . .. . . . . . . . .. 5
These questions are about how you feel and how things have been with you during the past 4 weeks. For each question,
please give the one answer that comes closest to the way you have been feeling.
6. How much of the time during the past 4 weeks…
a. Have you felt calm and peaceful?
b. Did you have a lot of energy?
c. Have you felt downhearted and
depressed?
All
of the
time
1
1
Most
of the
time
2
2
A
good
bit
of the
time
3
3
1
2
3
Some
of the
Time
4
4
A
little
of
the
time
5
5
None
of
the
time
6
6
4
5
6
7. During the past 4 weeks, how much of the time has your physical health or emptional problems interfered with your
social activities (like visiting friends, relatives, etc.)?
All of the time. . . . . . .. . . . . . . . . . . . 1
Most of the time,. . …. . . . . . . . . . . . . .2
Some of the time …. . . . . . . . . . . . . . . 3
A little of the time. . . . . . . . . . . . . . . . . 4
None of the time. . . . . . . . .. . . . . . . . .. 5
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SF-20
1. In general, would you say your health is…
Excellent. . . . . . . . . . . . .. .. .. . . . . . . . 1
Very Good . . . . . .. .. . . . . . . . . . . . . .. . 2
Good . . . . . .. . . . . . . .. . . . . . . .. . . . . 3
Fair . . . . . . .. . . .. . .. .. . . . . . . . . . . . . 4
Poor . . . . .. . . .. . .. . . .. . . . . . .. . . . . . 5
2. For how long (if at all) has your health limited you in each of the following activities?
a. The kinds or amounts of vigorous
activities you can do, like lifting
heavy objects, running, or
participating in strenuous sports?
b. The kinds or amounts of moderate
activities, like moving a table,
carrying groceries, or bowling?
c. Walking uphill or climbing a few
flights of stairs?
d. Bending, lifting or stooping?
e. Walking one block?
f. Eating, dressing, bathing or using the
toilet?
Limited
for more
than 3
months
Limited
for 3
months
or less
Not limited
at all
1
2
3
1
2
3
1
1
1
2
2
2
3
3
3
1
2
3
3. How much bodily pain have you had during the past 4 weeks? Would you say…
None . . . . . . . . . . . . . . . . . . . . . . . 1
Very mild,. . . . . . . . . . . . . . . . . . .2
Mild,. . . . . . . . . . . . . . . . . . . . . . . .3
Moderate . . . . . . . . . . . . . . . . . . . .4
Severe, or. . . . . . . . . . . . . . . . . . . .5
Very severe?. . . . . . . . .. . . . . . . . .6
4. Does your health keep you from working at a job, doing work around the house, or going to school?
YES, for more than 3 months . . . . 1
YES, for 3 months or less . . . . . . 2
NO. . . . . . . . . . . . . . . . . . . . . . . . .3
5. Have you been unable to do certain kinds or amounts of work, housework, or schoolwork because of your health?
YES, for more than 3 months . . . . 1
YES, for 3 months or less . . . . . . 2
NO. . . . . . . . . . . . . . . . . . . . . . . . .3
For each of the following questions, please give the one answer that comes closest to the way you have been feeling during
the past month.
9. How much of the time during the past month…
All
of the
time
Most
of the
time
A
good
bit
of the
time
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
1
2
2
3
3
4
4
5
5
6
6
1
2
3
4
5
6
a. Has your health limited your
social activities, like visiting
friends or close relatives?
b. Have you been a very nervous
person?
c. Have you felt calm and
peaceful?
d. Have you felt downhearted and
blue?
e. Have you been a happy person?
f. Have you felt so down in the
dumps that nothing could cheer
you up?
Some
of the
Time
A
little
of
the
time
None
of the
time
11. How true or false is each of the following statements for you?
a.
b.
c.
d.
I am somewhat ill
I am as healthy as anybody I know
My health is excellent
I have been feeling bad lately
Definitely
True
1
1
1
1
Mostly
True
2
2
2
2
Mostly
False
4
4
4
4
Definitely
False
5
5
5
5
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Survey of Activities and Fear of Falling in the Elderly (SAFFE)
1) Do you currently…
a. Go to the store?
b. Prepare simple meals?
c. Take a tub bath?
d. Get out of bed?
e. Take a walk for exercise?
f. Go out when it is slippery?
g. Visit a friend or relative?
h. Reach for something over your head?
i. Go to a place with crowds?
j. Walk several blocks outside?
k. Bend down to get something?
IF RESPONDENT ANSWERED “YES” TO ANY OF THE ABOVE (a THRU k), FOLLOW UP WITH:
2) When you _____, how worried are you that you might fall?
3) Do you not _____ because you are _____ that you might fall?
4) Are there other reasons why you do not _____?
5) What are the reasons that you do not_____?
6) Compared to 5 years ago, would you say that you are ______?
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Timed chair stand test
Critical issues
No previous international recommendations for standardized protocol exist
Exclusion criteria
Equipment
Stopwatch
Armless chair (height: 45 cm) with straight back
Procedure
Participant should be sitting on the chair with his/her feet on the
floor.
Participant is asked to rise from the chair without the help of
his/her arms.
The success is recorded. If successful, the participant can
proceed to the next step of chair rises.
Participant is asked to sit down again, with feet on the floor.
Participant is asked to rise from the chair without the help of
his/her arms (arms folded across chest), 10 times.
Time to complete 10 rises is recorded. If the person cannot
complete 10 rises, the number of completed rises is recorded.
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Timed “Up and Go”*
Directions:
The timed “Up and Go” test measures, in seconds, the time taken by an individual to stand up
from a standard arm chair (approximate seat height of 46 cm, arm height 65 cm), walk a distance
of 3 meters (approximately 10 feet), turn, walk back to the chair, and sit down. The subject wears
their regular footwear and uses their customary walking aid (none, cane, walker). No physical
assistance is given. They start with their back against the chair, their arms resting on the
armrests, and their walking aid at hand. They are instructed that, on the word “go” they are to get
up and walk at a comfortable and safe pace to a line on the floor 3 meters away, turn, return to
the chair and sit down again. The subject walks through the test once before being timed in order
to become familiar with the test. Either a stopwatch or a wristwatch with a second hand can be
used to time the trial.
Instructions to the patient:
“When I say ‘go’ I want you to stand up and walk to the line, turn and then walk back to the
chair and sit down again. Walk at your normal pace.”
Variations:
You may have the patient walk at a fast pace to see how quickly they can ambulate. Also you
could have them turn to the left and to the right to test any differences.
*Podsiadlo D, Richardson S. The timed “up and go”: a test of basic functional mobility for frail
elderly persons. JAGS 1991; 39: 142-148.
INSTRUMENT GUIDE FOR HEART DISEASE-SPECIFIC PROGRAMS
Instruments preceded by an asterisk (*) and bolded are common to a number of
conditions and can be found in the Cross-Cutting Instruments Guide
Important Note: While rigorous research was conducted to provide readers with all of the instrumentation
for implementing the programs outlined in this toolkit, for a limited number of programs, instrumentation
was not available for public use. Therefore, interested parties are encouraged to contact selected programs
to obtain permission for instruments not included here.
Instrument
Program
Congregate Meals Survey
* Fat-Related Diet Habits Questionnaire
• Eat Better Move More
Modified Baecke Questionnaire For Older Adults
• Eat Better Move More
Nutritional Screening Initiative (NSI) Checklist
Yale Physical Activity Survey
Including response cards
• Project Joy
• Eat Better Move More
• Project Joy
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ToC
POMP 5 CONGREGATE MEALS
EXTENDED CORE SURVEY
(PHONE VERSION: April 19, 2004)
I would like to ask you some questions about the nutrition program that you receive.
1.
During a typical week, how many days do you eat at the [NAME OF NUTRITION SITE]?
Enter # of days per week in this space.
2.
|___|
Please tell me how many meals you eat every day, including meals provided at a nutrition site?
1 meal………………………………………………………...
2 meals……………………………………………………….
3 meals……………………………………………………….
More than 3 meals……………………………………….….
Other……………………………………….….……………...
[Please describe______________________________]
3.
1
2
3
4
5
Think about the meal you get at the [NAME OF NUTRITION SITE] compared to all the other food you
usually eat each day. Please tell me whether the meal you get from the nutrition program is:
Less than 1/3 of the food you usually eat each day………………...…
About 1/3 of the food you usually eat each day……………………….
About 1/2 of the food you usually eat each day…………………….....
More than 1/2 of the food you usually eat each day……………………
4.
1
2
3
4
Now think about the days when you don’t have a meal at the [NAME OF NUTRITION SITE].
Do you eat:
About the same amount of food?…………………………… 1
More food?…………………………………………………..… 2
Less food?………………………………………………….…. 3
For Office Use:
Agency:________________________________________
State:_______________
Client ID:_______________________________________
Date:_______________
1
Self Administered …
Telephone …
Other …
5.
Let’s talk about the period of time about a month before you started the nutrition program. I am going
to read a number of ways you may have gotten your meals during that time. Please tell me whether
this was true most of the time, sometimes, or almost never.
□ CHECK THIS BOX, IF RESPONDENT DOES NOT REMEMBER.
a.
[READ EACH STATEMENT & REPEAT RESPONSES AS
NEEDED]
I cooked for myself.
b.
Family or friends provided me with meals.
1
2
3
c.
I ate at restaurants.
1
2
3
d.
I ate meals that were easy to fix like sandwiches,
microwavable meals, or soups.
1
2
3
e.
I ate meals that were ready to eat right out of the package.
1
2
3
f.
I skipped meals or ate less food.
1
2
3
g.
I saved food from other meals.
1
2
3
h.
Other, please explain
_______________________________________________
2
Most of
the time
1
Sometimes
2
Almost
never
3
6.
7.
Now I’m going to read some things that many people do for meals on the days when the [NAME OF
NUTRITION SITE] is not open, such as on weekends or holidays. Please tell me whether this was
true for you most of the time, sometimes, or almost never.
Most of
the time
1
Sometimes
2
Almost
never
3
a.
Family or friends provide me with meals.
b.
I eat meals that are easy to fix like sandwiches,
microwavable meals, or soups.
1
2
3
c.
I eat meals that are ready to eat right out of the package.
1
2
3
d.
I use the emergency packs they provide (Emergency
packs are for days when delivery is cancelled because of
inclement weather.)
1
2
3
e.
I skip meals or eat less food.
1
2
3
f.
I save food from other meals.
1
2
3
g.
Other, please explain
______________________________________________
Do you always have enough money or food stamps to buy the food you need?
Yes…………………………………………………………….
No……………………………………………………………..
1
2
Please answer the following questions by circling the response that best represents the amount and
type of food you usually eat.
8.
How many servings of fruit do you usually eat every day?
(1 serving = 1 piece; 1/2 cup chopped, cooked, or canned fruit; or 3/4 cup of juice)
0 servings………………………………………………….…
1 serving……………………………………………………..
2 servings………………………………………………….…
3 or more servings…………………………………………..
9.
1
2
3
4
When you eat the congregate meals, do you usually eat the fruit that is provided?
Yes…………………………………………………………….
No……………………………………………………………..
3
1
2
10.
How many servings of potatoes do you usually eat each day?
(1 serving = 1 small baked potato; 1/2 c mashed or boiled; 10 french fries; 1/2 c hashed browns)
0 servings…………………………………………………….
1 serving…………………………………………………..…
2 servings…………………………………………………….
3 or more servings…………………………………………..
11.
When you eat the congregate meals, do you usually eat the potatoes that are provided?
Yes…………………………………………………………….
No……………………………………………………………..
12.
1
2
How many servings of bread, cereal, rice, pasta, noodles, and tortillas do you usually eat
every day? (1 serving = 1 piece bread or tortilla; or 1/2 cup cereal, rice, pasta, noodles)
0 servings…………………………………………………….
1 – 2 servings………………………………………………..
3 – 5 servings………………………………………………..
6 or more servings…………………………………………..
15.
1
2
3
4
Other than potatoes, when you eat the congregate meals, do you usually eat the vegetables
that are provided?
Yes…………………………………………………………….
No……………………………………………………………..
14.
1
2
Other than potatoes, how many servings of vegetables do you usually eat every day?
(1 serving = 1 cup raw salad greens; 1/2 cup cooked or chopped raw vegetables; or 3/4 cup juice)
0 servings…………………………………………………….
1 serving……………………………………………………...
2 servings…………………………………………………….
3 or more servings…………………………………………..
13.
1
2
3
4
1
2
3
4
When you eat the congregate meals, do you usually eat the bread, cereal, rice, pasta,
noodles, or tortillas that are provided?
Yes…………………………………………………………….
No……………………………………………………………..
4
1
2
16.
How many servings of milk, cheese, yogurt, and calcium rich soy products do you usually
eat every day? (1 serving = 1 cup milk or yogurt; or 1 piece or slice of cheese)
0 servings………………………………………………….…
1 serving……………………………………………………...
2 servings…………………………………………………….
3 or more servings…………………………………………..
17.
When you eat the congregate meals, do you usually eat the milk, cheese, yogurt, or calcium
rich soy products that are provided?
Yes……………………………………………………………
No……………………………………………………………..
18.
1
2
How many servings of nuts, soy products, and beans (such as baked beans, pintos, kidney
beans, lima beans soybeans, or black-eyed peas) do you usually eat every day? (1 serving =
1-2 cups of beans or tofu; 4-6 tablespoons of peanut butter; and 1/2-1cup of nuts)
0 servings…………………………………………………….
1 serving…………………………………………………..…
2 servings………………………………………………….…
3 or more servings…………………………………………..
21.
1
2
3
4
When you eat the congregate meals, do you usually eat the meat, chicken, fish, or eggs that
are provided?
Yes……………………………………………………………
No……………………………………………………………..
20.
1
2
How many servings of meat, chicken, fish, and eggs do you usually eat every day? (1 serving
= 1 small piece, such as a small chicken breast, hamburger patty, or fish fillet; or 2-3 eggs)
0 servings………………………………………………….…
1 serving……………………………………………………..
2 servings………………………………………………….…
3 or more servings…………………………………………..
19.
1
2
3
4
1
2
3
4
When you eat the congregate meals, do you usually eat the nuts, soy products, or beans if
they are provided?
Yes………………………………………………………….…
No……………………………………………………………...
5
1
2
22.
Think about all the water or other non-alcoholic fluids you usually drink. How many glasses do
you usually drink per day?
0 servings……………………………………………………..
1 – 4 glasses…………………………………………………
5 – 7 glasses…………………………………………………
8 or more glasses……………………………………………
23.
1
2
3
4
I’m going to read some statements about the nutrition program. Please choose one of the following
options: yes, definitely; yes, I think so; I’m not sure; no, I don’t think so; or no, definitely not.
As a result of the nutrition program.....
Yes
Yes, I
[READ EACH STATEMENT & REPEAT
definitely think so
RESPONSES AS NEEDED]
a. I eat a healthier variety of food.
1
2
No,
I’m not No, I don’t definitely
not
sure
think so
3
4
5
Not
applicable
-1
b. I am better able to follow the special diet
that is prescribed by my doctor or
dietitian.
1
2
3
4
5
-1
c. I eat less salt (sodium).
1
2
3
4
5
-1
d. I eat less high fat foods.
1
2
3
4
5
-1
e. I can achieve or maintain a healthy
weight.
1
2
3
4
5
-1
f. I believe my health has improved and I
feel better.
1
2
3
4
5
-1
g. I am less hungry throughout the day.
1
2
3
4
5
-1
h. I can continue to live in my own home.
1
2
3
4
5
-1
6
24.
Now I want you to think of all the nutrition education information you have received through the
nutrition program. I am going to read some statements about the nutrition education information and I
want you to choose one of the following options: yes, definitely; yes, I think so; I’m not sure; no, I
don’t think so; or no, definitely not. [IF THE RESPONDENT HAS NOT PARTICIPATED IN ANY
NUTRITION EDUCATION AT THE SITE, CIRCLE NOT APPLICABLE.]
As a result of the nutrition education information I received…
[READ EACH STATEMENT &
REPEAT RESPONSES AS NEEDED]
a. I make healthier food choices.
b. I handle or store food more safely.
c.
I have shortened the time I let cooked
food stay outside the refrigerator.
d. I know what to eat for my health
conditions.
25.
Yes
definitely
1
Yes, I
think
so
2
I’m
not
sure
3
No, I
don’t
think so
4
No,
definitely
not
5
Not
applicable
-1
1
2
3
4
5
-1
1
2
3
4
5
-1
1
2
3
4
5
-1
Would you recommend this program to your friends, neighbors, and relatives?
Yes………………………………………...
No………………………………………….
Not Sure…………………………………..
7
1
2
3
26.
Now I’m going to read a list of services that may be offered through the nutrition program. Please tell
me which of these you have received.
Yes
1
No
2
b. Legal Help
1
2
c. Nutrition Counseling
1
2
d. Transportation
1
2
e. Help with shopping
1
2
f.
Help with personal care
1
2
g. Help with housekeeping
1
2
h. Help with cooking
1
2
Help getting benefits like food stamps and other public
assistance
1
2
Help paying for prescription drugs
1
2
k. None
1
2
l.
1
2
a. Case Management
i.
j.
27.
Other
(Describe) ______________________________________
Have your social opportunities increased since you became involved with the nutrition program
at [NAME OF NUTRITION SITE]?
Yes………………………………………...
No………………………………………….
28.
1
2
How would you rate nutrition program overall? Would you say….
Excellent…………………………………………….
Very Good …………………………………………
Good…………………………………………………
Fair, or………………………………………………
Poor………………………………………………….
8
1
2
3
4
5
29.
In general, would you say your health is excellent, very good, good, fair, or poor?
Excellent…………………………………………….
Very Good …………………………………………
Good…………………………………………………
Fair, or………………………………………………
Poor………………………………………………….
30.
1
2
3
4
5
Do you have any suggestions that would make the nutrition program better?
[RECORD SUGGESTIONS VERBATIM]
9
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Modified Baecke Questionnaire For Older Adults
1. How many flights of stairs do you walk up per day? One flight is 10 steps.
a. I never walk stairs
b. 1-5
c. 6-10
d. More than 10
2. If you go somewhere in your hometown, what kind of transportation do you use?
a. I never go out
b. Car
c. Public transportation
d. Bicycle
e. Walking
3. If you go out for shopping, what kind of transportation do you use?
a. I never go out
b. Car
c. Public transportation
d. Bicycle
e. Walking
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Determine Your Nutritional Health
The Warning Signs of poor nutritional health are often overlooked. Use this checklist to find
out if you or someone you know is at nutritional risk.
Read the statements below. Add up the numbers in the "YES" column for those that apply
for you.
YES
I have an illness or condition that made me change the kind and / or amount of food I
eat.
2
I eat fewer than 2 meals per day.
3
I eat few fruits or vegetables, or milk products.
2
I have 3 or more drinks of beer, liquor or wine almost every day.
2
I have tooth or mouth problems that make it hard for me to eat.
2
I don't always have enough money to buy the food I need.
4
I eat alone most of the time.
1
I take 2 or more different prescribed or over-the-counter drugs a day.
1
Without wanting to, I have lost or gained 10 pounds in the last 6 months.
2
I am not always physically able to shop, cook and / or feed myself.
2
Total
Total your Nutritional Score:
If it’s-
0-2
GOOD! Recheck your nutritional score in 6 months
3-5
You are at Moderate nutritional risk. See what can be done to
improve your eating habits and lifestyle. Your office on aging,
senior nutrition program, senior citizens center or health department can
help. Check your score again in 3 months
6 or more
You are at high nutritional risk Bring this checklist the next time you see
your doctor, dietitian or other qualified health or social service
professional. Talk to them about any problems you may have. Ask for
help to improve your nutritional health.
Remember that Warning Signs suggest risk, but do not represent a diagnosis of any condition. Turn to the page to learn more
about the Warning Signs of poor nutritional health.
The Nutrition Checklist is based on the Warning Signs described below.
Use the word DETERMINE to remind you of the Warning Signs.
Any disease, illness or chronic condition which causes you to change the way you eat, or makes it
hard for you to eat, puts your nutritional health at risk. Four out of five adults have chronic
diseases that are affected by diet. Confusion or memory loss that keeps getting worse is estimated
to affect one out of five or more older adults. This can make it hard to remember what, when or if
you've eaten. Feeling sad or depressed, which happens to about one in eight older adults, can
cause big changes in appetite, digestion, energy level, weight and well-being.
Eating too little and eating too much both lead to poor health. Eating the same foods day after day
or not eating fruits and vegetables, and milk products daily will also cause poor nutritional health.
One in five adults skip meals daily. Only 13% of adults eat the minimum amount of fruits and
vegetables needed. One in four older adults drink too much alcohol. Many health problems
become worse if you drink more than one or two alcoholic beverages per day.
A healthy mouth, teeth and gums are needed to eat. Missing, loose, or rotten teeth or dentures
which don't fit well or cause mouth sores make it hard to eat.
As many as 40% of older Americans have incomes of less than $6,000 per year. Having less -- or
chosing to spend less -- than $25-30 per week for food makes it very hard to get the foods you
need to stay healthy.
One-third of all older people live alone. Being with people daily has a positive effect on morale,
well-being and eating.
Many older Americans must take medicines for health problems. Almost half of older Americans
take multiple medicines daily. Growing old may change the way we respond to drugs. The more
medicines you take, the greater the chance for side effects such as increased or decreased appetite,
change in taste, constipation, weakness, drowsiness, diarrhea, nausea, and others. Vitamins or
minerals when taken in large doses act like drugs and can cause harm. Alert your doctor to
everything you take.
Losing or gaining a lot of weight when you are not trying to do so is an important warning sign
that must not be ignored. Being overweight also increases your chance of poor health.
Although most older people are able to eat, one of every five have trouble walking, shopping,
buying and cooking food, especially as they get older.
Most older people lead full and productive lives. But as age increases, risk of frailty and health
problems increase. Checking your nutritional health regularly makes good sense.
———————
Reprinted with permission from the Nutrition Screening Initiative, a project of the American Academy of
Family Physicians, the American Dietetic Association and the National Council on the Aging, Inc., and funded
in part by a grant from Ross Products Division, Abbott Laboratories.
APPENDIX 100
PRIOR AUTHORIZATION REQUEST, DMA-80
Instructions
Community Care Services Program
NUTRITIONAL SCREENING INITIATIVE (NSI) NUTRITIONAL HEALTH
CHECKLIST
Purpose: The purpose of the NSI Checklist is to identify individuals who are at high risk of
nutritional problems or who have poor nutritional status.
Who Completes/ When Completed: The care coordinator completes the NSI in CHAT at initial
assessment and reassessments. Should the client’s condition or situation change, the care
coordinator, completes the NSI, as needed, between reassessments.
NOTE: Referral sources include but are not limited to physicians, dietitians or other health
professionals, social services, oral health, mental health, nutrition education, support or
counseling services.
Instructions:
For each of the ten statements, read and circle the appropriate number in the “Yes” column which
describes each client/ client representative response. Total the numbers circled to identify the
client’s nutritional score.
Based on the total score, make the appropriate referrals, if indicated, as suggested in the reference
- Nutrition Interventions Manual for Professionals Caring for Older Americans Executive
Summary 1992. Document all activity relative to the NSI checklist referral, such as follow-up and
outcome results. Complete the NSI checklist as needed.
Distribution: A copy is filed in the client’s case record along with documentation regarding any
deviation from normal, specific instructions or referral information.
MT 2008-1 07/07
Appendix 100 page 118
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1
YALE PHYSICAL ACTIVITY SURVEY FOR OLDER ADULTS
Interviewer: Please hand the subject the list of activities (Card #1) while reading the following
statement.
Here is a list of common types of physical activities. Please tell me which of them you did
during a typical week in the last month. Our interest is learning about the types of physical
activity that are a part of your regular work and leisure routines.
For each activity you do, please tell me how much time (hours) you spend doing this activity
during a typical week.
Work
Time
(Hrs/wk)
Shopping
Intensity
Code
(Kcal/min)
3.5
Laundry (time loading, unloading, hanging, folding;
consider 1 load takes 15 minutes)
3.0
Light housework: tidying, dusting, sweeping, collecting
trash in home; polishing, indoor gardening;
ironing
3.0
Heavy housework: vacuuming, mopping; scrubbing floors
and walls; moving furniture, boxes, or
garbage cans
4.5
Food preparation (10+ minutes in duration): chopping, stirring
moving about to get food items, pans
2.5
Food service (10+ minutes in duration): setting table; carrying
food; serving food
2.5
Dish washing (10+ minutes in duration): clearing table;
washing/drying dishes, putting dishes away
2.5
Light home repair: small appliance repair; light home maintenance
3.0
Heavy home repair: painting, carpentry, washing/polishing car
5.5
Other:
2
Time
(Hrs/wk)
Intensity
Code
(Kcal/min)
Yardwork
Gardening: planting, weeding, digging, hoeing
4.5
Lawn mowing (walking only)
4.5
Clearing walks/driveway: sweeping, shoveling, raking
5.0
Other:
Caretaking
Older or disabled person (lifting, pushing wheelchair)
5.5
Childcare (lifting, carrying, pushing stroller)
4.0
Exercise
Brisk walking (10+ minutes in duration)
6.0
Pool exercises, stretching, yoga
3.0
Vigorous calisthenics, aerobics
6.0
Cycling, exercycle
6.0
Swimming (laps only)
6.0
Other:
Recreational Activities
Leisurely walking (10+ minutes in duration)
3.5
Dancing (moderate/fast): line, ballroom, tap, square
5.5
Bowling, Bocci ball
3.0
Golf (walking to each hole only)
5.0
Racquet sports: tennis, racquet ball
7.0
Other:
3
Interviewer: (Please read the following to the subject)
I would now like to ask you about certain types of activities that you have done during the past
month. I will ask you about how much vigorous activity, leisurely walking, sitting, standing, and
some other things that you usually do.
1.
About how many times during the month did you participate in vigorous activities that
lasted at least 10 minutes and caused large increases in breathing, heart rate, or leg fatigue or
caused you to perspire? (Hand subject Card #2.)
SCORE:
0 = Not at all (go to Question 3)
1 = 1 - 3 times per month
2 = 1 - 2 times per week
3 = 3 - 4 times per week
4 = 5+ times per week
7 = refused
8 = don’t know
FREQUENCY SCORE =
2.
About how long do you do this vigorous activity(ies) each time? (Hand subject Card #3.)
SCORE:
0 = Not applicable
1 = 10 - 30 minutes
2 = 31 - 60 minutes
3 = 60+ minutes
7 = refused
8 = don’t know
DURATION SCORE =
VIGOROUS ACTIVITY INDEX SCORE:
FREQUENCY SCORE * DURATION SCORE * 5 =
(Responses 7 or 8 are scored as missing)
4
3.
Think about the walks you have taken during the past month. About how many times per
month did you walk for at least 10 minutes or more without stopping which was not strenuous
enough to cause large increases in breathing, heart rate, or leg fatigure or cause you to perspire?
(Hand subject Card #2.)
SCORE:
0 = Not at all (go to Question 5)
1 = 1 - 3 times per month
2 = 1 - 2 times per week
3 = 3 - 4 times per week
4 = 5+ times per week
7 = refused
8 = don’t know
FREQUENCY SCORE =
4.
#3.)
When you did this walking, for how many minutes did you do it? (Hand subject Card
SCORE:
0 = Not applicable
1 = 10 - 30 minutes
2 = 31 - 60 minutes
3 = 60+ minutes
7 = refused
8 = don’t know
DURATION SCORE =
LEISURELY WALKING INDEX SCORE:
FREQUENCY SCORE * DURATION SCORE * 4 =
(Responses 7 or 8 are scored as missing)
5.
About how many hours a day do you spend moving around on your feet while doing
things? Please report only the time that you are actually moving. (Hand subject Card #4.)
SCORE:
0 = Not at all
1 = less than 1 hour per day
2 = 1 to less than 3 hours per day
3 = 3 to less than 5 hours per day
4 = 5 to less than 7 hours per day
5 = 7+ hours per day
7 = refused
8 = don’t know
MOVING SCORE =
MOVING INDEX SCORE = MOVING SCORE * 3 =
(Responses 7 or 8 are scored as missing)
6.
Think about how much time you spend standing or moving around on your feet on an
average day during the past month. About how many hours per day do you stand? (Hand subject
Card #4.)
5
SCORE:
0 = Not at all
1 = less than 1 hour per day
2 = 1 to less than 3 hours per day
3 = 3 to less than 5 hours per day
4 = 5 to less than 7 hours per day
5 = 7+ hours per day
7 = refused
8 = don’t know
STANDING SCORE =
STANDING INDEX SCORE = STANDING SCORE * 2 =
(Responses 7 or 8 are scored as missing)
7.
About how many hours did you spend sitting on an average day during the past month
(Hand the subject card #5)
SCORE:
0 = Not at all
1 = less than 3 hours
2 = 3 hours to less than 6 hours
3 = 6 hours to less than 8 hours
4 = 8+ hours
7 = refused
8 = don’t know
SITTING SCORE =
SITTING INDEX SCORE = SITTING SCORE * 1 =
(Responses 7 or 8 are scored as missing)
8.
About how many flights of stairs do you climb up each day?
(let 10 steps = 1 flight.)
9.
Please compare the amount of physical activity that you do during other seasons of the
year with the amount of activity you just reported for a typical week in the past month. For
example, in the summer, do you do more or less activity than what you reported doing in the past
month? (Interviewer: Please circle the appropriate score for each season.)
Spring
Summer
Fall
Winter
Lot more
1.30
1.30
1.30
1.30
Little more
1.15
1.15
1.15
1.15
Same
1.00
1.00
1.00
1.00
Little less
0.85
0.85
0.85
0.85
Lot less
0.70
0.70
0.70
0.70
SEASONAL ADJUSTMENT SCORE = SUM OVER ALL SEASONS/4 =
Don’t know
.
.
.
.
YALE PHYSICAL ACTIVITY SURVEY
CARD #1
WEEKLY PHYSICAL ACTIVITIES
Work
Shopping (e.g., grocery, clothes)
Laundry
Light Housework:
tidying, dusting, sweeping,
collecting garbage in home, polishing,
indoor gardening, ironing
Heavy Housework:
vacuuming, mopping, scrubbing floors
and walls, moving furniture, moving
boxes or garbage cans
Food Preparation (10+ minutes):
chopping, stirring, moving around to
get food items, pots or pans
Food Service (10+ minutes):
setting table, carrying food, serving
food
Dish Washing (10+ minutes):
clearing table, washing and drying
dishes, putting dishes away
Light Home Repair:
small appliance repair, light household
maintenance and repair tasks
Heavy Home Repair:
painting, washing and polishing car,
carpentry
Other:
Card #1, page 2
Yardwork
Gardening:
pruning, planting, weeding, hoeing,
digging
Lawn Mowing (walking only)
Clearing Walks and Driveway:
raking, shoveling, sweeping
Other:
Caretaking
Older or Disabled Person:
lifting, pushing wheelchair
Childcare:
lifting, pushing stroller
Exercise
Brisk walking for exercise (10+ min)
causes large increases in heart rate,
breathing or leg fatigue
Stretching exercises, yoga,
pool exercise
Vigorous calisthenics, aerobics:
causes large increases in heart rate,
breathing or leg fatigue
Cycling, exercycle
Lap swimming
Other:
Card #1, page 3
Recreational Activities
Leisurely walking (10+ minutes)
Hiking
Dancing (moderate/fast)
line dancing, ballroom, square, tap
Bowling, Boccie Ball
Golf (walking to each hole only)
Racquet Sports:
Other:
tennis, racquetball
YALE PHYSICAL ACTIVITY SURVEY
CARD #2
Not at all
1 - 3 times per month
1 - 2 times per week
3 - 4 times per week
5 or more times per week
Don't know
YALE PHYSICAL ACTIVITY SURVEY
CARD #3
10 - 30 minutes
31 - 60 minutes
60 or more minutes
Don't know
YALE PHYSICAL ACTIVITY SURVEY
CARD #4
Not at all
Less than 1 hour per day
1 to less than 3 hours per day
3 to less than 5 hours per day
5 to less than 7 hours per day
7 or more hours per day
Don't know
YALE PHYSICAL ACTIVITY SURVEY
CARD #5
Not at all
Less than 3 hours per day
3 hours to less than 6 hours per day
6 hours to less than 8 hours per day
8 or more hours per day
Don't know
INSTRUMENT GUIDE FOR OBESITY-SPECIFIC PROGRAMS
You may consult the Instrument Guides for the specific instrumentation related to the
evidence-based programs below that would be appropriate for older adults with obesity.
Condition
Program Name
•
Diabetes Education & Prevention with a Lifestyle Intervention Offered at
the YMCA (DEPLOY)
Diabetes
•
Diabetes Prevention Program (DPP)
•
Eat Better Move More
Diabetes
•
Group Lifestyle Balance (GLB)
Diabetes
Heart Disease
BROOKDALE
DEMONSTRATION
INITIATIVE IN
HEALTHY URBAN
AGING:
BRIDGING THE
DIVIDE BETWEEN
PUBLIC HEALTH &
HEALTHY AGING
EVIDENCE-BASED
TOOLKIT:
Cross-Cutting
Instruments
PREPARED FOR:
THE COMMISIONER
NEW YORK CITY
DEPARTMENT FOR
THE AGING
LILLIAM BARRIOS-PAOLI
COMMISSIONER
APRIL 2010
FUNDING PROVIDED BY:
OFFICE OF THE MAYOR
CITY OF NEW YORK
MICHAEL R. BLOOMBERG
MAYOR
CREATED BY:
THE BROOKDALE
CENTER FOR HEALTHY
AGING & LONGEVITY
OF HUNTER COLLEGE/
CUNY
3
6 Minute Walk Test
•Tab 1
CES-D Scale
•Tab 2
CHAMPS - English
and Spanish with
manuals
•Tab 3
Fat Related Diet
Habits
Questionnaire
•Tab 4
PASE
•Tab 5
SF-36 and scoring
guide
•Tab 6
Sickness Impact
Profile
•Tab 7
CROSS-CUTTING INSTRUMENTS GUIDE
Instrument
6-Minute Walk Test
Center for Epidemiologic Studies-Depression (CES-D) Scale
Community Health Activities Model Program for Seniors
(CHAMPS) Activity Questionnaire
English & Spanish versions, including manual and
scoring guide
Fat-Related Diet Habits Questionnaire
Physical Activity Scale for the Elderly (PASE)
Short Form-36 Health Survey (SF-36)
Including scoring guide
Sickness Impact Profile (SIP)
Condition
• Arthritis
• Falls
• Arthritis
• Depression
• Falls
• Arthritis
• Depression
• Diabetes
• Diabetes
• Heart Disease
• Arthritis
• Falls
• Depression
• Falls
• Arthritis
• Falls
ToC
6-Minute Walk Test
Description: The 6-Minute Walk test is a measure of endurance.
Equipment: stopwatch, rolling tape measure, track/loop walkway
Instructions: Monitor vital signs before and after each test if indicated. Assure patient
safety throughout the test. Give the same verbal instructions each time. “When I say ‘go’,
I want you to walk around this [track]. Keep walking until I say ‘stop’ or until you are too
tired to go any further. If you need to rest, you can stop until you feel ready to go again. I
am interested in measuring how far you can walk. You can begin when I say ‘go’.” Time
the subject for 6 minutes, then say ‘stop’. Measure the distance walked.
Stop testing based on the following criteria:
1. C/o angina symptoms (chest pain or tightness)
2. Any of the following symptoms:
a. Light-headedness
b. Confusion
c. Ataxia, staggering unsteadiness
d. Pallor
e. Cyanosis
f. Nausea
g. Marked dyspnea
h. Unusual fatigue
i. Signs of peripheral circulatory insufficiency
j. Claudication or other significant pain
k. Facial expressions signifying distress
3. Abnormal cardiac responses
a. Systolic blood pressure drops > 10 mmHg
b. Systolic blood pressure rises < 250 mmHg
c. Diastolic blood pressure rises to > 120 mmHg
d. Heart rate drops more than 15 beats per minute (given the subject was
walking the last minutes of the test versus resting)
Notify physician if test is terminated for any of the above reasons
6-Minute Walk Test Distances: Means and Standard Deviations by Age and Gender (Meters)
Age
60-69
70-79
80-89
Gender
(N)
Male (15)
Female (22)
Male (14)
Female (22)
Male (8)
Female (15)
Mean
SD
572
538
527
471
417
392
92
92
85
75
73
85
Normal Range
(2SD)
388-756
354-722
357-697
321-621
271-563
222-562
Steffen, T.M. (2000) Functional assessment: A literature review of four tools. Focus: Geriatric
Physical Therapy: An Independent Home Study Course for Individual Continuing Education.
ToC
Center for Epidemiologic Studies Depression Scale (CES-D), NIMH
Below is a list of the ways you might have felt or behaved. Please tell me how often you have felt this way during the past week.
During the Past
Week
Rarely or none of
the time (less than
1 day )
Some or a
little of the
time (1-2
days)
Occasionally or a
Most or all of
moderate amount of time the time (5-7
(3-4 days)
days)
1. I was bothered by things that usually
don’t bother me.
2. I did not feel like eating; my appetite
was poor.
3. I felt that I could not shake off the
blues even with help from my family or
friends.
4. I felt I was just as good as other
people.
5. I had trouble keeping my mind on
what I was doing.
6. I felt depressed.
7. I felt that everything I did was an
effort.
8. I felt hopeful about the future.
9. I thought my life had been a failure.
10. I felt fearful.
11. My sleep was restless.
12. I was happy.
13. I talked less than usual.
14. I felt lonely.
15. People were unfriendly.
16. I enjoyed life.
17. I had crying spells.
18. I felt sad.
19. I felt that people dislike me.
20. I could not get “going.”
SCORING: zero for answers in the first column, 1 for answers in the second column, 2 for answers in the third column, 3 for
answers in the fourth column. The scoring of positive items is reversed. Possible range of scores is zero to 60, with the higher
scores indicating the presence of more symptomatology.
ToC
CHAMPS Activities Questionnaire for Older Adults
Date:_________________________________
CHAMPS: Community Healthy Activities Model Program for Seniors
Institute for Health & Aging, University of California San Francisco
Stanford Center for Research in Disease Prevention, Stanford University
(11/06/00) © Copyright 1998
Do not reproduce without permission of the CHAMPS staff
Contact: Anita L. Stewart, Ph.D., UCSF, [email protected]
Name or ID:___________________________
This questionnaire is about activities that you may have done in the past 4 weeks. The questions on the
following pages are similar to the example shown below.
INSTRUCTIONS
If you DID the activity in the past 4 weeks:
Step #1
Check the YES box.
Step #2
Think about how many TIMES a week you usually did it, and write your response in the
space provided.
Step #3
Circle how many TOTAL HOURS in a typical week you did the activity.
Here is an example of how Mrs. Jones would answer question #1: Mrs. Jones usually visits her friends
Maria and Olga twice a week. She usually spends one hour on Monday with Maria and two hours on Wednesday with
Olga. Therefore, the total hours a week that she visits with friends is 3 hours a week.
In a typical week during the past 4 weeks,
did you…
1. Visit with friends or family (other than those
you live with)?
YES
NO
How many TIMES a week?_____ Î
How many TOTAL
hours a week did you
usually do it? Î
If you DID NOT do the activity:
• Check the NO box and move to the next question
2
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
In a typical week during the past
4 weeks, did you …
1. Visit with friends or family (other than those
you live with)?
YES How many TIMES a week?_____ Î
NO
2. Go to the senior center?
YES How many TIMES a week?_____ Î
NO
3. Do volunteer work?
YES How many TIMES a week?_____ Î
NO
4. Attend church or take part in church
activities?
YES How many TIMES a week?_____ Î
NO
5. Attend other club or group meetings?
YES How many TIMES a week?_____ Î
NO
6. Use a computer?
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
3
1-2½
hours
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
7. Dance (such as square, folk, line, ballroom)
(do not count aerobic dance here)?
YES How many TIMES a week?_____ Î
NO
8. Do woodworking, needlework, drawing, or
other arts or crafts?
YES How many TIMES a week?_____ Î
NO
9. Play golf, carrying or pulling your equipment
(count walking time only)?
YES How many TIMES a week?_____ Î
NO
10. Play golf, riding a cart (count walking time
only)?
YES How many TIMES a week?_____ Î
NO
11. Attend a concert, movie, lecture, or sport
event?
YES How many TIMES a week?_____ Î
NO
12. Play cards, bingo, or board
games with other people?
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
4
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
13. Shoot pool or billiards?
YES How many TIMES a week?_____ Î
NO
14. Play singles tennis (do not count doubles)?
YES How many TIMES a week?_____ Î
NO
15. Play doubles tennis (do not count singles)?
YES How many TIMES a week?_____ Î
NO
16. Skate (ice, roller, in-line)?
YES How many TIMES a week?_____ Î
NO
17. Play a musical instrument?
YES How many TIMES a week?_____ Î
NO
18. Read?
YES How many TIMES a week?_____ Î
NO
19. Do heavy work around the house (such as
washing windows, cleaning gutters)?
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
5
1-2½
hours
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
20. Do light work around the house (such as
sweeping or vacuuming)?
YES How many TIMES a week?_____ Î
NO
21. Do heavy gardening (such as spading,
raking)?
YES How many TIMES a week?_____ Î
NO
22. Do light gardening (such as watering
plants)?
YES How many TIMES a week?_____ Î
NO
23. Work on your car, truck, lawn mower, or
other machinery?
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
7-8½
hours
9 or
more
hours
7-8½
hours
9 or
more
hours
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
**Please note: For the following questions about running and walking, include use of a treadmill.
24. Jog or run?
YES How many TIMES a week?_____ Î
NO
25. Walk uphill or hike uphill (count only uphill
part)?
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
6
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
YES How many TIMES a week?_____ Î
NO
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
30. Do other aerobic machines such as rowing,
or step machines (do not count treadmill or
stationary cycle)?
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
26. Walk fast or briskly for exercise (do not
count walking leisurely or uphill)?
YES How many TIMES a week?_____ Î
NO
27. Walk to do errands (such as to/from a store
or to take children to school (count walk time
only)?
YES How many TIMES a week?_____ Î
NO
28. Walk leisurely for exercise or pleasure?
YES How many TIMES a week?_____ Î
NO
29. Ride a bicycle or stationary cycle?
1-2½
hours
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
5-6½
hours
YES How many TIMES a week?_____ Î
NO
31. Do water exercises (do not count other
swimming)?
YES How many TIMES a week?_____ Î
NO
7
1-2½
hours
3-4½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
32. Swim moderately or fast?
YES How many TIMES a week?_____ Î
NO
33. Swim gently?
YES How many TIMES a week?_____ Î
NO
34. Do stretching or flexibility exercises (do not
count yoga or Tai-chi)?
YES How many TIMES a week?_____ Î
NO
35. Do yoga or Tai-chi?
YES How many TIMES a week?_____ Î
NO
36. Do aerobics or aerobic dancing?
YES How many TIMES a week?_____ Î
NO
37. Do moderate to heavy strength training
(such as hand-held weights of more than 5 lbs.,
weight machines, or push-ups)?
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
YES How many TIMES a week?_____ Î
NO
8
1-2½
hours
1-2½
hours
3-4½
hours
3-4½
hours
5-6½
hours
5-6½
hours
In a typical week during the past
4 weeks, did you …
38. Do light strength training (such as hand-held How many TOTAL
weights of 5 lbs. or less or elastic bands)?
hours a week did you
YES How many TIMES a week?_____ Î usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
1-2½
hours
3-4½
hours
5-6½
hours
7-8½
hours
9 or
more
hours
How many TOTAL
hours a week did you
usually do it? Î
Less
than
1 hour
7-8½
hours
9 or
more
hours
NO
39. Do general conditioning exercises, such as
light calisthenics or chair exercises (do not
count strength training)?
YES How many TIMES a week?_____ Î
NO
40. Play basketball, soccer, or racquetball (do
not count time on sidelines)?
YES How many TIMES a week?_____ Î
NO
41. Do other types of physical activity not
previously mentioned (please specify)?
__________________________
YES How many TIMES a week?_____ Î
NO
Thank You
9
1-2½
hours
3-4½
hours
5-6½
hours
Cuestionario de Actividades Para Personas de Edad Avanzada
CHAMPS: Modelo de Programa Comunitario de Actividades Saludables Para Personas de Edad Avanzada
Instituto Para la Salud y Madurez, Universidad de California, San Francisco
Centro Para la Investigación en Prevención de Enfermedades de Stanford
(3 de Octubre, 2001) © Copyright 1998
Favor de no reproducir sin permiso
Contacto Anita L. Stewart, Ph.D., UCSF, [email protected]
Fecha:_________________________________
Nombre o ID:___________________________
ESTE EJEMPLO ES PARA SABER COMO LLENAR EL CUESTIONARIO.
Si HIZO la actividad en las últimas 4 semanas:
Paso #1
Marque el cuadrado que dice “SI”.
Paso #2
Luego, piense cuantas VECES lo hizo por semana usualmente, y escriba la respuesta sobre la
linea que sigue.
Después, responda a cuantas horas, EN TOTAL hizo la actividad en una semana típica y ponga
un círculo alrededor de su respuesta.
Paso #3
Aquí está un ejemplo de como la Sra. Díaz llenaría el cuestionario: La Sra. Díaz usualmente visita a sus amigas Maria y Olga
2 veces por semana. A Maria la visita por 1 hora los lunes y a Olga la visita los miércoles por 2 horas. Así que EL TOTAL de
horas a la semana que visita a sus amistades es 3 horas por semana.
En una semana típica de las últimas 4
semanas, …..
1. ¿Visitó amigos o familiares (no con los que
vive)?
SI ¿Cuántas VECES por semana?_____ Î
NO
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
Si NO HIZO la actividad:
• Marque el cuadrado que dice “NO” y pase a la siguiente pregunta.
2
5 a 6½
horas
7 a 8½
horas
9 o más
horas
En una semana típica de las últimas
4 semanas, …..
1. ¿Visitó amigos o familiares (no con los que
vive)?
SI ¿Cuántas VECES por semana?_____ Î
NO
2. ¿Fué al centro de personas mayores de edad?
SI ¿Cuántas VECES por semana?_____ Î
NO
3. ¿Hizo trabajo voluntario?
SI ¿Cuántas VECES por semana?_____ Î
NO
4. ¿Asistió a la iglesia o a actividades de la
iglesia?
SI ¿Cuántas VECES por semana?_____ Î
NO
5. ¿Asistió a otros clubs ú otras reuniones?
SI ¿Cuántas VECES por semana?_____ Î
NO
6. ¿Usó una computadora?
SI ¿Cuántas VECES por semana?_____ Î
NO
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
3
En una semana típica de las últimas
4 semanas, …..
7. ¿Bailó (tal como salsa, cumbia, merengue,
banda, folklórico) (no cuente la danza
aeróbica)?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
8. ¿Hizo carpintería, trabajó con agujas, dibujó o ¿Cuántas horas
hizo otras artes o artesanías?
EN TOTAL por
SI ¿Cuántas VECES por semana?_____ Î semana lo hizo
usualmente? Î
NO
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
9. ¿Jugó golf, acarreando o jalando su equipo de ¿Cuántas horas
golf (solo cuente el tiempo que paso
EN TOTAL por
caminando)?
semana lo hizo
SI ¿Cuántas VECES por semana?_____ Î usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
NO
10. ¿Jugó golf, montando en un carrito (solo
cuente tiempo que pasó caminando)?
SI ¿Cuántas VECES por semana?_____ Î
NO
11. ¿Asistió a conciertos, cine, lecturas o
eventos deportivos?
SI ¿Cuántas VECES por semana?_____ Î
NO
4
En una semana típica de las últimas
4 semanas, …..
12. ¿Jugó cartas, bingo o juegos de mesa con
otras personas?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
14. ¿Jugó partido simple de tenis (“singles”) (no ¿Cuántas horas
cuente jugar tenis de dobles)?
EN TOTAL por
SI ¿Cuántas VECES por semana?_____ Î semana lo hizo
usualmente? Î
NO
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
13. ¿Jugó billar?
SI ¿Cuántas VECES por semana?_____ Î
NO
15. ¿Jugó tenis de dobles (no cuente jugar
partido simple de tenis)?
SI ¿Cuántas VECES por semana?_____ Î
NO
16. ¿Patinó (en hielo, con ruedas o
“rollerblades”)?
SI ¿Cuántas VECES por semana?_____ Î
NO
17. ¿Tocó un instrumento musical?
SI ¿Cuántas VECES por semana?_____ Î
NO
5
En una semana típica de las últimas
4 semanas, …..
18. ¿Leyó?
SI ¿Cuántas VECES por semana?_____ Î
NO
19. ¿Hizo trabajo pesado en el hogar (tal como
lavar ventanas o limpiar las goteras en el
tejado)?
SI ¿Cuántas VECES por semana?_____ Î
NO
20. ¿Hizo trabajo ligero en el hogar (tal como
barrer o pasar la aspiradora)?
SI ¿Cuántas VECES por semana?_____ Î
NO
21. ¿Hizo jardinería pesada (tal como usar una
pala o rastrillo)?
SI ¿Cuántas VECES por semana?_____ Î
NO
22. ¿Hizo jardinería ligera (tal como regar las
plantas)?
SI ¿Cuántas VECES por semana?_____ Î
NO
23. ¿Trabajó arreglando su carro, camioneta,
cortadora de césped, o alguna otra máquina?
SI ¿Cuántas VECES por semana?_____ Î
NO
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
6
En una semana típica de las últimas
4 semanas, …..
**Por favor tome en cuenta: Para las preguntas sobre correr o caminar, también incluir cuando lo hace en el
“treadmill”(es una máquina en la que puede correr o caminar).
24. ¿Hizo “jogging” o corrió?
SI ¿Cuántas VECES por semana?_____ Î
NO
25. ¿Caminó en subida (solo cuente la parte en
subida)?
SI ¿Cuántas VECES por semana?_____ Î
NO
26. ¿Caminó rápido o de prisa por ejercicio (no
cuente caminar tranquilamente o caminar en
subida)?
SI ¿Cuántas VECES por semana?_____ Î
NO
27. ¿Caminó para hacer mandados (por
ejemplo ir y venir de la tienda o llevar a los
niños a la escuela). (Solo cuente tiempo
caminando)?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
28. ¿Caminó tranquilamente para ejercicio o
placer?
SI ¿Cuántas VECES por semana?_____ Î
NO
7
En una semana típica de las últimas
4 semanas, …..
29. ¿Montó bicicleta o bicicleta estacionaria?
SI ¿Cuántas VECES por semana?_____ Î
NO
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
30. ¿Usó máquinas aerobicas como las
máquinas de remos o las máquinas de escalones
tal como las máquinas “step” o “stair” (No
incluya el “treadmill” ni bicicleta estacionaria)?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
31. ¿Hizo ejercicios aquáticos (no cuente
natación)?
SI ¿Cuántas VECES por semana?_____ Î
NO
32. ¿Nadó a velocidad moderada o rápida?
SI ¿Cuántas VECES por semana?_____ Î
NO
33. ¿Nadó suávemente?
SI ¿Cuántas VECES por semana?_____ Î
NO
34. ¿Hizo ejercicios de estiramiento o para
flexibilidad (no cuente Yoga o Tai-Chi)?
SI ¿Cuántas VECES por semana?_____ Î
NO
8
En una semana típica de las últimas
4 semanas, …..
35. ¿Hizo Yoga o Tai-chi?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
37. ¿Hizo entrenamiento moderado o pesado
para mejorar la fuerza física (tal como pesas
para las manos de más de 5 libras, máchinas de
pesas, lagartijas o planchas)?
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
38. ¿Hizo entrenamiento liviano para mejorar la ¿Cuántas horas
fuerza física (tal como pesas para las manos de 5 EN TOTAL por
libras o menos, o ejercicios con elásticos)?
semana lo hizo
SI ¿Cuántas VECES por semana?_____ Î usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
36. ¿Hizo aeróbicos o danza aeróbica?
SI ¿Cuántas VECES por semana?_____ Î
NO
NO
39. ¿Hizo ejercicio de acondicionamiento
¿Cuántas horas
general, tal como calistenia o ejercicios sentados EN TOTAL por
(no cuente ejercicios para la fuerza física)?
semana lo hizo
SI ¿Cuántas VECES por semana?_____ Î usualmente? Î
NO
9
En una semana típica de las últimas
4 semanas, …..
40. Juegó basketbol, futbol, o racquets/raquetbol ¿Cuántas horas
(no cuente tiempo fuera como suplente)?
EN TOTAL por
SI ¿Cuántas VECES por semana?_____ Î semana lo hizo
usualmente? Î
NO
41. ¿Hizo otras actividades físicas que no hayan
sido mencionadas previamente (especifique)?
__________________________
¿Cuántas horas
EN TOTAL por
semana lo hizo
usualmente? Î
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
Menos
de 1
hora
1 a 2½ 3 a 4½
horas horas
5 a 6½
horas
7 a 8½
horas
9 o más
horas
SI ¿Cuántas VECES por semana?_____ Î
NO
Muchas Gracias
10
Table B1: Revised Codebook for CHAMPS Physical Activity Measures
The only change is that item number 36 is included in all measures
May 22, 2003
Variable Label
Caloric
expenditure/week
in all exerciserelated activities1
Caloric
expenditure/week
in moderateintensity exerciserelated activities
Frequency/week of
all exercise-related
activities
Frequency/week of
moderate-intensity
exercise-related
activities
1
Item
Coding Algorithms
Numbers
7, 9, 10, 14For each activity:
16, 19-35, 36- 1. Create new duration variables for each activity recoded as
follows: 1=0.5, 2=1.75, 3=3.75, 4=5.75, 5=7.75, 6=9.75; If
40
duration variable is not answered, score = 0. Duration is
hours/week.
2. For each recoded duration variable, create new weighted
duration variable for each activity by multiplying duration
variable (#1) by corresponding MET value (see Table 2).
3. For each weighted duration variable, create caloric
expenditure per week variable for each activity by
multiplying weighted duration variable (#2) by 3.5 and by
60 (to convert METs/minute to METs/hour) and by (weight
in kg/200).
4. Sum caloric expenditure per week variables across
activities to create caloric expenditure/week.
7, 9, 14-16,
Same as above, subset of activities with MET values >3.0.
19, 21, 23-26,
29-33, 36-38,
40
7, 9, 10, 14SUM frequency scores/week for each of the activities (allow
16, 19-35, 36- those with missing data on frequency to be included in the
40
sum).
7, 9, 14-16,
19, 21, 23-26,
29-33, 36-38,
40
SUM frequency scores/week for each of the activities (allow
those with missing data on frequency to be included in the
sum).
Based on American College of Sports Medicine formula: kcal/minute = METs * 3.5 * (body weight in kg/200). Our
formula converts this into kcal/week. ACSM’s Guidelines for Exercise Testing and Prescription, 5th Edition.
Baltimore: Williams & Wilkins (1995).
CHAMPS
Community Healthy Activities Model Program for Seniors
COMMUNITY HEALTHY ACTIVITIES MODEL PROGRAM
FOR SENIORS II (CHAMPS II)
PROGRAM MANUAL
October 15, 2003
Authors: Dawn Gillis, M.S., Barbara McLellan, M.P.H., Nina Sperber, M.A.,
Leah Tuzzio, M.P.H., Carol Verboncoeur, M.A., and Anita L. Stewart, Ph.D.
Edited by: Norman Fineman, Ph.D.
Funding provided by the National Institute on Aging, Grant No. AG09931
The CHAMPS II manual is protected by the United States copyright law, with all rights reserved.
These materials may be used and adapted freely subject to the following terms:
a) Any use of these materials in either original or adapted form must be acknowledged by the
following citation: Community Healthy Activities Model Program for Seniors II (CHAMPS
II): Program Manual. (2003) University of California, San Francisco: Institute for Health
& Aging, San Francisco, CA.; and,
b) These materials may not be sold in either original or adapted form.
1
CHAMPS
Community Healthy Activities Model Program for Seniors
TABLE OF CONTENTS
Introduction........................................................................................................................................ 3
Staffing................................................................................................................................................ 5
Participants ........................................................................................................................................ 7
Outreach and Recruitment ............................................................................................................... 8
Enrollment........................................................................................................................................ 14
Physical Activity Support Mechanisms ......................................................................................... 17
Feedback and Diffusion................................................................................................................... 28
Appendix 1: Motivational Interviewing Principles, Strategies, and Skills................................. 29
Appendix 2: Initial Contact Letter................................................................................................. 31
Appendix 3: Informational Meeting Agenda and Script ............................................................. 32
Appendix 4: Medical History Questionnaire ................................................................................ 37
Appendix 5: Medical Release Form ............................................................................................... 44
Appendix 6: Notification Letter to Participant’s Physician ........................................................ 45
Appendix 7: Script and Phone Screen to Schedule 6-Month Functional Fitness Assessment.. 46
Appendix 8: Medical History Questionnaire 6-Month Update ................................................... 48
Appendix 9: Activity Log ................................................................................................................ 50
Appendix 10: Activity Log Tips...................................................................................................... 54
Appendix 11: Telephone Follow-up Form..................................................................................... 55
Appendix 12: Sample Newsletter ................................................................................................... 57
2
CHAMPS
Community Healthy Activities Model Program for Seniors
Introduction
Overview
The Community Healthy Activities Model Program for Seniors (CHAMPS) is an inclusive, choicebased physical activity promotion program to increase the lifetime physical activity levels of
seniors. The program utilizes a public-health approach, targeting community-dwelling sedentary
and underactive adults aged 65 and older with a broad range of health problems. The central
premise of the program is that physical activity has benefits for everyone regardless of age and
health status.
The program supports and encourages participants to develop a balanced exercise regimen
(endurance, strength training, flexibility, balance, and coordination). This can include taking part in
physical activity classes and programs in their community or exercising on their own. Participants
are encouraged to develop a regimen that takes into account their health problems, activity
preferences, abilities, interests, available resources, readiness to change and other factors. Using a
client-centered approach, participants explore ways to motivate themselves, overcome barriers, and
exercise safely. Emphasis is placed on personal choice and progressing at their own pace.
CHAMPS Research
CHAMPS II was designed by researchers at the University of California, San Francisco (UCSF) and
Stanford University to increase the physical activity level of sedentary and underactive adults aged
65 years and older. It grew out of an earlier program,
CHAMPS I, which referred participants to existing classes
Information on CHAMPS
and programs.
research can be found at
www.ucsf.edu/champs/
The CHAMPS II physical activity promotion program is
based mainly on social cognitive theory, and utilizes
principles of self-efficacy enhancement, readiness to change, and motivational strategies. Both
CHAMPS programs were successful in increasing physical activity. All publications and
information about CHAMPS research are available on the CHAMPS website.
CHAMPS II Program Goals
Intermediate Goals
•
To encourage and support the efforts of sedentary and underactive older adults who wish to
obtain health benefits through increased physical activity
•
To motivate participants who are reluctant or uncommitted to exercise to increase their
activity level by helping them resolve ambivalence
•
To encourage participants to develop a balanced physical activity regimen that focuses on
endurance, strength training, flexibility, balance, and coordination
Long-Term Goal
•
To significantly increase participants’ overall physical activity levels through taking part in
structured and unstructured physical activities of light to moderate intensity
3
CHAMPS
Community Healthy Activities Model Program for Seniors
CHAMPS Program Principles
Client-Centered, Individually Tailored Approach
Client-centered motivational strategies and cognitive behavioral techniques are used to help
participants make their own decisions regarding how and when to become more active. CHAMPS
II adopted the “spirit” of motivational interviewing1 as a model of interaction between physical
activity counselors and participants. Physical activity counselors were trained in techniques and
strategies to promote productive interactions with program participants.
Unconditional Respect for Participants
Physical activity counselors do not judge participants’ level of progress, but empathize with
participants’ concerns by showing interest and respecting their choices. They uncritically support
participants’ efforts to be physically active and encourage them to develop their own strategies to
overcome barriers.
Focus on Safety
Participants’ safety is a principal program concern. Physical activity counselors are trained to teach
participants to exercise safely and to consult their physician about medical concerns related to their
program.
Using This Manual
This manual is written for a wide audience of health professionals, fitness professionals, seniorserving agencies, parks and recreation departments, and academic research groups. Its central
purpose is to describe the process of implementing CHAMPS program components to facilitate the
development and testing of similar programs by others. We have drawn upon our experiences
conducting the program to provide readers with practical recommendations for setting up a
successful program in their local communities. The following are discussed in this manual:
1. Program Staffing and program participants
2. Outreach and recruitment
a. Awareness campaign
b. Preliminary screening by telephone
c. Informational meeting
3. Enrollment
a. Medical screening
b. Functional fitness assessment
4. Physical activity support mechanisms
a. Personal planning session
b. Telephone support
c. Group workshops
d. Newsletters
e. Activity logs
1
Rollnick, S., & Miller, W. (1995). What is motivational interviewing? Behavioural and Cognitive
Psychotherapy, 23, 325-334.
4
CHAMPS
Community Healthy Activities Model Program for Seniors
Staffing
A multidisciplinary team developed CHAMPS as a research study and a core group of the original
study designers implemented the program and conducted the research. This team included
psychologists, health educators, exercise physiologists, geriatricians, nurses, and statisticians. In
order to conduct the program, the staff shared expertise in exercise safety for older adults with
varying medical conditions, exercise instruction skills, principles and information related to exercise
recommendations for this age group, and motivational counseling styles and strategies to encourage
behavior change. CHAMPS had three masters’ level staff members (an exercise physiologist for
high-risk participants, a health educator, and a psychologist [who was also the project coordinator])
to oversee a total of 85 participants, develop the workshops and perform most of the tasks
associated with a research project in the initial year. These staff members will be referred to as
physical activity counselors (PA counselors) throughout this document. In addition there was a fulltime research associate who helped with many aspects of the project.
Prior to conducting the program, the PA counselors attended multi-day trainings regarding exercise
for older adults at the Cooper Institute in Dallas, Texas; attended multi-day trainings in motivational
interviewing; and some attended courses in self-management for people with chronic conditions.
Beyond their formal training, staff also kept current with professional literature related to older
adults and exercise and attended professional conferences. As the program progressed, PA
counselors conferred with one another to discuss challenging situations with participants.
What is important for others attempting to develop a similar program is that staff has the
qualifications to plan and conduct the program. These qualifications may be found in an array of
disciplines such as kinesiology, exercise physiology, physical therapy, sports psychology, physical
education, gerontology, nursing, health education, psychology, and social work. Staff
qualifications and skills vary across the program components and are briefly listed here.
1) Outreach and recruitment
•
Presentation skills
•
Trained in motivational skills and techniques
•
Familiar with benefits of exercise for older adults
•
Familiar with special exercise-related concerns of older adults
•
Knowledgeable about the enrollment requirements and project details
2) Medical screening as offered in CHAMPS
•
Involvement of physician to review screening procedures, review individual cases, and
address questions of staff nurse/exercise physiologist throughout the project.
•
Nurse (with experience working in cardiac rehab or similar) to initially review selfreport medical history, check blood pressure and heart rate, determine if physician
consent is needed prior to functional fitness testing or if any tests should be omitted or
modified, assist with follow-up medical clearance and/or questions as needed.
•
Exercise physiologist (with experience conducting fitness testing and prescribing
exercise for older adults with various medical conditions) to assist the nurse with
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monitoring of participants and to oversee the testing session. At the 6- and 12-month
assessments, the staff exercise physiologist served the screening role that the nurse
performed at baseline and additional exercise physiologists helped oversee the testing
and monitoring of participants.
3) Functional Fitness Assessment
•
Physician, nurse, and exercise physiologist(s) as noted above.
•
Additional trained staff for check in/out and conducting assessments.
•
Note that staff should maintain current CPR and 1st aid certifications to conduct the
assessments.
4) Enrollment
•
Knowledgeable about the enrollment requirements and project details
•
Trained to administer questionnaires and other paperwork
5) Physical activity support mechanisms
•
Counseling skills and exercise knowledge to work directly with participants during
personal planning session, telephone support, and workshops (which often included
small discussion groups)
o Experienced exercise physiologist (or similar professional) to work with higher
risk cases, to respond to individual questions in workshops, to serve as a resource
for other staff, and to follow-up with physicians as needed
•
Teaching skills and appropriate background to conduct workshops (which included a
range of activities such as small group discussions, interactive presentations, and miniexercise sessions focused on proper form and safe exercise techniques)
o Guest instructors can also provide additional expertise
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Participants
Eligibility
Participants in CHAMPS II were members of Medicare Health Maintenance Organizations (HMO)
within a large multi-specialty medical group practice in Northern California, the Palo Alto Medical
Foundation (PAMF). Throughout the manual, we refer to PAMF as the “medical group.”
Consistent with a public health approach, the program aims to be as inclusive as possible. For the
CHAMPS II research, participants had to meet the following eligibility criteria:
1. Sedentary or underactive:
• Sedentary refers to individuals that do not “set aside time for regular exercise such as
brisk walking, swimming, dancing, riding an exercise bike, or taking part in
recreational sports.”
• Underactive refers to individuals who have not exercised for at least the prior 3
months or more, or who participate in some physical activities but do not meet the
minimum eligibility criteria for frequency (> 3 times per week), duration (> 20
minutes per session), or intensity (produces sweat, or increases heart rate or
breathing).
2. Had no recent serious medical condition such as a cardiac event, insulin-dependent diabetes,
or hospitalization for a major disease that could limit participation in unsupervised light-tomoderate physical activity.
Characteristics of the Study Population (N=173)
Demographics
• Participants ranged in age from 65 to 90 years old, with a mean age of 74
•
66% were female and 9% were non-Caucasian
•
Most participants had at least some college (19% high school or less, 25% some college,
27% college degree, 6% some graduate school, and 22% graduate degree)
•
Almost 50% had family incomes between $20,000 and $40,000 and approximately 19% had
incomes less than $20,000
Health and Physical Activity Level
Participants had a range of self-reported health conditions typical of the older U.S. population:
• Arthritis or joint problems (65%)
•
Hypertension (40%)
•
Cardiovascular problems (16%)
•
Asthma, chronic bronchitis, or emphysema (10%)
• Diabetes (7%)
Physical activity levels were distributed as follows:
• Sedentary (45%)
•
Underactive (55%)
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Outreach and Recruitment
Overview
There were three phases in outreach and recruitment; each is described in this section
•
Awareness Campaign: A sample of members of a Medicare HMO was informed about the
upcoming study in an initial contact letter and the study was mentioned in a medical group
newsletter.
•
Preliminary Screening by Telephone: A telephone interview screened for preliminary
eligibility and enumerated the population; eligible respondents were invited to an
informational meeting.
•
Informational Meeting: This meeting provided an overview of the program and research;
persons attending the informational meeting were invited to enroll.
Theoretical Basis of Recruitment Strategies
Four theoretical perspectives inform the outreach and recruitment strategies used by CHAMPS:
social marketing, social influence, the transtheoretical model, and motivational interviewing. We
briefly summarize each perspective and then describe the specific strategies to recruit participants.
Social Marketing
“Social marketing is the application of commercial marketing technologies to the analysis,
planning, execution, and evaluation of programs designed to influence the voluntary behavior of
target audiences in order to improve their personal welfare and that of their society.”2
Social Influence
Social influence theory posits that persons of authority can effect change in individuals’ behavior
because they are trusted. By following the recommendations of an authority figure, individuals may
come to believe that they are making good decisions. Individuals may also influence others through
building and maintaining relationships.3
The Transtheoretical Model: Stages of Change
The transtheoretical model of behavioral change4 is widely accepted by behavioral scientists to
explain the process of behavioral change. The model suggests that individuals’ readiness to make
behavioral changes recommended by an educational intervention are tied to their mental stage of
2
Andreasen, A. R. (1995). Marketing Social Change: Changing Behavior to Promote Health, Social
Development, and the Environment. San Francisco: Jossey-Bass.
3
Cialdini, R. B., & Trost, M. R. (1998). Social influence: social norms, conformity, and compliance. In D. T.
Gilbert, S. T. Fiske & G. Lindzey (Eds.), The Handbook of Social Psychology (Fourth Edition ed., Vol. 2, pp.
151-192). Boston: The McGraw-Hill Companies, Inc.
4
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an
integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395. and Prochaska, J.
O., Redding, C. A., & Evers, K. E. (1997). The Transtheoretical Model and stages of change. In K. Glanz, F.
M. Lewis & B. K. Rimer (Eds.), Health Behavior and Health Education (2nd ed.). San Francisco: JosseyBass Publishers.
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readiness. The model posits a series of stages of readiness: the precontemplative stage (not even
thinking about changing); the contemplative stage (thinking about changing); the action stage
(making efforts toward change); and the maintenance stage (maintaining the changes).
Understanding the stage that the patient is in at the time of intervention can assist with tailoring
messages and strategies.
Motivational Interviewing
“Motivational interviewing is a directive, client-centered counseling style for eliciting behaviour
change by helping clients to explore and resolve ambivalence. It is most centrally defined not by
technique but by its spirit as a facilitative style for interpersonal relationship.”5 The technique involves asking
See Appendix 1: Motivational
open-ended questions, listening reflectively, and reinforcing
Interviewing Principles,
positive statements about changing the desired behavior,
Strategies, and Skills
and has been shown to be effective in engaging patients in
6
treatment and facilitating behavioral change.
Developing Recruitment Messages and Materials
Gathering Information from Targeted Community
Five focus groups and several individual interviews with staff members at senior-service agencies,
volunteers at senior centers, and health educators at the medical group were used to gather
information about existing programs, community needs, and planned outreach/recruitment
materials. Focus group topics included:
•
Aging, active living, exercise, and physical activity
•
Motivators and barriers to joining a program such as CHAMPS
•
Evaluation of recruitment materials which included an envelope, an initial contact letter, a
response post card, and use of a telephone invitation to an informational meeting
Developing Invitational Messages
We developed several stage-appropriate messages that were used at the end of the telephone
interview to recruit new participants. A computer-assisted telephone interview (CATI) program
was written to assign respondents to one of three groups: (1) individuals ready to attend an
informational meeting; (2) individuals reluctant to join an action-oriented program; and (3)
ineligible individuals. Subsequent conversation with each respondent was guided by his or her
group assignment. The CATI program generated a script for the balance of the conversation, based
upon prospective participants’ eligibility status and readiness to hear about exercise. CATI
interviewers were trained in motivational techniques in order to have a dialogue with respondents in
the second group.
Using Social Influence Theory to Reinforce Program Credibility
Based on the assumption of social influence theory that advice from trusted authority figures can
facilitate individuals’ behavioral change, we enlisted the endorsement of the medical group and a
5
Rollnick, S., & Miller, W. (1995). What is motivational interviewing? Behavioural and Cognitive
Psychotherapy, 23, 325-334.
6
Miller, W. R., & Rollnick, S. (1991). Motivational Interviewing. New York: The Guilford Press.
9
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noted geriatrician to increase potential participants’ interest in the program and establish the
legitimacy and value of CHAMPS.
Phase One of Recruitment: Awareness Campaign
Defining our population as members of an HMO in a medical group enabled us to use proactive
methods to reach potential participants. This took two forms: 1) an article in the monthly medical
group newsletter about the upcoming study, which was mailed to billed patients and distributed
throughout the medical group facilities, and 2) an initial
contact letter to sampled persons from a geriatrician at
See Appendix 2: Initial
the medical group. The initial contact letter was printed
Contact Letter
on the medical group’s letterhead, and was signed by a
well-known geriatrician.
Phase Two of Recruitment: Preliminary Screening by Telephone
The initial contact letter was followed up by a telephone survey, which included questions on the
following topics:
•
Eligibility criteria
•
Health behavior and/or risk factors (e.g., exercise, smoking, weight, stress)
•
Health status
•
Exercise readiness
•
Social support
•
Transportation issues
•
Satisfaction with own health and fitness
•
Confidence about own physical activity ability
•
Restricted activity days (health limitations in daily activity)
•
Interest in learning more about various health topics
•
Knowledge of current physical activity guidelines
Verbal Invitation to Invitational Meeting and Use of CATI Program
Persons who were not eligible were thanked for their participation at the conclusion of the
interview. For those who were eligible, aided by the CATI program, CHAMPS interviewers
customized the recruitment message based on their perceived readiness to attend the informational
meeting. Motivational strategies were used particularly at this stage of the telephone interview in
which invitations were being made.
Respondents were judged as “ready” if they said they had thought about doing some physical
activity AND were interested in learning more about physical activity. These respondents were
thanked for taking the survey and invited to attend the informational meeting to hear about a new
health program.
Respondents that were judged as “less ready” to attend the informational meeting included those
that had thought about doing some physical activity but were NOT interested in learning more
about physical activity or that were completely inactive. These individuals were also invited to
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learn more about the study by attending a group informational meeting, however, the conversational
scripts differed to account for their possible ambivalence. An example of one of these scripts and a
typical dialogue are presented below.
Example of a Motivational Script
The following script was used with respondents who indicated in the telephone survey that they
were not physically active but were considering becoming more active, and were not interested in
learning more about physical activity:
Use MI approach. Pick two or three topics to probe for further information.
We’re almost finished. Thank you for being so helpful. I have just a few more questions to ask
based on some of your previous answers. These are open-ended questions so I will be writing down
your responses as we speak.
You mentioned that you were not currently setting aside time to do exercise such as brisk walking or
swimming but you have been thinking about starting something. What can you tell me about that?
(REFLECT BACK ANSWER AND CONTINUE TOPIC). If you wanted to add more physical activity
to your day, what activities would interest you? (PARAPHRASE ANSWER AND EXPLORE TOPIC).
Pick other topics from survey questions about confidence, safety issues, energy levels, time
constraints.
End conversation with invitation.
Thanks so much for giving me your time. We’re looking for older adults such as you who (INSERT
SOMETHING POSITIVE RESPONDENT SAID SUCH AS)
…....are willing to try new ideas
…....interested in being able to live independently
…....want to continue taking trips with grandchildren
As the letter from Dr. Bortz mentioned, we are working on a project to find ways to help older adults
improve their overall health and well-being. I’d like to offer you an invitation to hear about the free
program that is part of this project.
Theoretically, the extra time spent in conversation with a respondent helps to establish rapport and
perhaps encourages him/her to be “more ready” to respond in a positive manner to the invitation to
attend the information meeting. The conversation provides an opportunity for the respondent to
think more about the possibilities for being physically active and also offers a forum to express
concerns about barriers to physical activity.
Phase Three of Recruitment: Informational Meeting
Purpose
•
To describe the program in detail (what to expect, who can participate, participant
requirements, activities available)
•
To emphasize the benefits of increased physical activity for
people of all ages and functional levels
•
To emphasize the individualized nature of the program
•
To motivate potential participants to enroll in the program
11
See Appendix 3: Informational
Meeting Agenda and Script
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Community Healthy Activities Model Program for Seniors
Group informational meetings were held at the auditorium of the medical group over a 5-month
period. Attendance at the meetings ranged from 14 to 42 prospective participants.
Motivational Speaker and Message
The motivational speaker, Dr. Walter M. Bortz, II was well-known at the medical group as a
geriatrician and is the author of several books on aging.7 His message emphasized these points:
• There is a link between exercise and physical functioning
•
The aging process is affected by lifestyle choices
•
Many health conditions are associated with aging - muscle weakness, joint stiffness, and
shortness of breath – but are in part caused by disuse of the associated muscle, joint or
cardiovascular system
•
There is no time to waste. Anyone at any age can benefit from starting to exercise
•
Participation in CHAMPS II will help answer some scientific questions.
•
Participation in CHAMPS II may help maintain or improve one’s ability to function as
independently as possible
Slide Show
A slide show was presented of older adults participating in various physical activities. The central
messages of the slide show were
• Almost everyone can enjoy exercise;
•
Expensive exercise clothes are not necessary;
•
A wide variety of activities is available; and
•
Exercise can be done alone or in a group.
The slide show also informed potential participants about the research study design, including what
the study hoped to accomplish, the scientific importance of a randomized design, and enrollment
requirements, including the time commitment for data collection.
Recruitment Mechanisms
It was emphasized that individuals did not have to be ready to increase their physical activity to join
the program.
“This is an individually tailored program. We will work with you to help you accomplish
what you want to accomplish. We’d like you to enroll in the program whether or not you are
ready to increase your levels of physical activity.”
Attendees indicated their interest in joining CHAMPS II by responding “yes,” “no,” or “maybe” on
a response card placed on each seat. Those who responded “yes” were asked to sign-up for the
study and schedule an enrollment appointment. Participants who said “yes” but did not sign up
were called to schedule an appointment.
7
Bortz, W. M. (1996). Dare to Be 100: 99 Steps to a Long, Healthy Life: Fireside.
Bortz, W. M., & Tennant, R. (2001). Living Longer for Dummies. New York: John Wiley & Sons.
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Telephone interviewers trained in motivational interviewing skills called attendees that answered
“maybe” on the response card. These interviewers worked with
See Appendix 1: Motivational
potential participants to explore their hesitation to exercise,
Interviewing Principles,
help resolve their ambivalence about exercising, and overcome
Strategies, and Skills
barriers to joining the study.
Enrollment Folders
Staff handed out (or mailed) folders with the needed enrollment forms to each attendee who wished
to enroll in the program. Staff asked attendees to complete the forms on their own and bring them
to the enrollment appointment, at which time staff members would assist them with any problems
they encountered with the forms. The forms included:
•
Information about the study
•
An informed consent form
•
A medical history and a baseline questionnaire
•
A physician contact form that gave permission for project staff to notify each patient’s
primary care physician about the patient’s participation in the project
Participant Reactions to Informational Meetings
Program enrollees rated the informational meeting as “very helpful,” and stated that it encouraged
them to start and “stick with” their individual physical activity regimens. During focus groups at
the conclusion of the intervention, participants (especially men) noted that this meeting was an
important motivating factor for joining CHAMPS.8
8
Gillis, D. E., Grossman, M. D., McLellan, B. Y., King, A. K., & Stewart, A. L. (2002). Participant's
evaluations of program components of a physical activity promotion program for senior (CHAMPS II).
Journal of Aging and Physical Activity, 3, 336-353.
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Enrollment
Enrollment into the CHAMPS II program consisted of attending an enrollment session, completing
medical screening and a baseline assessment, and receiving a functional fitness assessment. The
portions of this enrollment that are relevant to the program itself (versus the research aspects)
include the medical screening and the functional fitness assessment. These are each described in
this section.
Medical Screening
Purpose
•
To allow the nurse (at baseline) and exercise physiologist (at 6 and 12 months) to review
and discuss with participants the self-reported medical history form, and to measure their
blood pressure and heart rate
•
To determine if participants may proceed with the functional fitness assessment or if followup with their physician is needed prior to the functional fitness assessment
•
To determine if any of the functional fitness assessments need to be modified or omitted
because of medical concerns about the participants
•
To determine if participants need additional assistance or monitoring during the assessments
•
To inform participants’ physical activity counselor about conditions that could affect the
guidance they provide
•
To exclude participants who should not initiate an unsupervised light-to-moderate intensity
physical activity program because of medical problems that had not been identified on the
enumeration survey
Self-Reported Medical History
The medical screening process includes a questionnaire that allows participants to self-report their
medical history. The questionnaire is more detailed than the brief enumeration medical screening
and functions as a baseline health evaluation for the
See Appendix 4: Medical History
study. This information also helps to appropriately match
Questionnaire
participants and PA counselors.
Notifying the Participant’s Physician
Because CHAMPS II was conducted in a medical group setting, it was appropriate to ask
participants for the names of their primary care medical doctors. CHAMPS staff members obtained
participants’ written consent to contact their doctors.
For participants with no serious, unstable medical problems (such as angina that had not been
discussed with his/her physician, uncontrolled hypertension, presence of a pace maker), letters were
sent to their primary care physicians notifying physicians of their patient’s participation in the study
and asking them to contact the program staff if they had
See Appendix 5: Medical Release
any concerns or questions. The letters were hand delivered
Form and Appendix 6, Notification
to the physicians’ offices although certified mail could
Letter to Participant’s Physician
have been used to ensure delivery.
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For those with more serious medical problems such as angina with exertion, the participant was
asked to discuss the condition and with his/her physician. These individuals typically needed
medical clearance from his/her physician prior to enrollment into the project. Individual cases were
discussed by the geriatrician (medical director of the project), staff nurse, and staff exercise
physiologist. The procedures varied slightly depending on where in the screening process it was
determined that clearance was needed. The study physician, nurse, and/or exercise physiologist
assisted with this process until medical clearance was obtained.
Medical Screening at Subsequent Functional Fitness Assessment
For the 6- and 12-month assessments, participants
See Appendix 7: Script and Phone Screen to
completed a brief telephone screen asking about
Schedule 6-Month Functional Fitness
changes in their medical history in the prior months
Assessment
to determine if the nurse or exercise physiologist
should discuss these changes before scheduling an assessment. Participants also completed a
medical history update that the exercise physiologist
See Appendix 8: Medical History
reviewed at the functional fitness assessment. The staff
Questionnaire 6-Month Update
physician and nurse were contacted as needed for
questions or follow-up.
Functional Fitness Assessment
Purposes
•
To assess participants’ functional fitness through simple performance-based tests of
functioning, including measures of balance, upper and lower body strength, low
back/hamstring flexibility, and cardio respiratory endurance
•
To measure changes in fitness over time using repeated tests at 6 and 12 months
•
To provide feedback to participants
Specific Functional Fitness Tests
We used a battery of functional fitness tests developed by Guralnik et al.9 which included the
standing static balance test, the eight-feet time to walk test, and chair stands, as well as three other
tests.
1) Standing static balance test.9 The test requires participants to stand for ten seconds with
their feet: side-by-side, semi tandem, and tandem. Note that participants only progress to the next
stance if they are able to accomplish the ten seconds in the current stance.
2) Eight-feet time to walk test.9 This test measures participants’ time to walk eight feet at
their usual pace. A walking aid may be used. The test is performed twice.
3) Chair stands.9 This test assesses lower body muscular strength and endurance.
Participants stand up from a chair with their arms crossed at their chest and then return to a seated
position. Testers note if participants need to use their hands or a walking aid to push off the chair.
Participants are asked to perform the task as quickly as possible. The test measures the time to
complete five repetitions.
9
Guralnik, J. M., Branch, L. G., Cummings, S. R., & Curb, J. D. (1989). Physical performance measures in
aging research. Journal of Gerontology, 44, M141-146.
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4) Lift and reach test. This test assesses upper body muscular strength and endurance.
While seated, a participant lifts a weighted box onto a 13’’ shelf as many times as possible in one
minute. The standard weight used is 20 pounds for men (which may be reduced to 10, 5, or 2.5
pounds), and 10 pounds for women (which may be reduced to 5 or 2.5 pounds). The test measures
the number of times a participant lifts the weight in one minute.
5) Sit and reach test. This test assesses lower back and hamstring flexibility. Participants
sit on the floor (or on a table if it is difficult for them to get down or up from the floor). They
extend both legs forward, bending their knees slightly and placing their feet against the back of a sit
and reach box that includes a measuring stick. Participants then gently reach forward with two
hands (one on top of the other), flexing their torso as far as possible without incurring discomfort.
The test measures the distance of the fingertips from the feet, indicated by the measuring stick.
6) Six-minute walk. This test assesses cardiorespiratory endurance. Participants are
encouraged to cover as much distance as possible at a pace at which they do not incur shortness of
breath. A walking aid may be used. The test measures the distance covered in 6 minutes.
NOTE: Rikli and Jones published a battery of functional fitness tests for older adults called the
“Senior Fitness Test,”10 which we recommend using because testing results may be compared to
national norms for age and gender.
The Testing Process
•
Participants signed up for the functional fitness assessment at the informational meeting or
at the time of a follow-up phone call
•
Test administrators were trained by an exercise physiologist
•
The assessment was held in the auditorium of the medical group and was conducted using a
“station” formation which participants completed all of the tests in a specified sequence,
beginning with the medical screening
•
The functional fitness assessment results were discussed at the participants’ personal
planning session
•
All test results during the program period (baseline, six, and 12 months) were discussed at
the end of the one-year program.
NOTE: During the functional fitness assessment, staff members reviewed the completed physical
activity questionnaires and other paperwork with
participants. Participants received a physical
See section on Physical Activity Support
Mechanism: Activity Logs
activity log (and tip sheet) to be completed prior to
the personal planning session.
10
Rikli, R. E., & Jones, C. J. (2001). Senior Fitness Testing Manual. Champaign, Illinois: Human Kinetics.
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Physical Activity Support Mechanisms
Introduction
This section presents details about the five mechanisms we used to support participants in their
efforts to increase physical activity:
•
Personal planning session
•
Telephone support
•
Group workshops
•
Newsletters
•
Activity logs
As noted above, CHAMPS is a client-centered, self-management program. A PA counselor is
assigned to each participant and bears responsibility for the long-term interaction between the
participant and the program, but participants make personal choices about their physical activities
and goals. The support mechanisms are designed to encourage participants to find personally
meaningful goals and to provide motivation, encouragement, and reinforcement for successful
changes in activity, no matter how slow the progress. Participants are only required to attend the
personal planning session, to receive telephone calls, and to complete activity logs (for two weeks
of every month). PA counselors strongly encourage participants to attend the initial workshops that
cover exercise safety and getting started; other workshops are optional based on their interest.
Physical Activity Support Mechanism: Personal Planning Session
Purpose
•
To enroll and randomize participants into intervention and wait-list control group.
•
To discuss participants’ needs, concerns, and preferences based on their readiness to
increase their level of physical activity
•
To establish a relationship between the physical activity counselors and participants
•
To motivate participants to attend the first workshop and to discuss details of the program
•
To individualize initial plans based on discussion of participants’ needs, concerns, and
preferences
•
To set an initial short-term goal for participants based on their readiness to increase their
level of physical activity
•
To briefly review two exercise booklets that are given to participants
Program Folders for Counselors
Participants were assigned to specific PA counselors based on their medical needs and schedules.
Participants with complicated medical histories (conditions other than controlled hypertension or
arthritis) were assigned to the exercise physiologist for activity support.
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Program folders were assembled for all participants, which helped the PA counselors provide
personal support to each participant. Each folder included participants’:
•
Screening and demographic information
•
Photo
•
Completed physical activity questionnaire
•
Functional fitness assessment results
•
Baseline activity log
•
Signed informed consent
•
Physician contact information
Preparing for the Personal Planning Session
Prior to each session, PA counselors reviewed and summarized participants’ completed medical
history questionnaires and the results of the functional fitness assessments. Counselors also
determined participants’ contraindications to exercise, discussed concerns with the staff nurse and
exercise physiologist, and selected appropriate handouts for participants.
Resources available to PA counselors included: a nursing drug guide and exercise guidelines for
individuals with various diseases, handouts and materials in a portable file folder brought by the
counselor to the session, a private space with a table, two chairs, and enough room to demonstrate
stretching exercises.
NOTE: Another good resource for program staff is ACSM’s Exercise Management for Persons with
Chronic Diseases and Disabilities, Second Edition11
Planning Session Agenda
The planning session focused on the following topics:
1) Defining roles and responsibilities. Each PA counselor and participant discussed a
partnership agreement which described each of their roles and responsibilities. These included
maintaining monthly telephone contact, keeping activity logs, and completing 6- and 12-month
assessments (questionnaires and functional fitness testing).
2) Review timeline. PA counselors scheduled the first telephone appointment, distributed a
flyer for the first workshop, and reviewed the commitment to the program including completion of a
12-month assessment.
3) Review functional fitness assessment results. PA counselors explained the individual
variability of testing results, i.e., the time to complete the chair stands could vary if they were
feeling better on one day versus another day. They also explored participants’ feelings about the
tests and whether there were any areas of physical functioning they were interested in focusing on
during their program.
11
ACSM's exercise management for persons with chronic diseases and disabilities (2nd ed.) Champaign,
Illinois: Human Kinetics (2003).
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4) Review completed activity logs. PA counselors reviewed and discussed with participants
the activity logs that they completed for two weeks prior
See Appendix 9, Activity Log, and
to the appointment. They also reviewed the work effort
Appendix 10, Activity Log Tips
scale and activity log tip sheet again.
5) Discuss the physical activity plan. The PA counselor and participant discussed many
factors as they worked together to develop a reasonable plan to increase (or to at least think about
increasing) the participant’s physical activity. Depending on the PA counselor’s background and
the individual’s needs, the counselor served as a resource and helped provide information for the
participant to determine his/her own plan. At times, PA counselors recommended additional
follow-up with the staff exercise physiologist or personal physician.
6) Readiness to change and preferences for different activities. Depending on participants’
readiness to change, PA counselors discussed participants’ interests, barriers, and options. When
participants were not ready to start a new physical activity, PA counselors asked questions about
participants’ barriers and discussed with them the pros and cons of changing their current level of
physical activity. Participants were encouraged to come up with their own reasons for possibly
increasing activity sometime in the near future. When discussing preferences for exercise, PA
counselors always discussed safety issues around those exercises.
•
Home- versus class-based options for exercise. PA counselors had lists of community sites
that offered physical activity classes for seniors. Both class-based and home-based
possibilities were explored; they discussed factors such as preference for group versus
individual options, location, costs, schedules, and safety concerns.
•
Goal setting. If participants seemed ready to begin a new activity, PA counselors discussed
current guidelines for endurance, strength, flexibility, and balance. They also discussed an
appropriate, step-by-step way to increase physical activity (start light, slowly increase).
Participants were asked to think about the overall goal that they wanted to reach by the end
of the year and about the small steps they would take to reach that goal.
•
Education around exercise and safety. PA counselors distributed and reviewed two
exercise booklets: Exercise and Your Heart: A Guide to Physical Activity (American Heart
Association 1993) and Pep Up Your Life (American Association of Retired Persons 1994).
•
When it was appropriate, staff members also provided handouts including tips developed by
the staff nurse on topics such as exercising safely and taking precautions with certain
chronic conditions.
•
PA counselors explained the importance of moderation, demonstrated the “talk test,”
showed some modifications of exercises in one of the books, and discussed the “perceived
exertion scale.”12
•
PA counselors reviewed a Behavioral Contract designed to help participants come up with a
self-selected goal for the following week.
•
Self-monitoring. Participants were asked to fill out activity logs for at least two weeks out
of each month. The forms were designed to provide information to PA counselors for use in
telephone support and to function as a feedback mechanism for participants. Staff members
12
Borg, G. A. V. (1982). Psychophysical bases of perceived exertion. Medicine and Science in
Sports and Exercise, 14, 377-381.
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mailed to participants each month the logs, a stamped, addressed return envelope, and a
newsletter.
At the end of the session, PA counselors scheduled a follow-up telephone appointment. They also
encouraged participants to sign up for the first workshop about exercise basics, including safety.
NOTE: The materials given to participants were the most relevant and economical available at the
time. These materials were given to provide some "self-help” in a written format. Currently, we
recommend having the participants obtain the free book: Exercise: A Guide from the National
Institute on Aging13 which is available in English and Spanish.
A Recommendation for Future Programs
The CHAMPS PA counselors recommend that future programs include a follow-up session with
high-risk participants and with those not ready to begin exercising. Because the initial session
covers so much material, a follow-up session to review key safety issues or concerns, practice more
of the self-monitoring skills, and address more thoroughly any special needs for higher risk
individuals might be useful. For those not ready to begin exercising, additional one-on-one sessions
would have allowed more time to work on behavioral strategies to help participants transition to a
point of readiness.
Physical Activity Support Mechanism: Telephone Support
Purpose
•
To provide support, motivation, and follow-up for all participants
•
To acknowledge participants’ readiness to change and adopt appropriate strategies
•
To help participants take the steps to reach their goals
•
To develop strategies to overcome barriers
•
To discuss with participants changes in their medical condition and how these changes can
affect physical activity planning
Details
Telephone calling also utilized techniques of “motivational interviewing.” As mentioned earlier,
this is an approach that acknowledges a person’s readiness to change, is nonjudgmental, and
encourages participants to make their own choices regarding the next steps in their physical activity
planning and the strategies they use for overcoming barriers.
Generally, participants reported that telephone support is an effective strategy for encouraging the
development of a regular physical activity program. To accommodate busy schedules, we noted
participants’ preferred times for receiving phone calls in each participant’s folder during the
planning session. Sometimes participants were called after business hours. In some cases, phone
appointments were scheduled in advance.
Prior to calling, PA counselors reviewed participants’ activity logs, notes from their personal
planning session (including medical concerns), and notes from previous telephone calls.
13
Available from http://www.nia.nih.gov/exercisebook/
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Structure of Telephone-Based Motivational Support Sessions
Telephone calls followed a general outline, which changed as participants neared the end of the
one-year program to focus on relapse prevention and ways to continue being physically active after
the program support ended.
See Appendix 11, Telephone
Follow-up Form
PA counselors began phone calls with open-ended questions about
participants’ physical activity program and overall health and wellbeing. They listened reflectively to participants’ comments, probed for information about why their
individual activity plan may or may not be working for them, and provided positive reinforcement
for accomplishments.
Other Topics Discussed by PA counselors
Medical Concerns. PA counselors queried participants about any changes in their medical
conditions and about signs and symptoms of exercise intolerance such as new or increased pain
related to exercise. (NOTE: Participants brought up a wide range of medical concerns from
increased joint pain with strengthening exercises to chest pain with walking). Depending on the PA
counselor’s background some situations included:
• Participant should talk to a physician regarding his/her medical concerns.
• Staff exercise physiologist could discuss some questions/concerns regarding a participant’s
exercise program. For instance, if a participant felt that certain exercises aggravated his/her
arthritis, they could discuss the situation such as the type of arthritis, what exercises the
person was doing, and potential modifications that could be tried or whether certain
exercises should be avoided (such as during a flare-up of rheumatoid arthritis).
• At times, staff could obtain permission from those with medical concerns related to their
exercise program to have the exercise physiologist, nurse, and/or geriatrician work with a
participant’s physician for additional recommendations.
Goals, Barriers, and Motivation. PA counselors discussed participants’ recent physical activity
based on their returned activity logs. Additionally, they discussed barriers to participants’ activity
program and ways to overcome them. Participants were encouraged to problem solve and come up
with their own strategies to overcome barriers. When participants were unable to solve their
activity problems, PA counselors asked permission to offer solutions that “worked for others,” and
then offered participants a menu of options. Other topics included:
•
Strategies to resume activity after a medical or personal interruption
•
Goal-setting for the following month
•
Arrangements for follow-up phone calls and workshop attendance
NOTE: Participants discussed a wide variety of situations with PA counselors. Illness, surgery, and
deaths of friends or family members were both major barriers and sometimes major motivators to
exercising.
Frequency of Phone Calls
Event
Initial telephone call
Months 1-3
Months 4-12
Frequency
One time, 1-2 weeks after personal planning session
Every two weeks
Monthly
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Physical Activity Support Mechanism: Group Workshops
Purpose
•
To teach the basics of exercise safety
•
To provide information about health and wellness topics using a step-by-step approach,
practical experience, and examples of others in the group (modeling)
•
To have participants try different types of physical activities under supervision, with staff
making appropriate corrections and suggestions
•
To have participants practice self-management techniques for overcoming barriers
•
To build self-efficacy and provide group support
Format
We conducted 10 monthly workshops formatted as small groups. The workshops provided
participants with information about and practical tips on how to do various exercises and how to
safely increase physical activity level. The workshops also provided participants with opportunities
to exchange ideas with each other.
NOTE: Although the workshops were optional, we strongly encouraged participants to attend the
initial workshops.
Specific Workshop Topics & Descriptions of Demonstrations
We present here a brief summary of each of the 10 workshops.
Workshop #1: EXERCISE BASICS
Goal: To teach basics rules of exercising safely
Content
1. Normal responses to exercise and
signs and symptoms of doing “too
much” exercise
2. Contraindicated movements
3. Introduction to the different types of
exercises (endurance, strength,
flexibility, and balance) and their
benefits
Practical Lessons Using
Demonstrations and Practice
1. How to use the rating of perceived effort
scale (RPE) and talk test
2. How to do seated/ standing, marching, and
arm movements for warm up,
cardiorespiratory fitness, and cool down
3. Flexibility exercises
Note: Participants met in small groups to discuss
overcoming barriers and setting goals.
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Workshop #2: STRENGTH AND POSTURE
Goal: To educate participants about building strength and improving posture
Content
Practical Lessons Using
Demonstrations and Practice
1.
2.
3.
4.
5.
How to identify personal motivators
Problem solving
Importance of posture
Benefits of strength training
Current recommendations for
strength training
6. Key safety issues
1. Proper posture for sitting, standing, lifting,
and carrying objects
2. Strengthening exercises using resistance
bands and/or dumbbells
3. Stretching exercises (review from
workshop #1)
Note: Participants met in small groups to identify
personal motivators and practice problem solving.
Workshop #3: WALKING AND HEART RATE CLINIC
Goal: To practice walking at a safe rate and have fun outdoors.
(This workshop was held at a local sports track)
Content
Practical Lessons Using
Demonstrations and Practice
1. How to measure heart rate and
calculate target heart rate
2. The influence of medications,
pacemakers, etc. on heart rate
3. Walking safely (environmental
hazards, footwear, etc.)
1. How to use the rating of perceived effort
scale (RPE) and talk test
2. How to measure and calculate heart rate
3. How to properly warm-up and stretch
4. Walking on the track for cardio-respiratory
fitness
5. Cool down and post-exercise stretches
Workshop #4: FITNESS FAIR
Goal: To introduce participants to a wide range of community physical activity classes for
older adults
Content
Practical Lessons Using
Demonstrations and Practice
1. Benefits of participating in fitness
classes in the community
2. Finding the right class with concerns
for cost, location, intensity level,
schedule, and format
3. Classes represented included: gentle
aerobics, water aerobics, general
conditioning, yoga
1. Several class leaders invited class members
to perform typical exercises to demonstrate
the nature of the class.
2. CHAMPS participants were invited to try
some of the exercises
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Workshop #5: IMPROVING BALANCE & PREVENTING FALLS
Goal: To educate participants about exercises that promote balance and coordination and
increase awareness of other factors associated with fall prevention
Content
Practical Lessons Using
Demonstrations and Practice
1. Body mechanics related to balance
and fall prevention
2. Facts on falling
3. A Tai chi guest instructor discussed
the benefits of tai chi.
4. Staff presented a slide show on
factors related to falls
1.
2.
3.
4.
5.
6.
Lower body strength exercises
Feet/ankle range of motion exercises
Balance and coordination exercises
What to do if you fall
Tai chi movements
How to get safely down to and up from the
floor
Workshop #6: FINDING TIME & MOTIVATION FOR PHYSICAL ACTIVITY
Goal: To help participants evaluate how to fit appropriate physical activity into their daily
lives
Content
Practical Lessons Using
Demonstrations and Practice
1. Reframing and considering other
points of view to overcoming
common barriers
2. Various “tools” to motivate oneself
to maintain or increase physical
activity
1. 24 hour personal time study of sedentary
and active behavior
2. Participants considered other points of view
for overcoming common barriers
3. Participants made a physical activity
contract for the next week
4. Participants practiced stretching exercises
during “stretch break”
Workshop #7: MAINTAINING/ACHIEVING HEALTHY DIET & BODY WEIGHT
Goal: to educate participants on healthy approaches to weight management
Content
Practical Lessons
1. Healthy approaches to losing,
gaining, and maintaining body
weight
2. Relationship between diet, exercise,
and weight control
3. Nutritional needs of older adults
4. Reading food labels
1. A game comparing food labels
2. A group discussion to identify two personal
eating modifications that would lead to a
healthier diet
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Workshop #8: MANAGING YOUR STRESS RESPONSE
Goal: to help participants identify and manage their responses to stressors
Content
Practical Lessons
1. Physical responses to stress
2. Methods to modify the stress
response
1. 10 minute stretch break
2. Relaxation exercises
3. Note: Participants met in small groups so
that they could discuss their personal
stressors based on homework assignments.
Workshop #9: EXERCISE OPTIONS & PROGRESSION
Goal: to help participants develop strategies for incorporating regular physical activity into
their daily lives and progressing toward individual goals.
Content
Practical Lessons
1. Ways to adapt exercise routines to
meet personal needs and to keep
exercise safe including proper body
mechanics and effort level
2. Relationship of person’s current
exercise program vs. optimal
program for reaching personal goals
3. Ways to progress and to continue
developing exercise program
1. Identify correct and incorrect exercise
techniques including body alignment in an
assortment of exercise videos
2. Follow and adapt for oneself the exercises
shown in various exercise videos
3. Try some basic folk dancing steps (guest
instructor)
Workshop #10: YEAR 1 UPDATE & REVIEW OF PERFORMANCE SCORES
Goal: to discuss individual results and present aggregate findings at the end of the program
year.
Content
Practical Lessons
1. A review of Year 1 CHAMPS
program and options for Year 2
2. Interpretation of individual data
summaries from baseline, 6-month,
and 1-year functional fitness
assessments
3. Research findings that were
presented at various conferences in a
poster format
1. Reviewed functional fitness assessment
summaries in relation to their own physical
activity regimen
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Physical Activity Support Mechanism: Monthly Newsletters
Purpose
•
To provide participants with the latest information about physical activity
•
To reinforce information provided during workshops
•
To remind participants of workshop dates and topics, upcoming program events, and/or
related presentations at the medical group
•
To keep participants interested in the program and their own physical activity and help them
feel part of an organized program
•
To motivate participants with stories of individual participants’ successes and challenges
Details
The newsletters were sent out by mail each month with the activity log. This monthly mailing
provided regular contact with the participants. Staff members often added brief hand-written notes
to the newsletter. In addition to the above, the newsletters’ content included myth busters and tips
of the month about exercise and health. We endeavored to make the newsletter understandable to
participants with a range of reading levels. To this end, the format included pictures, logos,
cartoons, large print and plain font styles, and also was
See Appendix 12: Sample Newsletter
printed with high contrast (black text on very light
colored paper) and limited to two sides of one page.
Physical Activity Support Mechanism: Activity Logs
Purpose
•
To enable participants to self-monitor their physical activities
•
To help participants set personal goals
•
To facilitate PA counselors’ telephone support discussions with participants about their
goals and their progress in achieving their goals
Details
Participants recorded their physical activities in logs during one 2-week period each month. The
initial (baseline) log was completed prior to the personal planning session. During the planning
session, PA counselors reviewed the first log for accuracy. During the year, logs were mailed to
participants each month along with the newsletter,
See Appendix 9, Activity Log, and
workshop announcements, and a cover letter with
Appendix 10, Activity Log Tips
personal notes.
Use of Activity Logs by PA Counselors
•
Activity logs were used during telephone support calls to compare participants’ current and
past levels of activity and to discuss with participants their success in meeting their goals for
that time period.
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•
Prior to mailing the blank logs, PA counselors usually wrote motivational notes on the logs
of participants who were difficult to reach by phone or who seemed to need some additional
support.
Challenges of Using Activity Logs
PA counselors found that it was often difficult for participants to quantify the amount of physical
activity they performed. For example, many participants reported that they were “busy” all day and
regarded as “physical” some sedentary activities such as “driving the car to the supermarket.” Also,
a few participants did not fill out the logs and/or did not return them in a timely manner. In these
cases the information was collected by phone.
NOTE: Although some participants felt that completing activity logs was a burdensome task, others
reported that the logs provided motivation to stay active.14
14
Gillis, D. E., Grossman, M. D., McLellan, B. Y., King, A. K., & Stewart, A. L. (2002). Participant's
evaluations of program components of a physical activity promotion program for seniors (CHAMPS II).
Journal of Aging and Physical Activity, 3, 336-353.
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Feedback and Diffusion
Participant Feedback
We asked participants for input on various aspects of the program after they completed the
CHAMPS II program. Eighty participants completed a survey to rate how helpful different
components of the program (such as activity logs, newsletters, and the informational meeting) were
for starting or maintaining their physical activity program. In addition, 20 participants took part in a
focus group in which they were asked about the most and least useful aspects of the program.
Overall, survey participants rated as most helpful staff members’ personal attention, encouragement
and telephone calls, the informational meeting, and the personal physical activity planning session.
Focus group participants also rated personal attention by staff members as one of the program’s
most helpful features. The aspects of personal attention that seemed most helpful to participants
were one-on-one contact with and positive feedback and verbal support from staff members, as well
as staff members’ nonjudgmental approach. For details, see Gillis, Grossman, McLellan, King and
Stewart.15.
Subsequent Program
Given the success of CHAMPS II, the researchers obtained a grant from The California Endowment
to diffuse the program by working with three different community sites in and around San
Francisco, California. The goal of this diffusion research is to adapt and implement the CHAMPS
II program to meet the needs and resources of individuals and diverse communities. Please see our
web site at www.ucsf.edu/champs/ for more information.
15
Gillis, D. E., Grossman, M. D., McLellan, B. Y., King, A. K., & Stewart, A. L. (2002). Participant's
evaluations of program components of a physical activity promotion program for seniors (CHAMPS II).
Journal of Aging and Physical Activity, 3, 336-353.
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Appendix 1: Motivational Interviewing Principles, Strategies, and Skills
Motivational interviewing is a directive, client-centered counseling style for eliciting behaviour
change by helping clients to explore and resolve ambivalence. It is most centrally defined not by
technique but by its spirit as a facilitative style for interpersonal relationship (Rollnick & Miller,
1995).
CHAMPS II adopted the “spirit” of motivational interviewing as the primary style behind the interpersonal
relationships between program staff and program participants. Staff members were trained in the techniques
and strategies that are used to promote productive interactions with program participants, with “a focus on
exploring and resolving ambivalence, which is a key obstacle to change.” (Rollnick & Miller, 1995)
How is the “spirit” of motivational interviewing used to encourage behavior change such as increased
physical activity? Paraphrasing from Rollnick and Miller’s 1995 article, the key points are:
1. Staff help participants identify their own values and goals to evoke motivation to change.
2. It is the participant’s responsibility to articulate the costs and benefits of taking on new activities
or changing behaviors. The staff task is to facilitate discussion of both sides of the dilemma and
guide participant toward a resolution of the ambivalence, hopefully in a positive direction.
3. Direct persuasion, advice giving, argumentation, and aggressive confrontation are avoided as
methods to encourage change. While there is a place for advice-giving when a participant asks
for suggestions, motivational interviewing is based on an eliciting style.
4. Staff must be very attentive and responsive to participant’s motivational signals in order to
support but not push for change. If a participant makes comments that imply resistance, that
may be a sign that a staff member has assumed greater participant readiness to make a change
than is the reality.
5. The relationship between staff and participant is a partnership, with the staff respecting each
participant’s freedom to make choices, regardless of the consequences. The only caveat occurs
when a participant reports excessive physical activity that could be unsafe due to medical and
physical circumstances, such as pre-existing cardiac conditions. In such an instance, the
participant is strongly advised to make changes to ensure safety.
Behaviors that are characteristic of the motivational interview style can be learned and skills will develop
with practice. The most important techniques include:
1. Reflective listening to understand what a participant is trying to communicate.
2. Expressing support and acceptance.
3. Eliciting and selectively reinforcing any mention of positive change from the participant.
4. Checking on the participant’s readiness to make changes, making sure not to get ahead of the
participant or make assumptions about readiness, willingness, and ability to make changes.
5. Encouraging self-determination and problem-solving. “You’re probably the best judge of what
will work for you.” “What do you think about this situation?”
CHAMPS staff when discussing physical activity behavior with participants used open-ended questions,
affirmations, reflective listening, and summaries, recalled with the acronym “OARS”. These techniques
are taught in many communication courses and are useful tools for all types of interpersonal interactions.
•
•
For more information on motivational interviewing, refer to:
www.motivationalinterview.org
Rollnick, S. and Miller, W. R. (1995). What Is Motivational Interviewing? Behavioural and Cognitive
Psychotherapy, 23, 325-334.
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•
•
Or read one of William R. Miller and Stephen Rollnick’s books on the subject:
Miller, W. R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive
Behavior. New York: The Guilford Press.
Miller, W. R.. & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change (2nd ed.).
New York: The Guilford Press.
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Appendix 2: Initial Contact Letter
Date
Name
Address
Dear:
As a member of the [name of sponsoring medical group or agency], you have the opportunity to participate
in an exciting new program and research study. You have been randomly selected to take part in the first
phase of the study, a short telephone interview about the health and health practices of adults 65 years of age
and older.
This health survey is being conducted by researchers at [name of institution and sponsoring agency]. You
may have read about it in a recent issue of [medical group newsletter]. A copy of the article is enclosed.
In a few weeks, you will be called by an interviewer who will invite you to complete a 15 minute survey over
the telephone. If you decide to complete the interview you will be making a valuable scientific contribution.
Your participation in this survey will increase our understanding of the health practices and needs of older
adults. In addition, the interview will help determine if you are eligible for the second phase of the project, a
new program that may help you improve your health. The program is free and is especially designed to meet
the needs of older adults.
I am very enthusiastic about this program and I encourage you to take part in the short survey. However,
please note that your participation in the telephone interview is voluntary. You may refuse to continue with
the phone call at any time. I hope you will choose to take part in this important project.
Sincerely,
[Name of physician or other well-known person in community]
Encl.
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Appendix 3: Informational Meeting Agenda and Script
I.
II.
III.
IV.
V.
Introduction
A.
Welcome
• Introductions of project staff
• General information (such as refreshments and location of restrooms)
B.
Purpose of Meeting
• by completing the telephone survey, you have already made an important contribution
(thank you!)
• next hour, who we are and what the CHAMPS program is about
• make informed decision about whether or not to take part in this program
• when making decision about CHAMPS you will fall into 1 of 3 categories: YES -- sign
me up now
NO -- this program is not for me
MAYBE -- I need to think about this some more
• at end of meeting we will ask you to complete a card and turn it in, the info you provide
will be beneficial
• draw for door prize
C.
Sequence of Meeting
To start off our meeting...
• -- who and what is CHAMPS
-- health benefits of physical activity
• -- slide show on what we mean by physical activity
• -- specifics of the CHAMPS program
• -- importance of physical activity
• Complete response forms/door prize
• Signup for functional fitness assessment
• Throughout please stop and ask us questions or clarify meaning
• Any questions?
CHAMPS: General Aims and Scientific Importance
Health Benefits of Physical Activity (brief talk)
What is Physical Activity (slide show)
CHAMPS: Specifics of the Program
We’ve given you a lot of information on the benefits of physical activity and now I’d like to tell you
more about the specifics of the CHAMPS program.
You may be asking yourself, “What will I learn if I take part in CHAMPS?”
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Slide 1: What Will I Learn?
•
Physical activity can be fun
•
How to:
 Exercise safely
 Motivate yourself
 Overcome barriers
 Set goals
 Maintain independence
As discussed earlier, CHAMPS is...
Slide 2: Personalized Physical Activity Program
•
You choose the activity
•
You decide if home or class based
•
We will help you get started
•
We will help you modify your program (if necessary)
•
We will help you maintain your program
In this program we will work with you at your own pace. You will start slowly...
So that your program is safe...
Slide 3: CHAMPS Program
Start slowly, progress gradually
•
Safe
•
Comfortable
•
Enjoyable
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The main features of the CHAMPS program include:
Slide 4: Main Features of Program
•
Personal counseling: This includes working one-onone with your physical activity counselor to plan your
program.
•
Telephone follow-up: You receive this from your
physical activity counselor, who will check in to make
sure everything is ok with your program and answer
any questions you may have.
•
Group workshops: Our staff will conduct these
monthly on specific topics of interest such as exercise
safety, proper nutrition, and stress management.
•
Latest information: We will also keep you up to date
on key research related to physical activity and older
adults.
So those are the main features of the CHAMPS program. Now, I’d like to take you through the program
step-by-step.
After hearing us speak today, if you decide you want to take part in CHAMPS the next step would be to sign
up for a functional fitness assessment. When you sign up for this meeting we will give you some materials to
complete beforehand. These include: an informed consent, medical history, and an activities questionnaire.
At the meeting you will also participate in some simple physical measures. (Demonstrate) These are simple
measures of your physical abilities such as how many times you can sit and stand in 1 minute, how long it
takes you to walk a short distance, and how far you can walk in 6 minutes.
Slide 5: Sequence of Events
•
•
•
⇒
⇒
⇒
⇒
Telephone Survey (already completed)
Informational Meeting
Functional Fitness Assessment
informed consent
medical history
questionnaire
physical measures
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After the Functional Fitness Assessment is the Personal Planning Session where you will meet oneon-one with your physical activity counselor. During this meeting you will be randomly assigned to
either the intervention group or a wait-list control group. [Note: meeting facilitator discusses
methods and purpose of randomization, including differences between groups and benefits to
participants.]
Questions?
OK, lets move on. Who can participate in the CHAMPS Program?
Slide 6: Who Can Participate
Member of HMO
• Participating in little or no physical activity
or
Just started physical activity
• Planning to stay in the South Bay
• Willing to be randomized
OK, so if you decide to take part in CHAMPS, this is what you can expect from our staff:
Slide 7: What to Expect from CHAMPS Staff?
•
Personalized physical activity program (we will work
with you to design a personalized....)
•
Personal attention from our trained staff
•
Latest information (we will provide the latest
information on physical activity for older adults and
the health benefits of regular exercise)
•
Special workshops
•
Confidentiality
•
Feedback
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Since CHAMPS is a partnership between our staff and you, this is what we will expect from you:
Slide 8: What to Expect from You?
•
Minimum 1 year commitment
•
Take part in all assessments
•
Provide feedback
VI. Motivational Speaker
VII. Invitation to fill out response card and sign up for next step.
VIII. Thank you for attending
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Appendix 5: Medical Release Form
As a courtesy to your primary care physician, we would like to inform him/her about
your participation in CHAMPS. If this is agreeable to you, please provide his/her
name and sign below:
Primary Care Physician’s Name: ______________________________________
_____________________________________Date: ________/________/______
Signature
month
day
year
44
CHAMPS
Community Healthy Activities Model Program for Seniors
Appendix 6: Notification Letter to Participant’s Physician
Name
Address
Date
Dear Dr. [name]:
Your patient, [patient name], has taken the initiative to improve her health by enrolling in the Community
Healthy Activities Model Program for Seniors (CHAMPS). CHAMPS is a research project funded by
[funding source] and is being conducted at [clinic or agency name] by [project director name and institution].
In addition, [physician name] of [clinic] is the medical director of the study. Attached is a summary sheet
explaining the CHAMPS program.
One of my roles in the CHAMPS project is to serve as a liaison between the [clinic or agency name]
physicians and the CHAMPS staff. . As an exercise physiologist, I will provide physical activity counseling
for many of the participants, especially those with chronic medical conditions.
In preparation for this program, your patient has completed a medical history form which has been reviewed
by our staff nurse and [physician name]. If you have any medical concerns about this person's participation
in the study, please call me at [clinic or agency name] (325-6185) or at the CHAMPS main office (323-0601)
prior to [date of your patient's enrollment meeting].
Thank you for your assistance in this endeavor. Should you have any questions, please do not hesitate to
contact me or the CHAMPS staff.
Sincerely,
Name
Title
45
CHAMPS
Community Healthy Activities Model Program for Seniors
Appendix 7: Script and Phone Screen to Schedule 6-Month Functional
Fitness Assessment
CHAMPS
Community Healthy Activities Model Program for Seniors
SCRIPT TO SCHEDULE 6-MONTH ASSESSMENT
*Need participants name, address, phone number, & enrollment appointment book
*Make notes on telephone contact sheet
, This is
from CHAMPS. I am calling to set up an appointment for
Hello
your six-month assessment. This assessment will consist of questionnaires and physical functioning tests
just like those you completed when you joined the study. You will receive $10 for completing the
questionnaires and tests.
Before we schedule a time, I need to ask you a brief set of questions to check if your medical condition has
changed since you enrolled in the study. This should only take a couple of minutes. Is this a good time?
If YES-- Continue with PHONE SCREENING FOR 6-MONTH ASSESSMENT
If NOT convenient time--Schedule time to call back
If REFUSE- Thank them for their time, hang up and alert project director
After completion of screening questions:
If YES to any of the screening questions, inform them that the exercise physiologist will be calling them
to discuss the information in greater detail before scheduling.
If NO to ALL screening questions, schedule for testing:
Thanks for answering those questions. It seems like it would be O.K. for you to come in for the physical
functioning tests. Would you like to get your calendar to set up a time to come to the clinic?
If YES -- continue with script
If NO -- set up time to call back
Testing will be conducted at the same location at the PAMF auditorium above Urgent Care. Your
appointment should last approximately one hour. I will send you two questionnaires to complete one to
two days before your appointment. Please bring the completed questionnaires with you to your
. If you
appointment. Do you have any questions? I would like to verify that your address is
have any questions between now and your appointment, you may contact me at the CHAMPS office at 3230601. Thank you very much for your time.
46
CHAMPS
Community Healthy Activities Model Program for Seniors
QM6
ID
Date
Interviewer's Initials
CHAMPS
Community Healthy Activities Model Program for Seniors
PHONE SCREENING FOR 6-MONTH ASSESSMENT
Instructions: Please answer yes or no to the following questions. Your responses will be regarded as strictly
confidential.
1. Are you currently recovering from any injury or surgery?
YES
NO
2. Have you been diagnosed with any new medical condition in the past 6 months
such as high blood pressure or diabetes?
YES
NO
3. Have you been diagnosed with any heart beat irregularities, heart condition, or
stroke in the past 6 months?
YES
NO
4. Have you been diagnosed with congestive heart failure in the past 6 months?
YES
NO
5. Have you experienced any chest pain in the past 6 months?
YES
NO
6. Have you experienced any loss of consciousness in the past 6 months?
YES
NO
7. Has your doctor restricted your physical activity in the past 6 months?
YES
NO
8. Have you been hospitalized in the past 6 months?
YES
NO
**If YES to any of the above questions, inform them that that staff exercise physiologist or nurse will be
calling them to discuss the information in greater detail before scheduling
**If NO to all questions, schedule for testing using SCRIPT TO SCHEDULE 6-MONTH ASSESSMENT
Interviewer's Comments:
47
CHAMPS
Community Healthy Activities Model Program for Seniors
Appendix 10: Activity Log Tips
The following is a list of tips to help you fill out the activity logs effectively so that we obtain the
research information needed.
A.
Monday – Date: ____/____/____
B.
Class
Activity#1: ____________________________
Activity#2: ____________________________
Activity#3: ____________________________
Comments:
N
N
N
Y
Y
Y
C.
Time
(min.)
_______
_______
_______
D.
Effort
_______
_______
_______
A) Activity:
• Specify exact activity (e.g. walking, stretching, stationary bike). Please do not write in
just the word “exercise”.
• Even though these activities may be tiring do not record the following:
Shopping / Errands
Work
Meditation / Stress management
Driving
• Do record walking to and from the grocery store, work, or to lunch if it is clearly stated
and does not include time spent shopping, working, or eating lunch.
• Physical therapy:
♦ Only record the times when you are doing the actual exercises by yourself.
♦ Do not record the physical therapy sessions with your physical therapist.
• Do not group unrelated activities together such as gardening and housework, write as
two separate activities since we need to code each activity separately.
• Do group similar activities together such as vacuuming and cleaning windows as
housework. If you are unclear then state the activities separately.
B) Class:
• Please remember to circle Y=yes or N=no for whether the activity is a class you are
taking or not. Exercising to a video or TV program is not considered a class.
C) Time:
• Remember to fill in the amount of time in minutes doing a particular activity.
♦ Avoid writing in all day.
• Estimate the time to the best of your ability.
D) Work Effort
Remember to:
• Use scale
• Estimate work effort for overall activity instead of giving ranges.
54
CHAMPS
Community Healthy Activities Model Program for Seniors
Appendix 11: Telephone Follow-up Form
CHAMPS Telephone Follow-Up – 1st Contact
Name: ____________________
Counselor: ________________
Best Time: ________________
Id#: _________________
Date: ____/____/____
Phone #: _____________
Time start: ___________
Introduction
How are you doing? (reflective listening)
How is your physical activity program doing? (reflective listening)
What changes in your health have you noticed during the last ______ weeks? (reflective listening)
Pain
Do you have any pain associated with exercise? YES
NO
When do you have this pain?
Where is the pain located?
Can you describe the pain?
How severe is the pain (1 = mild, 5 = moderate; 10 = severe)
How long have you had the pain?
Does the pain prevent you from doing your exercise? YES
Have you sought medical treatment for your pain? YES
NO
If YES, for how long?
NO If YES, what?
Goals, Barriers & Motivation
What goals have you set for yourself this week? (reflective listening) -- Discuss Contract
Do you foresee any obstacles for the next 2 weeks that may make exercise difficult? YES
If YES, what is the obstacle?
Will it prevent you from exercising? YES
NO
If YES, for how long?
NO
Have you thought about how to alter, adapt, avoid this obstacle to maintain your exercise program?
If currently NOT exercising:
When was the last time you exercised?
55
CHAMPS
Community Healthy Activities Model Program for Seniors
What has prevented you from exercising?
What is your confidence in your ability to restart a regular exercise program? 0 to 100% _________
Do you have any ideas to help you start your exercise program?
Do you feel an additional phone call would be helpful 1 to 2 days after you restart your program?
Is there anything else you would like to discuss with me at this time?
56
CHAMPS Newsletter
Community Healthy Activities Model Program for Seniors
March 1998
Vol. 2/ No. 12
CHAMPS Workshop Dates
Workshop #9: Exercise Options
and Progression
Rain or shine, come join us on:
Wednesday, March 18th
from 2:30 to 4:00 PM
• Try some new moves with
a local folk dance instructor.
• Review safety issues and critique exercise
videos available at the public library.
• Determine if your current physical activity
program is optimal for reaching your goals.
• Identify ways to increase strength,
endurance, flexibility and balance.
Please call by:  Tuesday, March 17th
to sign-up.
Just a reminder...
Workshop #10 is the last workshop in our series.
At this workshop we will provide you with your
individual physical evaluation scores.
Workshop #10 will be held several times throughout the next few months. Sign up will occur
once your 24-Month Evaluation is
complete. If you have any questions about this
workshop, please contact your exercise counselor
at the CHAMPS office.
Clinic Lectures
The clinic’s Education Department is offering the following lecture:
March 11th: Now Where Did I Put My Keys?
2:30 to 4:30 PM
This lecture will take place in the auditorium.
To register call: (xxx)xxx-xxxx.
CHAMPS Headliner
Group A participants may
recognize the name of our
headliner – Participant Name.
He was highlighted two years
ago for his enthusiasm and
dedication to staying fit so that he could keep
playing golf.
Now, at a young age of 92, this participant has
once again motivated and impressed us all.
This fall, he had a tough time with
pneumonia. The rains were also making it
difficult to get out there and golf. One day he
noticed that his watch band was slipping
around on his wrist. He said, “ I knew I must
be getting weak all over and I needed to do
something about it.”
This participant took action and signed up for
a Foothill College exercise class - the first
exercise class of his life! Now he is using
exercise machines for upper and lower body
strengthening, plus using the treadmill and
stationary bike 3 to 4 times per week. After a
workout last week, he still had the energy to
go hit a bucket of balls. He’ll be ready for
golf this season and rumor has it that he’ll be
showing off some new strong, rippling
muscles!
CHAMPS Myth-Buster
of the Month
True or False?
If you haven’t been able to fit
more physical activity into
your life by now, it’s never
going to happen.
See back page for answer
401 Burgess Drive, Suite 405, Menlo Park, CA (650) 323-0601
Tip of the Month:
The Surgeon General’s
Recommendations for
Physical Activity
Experts agree that for better
health, physical activity should be
performed regularly. While this is
old news for CHAMPS participants, we
thought we’d share the recommendations
from Physical Activity and Health, A Report of
the Surgeon General, 1996.
* You’re never too old to exercise.
* People of all ages should include a minimum
of 30 minutes of moderate intensity exercise
on most, if not all, days of the week.
* Greater health benefits can be obtained by
taking part in physical activity of more
vigorous intensity or of longer duration (as
long as medical concerns are addressed).
* Supplement endurance activities with
strength-developing exercises at least 2 times
a week. Strengthening exercises help to
improve musculoskeletal health, maintain
indepen-dence in performing the activities of
daily life, and reduce the risk of falling.
How can you reach these goals? The
Surgeon General’s report suggests you start
with what you are currently doing and slowly
add activity to each of your days. In Aesop’s
classic fable, it’s the tortoise that wins the
race; our CHAMPS workshops have
emphasized this same “slow but steady”
approach to reaching your fitness goals.
Limit your progression to 10% a week. For
example, if you now walk 20 minutes a day,
try 22 minutes a day next week.
There are four approaches to increasing your
activity:
1) Add new activities (one at a time) to
balance your fitness program. Try dance, tai
chi, check out a community class, go walking
with the Sierra Club. The opportunities are
endless!
2) Increase the frequency of the activity you
are currently doing. Moderate level (work
effort from 11 to 13) endurance, flexibility and
balance activities can be done every day of
the week. Strength activities are usually
recommended 2-3 times a week (more often
is “O.K.” if the intensity is light).
3) Increase the intensity (work effort) of
the activity. For instance, try walking slightly
faster. Check with your physician before
progressing to a vigorous effort (work
effort 14 and above).
4) Increase the duration of the activity.
For example, swim an extra lap or gently
hold a stretch a few more seconds.
If you have any questions about increasing
your activity, give us a call at the CHAMPS
office.
Say “Cheese” for Research!
We need photos or slides of you,
your family, or friends involved in
vigorous physical activities such as
tennis, basket-ball, skiing, hiking, cycling or
military exercises to help illustrate one of our
staff’s research paper on lifetime physical
activity. She will present this paper at the annual
meeting of the Society of Behavioral Medicine.
Your old photos from the 1920’s through the
1970’s would be especially welcome. Please call
the CHAMPS office at 323-0601 as soon as
possible. She will make a copy of your photo and
return the original.
CHAMPS Myth-Buster
of the Month
False!
Research has shown that the amount of progress
people make as they follow health promotion
programs such as CHAMPS is directly related
to how ready they were to make a change at the
start of the program. If you felt uncertain about
becoming physically active when you joined
CHAMPS, it might take you a long time to
make beneficial changes. HOWEVER, don’t
give up! Research also has shown a considerable “delayed effect” for health promotion
programs. In other words, when you’re ready,
you’ll be able to fit in more activity. Read the
CHAMPS Headliner for an example of this!
ToC
Fat-Related Diet Habits Questionnaire
I. Interviewer Administered Format
Please consider your food choices over the past MONTH
In the past month…
1.
Usually
Often
Sometimes
Rarely
or
Never
REF
1
2
3
4
ref
How often did you remove
the skin?
(READ 1 – 4)
1
2
3
4
ref
Did you eat red meat such as beef, pork or lamb?
1 YES
When you ate red meat
2 NO
2a. How often did you trim all
3 NA/REF
the visible fat?
(READ RESPONSES IF
NECESSARY)
1
2
3
4
ref
1
2
3
4
ref
1
2
3
4
ref
1
2
3
4
ref
Did you eat spaghetti or noodles?
1 YES
When you ate spaghetti or noodles
2 NO
6a. Were they plain, or with a red
3 NA/REF
or tomato sauce without meat?
1
2
3
4
ref
Did you eat cooked vegetables?
1 YES
When you ate cooked vegetables
2 NO
7a. How often did you add butter,
3 NA/REF
margarine or other fat?
1
2
3
4
ref
1
2
3
4
ref
Did you eat chicken?
1 YES
2 NO
3 NA/REF
When you ate chicken
1a. How often was it fried?
(READ 1 – 4)
1b.
2.
3.
4.
5.
6.
7.
Did you eat ground meat?
1 YES
When you ate ground meat
2 NO
3a. How often was it extra lean?
3 NA/REF
Did you eat fish?
1 YES
2 NO
3 NA/REF
When you ate fish
4a. How often was it fried?
Did you have at least one vegetarian dinner or main meal –
that is, without meat, fish, eggs or cheese?
1 YES
5a. How often did you have a
2 NO
vegetarian dinner?
3 NA/REF
7b.
How often were they fried?
1
In the past month…
8.
9.
10.
11.
12.
13.
14.
Usually
Often
Rarely
or
Never
REF
Did you eat potatoes?
1 YES
When you ate potatoes
2 NO
8a. How often were they fried, like
3 NA/REF
French fries or hash browns?
Sometimes
1
2
3
4
ref
Did you eat baked or boiled potatoes?
1 YES
When you ate baked or boiled
2 NO
potatoes
3 NA/REF
9a. How often did you eat them
without any butter, margarine or
sour cream?
1
2
3
4
ref
Did you eat green salads?
1 YES
When you ate green salads
2 NO
10a. How often did you use no
3 NA/REF
dressing?
1
2
3
4
ref
10b. How often did you use low-fat
or non-fat dressing?
1
2
3
4
ref
Did you eat bread, rolls or muffins?
1 YES
When you ate bread, rolls or muffins
2 NO
11a. How often did you eat them
3 NA/REF
without butter or margarine?
1
2
3
4
ref
Did you drink milk or use milk on cereal?
1 YES
When you had milk
2 NO
12a. How often was it 1% or nonfat
3 NA/REF
milk?
1
2
3
4
ref
Did you eat cheese, including on sandwiches or in
cooking?
1 YES
When you ate cheese
2 NO
13a. How often was it specially-made
3 NA/REF
low-fat cheese??
1
2
3
4
ref
1
2
3
4
ref
Did you eat dessert?
1 YES
When you ate dessert
2 NO
14a. How often did you eat only
3 NA/REF
fruit?
2
In the past month…
15.
16.
17.
18.
19.
20.
21.
22.
Usually
Often
Rarely
or
Never
REF
Did you eat home-baked cookies, cakes or pies?
1 YES
When you ate home-baked cookies,
2 NO
cakes or pies
3 NA/REF
15a. How often were they made with
less butter, margarine or oil than
the recipe called for?
Sometimes
1
2
3
4
ref
Did you eat frozen desserts like ice cream or sherbet?
1 YES
When you ate frozen desserts
2 NO
16a. How often did you choose
3 NA/REF
frozen yogurt, sherbet or low-fat
or non-fat ice cream?
1
2
3
4
ref
Did you eat snacks between meals?
1 YES
When you ate snacks between meals
2 NO
17a. How often did you eat raw
3 NA/REF
vegetables or fresh fruit?
1
2
3
4
ref
Did you sauté or pan fry any foods?
1 YES
When you sautéed or pan fried foods
2 NO
18a. How often did you use Pam® or
3 NA/REF
other non-stick spray instead of
oil, margarine or butter?
1
2
3
4
ref
Did you use mayonnaise or mayonnaise-type spread?
1 YES
When you used mayonnaise or
2 NO
mayonnaise type spread
3 NA/REF
19a. How often did you choose lowfat or nonfat types?
1
2
3
4
ref
Did you eat breakfast?
1 YES
When you ate breakfast
2 NO
20a. How often did you have fresh
3 NA/REF
fruit?
1
2
3
4
ref
Did you eat lunch?
1 YES
When you ate lunch
2 NO
21a. How often did you have one or
3 NA/REF
more vegetables, not including
potatoes or salad?
1
2
3
4
ref
At dinner (or your main meal), how often did you have
two or more vegetables, not including potatoes or salad?
1
2
3
4
ref
3
Fat-Related Diet Habits Questionnaire
II. Example of Self-Administered Format
4
Fat-Related Diet Habits Questionnaire Eating Pattern Score Sheet
QUESTION
RESPONSE
Factor 1 (Substitution)
10b
12a
13a
15a
16a
18a
19a
_______
_______
_______
_______
_______
_______
_______
Total
_______ + number answered = Factor 1 score _____
1b
2a
3a
_______
_______
_______
Total
_______ + number answered = Factor 2 score _____
1 a*
4 a*
7b*
8 a*
_______
_______
_______
_______
Total
_______ + number answered = Factor 3 score _____
5a
14a
17a
_______
_______
_______
Total
_______ + number answered = Factor 4 score _____
6a
7 a*
9a
10a
11a
_______
_______
_______
_______
_______
Total
_______ + number answered = Factor 5 score _____
Factor 2 (Modify meat)
Factor 3 (Avoid frying)
Factor 4 (Replacement)
Factor 5 (Avoid fat)
∑ Factors
___________ = _____________
5
*Reverse order scoring (done as follows: 1=4, 2=3, 3=2, 4=1). For example, a recorded score of 1
will be noted as a 4 on this score sheet, a 2 will be scored as a 3, and so on.
Items 14, 17, 20, 21, and 22 are used for vegetable-related dietary patterns. See: Satia JA, et al,
Nutrition, 18: 247-54, 2002, for more information.
Summary score
5
References:
1.
Kristal AR, Shattuck AL, and Henry HJ. Patterns of dietary behavior associated with
selecting diets low in fat: reliability and validity of a behavioral approach to dietary assessment. J Am
Diet Assoc 1990;90:214-20.
2.
Kristal AR, White E, Shattuck AL, et al. Long-term maintenance of a low-fat diet: durability
of fat-related dietary habits in the Women's Health Trial. J Am Diet Assoc 1992;92:553-9.
3.
Kristal AR, Beresford SA, and Lazovich D. Assessing change in diet-intervention research.
Am J Clin Nutr 1994;59:185S-9S.
4.
Glasgow R, Perry JD, Toobert DJ, and Hollis JF. Brief assessments of dietary behavior in
field settings. Addict Behav 1996;21:239-47.
5.
Shannon J, Kristal AR, Curry SJ, and Beresford SA. Application of a behavioral approach to
measuring dietary change: the fat- and fiber-related diet behavior questionnaire. Cancer Epidemiol
Biomarkers Prev 1997;6:355-61.
6.
Kristal AR, Shattuck AL, and Patterson RE. Differences in fat-related dietary patterns
between black, Hispanic, and white women: Results from the Women's Health Trial Feasibility
Study in Minority Populations. Public Health Nutr 1999;2:273-6.
7.
Kristal AR, Curry SJ, Shattuck AL, Feng Z, and Li S. A randomized trial of a tailored, selfhelp dietary intervention: The Puget Sound Eating Patterns Study. Prev Med 2000;31:380-9.
6
ToC
ToC
SF-36 QUESTIONNAIRE
Name:____________________
Ref. Dr:___________________
ID#: _______________
Date: _______
Age: _______
Gender: M / F
Please answer the 36 questions of the Health Survey completely, honestly, and without interruptions.
GENERAL HEALTH:
In general, would you say your health is:
Excellent
Very Good
Good
Fair
Poor
Compared to one year ago, how would you rate your health in general now?
Much better now than one year ago
Somewhat better now than one year ago
About the same
Somewhat worse now than one year ago
Much worse than one year ago
LIMITATIONS OF ACTIVITIES:
The following items are about activities you might do during a typical day. Does your health now limit you in these
activities? If so, how much?
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.
Yes, Limited a lot
Yes, Limited a Little
No, Not Limited at all
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Lifting or carrying groceries
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Climbing several flights of stairs
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Climbing one flight of stairs
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Bending, kneeling, or stooping
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Walking more than a mile
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Walking several blocks
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Walking one block
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
Bathing or dressing yourself
Yes, Limited a Lot
Yes, Limited a Little
No, Not Limited at all
PHYSICAL HEALTH PROBLEMS:
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as
a result of your physical health?
Cut down the amount of time you spent on work or other activities
Yes
No
Accomplished less than you would like
Yes
No
Were limited in the kind of work or other activities
Yes
No
Had difficulty performing the work or other activities (for example, it took extra effort)
Yes
No
EMOTIONAL HEALTH PROBLEMS:
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as
a result of any emotional problems (such as feeling depressed or anxious)?
Cut down the amount of time you spent on work or other activities
Yes
No
Accomplished less than you would like
Yes
No
Didn't do work or other activities as carefully as usual
Yes
No
SOCIAL ACTIVITIES:
Emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?
Not at all
Slightly
Moderately
Severe
Very Severe
PAIN:
How much bodily pain have you had during the past 4 weeks?
None
Very Mild
Mild
Moderate
Severe
Very Severe
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the
home and housework)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
ENERGY AND EMOTIONS:
These questions are about how you feel and how things have been with you during the last 4 weeks. For each
question, please give the answer that comes closest to the way you have been feeling.
Did you feel full of pep?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Have you been a very nervous person?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Have you felt so down in the dumps that nothing could cheer you up?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Have you felt calm and peaceful?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Did you have a lot of energy?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Have you felt downhearted and blue?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Did you feel worn out?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Have you been a happy person?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
Did you feel tired?
All of the time
Most of the time
A good Bit of the Time
Some of the time
A little bit of the time
None of the Time
SOCIAL ACTIVITIES:
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with
your social activities (like visiting with friends, relatives, etc.)?
All of the time
Most of the time
Some of the time
A little bit of the time
None of the Time
GENERAL HEALTH:
How true or false is each of the following statements for you?
I seem to get sick a little easier than other people
Definitely true
Mostly true
Don't know
Mostly false
Definitely false
I am as healthy as anybody I know
Definitely true
Mostly true
Don't know
Mostly false
Definitely false
I expect my health to get worse
Definitely true
Mostly true
Don't know
Mostly false
Definitely false
My health is excellent
Definitely true
Don't know
Mostly false
Definitely false
Mostly true
ToC
Sickness
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Copyright © The Johns Hopkins University 1977
All Rights Reserved
SIP - 10030
SD I - 03564
SD II - 03657
THE FOLLOWING INSTRUCTIONS ARE FOR THE
INTERVIEWER-ADMINISTERED QUESTIONNAIRE
INSTRUCTIONS TO BE READ TO THE RESPONDENT
Before beginning the questionnaire, I am going to read you the instructions.
You have certain activities that you do in carrying on your life. Sometimes you do all of these
activities. Other times, because of your state of health, you don't do these activities in the usual way:
you may cut some out; you may do some for shorter lengths of time; you may do some in different
ways. These changes in your activities might be recent or longstanding. We are interested in learning
about any changes that describe you today and are related to your state of health.
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I will be reading statements that people have told us describe them when they are not
completely well. Whether or not you consider yourself sick, there may be some statements that will
stand out because they describe you today and are related to your state of health. As I read the
questionnaire, think of yourself today. I will pause briefly after each statement. When you hear one
that does describe you and is related to health please tell me and I will check it.
Let me give you an example. I might read the statement "I am not driving my car." If this
statement is related to your health and describes you today, you should tell me. Also, if you have not
been driving for some time because of your health, and are still not driving today, you should respond
to this statement.
If you are in the hospital today, you are here because of your state of health, and you are not
doing a number of the things you usually do. For instance, if driving is usual for you, then you are not
driving today because you are in the hospital, and you should respond to this statement.
On the other hand, if you never drive or are not driving today because your car is being
repaired, the statement, "I am not driving my car" is not related to your health and you should not
respond to it. If you simply are driving less, or are driving shorter distances, and feel that the statement
only partially describes you, please do not respond to it.
I am now going to begin the questionnaire. Please tell me if you want me to slow down, repeat
a statement, or stop so that you can think about one. Also let me know any time you would like to
review the instructions. Remember we are interested in the recent or longstanding changes in your
activities that are related to your health.
© The Johns Hopkins University, 1977. All Rights Reserved
i
THE FOLLOWING INSTRUCTIONS ARE FOR
THE SELF-ADMINISTERED QUESTIONNAIRE
PLEASE READ THE ENTIRE INTRODUCTION BEFORE YOU READ
THE QUESTIONNAIRE. IT IS VERY IMPORTANT THAT
EVERYONE TAKING THE QUESTIONNAIRE FOLLOWS
THE SAME INSTRUCTIONS.
You have certain activities that you do in carrying on your life. Sometimes you do all of these
activities. Other times, because of your state of health, you don't do these activities in the usual way:
you may cut some out; you may do some for shorter lengths of time; you may do some in different
ways. These changes in your activities might be recent or longstanding. We are interested in learning
about any changes that describe you today and are related to your state of health.
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The questionnaire booklet lists statements that people have told us describe them when they are not
completely well. Whether or not you consider yourself sick, there may be some statements that will
stand out because they describe you today and are related to your state of health. As you read the
questionnaire, think of yourself today. When you read a statement that you are sure describes you and
is related to your health, place a check on the line to the right of the statement. For example:
I am not driving my car
(031)
If you have not been driving for some time because of your health, and are still not driving today, you
should respond to this statement.
On the other hand, if you never drive or are not driving today because your car is being repaired,
the statement, "I am not driving my car" is not related to your health and you should not check it. If you
simply are driving less, or are driving shorter distances, and feel that the statement only partially
describes you, do not check it. In all of these cases you would leave the line to the right of the
statement blank. For example:
I am not driving my car
(031)
Remember that we want you to check this statement only if you are sure it describes you today and
is related to your state of health.
© The Johns Hopkins University, 1977. All Rights Reserved
i
Read the introduction to each group of statements and then consider the statements in the order
listed. While some of the statements may not apply to you, we ask that you please read all of them.
Check those that describe you as you go along. Some of the statements will differ only in a few words,
so please read each one carefully. While you may go back and change a response, your first answer is
usually the best. Please do not read ahead in the booklet
Once you have started the questionnaire, it is very important that you complete it within one day
(24 hours).
If you find it hard to keep your mind on the statements, take a short break and then continue.
When you have read all of the statements on a page, put a check in the BOX in the lower right-hand
corner. If you have any questions, please refer back to these instructions.
Please do not discuss the statements with anyone, including family members, while doing the
questionnaire.
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Now turn to the questionnaire booklet and read the statements. Remember we are interested in the
recent or longstanding changes in your activities that are related to your health.
© The Johns Hopkins University, 1977. All Rights Reserved
ii
(SR-0499)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I spend much of the day lying down in order to rest
_____
(083)
2.
I sit during much of the day
_____
(049)
3.
I am sleeping or dozing most of the time - day and night
_____
(104)
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I lie down more often during the day in order to rest
_____
(058)
5.
I sit around half-asleep
_____
(084)
6.
I sleep less at night, for example, wake up too early,
don't fall asleep for a long time, awaken frequently
_____
(061)
I sleep or nap more during the day
_____
(060)
7.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
1
(EB-0705)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
I say how bad or useless I am, for example, that I am
a burden on others
_____
(087)
2.
I laugh or cry suddenly
_____
(068)
3.
I often moan and groan in pain or discomfort
_____
(069)
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4.
I have attempted suicide
_____
(132)
5.
I act nervous or restless
_____
(046)
6.
I keep rubbing or holding areas of my body that hurt or
are uncomfortable
_____
(062)
I act irritable and impatient with myself, for example,
talk badly about myself, swear at myself, blame myself
for things that happen
_____
(078)
8.
I talk about the future in a hopeless way
_____
(089)
9.
I get sudden frights
_____
(074)
7.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
2
(BCM-2003)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I make difficult moves with help, for example, getting
into or out of cars, bathtubs
_____
(084)
I do not move into or out of bed or chair by myself
but am moved by a person or mechanical aid
_____
(121)
3.
I stand only for short periods of time
_____
(072)
4.
I do not maintain balance
_____
(098)
5.
I move my hands or fingers with some limitation or
difficulty
_____
(064)
6.
I stand up only with someone's help
_____
(100)
7.
I kneel, stoop, or bend down only by holding on to
something
_____
(064)
8.
I am in a restricted position all the time
_____
(125)
9.
I am very clumsy in body movements
_____
(058)
10.
I get in and out of bed or chairs by grasping something
for support or using a cane or walker
_____
(082)
11.
I stay lying down most of the time
_____
(113)
12.
I change position frequently
_____
(030)
13.
I hold on to something to move myself around in bed
_____
(086)
2.
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(Continued on next page)
© The Johns Hopkins University, 1977. All Rights Reserved
3
(Continued from previous page)
14.
I do not bathe myself completely, for example, require
assistance with bathing
_____
(089)
I do not bathe myself at all, but am bathed by someone
else
_____
(115)
16.
I use bedpan with assistance
_____
(114)
17.
I have trouble getting shoes, socks, or stockings on
_____
(057)
18.
I do not have control of my bladder
_____
(124)
15.
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19.
I do not fasten my clothing, for example, require
assistance with buttons, zippers, shoelaces
_____
(074)
20.
I spend most of the time partly undressed or in pajamas
_____
(074)
21.
I do not have control of my bowels
_____
(128)
22.
I dress myself, but do so very slowly
_____
(043)
23.
I get dressed only with someone's help
_____
(088)
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
4
(HM-0668)
THIS GROUP OF STATEMENTS HAS TO DO WITH ANY WORK YOU USUALLY DO IN
CARING FOR YOUR HOME OR YARD. CONSIDERING JUST THOSE THINGS THAT
YOU DO, PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU
ARE SURE DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH
_________________________________________________________________________________
1.
I do work around the house only for short periods of
time or rest often
_____
(054)
I am doing less of the regular daily work around the
house than I would usually do
_____
(044)
I am not doing any of the regular daily work around
the house that I would usually do
_____
(086)
I am not doing any of the maintenance or repair work
that I would usually do in my home or yard
_____
(062)
I am not doing any of the shopping that I would
usually do
_____
(071)
I am not doing any of the house cleaning that I would
usually do
_____
(077)
I have difficulty doing handwork, for example, turning
faucets, using kitchen gadgets, sewing, carpentry
_____
(069)
I am not doing any of the clothes washing that I would
usually do
_____
(077)
9.
I am not doing heavy work around the house
_____
(044)
10.
I have given up taking care of personal or household
business affairs, for example, paying bills, banking,
working on budget
_____
(084)
2.
3.
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4.
5.
6.
7.
8.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
5
(M-0719)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I am getting around only within one building
_____
(086)
2.
I stay within one room
_____
(106)
3.
I am staying in bed more
_____
(081)
4.
I am staying in bed most of the time
_____
(109)
5.
I am not now using public transportation
_____
(041)
6.
I stay home most of the time
_____
(066)
7.
I am only going to places with restrooms nearby
_____
(056)
8.
I am not going into town
_____
(048)
9.
I stay away from home only for brief periods of time
_____
(054)
10.
I do not get around in the dark or in unlit places
without someone's help
_____
(072)
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CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
6
(SI-1450)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I am going out less to visit people
_____
(044)
2.
I am not going out to visit people at all
_____
(101)
3.
I show less interest in other people's problems, for
example, don't listen when they tell me about their
problems, don't offer to help
_____
(067)
I often act irritable toward those around me, for example,
snap at people, give sharp answers, criticize easily
_____
(084)
5.
I show less affection
_____
(052)
6.
I am doing fewer social activities with groups of people
_____
(036)
7.
I am cutting down the length of visits with friends
_____
(043)
8.
I am avoiding social visits from others
_____
(080)
9.
_____
(051)
I often express concern over what might be happening
to my health
_____
(052)
11.
I talk less with those around me
_____
(056)
12.
I make many demands, for example, insist that people
do things for me, tell them how to do things
_____
(088)
I stay alone much of the time
_____
(086)
4.
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10.
13.
My sexual activity is decreased
(Continued on next page)
© The Johns Hopkins University, 1977. All Rights Reserved
7
(Continued from previous page)
14.
I act disagreeable to family members, for example,
I act spiteful, I am stubborn
_____
(088)
I have frequent outbursts of anger at family members,
for example, strike at them, scream, throw things
at them
_____
(119)
I isolate myself as much as I can from the rest of
the family
_____
(102)
17.
I am paying less attention to the children
_____
(064)
18.
I refuse contact with family members, for example, turn
away from them
_____
(115)
I am not doing the things I usually do to take care of
my children or family
_____
(079)
I am not joking with family members as I usually do
_____
(043)
15.
16.
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19.
20.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
8
(A-0842)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I walk shorter distances or stop to rest often
_____
(048)
2.
I do not walk up or down hills
_____
(056)
3.
I use stairs only with mechanical support, for example,
handrail, cane, crutches
_____
(067)
I walk up or down stairs only with assistance from
someone else
_____
(076)
5.
I get around in a wheelchair
_____
(096)
6.
I do not walk at all
_____
(105)
7.
I walk by myself but with some difficulty, for
example, limp, wobble, stumble, have stiff leg
_____
(055)
8.
I walk only with help from someone
_____
(088)
9.
I go up and down stairs more slowly, for example,
one step at a time, stop often
_____
(054)
10.
I do not use stairs at all
_____
(083)
11.
I get around only by using a walker, crutches,
cane, walls, or furniture
_____
(079)
I walk more slowly
_____
(035)
4.
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CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
9
(AB-0777)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I am confused and start several actions at a time
_____
(090)
2.
I have more minor accidents, for example, drop things,
trip and fall, bump into things
_____
(075)
3.
I react slowly to things that are said or done
_____
(059)
4.
I do not finish things I start
_____
(067)
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5.
I have difficulty reasoning and solving problems, for
example, making plans, making decisions, learning
new things
_____
(084)
I sometimes behave as if I were confused or disoriented
in place or time, for example, where I am, who is
around, directions, what day it is
_____
(113)
I forget a lot, for example, things that happened recently,
where I put things, appointments
_____
(078)
8.
I do not keep my attention on any activity for long
_____
(067)
9.
I make more mistakes than usual
_____
(064)
10.
I have difficulty doing activities involving concentration
and thinking
_____
(080)
6.
7.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
10
(C-0725)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I am having trouble writing or typing
_____
(070)
2.
I communicate mostly by gestures, for example, moving
head, pointing, sign language
_____
(102)
My speech is understood only by a few people
who know me well
_____
(093)
I often lose control of my voice when I talk, for
example, my voice gets louder or softer, trembles,
changes unexpectedly
_____
(083)
5.
I don't write except to sign my name
_____
(083)
6.
I carry on a conversation only when very close to the
other person or looking at him
_____
(067)
I have difficulty speaking, for example, get stuck,
stutter, stammer, slur my words
_____
(076)
8.
I am understood with difficulty
_____
(087)
9.
I do not speak clearly when I am under stress
_____
(064)
3.
4.
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7.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
11
THE NEXT GROUP OF STATEMENTS HAS TO DO WITH ANY WORK YOU USUALLY
DO OTHER THAN MANAGING YOUR HOME. BY THIS WE MEAN ANYTHING THAT
YOU REGARD AS WORK THAT YOU DO ON A REGULAR BASIS.
DO YOU USUALLY DO WORK OTHER THAN
MANAGING YOUR HOME?
_____
_____
YES
NO
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IF YOU ANSWERED YES, GO ON TO THE NEXT PAGE.
IF YOU ANSWERED NO:
ARE YOU RETIRED?
IF YOU ARE RETIRED, WAS YOUR
RETIREMENT RELATED TO
YOUR HEALTH?
IF YOU ARE NOT RETIRED, BUT ARE
NOT WORKING, IS THIS RELATED TO
YOUR HEALTH?
NOW SKIP THE NEXT PAGE.
© The Johns Hopkins University, 1977. All Rights Reserved
12
_____
YES
_____
NO
_____
YES
_____
NO
_____
YES
_____
NO
(W-0515)
IF YOU ARE NOT WORKING AND IT IS NOT BECAUSE OF
YOUR HEALTH, PLEASE SKIP THIS PAGE.
NOW CONSIDER THE WORK YOU DO AND RESPOND TO (CHECK) ONLY THOSE
STATEMENTS THAT YOU ARE SURE DESCRIBE YOU TODAY AND ARE RELATED TO
YOUR STATE OF HEALTH. (IF TODAY IS A SATURDAY OR SUNDAY OR SOME
OTHER DAY THAT YOU WOULD USUALLY HAVE OFF, PLEASE RESPOND AS IF
TODAY WERE A WORKING DAY.)
_________________________________________________________________________________
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1.
I am not working at all
_____
(IF YOU CHECKED THIS STATEMENT, SKIP TO THE NEXT PAGE.)
(361)
2.
I am doing part of my job at home
_____
(037)
3.
I am not accomplishing as much as usual at work
_____
(055)
4.
I often act irritable toward my work associates, for example,
snap at them, give sharp answers, criticize easily
_____
(080)
5.
I am working shorter hours
_____
(043)
6.
I am doing only light work
_____
(050)
7.
I work only for short periods of time or take frequent
rests
_____
(061)
I am working at my usual job but with some changes,
for example, using different tools or special aids,
trading some tasks with other workers
_____
(034)
I do not do my job as carefully and accurately as usual
_____
8.
9.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
13
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(RP-0422)
THIS GROUP OF STATEMENTS HAS TO DO WITH ACTIVITIES YOU USUALLY DO IN
YOUR FREE TIME. THESE ACTIVITIES ARE THINGS THAT YOU MIGHT DO FOR
RELAXATION, TO PASS THE TIME, OR FOR ENTERTAINMENT. PLEASE RESPOND
TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE DESCRIBE YOU
TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I do my hobbies and recreation for shorter periods
of time
_____
(039)
2.
I am going out for entertainment less often
_____
(036)
3.
I am cutting down on some of my usual inactive
recreation and pastimes, for example, watching
TV, playing cards, reading
_____
(059)
I am not doing any of my usual inactive recreation
and pastimes, for example, watching TV, playing
cards, reading
_____
(084)
I am doing more inactive pastimes in place of my
other usual activities
_____
(051)
6.
I am doing fewer community activities
_____
(033)
7.
I am cutting down on some of my usual physical
recreation or activities
_____
(043)
I am not doing any of my usual physical recreation or
activities
_____
(077)
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4.
5.
8.
CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
14
(E-0705)
PLEASE RESPOND TO (CHECK) ONLY THOSE STATEMENTS THAT YOU ARE SURE
DESCRIBE YOU TODAY AND ARE RELATED TO YOUR STATE OF HEALTH.
_________________________________________________________________________________
1.
I am eating much less than usual
_____
(037)
2.
I feed myself but only by using specially prepared
food or utensils
_____
(077)
I am eating special or different food, for example,
soft food, bland diet, low-salt, low-fat, low-sugar
_____
(043)
4.
I eat no food at all but am taking fluids
_____
(104)
5.
I just pick or nibble at my food
_____
(059)
6.
I am drinking less fluids
_____
(036)
7.
I feed myself with help from someone else
_____
(099)
8.
I do not feed myself at all, but must be fed
_____
(117)
9.
I am eating no food at all, nutrition is taken
through tubes or intravenous fluids
_____
(133)
3.
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CHECK HERE WHEN YOU HAVE READ ALL STATEMENTS ON THIS PAGE
© The Johns Hopkins University, 1977. All Rights Reserved
15
NOW, PLEASE REVIEW THE QUESTIONNAIRE TO BE CERTAIN YOU
HAVE FILLED OUT ALL THE INFORMATION. LOOK OVER THE BOXES
ON EACH PAGE TO MAKE SURE EACH ONE IS CHECKED SHOWING
THAT YOU HAVE READ ALL OF THE STATEMENTS. IF YOU FIND A
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BOX WITHOUT A CHECK, THEN READ THE STATEMENTS ON THAT
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PAGE.
© The Johns Hopkins University, 1977. All Rights Reserved
16
CALCULATION OF CATEGORY SCORES, DIMENSION SCORES,
AND OVERALL SIP SCORE
The score for each category is calculated by adding the scale values for each item checked
within the category and dividing by the maximum possible dysfunction score for the category. This
figure is then multiplied by 100 to obtain the category score.
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Two dimension scores may be calculated. The physical dimension score is obtained by adding
the scale values for each item checked within categories BCM, M, and A, dividing by the maximum
possible dysfunction score for these categories, and then multiplying by 100; the psychosocial
dimension score is obtained by adding the scale values for each item checked within categories EB, SI,
AB, and C, dividing by the maximum possible dysfunction score for these categories, and then
multiplying by 100. The scores for the remaining categories are always calculated individually.
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The overall score for the SIP is calculated by adding the scale values for each item checked
across all categories and dividing by the maximum possible dysfunction score for the SIP. This figure
is then multiplied by 100 to obtain the SIP overall score.
In the SIP booklet the scale values are coded to one decimal as follows:
1.
Following the checking line for each item, the item number and scale value are shown, e.g.,
070-083 indicates item 70 has a scale value of 8.3.
2.
Following each category code in the upper right-hand corner of the page, the total possible scale
value for the category is shown, e.g., SR-0499 indicates a total possible scale value of 49.9 for
category SR.
3.
On the title page of the booklet in the lower right-hand corner appears SD I-03564 and SD
II-03657. These indicate a total possible scale value of 356.4 for the physical scoring
dimension, and total scale value of 365.7 for the psychosocial scoring dimension. These are the
denominators for calculating the respective dimension scores.
4.
Also on the title page of the booklet in the lower right-hand corner appears SIP-10030
indicating a total possible scale value of 1003.0 for the entire SIP. This is the denominator for
calculating the overall SIP score.
Please note that there are two special considerations in scoring Category W - Work:
© The Johns Hopkins University, 1977. All Rights Reserved
17
(1)
When a subject answers YES to either,
"If you are retired, was your retirement related to your health?" or
"If you are not retired, but are not working, is this related to your health?",
he is instructed to skip Category W - Work. However, in editing the questionnaire prior to
coding or scoring, for subjects who answered YES to either of these questions, item 100 should
be checked.
(2)
Item 100, the first item, has been coded 100-361, indicating an unusually high scale value. The
scale value for this item has been statistically adjusted to take into account the fact that when
item 100 is checked no other item in category W can be checked.
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© The Johns Hopkins University, 1977. All Rights Reserved
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