Title

Effectiveness of Lifestyle Redesign® in the Context of Real World Conditions

Start Time

15-10-2009 10:45 AM

End Time

15-10-2009 11:15 AM

Abstract

The original USC Well Elderly Study (WE1), an efficacy study, demonstrated that Lifestyle Redesign (R) could forestall declines associated with aging and in some domains lead to a positive gain in health and well being. Moving beyond this study the Well Elderly II Study (WEII), an effectiveness study, was designed to assess the generality of the intervention’s effect across a wider study population and expanded set of outcome variables. The specific goals of this study were to replicate the first study under more natural, real world conditions: a more heterogeneous sample, greater variability in age, ethnicity and socio-economic status, and across a much larger number of community sites. In the Well Elderly II, a randomized clinical trial, 460 ethnically diverse elders from 21 different sites participated in the Lifestyle Redesign program for a six month period. In addition to weekly meetings participants were offered 10 individual sessions. The goal of the program was to assisted elders in developing healthy habits in their everyday activities to promote wellness. The intent to treat analysis revealed that participants evidenced more positive changes compared to the control participants, in the following domains: bodily pain, vitality, social functioning, mental health, composite mental functioning (SF-36v2), greater life satisfaction (LSI-Z) and less depression (CES-D). The results of the intent-to-treat also demonstrated a diminished intervention effect for Well Elderly II relative to Well Elderly I. The purpose of this paper is to a) report on the findings of the Well Elderly II study; b) brainstorm with the audience the potential reasons underling the outcomes; c) to discuss the differences between efficacy and effectiveness studies and how these types of research influenced the differing outcome measures of Well Elderly I and Well Elderly II and d) to explore how the well elderly research trajectory relates to the ongoing growth of Occupational Science as a discipline.

References

Jackson, J., Mandel, D., Blanchard, J., Carlson, M., Cherry, B., Azen, S., Chor, C., Jordan-Marsh, M., Forman, F., White, B., Granger, D., Knight, B., Clark, F (2009). Confronting challenges in intervention research with ethnically diverse older adults: the USC well elderly II trial. Clinical Trials. 6: 90-101. DOI: 10.1177/1740774508101191 [Access Author Manuscript]

Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark, F. (1998). Occupation in lifestyle redesign: The well elderly study occupational therapy program. American Journal of Occupational Therapy, 52(5), 326-336.

Clark, F. Azen, S., Zemke, R., Jackson, J., Carlson, M., Mandel, D., Hay, J., Josephson, K., Cherry, B., Hessel, C., Palmer, J.P., & Lipson, L. (1997). Occupational therapy for independent-living older adults. Journal of the American Medical Association, 278, 1321-1326. DOI: 10.1001/jama.1997.03550160041036

Glasgow, RE., Lichtenstein, E., Marcus, AC., (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-toeffectiveness transition. American Journal of Public Health. 93(8),1261-1267. Access Article

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Oct 15th, 10:45 AM Oct 15th, 11:15 AM

Effectiveness of Lifestyle Redesign® in the Context of Real World Conditions

The original USC Well Elderly Study (WE1), an efficacy study, demonstrated that Lifestyle Redesign (R) could forestall declines associated with aging and in some domains lead to a positive gain in health and well being. Moving beyond this study the Well Elderly II Study (WEII), an effectiveness study, was designed to assess the generality of the intervention’s effect across a wider study population and expanded set of outcome variables. The specific goals of this study were to replicate the first study under more natural, real world conditions: a more heterogeneous sample, greater variability in age, ethnicity and socio-economic status, and across a much larger number of community sites. In the Well Elderly II, a randomized clinical trial, 460 ethnically diverse elders from 21 different sites participated in the Lifestyle Redesign program for a six month period. In addition to weekly meetings participants were offered 10 individual sessions. The goal of the program was to assisted elders in developing healthy habits in their everyday activities to promote wellness. The intent to treat analysis revealed that participants evidenced more positive changes compared to the control participants, in the following domains: bodily pain, vitality, social functioning, mental health, composite mental functioning (SF-36v2), greater life satisfaction (LSI-Z) and less depression (CES-D). The results of the intent-to-treat also demonstrated a diminished intervention effect for Well Elderly II relative to Well Elderly I. The purpose of this paper is to a) report on the findings of the Well Elderly II study; b) brainstorm with the audience the potential reasons underling the outcomes; c) to discuss the differences between efficacy and effectiveness studies and how these types of research influenced the differing outcome measures of Well Elderly I and Well Elderly II and d) to explore how the well elderly research trajectory relates to the ongoing growth of Occupational Science as a discipline.