Page 209 - Hospital Authority Convention 2018

Service Enhancement Presentations

F6.2 Enhancing Partnership with Patients and Community 10:45 Room 421

Effects of Multimodal Physical Training on Motor Performances and Cognitive Functions of Persons with Mild to
Moderate Dementia in Hong Kong: A Multi-Center, Randomised Controlled Trial
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Chao CYL , Lau PMY , Chau KF , Lee MP , Tam SKF , Wong GHS , Yu JWK , Au AHM , Tong JMC , Chau MWR , Poon MWY ,
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Luk HKY , Chan ACM 1 HOSPITAL AUTHORITY CONVENTION 2018
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1 Physiotherapy Department, Queen Elizabeth Hospital, Department of Medicine, Queen Elizabeth Hospital, Department of
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Medicine, Hong Kong Buddhist Hospital, Physiotherapy Department, Kowloon Hospital, Physiotherapy Department, Hong
Kong Buddhist Hospital, Hong Kong
Introduction
Dementia is a debilitating disease resulting in progressive decline in cognition that subsequently leads to a gradual
deterioration of physical, emotional, and social functioning. The loss of strength and balance may also induce a high risk of
fall. Over time, it brings a high psychosocial burden and distress to caregivers in providing a high level of caring and support
in this target group of persons.
Objectives
This study aimed to evaluate whether educational talks together with a well-structured multimodal physical exercise training
programme can (1) promote motor performances (strength, endurance and balance control) and reduce risk of fall; (2) improve
cognitive functions and depression; (3) maintain functional independence; and (4) reduce stress of caregivers of persons with
mild to moderate dementia in Hong Kong population.
Methodology
An assessor-blind, randomised controlled trial was conducted. Ethics approval was obtained from research committee (KC/
KE-14-0143/FR-2). 67 elderly with mild to moderate dementia whose Clinical Dementia Rating was 1 or 2 were recruited. They
were randomly allocated into either interventional group (n=35) or control group (n=32) by blocked randomisation method.
Subjects in the interventional group received 24 sessions of well-structured multimodal physical exercise training programme
that incorporated all progressive resistance, aerobic, and dual-task balance training two days a week and 90 minutes a day
for a total of 12 weeks. Subjects in the control group received home exercise programme on general stretching exercise and
light intensity mobilisation exercise. Both study groups and their caregivers received two sessions of educational classes on
disease management, strategies to delay symptoms of dementia, fall prevention and caring skills. Outcomes were measured
at baseline, end of training and 12-month follow-up. Permission was granted in using Mini-mental State Examination (MMSE)
by PAR for the current study. Statistical analysis was conducted using 2-way repeated measures ANOVA by an intention-to-
treat analysis approach.
Results
Drop-out was 11.9% and 17.9% at end of training and 12-month follow-up, respectively. Upon completion of 12-week
training, significant treatment effects (all p<0.05) were evident on motor performances health outcomes (improved
quadriceps muscular strength, six-minute walk distance, timed up and go test and Berg Balance Scale [pre/post values
of 15.4±4.7/16.8±5.5 kgf, 199.4±74.6/217.8±78.7 meter, 21.9±16.4/19.7±13.7 second, and 43.3±11.6/45.5±9.7 respectively])
while cognitive domains were maintained till one-year follow-up as compared with baseline (MMSE [17.4±4.9/17.7±5.2];
Montreal Cognitive Assessment [13.7±5.4/13.9±5.5]) in the interventional group. Disability Assessment of Dementia Scale
was significantly higher while Zarit Burden Interview scores was significantly lower in the interventional group as compared
with control group (71.9±19.4 vs. 66.8±24.1, p=0.002 and 25.8±15.4 vs. 30.9±15.3, p=0.027 respectively). Geriatric Depression
Scale-Short Form and fall episodes did not demonstrate significant group or interaction effects between the 2 groups.
Dementia is associated with multiple daily life challenges that significantly affect both the patients and their caregivers. Tuesday, 8 May 2018
Provision of multimodal physical training together with appropriate support and education helped to slow down the rate of
disease progression and relieved the stress and burden of caregivers.

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