Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial

May combine two claims.

Black, Asian, and Latino elders, as well as immigrant elders, are at particularly high risk for disability.

“Black (8), Asian (9) and Latino elders (10) are at particular high risk for disability as well as immigrant elders, who exhibit worse mental health than native-born elders (11).”

• cites [8] Pickett, 2013, Late-life depression in older African Americans: a comprehensive review of epidemiological and clinical data, Int J Geriatr Psychiatry sourceCould not verify

  Citation (8) is attached to the claim about Black elders, not the separately cited claims about Asian, Latino, or immigrant elders. The Results discuss links between disability and depressive symptoms among older African Americans, but do not establish that Black elders are at particularly high risk for disability. Searches for a comparative disability risk found no such passage in our copy; page numbers were unavailable. (LLM, conf=0.72)

  Experimental — accuracy not yet measured
• cites [9] Abe-Kim, 2007, Use of mental health–related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study, Am J Public Health sourceCould not verify

  Citation 11 is attached to the claim that immigrant elders have worse mental health than native-born elders. The Results and Discussion compare mental health–related service use among immigrant and US-born Asian Americans, but do not establish that comparison of elders’ mental health or disability risk. Searches for elders, disability, and mental-disorder prevalence did not locate support for the attributed claim. (LLM, conf=0.77)

  Experimental — accuracy not yet measured
• cites [10] Garcia, 2017, Aging and disability among Hispanics in the United States: current knowledge and future directions, Innovation Aging sourceSupported

May combine two claims.

Adding a functional disability prevention component can reduce mental health symptoms and build leg power, which correlates better than strength with functional activities.

“The addition of a functional disability prevention component can reduce mental health symptoms (22) and build resistance or leg power, as power correlates better than strength with functional activities (23).”

• cites [22] Cooney, 2013, Exercise for depression, Cochrane Database Syst RevNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [23] Bean, 2002, The relationship between leg power and physical performance in mobility‐limited older people, J Am Geriatr Soc sourceSupported

May combine two claims.

At 12 months, the intervention effect on LLFDI remained significant, with an effect size slightly larger but not significantly different from the 6-month effect.

“Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25”

• Also stated in: § Intent-to-treat analysis · plain

  “but the effect size on LLFDI was slightly bigger although not significantly different from the 6-month effect size (t[850.1]=−0.28, p=0.78)”

May combine two claims.

At 12 months, full compliance was associated with improvement in GAD-7, the only time this was observed (t[7.0]=−3.9, p<0.01).

“The effect of full compliance at 12-months was the only time when an improvement in GAD-7 was observed (t[7.0]=−3.9, p<0.01).”

May combine two claims.

Except for SPPB, intervention effects at 6 and 12 months were similar in magnitude for LLFDI, WHODAS 2.0, and HSCL-25, with significant overall time-by-treatment interactions.

“Except for SPPB, the intervention effects at 6- and 12-months were very similar in magnitude for LLFDI, WHODAS 2.0 and HSCL-25, with overall time-by-treatment significant interactions (F[3,2178.8]=3.0, p=0.03; F[3,3678.4]=3.0, p=0.03; and F[3,3321.5]=2.9, p=0.04, respectively; see Table 8, SDC).”

May combine two claims.

A joint global test found a significant treatment effect across the five outcomes at the 0.05 level (χ2[5]=14.3, p=0.01), with effect sizes of the same magnitude.

“The joint test found a significant effect of the treatment through the five outcomes at the α=0.05 level (χ2[5]=14.3, p=0.01), and the estimated effect sizes were of the same magnitude (see Table 2, SDC).”

May combine two claims.

Participants reported barriers including other scheduled activities such as medical appointments, not feeling well enough, and transportation issues to the community-based organization because of reliance on public transportation.

“Participants noted other scheduled activities, such as medical appointments; not feeling well enough; or transportation issues to the CBO, given reliance on public transportation.”

May combine two claims.

Intent-to-treat effect sizes ranged from Cohen's d 0.23 to 0.28, indicating small effects.

“Effect sizes (Cohen’s d) ranged from 0.23 to 0.28, suggesting small effects in the intent-to-treat analysis (63).”

• cites [63] Koppelmans, 2019, Mechanisms underlying exercise as a treatment for depression, Am J Geriatr Psychiatry sourceNot checked — no full text of the source

May combine two claims.

79% of participants were very satisfied with their sessions, and satisfaction was higher among those who attended more than 50% of both Positive Minds and Strong Bodies sessions (88% versus 66%).

“Participants’ satisfaction rating (see Methods 4, SDC) indicated that 79% of participants were very satisfied with their sessions. This percentage was higher among participants who attended more than 50% of both PM and SB sessions (88% versus 66%, t[84]=−3.5, p<0.001).”

May combine two claims.

Of 153 individuals enrolled in Strong Bodies, 37 (24.2%) completed all 36 sessions, and 35 (22.9%) did not initiate treatment because of hurricane-related lack of facilities, delayed medical clearance, or death.

“Of 153 individuals enrolled in SB, 37 (24.2%) completed all 36 sessions, 21 (13.7%) completed 25–35 sessions, 39 (25.5%) completed 1–24 sessions, 21 (13.7%) declined or dropped out, and 35 (22.9%) did not initiate treatment due to hurricane-related lack of facilities in Puerto Rico and Florida, failed/delayed medical clearance because of hurricane, or death.”

May combine two claims.

More than half of participants attended more than 50% of Positive Minds and Strong Bodies sessions, and nearly half received the combined intervention at a moderate compliance rate.

“More than half of participants attended >50% of the PM and SB sessions; and nearly half received the combined intervention at a moderate rate of compliance.”

May combine two claims.

At 12 months, full compliance was associated with significant LLFDI and WHODAS 2.0 effects that were not significantly different from the 6-month effect size.

“These participants also demonstrated significant LLFDI and WHODAS 2.0 effects for the 12-months outcomes, that were not significantly different from the 6-month effect size”

May combine two claims.

At baseline, about 57.5% of participants rated their physical health as poor or fair, 87.3% reported chronic conditions, 69.5% identified as immigrants, and 66.1% spoke a primary language other than English.

“At baseline, around 57.5% of participants rated their physical health as poor or fair, 87.3% reported chronic conditions, and 69.5% identified as immigrants, with 66.1% speaking a primary language other than English.”

May combine two claims.

There is a compliance-benefit effect, with compliance being an important determinant of intervention response.

“PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of intervention response.”

• Also stated in: § Compliance analysis · plain

  “Table 4 shows that intervention effects at 6-month follow-up on physical function and symptom reduction varied by intervention compliance; the greatest effect was observed among participants who fully adhered to the protocol and completed target treatment sessions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The trial randomized 307 participants equally to the intervention or enhanced usual care, with 153 assigned to intervention and 154 to control.

“Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care.”

• Also stated in: § Randomization · plain

  “307 eligible participants were randomized to the intervention (N=153) or control condition (N=154) within site, in a ratio of 1:1 for each two-person block.”

May combine two claims.

This work addresses the Institute of Medicine's call to build a disability prevention workforce and provides evidence for using paraprofessionals.

“Our work similarly addresses the Institute of Medicine’s report on the need to build a disability prevention workforce (4), with evidence for the use of paraprofessionals.”

• cites [4] Blazer, 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The study conducted quality control on each research assistant's first two interviews and on a random 15% sample of interviews to standardize administration.

“To ensure standardized administration, we conducted quality control of each RA’s first two interviews and a random sample of 15% of interviews.”

May combine two claims.

The low Strong Bodies compliance may reflect minority elders' competing health demands, given that close to half rated their health as fair or poor and more than three-fourths had at least one chronic physical condition.

“This may highlight minority elders’ competing health demands, since close to half rated their health as fair or poor and more than three-fourths had at least one chronic physical condition.”

May combine two claims.

Community health workers have been used to deliver evidence-based treatments, address personnel shortages, increase diversity, and compensate for a lack of bilingual and bicultural clinicians.

“Community health workers (CHWs) have been used to deliver evidence-based treatments (36), tackle personnel shortages (36), increase diversity, and offset the lack of bilingual/bicultural clinicians (37).”

• cites [36] Wennerstrom, 2015, Integrating community health workers into primary care to support behavioral health service delivery: a pilot study, J Ambulatory Care Manage sourceNot checked — no full text of the source
• cites [37] Singh, 2005, A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults, J Gerontol A sourceNot checked — no full text of the source

May combine two claims.

After adjusting for language, race/ethnicity, clinical site, current pharmacotherapy or fitness service use, and baseline severity, estimated intervention effects were virtually the same, with no significant interactions.

“After adjusting for language, estimated effects were virtually the same, with no significant interaction effects between intervention and language groups or when adjusting for patient’s race/ethnicity or clinical site as well as for current pharmacotherapy and/or fitness service use and severity of baseline physical functioning/mental health symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Racial/ethnic and language concordance are important factors in racial/ethnic minority health experiences.

“This aligns with literature showing that racial/ethnic and language concordance are important factors in racial/ethnic minority health experiences (68).”

• cites [68]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The study uniquely combined physical and mental health interventions delivered by paraprofessionals and showed gains in elders' physical and mental health functioning.

“Uniquely, we combined physical and mental health interventions, administered by paraprofessionals, showing gains in elders’ physical and mental health functioning.”

May combine two claims.

Baseline tests found no significant differences between intervention and control groups, suggesting successful randomization.

“We used i-tests and chi- square tests to assess baseline differences between intervention and control groups and found no significant differences, suggesting successful randomization.”

Classified as probably not a substantial claim.

Research assistants who conducted interviews were blinded to participants' study condition.

“Interviewing research assistants (RAs) were blinded to participant study condition.”

Classified as probably not a substantial claim.

For physical function outcomes, 35 intervention participants who did not receive Strong Bodies sessions because of hurricane-related lack of facilities were excluded, along with their control counterparts, to rebalance the sample.

“When assessing intervention effectiveness on physical function outcomes (SPPB, LLDFI, WHODAS), 35 intervention participants who did not engage in SB sessions were excluded from analysis, given that no facilities were available after hurricanes hit towns in two sites. Their control counterparts, per the two-person block randomization, were also excluded to rebalance the sample (see Methods 5, SDC).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The trial was approved by the relevant institutional review boards, and all participants gave informed consent.

“It was approved by the institutional review boards for Massachusetts General Hospital/Partners HealthCare and New York University, with ceded reviews for partnering CBOs (see Table 5, SDC) conducting human subjects research. All participants provided informed consent.”

May combine two claims.

Because the sample focused on Latino and Asian ethnic/racial minorities and immigrants, the findings cannot be assumed to generalize to other minority groups, and the sample was insufficient for cross-group comparisons.

“Our sample of minority participants focuses on Latino and Asian ethnic/racial minorities and immigrants. We cannot be sure the findings generalize to other minority groups or have a sufficient sample for cross-group comparisons.”

May combine two claims.

The study did not use equipment capable of precisely measuring strength and velocity and instead relied on research-assistant-administered assessments.

“We did not use equipment capable of measuring strength and velocity in a precise way, but relied on RA-administered assessments.”

May combine two claims.

PMSB is a promising preventive intervention that brings culturally competent services into the community to meet client needs.

“This trial shows that PMSB is a promising preventive intervention that moves culturally-competent services into the community to meet client needs.”

Probably not a substantial claim: may not pass S2 (checkable).

PMSB can be a valuable tool in disability prevention to address workforce shortages and disparities in service access and quality for minority elders.

“Throughout the field of disability prevention, PMSB can be a valuable tool to address workforce shortages, disparities in service access, and disparities in service quality for minority elders.”

May combine two claims.

Outcome measures underwent rigorous translation and showed adequate internal consistency within language groups, but the sample was insufficient for formal measurement invariance analyses.

“Although outcome measures went through a rigorous translation process and demonstrated adequate internal consistency within language group, our sample was insufficient to carry out more formal measurement invariance analyses.”

May combine two claims.

Usual clinic-based services do not include evidence-based mental health interventions, have poor patient compliance, and lack training and supervision resources.

“Usual clinic-based services do not incorporate evidence-based mental health interventions, (17) lack patient compliance (17, 18), and lack resources for training and supervision (19).”

• cites [17] Gallagher-Thompson, 1994, Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers, J Consult Clin Psychol sourceNot checked — no full text of the source
• cites [18] Ciechanowski, 2004, Community-integrated home-based depression treatment in older adults: a randomized controlled trial, JAMA sourceNot checked — no full text of the source
• cites [19] Katon, 2006, Dissemination of evidence‐based mental health interventions: importance to the trauma field, J Trauma Stress sourceNot checked — no full text of the source

May combine two claims.

Evidence-based approaches exist for improving coping by treating mood symptoms and for functional restoration by improving mobility.

“Yet, evidence-based approaches exist for improving coping (by treating mood symptoms; 20) and for functional restoration (by improving mobility; 21).”

• cites [20] Bryant, 2017, Psychological interventions for older adults: Evidence-based treatments for depression, anxiety, and carer stress sourceNot checked — no full text of the source
• cites [21] Bean, 2004, Increased Velocity Exercise Specific to Task (InVEST) training: a pilot study exploring effects on leg power, balance, and mobility in community‐dwelling older women, J Am Geriatr Soc sourceNot checked — no full text of the source

May combine two claims.

The GAD-7 had internal consistency of Cronbach's alpha 0.82 overall and 0.78 to 0.88 across languages.

“overall α=0.82; range of α=0.78–0.88”

May combine two claims.

The findings suggest that age-related decline in physical function can be decelerated at least partially, independent of ethnicity and even with mental health conditions.

“Our findings showed significant gains in directly measured (SPPB) as well as patient reported (LLFDI) outcomes, suggesting that decline of physical function with age can be decelerated, at least partially, independent of participant’s ethnicity and even in the presence of mental health conditions.”

May combine two claims.

The HSCL-25 had internal consistency of Cronbach's alpha 0.92 in the full sample and 0.90 to 0.95 across the four languages.

“internal consistency (Cronbach’s alpha) for the full sample α=0.92; range of α=0.90–0.95 for the four languages”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Clinical supervisors, a community advisory group, and the research team evaluated the intervention's cultural equivalence and tracked wording or presentation changes to compare understanding across groups.

“Our culturally diverse clinical supervisors, community advisory group, and research team evaluated the cultural equivalence of our intervention and tracked changes in wording or presentation, to compare understanding across groups.”

May combine two claims.

Of 307 randomized participants, 262 completed at least two post-baseline assessments and 232 completed all three, with no significant difference between intervention and control groups.

“Of the 307 randomized participants, 262 completed at least two post-baseline assessments (85.3%) and 232 completed all three post-baseline assessments (75.6% retention rate), with no significant difference in number of completed assessments between intervention and control (χ2[3]=1.1, p=0.79).”

May combine two claims.

Positive Minds session fidelity was 80.5%, and Strong Bodies session fidelity was 65.9%.

“PM session fidelity was 80.5% (ranging from 76.9% to 83.7%); whereas fidelity for SB sessions was 65.9% (ranging from 65.2% to 66.7%).”

May combine two claims.

The WHODAS 2.0 had internal consistency of Cronbach's alpha 0.84 overall and 0.81 to 0.86 across languages.

“overall α=0.84; range of α=0.81–0.86”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Primary outcome measures were translated and back-translated, and a multinational expert panel resolved ambiguities found in back-translation.

“We translated and back translated the standard English versions of our primary outcome measures (see Table 1, SDC). When the back translation revealed ambiguities, we engaged a multinational panel of experts to resolve them.”

Classified as probably not a substantial claim.

The study used multiple imputation to handle missing data and incomplete assessments.

“We used multiple imputation to account for missing data/incomplete assessments (see Methods 5, SDC).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Community health workers received two days of workshops, four months of role plays for all 10 sessions, and at least 75% fidelity checks.

“Training involved two intensive days of workshops on core intervention elements and delivery, followed by four months of CHW role plays for all 10 sessions and 75% minimum fidelity checks.”