Trial Outcomes & Findings for LiveSMART Trial to Prevent Falls in Patients With Cirrhosis (NCT NCT05794555)

NCT ID: NCT05794555

Last Updated: 2026-07-31

Results Overview

Composite outcome is defined as any of the following: • Injurious Fall: Fracture, dislocation, cut, head injury, soft - tissue injury requiring medical intervention including: Hospitalization or overnight observation in the Emergency Room (ER); surgery, transfusion, stitches * Non - Injurious Fall: Inadvertently coming to rest on the floor or lower level * Include falls that result in minor injuries that are addressed with first aid (e.g., ice, bandage) * Incident Overt HE: Acute disorientation requiring hospitalization or the initiation of HE - directed therapy, confirmed by a gastroenterologist or study investigator * Death: Mortality with any cause * Liver transplant: Replacement of a diseased liver with the healthy liver from another person because of acute-on-chronic liver failure (using the EASL-CLIF-C definition consisting of an acute increase in the bilirubin and/or INR, acute kidney injury, overt HE, hypertension, and hypoxia).

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

233 participants

Primary outcome timeframe

Baseline to 24 weeks

Results posted on

2026-07-31

Participant Flow

3 consented individuals beyond the 230 shown below were determined to be ineligible, so their data was not included in any modules.

Participant milestones

Participant milestones
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Stage 1 (Week 1 [Baseline] to Week 12)
STARTED
52
61
53
64
Stage 1 (Week 1 [Baseline] to Week 12)
COMPLETED
52
52
53
59
Stage 1 (Week 1 [Baseline] to Week 12)
NOT COMPLETED
0
9
0
5
Stage 2 (Week 12 to Week 24)
STARTED
52
52
53
59
Stage 2 (Week 12 to Week 24)
COMPLETED
49
50
52
58
Stage 2 (Week 12 to Week 24)
NOT COMPLETED
3
2
1
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Stage 1 (Week 1 [Baseline] to Week 12)
Withdrawal by Subject
0
5
0
1
Stage 1 (Week 1 [Baseline] to Week 12)
Physician Decision
0
3
0
0
Stage 1 (Week 1 [Baseline] to Week 12)
Lost to Follow-up
0
1
0
0
Stage 1 (Week 1 [Baseline] to Week 12)
Transplant because of Acute-on-Chronic Liver Failure (ACLF)
0
0
0
1
Stage 1 (Week 1 [Baseline] to Week 12)
Overt HE
0
0
0
3
Stage 2 (Week 12 to Week 24)
Withdrawal by Subject
1
1
0
1
Stage 2 (Week 12 to Week 24)
Physician Decision
0
0
1
0
Stage 2 (Week 12 to Week 24)
Death
0
1
0
0
Stage 2 (Week 12 to Week 24)
Overt HE
2
0
0
0

Baseline Characteristics

LiveSMART Trial to Prevent Falls in Patients With Cirrhosis

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Total
n=230 Participants
Total of all reporting groups
Age, Continuous
62.6 years
STANDARD_DEVIATION 11.3 • n=9 Participants
61.9 years
STANDARD_DEVIATION 11.1 • n=27 Participants
61.6 years
STANDARD_DEVIATION 10.9 • n=267 Participants
61.2 years
STANDARD_DEVIATION 12.0 • n=265 Participants
61.8 years
STANDARD_DEVIATION 11.3 • n=568 Participants
Sex: Female, Male
Female
34 Participants
n=9 Participants
39 Participants
n=27 Participants
32 Participants
n=267 Participants
33 Participants
n=265 Participants
138 Participants
n=568 Participants
Sex: Female, Male
Male
18 Participants
n=9 Participants
22 Participants
n=27 Participants
21 Participants
n=267 Participants
31 Participants
n=265 Participants
92 Participants
n=568 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants
n=9 Participants
4 Participants
n=27 Participants
5 Participants
n=267 Participants
7 Participants
n=265 Participants
18 Participants
n=568 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
50 Participants
n=9 Participants
57 Participants
n=27 Participants
48 Participants
n=267 Participants
57 Participants
n=265 Participants
212 Participants
n=568 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=9 Participants
0 Participants
n=27 Participants
0 Participants
n=267 Participants
0 Participants
n=265 Participants
0 Participants
n=568 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=9 Participants
1 Participants
n=27 Participants
0 Participants
n=267 Participants
2 Participants
n=265 Participants
3 Participants
n=568 Participants
Race (NIH/OMB)
Asian
1 Participants
n=9 Participants
2 Participants
n=27 Participants
0 Participants
n=267 Participants
1 Participants
n=265 Participants
4 Participants
n=568 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=9 Participants
0 Participants
n=27 Participants
0 Participants
n=267 Participants
0 Participants
n=265 Participants
0 Participants
n=568 Participants
Race (NIH/OMB)
Black or African American
5 Participants
n=9 Participants
0 Participants
n=27 Participants
2 Participants
n=267 Participants
4 Participants
n=265 Participants
11 Participants
n=568 Participants
Race (NIH/OMB)
White
46 Participants
n=9 Participants
57 Participants
n=27 Participants
51 Participants
n=267 Participants
55 Participants
n=265 Participants
209 Participants
n=568 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=9 Participants
1 Participants
n=27 Participants
0 Participants
n=267 Participants
1 Participants
n=265 Participants
2 Participants
n=568 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=9 Participants
0 Participants
n=27 Participants
0 Participants
n=267 Participants
1 Participants
n=265 Participants
1 Participants
n=568 Participants
Region of Enrollment
United States
52 Participants
n=9 Participants
61 Participants
n=27 Participants
53 Participants
n=267 Participants
64 Participants
n=265 Participants
230 Participants
n=568 Participants
Cognitive Function Based on the Animal Naming Test (ANT)
20.31 animals named
STANDARD_DEVIATION 4.91 • n=9 Participants
22.61 animals named
STANDARD_DEVIATION 5.79 • n=27 Participants
21.88 animals named
STANDARD_DEVIATION 5.76 • n=267 Participants
21.84 animals named
STANDARD_DEVIATION 6.04 • n=265 Participants
21.71 animals named
STANDARD_DEVIATION 5.69 • n=568 Participants
Visual Analog Scale (VAS)
70.44 units on a scale
STANDARD_DEVIATION 21.02 • n=9 Participants
69.57 units on a scale
STANDARD_DEVIATION 19.39 • n=27 Participants
68.42 units on a scale
STANDARD_DEVIATION 17.06 • n=267 Participants
69.67 units on a scale
STANDARD_DEVIATION 17.02 • n=265 Participants
69.54 units on a scale
STANDARD_DEVIATION 18.53 • n=568 Participants
The Patient Reported Outcome Measurement Information System (PROMIS)-29+2 Profile (PROPr)
0.41 units on a scale
STANDARD_DEVIATION 0.23 • n=9 Participants
0.43 units on a scale
STANDARD_DEVIATION 0.22 • n=27 Participants
0.38 units on a scale
STANDARD_DEVIATION 0.24 • n=267 Participants
0.46 units on a scale
STANDARD_DEVIATION 0.24 • n=265 Participants
0.42 units on a scale
STANDARD_DEVIATION 0.23 • n=568 Participants
Depression Based on The Patient Reported Outcome Measurement Information System (PROMIS)-29+2 v2.1
50.24 t score
STANDARD_DEVIATION 9.96 • n=9 Participants
47.30 t score
STANDARD_DEVIATION 7.27 • n=27 Participants
51.70 t score
STANDARD_DEVIATION 9.82 • n=267 Participants
49.21 t score
STANDARD_DEVIATION 8.41 • n=265 Participants
49.50 t score
STANDARD_DEVIATION 8.93 • n=568 Participants
Sleep Quality Based on the PROMIS-29+2 v2.1
52.55 t score
STANDARD_DEVIATION 6.93 • n=9 Participants
51.24 t score
STANDARD_DEVIATION 5.75 • n=27 Participants
52.12 t score
STANDARD_DEVIATION 6.91 • n=267 Participants
51.30 t score
STANDARD_DEVIATION 5.63 • n=265 Participants
51.75 t score
STANDARD_DEVIATION 6.26 • n=568 Participants
Physical Frailty Based on the Activities of Daily Living (ADLs)
5.83 units on a scale
STANDARD_DEVIATION 0.62 • n=9 Participants
5.79 units on a scale
STANDARD_DEVIATION 0.58 • n=27 Participants
5.79 units on a scale
STANDARD_DEVIATION 0.45 • n=267 Participants
5.81 units on a scale
STANDARD_DEVIATION 0.39 • n=265 Participants
5.80 units on a scale
STANDARD_DEVIATION 0.51 • n=568 Participants
Short Form (SF) - 8
66.85 t score
STANDARD_DEVIATION 24.00 • n=9 Participants
68.43 t score
STANDARD_DEVIATION 18.18 • n=27 Participants
62.33 t score
STANDARD_DEVIATION 20.79 • n=267 Participants
67.30 t score
STANDARD_DEVIATION 20.35 • n=265 Participants
66.36 t score
STANDARD_DEVIATION 20.79 • n=568 Participants

PRIMARY outcome

Timeframe: Baseline to 24 weeks

Composite outcome is defined as any of the following: • Injurious Fall: Fracture, dislocation, cut, head injury, soft - tissue injury requiring medical intervention including: Hospitalization or overnight observation in the Emergency Room (ER); surgery, transfusion, stitches * Non - Injurious Fall: Inadvertently coming to rest on the floor or lower level * Include falls that result in minor injuries that are addressed with first aid (e.g., ice, bandage) * Incident Overt HE: Acute disorientation requiring hospitalization or the initiation of HE - directed therapy, confirmed by a gastroenterologist or study investigator * Death: Mortality with any cause * Liver transplant: Replacement of a diseased liver with the healthy liver from another person because of acute-on-chronic liver failure (using the EASL-CLIF-C definition consisting of an acute increase in the bilirubin and/or INR, acute kidney injury, overt HE, hypertension, and hypoxia).

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Number of Participants Experiencing a Hierarchical Composite of Events Over 24 Weeks: Injurious Falls, Non-injurious Falls, Incident Hepatic Encephalopathy, Liver Transplant, and Death/Transplant
11 Participants
10 Participants
14 Participants
29 Participants

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Results reflect the number of participants who experienced at least one injurious fall. Injurious falls include: Fracture, dislocation, cut, head injury, soft - tissue injury requiring hospitalization.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Injurious Falls
6 Participants
4 Participants
7 Participants
12 Participants

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Results reflect the number of participants who experienced at least one non-injurious fall. Non- injurious falls include: Inadvertently coming to rest on the floor or lower level.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Non-Injurious Falls
13 Participants
9 Participants
16 Participants
23 Participants

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Incident Overt HE includes: Acute disorientation requiring hospitalization or the initiation of HE - directed therapy, confirmed by a gastroenterologist or study investigator.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Incident Overt Hepatic Encephalopathy (HE)
1 Participants
0 Participants
1 Participants
3 Participants

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Results reflect participants who died, or who received a liver transplant because of ACLF.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Death/Transplant for Acute-on-Chronic Liver Failure (ACLF)
0 Participants
1 Participants
0 Participants
1 Participants

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Results reflect the number of participants who received replacement of a diseased liver with the healthy liver from another person for any reason other than ACLF.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Incident of Liver Transplant for Non-ACLF Reason
0 Participants
0 Participants
1 Participants
1 Participants

SECONDARY outcome

Timeframe: Approximately 26 Weeks

Days-alive and out-of-the-hospital is a continuous value, 1 for each day alive, 0 for days in hospital. Participants were queried and data was also abstracted from the Electronic Medical Record (EMR). Results reflect the average number of days participants were alive and out of the hospital.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Days-alive and Out-of-the-hospital
176.19 Days-alive and out-of-the-hospital
Standard Deviation 20.15
174.80 Days-alive and out-of-the-hospital
Standard Deviation 15.48
177.26 Days-alive and out-of-the-hospital
Standard Deviation 8.62
166.78 Days-alive and out-of-the-hospital
Standard Deviation 36.14

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

The animal naming test assesses cognitive function. It is a timed test that that consists of participants listing as many unique animals as possible in 60 seconds. This is a validated test used for the assessment of hepatic encephalopathy. The score is the number of unique animals named (higher is better). Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Cognitive Function Based on the Animal Naming Test (ANT)
1.39 animals named
Standard Deviation 5.60
2.74 animals named
Standard Deviation 5.46
0.83 animals named
Standard Deviation 5.67
1.94 animals named
Standard Deviation 4.90

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

This was a 1-item global rating of health scored 0-100. A score of 100 means the best health and 0 means the worst health imagined. Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Visual Analog Scale (VAS)
-1.36 score on a scale
Standard Deviation 22.94
8.14 score on a scale
Standard Deviation 14.38
2.88 score on a scale
Standard Deviation 15.14
2.09 score on a scale
Standard Deviation 21.31

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

PROPr is the combined score of the two scales in the PROMIS 29+2, a quality-of-life scale and a pain-rating scale, and is used to calculate a preference score. The scores from both scales provide an overall summary of health-related quality of life based on multiple domains summarizing a metric ranging from 0 (as bad as dead) to 1 (perfect or ideal health). Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in The Patient Reported Outcome Measurement Information System (PROMIS)-29+2 v2.1 Profile (PROPr)
0.01 score on a scale
Standard Deviation 0.18
0.03 score on a scale
Standard Deviation 0.22
-0.01 score on a scale
Standard Deviation 0.14
-0.03 score on a scale
Standard Deviation 0.15

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

There were 4 questions that participants completed regarding depression. The scores were converted to t scores, which were normalized from the raw scores. The t score ranged from 0-100 with 0 denoting worst depression and 100 indicating no depression. Results reflect the change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Depression Based on The Patient Reported Outcome Measurement Information System (PROMIS)-29+2 v2.1
-0.87 t score
Standard Deviation 6.05
0.53 t score
Standard Deviation 7.51
0.14 t score
Standard Deviation 6.75
0.15 t score
Standard Deviation 7.15

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

There were 4 questions that participants completed regarding sleep quality. The scores were converted to t scores, which were normalized from the raw scores. The t score ranged from 0-100 with 0 denoting worst sleep quality and 100 indicating best sleep quality. Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Sleep Quality Based on the PROMIS-29+2 v2.1
-1.52 t score
Standard Deviation 5.84
0.10 t score
Standard Deviation 7.28
-1.08 t score
Standard Deviation 4.97
-0.57 t score
Standard Deviation 3.82

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: No data for this outcome was collected because the majority of participants were enrolled remotely, so none conducted the assessments for physical frailty. There are no plans to collect this data later now that the trial has concluded.

Physical frailty was assessed with this index and was a composite of handgrip, timed chair-stands, and balance. The index ranged from -1.26 (robust) to 6.9 (frail), 50th percentile is 3.9. For individuals enrolled remotely, the study team assessed chair-stands.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Baseline to 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

Activities of daily living (ADLs), is a validated self-reported measure (disability is defined as \>1 ADL deficit) recommended by the American Society for Transplantation and AASLD. The score ranged from 0 to 6 (6 indicating full independence, 4 moderate impairment, and 2 or less severe functional impairment). Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Physical Frailty Based on the Activities of Daily Living (ADLs)
-0.17 score on a scale
Standard Deviation 0.44
-0.07 score on a scale
Standard Deviation 0.88
0.06 score on a scale
Standard Deviation 0.52
0.07 score on a scale
Standard Deviation 0.43

SECONDARY outcome

Timeframe: 24 weeks

Evaluation of intervention fidelity was assessed at 50% and 100% of study completion. Results reflect participants who maintained fidelity by completing at least one of the following key intervention components: coordinator trainings, lactulose prescriptions ordered, enhanced usual care components delivered, Short Message Service (SMS) assessments sent, study visits completed, or exercise sessions completed.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Intervention Fidelity
52 Participants
61 Participants
53 Participants
64 Participants

SECONDARY outcome

Timeframe: 24 weeks

Population: Results are provided for participants who actually received the named intervention in the row below.

Adherence to lactulose, Tai-Chi, and nighttime protein supplementation was monitored. Results reflect the number of participants who discontinued their assigned intervention.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Participant Adherence
Lactulose
10 Participants
13 Participants
0 Participants
0 Participants
Participant Adherence
Tai-Chi
12 Participants
0 Participants
17 Participants
0 Participants

SECONDARY outcome

Timeframe: 12 weeks and 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

Satisfaction with the trial was assessed using the 6-item Patient Global Impression of Change (PGIC). Participants selected from 1 (very much improved) to 7 (very much worse). Lower scores indicated higher satisfaction.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Participant Satisfaction With the Trial and Interventions Based on the Patient Global Impression of Change (PGIC)
Week 12
3.40 score on a scale
Standard Deviation 1.05
3.38 score on a scale
Standard Deviation 0.91
3.58 score on a scale
Standard Deviation 1.06
3.32 score on a scale
Standard Deviation 1.05
Participant Satisfaction With the Trial and Interventions Based on the Patient Global Impression of Change (PGIC)
Week 24
3.11 score on a scale
Standard Deviation 1.29
3.26 score on a scale
Standard Deviation 1.22
3.24 score on a scale
Standard Deviation 1.06
3.36 score on a scale
Standard Deviation 1.02

SECONDARY outcome

Timeframe: 24 weeks

Population: Results are based on an intent-to-treat (ITT) analysis.

The SF-8 is an abbreviated 8-item version of an original 36-item health survey (SF-36). It is a generic multipurpose quality of life instrument. It contains psychometrically based physical and mental health summary measures. The eight domains include general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health and role emotional. The scores were converted to t scores, which were normalized from the raw scores. The t score ranged from 0-100 with 0 denoting worst quality of life and 100 indicating best quality of life. Results reflect change from baseline.

Outcome measures

Outcome measures
Measure
Treatment (Lactulose) Plus Enhanced Usual Care Then TeleTai-Chi Exercise Classes
n=52 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. Participants receiving Lactulose at stage1 will continue in stage2. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Treatment (Lactulose) Plus Enhanced Usual Care Then Recommended Exercise
n=61 Participants
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) and then re-randomization to Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Participants that receive Lactulose during stage 1 will continue this in stage 2. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Enhanced Usual Care Group Followed by Tele-Tai Chi Exercise Classes
n=53 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Enhanced Usual Care Group Followed by Investigator Recommended Exercise
n=64 Participants
Enhanced Usual Care (EUC) at Stage 1 (12 weeks) and then re-randomization to EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Change in Short Form (SF) - 8
1.26 t score
Standard Deviation 18.03
5.10 t score
Standard Deviation 14.56
2.91 t score
Standard Deviation 14.99
-0.18 t score
Standard Deviation 17.02

Adverse Events

Stage 1: Treatment (Lactulose) Plus Enhanced Usual Care (EUC)

Serious events: 5 serious events
Other events: 15 other events
Deaths: 0 deaths

Stage 1: EUC

Serious events: 10 serious events
Other events: 25 other events
Deaths: 0 deaths

Stage 2: Lactulose + EUC + TeleTai-Chi Exercise Classes

Serious events: 7 serious events
Other events: 5 other events
Deaths: 0 deaths

Stage 2: Lactulose + EUC + Recommended Exercise

Serious events: 2 serious events
Other events: 5 other events
Deaths: 1 deaths

Stage 2: EUC + TeleTai-Chi Exercise Classes

Serious events: 3 serious events
Other events: 6 other events
Deaths: 0 deaths

Stage 2: EUC + Recommended Exercise

Serious events: 7 serious events
Other events: 14 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Stage 1: Treatment (Lactulose) Plus Enhanced Usual Care (EUC)
n=113 participants at risk
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures.
Stage 1: EUC
n=117 participants at risk
Enhanced Usual Care (EUC) at Stage 1 (12 weeks). EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures.
Stage 2: Lactulose + EUC + TeleTai-Chi Exercise Classes
n=52 participants at risk
Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Stage 2: Lactulose + EUC + Recommended Exercise
n=52 participants at risk
Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Stage 2: EUC + TeleTai-Chi Exercise Classes
n=53 participants at risk
EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Stage 2: EUC + Recommended Exercise
n=59 participants at risk
EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
General disorders
Injurious Falls
1.8%
2/113 • 24 weeks
3.4%
4/117 • 24 weeks
3.8%
2/52 • 24 weeks
0.00%
0/52 • 24 weeks
3.8%
2/53 • 24 weeks
6.8%
4/59 • 24 weeks
Hepatobiliary disorders
Acute on chronic liver failure
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Cardiac disorders
Cardiac Event
0.88%
1/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Surgical and medical procedures
Complications status post procedure
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Metabolism and nutrition disorders
Electrolyte abnormality
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Gastrointestinal disorders
Gastrointestinal Bleeding
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
5.8%
3/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Hepatobiliary disorders
Hepatic Encephalopathy
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Infections and infestations
Infection
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
3.8%
2/52 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Hepatobiliary disorders
Pancreatitis
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Surgical and medical procedures
Planned Procedure
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/53 • 24 weeks
0.00%
0/59 • 24 weeks
Hepatobiliary disorders
Portal vein thrombosis
0.88%
1/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Gastrointestinal disorders
Small Bowel Obstruction
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Nervous system disorders
Stroke
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Nervous system disorders
neurologic abnormality
0.88%
1/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks

Other adverse events

Other adverse events
Measure
Stage 1: Treatment (Lactulose) Plus Enhanced Usual Care (EUC)
n=113 participants at risk
Lactulose plus Enhanced Usual Care (EUC) at Stage1 (12 weeks) Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures.
Stage 1: EUC
n=117 participants at risk
Enhanced Usual Care (EUC) at Stage 1 (12 weeks). EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures.
Stage 2: Lactulose + EUC + TeleTai-Chi Exercise Classes
n=52 participants at risk
Lactulose plus EUC then TeleTai-Chi exercise classes at Stage2 EUC: Participants provided and counseled on 2 methods to enhance care. First, a handout on nutrition and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein snack at night. Second, counsel participants on fall-prevention methods for day-to-day life. Participants will be provided a standard handout of CDC-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to slowly increase dose over the first week of Stage1. The prescribed max dose will be 30 mL twice daily. The dose will slowly increase to max or until participants reach 2-3 soft bowel movements daily. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor 3 times per week (for approximately 12 weeks). Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Stage 2: Lactulose + EUC + Recommended Exercise
n=52 participants at risk
Lactulose plus EUC then Investigator-Recommended Exercise at Stage2 EUC: Participants will be provided and counseled on 2 methods to enhance care. First, a handout on nutrition recommendations and protein supplementation, including recommendation of high protein snacks in daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). Second will be to counsel participants on fall prevention methods to enact in day-to-day life. Participants will be provided a standard handout of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Lactulose: Participants will be prescribed lactulose and also receive EUC. Lactulose will be taken on a specific schedule based on average number of bowel movements per day, starting at 15 milliliter (mL) dose. Participants will be instructed to increase the dose over the first week of Stage1. The prescribed maximum dose will be 30 mL (20g) twice daily. The dose will slowly increase toward the maximum or until participants reach 2-3 soft bowel movements daily. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Stage 2: EUC + TeleTai-Chi Exercise Classes
n=53 participants at risk
EUC then Tele-Tai Chi exercise classes at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. TeleTai-Chi (virtual): TeleTai-Chi will be taught remotely via live Zoom classes of up to 15 patients by a certified TeleTai-Chi instructor three times per week (for approximately 12 weeks). Classes will be conducted via a HIPAA-compliant Zoom server through the University of Michigan. Participants will be instructed to use Zoom by smartphone, tablet, or computer. High-Definition Multimedia Interface (HDMI) cables and other device specific equipment to connect devices to televisions will be provided.
Stage 2: EUC + Recommended Exercise
n=59 participants at risk
EUC then Investigator-Recommended Exercise at Stage 2 Enhanced Usual Care: Patients will be provided and counseled on two methods which will enhance care. The first is a handout on nutrition recommendations and protein supplementation. This will include the recommendation of both high protein snacks during the daytime (e.g., protein bars) and a high-protein night-time snack (e.g., peanut butter and crackers). The second will be to counsel participants on falls prevention methods that can be enacted in day-to-day life. All participants will be provided with a standard hand-out of Centers for Disease Control and Prevention (CDC)-endorsed fall-risk reduction measures. Investigator recommended exercise: Participants randomized to enhanced usual care will be reminded of standard fall precautions outlined in the Fall Prevention Primer that were provided in Stage 1 and will receive exercise recommendations.
Surgical and medical procedures
Planned Procedure
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Gastrointestinal disorders
Small Bowel Obstruction
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Gastrointestinal disorders
Ulcerative Colitis
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Nervous system disorders
Neurological Abnormality
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Hepatobiliary disorders
Ascites
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
1.7%
1/59 • 24 weeks
Infections and infestations
Infection
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/52 • 24 weeks
1.9%
1/53 • 24 weeks
0.00%
0/59 • 24 weeks
Musculoskeletal and connective tissue disorders
Non-fall injury
0.88%
1/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
General disorders
Non-Injurious Falls
12.4%
14/113 • 24 weeks
18.8%
22/117 • 24 weeks
9.6%
5/52 • 24 weeks
5.8%
3/52 • 24 weeks
7.5%
4/53 • 24 weeks
16.9%
10/59 • 24 weeks
Metabolism and nutrition disorders
Electrolyte abnormality
0.00%
0/113 • 24 weeks
0.00%
0/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/53 • 24 weeks
0.00%
0/59 • 24 weeks
Gastrointestinal disorders
Gastrointestinal Bleeding
0.00%
0/113 • 24 weeks
2.6%
3/117 • 24 weeks
0.00%
0/52 • 24 weeks
1.9%
1/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks
Hepatobiliary disorders
Hepatic Encephalopathy
0.00%
0/113 • 24 weeks
0.85%
1/117 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/52 • 24 weeks
0.00%
0/53 • 24 weeks
0.00%
0/59 • 24 weeks

Additional Information

Elliot Tapper

University of Michigan

Phone: 734-647-9252

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place