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).
COMPLETED
PHASE3
233 participants
Baseline to 24 weeks
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
| 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
| 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
| 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 weeksComposite 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
| 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 weeksResults 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
| 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 weeksResults 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
| 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 weeksIncident Overt HE includes: Acute disorientation requiring hospitalization or the initiation of HE - directed therapy, confirmed by a gastroenterologist or study investigator.
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 weeksResults reflect participants who died, or who received a liver transplant because of ACLF.
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 weeksResults 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
| 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 WeeksDays-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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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 weeksPopulation: 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
| 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 weeksEvaluation 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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 weeksPopulation: 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
| 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)
Stage 1: EUC
Stage 2: Lactulose + EUC + TeleTai-Chi Exercise Classes
Stage 2: Lactulose + EUC + Recommended Exercise
Stage 2: EUC + TeleTai-Chi Exercise Classes
Stage 2: EUC + Recommended Exercise
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
| 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
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place