***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) OBJECTIVES To examine whether activity restriction specifically induced by fear of falling ( FF ) contributes to greater risk of disability and decline in physical function .  DESIGN Prospect i ve cohort study . SETTING Population -based older cohort . PARTICIPANTS Six hundred seventy-three community-living elderly ( > or = 65 ) participants in the Invecchiare in Chianti Study who reported FF . MEASUREMENTS FF , fear-induced activity restriction , cognition , depressive symptoms , comorbidities , smoking history , and demographic factors were assessed at baseline . Disability in activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) and performance on the Short Performance Physical Battery ( SPPB ) were evaluated at baseline and at the 3-year follow-up . RESULTS One-quarter ( 25.5 % ) of participants did not report any activity restriction , 59.6 % reported moderate activity restriction  ( restriction or avoidance of < 3 activities ) , and 14.9 % reported  severe activity restriction  ( restriction or avoidance of > or = 3 activities ) . The severe restriction group reported significantly higher IADL disability and worse SPPB scores than the no restriction and moderate restriction groups . Severe activity restriction was a significant independent predictor of worsening ADL disability and accelerated decline in lower extremity performance on SPPB over the 3-year follow-up . Severe and moderate activity restriction were independent predictors of worsening IADL disability . Results were consistent even after adjusting for multiple potential confounders . CONCLUSION In an elderly population , activity restriction associated with FF is an independent predictor of decline in physical function . Future intervention studies in geriatric preventive care should directly address risk factors associated with FF and activity restriction to substantiate long-term effects on physical abilities and autonomy of older persons Background Development of longer term stroke rehabilitation services is limited by lack of evidence of effectiveness for specific interventions and service models . We describe the protocol for a multicentre r and omised controlled trial which is evaluating an extended stroke rehabilitation service . The extended service commences when routine ‘ organised stroke care ’ ( stroke unit and early supported discharge ( ESD ) ) ends . Methods / design This study is a multicentre r and omised controlled trial with health economic and process evaluations . It is set within NHS stroke services which provide ESD . Participants are adults who have experienced a new stroke ( and carer if appropriate ) , discharged from hospital under the care of an ESD team . The intervention group receives an extended stroke rehabilitation service provided for 18 months following completion of ESD . The extended rehabilitation service involves regular contact with a senior ESD team member who leads and coordinates further rehabilitation . Contact is usually by telephone . The control group receives usual stroke care post-ESD . Usual care may involve referral of patients to a range of rehabilitation services upon completion of ESD in accordance with local clinical practice . R and omisation is via a central independent web-based service . The primary outcome is extended activities of daily living ( Nottingham Extended Activities of Daily Living Scale ) at 24 months post-r and omisation . Secondary outcomes ( at 12 and 24 months post-r and omisation ) are health status , quality of life , mood and experience of services for patients , and quality of life , experience of services and carer stress for carers . Re source use and adverse events are also collected . Outcomes are undertaken by a blinded assessor . Implementation and delivery of the extended stroke rehabilitation service will also be described . Semi-structured interviews will be conducted with a sub sample of participants and staff to gain insight into perceptions and experiences of rehabilitation services delivered or received . Allowing for 25 % attrition , 510 participants are needed to provide 90 % power to detect a difference in mean Nottingham Extended Activities of Daily Living Scale score of 6 with a 5 % significance level . Discussion The provision of longer term support for stroke survivors is currently limited . The results from this trial will inform future stroke service planning and configuration . Trial registration This trial was registered with IS RCT N ( identifier : IS RCT N45203373 ) on 9 August 2012 BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs INTRODUCTION Family carers play an important role in providing care for frail older Australians . Carers have increased rates of depression , burden and poor physical health compared with non-carers . Physical activity has been shown to improve outcomes ; however there is limited research investigating outcomes in older carers and less on physical activity for both the carer and care recipient . RESEARCH QUESTION Does a home-based individualised physical activity intervention design ed for both the carer and care recipient improve depression severity in older carers ? PARTICIPANTS AND SETTING 273 community-dwelling carers with depressive symptoms and their care recipients will be recruited for a r and omised controlled trial . Baseline assessment will consist of functional , psychological , and physical measures and information about service use . INTERVENTION AND CONTROL : Participants will be r and omised to receive either a physical activity program ( intervention ) , a social support program ( social control ) , or usual care ( control ) . The intervention and social control groups will have five home visits over six months . MEASUREMENTS All participants will be re-assessed after completion of the program and then six months later to evaluate sustainability of outcomes . The primary outcome measure is the 15-item Geriatric Depression Scale for carers . Secondary outcomes include physical measures for carers and care recipients , carer burden , carer satisfaction , care recipient depression , and cost-effectiveness . All assessors will be blind to group allocation . DISCUSSION This study has the potential to demonstrate that physical activity interventions can be delivered simultaneously to older carers and care recipients to improve mental and physical outcomes Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation Background People with dementia progressively lose abilities and are prone to falling . Exercise- and activity-based interventions hold the prospect of increasing abilities , reducing falls , and slowing decline in cognition . Current falls prevention approaches are poorly suited to people with dementia , however , and are of uncertain effectiveness . We used multiple sources , and a co-production approach , to develop a new intervention , which we will evaluate in a feasibility r and omised controlled trial ( RCT ) , with embedded adherence , process and economic analyses . Methods We will recruit people with mild cognitive impairment or mild dementia from memory assessment clinics , and a family member or carer . We will r and omise participants between a therapy programme with high intensity supervision over 12 months , a therapy programme with moderate intensity supervision over 3 months , and brief falls assessment and advice as a control intervention . The therapy programmes will be delivered at home by mental health specialist therapists and therapy assistants . We will measure activities of daily living , falls and a battery of intermediate and distal health status outcomes , including activity , balance , cognition , mood and quality of life . The main aim is to test recruitment and retention , intervention delivery , data collection and other trial processes in advance of a planned definitive RCT . We will also study motivation and adherence , and conduct a process evaluation to help underst and why results occurred using mixed methods , including a qualitative interview study and scales measuring psychological , motivation and communication variables . We will undertake an economic study , including modelling of future impact and cost to end-of-life , and a social return on investment analysis . Discussion In this study , we aim 
    Output:
    
The study suggested that the intervention is both feasible and acceptable to stakeholders .
A number of modifications were recommended to address some of the issues arising during feasibility testing .
The measurement of outcome measures was successful .
The study has highlighted the feasibility of delivering a creative , tailored , individual approach to intervention for people with dementia following a fall .
Although the intervention required greater investment of time than usual practice , many staff valued the opportunity to work more closely with people with dementia and their carers .