Impact of tailored message notifications for frailty prevention in older adults: a quasi-randomized controlled study using a regression discontinuity design.
Yasuyuki Kurasawa, Yoshiharu Yokokawa
PMID 39354930WHAT IT FOUND
One tailored letter a year to older adults flagged as pre-frail or frail did not clearly improve frailty scores a year later.
Small gains appeared only when missing answers were ignored, and disappeared when they were filled in.
Key findings
01For people just above the pre-frailty cutoff, the message reduced next-year Kihon Checklist scores in the unadjusted and in the age- and sex-adjusted analyses of complete data, but the effect was no longer statistically significant once missing answers were imputed.
02For people above the frailty cutoff, only the unadjusted model at the narrowest bandwidth showed a significant reduction; the adjusted and imputed models found nothing.
03The estimated effects shrank as people further from the cutoff were included, so the findings only describe people whose scores sit close to the cutoff.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The finding depends entirely on how close to the cutoff you look. The reductions were significant only in the narrowest band around the cutoff and disappeared as more people were included, so the study cannot be generalised to pre-frail or frail older adults in general. Up to 27.2% of checklist answers were missing. When they were filled in statistically, the effects disappeared, which the authors attribute to the people who answered everything being the healthier and more motivated ones. Age and sex differed between the compared groups at both cutoffs, so the groups either side of the threshold were not as alike as the design assumes. This is one municipality in a mountainous region, and the message was sent only once a year, so frequency and content were not tested against any alternative. It is an observational comparison around a cutoff, not a randomised trial, and it relies on routine self-reported questionnaire data.
Declared interests
The study received no external funding. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the small improvements in the pre-frail group as proof that posted advice works. They were significant only in the complete-data analyses at the narrowest band around the cutoff and they disappeared once missing answers were filled in, and the frail group showed no significant effect in any adjusted or imputed model.
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