title: Implementation challenges and functional outcome predictors for elder community-based disability prevention programs.
abstract: OBJECTIVE
  Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. However, it is often difficult to replicate clinical trials into real-world practice settings. We (a) compared replication and clinical trial functional changes, (b) compared replication and clinical trial program structures and processes of care, and, additionally, (c) examined how replication client and site features are associated with function.
  
  
  METHODS
  We used secondary longitudinal data on 719 elder clients, and primary data through interviews with nurses, social workers, and site managers for the replication, and compared this to original trial data. We analyzed associations between baseline self-efficacy and functional outcomes and between site features and functional outcomes using multivariate and logistic models for the replication.
  
  
  RESULTS
  Replication functional outcome changes were lower and structures and processes were less intense than in the original clinical trial. Baseline client higher self-efficacy positively influenced 12-month function, and smaller sites and urban sites had better functional outcomes than larger sites and rural sites for the replication.
  
  
  CONCLUSIONS
  Exploring systemic strategies for using available resources to improve research translation is essential. In addition, practitioners need to focus on client self-efficacy enhancement techniques, which may be more important in replication studies to improve function.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, ENRM Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA. adossa@bu.edu
authors.forename: Almas
authors.initials: A
authors.lastname: Dossa
authors.forename: John A
authors.initials: JA
authors.lastname: Capitman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology; D003153:Community Health Services / Q000379:methods*; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D026741:Physical Therapy Modalities; D020377:Self Efficacy