
Clare RobertsonUniversity of Otago · Department of Medicine (Dunedin)
Clare Robertson
PhD BSc(Hons) BCom
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101
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Introduction
Skills and Expertise
Publications
Publications (101)
Background:
Many randomised trials have count outcomes, such as the number of falls or the number of asthma exacerbations. These outcomes have been treated as counts, continuous outcomes or dichotomised and analysed using a variety of analytical methods. This study examines whether different methods of analysis yield estimates of intervention effe...
Background
Multifocal glasses (bifocals, trifocals, and progressives) increase the risk of falling in elderly people, but how they do so is unclear. To explain why glasses with progressive addition lenses increase the risk of falls and whether this can be attributed to false projection, this study aimed to 1) map the prismatic displacement of a pro...
To evaluate the cost effectiveness of manual physiotherapy, exercise physiotherapy, and a combination of these therapies for patients with osteoarthritis of the hip or knee.
206 adults who met the American College of Rheumatology criteria for hip or knee osteoarthritis were included in an economic evaluation from the perspectives of the New Zealand...
Clinical question:
Which types of interventions reduce falls in older people living in the community?
Bottom line:
Fall-prevention exercise programs, usually including muscle strengthening and balance retraining, were associated with lower fall rates in community-dwelling older people whether or not individuals were selected on the basis of fall...
Objective:
To evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee.
Design:
In this 2 × 2 factorial randomized controlled trial, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or kn...
Background:
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010.
Objectives:
To assess the effectiveness of interventions designed to reduce falls by older people in care facilities and hospitals.
Search methods:
We sear...
Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.
To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Re...
This study sought to evaluate the safety and feasibility of all operators at a single center changing from predominantly femoral to radial access for coronary percutaneous procedures.
The radial artery is currently regarded as a useful vascular access site for coronary angiography and percutaneous coronary intervention (PCI). The reduction in local...
To investigate the cost-effectiveness of nonpharmacological, nonsurgical interventions for the treatment of hip and/or knee osteoarthritis.
We identified economic evaluations or cost studies associated with randomized or quasi-randomized controlled trials that assessed nonpharmacologic, nonsurgical interventions for the treatment of hip and/or knee...
Using two instruments (SF-6D and EQ-5D) to estimate quality adjusted life years (QALYs), we conducted an economic evaluation of a 12-month randomized controlled trial with a 12-month follow-up study in older women to evaluate the value for money of two doses of resistance training compared with balance and tone classes. We found that the incrementa...
To determine whether the health and cost benefits of resistance training were sustained 12 months after formal cessation of the intervention.
Cost-utility analysis conducted alongside a randomized controlled trial.
Community-dwelling women aged 65 to 75 living in Vancouver, British Columbia.
One hundred twenty-three of the 155 community-dwelling wo...
Introduction Clinical guidelines for the treatment of hip and knee osteoarthritis recommend non-pharmacological and non-surgical treatments. Exercise treatments are recommended as primary strategies, but specific exercise programme components have not been specified. Early evidence indicates that manual physiotherapy is effective for hip and knee o...
We estimated the incremental cost-effectiveness of a once-weekly or twice-weekly resistance training intervention compared with balance and tone classes in terms of falls prevented and quality-adjusted life years (QALYs) gained. Both resistance training interventions were more likely to save health care resource money and offer better health outcom...
Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representatio...
Cognitive decline is a major public health care issue and a well-recognized clinical manifestation of cognitive decline are falls. Seniors with cognitive impairment fall at twice the rate of peers without cognitive impairment 1, 2.
Exercise training may be an effective strategy against cognitive decline 3–6 and it is recommended for prevention of...
Individual assessment and treatment are important for older people at high risk of falls and injury. But falls are common. The problem cannot be addressed solely on an individual patient, individual clinician basis. Fall prevention programs that have broad coverage, good uptake and adherence, and can be seen to maintain independent living benefit i...
Falls in older people result in substantial health burden. Compelling evidence indicates that falls can be prevented. We developed comprehensive guidelines for economic evaluations of fall prevention interventions to facilitate publication of high-quality economic evaluations of the effective strategies and aid decision making.
The importance of ec...
Correcting vision can help, but do so with care
To investigate the value for money of strategies to prevent falls in older adults living in the community.
Systematic review of peer reviewed journal articles reporting an economic evaluation of a falls prevention intervention as part of a randomised controlled trial or a controlled trial, or using an analytical model. MEDLINE, PUBMED, EMBASE and N...
Our objective was to determine international estimates of the economic burden of falls in older people living in the community. Our systematic review emphasized the need for a consensus on methodology for cost of falls studies to enable more accurate comparisons and subgroup-specific estimates among different countries.
The purpose of this study wa...
Falls by older people in nursing care facilities and hospitals are common events that may cause loss of independence, injuries, and sometimes death as a result of injury. Effective interventions are important as they will have significant health benefits. This review includes 41 trials involving 25,422 participants, with about three quarters being...
OBJECTIVES: To investigate the value for money of strategies to prevent falls in older adults living in the community. DESIGN: Systematic review of peer reviewed journal articles reporting an economic evaluation of a falls prevention intervention as part of a randomised controlled trial, a controlled trial, or using an analytic model. We searched M...
Non-pharmacological, non-surgical interventions are recommended as the first line of treatment for osteoarthritis (OA) of the hip and knee. There is evidence that exercise therapy is effective for reducing pain and improving function in patients with knee OA, some evidence that exercise therapy is effective for hip OA, and early indications that ma...
Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.
To assess the effects of interventions designed to reduce the incidence of falls in elderly people (l...
Approximately 30% of people over 65 years of age living in the community fall each year.
To assess the effects of interventions to reduce the incidence of falls in older people living in the community.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, CI...
To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people.
Randomized, controlled trial.
Screening for previous falls in family practice followed by community-based intervention.
Three hundred twelve community-living people aged 75 and older who had fallen...
Guidelines recommend that fall prevention programmes for older people include multifactorial interventions.
We aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fall prevention.
We searched the literature for trials of interventions aimed at preventin...
The aim of this study was to establish the prevalence of depression in a sample of older adults with impaired vision and investigate associations between physical and visual disability and depression.
We analyzed cross-sectional baseline data from 391 participants aged >or=75 years with visual acuity of 6/24 (20/80) or less, recruited for a randomi...
Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few randomised controlled trials in a real life health care setting. We describe the rationale, intervention, study design, recruitment strategies and baseline characteristics of participants in a randomised controlled trial of a multifactoria...
In a randomized controlled trial testing a home safety program designed to prevent falls in older people with severe visual impairment, it was shown that the program, delivered by an experienced occupational therapist, significantly reduced the numbers of falls both at home and away from home.
To investigate whether the success of the home safety a...
Over 60% of falls experienced by older people result from multiple aetiological factors. Preventing falls in individual patients requires the identification and treatment of these interacting factors. Multifactorial interventions have been successful in some, but not all, fall prevention trials. Preventing falls in populations requires selection of...
To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision.
Randomised controlled trial.
Dunedin and Auckland, New Zealand.
391 women and men aged > or =75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) co...
Many different and sometimes inappropriate statistical techniques have been used to analyze the results of randomized controlled trials of falls prevention programs for elderly people. This makes comparison of the efficacy of particular interventions difficult.
We used raw data from two randomized controlled trials of a home exercise program to com...
Background:
Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.
Objectives:
To assess the effects of interventions designed to reduce the incidence of...
Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most fro...
Our research group has established the effectiveness of an individually tailored home exercise program to prevent falls and fall injuries in older people in four controlled trials. In one of these trials we evaluated the applicability of the exercise program to routine primary health care practice and the feasibility of nurses implementing the prog...
To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women.
An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme...
To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.
Randomised controlled trial with one year's follow up.
Community health service at a New Zealand hospital.
240 women and men aged 75...
To assess the effectiveness of trained nurses based in general practices individually prescribing a home exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.
Controlled trial with one year's follow up.
32 general practices in seven southern New Zealand centres.
450 women and men...
Objectives: To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme. Design: Randomised controlled trial with one year's follow up. Setting: Community health service at a New Zealand hospita...
Muscle weakness and impaired balance are risk factors underlying many falls and fall injuries experienced by older people. Fall prevention strategies have included exercise programmes that lower the risk of falling by improving strength and balance. We have developed an individually tailored, home-based, strength and balance retraining programme, w...
Thesis (doctoral)--University of Otago, 2000. Photocopy.
To assess the effectiveness of exercise programmes in preventing falls (and/or lowering the risk of falls and fall related injuries) in older people.
A review of controlled clinical trials designed with the aim of lowering the risk of falling and/or fall injuries through an exercise only intervention or an intervention that included an exercise com...
after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial.
we aimed to assess the effectiveness of the programm...
To assess the effectiveness of psychotropic medication withdrawal and a home-based exercise program in reducing falls in older people.
A randomized controlled trial with a two by two factorial design.
Seventeen general practices in Dunedin, New Zealand.
Women and men aged 65 years registered with a general practitioner and currently taking psychotr...
To examine prospective changes in food habits and nutrient intakes in a representative New Zealand sample of community dwelling adults aged 70 y and over.
Longitudinal study with food intake data collected in 1988/89 and again in 1995/96. In an attempt to distinguish age, time and cohort effects, data were analysed longitudinally, cross-sectionally...
To compare the prevalence of smoking, factors associated with smoking, ex-smokers and reasons for stopping in Maori and Europeans aged 10 years and older.
Demographic and smoking data were obtained by personal interview using a standard questionnaire and assisted by Maori health carers. Report-back meetings were held.
The smoking status in 713 subj...
Some patients with coronary artery disease experience continued progression of one or more coronary lesions despite treatment with drugs that inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase activity and markedly lower plasma cholesterol levels. We examined relationships between the progression of coronary artery lesions and plasma lipoprote...
To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing falls and injuries in elderly women.
Randomised controlled trial of an individually tailored programme of physical therapy in the home (exercise group, n = 116) compared with the usual care and an equal number of social visits (control...
There are conflicting reports about the effects of angiotensin converting enzyme inhibitors on insulin sensitivity and glycaemic control. In addition, the chronic effects of ACEI on insulin sensitivity in normotensive but insulin resistant individuals have been controversial.
To determine the long-term effects of low-dose captopril or enalapril on...
Objectives:
This study sought to compare the clinical features and outcome of a first myocardial infarction with onset of symptoms during or within 30 min of exercise, at rest and in bed.
Background:
It is not known whether activity at onset influences outcome of acute myocardial infarction.
Methods:
Information collected using a standard ques...
To determine the current prevalence of hyperuricaemia and gout in New Zealand Maori and Europeans for comparison with previous studies.
342 Maori and 315 European men and women aged 15 years and older were studied by personal interview and a musculoskeletal system examination. The 1977 ARA criteria for gout in a survey setting were used and serum u...
The object of the study was to determine whether the increased mortality associated with low blood pressure in elderly people
arises because of the adverse effects of hypotension or because of confounding variables. A community sample of 782 people
aged 70 years and older was followed for 3 years. Blood pressure measurements were taken on initial a...
There are conflicting reports about the effects of ACE inhibitors (ACEI) on insulin sensitivity and glycaemic control. Most studies have used a standard high dose of an ACEI but there have been no studies reported to establish whether any changes in glycaemic control or insulin sensitivity associated with ACEI are dose-related.
To examine the effec...
Falls are not a mundane and inevitable consequence of ageing, but are a serious threat to the health and the independence of many older people. There is now very good evidence that the risk of falls can be significantly lowered by careful clinical evaluation and institution of a physical retraining programme.
Peroxidation of low density lipoproteins (LDL) may be involved in the development of atherosclerosis which is prevalent in patients with chronic renal failure and renal transplant recipients. We determined the copper ion catalyzed oxidation in vitro, vitamin E content, and chemical and fatty acid composition of LDL isolated from 38 patients with re...
In a cross-sectional study of a total population aged 70 years and over in a rural New Zealand township (sample size 682)
we investigated factors which characterize those who felt they had a great deal of control and those who felt they had little
or no control over future health. In a significant logistic regression model those with a feeling of a...
Plasma lathosterol concentration which is an index of cholesterol synthesis rate was measured in 36 patients with chronic renal failure (CRF) including 13 who were dialysis independent, 12 receiving hemodialysis and 11 on continuous ambulatory peritoneal dialysis (CAPD), 17 renal transplant recipients and 27 healthy control subjects. Concentrations...
The aim of the study was to compare red blood cell (RBC) fatty acid composition, plasma lipids and lipoproteins and dietary intake between urban and rural Melanesian Fijians.
A cross-sectional study was performed in a random subsample (n = 154) from a total survey population of 589 subjects.
Melanesian Fijians living in the relatively urban settlem...
Accumulation and distribution of cell cholesterol in plasma lipoproteins of incubated blood was examined in 36 patients with chronic renal failure including 13 who were dialysis-independent, 12 on haemodialysis, and 11 on continuous ambulatory peritoneal dialysis (CAPD), 17 renal transplant recipients, and 8 healthy controls. In addition, transport...
Recent studies have confirmed that vigorous exercise can trigger myocardial infarction (MI), but it is not clear whether outcome is influenced by the activity at the onset of symptoms. This study compares clinical features and in hospital mortality for patients (pts) whose symptoms of MI began at rest, in bed, or during or after exercise.A standard...
Plasma newly-synthesized cholesteryl ester transfer (NCET) rate and concentrations of lipids, lipoproteins and apolipoproteins A1 and B were measured in chronic renal failure patients (dialysis independent and dialysis dependent), patients with a functioning renal transplant and in healthy control subjects with comparable ages and plasma triglyceri...
The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability...
Low blood pressure has been associated with increased mortality in older people, but it is unclear whether the hypotension is a risk in its own right or just a marker of disease. In this study we investigated the extent to which those in the lowest decile of systolic and diastolic pressures could be predicted by measures of cardiovascular disease a...
A community-based sample of people > or = 70 years from Mosgiel, New Zealand, was investigated to determine the relation of age, diet, exercise, drugs, and anthropometric measurements with glucose and insulin. From an initial sample of 856 subjects on August 1, 1988, 782 (91.4%) completed the questionnaires and physical examination. Glucose was est...
To determine factors that characterize those 80 years and over free of clinical coronary heart disease (CHD).
Cross-sectional intergroup comparison.
Rural New Zealand town.
All those 70 years and over registered with the sole health center. Seven hundred eighty-two subjects were seen, a 91.4% response rate. Subjects were divided by World Health Org...
Plasma cholesteryl ester transfer protein (CETP) activity and distribution of red blood cell (RBC) cholesterol among plasma lipoproteins during incubation of blood were determined in 14 distance runners and 10 sedentary men. Mean plasma CETP activity was similar in the runners (31% 10 microliters-1 18 h-1) and the sedentary men (32% 10 microliters-...
Plasma plant sterol concentrations (an index of cholesterol absorption efficiency) and plasma lathosterol concentration (an index of cholesterol synthesis rate) were measured in 52 patients with non-insulin dependent diabetes mellitus (NIDDM) and 36 non-diabetic controls. Plasma plant sterol concentrations were significantly (P less than 0.01) lowe...
Faecal steroid excretion, including betasitosterol excretion, whole-body cholesterol synthesis, plasma lipids, and lipoprotein concentrations and habitual diet, were determined in 14 male distance runners and 14 sedentary men. The proportion of cholesterol-derived steroids excreted as bile acids, and the quantity of betasitosterol excreted in the f...
Fecal bile acid concentration, fecal characteristics, bowel habits and habitual food intake were measured in male distance runners (n = 14) and sedentary men (n = 14). Fecal bile acid concentration was significantly (p less than 0.05) lower and stool weight, frequency of defecation and daily intake of fibre, carbohydrate, and protein were significa...
Plasma lathosterol concentration is taken to be an index of the rate of cholesterol synthesis and plasma concentrations of plant sterols just as campesterol and betasitosterol are taken to be indeces of cholesterol absorption efficiency. These noncholesterol sterols were measured in plasma from 14 male distance runners and 10 sedentary men. Plasma...
Abstract In order to study the effects of eicosapentaenoic acid (Maxepa®), Maxepa® placebo and aspirin/dipyridamole combination on the clinical course and restenosis rate of atherosclerotic lesions after percutaneous transluminal coronary angioplasty 79 men and 29 women were randomly divided into three treatment groups and restudied angiographicall...
This study describes the efficacy of the drug simvastatin. It is likely to be the first HMG CoA reductase inhibitor in Australia and New Zealand available for the treatment of hyperlipidemia.
Twenty-four patients, 12 men and 12 women with primary hypercholesterolemia were randomly allocated to treatment by cholestyramine (eight patients) or to simv...