The interventions were described thoroughly. The control arm represented standard care and enabled appropriate comparisons to be made. Further definition of what was included in standard care would enable better assessment of whether standard care in Finland is generalisable to other settings.
The study methods were well described and appeared appropriate. Exclusion criteria included people living in institutions, deaf persons, blind persons and those who needed aid from others to move, which some may consider to be too restrictive in a population over the age of 75 years. The participates were selected based on their interest and preference for particular activities and the impact of this on the results should not be overlooked. The pragmatic approach to identifying and selecting participants could have potentially introduced an element of bias. However, if introduced into clinical practice it is likely that the same type of participates would elect to participate and therefore the effect seen in this study may be reflective of clinical reality.
The scale used for subjective health appeared to be derived specifically for this study. However, a general instrument of patient quality of life and additional measurements of the Montgomery-Asberg depression scale would have been appropriate. Use of a subjective unvalidated tool increases uncertainty in the findings.
The perspective of costs was not reported but it was apparent that a health services perspective was adopted. Resource use and unit costs were derived appropriately for health expenditures. The total cost of the intervention was reported but was not broken into component parts, which limited any assessment of generalisability and transferability of the intervention costs.
Analysis and results:
On the whole the analysis was well reported. A full economic evaluation (in which the cost of the intervention and comparator were included and an incremental analysis was presented) would have produced more robust results with which to inform decision making and given a better picture of uncertainty surrounding any such decisions to implement the interventions.
The authors conducted a thorough comparison of their study results to those of others and found that their results were in concordance. The authors referenced additional study results reported in other papers for qualitative analysis of participant empowerment and well-being (Savikko 2008) and effects on forming long-standing new friendships (Routasalo et al. 2009). Both of these publications reinforced the findings of this study.
The authors acknowledged some limitations: the study had extremely good adherence (2.5% intervention drop-out), which may not be representative; and the sample size calculations, although the study appeared sufficiently powered for resource use and mortality.
The study was generally well conducted and the authors conclusions appear appropriate. There remains some uncertainty in the cost-effectiveness of the intervention.