BackgroundPromoting physical activity (PA) in patients during and/or after an inpatient stay appears important but challenging. Interventions using activity trackers seem promising to increase PA and enhance recovery of physical functioning.ObjectiveTo review the effectiveness of physical activity interventions using activity trackers on improving PA and physical functioning, compared to usual care in patients during and/or after inpatient care. In addition, it was determined whether the following intervention characteristics increase the effectiveness of these interventions: the number of behaviour change techniques (BCTs) used, the use of a theoretical model or the addition of coaching by a health professional.DesignSystematic review and meta-analysis.Data SourcesPubMed, EMBASE, Cinahl, SportDiscus and Web of Science databases were searched in March 2020 and updated in March 2021.Eligibility criteria for selecting studiesRandomized controlled trials (RCTs) including interventions using activity trackers and feedback on PA in adult patients during, or less than 3 months after, hospitalization or inpatient rehabilitation.MethodsFollowing database search and title and abstract screening, articles were screened on full text for eligibility and then assessed for risk of bias by using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses, including subgroup analysis on intervention characteristics, were conducted for the outcomes PA and physical functioning.ResultsOverall, 21 RCTs totalling 2355 patients were included. The trials covered a variety of clinical areas. There was considerable heterogeneity between studies. For the 13 studies that measured PA as an outcome variable(N = 1435), a significant small positive effect in favour of the intervention was found (standardized mean difference (SMD) = 0.34; 95%CI 0.12–0.56). For the 13 studies that measured physical functioning as an outcome variable (N = 1415) no significant effect was found (SMD = 0.09; 95%CI -0.02 - 0.19). Effectiveness on PA seems to improve by providing the intervention both during and after the inpatient period and by using a theoretical model, multiple BCTs and coaching by a health professional.ConclusionInterventions using activity trackers during and/or after inpatient care can be effective in increasing the level of PA. However, these improvements did not necessarily translate into improvements in physical functioning. Several intervention characteristics were found to increase the effectiveness of PA interventions.Trial registrationRegistered in PROSPERO (CRD42020175977) on March 23th, 2020.
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OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy.METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed.CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
OBJECTIVE: In this pilot study, we investigated the feasibility of a home-based, remotely guided exercise intervention for patients with gliomas.DESIGN: Pilot randomized controlled trial (RCT) with randomization (2:1) to exercise or control group.SUBJECTS: Patients with stable grade II and III gliomas.INTERVENTION: The six-month intervention included three home-based exercise sessions per week at 60%-85% of maximum heart rate. Participants wore heart rate monitors connected to an online platform to record activities that were monitored weekly by the physiotherapist.MAIN MEASURES: Accrual, attrition, adherence, safety, satisfaction, patient-reported physical activity, VO2 peak (by maximal cardiopulmonary exercise testing) and body mass index (BMI) at baseline and at six-month follow-up.RESULTS: In all, 34 of 136 eligible patients (25%) were randomized to exercise training ( N = 23) or the control group ( N = 11), of whom 19 and 9, respectively, underwent follow-up. Mean adherence to prescribed sessions was 79%. Patients' experiences were positive. There were no adverse events. Compared to the control group, the exercise group showed larger improvements in absolute VO2 peak (+158.9 mL/min; 95% CI: -44.8 to 362.5) and BMI (-0.3 kg/m²; 95% CI: -0.9 to 0.2). The median increase in physical activity was 1489 metabolic equivalent of task (MET) minutes higher in the exercise group. The most reported reasons for non-participation were lack of motivation or time.CONCLUSION: This innovative and intensive home-based exercise intervention was feasible in a small subset of patients with stable gliomas who were interested in exercising. The observed effects suggest that the programme may improve cardiorespiratory fitness. These results support the need for large-scale trials of exercise interventions in brain tumour patients.
Aanleiding Onderzoek wijst uit dat de leesvaardigheid van zowel vmbo- als hbo-studenten te wensen over laat; studerend lezen gaat ze niet goed af. Zowel hbo- als vmbo-studenten blijken vaak onvoldoende in staat om op een bevredigende manier kennis te verwerven uit studieteksten. Samenvattend is de vraag vanuit de onderwijspraktijk: 1) Op welke wijze kunnen vmbo-leerlingen en hbo-studenten binnenschools leren om informatie uit teksten te gebruiken voor (studeertaken gericht op) kennisverwerving? 2) In hoeverre kan men bij het uitvoeren van lees-studeertaken in groepjes gebruikmaken van ICT? Doelstelling Doel van het project is de ontwikkeling van een nieuwe leeromgeving voor studerend lezen in het vmbo en hbo, en het bepalen van de effectiviteit daarvan. Het onderzoek bestaat uit 2 delen. 1) Ontwikkelonderzoek. Het onderzoeksteam optimaliseert de leeromgeving in samenwerking met lerarenopleiders en vmbo-leerkrachten en de ICT-ondersteuning wordt afgestemd op de praktijk van het zaakvakonderwijs. 2) Effectonderzoek. Er worden twee 'randomized controlled trials' uitgevoerd (een in het vmbo en een in het hbo) om te toetsen welke effecten de nieuwe leeromgeving heeft op de vaardigheid 'studerend lezen' van leerlingen en studenten. Voorafgaand aan de experimenten maken de leerlingen/studenten voortoetsen om hun woordenschat en studerend lezen in kaart te brengen. De resultaten worden ingezet als co-variaten. Beoogde resultaten Het project resulteert in: 1) meer aandacht voor ondersteuning bij het lezen van teksten in vakonderwijs; 2) de ontwikkeling van een nieuwe leeromgeving voor studerend; 3) vergroting van de leesvaardigheden van vmbo-leerlingen/hbo-studenten. Het consortium zal de gegenereerde kennis over didactiek voor studerend lezen en de rol van de ICT-ondersteunde leeromgeving daarin verspreiden via wetenschappelijke artikelen en een proefschrift, presentaties op onderwijsconferenties en publicaties in landelijke vaktijdschriften voor het vmbo en hbo. De ontwikkelde didactiek wordt door Hogeschool Rotterdam geïntegreerd in het curriculum van de lerarenopleiding en wordt verspreid binnen de hogeschool, de consortiumscholen en de scholen van het Rotterdamse schoolbestuur BOOR. Ook Stichting Lezen, een intermediair tussen wetenschap en beroepspraktijk, gaat kennis over de didactiek verspreiden. Uitgeverij ThiemeMeulenhoff helpt de didactiek en leeromgeving beschikbaar te maken voor het onderwijsveld.
