BACKGROUND: Combining increased dietary protein intake and resistance exercise training for elderly people is a promising strategy to prevent or counteract the loss of muscle mass and decrease the risk of disabilities. Using findings from controlled interventions in a real-life setting requires adaptations to the intervention and working procedures of healthcare professionals (HCPs). The aim of this study is to adapt an efficacious intervention for elderly people to a real-life setting (phase one) and test the feasibility and potential impact of this prototype intervention in practice in a pilot study (phase two).METHODS: The Intervention Mapping approach was used to guide the adaptation in phase one. Qualitative data were collected from the original researchers, target group, and HCPs, and information was used to decide whether and how specified intervention elements needed to be adapted. In phase two, a one-group pre-test post-test pilot study was conducted (n = 25 community-dwelling elderly), to elicit further improvements to the prototype intervention. The evaluation included participant questionnaires and measurements at baseline (T0) and follow-up (T1), registration forms, interviews, and focus group discussions (T1). Qualitative data for both phases were analysed using an inductive approach. Outcome measures included physical functioning, strength, body composition, and dietary intake. Change in outcomes was assessed using Wilcoxon signed-rank tests.RESULTS: The most important adaptations to the original intervention were the design of HCP training and extending the original protein supplementation with a broader nutrition programme aimed at increasing protein intake, facilitated by a dietician. Although the prototype intervention was appreciated by participants and professionals, and perceived applicable for implementation, the pilot study process evaluation resulted in further adaptations, mostly concerning recruitment, training session guidance, and the nutrition programme. Pilot study outcome measures showed significant improvements in muscle strength and functioning, but no change in lean body mass.CONCLUSION: The combined nutrition and exercise intervention was successfully adapted to the real-life setting and seems to have included the most important effective intervention elements. After adaptation of the intervention using insights from the pilot study, a larger, controlled trial should be conducted to assess cost-effectiveness.TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov NL51834.081.14 (April 22, 2015).
Surgery is aimed at improving a patient's health. However, surgery is plagued with a risk of negative consequences, such as perioperative complications and prolonged hospitalization. Also, achieving preoperative levels of physical functionality may be delayed. Above all, the "waiting" period before the operation and the period of hospitalisation endanger the state of health, especially in frail patients.The Better in Better out™ (BiBo™) strategy is aimed at reducing the risk of a complicated postoperative course through the optimisation and professionalisation of perioperative treatment strategies in a physiotherapy activating context. BiBo™ includes four steps towards optimising personalised health care in patients scheduled for elective surgery: 1) preoperative risk assessment, 2) preoperative patient education, 3) preoperative exercise therapy for high-risk patients (prehabilitation) and 4) postoperative mobilisation and functional exercise therapy.Preoperative screening is aimed at identifying frail, high-risk patients at an early stage, and advising these high-risk patients to participate in outpatient exercise training (prehabilitation) as soon as possible. By improving preoperative physical fitness, a patient is able to better withstand the impact of major surgery and this will lead to both a reduced risk of negative side effects and better short-term outcomes as a result. Besides prehabilitation, treatment culture and infrastructure should be inherently changing in such a way that patients stay as active as they can, socially, mentally and physically after discharge.
Background Fall prevention programs have been proven effective in reducing falls and fall-related injuries in specific target groups and settings. However, implementing these programs on a larger scale often requires adjustments for feasibility. This study assessed the effectiveness of a nationally implemented fall prevention intervention compared to usual care in community-dwelling older adults. Methods This single-blinded, multicentre randomized controlled trial included 264 community-dwelling non- and pre-frail adults, aged 65 years or older with an increased fall risk. The intervention group participated in the In Balance intervention and the control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months. Secondary outcomes included the Timed Up and Go and Four Stage Balance Test, and the 36-Item Short Form Health Survey. We imputed missing data by multiple imputation, and analysed outcomes using generalized linear- and linear mixed-effects models. Analyses were done for the total group and stratified for frailty status. Results The mean number of falls per person over 12 months was not statistically different between the intervention and control group (respectively 1.67 (SE 0.24) and 1.98 (0.37); incidence rate ratio 0.85 (95% CI 0.51-1.43)), nor the mean number of fall-related injuries (respectively 0.70 (SE 0.11) and 0.97 (0.18); incidence rate ratio 0.73 (95% CI 0.44-1.19)). Secondary outcomes also showed no significant differences between group, frailty status and over time. Conclusions Although the number of falls and fall-related injuries was lower among In Balance participants, and balance, mobility, physical function, and emotional well-being improved, these differences were not statistically significant. Impact statement The implemented In Balance program appears to be less effective than a priori assumed, possibly due to insufficient adherence to the program in practice.
De zorgvraag neemt toe door de vergrijzing, wat leidt tot een toename van aandoeningen zoals mensen met Parkinson of beroertes. Dit resulteert in een grotere behoefte aan zorg terwijl het aantal zorgmedewerkers afneemt. Veel ouderen belanden in een intensief revalidatietraject waarin zij vaak onder begeleiding van fysiotherapeuten motorische vaardigheden opnieuw moeten aanleren. Om de gewenste trainingsintensiteit te bereiken voor optimaal herstel worden patiënten aangemoedigd om thuis zelfstandig te oefenen, maar dit gebeurt vaak niet voldoende. Laagdrempelige technologieën, zoals Augmented Reality (AR), integreren digitale beelden in de echte wereld, waarmee interactieve spelvormen kunnen worden ontwikkeld. Door middel van deze spelvormen kunnen patiënten loop- en balansvaardigheden trainen, wat patiënten stimuleert en motiveert om meer te oefenen. De applicatie RealityDTx, ontwikkeld door Strolll, stelt gebruikers in staat om gestandaardiseerde klinische testen op een leuke manier af te nemen. Zo kun je bijvoorbeeld digitaal een basketbal projecteren en proberen zo vaak mogelijk te scoren als variant op de Timed Up & Go test (TUG). Deze spellen kunnen zowel in de kliniek als thuis worden gebruikt op een tijd en plaats die hen uitkomt, waardoor de voortgang van patiënten gemonitord kan worden op afstand. Bovendien kunnen interactieve spellen het oefenen leuker maken, wat kan leiden tot een hogere therapietrouw. Door met deze AR-brillen op een doelgroep-specifiek sportief evenement te staan krijgen mensen op een aantrekkelijke manier de mogelijkheid om kennis te maken met wetenschappelijk onderzoek en een nieuwe ontwikkeling op het gebied zorgtechnologie. Het doel van de testcase is om eerste indrukken te verkrijgen van de validiteit, betrouwbaarheid en hanteerbaarheid van Reality DTx, waarmee de fysieke prestatie zowel gemeten (afname klinische testen) als geoefend (gang- en balans spellen) kan worden.
