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: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care.Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty.Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d.Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales "function in sport and recreational activities" and "hip-related quality of life" of HOOS, and on the subscale "physical role limitations" of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes.Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care.Keywords: home-based rehabilitation program; internet; osteoarthritis; physiotherapy; rehabilitation; remote coaching; tablet app; total hip arthroplasty; total hip replacement; usual care.
Purpose: Elucidating the complex interactions between physical activity (PA), a multidimensional concept, and physical capacity (PC) may reveal ways to improve rehabilitation interventions. This cross-sectional study aimed to explore which PA dimensions are related to PC in people after minor stroke. Materials and methods: Community dwelling individuals >6 months after minor stroke were evaluated with a 10-Meter-Walking-Test (10MWT), Timed-Up & Go, and the Mini Balance Evaluation System Test. The following PA outcomes were measured with an Activ8 accelerometer: counts per minute during walking (CPMwalking; a measure of intensity), number of active bouts (frequency), mean length of active bouts (distribution), and percentage of waking hours in upright positions (duration). Multivariable linear regression models, adjusted for age, sex and BMI, were used to assess the relationships between PC and PA outcomes. Results: Sixty-nine participants [62.2 ± 9.8 years, 61% male, 20 months post onset (IQR 13.0–53.5)] were included in the analysis. CPMwalking was significantly associated to PC in the 10MWT (std. ß ¼ 0.409, p ¼ 0.002), whereas other associations between PA and PC were not significant. Conclusions: The PA dimension intensity of walking is significantly associated with PC, and appears to be an important tool for future interventions in rehabilitation after minor stroke
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.
