Korte beschouwing over de toerusting van sociaal werkers die te maken krijgen met morele dilemma's in de beroepspraktijk.
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OBJECTIVE: This scoping review aimed to gather current knowledge on accurately identifying and distinguishing between non-frail, pre-frail, and frail older adults using gait and daily physical activity (DPA) parameters and/or models that combine gait with DPA parameters in both controlled and daily life environments.METHODS: Following PRISMA-ScR guidelines, a systematic search was conducted across seven databases using key terms: "frail", "gait or walk", "IMU", and "age". Studies were included if they focused on gait analysis using Inertial Measurement Units (IMUs) for walking distances greater than 10 meters. Extracted data included study design, gait and DPA outcomes, walking conditions, and classification model performance. Gait parameters were grouped into four domains: spatio-temporal, frequency, amplitude, and dynamic gait. DPA parameters were synthesized into three categories: postural and transition, variability, and physical activity pattern.RESULTS: A total of 15 cross-sectional studies involving 2,366 participants met the inclusion criteria. Gait analysis showed (pre)frail individuals had slower, shorter steps with longer stride times compared to non-frail individuals. Pre-frail individuals showed distinct gait patterns in periodicity, magnitude range, and variability. In daily activities, (pre)frail individuals displayed shorter, fragmented walking periods and longer transitions between positions. Walking variation identified pre-frail status, showing progressive decreases from non-frail to frail states. Combined gait and daily physical activity models achieved over 97% accuracy, sensitivity and specificity in distinguishing between groups.DISCUSSION: This review provides an updated synthesis of the relationship between various gait and/or DPA parameters and physical frailty, highlighting gaps in pre-frailty detection and the variability in measurement protocols. It underscores the potential of long-term, sensor-based monitoring of daily physical activity for advancing pre-frailty screening and guiding future clinical trials. Structured Abstract BACKGROUND: Changes in gait and physical activity are critical indicators of frailty. With advancements in wearable sensor technology, long-term gait analysis using acceleration data has become more feasible. However, the contribution of parameters beyond gait speed, such as gait dynamics and daily physical activity (DPA), in identifying frail and pre-frail individuals remains unclear.OBJECTIVE: This scoping review aimed to gather knowledge on accurately identifying and differentiating physical pre-frail and frail individuals from non-frail individuals using gait parameters alone or models that combine gait and DPA parameters, both in controlled settings and daily life environments.METHODS: The review followed PRISMA-ScR guidelines. A search strategy incorporating key terms-"frail", "gait or walk", "IMU", and "age"-was applied across seven databases from inception to March 1, 2024. Studies were included if they focused on gait analysis in controlled or daily environments using Inertial Measurement Units (IMUs) and involved walking distances longer than 10 meters. Data on walking conditions, gait outcomes, classification methods, and results were extracted. Gait parameters were categorized into four domains: spatio-temporal, frequency, amplitude, and dynamic gait. DPA parameters were synthesized into three categories: postural and transition, variability, physical activity pattern.RESULTS: A total of 15 cross-sectional observational studies met the eligibility criteria, covering 2,366 participants, with females representing 27%-80% of the sample and ages ranging from 60 to 92 years. Regarding gait parameters, (pre)frail individuals exhibited longer stride times, slower walking speeds, shorter steps, and reduced cadence compared to non-frail individuals. In three studies, pre-frail could be distinguished from the non-frail and frail group through gait periodicity, range of magnitude, and gait variability. DPA patterns differed between groups, with (pre)frail individuals showing shorter and more fragmented walking periods, brief walking bouts and longer postural transitions. Walking bout variation (CoV) effectively identified pre-frail status, decreasing 53.73% from non-frail to pre-frail, and another 30.87% from pre-frail to frail. Models combining both gait and DPA parameters achieved the highest accuracy (97.25%), sensitivity (98.25%), and specificity (98.25%) in distinguishing between groups.DISCUSSION: This scoping review provides an updated overview of the current knowledge and gaps in understanding the relationship between gait parameters across different domains and DPA parameters along with physical frailty. Significant variability in gait measurement methods and protocols complicates direct comparisons between studies. The review emphasizes the need for further research, particularly in pre-frailty screening, and underscores the potential of inertial sensor-based long-term monitoring of daily physical activity for future clinical trials.
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Full text beschikbaar met HU-account. Bespreking van: Barbara van Caem-Posch (2012). Buurtregie met mate. Over spanning tussen nabijheid en distantie in de relatie tussen politie en burgers. De conclusies en aanbevelingen vormen samen een soort ‘cliffhanger’. De lezer vraagt zich af of de verklaring voor de teleurstellende effecten van Amsterdamse buurtregie wellicht ook zijn toe te schrijven aan de weerbarstigheid van het implementeren van community policing in het algemeen. Het was mooi geweest om deze weging van community policing ter afsluiting in het licht van eerdere, empirische bevindingen te plaatsen. Temeer omdat de politiepraktijk blijft hameren op de invoer van community policing, terwijl er in de wetenschap consensus bestaat over de beperkte slagingskans van de implementatie van het concept (p. 24). Door de conclusies in een bredere context te plaatsen hadden wellicht een bredere praktijk en ook de academie nog van een smakelijk toetje kunnen worden voorzien. Want het proefschrift smaakt naar meer. Waar buitenstaanders maar weinig gelegenheid hebben om achter de coulissen van de politiepraktijk te kijken, wijst Van Caem ons in haar proefschrift vakkundig en analytisch de weg. Haar ruime ‘blauwe’ ervaring leidde tot een goed beschreven, academische weging van de Amsterdamse buurtregie op effectiviteit ten aanzien van burgerbetrokkenheid. Het is daarbij bewonderenswaardig hoe zij haar praktische betrokkenheid heeft weten om te zetten in een toegevoegde waarde voor haar academisch speurwerk. Amsterdamse buurtregie blijkt nog fikse moeite te hebben met de beoogde paradigmashift van lawfull policing naar community policing. Maar het resultaat van Van Caems paradigmawisseling naar de wetenschap mag er zijn. Haar proefschrift is voor zowel praktijkmensen als wetenschappers een leerzame studie en een nuttig naslagwerk geworden
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