Aging is associated with a decline in the ability to carry out daily tasks. Physical activity can delay or diminish the decline and increase the ability of older adults to live independently at home. Performing home-based exercises can help older adults achieve the recommended levels of physical activity. Technology allows exercise programs to be tailored to individual needs. This thesis describes a blended intervention that was developed and evaluated according to the Medical Research Council framework. The principal findings are that older adults are motivated to perform technology-supported home-based exercises if they help them maintain self-reliance and there is sufficient guidance, safety is taken into account, and adherence is stimulated. To meet those conditions, a blended intervention was developed that was based on functional exercises, behavior change theory and human guidance. A custom-made tablet application appears to be usable by the target audience. A process evaluation has shown that the tablet as well as the coach support older adults in the various phases of self-regulating their exercise behavior. The blended intervention stimulates intrinsic motivation by supporting the autonomy of participants, fostering competence and, for some, meeting the need for relatedness by offering emotional support. Data derived from the tablet demonstrate that older adults participating in the intervention exhibit exercise behavior that is in line with WHO guidelines and that engagement with the tablet was a contributing factor. Future work should include assessment of intervention fidelity and explore which aspects of coaching can and cannot be further automated.
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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.
BackgroundThere is a shift from inpatient to home-based geriatric rehabilitation (HBGR), and potential benefits are demonstrated. Previously, a theoretical HBGR model, version 1.0, has been developed, outlining its essential components. However, clear guidance on the practical design and organisation of HBGR in everyday practice is still lacking. Therefore, determining the optimal design for this complex intervention is essential for its successful implementation in daily practice. The objective of this study is to redesign the theoretical HBGR trajectory and assess its feasibility, acceptability, and usability from both patient and professional perspectives.MethodsA redesign and feasibility study based on the MRC framework was conducted in a Dutch skilled nursing facility using the MRC framework in co-creation with eleven healthcare professionals and four patient representatives. The HBGR trajectory 1.0, comprises four building blocks (structure, process, environment, and outcomes) based on the Post-Acute-Care rehabilitation quality framework. Version 1.0 was redesigned during the development phase and subsequently pilot-tested in daily practice during the feasibility phase. Adjustments were made based on semi-structured interviews with ten patients and (interim) evaluations.ResultsThe HBGR trajectory 1.0 has been redesigned into version 2.0. It contains eleven elements: individualised goal setting, providing HBGR is the default unless otherwise indicated, an information letter, blended eHealth, mapping the patient’s living environment, stimulation support from informal caregivers, collaboration with community care nursing, rehabilitation coordination, central planning, therapy at home, and online multidisciplinary evaluation. Version 2.0 was enthusiastically endorsed by patients, patient representatives, and professionals, who found it feasible, acceptable, and usable in daily practice.ConclusionThe HBGR trajectory 1.0 was adapted, tested, and finally redesigned into version 2.0. The study revealed that involving patients, their representatives, and healthcare professionals was critical to garnering support and facilitating implementation. Key developments align with global trends and include the successful integration of eHealth with traditional treatment methods, enhanced collaboration and knowledge sharing among community care nurses, and increased involvement of informal caregivers in rehabilitation. This redesigned HBGR trajectory is ready for evaluation and implementation in follow-up effectiveness research.
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