Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Background: Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods: We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff (n = 23) and program trainers (n=4). Results: The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions: The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment.
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For creating sports innovations we need tools to collect data on physical activity behaviour. Collecting data is time-consuming and expensive. Therefore, sharing data and using it to answer multiple research questions is desirable. Especially in larger multidisciplinary research projects, it is beneficial if a diverse data set can be collected effortlessly. For this, we created a smartphone app that can be used for scientific data collection on physical activity behavior in sport research.The requirement for the app was that the different research partners could contribute, use the app independently and that the individual contributions could be easily combined into a larger app. We created a base app which provides a framework for easy implementation of custom modules. Each functionality in the app is represented in a module and can be created by different parties. The app uses the EventBus framework [1] to allow easy communication between independent modules including an independent GUI. In our presentation we will further explain this independance using the beacon physical activity app BAMBEA [4] .Over the span of three years we made a sensor collection-, emotion input-, beacon scanner-, beacon handler-, goal-, reward- and message/notification-module. We combined different modules into different versions. A first version initially focused on running behaviour and used a movement- and a heart rate-module that were originally created for research [2] and different modules of partners (like gait step frequency and emotion detection). The app was extended with a GUI to test the user experience of the modules [3]. Finally, the framework was updated and combined different modules and a new GUI for a bootcamp app [4]. In conclusion we experienced the modular framework as a good solution for reuse and collaboration within multidisciplinary research projects. By allowing for the independent development of modules only intense communication between partners was needed when conflicts occurred between modules. Another advantage was that partners could develop their module in their desired programming language and later integrate their module in the app by providing a small wrapper. We consider the framework approach as a success for projects where close collaboration is desired with a multidisciplinary team. However, we would not advise this approach when it can be expected that multiple heavy performance solutions are required and resources like data collection, storage and backup cannot be shared. In that case a tight integration and continuous collaborative implementation is likely a preferred approach.This research is made possible by the Amsterdam University of Applied Sciences research programs Urban Vitality, Amsterdam Creative Industries Network, the Amsterdam Institute of Sport Sciences (AISS) and by the Dutch National program COMMIT/.
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After the violent disintegration of Yugoslavia, a flourishing cultural scene was established in Croatia’s capital Zagreb. The scene calls itself: independent culture. In this book, Sepp Eckenhaussen explores the history of Zagreb’s independent culture through three questions: How were independent cultures born? To whom do they belong? And what is the independence in independent culture? The result is a genealogy, a personal travel log, a mapping of cores of criticality, a search for futurologies, and a theory of the scene.Once again, it turns out that localist perspectives have become urgent to culture. The untranslatability of the local term ‘independent culture’ makes it hard for the outsider to get a thorough understanding of it. But it also makes the term into a crystal of significance and a catalyst of meaning-making towards a theory of independent culture.
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Expectations are high with regards to smart home technology. In particular, smart home technology is expected to support or enable independent living by older adults. This raises the question: can smart home technology contribute to independent living, according to older adults themselves? This chapter aims to answer this question by reviewing and discussing older adults’ perspectives on independence and their views on smart home technology. Firstly, older adults’ opinions on independence and aging in place are discussed. Secondly, this chapter will review to what extent smart home technology can support older adults’ independence. Thirdly, it will be explained how community-dwelling older adults’ concept of independence entails three distinct types or modes, and how these modes are related to their perceptions and acceptance of technology. In the last section of this chapter, an overview of key points is presented, and recommendations for technology designers, policy makers, and care providers are postulated.
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The purpose of the design-based research reported here is to show – as a proof of principle – how the idea of scaffolding can be used to support primary teachers in a professional development programme (PDP) to design and enact language-oriented science lessons. The PDP consisted of six sessions of 2.5 h each in which twelve primary school teachers took part over a period of six months. It centralised the language support that pupils need to reason during science lessons. In line with the idea of scaffolding, the structure of the PDP targeted teachers' gradual independence in designing lessons. The first research question is how scaffolding was enacted during the PDP. The analysis of video recordings, field notes, researcher and teacher logs, and teacher design assignments focused on the enactment of three scaffolding characteristics: diagnosis, responsiveness and handover to independence. The second research question concerns what teachers learned from the participation in the PDP that followed a scaffolding approach. The data analysis illustrates that these teachers had learned much in terms of designing and enacting language-oriented science lessons. In terms of diagnosis and responsiveness, our PDP approach was successful, but we problematise the ideal of scaffolding approaches focused on handover to independence.
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High Performance Organization (HPO) characteristics indicate why an organization is able to achieve significantly better results than other organizations and these characteristics can facilitate associations to optimize employees’ work outcomes. The independent professional (IP) is an increasingly occurring phenomenon in the labor market that fulfils an organizations’ need for flexibility in knowledge productivity. This study focuses on the contribution of HPO characteristics to the knowledge productivity of IP's. It was conducted among managers and HRM professionals in various Dutch knowledge-intensive organizations that frequently enlist the services of IPs. This study found a number of HPO attributes that appeared to contribute to the IPs' knowledge productivity, namely the quality of management, an open and actionfocused organizational culture, and continual improvement and innovation. We will use these results to look ahead and consider the future consequences for professional practice. Managers and HRM professionals should strive to contribute to the incorporation of these characteristics within the organization in order to safeguard and enhance knowledge productivity of independent professionals.
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Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.
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Ageing potentially poses a threat to independent functioning of older adults. Although clinicians commonly focus on physical factors limiting Functional Independence (FI), it is likely that personal and environmental interactions also seem important to maintain FI. Herewith, FI exceeds several professional borders and calls for a uniform, multidisciplinary interdisciplinary supported definition of FI. This study aims to provide such a definition of FI in community dwelling older people. A scoping review was performed. Pubmed/Medline, Psychinfo and CINAHL were searched for studies describing aspects of FI. A literature-based definition of FI was discussed by experts (n = 7), resulting in a formulated final definition of FI and insight into contributing factors to FI. A multidisciplinairy focusgroup a stakeholder consultation (n = 15) ensured clinical relevance for daily practice. Data from the focusgroup stakeholder consultation were analyzed by using Atlas.ti (version 8). Based on the literature search, 25 studies were included. FI was finally defined as “Functioning physically safely and independent from another person, within one’s own context”. The contributing factors of FI comprised physical capacity combined with coping, empowerment and health literacy. Moreover, the level of FI is influenced by someone’s own context. This study confirms the relevance of the physical aspect of FI, but additionally stresses the importance of psychological factors. In addition, this study shows that one’s context may affect the level of FI as well. This underlines the importance of a holistic view and calls for multidisciplinary interdisciplinary collaboration in community-dwelling older people.
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The aging population presents challenges for healthcare, particularly in maintaining the functional independence of older adults. The Decision Support Tool for Functional Independence was developed to identify declines in functional independence and promote collaboration between healthcare professionals. The DST-FI is specifically designed to support interprofessional collaboration between medical and social care providers, such as GPs, physiotherapists, nurses, and social workers. This study examines the barriers and facilitators to implementing the tool in primary care.
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