Powerful Ageing is a power training intervention offered by Dutch municipalities to improve the physical functioning of its older residents, thereby reducing their reliance on assistive living devices and social support services. This study aimed to investigate the effects of Powerful Ageing on muscle power, physical performance, and physical functioning in older adults immediately following the intervention and at 1-year follow-up. The study design was a prospective longitudinal case series. Eligible older adults requesting social support services from their municipality participated in a 14-week power training intervention. Primary outcomes were categorized according to ICF health domains: within the function domain, muscle power was measured with a Power Squat Test and a Lifting Test; within the activities domain, physical performance was assessed using the Star Agility Run and Timed Up-and-Go Test; and within the participation domain, physical functioning was assessed using a patient-specific complaints questionnaire. Participant motivation, a secondary outcome, was assessed using a short questionnaire.
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Previous research shows that power training can increase power output in older adults and may also improve physical performance, physical functioning, and independence. However, power training interventions have not been optimized for older adults. The aim of this study was to assess the feasibility and preliminary effectiveness of a power training program called Powerful Ageing in older adults. A total of 28 older adults participated in a 12-week power training intervention at an intensity of 20-30% 1RM. The primary outcome, feasibility, was assessed through intervention retention, adherence (attendance and compliance), and safety. Secondary outcomes were measured in health domains of the ICF. In the function domain, muscle power and anaerobic power were assessed using a weighted squat and Wingate test, respectively. In the activities domain, physical performance was measured using the 6-minute walk test, and in the participation domain, physical activity in daily life and health status were evaluated using an accelerometer and the SF-36 questionnaire, respectively.
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Studies evaluating the effects of power training in older adults use a variety of measurement tools and outcome parameters, limiting comparability of results and calling the validity of conclusions into question. This study aimed to identify a core outcome set (COS) to measure the effects of power training in older adults, encompassing the function, activities, and participation domain of the International Classification of Functioning, Disease, and Health (ICF). Twenty-one tests were evaluated based on their ability to measure muscle power and the effects of power training. Our methodology consisted of two Delphi survey rounds and an expert panel meeting using modified Nominal Group Technique. The COS consisted of tests considered most feasible for clinical practice and least burdensome for older adults. The COS included the Squat Jump Test (paired with accelerometery-based instrumentation) and the Timed Up-and-Go Test for the function and function and activities domain, respectively. No test was identified for the participation domain, however, experts proposed using daily-life accelerometery until more suitable outcome measures are defined and validated. This study addresses a critical research gap in standardised assessment protocols, and contributes to a multifaceted approach to measuring the impact of power training in older adults.
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The emergence of organic planning practices in the Netherlands introduces new, non-conventional, local actors initiating bottom-up urban developments. Dissatisfied with conventional practices and using opportunities during the 2008 financial crisis, these actors aim to create social value, thus challenging prevailing institutions. Intrigued by such actors becoming more present and influential in urban planning and development processes, we aim to identify who they are. We use social entrepreneurship and niche formation theories to analyse and identify three types of social entrepreneurs. The first are early pioneers, adopting roles of a developer and end-user, but lacking position and power to realize goals. Secondly, by acting as boundary spanners and niche entrepreneurs, they evolve towards consolidated third sector organizations in the position to realize developments. A third type are intermediate agents facilitating developments as boundary spanners and policy entrepreneurs, without pursuing urban development themselves but aiming at realizing broader policy goals. Our general typology provides a rich picture of actors involved in bottom-up urban developments by applying theories from domains of innovation management and business transition management to urban planning and development studies. It shows that the social entrepreneurs in bottom-up urban development can be considered the result of social innovation, but this social innovation is set within a neoliberal context, and in many cases passively or actively conditioned by states and markets.
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Background: Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) – including cognitive/physical exercise applications, activity-tracking, psycho-education – after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. Methods: Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it’s mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n=165 patients) were extracted from the eRehabilitation applications. Results: Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0–7.75] versus 7.0 [6.0–7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0–8.0] versus 5.5 [4.0–7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. Conclusion: Main improvements of the implementation of eRehabilitation are related to professionals’ perceptions of the intervention, integration of eRehabilitation and contextual factors.
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This article analyses four of the most prominent city discourses and introduces the lens of urban vitalism as an overarching interdisciplinary concept of cities as places of transformation and change. We demonstrate the value of using urban vitalism as a lens to conceptualize and critically discuss different notions on smart, inclusive, resilient and sustainable just cities. Urban vitalism offers a process-based lens which enables us to understand cities as places of transformation and change, with people and other living beings at its core. The aim of the article is to explore how the lens of vitalism can help us understand and connect ongoing interdisciplinary academic debates about urban development and vice versa, and how these ongoing debates inform our understanding of urban vitalism.
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Like the professionals, design students tend to avoid the complexity of the user context, and moral issues are largely overlooked. This inspired us to explore whether we could engage design students in thinking about moral issues by exploring different ethical frameworks in their designing. As a case environment we chose smart-grid product service combinations. In this paper we first discuss the ethical frameworks of four selected philosophers’: Plato, Rousseau, Kant, & Mill. Then we will describe the student design process, the resulting four smart grid service concepts and the user insights that came from a user evaluation. We discuss how this approach allowed the students to get insights in their own ethical stance and how they allowed users to reflect on possible futures. We also discuss how these ‘probing’ concepts were used within the larger smart grid project.
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