OBJECTIVES: To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge.DESIGN: Prospective observational cohort study conducted in 2015-2017.SETTING AND PARTICIPANTS: Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals.METHODS: Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index.RESULTS: The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250-1146] at the last day of hospitalization. This increased to 1750 (IQR 675-4114) steps 1 day postdischarge, and to 1997 (IQR 938-4098) steps 7 days postdischarge. Age [β = -57.93; 95% confidence interval (CI) -111.15 to -4.71], physical performance (β = 224.95; 95% CI 117.79-332.11), and steps in hospital (β = 0.76; 95% CI 0.46-1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = -1400; 95% CI -2380 to -420; P = .005).CONCLUSIONS AND IMPLICATIONS: Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3±6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specifcity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62–0.65, 0.59–0.63 and 0.60–0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specifcity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specifcity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specifcity, whereas sensitivity was higher for the GFI and TFI.
Background: Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). Purpose: To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR. Methods: Patients were included 2-3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as 'high levels of kinesiophobia' (HighKin) and ≤ 28 as 'low levels of kinesiophobia' (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis. Results: Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated 'tailored information and support from a health care provider' as most important need after hospital discharge. Conclusion: This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR. Keywords: Acute cardiac hospitalization; Cardiac rehabilitation; Cardiovascular disease; Exercise; Fear of movement; Physical activity.
Voor patiënten met long- of gastro-intestinale kanker die een operatie hebben ondergaan zijn een goed op elkaar afgestemde hoeveelheid lichamelijke activiteit in combinatie met voldoende eiwitinname, na de operatie essentieel voor een goed herstel. Na ontslag uit het ziekenhuis is de inzet van een fysiotherapeut en diëtist die elkaar aanvullen geen vanzelfsprekendheid terwijl zij elkaar juist kunnen versterken. Met het bestaande OPRAH (Optimizing-Physical-Recovery-After-Hospitalization) herstelprogramma ondersteunen fysiotherapeuten en diëtisten patiënten na een operatie met een eHealth applicatie met monitoring en coaching. Omdat de beroepen fysiotherapie en diëtetiek van oudsher hands-on zijn vraagt deze manier van behandelen een transitie in denken en manier van werken. Professionals vinden het moeilijk om de behandeling op elkaar af te stemmen, op afstand te coachen en de technologie van een eHealth applicatie te integreren in de praktijk. Daarnaast is nog niet bekend wat de optimale combinatie van hoeveelheid voeding en beweging is en waarom bepaalde patiënten wel goed op het OPRAH herstelprogramma reageren en andere patiënten niet. De technologie van OPRAH waarbij grote hoeveelheden informatie over voeding en beweging wordt verzameld, biedt de mogelijkheid om met kunstmatige intelligentie nieuwe verbanden te leggen en deze praktijkvragen te beantwoorden maar deze techniek wordt nog niet toegepast. Het doel van deze aanvraag is om de interprofessionele samenwerking tussen fysiotherapeuten en diëtisten bij de behandeling van patiënten met kanker te versterken en het OPRAH herstelprogramma te optimaliseren. In dit project onderzoeken we verbanden tussen veranderingen in voeding en beweging bij patiënten met kanker die een operatie ondergaan, ontwerpen we een infrastructuur voor structurele dataverzameling van voeding en beweging (WP1) en onderzoeken we hoe we de interprofessionele afstemming kunnen versterken (WP1). Op basis van de bevindingen passen we het OPRAH herstelprogramma aan en testen we deze in de praktijk (WP3). WP4 is gericht op doorwerking naar de beroepspraktijk en het onderwijs.
