BackgroundEarly structured mobilization has become a key element of Enhanced Recovery After Surgery programs to improve patient outcomes and decrease length of hospital stay. With the intention to assess and improve early mobilization levels, the 8-point ordinal John Hopkins Highest Level of Mobility (JH-HLM) scale was implemented at two gastrointestinal and oncological surgery wards in the Netherlands. After the implementation, however, healthcare professionals perceived a ceiling effect in assessing mobilization after gastrointestinal and oncological surgery. This study aimed to quantify this perceived ceiling effect, and aimed to determine if extending the JH-HLM scale with four additional response categories into the AMsterdam UMC EXtension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale reduced this ceiling effect.MethodsAll patients who underwent gastrointestinal and oncological surgery and had a mobility score on the first postoperative day before (July–December 2018) or after (July–December 2019) extending the JH-HLM into the AMEXO scale were included. The primary outcome was the before-after difference in the percentage of ceiling effects on the first three postoperative days. Furthermore, the before-after changes and distributions in mobility scores were evaluated. Univariable and multivariable logistic regression analysis were used to assess these differences.Results Overall, 373 patients were included (JH-HLM n = 135; AMEXO n = 238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score before extending the JH-HLM into the AMEXO as compared to 4 (1.7%) patients after (OR = 0.021, CI = 0.007–0.059, p ConclusionsA substantial ceiling effect was present in assessing early mobilization in patients after gastrointestinal and oncological surgery using the JH-HLM. Extending the JH-HLM into the AMEXO scale decreased the ceiling effect significantly, making the tool more appropriate to assess early mobilization and set daily mobilization goals after gastrointestinal and oncological surgery.
MULTIFILE
Self-efficacy and outcome expectations regarding client activation determine professionals’ level of actively engaging clients during daily activities. The Client Activation Self-Efficacy and Outcome Expectation Scales for nurses and domestic support workers (DSWs) were developed to measure these concepts. This study aimed to assess their psychometric properties. Cross-sectional data from a sample of Dutch nurses (n=150) and DSWs (n=155) were analysed. Descriptive statistics were used to examine floor and ceiling effects. Construct validity was assessed by testing research-based hypotheses. Internal consistency was determined with Cronbach’s alpha. The scales for nurses showed a ceiling effect. There were no floor or ceiling effects in the scales for domestic support workers. Three out of five hypotheses could be confirmed (construct validity). For all scales, Cronbach’s alpha coefficients exceeded 0.70. In conclusion, all scales had moderate construct validity and high internal consistency. Further research is needed concerning their construct validity, testretest reliability and sensitivity to change.
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BackgroundCardiac rehabilitation (CR) can reduce mortality and improve physical functioning in older patients, but current programs do not support the needs of older patients with comorbidities or frailty, for example due to transport problems and physical limitations. Home-exercise-based cardiac rehabilitation (HEBCR) programs may better meet these needs, but physiotherapy guidelines for personalising HEBCR for older, frail patients with cardiovascular disease are lacking.PurposeTo provide expert recommendations for physiotherapists on how to administer HEBCR to older adults with comorbidities or frailty.MethodsThis Delphi study involved a panel of Dutch experts in physiotherapy, exercise physiology, and cardiology. Three Delphi rounds were conducted between December 2020 and February 2022. In the first round panellists provided expertise on applicability and adaptability of existing CR-guidelines. In the second round panellists ranked the importance of statements about HEBCR for older adults. In the third round panellists re-ranked statements when individual scores were outside the semi-interquartile range. Consensus was defined as a semi-interquartile range of ≤ 1.0.ResultsOf 20 invited panellists, 11 (55%) participated. Panellists were clinical experts with a median (interquartile range) work experience of 20 (10.5) years. The panel reached a consensus on 89% of statements, identifying key topics such as implementing the patient perspective, assessing comorbidity and frailty barriers to exercise, and focusing on personal goals and preferences.ConclusionThis Delphi study provides recommendations for personalised HEBCR for older, frail patients with cardiovascular disease, which can improve the effectiveness of CR-programs and address the needs of this patient population. Prioritising interventions aimed at enhancing balance, lower extremity strength, and daily activities over interventions targeting exercise capacity may contribute to a more holistic and effective approach, particularly for older adults.
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In het project CW4.0 onderzoeken MKB’ers uit de houtindustrie en Smart Industry samen met de Hogeschool van Amsterdam (HvA), kennispartners TNO, HMC en Bouwlab R&Do en partners in hospitality hoe zinvolle toepassingen te maken van resthout, met behulp van Industry 4.0-principes. Hoogwaardig hout blijft momenteel ongebruikt, omdat het te arbeids-intensief is grote hoeveelheden ongelijkmatige stukken hout van verschillende grootte en houtsoort te verwerken. Waardevol resthout wordt zo waardeloos afval, tegen de principes van de circulaire economie in. CW4.0 richt zich op de ontwikkeling van geautomatiseerde processen voor houtverwerking gebaseerd op Industry 4.0 technologieën - met behulp van digitale ontwerptools en industriële robots. Uit eerdere projecten van HvA en partners is gebleken dat deze processen het gebruik van resthout levensvatbaar kunnen maken, in het bijzonder voor toepassingen in de hospitality sector, bijvoorbeeld voor receptiebalies, hotelmeubilair en interieurdelen. CW4.0 wordt dan ook uitgevoerd in samenwerking met hospitality-ontwerpers en hotelketels. Het onderzoek concentreert zich op 1) het creëren van een digital twin (=digitale kopie van een beoogd object of proces, om dit te onderzoeken zonder het eerst te hoeven bouwen) van een ‘upcycle houtfabriek’; 2) het realiseren en beproeven van secties van de fabriek; 3) het ontwerpen en prototypen van hospitality toepassingen en 4) het evalueren van de business case van deze toepassingen en de fabriek in het algemeen. Na afloop is er kennis beschikbaar voor houtindustrie om afval te verminderen, voor Smart Industry om hun digitale technologieën toe te passen voor upcycling van materialen, en voor horecapartners om waardevolle toepassingen te creëren van resthout. Het project is een belangrijke stap in de opschaling van industriële robotproductie met circulaire materialen. Het legt een nieuwe, belangrijke verbinding tussen Smart Industry en de circulaire transitie, gericht op het aanpakken van urgente maatschappelijke uitdagingen verband houdend met materiële schaarste en de mondiale milieucrisis.
