Achtergrond: De Two-Minute Step Test (TMST) is een meetinstrument gericht op het beoordelen van uithoudingsvermogen. Verscheidene psychometrische eigenschappen van de TMST-NL (Nederlands vertaalde versie) zijn onderzocht bij intramuraal wonende ouderen. De gevoeligheid voor verandering en de responsiviteit is bij deze patiëntenpopulatie nog niet vastgesteld. Doel: Het vaststellen van de gevoeligheid voor verandering en de responsiviteit (Minimal Clinical Important Difference) van de TMST-NL bij intramuraal wonende ouderen. Design: Prospectief responsiviteitsonderzoek.Methode: De onderzoekspopulatie bestond uit intramuraal wonende ouderen. Deelnemers hebben twee meetmomenten (T0 en T1) ondergaan waartussen ze drie maanden fysiotherapie gericht op uithoudingsvermogen ontvingen. Om de gevoeligheid van verandering te meten werd de distributie methode gebruikt waarbij de correlatie met de 6-minuten wandeltest (6MWT) werd getoetst. Via de anker methode met de Receiver Operating Characteristic (ROC) curve werd de MCID bepaald.Metingen voor het aerobe uithoudingsvermogen werden verricht met de TMST-NL en de 6-minuten wandeltest (6MWT). De Global Rating of Change (GRC) en de Borg Category-Ratio10 (BORG-CR10) werden gebruikt als subjectieve vragenlijsten om verandering van de gezondheidssituatie en vermoeidheid te meten.Resultaten: Intramurale ouderen (N=50) met een gemiddelde (SD) leeftijd van 83,96 jaar (6,96) zijn geïncludeerd. De correlatie tussen de verschilscores van de TMST-NL en de 6MWT over de deelnemerspopulatie die T1 ook hebben afgerond (N= 36) kwam uit op r=0.51 (P <0.05). Vanuit de ROC curve werd een MCID van 8,50 stappen berekend. De AUC-waarde was 0,74 (95% CI 0,54-0,94; P =0.02). Conclusie: De TMST-NL is gevoelig voor verandering en responsief bij intramuraal wonende ouderen. Echter doordat de MCID binnen de minimale meetfout (MDC) valt moeten de resultaten voor individuele evaluatie bij deze doelgroep met voorzichtigheid worden geïnterpreteerd.
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Background: An estimated 18 million people in the world have to cope with a decline in intellectual functioning that is not a normal part of the ageing process, called dementia. By 2025, this number is expected to reach 34 million. Alzheimer's disease accounts for 50-70 % of all cases of dementia. In the Netherlands, about two thirds of those affected live at home, with or without a partner. The increasing group of older adults with dementia presents great challenges in terms of creating suitable living environments and appropriate housing. Extramural housing needs further development, as opposed to intramural housing, such as nursery homes. The new extramural housing forms account for and compensate decreasing vitality and overall health status through the use of ICT and other technologies to serve human well-being. This should facilitate both residents and alleviate the intensity of care given by voluntary and professional care givers. In order to create these optimal dwellings at cost effective prices, evidence-based introduction of architectural measures and technological applications is essential. Existing knowledge is best viewed as an effort to expand and stimulate thinking on the relationships between dementia and design; thus, knowledge is largely a collection of hypotheses amenable to, and requiring, implementation and validation.This PhD-project will research some of the design aspects and needs, relevant to the technological home environment for older adults with dementia. This PhD project is shared with Hogeschool Utrecht, Lectureship of Demand Driven Care. Aim of research: Assessing thermal, lighting, and acoustic requirements, feasible home modifications and teleservices to sustain independence and well-being, both being the end product of all services rendered. Results so far indicate that requirements of older adults with dementia differ largely from the requirements of healthy older adults.
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The 'implementation' and use of smart home technology to lengthen independent living of non-instutionalized elderly have not always been flawless. The purpose of this study is to show that problems with smart home technology can be partially ascribed to differences in perception of the stakeholders involved. The perceptual worlds of caregivers, care receivers, and designers vary due to differences in background and experiences. To decrease the perceptual differences between the stakeholders, we propose an analysis of the expected and experienced effects of smart home technology for each group. For designers the effects will involve effective goals, caregivers are mainly interested in effects on workload and quality of care, while care receivers are influenced by usability effects. Making each stakeholder aware of the experienced and expected effects of the other stakeholders may broaden their perspectives and may lead to more successful implementations of smart home technology, and technology in general.
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