Objective This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users. Methods Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model. Results Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends. Conclusions Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.
BACKGROUND: The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. The same holds for sensor monitoring-based coaching in addition to OT. Here, we describe the design of a study investigating the effect of sensor monitoring embedded in an OT rehabilitation program on the recovery of ADL among older individuals after hip fracture.METHODS/ DESIGN: Six nursing homes will be randomized in a three-arm stepped wedge cluster randomized trial. All nursing homes will initially provide standard care. At designated time points, nursing homes, successively and in random order, will cross over to the provision of OT and at the next time point, to sensor monitoring-enhanced OT. A total of 288 older individuals, previously living alone in the community, who after a hip fracture were admitted to a geriatric rehabilitation ward for a short-term rehabilitation, will be enrolled. Individuals in the first intervention group (OTc) will participate in an OT rehabilitation program with coaching based on cognitive behavioral therapy (CBT) principles. In the sensor monitoring group, sensor monitoring is added to the OT intervention (OTcsm). Participants will receive a sensor monitoring system consisting of (i) an activity monitor during nursing home stay, (ii) a sensor monitoring system at home and a (iii) a web-based feedback application. These components will be embedded in the OT. The OT consists of a weekly session with an occupational therapist during the nursing home stay followed by four home visits and four telephone consultations. The primary outcome is patient-perceived daily functioning at 6 months, assessed using the Canadian Occupational Performance Measure (COPM).DISCUSSION: As far as we know, this study is the first large-scale stepped wedge trial, studying the effect of sensor monitoring embedded in an OT coaching program. The study will provide new knowledge on the combined intervention of sensor monitoring and coaching in OT as a part of a rehabilitation program to enable older individuals to perform everyday activities and to remain living independently after hip fracture.TRIAL REGISTRATION NUMBER: Netherlands National Trial Register, NTR 5716 Date registered: April 1 2016.
BACKGROUND: To evaluate whether a training programme is a feasible approach to facilitate occupational health professionals' (OHPs) use of knowledge and skills provided by a guideline.METHODS: Feasibility was evaluated by researching three aspects: 'acceptability', 'implementation' and 'limited efficacy'. Statements on acceptability and implementation were rated by OHPs on 10-point visual analogue scales after following the training programme (T2). Answers were analysed using descriptive statistics. Barriers to and facilitators of implementation were explored through open-ended questions at T2, which were qualitatively analysed. Limited efficacy was evaluated by measuring the level of knowledge and skills at baseline (T0), after reading the guideline (T1) and directly after completing the training programme (T2). Increase in knowledge and skills was analysed using a non-paramatric Friedman test and post-hoc Wilcoxon signed rank tests (two-tailed).RESULTS: The 38 OHPs found the training programme acceptable, judging that it was relevant (M: 8, SD: 1), increased their capability (M: 7, SD: 1), adhered to their daily practice (M: 8, SD: 1) and enhanced their guidance and assessment of people with a chronic disease (M: 8, SD: 1). OHPs found that it was feasible to implement the programme on a larger scale (M: 7, SD: 1) but foresaw barriers such as 'time', 'money' and organizational constraints. The reported facilitators were primarily related to the added value of the knowledge and skills to the OHPs' guidance and assessment, and that the programme taught them to apply the evidence in practice. Regarding limited efficacy, a significant increase was seen in OHPs' knowledge and skills over time (X2 (2) = 53.656, p < 0.001), with the median score improving from 6.3 (T0), 8.3 (T1) and 12.3 (T2). Post-hoc tests indicated a significant improvement between T0 and T1 (p < 0.001) and between T1 and T2 (p < 0.001).CONCLUSIONS: The training programme was found to be a feasible approach to facilitate OHPs' use of knowledge and skills provided by the guideline, from the perspective of OHPs generally (acceptability and implementation) and with respect to their increase in knowledge and skills in particular (limited efficacy).
