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.
Background: Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. Methods: A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. Results: 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. Conclusions: German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. Trial registration: The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).
Purpose The aim of this study was to gain insight into the perspectives of older adults on the quality of geriatric rehabilitation (GR) during the trajectory of GR from admission until six weeks after discharge.Methods We conducted a longitudinal qualitative study. Participants were interviewed three times: at the start of rehabilitation, at discharge, and six weeks after discharge. The data were analysed using a thematic analysis.Results In total, 50 interviews were conducted, with 18 participants being interviewed multiple times. The following themes emerged: 1. A bond of trust with health care professionals (HCPs), 2. Being prepared and informed at all stages of GR, 3. Participants emphasise physical and occupational therapy rather than other aspects of care as comprising GR 4. Changing needs regarding (the extent of) involvement in decision-making, 5. Contact with family and peers.Conclusion For older adults, preparation for and good organisation of rehabilitation and social interaction with HCPs and other older adults were found to be important for the perceived quality of GR. Social interaction is infuenced by how HCPs engage with older adults in all the phases of the rehabilitation process. Older adults have varying preferences about involvement in decision-making during GR. These perspectives should be acknowledged and acted upon in clinical practice to further improve the quality of care in GR.
MULTIFILE
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
Longaandoeningen, zoals COPD, veroorzaken problemen in het dagelijks functioneren door een afgenomen uithoudingsvermogen, benauwdheid en (bewegings-) angst. Tijdens longrevalidatie vormen inspanningstraining en het leren omgaan met dagelijkse fysieke beperkingen (zoals benauwdheid bij inspanning) de hoeksteen van de behandeling. Het is voor patiënten moeilijk om een actieve leefstijl te behouden. Na deelname aan revalidatie gaan trainingseffecten verloren door een verminderd aanbod van trainingsprikkels (reversibiliteit). Daarnaast wordt, een jaar na de revalidatie, maar liefst 20% van de patiënten opnieuw opgenomen in het ziekenhuis met een longaanval (exacerbatie). Door de verschuiving van (dure) derdelijns naar eerstelijns zorg, hebben meer patiënten toegang tot de zorg die ze nodig hebben. Hierdoor kan verergering van klachten voorkomen worden. Naast fysieke inspanning is het voor oefen- en fysiotherapeuten belangrijk om patiënten een duurzame actieve leefstijl aan te leren en het zelfmanagement van patiënten te vergroten. Een blended beweeginterventie, om het zelfmanagement (omtrent beweging, benauwdheid en beweginsgangst) van COPD patiënten te stimuleren, zowel in de praktijk als in de thuissituatie middels een eHealth toepassing, biedt mogelijk uitkomst. Echter, missen therapeuten kennis en handvatten om blended care toe te passen in de praktijk. Het doel van dit project is om samen met fysiotherapeuten en oefentherapeuten een blended care programma in te richten voor patiënten met COPD. In werkpakket 1 inventariseren we de behoeften en belemmerende factoren van een blended beweeginterventie bij therapeuten en patiënten. Op basis van deze bevindingen worden de belangrijkste elementen van de interventie geselecteerd en wordt, in co-creatie met eindgebruikers de eerste versie van de interventie ontwikkeld (WP2). Om te bepalen wat de toegevoegde waarde van de interventie is, worden de voorlopige effectiviteit en haalbaarheid onderzocht waarbij 25 eerstelijns therapeuten de blended interventie gaan gebruiken (WP3). In WP4 worden scholingsmodules ontwikkeld voor studenten en therapeuten om kennis over zelfmanagement en technologie bij COPD te vergroten.
