Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.
Aims: Medication non-adherence post-discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post-discharge. Methods: We performed a secondary analysis of the CCB randomized single-blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi-component intervention study, community nurses performed medication reconciliation and observed medication-related problems (MRPs) during post-discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high-risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. Results: For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group (n = 99) and 88.5% in the control group (n = 99), decreasing to 85.2% and 84.1% post-discharge, respectively (unadjusted difference: -2.6% (95% CI -9.8 to 4.6, P = .473); adjusted difference -3.3 (95% CI -10.3 to 3.7, P = .353)). Post-hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non-users (Pinteraction = .085). In total, 77.0% of the patients had at least one MRP post-discharge. Conclusions: Our findings indicate that a multi-component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
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Objectives: To develop an instrument to measure adherence to frequency, intensity, and quality of performance of home-based exercise (HBE) programs recommended by a physical therapist and to evaluate its construct validity and reliability in patients with low back pain. Methods: The Exercise Adherence Scale (EXAS) was developed following a literature search, an expert panel review, and a pilot test. The construct validity of the EXAS was determined based on data from 27 participants through an investigation of the convergent validity between adherence, lack of time to exercise, and lack of motivation to exercise. Associations between adherence, pain, and disability were determined to test divergent validity. The reliability of the EXAS quality of performance score was assessed using video recordings from 50 participants performing four exercises. Results: Correlations between the EXAS and lack of time to exercise, lack of motivation to exercise, pain, and disability were rho = 0.47, rho = 0.48, rho = 0.005, and rho = 0.24, respectively. The intrarater reliability of the quality of performance score was Kappa quadratic weights (Kqw) = 0.87 (95%-CI 0.83–0.92). The interrater reliability was Kqw = 0.36 (95%-CI 0.27–0.45). Conclusions: The EXAS demonstrates acceptable construct validity for the measurement of adherence to HBE programs. Additionally, the EXAS shows excellent intrarater reliability and poor interrater reliability for the quality of performance score and is the first instrument to measure adherence to frequency, intensity, and quality of performance of HBE programs. The EXAS allows researchers and clinicians to better investigate the effects of adherence to HBE programs on the outcomes of interventions and treatments.
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Veel patiënten gebruiken hun medicijnen nog niet optimaal. Ondanks het groeiende aantal interventies en innovaties om de therapietrouw te bevorderen, lukt het maar mondjesmaat om deze ook grootschalig toe te passen in de dagelijkse praktijk. Het Make-It consortium, wat staat voor Medication Adherence Knowledge, Expertise and Implementation Taskforce, houdt zich sinds 1 juli 2019 bezig met de vraag hoe de therapietrouw in de praktijk verbeterd kan worden. Hiertoe begeleidt het consortium proeftuinen die, met subsidie uit de ZonMw STIP ronde laagdrempelige therapietrouw, interventies in de dagelijkse praktijk willen implementeren.Doel Patiënten die chronisch medicatie gebruiken helpen hun medicijnen optimaal te gebruiken. Resultaten Kennis over de implementatie van interventies en innovaties, succesfactoren en knelpunten hiervan, een verbeterde therapietrouw bij patiënten. Looptijd 01 januari 2019 - 01 juli 2025 Aanpak Tijdens het onderzoeksproject worden verschillende interventies, om de therapietrouw in de praktijk te bevorderen, getest. De interventies die succesvol blijken, zullen geïmplementeerd worden in de zorg die geleverd wordt door de deelnemende proeftuinen. Update: Vier proeftuinen hebben in 2020 subsidie gekregen van ZonMw om hun project uit te voeren. De proeftuinen bestaan uit zorgverbanden uit Amsterdam, Almere, Amersfoort en Utrecht. Alle vier zijn zij voorlopers op het gebied van innovatieve zorgprojecten. Momenteel zijn de vier proeftuinen bezig met de afronding van de implementatie van de door hun gekozen interventies. In 2022 hebben vier nieuwe proeftuinen subsidie gekregen voor de laatste ronde van de STIP Call van ZonMw. Dit zijn zorgverbanden uit de Nederlandse Antillen, Friesland, Vleuten en Limburg. Deze proeftuinen zullen in het najaar van 2022 starten met de implementatie van de interventies die zij gekozen hebben.
