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López-Novis I, Marques-Sule E, Deka P, Dobarrio-Sanz I, Klompstra L, Hernández-Padilla JM. Exploring physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity: A qualitative study. J Adv Nurs 2024. [PMID: 39152567 DOI: 10.1111/jan.16403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
AIM To explore the physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity. DESIGN Descriptive qualitative study. METHOD Data collection was conducted through semi-structured interviews with 19 community-dwelling oldest-old adults with chronic multimorbidity. The study was conducted between December 2022 and May 2023. ATLAS.ti software was used for data analysis. RESULTS Three main themes with their respective sub-themes and units of meaning were developed from the data analysis: (1) motivational factors for engaging in physical activity; (2) fear of getting hurt during physical activity and (3) confidence in being physically active. CONCLUSION Motivation, kinesiophobia and confidence are three core elements that influence the experience of physical activity in oldest-old adults with chronic multimorbidity. Interventions tailored to meet the needs of the oldest-old adults are important for promotion and development of active ageing. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses and other healthcare professionals should design, implement and evaluate interventions that aim to increase oldest-old adults' motivation and confidence, while decreasing their fear to engage in physical activity. IMPACT This study provides insights into the way community-dwelling oldest-old adults with chronic multimorbidity experience physical activity in their daily lives. Our findings suggest that motivation, kinesiophobia and confidence are key factors for oldest-old adults to engage in physical activity. These findings could contribute to the design and implementation of interventions that specifically aim at raising the physical activity levels of community-dwelling oldest-old adults with chronic multimorbidity. REPORTING METHOD The study findings are reported according to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Iria Dobarrio-Sanz
- Faculty of Health Sciences, Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - José Manuel Hernández-Padilla
- Faculty of Health Sciences, Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller HH, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences. Disabil Rehabil 2024; 46:2999-3006. [PMID: 37493172 DOI: 10.1080/09638288.2023.2239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/15/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, North York, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Suzanne N Morin
- McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | | | - Zach Weston
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences. Clin Rehabil 2023; 37:713-724. [PMID: 36510450 DOI: 10.1177/02692155221144370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. DESIGN AND SETTING We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. PARTICIPANTS Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). RESULTS Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. CONCLUSION Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
| | | | - Suzanne N Morin
- 5620McGill University, Montréal, QC, Canada
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Zach Weston
- 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
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Alin CK, Grahn-Kronhed AC, Uzunel E, Salminen H. Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study. Arch Rehabil Res Clin Transl 2022; 3:100154. [PMID: 34977537 PMCID: PMC8683839 DOI: 10.1016/j.arrct.2021.100154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis. Design A 6-month postintervention follow-up of women who were involved in the interventions in the RCT. Setting The study was conducted in a primary health care center in Stockholm, Sweden. Participants In this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT. Interventions The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily. Main Outcome Measures Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10. Results After 6 months there were no significant differences between the groups in back extensor strength or back pain. Analyses within the groups showed that achieved results during 6 months intervention in the RCT were maintained after 6 months of voluntary use of the spinal orthosis and training. In the spinal orthosis group, back extensor strength mean was 81.7 N, and back pain median was 3 mm. In the training group back extensor strength mean was 72.8 N, and back pain median was 3 mm. There were no changes for any other measurements performed. Conclusions Voluntary use of the spinal orthosis or exercise during a 6-month follow-up period maintained the increase in back extensor muscle strength obtained during the RCT. Estimation of back pain was not influenced. This indicates that the women had continued to use the spinal orthosis and exercise.
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Affiliation(s)
- Christina Kaijser Alin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden
| | - Ann-Charlotte Grahn-Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Mjölby, Sweden.,Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elin Uzunel
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden
| | - Helena Salminen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.,Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden
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Halén C, Gripenberg S, Roaldsen KS, Dohrn IM, Halvarsson A. "A manageable and challenging fall prevention intervention with impact on society" - older women's perspectives on participation in the stayBalanced training programme. Physiother Theory Pract 2021; 38:2806-2816. [PMID: 34550046 DOI: 10.1080/09593985.2021.1972498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Efficient and effective evidence-based practice (EBP) strategies for managing fall prevention in primary health care are of great importance. To ensure that EBP methods have the potential to be implemented and maintained in clinical practice, patient perspective must be ensured. Novel programs need to be perceived as meaningful and feasible, and in line with the patients' values, preferences and needs. PURPOSE To describe how older women with osteoporosis experience participation in the StayBalanced Programme. METHODS Individual semi-structured interviews with 39 women aged 67-86 with osteoporosis, impaired balance and fear of falling. Data were analyzed with thematic analysis. RESULTS The analysis resulted in three main themes; "Managing and challenging training through support and enjoyment," "Structured training leads to safety and self-awareness" and "Lack of structured balance training means missed benefits, for both the individual and society." The participants experienced that the increased safety and self-awareness achieved through the challenging and motivating training, were transferred to daily life, thus, leaving them less exposed to falls, fall injuries and fear of falling. They expressed concerns about lack of knowledge translation regarding the positive effects of structured and challenging balance training, which left older adults and society without the benefits of evidence-based intervention. CONCLUSIONS The StayBalanced Programme was appreciated and acceptable from the perspective of the participants, and in line with their values and preferences, one of three key components of EPB. The results of this study may support the uptake of the evidence-based StayBalanced Programme for fall prevention in clinical practice.
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Affiliation(s)
- Carolina Halén
- Allied Health Professionals Function, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Gripenberg
- Allied Health Professionals Function, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Kirsti Skavberg Roaldsen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Ing-Mari Dohrn
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Halvarsson
- Allied Health Professionals Function, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Shorey S, Chan V. Women Living With Osteoporosis: A Meta-Synthesis. THE GERONTOLOGIST 2021; 61:e39-e47. [PMID: 31876904 DOI: 10.1093/geront/gnz173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The experiences and needs of individuals with osteoporosis, especially among women, are poorly understood. This meta-synthesis aimed to examine the experiences and needs of women living with osteoporosis. RESEARCH DESIGN AND METHODS Six databases were searched for qualitative studies from each database's inception to July 18, 2019. Qualitative data were meta-summarized, then meta-synthesized. RESULTS A total of 2,781 studies were obtained, and 2,768 studies were screened after the removal of 13 duplicates. Two thousand seven hundred and sixty studies failed to meet the eligibility criteria, resulting in the inclusion of eight studies in this meta-synthesis. Three themes emerged: (a) physical and psychological consequences of living with osteoporosis, (b) coping strategies to "live better" with osteoporosis, and (c) sources of support and support needs. DISCUSSION AND IMPLICATIONS Women living with osteoporosis experienced negative physical and psychological consequences that led to changes in their lives, particularly in their relationships. They adopted various coping strategies such as acceptance and engaging in doing things that they loved. They expressed support needs such as educational and self-help groups that may help them to cope better. As the included studies were only from the West, more studies from geographically diverse backgrounds such as the Middle East and Asia are required to explore the experiences and needs of women living with osteoporosis. Theory-based health services that incorporate active coping strategies such as self-seeking behaviors should be designed to create awareness about osteoporosis to assist such women in maintaining their independence and overall well-being to age gracefully.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
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Alin CK, Frisendahl N, Kronhed ACG, Salminen H. Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care. Arch Osteoporos 2020; 15:171. [PMID: 33123853 PMCID: PMC7595975 DOI: 10.1007/s11657-020-00754-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture. PURPOSE The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis. METHOD We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted. RESULTS The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief. CONCLUSION In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.
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Affiliation(s)
- Christina Kaijser Alin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.
| | - Nathalie Frisendahl
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Solna, Sweden
| | - Ann-Charlotte Grahn Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Mjölby, Sweden
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre Stockholm, Stockholm, Sweden
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Promoting adherence to organised physical activity among socially disadvantaged older people. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19001132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AbstractGroup-based physical activity (PA) in community-based settings represents a promising avenue for promoting healthy ageing, however, lower levels of adherence have been found to be associated with aspects of social disadvantage. Providers are in a key position to provide important insights about strategies to improve adherence, however, few studies have examined their perspectives. In this study, 30 community service providers were interviewed, and 42 older people participated in focus groups to identify actions perceived as effective for promoting adherence to organised PA, with a focus on factors relevant to older people experiencing socio-economic disadvantage, social isolation, living with a disability or from culturally and linguistically diverse backgrounds. Data were analysed thematically. Adherence barriers included deteriorating health, lack of belonging and loss of motivation. Helpful strategies for addressing deteriorating health included maintaining programme flexibility, facilitating access to health and other services, and supporting participants to adapt to acquired limitations. Belonging can be fostered by creating positive and inclusive experiences, ensuring safe and stigma-free environments, providing opportunities to forge personal connections and demonstrating care. Motivation may be enhanced by ensuring activities are of interest and functional benefit, programme settings are suitable and appealing, and enjoyment is prioritised. In conclusion, a range of strategies is likely to be necessary to mitigate risks to adherence and support continued participation in organised PA among socially disadvantaged older people.
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Palmgren A, Ståhle A, Skavberg Roaldsen K, Dohrn IM, Halvarsson A. "Stay balanced" - effectiveness of evidence-based balance training for older adults transferred into a physical therapy primary care setting - a pilot study. Disabil Rehabil 2019; 42:1797-1802. [PMID: 30616441 DOI: 10.1080/09638288.2018.1535631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the effects of the Stay Balanced program when this is transferred into a clinical setting regarding balance, gait speed, leg muscle strength, concerns about falling, and physical activity.Method: Implementation pilot study with a pre-post intervention design. Fifteen older adults, 75-91 years of age, participated in a progressive balance training program with a focus on divided attention. The balance training was performed in group sessions twice a week for 10 weeks at a primary care physical therapy clinic. Training efficacy was evaluated after completion of training as well as after 3 months using the Mini-Balance Evaluation Systems Test (Mini-BESTest), 10-meter walk test, 30-s chair stand test, Fall Efficacy Scale-International (FES-I), and steps/day.Results: Significant improvements were shown at the 10-week follow up for balance, gait speed, leg muscle strength, and concerns about falling (p < 0.008). At the 3-month follow-up balance, leg muscle strength and concerns about falling showed persistent improvement compared to baseline (p < 0.045). No significant differences were found for physical activity.Conclusions: This study confirms the results of our previous randomized controlled trials (RCTs), and suggests that the Stay Balanced program can be transferred to clinical physiotherapy practice. The program was appreciated by the participants and proved to be safe, effective, and feasible in primary care.Implication for rehabilitationThe Stay Balance program can easily be transferred to clinical practice without losing the effectiveness of the intervention in older adults with balance problems.The program was appreciated by the participants and proved to be safe, effective, and feasible when executed in primary care.Stay Balance program is an individually adjusted and progressive group balance training including exercises with divided attention that can easily be transferred to tasks in daily life.
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Affiliation(s)
- Anna Palmgren
- Valley Rehab Southern, Enskededalen, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Agneta Ståhle
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Kirsti Skavberg Roaldsen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, NO, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, NO, Norway
| | - Ing-Mari Dohrn
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Grönstedt H, Vikström S, Cederholm T, Franzén E, Seiger Å, Wimo A, Faxén-Irving G, Boström AM. A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence: a cluster randomized clinical trial. BMC Geriatr 2018; 18:138. [PMID: 29898671 PMCID: PMC6000965 DOI: 10.1186/s12877-018-0824-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored. METHODS The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed. DISCUSSION The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02702037.
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Affiliation(s)
- Helena Grönstedt
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Vikström
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.,Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Åke Seiger
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Science and Society, Division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Faxén-Irving
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals, Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Anne-Marie Boström
- Stockholms Sjukhem R&D unit, Stockholm, Sweden. .,Theme Aging, Karolinska University Hospital, Stockholm, Sweden. .,Department of Neurobiology, Care science and Society Division of nursing, Karolinska Institutet, Stockholm, Sweden. .,Western Norway University of Applied Sciences, Haugesund, Norway.
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Svensson HK, Olsson LE, Hansson T, Karlsson J, Hansson-Olofsson E. The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures-a systematic review of the literature. Osteoporos Int 2017; 28:2521-2540. [PMID: 28585054 PMCID: PMC5550548 DOI: 10.1007/s00198-017-4099-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/16/2017] [Indexed: 01/25/2023]
Abstract
Vertebral compression fracture (VCF) is a common fragility fracture and the starting point of a lasting, painful, disabling condition. The aim was to summarize evidence of person-centered/non-medical interventions supporting women with VCF. Results show small numbers of studies with only probable effect on function, pain, QoL, fear of falling, and psychological symptoms. The vertebral compression fracture (VCF) caused by osteoporosis is the third most common fragility fracture worldwide. Previously, it was believed that the pain caused by VCF was self-subsiding within weeks or a few months post-fracture. However, this positive prognosis has been refuted by studies showing that, for the great majority of patients, the VCF was the starting point of a long-lasting, severely painful, and disabling condition. The low number of studies focusing on the experience of the natural course of VCF, and what support is available and how it is perceived by those affected, calls for further investigation. Strengthening older patients' sense of security and increasing confidence in their own abilities are of great importance for successful rehabilitation following VCF. More research is needed to identify resources, possibilities, and strategies that can assist older patients to reach their goals to improve well-being. The purpose of this systematic review was to identify and summarize the current evidence of person-centered or other structured non-medical/non-surgical interventions supporting older women after experiencing an osteoporotic VCF. A systematic literature search was conducted on the MeSH terms encompassing osteoporosis and vertebral compression fractures in the PubMed-MEDLINE and Cumulative Index for Nursing and Allied Health Literature (CINAHL) databases during March through June 2015. The initial search identified 8789 articles, but only seven articles (six randomized controlled trials and one observational study with a control group) met the inclusion criteria. It became evident from the current study that the availability of evidence on the effects of non-medical interventions aiming to support older women with VCF is limited, to say the least. The trials included in this review have few limitations and were mainly considered to be of moderate quality. This systematic literature review suggests that non-medical interventions aiming to support older women with VCF might decrease levels of pain and use of analgesic as well as promote improved physical mobility and function. These interventions would probably result in an improved difference in experiences of fear of falling and perceived psychological symptoms, but would only slightly improve quality of life. However, given the nature of the seven studies, potential biases in patient selection, issues around precision with small cohorts, and failure to control for confounders, makes it difficult to draw a definitive conclusion about the significant effects of non-medical interventions. Incurring a VCF is a complex and diverse event, necessitating equally complex interventions to identify new ways forward. However, to date, interventions struggle with a risk of selection bias in that only the needs of the healthiest of the population are addressed and the voices of the remaining majority of the people affected by VCF are unheard.
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Affiliation(s)
- H K Svensson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden.
- Gothenburg Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - L-E Olsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden
- Gothenburg Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Hansson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Karlsson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Hansson-Olofsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden
- Gothenburg Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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