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de Waal MWM, Jansen M, Bakker LM, Doornebosch AJ, Wattel EM, Visser D, Smit EB. Construct validity, responsiveness, and interpretability of the Utrecht Scale for Evaluation of Rehabilitation (USER) in patients admitted to inpatient geriatric rehabilitation. Clin Rehabil 2024; 38:98-108. [PMID: 37743801 PMCID: PMC10631283 DOI: 10.1177/02692155231203095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The Utrecht Scale for Evaluation of Rehabilitation is a multi-domain measurement with good content validity, structural validity and reliability for measuring physical functioning (mobility, selfcare) and cognitive functioning in geriatric rehabilitation. We aimed to determine the construct validity of both Utrecht Scale for Evaluation of Rehabilitation scales and the responsiveness and interpretability of the scale for physical functioning in geriatric rehabilitation. DESIGN Prospective follow-up study embedded in routine care. SETTING Four care organisations in The Netherlands. SUBJECTS Patients admitted for inpatient geriatric rehabilitation (2021-2022). MAIN MEASURES Data collection included the Utrecht Scale for Evaluation of Rehabilitation, Mini-Mental State Examination, Barthel index, and a global rating scale anchor on recovery. Hypothesis testing was used to determine construct validity and responsiveness. For interpretability, minimal important change and floor and ceiling effects were determined. RESULTS The mean age of participants (n = 211) was 77 (SD 10.4). Their mean length of stay was 38.6 days (SD 26.3), and 81% returned home. The Utrecht Scale for Evaluation of Rehabilitation showed adequate construct validity, as all three hypotheses were confirmed for both scales. The Utrecht Scale for Evaluation of Rehabilitation-physical function scale showed adequate responsiveness, with all five hypotheses confirmed. The mean change for physical function (scale range 0-70) was 15.5 points (SD 17.1). The minimal important change for Utrecht Scale for Evaluation of Rehabilitation-physical function was 14.5 points difference for improvement. This scale showed no floor (2%) and ceiling effects (14%) at admission and discharge. CONCLUSIONS The Utrecht Scale for Evaluation of Rehabilitation showed to be effective for evaluating physical functioning during geriatric rehabilitation as well as screening cognitive functioning. In total, 14.5 points difference has been established as a minimal important change for physical functioning.
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Affiliation(s)
- Margot W M de Waal
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael Jansen
- Faculty of Health, Physiotherapy, University of Applied Sciences Leiden, Leiden, the Netherlands
- Woon Zorgcentra Haaglanden (WZH), The Hague, the Netherlands
| | - Loes M Bakker
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arno J Doornebosch
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- de Zorgcirkel, Purmerend, the Netherlands
| | - Dennis Visser
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- de Zorgcirkel, Purmerend, the Netherlands
| | - Ewout B Smit
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- University Network of care for Older people of Amsterdam UMC (UNO Amsterdam), Amsterdam UMC, Amsterdam, the Netherlands
- Vivium Zorggroep, Naarden, the Netherlands
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Geerars-van der Veen M, Ballemans J, Bongers AM, van Loon A, Smit EB. Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study. Gerontol Geriatr Med 2024; 10:23337214241246435. [PMID: 38686098 PMCID: PMC11057339 DOI: 10.1177/23337214241246435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.
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Affiliation(s)
- Marieke Geerars-van der Veen
- Location Vrije Universiteit Amsterdam, The Netherlands
- Rehabilitation Center Domstate, Utrecht, The Netherlands
- Utrecht University, The Netherlands
| | - Judith Ballemans
- Location Vrije Universiteit Amsterdam, The Netherlands
- Rehabilitation Center Domstate, Utrecht, The Netherlands
| | - Anna M. Bongers
- Location Vrije Universiteit Amsterdam, The Netherlands
- Rehabilitation Center Domstate, Utrecht, The Netherlands
| | - Anouk van Loon
- Location Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, The Netherlands
| | - Ewout B. Smit
- Location Vrije Universiteit Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, The Netherlands
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Visser D, Wattel EM, Gerrits KHL, van der Wouden JC, Meiland FJM, de Groot AJ, Jansma EP, Hertogh CMPM, Smit EB. Effectiveness and characteristics of physical fitness training on aerobic fitness in vulnerable older adults: an umbrella review of systematic reviews. BMJ Open 2022; 12:e058056. [PMID: 35641014 PMCID: PMC9157351 DOI: 10.1136/bmjopen-2021-058056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To present an overview of effectiveness and training characteristics of physical training on aerobic fitness, compared with alternative or no training, in adults aged over 65 years with various health statuses, providing a basis for guidelines for aerobic training of vulnerable older adults that can be used in geriatric rehabilitation. DESIGN An umbrella review of systematic reviews that included both randomised controlled trials and other types of trials. DATA SOURCES MEDLINE, Embase, CINAHL and the Cochrane Library were searched on 9 September 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included systematic reviews reporting on physical training interventions that are expected to improve aerobic fitness, presenting results for adults aged 65 years and older, describing at least one of the FITT-characteristics: Frequency, Intensity, Time or Type of exercise, and measuring aerobic fitness at least before and after the intervention. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted the data and assessed the risk of bias. A narrative synthesis was performed. RESULTS We included 51 papers on 49 reviews. Positive effect of training on aerobic fitness was reported by 33 reviews, 11 reviews remained inconclusive and 5 reviews reported no effect. Training characteristics varied largely. Frequency: 1-35 sessions/week, Intensity: light-vigorous, Time: <10-120 min/session and Types of exercise: many. The methodological quality was most often low. Subgroup analyses revealed positive effects for all health conditions except for trauma patients. Exercise characteristics from current existing guidelines are widely applicable. For vulnerable older adults, lower intensities and lower frequencies were beneficial. Some health conditions require specific adjustments. Information on adverse events was often lacking, but their occurrence seemed rare. CONCLUSION Physical fitness training can be effective for vulnerable older adults. Exercise characteristics from current existing guidelines are widely applicable, although lower frequencies and intensities are also beneficial. For some conditions, adjustments are advised. PROSPERO REGISTRATION NUMBER CRD42020140575.
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Affiliation(s)
- Dennis Visser
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Karin H L Gerrits
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Stichting Merem Medische Revalidatie, Hilversum, Noord-Holland, The Netherlands
| | - Johannes C van der Wouden
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Franka J M Meiland
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Aafke J de Groot
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elise P Jansma
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ewout B Smit
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Noord-Holland, The Netherlands
- Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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Jansen M, Doornebosch AJ, de Waal MW, Wattel EM, Visser D, Spek B, Smit EB. Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability. Arch Gerontol Geriatr 2021; 97:104509. [PMID: 34509903 DOI: 10.1016/j.archger.2021.104509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Establish content and structural validity, internal consistency, inter-rater reliability, and measurement error of the physical and cognitive scales of the Utrecht Scale for Evaluation clinical Rehabilitation (USER) in geriatric rehabilitation. MATERIAL AND METHODS First, an expert consensus-meeting (N=7) was organised for content validity wherein scale content validity index (CVI) was measured. Second, in a sample of geriatric rehabilitation patient structural validity (N=616) was assessed by confirmatory factor analyses for exploring unidimensionality. Cut-off criteria were: Root Mean Square Error of Approximation (RMSEA) ≤0.08; Comparative Fit Index (CFI) and Tucker Lewis Index (TLI) ≥0.95. Local independence (residual correlation<0.20) and monotonicity (Hi-coefficient ≥0.30 and Hs-coefficient ≥0.50) were also calculated. Cronbach alphas were calculated for internal consistency. Alpha's > 0.7 was considered adequate. Third, two nurses independently administered the USER to 37 patients. Intraclass-correlation coefficients (ICC) were calculated for inter-rater reliability (IRR), standard error of measurement (SEM) and Smallest Detectable Change (SDC). RESULTS The CVI for physical functioning was moderate (0.73) and excellent for cognitive functioning (0.97). Structural validity physical scale was acceptable (CFI;0.95, TLI;0.93, RMSEA;0.07, ECV;0.78, OmegaH;0.87; Monotonicity;(Hi;0.52-0.75 and Hs;0.63)). Cognitive scale was good (CFI;0.98, TLI;0.96, RMSEA;0.05, ECV;0.66 and OmegaH;0.90. Monotonicity;(Hi;0.30 -0.70 and Hs;0.61)). Cronbach's alpha were high: physical scale;0.92 and cognitive scale;0.94. Reliability physical scale ICC;0.94, SEM;5 and SDC;14 and cognitive scale ICC;0.88, SEM;5 and SDC;13. CONCLUSION The observational scales of the USER have shown sufficient content and structural validity, internal consistency, and interrater reliability for measuring physical and cognitive function in geriatric rehabilitation. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Michael Jansen
- Faculty of health, Physiotherapy, University of applied sciences Leiden, Leiden, The Netherlands; Woon Zorgcentra Haaglanden (WZH), The Hague, The Netherlands.
| | - Arno J Doornebosch
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherland
| | - Margot Wm de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherland
| | - Elizabeth M Wattel
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands
| | - Dennis Visser
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands
| | - Bea Spek
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Ewout B Smit
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands; Vivium Zorggroep Naarden, The Netherlands.
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Smit EB, Bouwstra H, Roorda LD, van der Wouden JHC, Wattel ELM, Hertogh CMPM, Terwee CB. A Patient-Reported Outcomes Measurement Information System Short Form for Measuring Physical Function During Geriatric Rehabilitation: Test-Retest Reliability, Construct Validity, Responsiveness, and Interpretability. J Am Med Dir Assoc 2021; 22:1627-1632.e1. [PMID: 33640312 DOI: 10.1016/j.jamda.2021.01.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To study the test-retest reliability and measurement error, construct validity, responsiveness, interpretability, and floor/ceiling effects of a Patient-Reported Outcomes Measurement Information System (PROMIS) short form designed to measure physical function in geriatric rehabilitation patients (PROMIS-PF-GR). DESIGN Prospective cohort. SETTING AND PARTICIPANTS Inpatient geriatric rehabilitation patients. METHODS We evaluated the test-retest reliability by re-administering PROMIS-PF-GR 3 to 5 days after the admission measurement. The intraclass correlation coefficient (ICC) was calculated to determine test-retest reliability; an ICC of ≥0.70 was considered sufficient. Measurement error was established by calculating the standard error of measurement and smallest detectable change. Construct validity and responsiveness were determined by testing a priori formulated hypotheses (criterion: ≥75% hypothesis not rejected). Interpretability was evaluated by calculating the minimal important change using predictive modeling and a global rating as criterion for change. Floor/ceiling effects were established by calculating the percentage patients with the minimum/maximum raw score (criterion: ≤15%) at admission and discharge. RESULTS A total of 207 patients participated in the study [mean ± standard deviation age (80 ± 8.3 years), 58% female]. More than one-half of patients (56%) reported to be improved during rehabilitation. The ICC was 0.79 (95% confidence interval 0.70-0.84), the standardized error of measurement was 3.8, and the smallest detectable change 10.6. None of the 4 hypotheses for construct validity were rejected; 2 out of 5 hypotheses for responsiveness were rejected. The minimal important change was 8.0 (95% confidence interval 4.1-12.5). No floor/ceiling effects were found. CONCLUSIONS AND IMPLICATIONS The PROMIS-PG-GR showed sufficient test-retest reliability, measurement error, and construct validity. We did not find sufficient evidence for responsiveness, which may be due to the unexplained weak correlation between the PROMIS change score and the Global Rating Scale. We still recommend the use the PROMIS-PG-GR for measuring self-reported physical function in geriatric rehabilitation.
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Affiliation(s)
- Ewout B Smit
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Hylco Bouwstra
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
| | - Johannes Hans C van der Wouden
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth Lizette M Wattel
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Smit EB, Bouwstra H, van der Wouden JC, Hertogh CMPM, Wattel EM, Roorda LD, Terwee CB. Development of a Patient-Reported Outcomes Measurement Information System (PROMIS®) short form for measuring physical function in geriatric rehabilitation patients. Qual Life Res 2020; 29:2563-2572. [PMID: 32318940 PMCID: PMC7434792 DOI: 10.1007/s11136-020-02506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2020] [Indexed: 12/05/2022]
Abstract
Purpose To develop and test the validity of a Patient-Reported Outcomes Measurement Information System (PROMIS®) short form for measuring physical function of geriatric rehabilitation patients. Methods Experts selected items from the Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) item bank and proposed new items to develop the PROMIS-PF short form for geriatric rehabilitation (PROMIS-PF-GR). Patients evaluated its content validity. Structural validity was assessed by evaluating unidimensionality (confirmatory, exploratory, and bi-factor analyses [criterion: Omega H > 0.80 and ECV > 0.60]), local independence (criterion: residual correlation < 0.20) ,and monotonicity (criterion: Hi-coefficient ≥ 0.30). Measurement invariance was assessed by evaluating Differential Item Functioning (DIF) between geriatric rehabilitation patients and people from the general population using ordinal logistic regression. Internal consistency was assessed by calculating Cronbach’s alpha (criterion: alpha ≥ 0.70). Results Experts selected 24 items from the PROMIS-PF item bank and proposed one new item which was not included in the short form. Patients considered the 24 items relevant and containing essential information. The PROMIS-PF-GR’s psychometric properties were evaluated in 207 patients (mean age ± SD, 80.0 ± 8.3 year; 58% female). The 24 items were found to be sufficiently unidimensional (Omega H = 0.82, ECV = 0.70), locally independent (98.7% item pairs), and monotone (all ≥ 0.32). Five items were flagged for DIF, but their impact on the total score was negligible. Cronbach’s alpha was 0.94. Conclusion The PROMIS-PF-GR was developed from the PROMIS-PF and has good content validity, structural validity, measurement invariance, and internal consistency in Dutch geriatric rehabilitation patients. We recommend to confirm the content validity of the PROMIS-PF-GR in other countries.
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Affiliation(s)
- E B Smit
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7 (room B-357), 1081 BT, Amsterdam, The Netherlands.
| | - H Bouwstra
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7 (room B-357), 1081 BT, Amsterdam, The Netherlands
| | - J C van der Wouden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7 (room B-357), 1081 BT, Amsterdam, The Netherlands
| | - C M P M Hertogh
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7 (room B-357), 1081 BT, Amsterdam, The Netherlands
| | - E M Wattel
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7 (room B-357), 1081 BT, Amsterdam, The Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - C B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
Objective: To explore the effect of goal-setting on physical functioning, quality of
life and duration of rehabilitation in geriatric rehabilitation compared to
care as usual. Data sources: Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from
initiation to October 2018. Methods: We included randomized controlled trials (RCTs), controlled before–after
studies and studies using historic controls of older patients (mean age
⩾55 years) receiving rehabilitation for acquired disabilities. Our primary
outcome was physical functioning; secondary outcomes were quality of life
and rehabilitation duration. Cochrane guidelines were used to assess the
risk of bias of the studies and extract data. Only RCT data were pooled
using standardized mean difference (SMD). Results: We included 14 studies consisting of a total of 1915 participants with a mean
age ranging from 55 to 83 years. Ten out of the 14 studies had a randomized
controlled design, 7 of which could be pooled for the primary outcome. The
risk of bias was judged high in several domains in all included studies. The
meta-analysis showed no statistically significant differences between
goal-setting and care as usual for physical functioning (SMD −0.11 (−0.32 to
0.10)), quality of life (SMD 0.09 (−0.56 to 0.75)) and rehabilitation
duration (MD 13.46 days (−2.46 to 29.38)). Conclusion: We found low-quality evidence that goal-setting does not result in better
physical functioning compared to care as usual in geriatric rehabilitation.
For quality of life and duration of rehabilitation, we could not exclude a
clinically relevant effect.
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Affiliation(s)
- Ewout B Smit
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Hylco Bouwstra
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Mpm Hertogh
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh CMPM. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2017; 9:71-76. [PMID: 29430267 PMCID: PMC5797203 DOI: 10.1007/s41999-017-0011-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/14/2017] [Indexed: 12/04/2022]
Abstract
Background Patient-centred goal setting is regarded as a beneficial intervention for geriatric rehabilitation. Nevertheless, its known laborious implementation in clinical practice remains an ongoing challenge. To improve implementation of patient-centred goal setting, the integration of goal setting with standardized measures has been proposed. Our objective of the current study was to explore the feasibility of Collaborative Functional Goal Setting (CFGS), i.e., using standardized functional measures to set and evaluate functional goals during geriatric rehabilitation. Materials and methods Three medical professionals working in two geriatric rehabilitation wards were trained in CFGS and interviewed at the end of the study. We aimed at including 20 patients who underwent the CFGS intervention and could participate in open interviews. Both interviews of the professionals and patients were qualitatively analyzed. Results Eight patients were included in the study, five of which could be interviewed. Both patients and professionals expressed a need for patient-centred goal setting. Patients indicated that goals were mainly set by the professional and that a rehabilitation plan was either not presented or its content was not clear to them. In contrast, the professionals regarded CFGS as patient-centred and potentially helpful in facilitating the goal-setting process. Nevertheless, the professionals indicated having difficulty with the implementation of the intervention. Conclusion In the current study, we demonstrated that patient-centred goal setting supported by functional measurements was not feasible in its present form which confirms the evidence from the literature that is difficult to perform patient-centred goal setting in clinical practice.
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Affiliation(s)
- Ewout B Smit
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Room H465, 1081 BT, Amsterdam, The Netherlands.
| | - Hylco Bouwstra
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Room H465, 1081 BT, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Room H465, 1081 BT, Amsterdam, The Netherlands
| | - Lizette M Wattel
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Room H465, 1081 BT, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Room H465, 1081 BT, Amsterdam, The Netherlands
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