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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Bazan LMP, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation After Acute Infection. J Am Med Dir Assoc 2024:S1525-8610(24)00344-X. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | | | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | | | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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Doornebosch AJ, Achterberg WP, Smaling HJA. Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study. BMC Med Educ 2024; 24:285. [PMID: 38486216 PMCID: PMC10941503 DOI: 10.1186/s12909-024-05291-8] [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] [Grants] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Interprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings. METHODS A constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed. RESULTS The perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) 'Involvement of patient, informal caregiver, and healthcare professional', categorised into: 'participation of patients and informal caregivers', 'behaviour and attitude of team members', 'expectations of team members towards each other', and 'exchange of information, knowledge, and reciprocity in communication'; and (2) 'A systematic approach to providing care for older people', consisting of: 'coordination of team procedures', and 'coordination of organisational procedures'. Also, one theme for multidisciplinary team meetings was identified: 'Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: 'team procedures', 'working systematically', and 'participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings. CONCLUSION People involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Arno J Doornebosch
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands.
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
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Wattel EM, Meiland FJM, van der Wouden JC, de Groot AJ, Hertogh CMPM, Gerrits KHL. Barriers and facilitators for physical fitness training in orthopedic geriatric rehabilitation. A qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38357823 DOI: 10.1080/09638288.2024.2314161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE The aim of this explorative, qualitative study is to identify factors that potentially influence the execution of physical fitness training in inpatient orthopedic geriatric rehabilitation (GR), from the perspectives of patients, their relatives and professionals. MATERIALS AND METHODS In GR wards of skilled nursing facilities in the Netherlands, semi-structured interviews were held with triads of patients, their relatives and responsible nurses, and focus groups with members of the multidisciplinary teams. Verbatim reports were analyzed according to the framework method. RESULTS We found twelve categories of barriers and facilitators related to characteristics of the patients, their family, staff, training program and organization. CONCLUSIONS The barriers and facilitators found largely correspond with those found for participation in exercise in related settings, but also show important differences. This overview of barriers and facilitators enables multidisciplinary teams to design improvements at the level of the organization and interventions, as well as at the level of the individual training program, tailoring it to the patient's circumstances and needs. Further research should focus on weighing these barriers and facilitators to develop a feasible guidance for daily practice, as well as testing their effect on the adherence to existing physical fitness training guidelines.
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Affiliation(s)
- Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Franka J M Meiland
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Johannes C van der Wouden
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Aafke J de Groot
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Karin H L Gerrits
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Merem Medische Revalidatie, Hilversum, The Netherlands
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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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Bosma MS, Caljouw MAA, Achterberg WP, Nijboer TCW. Prevalence, Severity and Impact of Visuospatial Neglect in Geriatric Stroke Rehabilitation, a Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1798-1805. [PMID: 37634546 DOI: 10.1016/j.jamda.2023.06.038] [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: 03/07/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Visuospatial neglect (VSN) is a common cognitive deficit of lateralized attention after stroke and can have a negative influence on patients' daily activities, community participation, and caregiver burden. VSN prevalence has been investigated in several mixed-age populations, but rarely in only an older population. As the population in geriatric rehabilitation (GR) is understudied and VSN may influence rehabilitation goals in GR (return home), we examined the prevalence of VSN as well as associations between VSN (severity) and population characteristics and the impact of VSN on functioning, length of stay, and discharge destination after GR. DESIGN Multicenter cross-sectional study. SETTING AND PARTICIPANTS Stroke patients admitted to GR. METHODS Three VSN tests (Star cancelation task, Line bisection task, and Catherine Bergego Scale) were administered in the first 2 weeks of GR admission. To examine VSN severity, a composite score was calculated based on scores of the 3 tests. RESULTS A total of 114 stroke patients were included [55.3% female; mean age 80.2 (SD 8.0) years]. VSN prevalence was 47.4%, in which allocentric and egocentric neglect were more prevalent than VSN during activities of daily living. Participants with VSN spent more days in GR compared to participants without VSN (median 68.5 vs 35.5 days) and had fewer home returns. In addition, VSN participants showed less mobility, lower cognitive functioning, and less independence during self-care compared to participants without VSN. Mobility, self-care, cognition, duration of rehabilitation, and home return were negatively associated with VSN severity. CONCLUSIONS AND IMPLICATIONS VSN is very prevalent in the GR stroke population. VSN severely hampers older people during daily activities and their rehabilitation process and, therefore, has a major personal and societal impact. Accordingly, systematic assessment of VSN in the early phase of geriatric rehabilitation with multiple VSN screening tests is recommended.
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Affiliation(s)
- Martine S Bosma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Zorggroep Florence, Rijswijk, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
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Wattel EM, de Groot AJ, Deetman-van der Breggen S, Bonthuis R, Jongejan N, Tol-Schilder MMR, van der Wouden JC, Gobbens R. Development of a practical guideline for person centred goal setting in geriatric rehabilitation: a participatory action research. Eur Geriatr Med 2023; 14:1011-1019. [PMID: 37460835 PMCID: PMC10587279 DOI: 10.1007/s41999-023-00830-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To improve goal setting in Geriatric Rehabilitation (GR), by developing an evidence-based practical guideline for patient-centred goal setting. METHODS Participatory action research (PAR) in a cyclical process, with GR professionals as co-researchers. Each cycle consisted of five phases: problem analysis, literature review, development, practical experience, feedback & evaluation. The evaluation was based on video recordings of goal setting conversations, and on oral and written feedback of the GR professionals who tested the guideline. RESULTS In two PAR-cycles the guideline was developed, consisting of eight recommendations for setting and using goals, and of practical advices elaborating three of the recommendations, concerning conversational skills specific for goal setting conversations. After the second cycle the research team concluded that the guideline was feasible in daily practice and effective when used consciously. CONCLUSION In this study, a practical guideline for setting and using goals in GR was developed. GR teams can improve their patient centred working with goals by discussing the recommendations in their team and choosing the recommendations to work on. This can be supported by the development of an interdisciplinary training. The effect on quality of care should be subject to further investigation.
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Affiliation(s)
- Elizabeth M. Wattel
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and 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 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | | | - Robin Bonthuis
- Zonnehuisgroep IJssel-Vecht, Location Stadshagen, Geriatric Rehabilitation, Zwolle, The Netherlands
| | - Niels Jongejan
- Stichting QuaRijn, Geriatric Rehabilitation Care, Doorn, The Netherlands
| | | | - Johannes C. van der Wouden
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Robbert Gobbens
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg University, Tilburg, The Netherlands
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Groen WG, Wattel EM, de Groot AJ, Meiland FJM, Hertogh CMPM, Gerrits KHL. Exercise testing and training in frail older adults with an orthopedic impairment participating in a geriatric rehabilitation program: an international Delphi study. Eur Geriatr Med 2023; 14:985-997. [PMID: 37400662 PMCID: PMC10587272 DOI: 10.1007/s41999-023-00819-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Little is known about exercise testing and training in orthopedic geriatric rehabilitation. This study aims to obtain expert-consensus-based recommendations on this matter. METHODS Using an online Delphi study we aimed to reach international expert consensus on statements related to testing and training of endurance capacity and muscle strength. Participants needed to have relevant research or clinical expertise. Statements were evaluated and explanatory comments could be provided. After each round anonymous results were presented to participants. Statements could be adjusted or new ones could be formulated if necessary. Consensus was defined as > 75% of participants agreeing. RESULTS Thirty experts completed the first round. Twenty-eight (93%) the second and 25 (83%) completed the third round. The majority of experts were physical therapists. Consensus was reached on a total of 34 statements. The statements and comments reflected the need for a pragmatic and tailored approach in this population both for testing and training. For example, for testing endurance capacity, a 6 Minute walk test was promoted and for testing muscle strength, performance in a functional activity was suggested. Ratings of perceived exertion were promoted for monitoring intensity of endurance and muscle strength training in patients without cognitive impairment. CONCLUSION In orthopedic GR, endurance and muscle strength testing should be pragmatic and is preferably performed in functional activities. For endurance training existing guidelines of the American College of Sports Medicine can be strived for but adapted as needed and for muscle strength training only lower intensities are agreed upon.
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Affiliation(s)
- Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands.
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aafke J de Groot
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Franka J M Meiland
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin H L Gerrits
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Merem Medische Revalidatie, Hilversum, The Netherlands
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Drenth H, Hobbelen HJSM, Finnema EJ. [Experiences, wishes and needs of patients with regard to patient participation during geriatric rehabilitation]. Tijdschr Gerontol Geriatr 2023; 54. [PMID: 37646358 DOI: 10.36613/tgg.1875-6832/2023.02.01] [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] [Indexed: 09/01/2023]
Abstract
Person-centered care is the result of shared goal setting and monitoring progress during rehabilitation in geriatric rehabilitation care (GR). It requires active patient involvement. Collaboration between health care professionals and patients is valuable in formulating goals and contributes to person-centered care. With this study we investigate how active participation is implemented in practice, what wishes GR patients have and what tools are needed for this. For this purpose, cross-sectional semi-structured interviews were conducted with 23 GR patients for 1 year. The research shows that patients want to be actively approached and supported by professionals for active patient participation. The extent to which and the way in which this is done are different, requiring a flexible approach that considers the needs and possibilities of the patient and his environment. Recommendations for practice have been formulated based on this study.
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Affiliation(s)
- Hans Drenth
- Hanzehogeschool Groningen
- ZuidOostZorg, Drachten
- FAITH research, Leeuwarden, Groningen
| | | | - Evelyn J Finnema
- Hanzehogeschool Groningen
- UMC Groningen
- NHL/Stenden, Leeuwarden
- FAITH research, Leeuwarden, Groningen
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Mattiazzo GF, Drewes YM, van Eijk M, Achterberg WP. Geriatric rehabilitation care after hip fracture. Eur Geriatr Med 2023. [PMID: 36788193 DOI: 10.1007/s41999-023-00755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE After acute hospital admission, patients with a hip fracture are frequently discharged to skilled nursing homes providing geriatric rehabilitation (GR). There are few evidence-based studies regarding specific treatment times and assessments during GR. This study aims to provide a description of care for hip fracture patients during GR in the Netherlands. METHODS Descriptive study analyzing the care pathways from GR facilities, regarding healthcare professionals involved, allocated treatment time per profession, total length of rehabilitation stay, and assessment instruments. Based on the reimbursement algorithm (diagnostic treatment combination = DBCs), of 25 patients, the registered actual treatment time per profession was calculated. RESULTS The care pathways pivoted on three groups of health care professionals: medical team (MT), physiotherapy (PT), and occupational therapy (OT). There was some discrepancy between the allocated time in the care pathways and the calculated mean actual treatment time from the DBCs. First week: MT 120-180 min, DBC 120 (SD: 59) minutes; PT 120-230 min, DBC 129 (SD: 58) minutes; and OT 65-165 min, DBC 93 (SD: 61) minutes. From week two onwards, MT 15-36 min, DBC 49 (SD: 29) minutes; PT 74-179 min, DBC 125 (SD: 50) minutes; and OT 25-60 min, DBC 47 (SD: 44) minutes. Dieticians, psychologists, and social workers were sporadically mentioned. There was heterogeneity in the assessment and screening tools. CONCLUSIONS It is difficult to define current standard care in GR after hip fracture in the Netherlands due to the diversity in care pathways and large practice variation. This is a problem in conducting randomized effectiveness research with care provided as control. TRIAL REGISTER AND DATE OF REGISTRATION NL7491 04-02-2019.
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Stefanakis M, Sakellari V, Klenk J, Kampe K, Klimek M, Pfeiffer K, Becker C. Unlocking the black box of geriatric physiotherapy : Quantification of physical activity and walking parameters during inpatient geriatric rehabilitation therapy sessions. Z Gerontol Geriatr 2022; 55:637-643. [PMID: 36326865 DOI: 10.1007/s00391-022-02126-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Physiotherapy and occupational therapy are currently described using the duration of treatment (days or weeks), the frequency of therapy sessions (on a daily or 3-5 days per week basis) and considering the duration of a session (e.g., 30 or 45 min). The content is often poorly defined and the intensity is rarely reported. Using digital technology some of these shortcomings can be overcome. The cumulative parameters of walking and activity sessions, the duration of walking, the time spent in an upright or lying/sitting position and the number of steps can now be analyzed. In this study, we examined the parameters during non-treatment periods and therapy time in patients recovering from fragility fractures. METHODS The study is a secondary data analysis of a trial that examined the improvement of physical activity (PA) and self-efficacy of fragility fracture patients. Changes in mobility parameters were measured using the ActivPal3 sensor during the 1st and 3rd weeks of rehabilitation and 104 patients were analyzed (mean age 82.5 years). Parameters included the time during supervised treatment, the mean number of steps, cumulative time in an upright position and walking duration, the number of walking intervals of > 10 s and sit to stand transfers. RESULTS Patients received 3-4 therapy sessions adding up to 90-120 min per day. More than 50% of the daily walking activities were achieved in these sessions until discharge. With this amount of therapeutic input most parameters meaningfully improved from baseline to the second measurement. The number of steps increased by 30%, the mean time in an upright position increased by 26% and the mean time spent walking increased by 49%. CONCLUSION The sensor-derived measurements describe the amount of walking activity administered during the supervised therapy sessions. This could be used as a starting point for future trials to improve the outcomes or as a standard of process evaluation for clinical services.
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Affiliation(s)
- Marios Stefanakis
- Physiotherapy Department, University of West Attica, 12243, Egaleo, Athens, Greece.
| | - Vasiliki Sakellari
- Physiotherapy Department, University of West Attica, 12243, Egaleo, Athens, Greece
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Karin Kampe
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Matthias Klimek
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany. .,Unit Digitale Geriatrie, Universitätsklinikum Heidelberg, Bergheimerstr. 20, 69115, Heidelberg, Germany.
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11
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Backman C, Harley A, Papp S, Webber C, Poitras S, Berdusco R, Beaulé PE, French-Merkley V. Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a protocol for a mixed method study. Pilot Feasibility Stud 2022; 8:124. [PMID: 35690813 PMCID: PMC9188093 DOI: 10.1186/s40814-022-01079-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures in older adults are significant contributors to severe functional decline and disability as well as hospitalization and increased health care costs. Research shows that timely referral to geriatric rehabilitation leads to better patient outcomes. Currently, a wide variability in the timing, the frequency, and the choice of appropriate setting for rehabilitation of hip fracture patients exists. AIM Evaluate the feasibility, acceptability, and preliminary effectiveness of PATH4HIP, a pathway intervention for timely transfer of post-operative geriatric hip fracture patients from hospital to rehabilitation to home. METHODS This is a single-arm, pragmatic feasibility study to measure reach, effectiveness, adoption, implementation, and maintenance of PATH4HIP, a pathway for post-operative hip fracture patients from a large academic health science center to a geriatric rehabilitation service in Ottawa, Canada. During a 6-month period, all hip fracture patients, 65 years of age or older who have undergone surgery and have met the eligibility criteria (n = 96), will be transferred to the geriatric rehabilitation service no later than post-operative day 6. Patients (n = 10-12) and clinicians who are working on the orthopedic team (n = 10-12) and on the geriatric rehabilitation service (n = 10-12) will be invited to participate in an interview to share their feedback on the intervention's feasibility and acceptability and to provide suggestions to improve PATH4HIP. Descriptive statistics will be used to summarize results of the quantitative data and content analysis will be used to analyze the qualitative data. The study will be open for recruitment from January to July 2022. DISCUSSION If feasible, PATH4HIP will result in the reduction of the post-operative acute care length of stay to less than or equal to 6 days, while having no detrimental effect on rehabilitation outcomes such as functional gains, or discharge destination.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa; Affiliate Investigator, Ottawa Hospital Research Institute, Affiliate Investigator, Bruyère Research Institute, 451, Smyth Road, RGN 3239, Ottawa, ON, K1H 8M5, Canada.
| | - Anne Harley
- Bruyere Continuing Care; Assistant Professor Faculty of Medicine, University of Ottawa, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Steve Papp
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Randa Berdusco
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery at The Ottawa Hospital, Faculty of Medicine, University of Ottawa, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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12
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Matsumoto A, Yoshimura Y, Nagano F, Bise T, Kido Y, Shimazu S, Shiraishi A. Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes. Int J Clin Pharm 2022; 44:749-761. [PMID: 35578145 DOI: 10.1007/s11096-022-01416-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/24/2021] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
Abstract
Background Evidence is scarce regarding polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine. Aim To investigate the prevalence of polypharmacy and PIMs and their association with outcomes in stroke rehabilitation. Method A retrospective cohort study was conducted with 849 older inpatients post-stroke. Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included functional independence measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay, and the rate of home discharge. To consider the effect of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes. Results After enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed in 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = - 0.062, P = 0.049), FIM-cognitive score (β = - 0.076, P = 0.014), energy intake (β = - 0.143, P = 0.005), and home discharge (OR: 0.458; 95% CI: 0.248, 0.847; P = 0.013). PIMs were negatively associated with home discharge (OR: 0.375; 95% CI: 0.195, 0.718; P = 0.003). Conclusion Polypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy was negatively associated with activities of daily living (ADL) but not with PIMs and ADLs, and both were associated with home discharge.
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Affiliation(s)
- Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto, 869-1106, Japan.
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshifumi Kido
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Department of Nutritional Management, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ai Shiraishi
- Department of Dental Office, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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13
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Gaßmann KG, Swoboda W, Tümena T, Schlee S, Trögner J. Geriatric assessment in the inpatient sector : 20 years quality assurance of the Geriatrics in Bavaria Database. Z Gerontol Geriatr 2022. [PMID: 34994852 DOI: 10.1007/s00391-021-02004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geriatric assessment is an integral part of geriatrics and leads to various improvements in the treatment of geriatric patients. MATERIAL AND METHODS Analysis of assessment data and patient characteristics in a large inpatient geriatric patient population. Evaluation of data from the Geriatrics in Bavaria Database (GiB-DAT) over 20 years as well as a cross-sectional study from 2020. Presentation of data for patients in inpatient acute geriatrics as well as continuing geriatric rehabilitation. RESULTS The number of patient records and participating hospitals has steadily increased for both inpatient care types to 821,913 (status 31 March 2021). The Barthel index and other assessment results show differentiated values between acute geriatrics and continuing geriatric rehabilitation. CONCLUSION The results demonstrate the differences in patient outcomes between the two types of care as well as changes in the setting over time. The constancy of the applied assessment instruments contributes to the comparability of the different hospitals; however, it is necessary to introduce new and alternative assessment instruments and to further develop inpatient geriatrics.
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14
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de Waal MWM, Haaksma ML, Doornebosch AJ, Meijs R, Achterberg WP. Systematic review of measurement properties of the Canadian Occupational Performance Measure in geriatric rehabilitation. Eur Geriatr Med 2022; 13:1281-1298. [PMID: 35999351 PMCID: PMC9722840 DOI: 10.1007/s41999-022-00692-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The Canadian Occupational Performance Measure (COPM) is used to inventory problems experienced by the patient to set goals and evaluate treatment. We aimed to make a systematic overview of measurement properties for people in geriatric rehabilitation. METHODS Seven electronic databases were searched for psychometric studies investigating content validity, construct validity, responsiveness, or reliability of the COPM in geriatric rehabilitation populations aged ≥ 60 years. Two reviewers independently abstracted data and assessed methodological quality from included studies. RESULTS Of 292 identified articles, 13 studies were included. The COPM showed good test-retest reliability (two studies), moderate inter-rater reliability (one study), and good content validity (one study with some risk of bias). Four studies with minimal risk of bias showed good construct validity as their hypotheses were confirmed. Responsiveness was moderate in three studies with adequate methodological quality. CONCLUSION All measurement properties have been studied in geriatric rehabilitation populations, and indicate that the COPM gives relevant information for geriatric rehabilitation, and scores can be assessed reliably and are responsive to change. Although there were many studies on construct validity, authors had different opinions on what exactly COPM-scores tell us, as they used a variety of comparator instruments and different hypotheses. Consensus on exact interpretation of the scores is needed.
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Affiliation(s)
- Margot W. M. de Waal
- grid.10419.3d0000000089452978University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Miriam L. Haaksma
- grid.10419.3d0000000089452978University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno J. Doornebosch
- grid.10419.3d0000000089452978University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wilco P. Achterberg
- grid.10419.3d0000000089452978University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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15
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Happe L, Hein A, Diekmann R. What do geriatric rehabilitation patients and experts consider relevant? Requirements for a digitalised e-coach for sustainable improvement of nutrition and physical activity in older adults - a qualitative focus group study. BMC Geriatr 2021; 21:712. [PMID: 34922492 PMCID: PMC8684219 DOI: 10.1186/s12877-021-02692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/01/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023] Open
Abstract
Background During geriatric rehabilitation, attempts are made to increase the patients’ health and functional capacity. In order to maintain these improvements in the medium- and long-term, behavioural changes regarding mobility and nutrition are also targeted, but these are often not sustainable. International studies show positive effects on the sustainability of the improvement of physical activity behaviour in healthy seniors through the use of electronic devices and software applications. Comparable approaches that include nutrition topics or combine them and were additionally developed for geriatric rehabilitation patients (≥70 years) to date are not known. The aim of this study was to identify what geriatric rehabilitation patients require from an electronic coaching system (e-coach) to support them in improving their nutritional and physical activity behaviour, and what content and features physiotherapists and dieticians consider relevant. Method Focus group interviews (09–11/2019) were conducted in a geriatric rehabilitation centre in Germany with patients aged 70 years and older, relatives and experts (physiotherapists and nutritionists). The focus groups were recorded, transcribed verbatim and analysed using content analysis. Results Three focus groups with patients and relatives (n = 17, 65% female, 16 (94%) in age category 70–99 years) and one focus group with experts (2 dieticians and 1 physiotherapist) were conducted. Relevant contents and feedback elements for nutrition and physical activity in old age were identified. The patients’ comments show that an e-coach must offer obvious benefits for the older persons and promote motivation in order to be used. The willingness to change nutrition and physical activity behaviour and the previous experiences in these areas are very heterogeneous, therefore content should be adaptable to different requirements. Conclusion Experts and patients identified quite similar contents, barriers and facilitators for a nutrition and physical activity e-coach. The e-coach needs to be able to address different points of behaviour change, enable adaptations to the individual patient and convince the older person that using it will help them to improve their nutrition and physical activity. It is also important that the e-coach is easy to use and can be easily integrated into the patient’s everyday life after rehabilitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02692-y.
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Affiliation(s)
- Lisa Happe
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
| | - Andreas Hein
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany
| | - Rebecca Diekmann
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany
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16
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van Haastregt JCM, Everink IHJ, Schols JMGA, Grund S, Gordon AL, Poot EP, Martin FC, O'Neill D, Petrovic M, Bachmann S, van Balen R, van Dam van Isselt L, Dockery F, Holstege MS, Landi F, Pérez LM, Roquer E, Smalbrugge M, Achterberg WP. Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance. Eur Geriatr Med 2021; 13:291-304. [PMID: 34800286 PMCID: PMC8605452 DOI: 10.1007/s41999-021-00575-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00575-4. Purpose To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Methods The guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined with experiences from experts in countries participating in the Geriatric Rehabilitation Special Interest Group of the European Geriatric Medicine Society. Results This guidance for post-acute COVID-19 rehabilitation is divided into a section addressing general recommendations for geriatric rehabilitation and a section addressing specific processes and procedures. The Sect. “General recommendations for geriatric rehabilitation” addresses: (1) general requirements for post-acute COVID-19 rehabilitation and (2) critical aspects for quality assurance during COVID-19 pandemic. The Sect. “Specific processes and procedures”, addresses the following topics: (1) patient selection; (2) admission; (3) treatment; (4) discharge; and (5) follow-up and monitoring. Conclusion Providing tailored geriatric rehabilitation treatment to post-acute COVID-19 patients is a challenge for which the guidance is designed to provide support. There is a strong need for additional evidence on COVID-19 geriatric rehabilitation including developing an understanding of risk profiles of older patients living with frailty to develop individualised treatment regimes. The present guidance will be regularly updated based on additional evidence from practice and research. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00575-4.
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Affiliation(s)
- Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Derby, UK
| | - Else P Poot
- Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Desmond O'Neill
- Trinity College Dublin Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Stefan Bachmann
- Department of Rheumatology and Internal Medicine, Kliniken Valens, Valens, Switzerland.,Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Frances Dockery
- Department of Geriatrics and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marije S Holstege
- Department of Research GRZPLUS, Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Laura M Pérez
- Clinical Head of Outpatient Clinic and Geriatric Home Care, Intermediate Care Hospital Parc Sanitari Pere Virgili, Barcelona, Spain.,Research Group on Aging, Frailty and Transitions in Barcelona (RE-FiT BCN), Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Esther Roquer
- Geriatric Service, University Hospital Sant Joan de Reus, Reus, Spain
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Chair of the Guidance Committee Post COVID-19 Geriatric Rehabilitation, Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
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Stuck AK, Mangold JM, Wittwer R, Limacher A, Bischoff-Ferrari HA. Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation. J Am Med Dir Assoc 2021; 23:880-884. [PMID: 34687605 DOI: 10.1016/j.jamda.2021.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility. METHODS Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves. RESULTS The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8). CONCLUSIONS AND IMPLICATIONS Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure.
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Affiliation(s)
- Anna K Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Joel M Mangold
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rachel Wittwer
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Heike A Bischoff-Ferrari
- Department of Aging Medicine, University Hospital Zurich, Zurich, Switzerland; Centre on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
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18
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Costa NA, Minicucci MF, Pereira AG, de Paiva SAR, Okoshi MP, Polegato BF, Zornoff LAM, Villas Boas PJF, Atherton PJ, Phillips BE, Banerjee J, Gordon AL, Azevedo PS. Current perspectives on defining and mitigating frailty in relation to critical illness. Clin Nutr 2021; 40:5430-5437. [PMID: 34653819 DOI: 10.1016/j.clnu.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/12/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 01/10/2023]
Abstract
Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.
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Affiliation(s)
- N A Costa
- Faculty of Nutrition, Univ Federal de Goiás (UFG), Goiânia, Brazil.
| | - M F Minicucci
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - A G Pereira
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - S A R de Paiva
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - M P Okoshi
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - B F Polegato
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - L A M Zornoff
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J F Villas Boas
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J Atherton
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - B E Phillips
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - J Banerjee
- Geriatric Emergency Medicine, University Hospitals of Leicester, School of Health Science, University of Leicester, Leicester, UK
| | - A L Gordon
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - P S Azevedo
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
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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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Beghi M, Cornaggia CM, Lozupone M, Piscitelli D, Perin C, Panza F. Late-life depression and its impact on rehabilitation after traumatic injuries. Aging Clin Exp Res 2021; 33:2313-2316. [PMID: 33156505 DOI: 10.1007/s40520-020-01744-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Francesco Panza
- Unit of Epidemiological Research On Aging, National Institute of Gastroenterology 'Saverio de Bellis', Research Hospital, Castellana Grotte, Bari, Italy.
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21
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Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, van Balen R, Kempen GIJM, Achterberg WP, van Haastregt JCM. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr 2021; 21:224. [PMID: 33794804 PMCID: PMC8017759 DOI: 10.1186/s12877-021-02170-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION Netherlands Trial Register: NTR5695 (7 March 2016).
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, 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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23
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Verstraeten LMG, van Wijngaarden JP, Pacifico J, Reijnierse EM, Meskers CGM, Maier AB. Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT. Clin Nutr 2021; 40:4090-4096. [PMID: 33622573 DOI: 10.1016/j.clnu.2021.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/02/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition and sarcopenia coexist in older adults, yet they remain largely undiagnosed and untreated, despite available interventions. This study aimed to assess the prevalence, the coexistence of, and the association between malnutrition and sarcopenia in geriatric rehabilitation inpatients. METHODS REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The association between malnutrition, diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2) (no sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia) was determined using multinomial logistic regression analyses, adjusted for age, sex, comorbidities and cognitive impairment. RESULTS Out of 506 geriatric rehabilitation inpatients, 51% were malnourished, 49% had probable sarcopenia, 0.4% had confirmed sarcopenia (non-severe) and 19% had severe sarcopenia. Malnutrition and probable sarcopenia and malnutrition and confirmed/severe sarcopenia coexisted in 23% and 13% of the 506 patients respectively. Malnutrition was not associated with probable sarcopenia (OR = 0.91, 95% CI = 0.58-1.42, p = 0.674) but with severe sarcopenia (OR = 2.07, 95% CI = 1.13-3.81, p = 0.019). CONCLUSION The prevalence, coexistence of, and the association between malnutrition and severe sarcopenia in geriatric rehabilitation inpatients warrant diagnosis at admission. Further research into feasible and effective interventions to counteract both conditions to improve geriatric rehabilitation outcomes is needed.
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Affiliation(s)
- L M G Verstraeten
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - J Pacifico
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - E M Reijnierse
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - A B Maier
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore.
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24
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Vluggen TPMM, van Haastregt JCM, Tan FE, Verbunt JA, van Heugten CM, Schols JMGA. Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial. BMC Geriatr 2021; 21:134. [PMID: 33622269 PMCID: PMC7903755 DOI: 10.1186/s12877-021-02082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care. Methods A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes. Results In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (− 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed. Conclusion The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects. Trial registration Current Controlled Trials ISRCTN62286281. Registered 19-3-2010. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02082-4.
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Affiliation(s)
- Tom P M M Vluggen
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands. .,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Frans E Tan
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of methodology and statistics, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Box 616, 6200, Maastricht, MD, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Eckert T, Wronski P, Bongartz M, Ullrich P, Abel B, Kiss R, Wensing M, Koetsenruijter J, Hauer K. Cost-Effectiveness and Cost-Utility of a Home-Based Exercise Program in Geriatric Patients with Cognitive Impairment. Gerontology 2021; 67:220-232. [PMID: 33503629 DOI: 10.1159/000512748] [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: 03/17/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There is a substantial lack of home-based exercise programs in the highly vulnerable group of geriatric patients with cognitive impairment (CI) after discharge from ward rehabilitation. Beyond clinical effectiveness, the cost-effectiveness of intervention programs to enhance physical performance is not well investigated in this target group. OBJECTIVE The aim of the study was to determine the cost-effectiveness of a 12-week home-based exercise intervention following discharge from ward rehabilitation compared to unspecified flexibility training for geriatric patients with CI from a societal perspective. METHODS This cost-effectiveness study was conducted alongside a randomized placebo-controlled trial. A total of 118 geriatric patients with CI (Mini-Mental State Examination score: 17-26) were randomized either to the intervention group (IG, n = 63) or control group (CG, n = 55). Participants in the IG received a home-based individually tailored exercise program to increase physical performance, while participants in the CG received unspecific flexibility training (placebo control). Healthcare service use, physical performance (Short Physical Performance Battery, SPPB), and quality of life (EQ-5D-3L) were measured over 24 weeks. The net monetary benefit (NMB) approach was applied to calculate incremental cost-effectiveness of the exercise intervention compared to the CG with respect to improvement of (a) physical performance on the SPPB and (b) quality-adjusted life years (QALYs). RESULTS Physical performance was significantly improved in the IG compared to the CG (mean difference at 24 weeks: 1.3 points; 95% confidence interval [95% CI] = 0.5-2.2; p = 0.003), while health-related quality of life did not significantly differ between the groups at 24 weeks (mean difference: 0.08; 95% CI = -0.05 to 0.21; p = 0.218). Mean costs to implement the home-based exercise intervention were EUR 284 per patient. The probability of a positive incremental NMB of the intervention reached a maximum of 92% at a willingness to pay (WTP) of EUR 500 per point on the SPPB. The probability of cost-utility referring to QALYs was 85% at a WTP of EUR 5,000 per QALY. CONCLUSION The home-based exercise intervention demonstrated high probability of cost-effectiveness in terms of improved physical performance in older adults with CI following discharge from ward rehabilitation, but not in terms of quality of life.
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Affiliation(s)
- Tobias Eckert
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany.,Karlsruhe Institute of Technology (KIT), Institute of Sport and Sport Science, Karlsruhe, Germany
| | - Pamela Wronski
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Bongartz
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany.,Network Aging Research (NAR), Heidelberg, Germany
| | - Phoebe Ullrich
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany
| | - Bastian Abel
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany
| | - Rainer Kiss
- Department of Health and Social Affairs, FHM Bielefeld, University of Applied Sciences, Bielefeld, Germany
| | - Michel Wensing
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department for General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Heidelberg, Germany,
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Belloni G, Seematter-Bagnoud L, Krief H, Aminian K, Büla CJ. Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients. Arch Phys Med Rehabil 2021; 102:1134-1139. [PMID: 33497699 DOI: 10.1016/j.apmr.2020.12.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation. DESIGN Prospective cohort study. SETTING Postacute rehabilitation facility. PARTICIPANTS Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge. RESULTS Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001). CONCLUSIONS In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.
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Affiliation(s)
- Giulia Belloni
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne; Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne.
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne; Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne
| | - Hélène Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Christophe J Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne
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Madruga-Flores M, Gómez-Del Río R, Delgado-Domínguez L, Martínez-Zujeros S, Pallardo-Rodil B, Baztán-Cortés JJ. [Predictive ability of baseline frailty and handgrip strength at admission on outcomes at discharge in a geriatric functional recovery unit]. Rev Esp Geriatr Gerontol 2021; 56:91-5. [PMID: 33478771 DOI: 10.1016/j.regg.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the predictive capacity of different frailty scales, as well as the strength of the handgrip, and to determine their relationship with clinical favourable outcomes. PATIENTS AND METHOD Prospective study of patients admitted to the Geriatric Functional Recovery Unit (GFRU) of the Hospital Central Cruz Roja. The «FRAIL» scale, «Clinical Frailty Scale» (CFS) and «Fragil-VIG» index, and handgrip strength by hydraulic dynamometer were completed on admission. A functional gain was assumed as 20 or more points in the Barthel Index and return to home, as good outcomes at discharge. The discriminative capacity of favourable outcomes for each frailty scale and handgrip strength was analysed by means of ROC curves, calculating the C statistic (area under the curve = AUC). RESULTS The analysis included 74 patients (median age 82 years; 48.5% women), admitted for stroke recovery (65%), orthopaedic pathology (16%), and other causes (19%). The prevalence of frailty varied between 31% (FRAIL scale), 40% (CFS), and 57.5% («Fragil-VIG»). Median handgrip strength was 15 Kg in males (interquartile range 11-21), and 9 Kg in females (interquartile range 7-12). At discharge, 51.5% of patients had a functional gain of 20 or more points in Barthel index, and 63% returned to their previous home. The discriminating ability to achieve acceptable functional gain at discharge was good for CFS (AUC = 0.72; 95% CI; 0.60-0.84) and «Fragil-VIG» (AUC = 0.72; 95% CI;0.58-0.82), and handgrip strength was the only tool related to return home (AUC = 0.68; 95% CI;0.56-0.81). CONCLUSION To evaluate frailty on admission to a GFRU contributes to predicting favourable clinical outcomes, but the discriminating capacity of each scale is variable.
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Bilek AJ, Borodin O, Carmi L, Yakim A, Shtern M, Lerman Y. Older patients with active cancer have favorable inpatient rehabilitation outcomes. J Geriatr Oncol 2021; 12:799-807. [PMID: 33358109 DOI: 10.1016/j.jgo.2020.12.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the characteristics and rehabilitation outcomes of older patients with active cancer (OPAC) undergoing post-acute inpatient rehabilitation (IR), and to evaluate which clinical factors are associated with poor rehabilitation outcomes. MATERIALS AND METHODS This is a retrospective study of patients aged ≥65 with active cancer undergoing IR following acute hospitalization at our tertiary hospital centre (N = 330). We collected data on patient, malignancy, and hospitalization characteristics, and IR outcomes including function, mobility, discharge destination, and mortality. Multivariate stepwise logistic regression was used to identify independent associations with the composite outcome of death within three months or discharge to long-term care (LTC). RESULTS Patient mean age was 80.1 ± 7.2 years. The most common malignancies were colon (30.9%) and hematologic (16.1%). Most patients were hospitalized urgently (64.8%) and underwent surgery (72.4%). From IR admission to discharge, patients ambulating independently increased from 14.0% to 52.0%. Discharge destination was to the community (80.4%), to LTC (7.6%), and transfer to an acute ward (7.2%), while 4.8% died during IR. One-year survival was 62.1%. The composite outcome was met by 24.8% of patients with multivariate logistic regression revealing independent associations (p < 0.05) with high baseline dependency, metastatic disease, low mobility score on IR admission, complications during acute care, and ≥ 75th percentile values for lactate dehydrogenase and alkaline phosphatase. CONCLUSION OPAC have favorable IR outcomes including high rate of community discharge, function and mobility gains, and lower mortality rates when compared with previously studied cancer rehabilitation populations. We identified several clinical markers associated with the composite outcome, which can guide post-acute discharge planning in patients with an unclear prognosis.
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Affiliation(s)
- Aaron Jason Bilek
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel.
| | - Oksana Borodin
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Liad Carmi
- Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Ariel Yakim
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Michael Shtern
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Yaffa Lerman
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
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van Wijngaarden JP, Wojzischke J, van den Berg C, Cetinyurek-Yavuz A, Diekmann R, Luiking YC, Bauer JM. Effects of Nutritional Interventions on Nutritional and Functional Outcomes in Geriatric Rehabilitation Patients: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2020; 21:1207-1215.e9. [PMID: 32723538 DOI: 10.1016/j.jamda.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/27/2019] [Revised: 02/19/2020] [Accepted: 04/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES It has been recognized that nutritional interventions play a role in improving the nutritional and functional status of older persons. This systematic review summarizes the evidence on nutritional and functional outcomes of nutritional interventions alone or in combination with physical exercise in geriatric rehabilitation patients. DESIGN Eight electronic databases were searched until July 1, 2019 to identify nutritional intervention studies in patients aged ≥60 years who were admitted to geriatric rehabilitation. A meta-analysis was performed to quantify intervention effects on serum albumin, muscle mass, and hand grip strength (HGS). RESULTS A total of 1962 studies were screened and 13 included in the systematic review. Studies were heterogeneous in interventions (4 nutritional interventions, 6 physical exercise + nutritional intervention, 1 timing of protein provision, 1 exercise + dietary advice, 1 nutrition-related nursing care) and outcomes. Among the 9 interventions that tested oral nutritional supplements (ONS) with protein, with or without exercise, 7 studies reported protein intake and 6 showed increased protein intakes, 2 of 5 studies showed increased albumin levels, and 5 of 9 reported an improvement in functional outcomes (BI, Functional Independence Measure, mobility). Meta-analyses showed no significant intervention effects on albumin [standardized mean difference (SMD) 0.45, 95% confidence interval (CI) -0.14, 1.04 (4 studies)], muscle mass [mean difference (MD) 2.14 kg, 95% CI -2.17, 6.45 (3 studies)], and HGS [SMD -0.04, 95% CI -0.55, 0.63 (3 studies)], but was based on a very limited number of studies. CONCLUSIONS AND IMPLICATIONS Only a limited number of studies with heterogeneous nutritional interventions and outcomes were available in the geriatric rehabilitation population. Studies that included ONS improved nutritional outcomes, especially protein intake and albumin levels. Functional outcomes improved in the majority of reporting studies. This indicates benefits of protein supplementation, with or without exercise, in this population. Future well-designed and well-powered clinical trials are needed to clarify existing controversial aspects.
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Affiliation(s)
| | - Julia Wojzischke
- Carl von Ossietzky Universität Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Claudia van den Berg
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | | | - Rebecca Diekmann
- Carl von Ossietzky Universität Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Yvette C Luiking
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Jürgen M Bauer
- Center for Geriatric Medicine, and Network Aging Research, University Heidelberg, Heidelberg, Germany
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Wouters TJ, van Dam van Isselt EF, Achterberg WP. Information needs of older patients living with chronic obstructive pulmonary disease (COPD) indicated for a specific geriatric rehabilitation programme: a prospective cohort study. Int J Palliat Nurs 2020; 26:238-245. [PMID: 32584692 DOI: 10.12968/ijpn.2020.26.5.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient information needs. However, it is unknown whether a geriatric rehabilitation programme for older patients with advanced COPD and severely impaired health status (the GR-COPD programme) does fit these patient information needs. OBJECTIVES The study aimed to identify the information needs of patients who were eligible for the GR-COPD programme, and investigated if health-related knowledge improved during rehabilitation. METHODS All patients indicated for the GR-COPD programme were eligible for this study. The information needs were measured with the Lung Information Needs Questionnaire (LINQ). FINDINGS The 158 patients (mean age 70.8 years; FEV1 %predicted: 35.5) showed relatively high baseline information needs (mean LINQ overall score: 8.6 [SD 3.1]), with the greatest need in the domains 'diet' and 'self-management'. After follow-up, the mean LINQ overall score significantly improved in patients who completed the GR-COPD programme (p=0.001). CONCLUSION Patients' knowledge showed a statistically significant improvement in some areas during the GR-COPD programme.
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Affiliation(s)
- Timotheus J Wouters
- Elderly Care Physician, Department of Public Health and Primary Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Eléonore F van Dam van Isselt
- Elderly Care Physician and Senior Researcher, Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilco P Achterberg
- Professor of Elderly Care Medicine, Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
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Vluggen TPMM, van Haastregt JCM, Verbunt JA, van Heugten CM, Schols JMGA. Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation. BMC Neurol 2020; 20:219. [PMID: 32471443 PMCID: PMC7260779 DOI: 10.1186/s12883-020-01791-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/26/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme. Methods In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme. Results A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme. Conclusion This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.
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Affiliation(s)
- Tom P M M Vluggen
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. .,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Grund S, Bauer J, Schuler M. [Post-acute geriatric rehabilitation outcomes in fracture patients treated in an orthogeriatric trauma center-A prospective investigation with historical control]. Z Gerontol Geriatr 2020; 53:564-571. [PMID: 32367172 DOI: 10.1007/s00391-020-01727-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the increasing amount of positive evidence with respect to mortality for the orthogeriatric co-management in a center for geriatric traumatology (CGT), effects on the course after the acute inpatient hospital treatment have been insufficiently investigated. METHODS Patients over 75 years old who needed rehabilitation following acute inpatient treatment before (retrospective, n = 90) and after (prospective, n = 99) the introduction of a certified CGT were investigated. The two groups were compared with respect to the frequency of discharge into an indication-specific (AHB) and geriatric rehabilitation, mobility performance including the five times sit-to-stand test, short physical performance battery (SPPB) and competence in activities of daily living with the Barthel index (BI). RESULTS After introduction of a CGT 17.2% (95 % confidence interval [95 % CI]: 10-25%; p < 0.027) of the patients were discharged to a specialized orthopedic inpatient rehabilitation (AHB) vs. 6.7% (95 % CI: 1-12%) before the introduction. Correspondingly less patients needed geriatric rehabilitation (before CGT 93.3 %, 95 % CI: 88.1-98.6 vs. CGT 82.8 %, 95 % CI: 75-90; p < 0.001). The overall outcome of post-acute geriatric inpatient rehabilitation improved in both groups but did not differ. Patients who needed two therapy sessions in the CGT were clearly poorer than those with one therapy session with respect to activities of daily living (BI: 34.1, 95 % CI: 30-37.2 vs. 41.2, 95 % CI: 30.9-51.4) and mobility performance (SPPB: 1.2, 95 % CI: 0.7-1.8 vs. 2.2, 95 % CI: 0.9-3.4; p = 0.048). The differences remained despite improvement of both groups during geriatric rehabilitation. CONCLUSION The establishment of a CGT enables more patients to be discharged into a less cost-intensive AHB. The more intensive treatment in the CGT offers more severely affected patients the chance for further functional improvement through post-acute inpatient geriatric rehabilitation. A predominantly closing treatment of patients in a CGT is not conceivable in the CGT model presented.
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Affiliation(s)
- Stefan Grund
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland. .,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.
| | - Jürgen Bauer
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
| | - Matthias Schuler
- Diakonissen Krankenhaus Mannheim Abteilung für Geriatrie, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
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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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Eichler S, Völler H, Reibis R, Wegscheider K, Butter C, Harnath A, Salzwedel A. Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:158. [PMID: 32252646 PMCID: PMC7137198 DOI: 10.1186/s12872-020-01452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/29/2020] [Indexed: 01/06/2023] Open
Abstract
Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.
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Affiliation(s)
- Sarah Eichler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany. .,Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany.
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Christian Butter
- Heart Center Brandenburg, Medical School Brandenburg, Bernau, Germany
| | | | - Annett Salzwedel
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
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Wojzischke J, van Wijngaarden J, van den Berg C, Cetinyurek-Yavuz A, Diekmann R, Luiking Y, Bauer J. Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis. Eur Geriatr Med 2020; 11:195-207. [PMID: 32297199 DOI: 10.1007/s41999-020-00294-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality. METHODS Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed. RESULTS 62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5-20) % and 47 (40-54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2-24.5) kg/m2. Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40-76% in this population. CONCLUSIONS Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.
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Bordne S, Rietz C, Schulz RJ, Zank S. Subjective well-being of geriatric patients during and after inpatient geriatric rehabilitation: a biopsychosocial prediction model. Eur Geriatr Med 2019; 10:965-75. [PMID: 34652771 DOI: 10.1007/s41999-019-00240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The study focused on indicators of subjective well-being (SWB) and how they developed during and after geriatric rehabilitation. Furthermore, a biopsychosocial prediction model for longer-term SWB was tested. METHODS Patients of an inpatient geriatric rehabilitation unit were assessed at admission, discharge and a three-month follow-up. Indicators of SWB comprised affect, life satisfaction, valuation of life and autonomy. Further, biomedical and psychosocial variables assessed upon admission were used to predict SWB at follow-up. Statistical analysis included repeated-measures (M)ANOVA depicting SWB development over time with Cohen's d for effect size, along with canonical correlation analyses used to test the biopsychosocial prediction model. RESULTS 78 out of 122 patients were assessed three times. Across all measurement points, different change patterns among SWB indicators were detected: Positive affect was significantly higher at follow-up than at admission (mean difference (MD) = .28, p < .01, Cohen's d = .37). Negative affect declined during rehabilitation (MD = - .29, p < .01, Cohen's d = .40) but increased again until follow-up (MD = .31, p < .01, Cohen's d = .42). Life satisfaction and valuation of life showed no change over time, while experience of autonomy gradually worsened from admission until follow-up (MD = - .29, p < .05, Cohen's d = .32). The biopsychosocial model revealed that personality traits and control beliefs best predicted SWB at follow-up. CONCLUSIONS Although geriatric rehabilitation has a positive effect on affect, it does not consistently improve other SWB indicators. Moreover, paying attention to psychological parameters such as personality in the daily geriatric routine could help to identify patients for whom longer-term SWB is particularly at risk.
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Baztán Cortés JJ, Martínez Zujeros S, Garmendia Prieto B, Pérez Morillo P, Martínez Cervantes Y, Resino Luis C, Román Belmonte JM, Gómez Pavón J, Pallardo Rodil B, Socorro García A. [Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. Rev Esp Geriatr Gerontol 2020; 55:18-24. [PMID: 31594677 DOI: 10.1016/j.regg.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.
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van Dam van Isselt EF, van Eijk M, van Geloven N, Groenewegen-Sipkema KH, van den Berg JWK, Nieuwenhuys CMA, Chavannes NH, Achterberg WP. A Prospective Cohort Study on the Effects of Geriatric Rehabilitation Following Acute Exacerbations of COPD. J Am Med Dir Assoc 2019; 20:850-856.e2. [PMID: 30982715 DOI: 10.1016/j.jamda.2019.02.025] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Older patients with chronic obstructive pulmonary disease (COPD), hospitalized for an acute exacerbation, often do not receive recommended post-acute pulmonary rehabilitation. This underuse might be related to the impaired clinical and functional status of these patients, who are more likely to present with frailty, comorbidities, and disability. Having developed and implemented a geriatric rehabilitation program for these patients (GR_COPD), the primary aim of this study was to investigate the effectiveness of this program. DESIGN AND INTERVENTION A prospective cohort study with a 3-month follow-up period. Patients who declined the GR_COPD program were considered as controls. SETTING AND PARTICIPANTS The study was conducted at the pulmonary department of 2 hospitals. Patients were eligible when hospitalized as a result of an acute exacerbation of COPD and indicated for the GR_COPD program based on standardized criteria. METHODS Primary outcome was defined as change in disease-specific health status measured with the clinical COPD questionnaire (CCQ), secondary outcome as the exacerbation rate ratio during follow-up. To balance potential confounders between the intervention and control group, propensity score-based weighted linear regression analyses were performed. RESULTS Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1) years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % of predicted], 78 received the GR_COPD program. The results of the CCQ showed a significant and clinically relevant treatment effect of -0.56 points [95% confidence interval (CI) -0.89, -0.23; P = .001). Patients in the control group had 2.77 times more exacerbations compared with the intervention group (95% CI 2.13, 3.58; P < .001). CONCLUSIONS/IMPLICATIONS This study shows a clinically relevant effect of the GR_COPD program on disease-specific health status and exacerbation rate. Implementation of the program for older patients with severe COPD hospitalized for an acute exacerbation is recommended.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands; Zorggroep Solis, Deventer, the Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Nan van Geloven
- Department of Medical Statistics, Leiden University Medical Centre, the Netherlands
| | | | | | - Cécile M A Nieuwenhuys
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
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Zuilekom SV, Schut RM, Munster BCV, Spies P. [ Geriatric rehabilitation of patients selected at the emergency department: patient factors related to rehabilitation outcome]. Tijdschr Gerontol Geriatr 2019; 50. [PMID: 32951366 DOI: 10.36613/tgg.1875-6832/2019.01.02] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.
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Affiliation(s)
| | - Renate M Schut
- Zorggroep Apeldoorn en omstreken, Apeldoorn, Netherlands
| | - Barbara C van Munster
- Universitair Medisch Centrum Groningen, Afdeling Interne Geneeskunde, Groningen, Netherlands, Groningen, Nederland
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Everink IHJ, van Haastregt JCM, Tan FES, Schols JMGA, Kempen GIJM. The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatr 2018; 18:285. [PMID: 30445923 PMCID: PMC6240181 DOI: 10.1186/s12877-018-0971-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/01/2018] [Indexed: 11/26/2022] Open
Abstract
Background To improve continuity and coordination of care in geriatric rehabilitation, an integrated care pathway was developed and implemented in The Netherlands. The purpose of this study was to assess the effects of this pathway on patients and informal caregivers. Methods Two cohorts of patients and their informal caregivers were prospectively recruited before implementation of the pathway (2011–2012) and after implementation of the pathway (2013–2014). Primary outcome measures were dependence in activities of daily living in patients (KATZ-15) and self-rated burden among informal caregivers (SRB-VAS). Secondary outcome measures were the frequency of performing extended daily activities, social participation, psychological well-being, quality of life and discharge location (patients) and quality of life and objective care burden (informal caregivers). Outcomes were measured at baseline, after three and after nine months. Results No effect was shown on the KATZ-15 after three and nine months. However, a larger percentage of patients were discharged home in the care pathway cohort (83% vs 58.1% after three months and 88.6% vs 67.4% after nine months; p = 0.004). Furthermore, after three months, patients from the care pathway cohort performed more extended daily activities (p = 0.014) and informal caregivers experienced a lower self-rated burden (p = 0.05). After nine months, these effects disappeared. No differences were found for the other outcome measures. Conclusions Due to the positive effects of the integrated care pathway, we are inclined to recommend implementing the care pathway in regular care. To have longer lasting effects among patients and informal caregivers, we suggest actively disseminating information about the pathway to primary care providers who are currently still unaware of its content. Trial registration ISRCTN90000867 (date of registration: 07-04-2016).
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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van Dam van Isselt EF, van Wijngaarden J, Lok DJA, Achterberg WP. Geriatric rehabilitation in older patients with cardiovascular disease: a feasibility study. Eur Geriatr Med 2018; 9:853-861. [PMID: 30546796 PMCID: PMC6267640 DOI: 10.1007/s41999-018-0119-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Cardiac rehabilitation in older patients after hospitalization because of cardiovascular disease is recommended. However, many older patients do not receive cardiac rehabilitation in daily practice, due to lack of referral and poor adherence. This can be related to impaired clinical and functional status of these patients, who are more likely to present with frailty, frequent comorbidities, and disability. Geriatric rehabilitation might be a possible solution to reduce barriers to cardiac rehabilitation attendance. We developed and implemented an inpatient geriatric rehabilitation programme that was provided immediately after discharge from the hospital, for older patients with a significant functional decline during hospital admission because of cardiovascular disease: 'the GR-cardio programme'. The primary aim of the present study is to investigate feasibility of the GR-cardio programme. METHODS This is a retrospective real-life feasibility study describing a consecutive series of older patients receiving the GR-cardio programme, with no control group. All patients had been hospitalized because of cardiovascular disease. Data on patient characteristics, functional status, health-related quality of life (HRQoL), readmissions, and mortality were collected from the patients file on admission, at discharge and 6 months after discharge from the GR-cardio programme. Feasibility of the programme was evaluated using the following outcomes: recruitment, resulting sample characteristics, safety, and preliminary evaluation of patients' responses to the GR-cardio programme. RESULTS In total, 58 patients [mean age 78.8 (± 9.8) years; 43% male] were included in the study. On admission, functional status and HRQoL were severely impaired but showed clinically relevant improvements. During the programme, three patients died. Eighty-three percent of all patients were discharged back home after completing the rehabilitation programme with a mean length of 38 days. Mortality rate during follow-up was the highest in patients with heart failure (32%). CONCLUSIONS This study indicates that geriatric rehabilitation for patients with cardiovascular disease is feasible. Furthermore, our results show that the GR-cardio programme can probably offer substantial benefits for patients in terms of improving functional status and HRQoL.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Zorggroep Solis, Deventer, The Netherlands.
| | | | - Dirk J A Lok
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Alter KE, Acevedo AT, Jackson A. Regional Rheumatic Disorders and Rehabilitation in Older Adults: An Update. Rheum Dis Clin North Am 2018; 44:453-473. [PMID: 30001786 DOI: 10.1016/j.rdc.2018.03.005] [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] [Indexed: 11/17/2022]
Abstract
Musculoskeletal problems are the most frequently reported complaints among older adults living in the community. The impact of the aging process on skeletal muscles and joints can have a profound effect on the ability of individuals to function. This article reviews the rehabilitation medicine approach to the evaluation of older adults with regional rheumatic disorders and the rehabilitation medicine considerations for clinical intervention. Future research is required to gain a greater understanding of the subject matter and its impact on the provision of care and patients' quality of life.
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Affiliation(s)
- Katharine E Alter
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA.
| | - Ana T Acevedo
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA
| | - Adrienne Jackson
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA
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Abstract
This systematic review summarizes the psychometric properties of goal-setting instruments that are applied within geriatric rehabilitation. PubMed Medline and Embase were systematically searched for eligible articles. Studies were included if they were conducted in a somatic or neurological rehabilitation setting, included patients aged ≥55 years and provided data on instruments' psychometric properties (validity, reliability, responsiveness), utility and/or feasibility. Eleven studies were included. Seven studies, all conducted by one research group, evaluated Goal-Attainment Scaling (GAS), two studies assessed the Canadian Occupational Performance Measure (COPM) and one study the Self-Identified Goals Assessment (SIGA), which is based on the COPM. One study assessed a core set of the International Classification of Functioning, Disability and Health (ICF) framework. High concurrent, content and predictive validity and inter-rater reliability were found for GAS. Responsiveness appears to be excellent. Concurrent validity and inter-rater reliability of the COPM and content validity of both the COPM and SIGA appear to be good. Responsiveness of both instruments seems to be poor. Content validity of the ICF core set was found to be fair; responsiveness appears to be very poor. There is little published data on goal-setting instruments in geriatric rehabilitation. Evidence for its psychometric properties may support GAS as goal-setting instrument and additional outcome measure. However, more research is required in order to evaluate GAS, as research conducted in other health care settings may provide important additional findings. Before the COPM (or SIGA) can be recommended as goal-setting instrument, its psychometric properties require further research.
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Affiliation(s)
- R van Seben
- R. van Seben, Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, PO Box 22660, Meibergdreef 9 1100 DD Amsterdam, The Netherlands, +31 (0) 20 56 61282,
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Kabboord AD, Van Eijk M, Buijck BI, Koopmans RTCM, van Balen R, Achterberg WP. Comorbidity and intercurrent diseases in geriatric stroke rehabilitation: a multicentre observational study in skilled nursing facilities. Eur Geriatr Med 2018; 9:347-353. [PMID: 29887923 PMCID: PMC5972181 DOI: 10.1007/s41999-018-0043-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/07/2017] [Accepted: 03/02/2018] [Indexed: 10/29/2022]
Abstract
Background Older patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status. Materials and methods This multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases. Furthermore, their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI). Results Of the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p < 0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33-19.2], compared to 1.73 [0.52-5.72] (comorbidity only) and 1.62 [0.53-4.94] (only BI ≤ 14). Conclusions On admission, functional impairments and comorbidity, particularly diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity integrated with functional status at the start of rehabilitation is essential to identify patients at risk. Finally, particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery .
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Affiliation(s)
- Anouk D Kabboord
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Monica Van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Bianca I Buijck
- Department of Neurology, Erasmus MC University Medical Center, 's-Gravendijkwal 230, Rotterdam, The Netherlands.,Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,"Joachim en Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
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Blindenbach S, Vrancken JWFA, van der Zeijden H, Reesink HJ, Brijker F, Smalbrugge M, Wattel EM. [Effects of Geriatric COPD rehabilitation on hospital admissions and exercise tolerance: a retrospective observational study]. Tijdschr Gerontol Geriatr 2018; 48:112-120. [PMID: 28447319 DOI: 10.1007/s12439-017-0214-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Frail COPD patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and functional limitations. Rehabilitation programs in nursing homes for geriatric patients with COPD have been developed. The effects of such programs are largely unknown. AIMS To assess the course of COPD-related hospital admissions and exercise tolerance in a cohort of frail COPD patients participating in geriatric COPD rehabilitation. METHODS Retrospective observational study with a follow up of 12 months after discharge from rehabilitation. COPD related hospital admission days were measured in the year before and after participating rehabilitation. Exercise tolerance was measured by the six minute walk test (6MWT) at admission and at discharge from rehabilitation. RESULTS Fifty-eight participants accomplished the rehabilitation program. Twelve patients died in the first year after discharge. The median number of hospital admission days in the year before participating rehabilitation was 21 (IQR 10-33). The first year after discharge this was decreased to a median of 6 (IQR 0-12). The 6MWT increased from 194 (SD 85) meters at admission to 274 (SD 95) meters at discharge (mean difference 80 m, SD 72; p < 0.05). CONCLUSIONS Geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.
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Affiliation(s)
| | | | | | - Herre J Reesink
- St. Antonius Ziekenhuis, Utrecht/Nieuwegein, Nederland.,OLVG, Amsterdam, Nederland
| | | | - Martin Smalbrugge
- Afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam Public Health research institute, VU Medisch Centrum, Amsterdam, Nederland
| | - Elizabeth M Wattel
- Afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam Public Health research institute, VU Medisch Centrum, Amsterdam, Nederland
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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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Hauer K, Ullrich P, Dutzi I, Beurskens R, Kern S, Bauer J, Schwenk M. Effects of Standardized Home Training in Patients with Cognitive Impairment following Geriatric Rehabilitation: A Randomized Controlled Pilot Study. Gerontology 2017; 63:495-506. [PMID: 28813696 DOI: 10.1159/000478263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Post-ward geriatric rehabilitation programs have hardly been developed and validated, which leaves a substantial gap in rehabilitative care in older adults and hinders full exploitation of maintained, but often unrecognized rehabilitation potentials. Geriatric rehabilitation patients with cognitive impairment represent a highly vulnerable population which is often affected by a lack of an ongoing support at the intersection between ward-based and post-ward rehabilitation. OBJECTIVE To determine the effect of a standardized home-based training program in geriatric patients with cognitive impairment following ward-based rehabilitation. METHODS A randomized controlled, single-blinded intervention trial (RCT) with wait list control design was used. Geriatric patients (n = 34; age: 81.9 ± 5.7 years) with cognitive impairment (MMSE: 18.8 ± 4.7), identified by predefined in- and exclusion criteria, were consecutively recruited from a geriatric rehab ward. Patients in the intervention group (IG, n = 17) performed a 6-week strength and functional home training. The control group (CG, n = 17) started an identical training 6 weeks later with an initial usual care period during the intervention for the IG. Functional performance (Short Physical Performance Battery; SPPB), clinically relevant functional deficits (Performance Oriented Assessment; POMA), and physical activity (Assessment of Physical Activity For Older Persons questionnaire; APAFOP) represented primary outcome measurements complemented by additional secondary outcome parameters. RESULTS The IG significantly increased functional performances in SPPB (total score: p = 0.012; chair rise: p = 0.007, balance: p = 0.066), reduced gait and balance deficits in POMA (total score: p = 0.006; balance: p = 0.034; gait: p = 0.019), and increased physical activity (APAFOP; p = 0.05) compared to the CG. Effect sizes showed medium to large effects for significant parameters (eta2 = 0.14-0.45). Training benefits and adherence were more pronounced following the immediate onset of post-ward training compared to a delayed start (eta2 = 0.06-0.23). CONCLUSION Results of this pilot study show that a feasible and easy to handle, home-based rehabilitation program increased functional performance and physical activity in a vulnerable, multimorbid patient group with cognitive impairment, in particular when the post-ward training onset was not postponed.
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Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, University of Heidelberg, Heidelberg, Germany
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Oesch P, Kool J, Fernandez-Luque L, Brox E, Evertsen G, Civit A, Hilfiker R, Bachmann S. Exergames versus self-regulated exercises with instruction leaflets to improve adherence during geriatric rehabilitation: a randomized controlled trial. BMC Geriatr 2017; 17:77. [PMID: 28330455 PMCID: PMC5363020 DOI: 10.1186/s12877-017-0467-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/17/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Improving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking. METHODS Design: single center parallel group non-blinded randomized controlled trial with central stratified randomization. SETTING center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days. Patients reported adherence (primary outcome), enjoyment and motivation daily. Balance during walking was measured blind before and after the treatment phase with an accelerometer. Analysis was by intention to treat. Repeated measures mixed models and Cohen's d effect sizes (ES, moderate if >0.5, large if > 0.8) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05. RESULTS From June 2014 to December 2015 217 patients were evaluated and 54 included, 26 in the EG and 28 in the CG. Adverse effects were observed in two patients in the EG who stopped because of pain during exercising. Adherence was comparable at day one (38 min. in the EG and 42 min. in the CG) and significantly higher in the CG at day 10 (54 min. in the CG while decreasing to 28 min. in the EG, p = 0.007, ES 0.94, 0.39-0.151). Benefits favoring the CG were also observed for enjoyment (p = 0.001, ES 0.88, 0.32 - 1.44) and motivation (p = 0.046, ES 0.59, 0.05-1.14)). There was no between-group effect in balance during walking. CONCLUSIONS Self-regulated exercise using instruction leaflets is superior to exergames regarding adherence, enjoyment and motivation in a geriatric inpatient rehabilitation setting. Effects were moderate to large. There was no between group difference in balance during walking. TRIAL REGISTRATION ClinicalTrials.gov, NCT02077049 , 6 February 2014.
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Affiliation(s)
- Peter Oesch
- Rehabilitationsklinik Valens, Taminaplatz 1, 7317, Valens, Switzerland.
| | - Jan Kool
- Rehabilitationsklinik Valens, Taminaplatz 1, 7317, Valens, Switzerland
| | - Luis Fernandez-Luque
- Norut, Tromsø, Norway.,Qatar Computing Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | | | | | - Anton Civit
- Architecture and Computer Technology Department, University of Seville, Seville, Spain
| | - Roger Hilfiker
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), 1950, Sion, Switzerland
| | - Stefan Bachmann
- Rehabilitationsklinik Valens, Taminaplatz 1, 7317, Valens, Switzerland.,Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
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49
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Scheffers-Barnhoorn MN, van Haastregt JCM, Schols JMGA, Kempen GIJM, van Balen R, Visschedijk JHM, van den Hout WB, Dumas EM, Achterberg WP, van Eijk M. A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial. BMC Geriatr 2017; 17:71. [PMID: 28320331 PMCID: PMC5359926 DOI: 10.1186/s12877-017-0465-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/14/2017] [Indexed: 05/29/2023] Open
Abstract
Background Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning. Methods/design This multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility. Discussion Targeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible. Trial registration Netherlands Trial Register: NTR 5695.
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.,Geriatric Center and Nursing Home Antonius Binnenweg, Laurens, Rotterdam, The Netherlands
| | - Jan H M Visschedijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making and Quality of Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Eve M Dumas
- Medical Psychology department, The Tjongerschans Hospital, Postbox 10500, 8440 MA, Heerenveen, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
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50
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Everink IHJ, van Haastregt JCM, Maessen JMC, Schols JMGA, Kempen GIJM. Process evaluation of an integrated care pathway in geriatric rehabilitation for people with complex health problems. BMC Health Serv Res 2017; 17:34. [PMID: 28086867 PMCID: PMC5237356 DOI: 10.1186/s12913-016-1974-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 12/30/2016] [Indexed: 11/25/2022] Open
Abstract
Background An integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations. A process evaluation was performed to assess the feasibility of this pathway. Methods The study design incorporated mixed methods. Feasibility was assessed thru if the pathway was implemented according to plan (fidelity and dose delivered), (b) if patients, informal caregivers and professionals were satisfied with the pathway (dose received) and (c) which barriers and facilitators influenced implementation (context). These components were derived from the theoretical framework of Saunders and colleagues. Data were collected using three structured face-to-face interviews with patients, self-administered questionnaires among informal caregivers, and group interviews with professionals. Furthermore, data were collected from the information transfer system in the hospital, patient files of the geriatric rehabilitation facility and minutes of evaluation meetings. Results In total, 113 patients, 37 informal caregivers and 19 healthcare professionals participated in this process evaluation. The pathway was considered largely feasible as two components were fully implemented according to plan and two components were largely implemented according to plan. The timing and quality of medical discharge summaries were not sufficiently implemented according to plan and professionals indicated that the triage instrument needed refinement. Healthcare professionals were satisfied with the implementation of the pathway and they indicated that due to improved collaboration, the quality of care provision improved. Although patients and informal caregivers were also satisfied with the care provision in the pathway, they indicated that the care organisations involved should pay more attention towards providing information about their treatment. Conclusions This process evaluation showed that patients, informal caregivers and professionals are fairly satisfied with the care provision in the pathway and professionals reported that collaboration improved. Extra attention should be paid to the components in the pathway that were not implemented according to plan. Trial registration ISRCTN90000867 Registered 7 April 2016.
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jose M C Maessen
- Department of Patient & Integrated Care, Maastricht University Medical Centre, P.O.Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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