Contextual determinants influencing the implementation of fall prevention in the community: a scoping review.

Background: Successful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community. Methods: A scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research. Results: Fourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as "networks and communications", "formally appointed internal implementation leaders", "available resources" and "patient needs and resources". The other constructs (n = 14) were identified only in the . Discussion: Findings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.

Psychometric evaluation of the Decision Support Tool for Functional Independence in community-dwelling older people.

Background: The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI. Methods: Sixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient. Results: Seven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated 'relevant' and 'complete', content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability. CONCLUSION: The DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.

Characteristics of patients with knee and ankle symptoms accessing physiotherapy: self-referral vs general practitioner's referral.

OBJECTIVES: To determine patient characteristics, frequency of use, type of symptoms and treatment outcomes in patients with knee or ankle symptoms, separately, for patients referred by their general practitioner (GP) and patients who self-referred. DESIGN: Longitudinal study. SETTING: Dutch primary care physical therapy practices. PARTICIPANTS: All patients who visited a physiotherapist with knee or ankle symptoms between 2006 and 2012. METHOD: Data were collected from the NIVEL Primary Care Database. The mode of access (self-referred or GP-referred) was determined for all patients. For analyses, descriptive statistics, unpaired t-tests, Chi-square test and logistic regression analyses were applied. RESULTS: The study included 6179 patients with knee or ankle symptoms. The use of self-referral increased from 26% in 2006 to 56% in 2012, and stabilised between 2010 and 2012. Self-referred patients were younger, had a higher education level and had a shorter duration of symptoms compared with GP-referred patients. Self-referred patients had fewer treatment sessions than GP-referred patients. CONCLUSIONS: Among patients with knee or ankle symptoms, younger patients, and those with a higher education level, a shorter duration of symptoms and recurrent symptoms were more likely to self-refer than other patients. Self-referred patients had fewer treatment sessions. After 2009, the frequency of self-referrals to physical therapists stabilised. Future studies should examine the effectiveness of physical therapy for patients who self-refer with acute knee and ankle symptoms.

Measurement properties of patient-specific instruments measuring physical function.

OBJECTIVE: To identify patient-specific self-assessment instruments, which measure physical function in patients with musculoskeletal disorders and to evaluate the descriptive properties and the psychometric qualities of these instruments. STUDY DESIGN AND SETTING: After a systematic search, included instruments were evaluated psychometrically by the checklist "quality criteria for measurement properties of health status instruments." RESULTS: Twenty-three studies were included, referring to 12 instruments. Nine different versions of the Patient-Specific Functional Scale (PSFS) were identified. The practical elaboration of the different versions of the PSFS varied widely. None of the instruments were tested on all psychometric quality criteria of the checklist. The PSFS described by Cleland et al. was most extensively investigated and obtained exclusively positive scores. Overall, construct validity, reliability, and responsiveness were evaluated most frequently. CONCLUSION: The descriptive properties and psychometric quality of patient-specific instruments measuring physical function are only partly investigated. The PSFS was the most investigated instrument: nine different versions have been evaluated psychometrically. The version of Cleland et al. was most extensively investigated, obtained exclusively positive scores following the quality criteria by Terwee et al., and could be recommended for clinical use therefore. Future research will be necessary to confirm the psychometric quality of patient-specific instruments measuring physical function in patients with musculoskeletal disorders.

Factors associated with physical activity in patients with osteoarthritis of the hip or knee: a systematic review.

OBJECTIVE: To give an overview of factors related to the level of physical activity in patients with hip or knee osteoarthritis (OA). METHODS: An extensive systematic literature search was conducted in PubMed, CINAHL and Embase. Inclusion criteria were: studies on patients with a diagnosis of OA of hip and/or knee, studies describing factors related to physical activity (objective or subjective), full length articles that were published in Dutch, German or English language. Two reviewers independently assessed the methodological quality. A best-evidence synthesis was performed for factors which were investigated in two or more studies. RESULTS: Eight studies were included, all with a cross-sectional design (five high quality and three low quality studies), resulting in, at most, limited evidence in the best-evidence synthesis. For patients with knee OA there is limited evidence that a lower level of physical function is associated with a lower level of physical activity. There is also limited evidence that depression is not associated with the level of physical activity. For patients with hip OA there is limited evidence that higher age, higher body mass index (BMI) and a low level of physical function is associated with a low level of physical activity. CONCLUSION: A high age (hip OA), a high BMI (hip OA) and a low level of physical function (both hip and knee OA) are related to a low level of physical activity. However, the level of evidence was only limited. Before new strategies and interventions to increase physical activity in patients with OA can be developed, high quality longitudinal studies are needed to get more insight in the causality between factors and low levels of physical activity.