Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review.

OBJECTIVE: To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. DATA SOURCES: Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. REVIEW METHODS: Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. RESULTS: A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. CONCLUSION: The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.

Post-acute COVID-19 geriatric rehabilitation : A European perspective.

Coronavirus disease 2019 (COVID-19) poses a threat to the health and independence of older people in particular. In this article we elaborate on the content and importance of post-acute COVID-19 geriatric rehabilitation from a European perspective. We explain the geriatric rehabilitation paradox and how this can and should be solved. We also present what post-acute COVID-19 geriatric rehabilitation should entail. This might not only help us to develop better geriatric rehabilitation services, but it should also inform pandemic preparedness in the future.

[Consulting the nursing home physician; an interesting but less used option]. / De verpleeghuisarts in consult: een te weinig benutte toegevoegde waarde.

OBJECTIVE: To describe the current use of the consultation function of nursing home physicians. Setting Descriptive inventory study. METHODS: A questionnaire (with 16 questions regarding the consultation function of nursing home physicians) was sent to the head of the medical staff of all nursing homes in The Netherlands (n=323). RESULTS: The response to the questionnaire was 78%. The use of the consultation function appeared to be very low. Only 20% of respondents answered that their medical staff was involved in weekly or monthly consultations upon request of general practitioners. Respondents mentioned unfamiliarity with the expertise of nursing home physicians as the main reason for this low consultation frequency. A positive relationship was found between the consultation frequency and some organizational parameters. CONCLUSION: Nursing home physicians are not often consulted by general practitioners. Compared to 7 years ago even a decline in the consultation frequency has occurred. Paradoxically, the current trend in chronic care to offer care and treatment as long as possible in the home situation of patients, leads to a situation in which Dutch nursing homes offer more and more complementary nursing and medical support to community care for chronically ill and disabled patients, still living at home. This trend stresses also the importance of more collaboration between general practitioners and nursing home physicians. Further research concerning the added value of this collaboration is necessary

Functional bowel symptoms in a general Dutch population and associations with common stimulants.

BACKGROUND: Functional gastrointestinal symptoms are often felt to be related to the use of alcohol, coffee and smoking. METHODS: A random sample of 500 adults was interviewed by telephone about their gastrointestinal symptoms and the use of alcohol, coffee and smoking. Dyspepsia and irritable bowel syndrome (IBS) were defined using common, internationally used criteria. RESULTS: Of those invited, 85.4% agreed to participate (43.5% male). Of the participants 21.4% had gastrointestinal symptoms >6 times/last year, 13.8% had dyspepsia, and 5.8% had IBS, the latter being more common among women. Of the men, 83.9% reported alcohol consumption, 92.0% drank coffee, and 52.2% smoked. Of the women 62.4% drank alcohol, 88.1% drank coffee and 29.8% smoked. Use of alcohol or coffee was not related to dyspepsia. Current smokers had a 2.3-fold increased risk (P=0.02) and former smokers a 2.7 increased risk (P=0.009) for dyspepsia compared to never smokers. No association between IBS and use of alcohol, coffee or smoking could be demonstrated. CONCLUSIONS: The prevalence of dyspepsia (13.8%) and of IBS (5.8%) in a general Dutch adult population appears to be lower than are reported in other countries. Use of alcohol and coffee was not associated with functional bowel symptoms. Former and current smoking were strongly related to dyspepsia.

Cryptogenic Salmonella-infected ruptured aortic aneurysms.

Salmonella-infected ruptured aortic aneurysms are a difficult surgical problem. Five patients with Salmonella-infected ruptured aortic aneurysms are presented. All patients were initially treated by in situ graft replacement, wide debridement of the infected aortic tissue and long-term systemic antibiotic therapy. The surgical technique of choice in acute situations, such as a rupture of the aneurysm, remains controversial. In the recent literature 26 reported cases were reviewed. Based on our clinical experience and these case reports, in situ bypass reconstruction can be justified as a surgical technique that gives at least a good short-term prognosis.