Learning with technology in physiotherapy education: design, implementation and evaluation of a flipped classroom teaching approach.

BACKGROUND: The purpose of the study was to describe the design, implementation and evaluation of a flipped classroom teaching approach in physiotherapy education. The flipped classroom is a blended learning approach in which students receive digital lectures as homework, while active learning activities are used in the classroom. Flipped classroom teaching enables a learning environment that aims to develop higher-order cognitive skills. METHODS: The study design was a historically controlled, prospective, cohort study. An eight week theoretical course on musculoskeletal disorders was redesigned, moving from a conventional approach to a flipped classroom model. Pre-class learning material consisted of about 12 h of video lectures and other digital learning resources that were split up over the duration of the course. In-class activities consisted of seven full-day seminars where students worked in groups in order to solve problem-based assignments. The assignments were designed to reflect authentic clinical problems and required critical thinking and reasoning. Outcomes were measured with course-grades and compared with historical controls of conventional teaching, using descriptive statistics. Self-perceived learning outcomes and students' experiences were also collected in a survey. RESULTS: Fifty-one students passed the course exam, two failed and one did not attend (n = 54). The share of students with Excellent, Very good and Good (ABC) performances increased by more than 10% relative to any previous year. In addition, Satisfactory, Sufficient and Failed performances (DEF) decreased by more than 10%. Almost two thirds of the students preferred the flipped classroom approach as compared with conventional teaching. Interaction with peers and educators, and flexibility, were the most positive factors that were reported by students. Long seminars, time-constraints and low motivation with respect to preparation and educators' roles were the most common complaints. CONCLUSIONS: A flipped classroom approach in physiotherapy education resulted in improved student performances in this professional programme, when compared with conventional teaching. Students responded positively to the collaborative learning environment, especially with respect to the associated autonomy and flexibility. There were indicators that all groups did not work optimally and that accountability to other group members did not always ensure pre-classroom preparations.

Association between health-related quality of life, physical fitness, and physical activity in older adults recently discharged from hospital.

The purpose of this study was to determine the relationship among health-related quality of life (HRQOL), physical fitness, and physical activity in older patients after recent discharge from hospital. One hundred fifteen independent-living older adults (ages 70-92 years) were included. HRQOL (Medical Outcomes Study 36-item Short Form Health Survey), physical activity (Physical Activity Scale for the Elderly), and physical fitness (Senior Fitness Test) were measured 2-4 weeks after discharge. Higher levels of physical activity and physical fitness were correlated with higher self-reported HRQOL. Although cause and effect cannot be determined from this study, the results suggest that a particular focus on the value of physical activity and physical fitness while in hospital and when discharged from hospital may be important to encourage patients to actively preserve independence and HRQOL. It may be especially important to target those with lower levels of physical activity, poorer physical fitness, and multiple comorbidities.

Prolonged strength training in older patients after hip fracture: a randomised controlled trial.

OBJECTIVE: the aim of this study was to assess the effect of a 12-week once-a-week prolonged strength-training programme in a group of home-dwelling older hip fracture patients. DESIGN: randomised, controlled; single-blind parallel-group trial. SETTING: intervention at outpatient's clinic. SUBJECTS: 95 patients with surgical fixation for a hip fracture completed a preceding 3-month progressive strength-training programme twice a week. METHODS: the programme comprised four exercises, performed at 80% of maximum capacity. Measurements were taken after 12 weeks of intervention. Outcome measurements were Berg Balance Scale (BBS), the sit-to-stand test, timed up-and-go test, maximal gait speed, 6-min walk test, Nottingham Extended Activities of Daily Living scale and the Short Form-12 questionnaire. RESULTS: we found no statistically significant difference between groups in the primary outcome BBS, presumably because of a ceiling effect. The intervention group showed significant improvements in strength, gait speed and gait distance, instrumental activities of daily living and self-rated health. CONCLUSIONS: twelve weeks of progressive strength training performed once a week, as a follow-up to a more intensive training period, seemed to improve strength and endurance and resulted in better self-reported NEADL and self-rated health after hip fracture. Hip fracture patients seem to constitute a group that needs long-term follow-up to achieve the improvements necessary for independent functioning.

Do behavioral disturbances predict falls among nursing home residents?

BACKGROUND AND AIMS: The purpose of our study was to examine whether severity of dementia, behavioral and psychological symptoms and depression can predict falls among nursing home residents, such as demographic variables, activities of daily living, and use of psychotropic drugs, when potential confounders are controlled for. METHODS: 1147 nursing home residents were examined in this one-year follow-up study. All residents were examined with the Physical Self-Maintenance scale (Activities of Daily Living - ADL), Clinical Dementia Rating Scale (CDR), Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, physical health and use of medication were collected from medical records. RESULTS: 40% of participants had at least one fall during the one-year follow-up period. Bivariate survival analysis revealed that low level of education, severe dementia, severe behavioral and psychological symptoms, severe depression, greater functional impairment, age, worsening in physical health, and use of sedatives, significantly predict one or more falls. Multivariate Cox regression analyses showed that age, higher scores on NPI and CDR, use of sedatives and dependency in ADL were all, independently of each other, predictors of an increased risk of falling. CONCLUSIONS: Having a high NPI score was identified as a significant and independent predictor of falls. Since falling is a common event which causes considerable morbidity and mortality in older people, these findings are important for healthcare and for the individuals concerned. To prevent falling in nursing homes, special attention must be paid to residents with severe dementia, to behavioral symptoms and use of sedatives.

Progressive strength training in older patients after hip fracture: a randomised controlled trial.

OBJECTIVE: the aim of this study was to assess the effect of a 3-month strength-training programme on functional performance and self-rated health in a group of home-dwelling older hip fracture patients. DESIGN: randomised, controlled; single-blind parallel-group trial. SETTING: intervention at outpatient's clinic. SUBJECTS: one hundred and fifty patients with surgical fixation for a hip fracture. METHODS: strength training was integrated into all stages of the programme. The programme comprised four exercises, half of them in a standing position, performed at 80% of maximum. Measurements were taken after the 3-month intervention. The primary outcome measurement was the Berg Balance Scale (BBS). Secondary outcomes were results of the sit-to-stand test, Timed Up-and-Go test, maximal gait speed, 6-min walk test, Nottingham Extended Activities of Daily Living scale and the SF-12 health status questionnaire. RESULTS: at baseline, there were no significant between-group differences. At follow-up, the intervention group showed highly significant improvements both in the primary endpoint (BBS, mean difference 4.7 points) and in secondary endpoints of tapping strength, mobility and instrumental activities of daily living. CONCLUSION: home-dwelling hip fracture patients can benefit from an extended supervised strength-training programme in a rehabilitation setting. These patients are capable of high-intensity strength training, which should optimise gains in physical function, strength and balance. Resistance exercise training seems to influence functional performance adaptation.

Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study.

The objective of the study was to examine the predictive effect of prospectively registered falls on survival within a randomly selected group of elderly women. A longitudinal study, with 9 years follows up after 1 year prospective fall registration was designed. Persons age 75 or more living in the community. A total of 300 Norwegian women; mean age was 80.8 participated in the study. Base-line registrations of health, functioning and medication were made. Falls which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period. Half of the women reported one or more falls (1-11). Eighty-six women (28.7%) experienced only one fall and 65 (21.7%) had at least two. During the 9-year follow-up period, 41.7% died. Cox regression analyzes demonstrated that frequent falling, old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period. Their relative risks of death when experiencing at least two falls was 1.6 (95% CI 1.1-2.4), P = 0.04, when compared with no falls. Older fallers appear to have markedly increased mortality. Since falls are common among elderly people, this is a relevant fact for public health policy. Increasing age, poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study. Because women represent the largest proportion of the elderly and falls are amendable, fall preventive may have the potential for significant impact on increasing year of life.

Progressive resistance training for community-dwelling women aged 90 or older; a single-subject experimental design.

PURPOSE: To examine the effect and feasibility of a 12-week programme of progressive resistance exercise on a group of nonagenarian (≥90 years) community-dwelling women. METHOD: An A-B single-subject experimental design was applied. Visual analyses were used for estimating the effect of the intervention. Outcome measurements were: Timed Up and Go (TUG), comfortable walking speed and 30-s chair stands. The programme comprised four exercises, following the principle of overload, aiming at improving strength in the main muscle groups. Feasibility of the progressive resistance intervention was assessed by recording the recruitment of participants, adherence to the intervention and adverse events. RESULTS: Twenty-seven women were invited; eight women aged 90 and above agreed to participate and six completed the study. They suffered from one to 10 chronic medical conditions. All improved their performance in the TUG test. Five of the six participants achieved a higher walking speed (11-59%) and four of them improved on the 30-s chair-stand test with five to 10 stands. No major adverse events were reported. CONCLUSION: Progressive resistance training was a safe and efficient method to enhance mobility and increase lower body strength in this heterogeneous group of nonagenarian community-dwelling women. IMPLICATIONS FOR REHABILITATION: Progressive resistance (PRT) training was found to be a safe and efficient method to enhance mobility and increase lower body strength in a group of community-dwelling women 90+. Participants with the poorest initial functional performance had great benefits, and the improvements appeared already after a few weeks of PRT. PRT might be useful in the rehabilitation field and could be implemented in facilities such as day care and senior centres frequented by very old persons with mobility limitations.

Prognostic factors for self-rated function and perceived health in patient living at home three months after a hip fracture.

PURPOSE: To explore the relationship between prefracture sociodemographic and health characteristics, basic activities of daily living, instrumental activities of daily living and perceived health 3 months after a hip fracture aged 65 or older. METHODS: Age, sex, living alone or not, use of walking aids and whether they had experienced another fall during the previous 6 months, were recorded in hospital and at a three-month follow-up. A total of 277 patients were included. The Barthel Index, the Nottingham Extended ADL Index, the Short Form-12 questionnaire, and the Mini Mental State Examination were used. RESULTS: Prefracture use of a walking aid outdoors was a predictor of postfracture dependency in basic activities of daily living: odds ratio (OR) 2.0, 95% confidence intervals (CI 1.1-3.6), reduced score in instrumental activities of daily living (OR 1.8; 95% CI 1.0-3.2) and reduced perceived physical health (p = 0.04). Prefracture instrumental activity of daily living was a predictor for dependency in basic activities of daily living (OR 3.3; 95% CI 1.7-6.3). Cognitive dysfunction was a risk factor for dependency in basic activities of daily living (OR 0.1; 95% CI 0.01-0.7). CONCLUSIONS: Prefracture use of outdoor walking aids, perceived physical health, cognitive function, instrumental activity of daily living and female gender were all predictors explaining the three-month outcomes for basic activities of daily living and instrumental activity of daily living.

Health, balance, and walking as correlates of climbing steps.

The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75-93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of "missteps" when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score.