The quality of geriatric rehabilitation from the patients' perspective: a scoping review.

BACKGROUND: the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. OBJECTIVE: the aim of this scoping review was to systematically synthesise the patients' perspective on the quality of GR. METHODS: we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. RESULTS: twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one's story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. CONCLUSION: in this study, we identified the aspects that determine the quality of rehabilitation from the patient's perspective, which may lead to a more holistic perspective on the quality of GR.

Effectiveness of sensor monitoring in a rehabilitation programme for older patients after hip fracture: a three-arm stepped wedge randomised trial.

OBJECTIVES: to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture. DESIGN, SETTING AND PATIENTS: three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracture patients ≥ 65 years old. INTERVENTIONS: patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months. MAIN OUTCOMES AND MEASURES: the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure. RESULTS: a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual. CONCLUSIONS AND RELEVANCE: among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual. TRIAL REGISTRATION: Dutch National Trial Register, NTR 5716.

Effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older individuals after hip fracture, the SO-HIP trial: study protocol of a three-arm stepped wedge cluster randomized trial.

BACKGROUND: The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. The same holds for sensor monitoring-based coaching in addition to OT. Here, we describe the design of a study investigating the effect of sensor monitoring embedded in an OT rehabilitation program on the recovery of ADL among older individuals after hip fracture. METHODS/ DESIGN: Six nursing homes will be randomized in a three-arm stepped wedge cluster randomized trial. All nursing homes will initially provide standard care. At designated time points, nursing homes, successively and in random order, will cross over to the provision of OT and at the next time point, to sensor monitoring-enhanced OT. A total of 288 older individuals, previously living alone in the community, who after a hip fracture were admitted to a geriatric rehabilitation ward for a short-term rehabilitation, will be enrolled. Individuals in the first intervention group (OTc) will participate in an OT rehabilitation program with coaching based on cognitive behavioral therapy (CBT) principles. In the sensor monitoring group, sensor monitoring is added to the OT intervention (OTcsm). Participants will receive a sensor monitoring system consisting of (i) an activity monitor during nursing home stay, (ii) a sensor monitoring system at home and a (iii) a web-based feedback application. These components will be embedded in the OT. The OT consists of a weekly session with an occupational therapist during the nursing home stay followed by four home visits and four telephone consultations. The primary outcome is patient-perceived daily functioning at 6 months, assessed using the Canadian Occupational Performance Measure (COPM). DISCUSSION: As far as we know, this study is the first large-scale stepped wedge trial, studying the effect of sensor monitoring embedded in an OT coaching program. The study will provide new knowledge on the combined intervention of sensor monitoring and coaching in OT as a part of a rehabilitation program to enable older individuals to perform everyday activities and to remain living independently after hip fracture. TRIAL REGISTRATION NUMBER: Netherlands National Trial Register, NTR 5716 Date registered: April 1 2016.

Expert Knowledge for Modeling Functional Health from Sensor Data.

BACKGROUND: ICT based solutions are increasingly introduced for active and healthy ageing. In this context continuous monitoring of older adults with domestic sensor systems has been suggested to provide important information about their functional health. However, there is not yet a solid model for the interpretation of the sensor data. OBJECTIVES: The aim of our study is to define a set of predictors of functional health that can be measured with domestic sensors and to determine thresholds that identify relevant changes in these predictors. METHODS: On the basis of literature we develop a model that relates functional health predictors to features derived from sensor data. The parameters of this model are determined on the basis of a study among health experts (n = 38). The use of the full model is illustrated with three cases. RESULTS: We identified 25 predictors and their attributes. For 12 of them that can be measured with passive infrared motion sensors we determined their parameters: the attribute thresholds and the urgency thresholds. CONCLUSIONS: With the parametrized predictors in the model, domestic sensors can be deployed to assess functional health in a standardized way. Three case examples showed how the model can be used as a screening instrument for functional decline.

Sensor monitoring to measure and support daily functioning for independently living older people: a systematic review and road map for further development.

OBJECTIVES: To study sensor monitoring (use of a sensor network placed in the home environment to observe individuals' daily functioning (activities of daily living and instrumental activities of daily living)) as a method to measure and support daily functioning for older people living independently at home. DESIGN: Systematic review. SETTING: Participants' homes. PARTICIPANTS: Community-dwelling individuals aged 65 and older. MEASUREMENTS: A systematic search in PubMed, Embase, PsycINFO, INSPEC, and The Cochrane Library was performed for articles published between 2000 and October 2012. All study designs, studies that described the use of wireless sensor monitoring to measure or support daily functioning for independently living older people, studies that included community-dwelling individuals aged 65 and older, and studies that focused on daily functioning as a primary outcome measure were included. RESULTS: Seventeen articles met the inclusion criteria. Nine studies used sensor monitoring solely as a method for measuring daily functioning and detecting changes in daily functioning. These studies focused on the technical investigation of the sensor monitoring method used. The other studies investigated clinical applications in daily practice. The sensor data could enable healthcare professionals to detect alert conditions and periods of decline and could enable earlier intervention, although limited evidence of the effect of interventions was found in these studies because of a lack of high methodological quality. CONCLUSION: Studies on the effectiveness of sensor monitoring to support people in daily functioning remain scarce. A road map for further development is proposed.