Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study

“This is an accepted version of an article published by Taylor & Francis in Disability and Rehabilitation-Assistive Technology on October 2022, available at: doi: 10.1080/17483107.2022.2138999.”Introduction Hip fracture results in an older person’s loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. Methods Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n=2), caregivers (n=3), and health providers (n=2)] with 45 participants (14 older adults, 21 caregivers, and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording, transcription, and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. Results Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. Conclusions Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture. Keywords: tele-rehabilitation; telemedicine; hip fracture; older adults with hip fracture; family caregivers; health providers; mobile applications; medical informaticsThis study was supported by EIT Health [210752]

Upper limb bone health : cadaveric, imaging and clinical studies with special emphasis on peripheral quantitative computed tomography

Introduction: Osteoporotic fractures are a major health care problem. A radial fracture is an important risk factor for osteoporosis that should initiate the assessment of bone health. Purpose: 1) To validate pQCT measures of bone in aged cadaveric radii. 2) To examine side-side differences in radial bone variables after disuse. 3) To test a novel intervention for secondary prevention of osteoporosis after an index radial fracture. Methods: Study Design: Part 1: Parts 1A and 1B are descriptive cadaveric studies. Part 2: Cross-sectional observational studies of bone response to disuse; Part 3: Part 3A is a 6-month intervention of secondary prevention of osteoporosis following a fragility fracture. Part 3B uses a questionnaire to ascertain barriers to investigation after fracture. Participants: Part 1: Cadaveric specimens from women (73 to 88 years) for Parts 1A and 1B. Part 2A: Women (52-87 years) who sustained a distal radius fracture and Part 2B: women and men (52 to 79 years) who had suffered a stroke. Part 3A: Women and men (50-90 years) with a fragility fracture; and Part 3B: physicians in British Columbia. Results: Part 1: With different pQCT acquisition-analysis protocols, total bone area varied by 3-34%; cortical area varied by 3-30% and total content by 6-45% from a criterion standard. Total bone content of the distal radius explained between 74 and 81% of bone strength. Part 2: There was a significant decrease in bone strength in participants who had upper limb disuse because of stroke or fracture. Part 3: A patient and physician intervention improved bone health investigation rate by a factor of 3.1 times (RR) after fragility fracture. BC doctors reported few barriers to investigating osteoporosis. Summary: Peripheral QCT acquisition and analysis protocols significantly influenced outcome variables. Patients do not have "normal" bone strength after fracture or stroke. In particular, there is an increased risk for non-dominant radial fractures to have lower bone strength and be associated with poorer limb function, compared with a dominant radial fracture. Physicians report no barriers to investigation after a fragility radial fracture and a systematic intervention may best address secondary prevention of osteoporosis.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture

“This is an original manuscript of an article published by Taylor & Francis in Disability and Rehabilitation on March 2019, available at: doi: 10.1080/09638288.2019.1577499.”Purpose: To translate the Cumulated Ambulation Score (CAS) into Spanish (CAS-E) and to examine the interrater reliability and agreement of the CAS-E. Materials and Methods: Two occupational therapists, independently reviewed 60 patients consecutively admitted to a traumatology service of a public hospital with a hip fracture, and rated the three CAS activities from 0 to 2, within the first post-surgery week. We determined the internal consistency of CAS-E using Cronbach’s α coefficient. To test reliability, we used weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). We determined the systematic between-rater bias using the McNemar–Bowker test. Results: No between-rater bias was seen, and the Cronbach’s α for the CAS-E was 0.89. The weighted kappa was ≥ 0.83 for the three individual activities and the total CAS-E, while the observed agreement was ≥ 0.87. The SEM and the SRD for the total CAS-E (0-6 points) were 0.18 and 0.83 points, respectively. Conclusions: We present the CAS for use in Spanish speaking countries and provide evidence for excellent relative and absolute reliability of the CAS-E to assess basic mobility for patients with hip fracture in an acute care hospital

Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture

Purpose: To translate the Cumulated Ambulation Score into Spanish, and to examine its inter-rater reliability, agreement and internal consistency. Materials and Methods: Two occupational therapists independently used the Spanish version of the Cumulated Ambulation Score (three activities scored from 0–2 points) to assess 60 consecutive patients with hip fracture within the first post-surgery week at a traumatology service of a public hospital. We used linear weighted kappa (κ) statistics to determine inter-rater reliability, percent agreement to assess measurement error, Cronbach’s α coefficient to establish the internal consistency, and the McNemar–Bowker test to evaluate for systematic between-rater differences. Results: The κ was ≥ 0.83 for the three individual activities and the total score, the percent agreement was ≥ 0.87, and Cronbach’s α was 0.89 with no observed systematic between-rater difference. Conclusions: This study provides evidence for almost perfect inter-rater reliability, excellent internal consistency, and high percent agreement of the Spanish version of the Cumulated Ambulation Score. Due to the strong psychometric properties, and its ease of use, we suggest it be used in Spanish speaking countries to assess early basic mobility status of patients with hip fracture until independence is reached.Implications for rehabilitationThe Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture.We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached.The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists. The Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture. We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached. The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists.</p