Physical activity in hard-to-reach physically disabled people:Development, implementation and effectiveness of a community-based intervention

Evidence for the benefits of an active lifestyle is abundant, not only for healthy people, but also people with a physical disability or chronic disease. Physical activity causes better and faster functional recovery, and improves wellbeing and social contacts. Existing interventions (structured programs) for stimulating physical activity in physically disabled people have a limited reach, since they reach their target populations mainly through rehabilitation centers, special education and general practitioners. This thesis aimed to develop, implement and evaluate a community-based intervention for stimulating physical activity, targeting hard-to-reach physically disabled people. In physically disabled people, physical activity was related to all components of health related quality of life (e.g. physical- and social functioning), except mental health. Stakeholders for an intervention (professionals and physically disabled people) indicated that an existing intervention should be adapted, and collaboration between organizations should be improved. Stakeholders suggested for instance individual coaching, role models, and activity monitoring as intervention methods. Based on stakeholders’ ideas, the existing intervention Activity Coach was adapted into Activity Coach+. Within Activity Coach+, the target population was reached through a network of organizations from health- and social backgrounds, and referred to an activity coach. After an intake at a local physiotherapist, participants were guided to existing organized and non-organized physical activity. Physical activity during activities of daily life was stimulated using an activity tracker. Participants were coached one year. Activity Coach+ appeared feasible and effective for improving walking ability, endurance capacity, dynamic balance and vitality, within the first four months after implementation

Development of an intervention to stimulate physical activity in hard-to-reach physically disabled people and design of a pilot implementation:an intervention mapping approach

INTRODUCTION: Physically disabled people are less physically active compared with healthy people. Existing physical activity (PA) interventions are limited in reach, since they are primarily rehabilitation or school based. The current study aims to develop a community-based intervention for stimulating PA in hard-to-reach physically disabled people. METHODS AND ANALYSIS: To systematically develop a PA-stimulating intervention, intervention mapping (six steps) was applied. PA level and health-related quality of life of patients after rehabilitation was determined using questionnaires (step 1). Qualitative research was performed to study professionals' and physically disabled people's ideas about intervention objectives, determinants and design (steps 2 and 3). Since experts expressed no need for a new intervention, the existing intervention 'Activity coach' was adapted to the specific target population. The adapted intervention 'Activity coach+' composes a network of intermediate organisations that refers participants to an activity coach, who coaches participants during 1 year. After a preintervention physical assessment by a physiotherapist, participants will be individually guided to existing organised or non-organised activities. An activity tracker will be used to monitor and stimulate PA in daily life (step 4). To support adoption and implementation, meetings between involved parties are organised (step 5). 'Activity coach+' is implemented in community in March 2017, and will be evaluated using a mixed-method analysis. Quantitative evaluation of intervention effects on PA, health and social participation takes place after 0, 2, 4, 6 and 12 months. The implementation process and experiences with the intervention will be determined using qualitative research (step 6). ETHICS AND DISSEMINATION: Insights from this study will be used for dissemination and further development of the intervention. The Medical Ethical Committee of the University Medical Center Groningen confirmed that formal ethical approval was not required (METc 2016/630). TRIAL REGISTRATION NUMBER: NTR6858

Participants' unspoken thoughts and feelings negatively influence the therapeutic alliance; a qualitative study in a multidisciplinary pain rehabilitation setting

PURPOSE: This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting. MATERIALS AND METHODS: A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth. RESULTS: Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered. CONCLUSIONS: Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered.Implications for rehabilitationDifferences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance.When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences.From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required.It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans.During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants

Perceptions, experiences, barriers and facilitators regarding nutritional intake of patients with chronic limb threatening ischemia:a qualitative study

Objective: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.Methods: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.Results: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.Conclusion: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI

Health Related Quality of Life in a Dutch Rehabilitation Population:Reference Values and the Effect of Physical Activity

Purpose To establish reference values for Health Related Quality of Life (HRQoL) in a Dutch rehabilitation population, and to study effects of patient characteristics, diagnosis and physical activity on HRQoL in this population. Method Former rehabilitation patients (3169) were asked to fill in a questionnaire including the Dutch version of the RAND-36. Differences between our rehabilitation patients and Dutch reference values were analyzed (t-tests). Effects of patient characteristics, diagnosis and movement intensity on scores on the subscales of the RAND-36 were analyzed using block wise multiple regression analyses. Results In total 1223 patients (39%) returned the questionnaire. HRQoL was significantly poorer in the rehabilitation patients compared to Dutch reference values on all subscales (p Conclusions HRQoL is poorer in rehabilitation patients compared to Dutch reference values. Physical components of HRQoL are affected by diagnosis. In rehabilitation patients an associatio