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]

Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers:a multicentre open-label randomised controlled trial

Background: Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods: In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings: Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation: This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding: EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.</p

Aprendiendo sobre educación sanitaria, evaluación y tratamiento de casos clínicos mediante el uso de recursos audiovisuales en entornos virtuales

El Espacio Europeo de Educación Superior marcó un cambio en la conceptualización del proceso de enseñanza-aprendizaje poniendo el foco en el papel activo de los/as estudiantes, los cuales han de ser guiados por el profesorado para que sean capaces de autogestionar su aprendizaje a lo largo de la vida. Por otro lado, la pandemia por Covid-19 puso de manifiesto la necesidad de crear materiales docentes que se pudieran integrar en entornos virtuales para facilitar y complementar dicho proceso de enseñanza-aprendizaje. El presente proyecto de innovación docente tuvo como objetivo crear un curso online en el que se integraran recursos didácticos audiovisuales para facilitar el aprendizaje del alumnado del Grado de Terapia Ocupacional sobre educación sanitaria, evaluación y tratamiento de casos clínicos. Para ello se elaboró un curso que fue administrado a través de la plataforma Prado al estudiantado del Grado de Terapia Ocupacional. Dicho curso se estructuró en 3 módulos, en los cuales se insertaron actividades que aseguraron la visualización de los contenidos incluidos en los módulos. Junto a las variables de factibilidad como son la adopción, adherencia y aceptación, se evaluó en incremento de conocimientos a través de un cuestionario pre-post diseñado para tal fin. Un total de 113 estudiantes con una media de edad realizaron el curso online. De ellos, el 83% fueron mujeres. La tasa de adopción del curso fure del 83%, la adherencia del 98%, y la aceptación del curso mostró una puntuación media (desviación estándar) de120.35 (13.48) puntos sobre un máximo de 147 puntos (medido con la escala UTAUT2). En términos de la adquisición de conocimientos, la puntuación media (desviación estándar) antes del curso fue de 6.97 (2.0) puntos sobre 18 puntos, y tras la realización del mismo fue de 15.12 (2.0) puntos. Aquellos estudiantes que previamente habían curso la asignatura del Grado de Terapia Ocupacional “Terapia Ocupacional para la Autonomía Personal: Actividades de la Vida diaria” obtuvieron un mayor incremento del aprendizaje [r=0.44, p <0.001). Apoyando estos resultados la teoría del aprendizaje significativo de Ausubel que enfatiza la necesidad de adquirir ciertos conocimientos previos para poder incorporar otros posteriores. Como conclusión se puede corroborar que el curso de formación creado es factible en estudiantes de terapia ocupacional y permite incrementar los conocimientos de dichos estudiantes. Incorporar este tipo de formación combinándola con la enseñanza en persona puede ser una forma de incrementar la participación y la mejora del proceso enseñanza-aprendizaje en el entorno universitario

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

ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic

Objective: Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. Methods: Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). Results: The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app’s perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. Conclusions: The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.University of Granada, Spain B11/56/

Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture

This is an Accepted Manuscript of an article published by SAGE PUBLICATIONS LTD in Journal of Telemedicine and Telecare on January 2022, available at doi: 10.1177/1357633X211073256.”Introduction: Telerehabilitation has emerged in the last years as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. Methods: The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients’ quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale (IFIS). Results: The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). Discussion: The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e., anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by EIT-Health (20471) and Foundation for Progress and Health from the Ministry of Andalusia, Spain (PI-0372-2014)

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

ActiveHip plus : A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic

ObjectiveHalf of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. MethodsSixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). ResultsThe ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. ConclusionsThe ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results

An m-Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial

Telerehabilitation interventions administered via a smartphone may provide new feasible and effective rehabilitation options at home for patients with hip fracture. However, to date, no such interventions have been shown to be effective in the recovery key health outcomes of these patients. The present multicentre randomized controlled trial (RCT) aims to test the effect of the ActiveHip+ m-Health system in the recovery of physical performance, functional level, quality of life, and other health-related outcomes in both patients with hip fracture and their family caregivers. A total of 104 patients older than 65 years, with hip fracture, and their family caregivers will be randomized into the ActiveHip+ rehabilitation (N = 52) or the control group (N = 52). ActiveHip+ is a 12-week smartphone-based rehabilitation program conducted in Granada and Cádiz (Spain) that includes: (1) 24 sessions of physical exercise and 12 sessions of occupational therapy; (2) seven educational modules for patients and for caregivers; and (3) general recommendations in activities of daily living. The control group will receive the usual rehabilitation protocol offered by the Andalusian Public Healthcare System. The primary outcome is the patient's physical performance, while the secondary outcomes are the patient's functional level, quality of life, pain, fear of falling, fitness perception, pre-fracture functional level, emotional status, and caregiver burden. The present project will substantially contribute to the existing knowledge by testing for the first time the efficacy and feasibility of a multidisciplinary m-Health system in the rehabilitation of patients with hip fracture