Older adults’ activity on a geriatric hospital unit: A behavioral mapping study

Systematic reviews highlight a preponderance of prolonged sedentary behavior in the hospital setting, with possible consequences for patients’ health and mobility. To date, most of the published literature in this field focus on the hospital experience for older adults with dementia or stroke. Few data describe hospital activity patterns in specialized geriatric units for frail older adults, who are already at risk of spending prolonged periods of time sitting. Yet, promoting older adults’ activity throughout hospitalization, when possible, is an avenue for exploration to identify opportunities to encourage more daily functional activities, and minimize the risk of post-hospital syndrome. These exploratory findings are an opportunity to, generate hypotheses for future testing, and act as a starting point to collaborate with front line clinicians to highlight the indoor environment’s role in promoting activity, and develop future strategies to safely introduce more activity into the acute care setting for older adult

Indoor Built Environment and Older Adults’ Activity: A Systematic Review

Bien que l’environnement physique puisse influencer l’activité des individus, peu de synthèses de connaissances portent sur les environnements intérieurs et les routines de la vie quotidienne des personnes âgées. Nous avons donc procédé à un examen systématique de publications revues par des pairs afin de guider les recherches et les pratiques futures. Les critères d’inclusion suivants ont été utilisés : études sans restriction quant au devis de recherche, à la date ou à la langue, portant sur les personnes âgées de 60 ans et plus, sur l’activité physique ou le comportement sédentaire, et l’environnement intérieur. Après avoir effectué des recherches dans cinq bases de données, deux des auteurs ont examiné les titres, les résumés et le texte intégral. La dernière recherche a été effectuée le 19 décembre 2020. Nous avons passé en revue 1367 citations et inclus 23 études se rapportant à des logements privés ou collectifs (p. ex. résidences avec services). Les caractéristiques intérieures favorisant l’activité physique étaient associées à trois domaines : les environs (p. ex. les commodités, les chemins), le bâtiment (p. ex. la superficie, le niveau de l’étage) et les équipements (p. ex. les ascenseurs, les couloirs). La connaissance des facteurs environnementaux intérieurs qui favorisent la participation des personnes âgées aux activités quotidiennes peut orienter les recherches et les politiques futures en matière de conception de logements.Although the physical environment can influence people’s activity, there are few knowledge syntheses for indoor environments and older adults’ daily life routines. Therefore, we conducted a systematic review of peer-reviewed evidence to inform future research and practice. Inclusion criteria were studies with any research designs, across all years and languages focused on older adults 60 years of age or more, on physical activity/sedentary behaviour and the indoor environment. After searching five databases, two authors completed title/abstract and full-text screening. The last search was on December 19, 2020. We screened 1,367 citations, and included 23 studies situated in private or collective dwellings (e.g., assisted living). We identified physical activity-supportive indoor features across three domains: campus (e.g., amenities, pathways), building (e.g., area, floor level), and fixtures (e.g., elevators, hallways). Knowledge of indoor environmental factors for older adults’ engagement in daily activities can guide future research and policy on housing design.Canada Research Chair

Self-Regulation in Children with Neurodevelopmental Disorders “SR-MRehab: Un Colegio Emocionante”: A Protocol Study

Self-regulation refers to the ability to control and modulate behavior, and it can include both emotional and cognitive modulation. Children with neurodevelopmental disorders may show difficulties in self-regulation. The main objective of this study is to improve self-regulation skills in children between 6 and 11 years of age with neurodevelopmental disorders. Methodology: A randomized controlled trial will be conducted with the use of “SR-MRehab: Un colegio emocionante”, based on a non-immersive virtual reality system where virtual objects can be managed by children in a natural way using their hands. Children will be recruited from several schools of Granada (Spain) and they will be randomly allocated to two groups. An assessment will be conducted before and after the intervention and 24 weeks after the end of the intervention process. The experimental group will receive the intervention using virtual reality. The control group will receive a standard self-regulation program. Both interventions will be performed once a week for a total of 10 sessions. Changes in self-regulation, as well as the acceptability of technology with the use of SR-MRehab, will be evaluated. The results will be published and will provide evidence regarding the use of this type of intervention in children with neurodevelopmental disorders. Trial registration: Registered with code NCT04418921.Programa Estatal de Generacion de Conocimiento y Fortalecimiento Cientifico y Tecnologico del Sistema de I+D+i y del Programa Estatal de I+D+i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigacion Cientifica y Tecnica y de Innovacion 2017 PID2019-108915RB-I00Teaching innovation project of the Degree in Occupational Therapy of the University of Granada about Emotional Skills 19-7

Indoor Built Environment and Older Adults’ Activity: A Systematic Review

Although the physical environment can influence people's activity, there are few knowledge syntheses for indoor environments and older adults' daily life routines. Therefore, we conducted a systematic review of peer-reviewed evidence to inform future research and practice. Inclusion criteria were studies with any research designs, across all years and languages focused on older adults 60 years of age or more, on physical activity/sedentary behaviour and the indoor environment. After searching five databases, two authors completed title/abstract and full-text screening. The last search was on December 19, 2020. We screened 1,367 citations, and included 23 studies situated in private or collective dwellings (e.g., assisted living). We identified physical activity-supportive indoor features across three domains: campus (e.g., amenities, pathways), building (e.g., area, floor level), and fixtures (e.g., elevators, hallways). Knowledge of indoor environmental factors for older adults' engagement in daily activities can guide future research and policy on housing design

Family Caregivers’ Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture

This research was funded by EIT Health (210752).Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.EIT Health 21075

High perceived caregiver burden for relatives of patients following hip fracture surgery

Purpose: To determine the profile of the main informal caregivers, evolution of the caregiver burden and influencing factors of caregiver burden at 1-year after hip fracture surgery. Methods: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed during one year following hip fracture surgery in a regional hospital. The perceived caregiver burden was assessed using the Caregiver Strain Index (CSI, 0-13 points). Results: The median (Q1-Q3) age of the 172 caregivers was 54 (47-65) years, of which 133 (77%) were woman and 94 (55%) were daughters of the patient. 79 of the 172 (46%) caregivers perceived a high level of burden (CSI ≥ 7 points) at the hospital. The corresponding CSI-data for 1-month, 3-months and 1-Year were 87 (51%), 61 (35%) and 45 (26%). A low pre-fracture functional status, post-surgery complications, older age of patients and younger age of caregivers influence caregiver burden at 1-year. Conclusions: The profile of the main caregiver of hip fracture is a woman of middle age and is the daughter of the patient. The perceived caregiver burden decreased from 1-month to 1- year. More efforts are needed to avoid post-surgical complications in order to prevent caregiver burden at 1-year. Ke

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

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

A New Tool for Assessment of Professional Skills of Occupational Therapy Students

The assessment of the acquisition of professional skills is an essential process in occupational therapy students. Until now, there has been no standardized and validated instrument for evaluating these skills in Spanish occupational therapy students. This study reports the development and testing of the psychometric properties of the professional skills in students of occupational therapy during their practical training. Methods: A new instrument was developed to assess the professional skills of occupational therapy students, called CPTO. A total of 69 occupational therapists participated in evaluating 295 occupational therapy students from the University of Granada, between the 2018 and 2021 academic years. Results: Of a total of 79 items, the factor analysis yielded a final solution of 33 items, which explains 70.22% of the variance with the following three dimensions: (1) self-appraisal and professional responsibility (α = 0.951); (2) communication skills and delivering intervention (α = 0.944); and (3) clinical reasoning for assessing and planning the intervention (α = 0.947). The instrument allows students with low, medium, high and excellent clinical skills to be differentiated according to the cutting points established by the quartiles. Conclusion: the instrument has good psychometric properties, and is a useful tool to assess professional competencies in occupational therapy students during their practice placement education.Unidad de Calidad Docente from University of Granad