Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway:A methodological guide and results of a large-scale deployment in the Netherlands

Abstract Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies

Towards cancer rehabilitation at home: design of a telerehabilitation service for lung cancer patients

Although lung resection still provides the best long-term outcome for lung cancer, it is also associated with a considerable decay in physical and psychosocial health status. If not controlled, these symptoms can hamper postsurgical recovery, and lead to unscheduled healthcare use. This study aimed to determine the clinical relevance of and functional requirements for a telerehabilitation (TR) service to support recovery following lung resection. A modular remote monitoring and treatment service, consisting of an ambulant health monitoring module and an online exercise program, was developed to improve survivorship care following lung surgery through a user-centred design approach. Results from the requirement elicitation indicate positive intentions of both patients and professionals to use the RMT service as part of current care practice. In early phase evaluation usability and technical reliability of the developed system was found high. Future research should establish level of adoption of the system by the end users, as well as the effects on post-surgery recovery when integrated with current healthcare processes

Strategies to improve effectiveness of physical activity coaching systems:Development of personas for providing tailored feedback

Mobile physical activity interventions can be improved by incorporating behavioural change theories. Relations between self-efficacy, stage of change, and physical activity are investigated, enabling development of feedback strategies that can be used to improve their effectiveness. A total of 325 healthy control participants and 82 patients wore an activity monitor. Participants completed a self-efficacy or stage of change questionnaire. Results show that higher self-efficacy is related to higher activity levels. Patients are less active than healthy controls and show a larger drop in physical activity over the day. Patients in the maintenance stage of change are more active than patients in lower stages of change, but show an equally large drop in level of physical activity. Findings suggest that coaching should at least be tailored to level of self-efficacy, stage of change, and physical activity pattern. Tailored coaching strategies are developed, which suggest that increasing self-efficacy of users is most important. Guidelines are provided

Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

Background Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs). Methods A user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs. Results The developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35–95) was rated acceptable. Conclusions A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine

Rest rust! physical active for active and healthy ageing

The aim of this paper is to give an insight on how physical activity can be defined, parameterized and measured in older adults and on different options to deal with citizen physical activity promotion at European level. Three relevant aspects are highlighted: 1. When talking about physical activity, two different aspects are often unfairly mixed up: “physical activity” and “physical capacity”. • Physical activity, is referred to as the level of physical activity someone is actually performing in daily life. • Physical capacity is referred to as the maximum physical activity a person can perform. 2. Both physical activity and physical capacity can be expressed in different dimensions such as time, frequency, or type of activity with the consequence that there are many tools and techniques available. In order to support people to choose an appropriate instrument in their everyday practice a list of 9 criteria that are considered important is defined. 3. Older adults score differently across the various physical dimensions, so strategies to promote physical activity should consider individual differences, in order to adapt for these variations

INLIFE - independent living support functions for the elderly : technology and pilot overview

In this paper, we present the European H2020 project INLIFE (INdependent LIving support Functions for the Elderly). The project brought together 20 partners from nine countries with the goal of integrating into a common ICT platform a range of technologies intended to assist community-dwelling older people with cognitive impairment. The majority of technologies existed prior to INLIFE and a key goal was to bring them together in one place along with a number of new applications to provide a comprehensive set of services. The range of INLIFE services fell into four broad areas: Independent Living Support, Travel Support, Socialization and Communication Support and Caregiver Support. These included security applications, services to facilitate interactions with formal and informal caregivers, multilingual conversation support, web-based physical exercises, teleconsultations, and support for transport navigation. In total, over 2900 people participated in the project; they included elderly adults with cognitive impairment, informal caregivers, healthcare professionals, and other stakeholders. The aim of the study was to assess whether there was improvement/stabilization of cognitive/emotional/physical functioning, as well as overall well-being and quality of life of those using the INLIFE services, and to assess user acceptance of the platform and individual services. The results confirm there is a huge interest and appetite for technological services to support older adults living with cognitive impairment in the community. Different services attracted different amounts of use and evaluation with some proving extremely popular while others less so. The findings provide useful information on the ways in which older adults and their families, health and social care services and other stakeholders wish to access technological services, what sort of services they are seeking, what sort of support they need to access services, and how these services might be funded

Towards a new treatment for chronic low back pain patients

It is hypothesized that the effectiveness of treatment of CLBP patients can be increased by (1) personalizing the treatment by providing treatments that enable individual goal setting and are based on the patients needs and capacities; (2) using technology to make the patient less dependent on the healthcare professional and give him more responsibility for his treatment outcome and; (3) making the treatment ambulant, so that it becomes possible to treat the patient in his own daily environment. Starting from this hypothesis, this thesis focuses on: the development and testing of an ambulant personalized treatment for patients with CLBP that uses technology to support the patient to improve his health status

MONITORING AND PERSONALIZED FEEDBACK

Address of correspondence

Patient acceptance of a telemedicine service for rehabilitation care: A focus group study

Background and purpose: Despite positive outcomes, widespread implementation of telemedicine services in rehabilitation care is lacking. This could, for a large part, be attributed to a lack of end-user acceptance. The aim of this article is to look beyond the common theoretical approaches towards end-user acceptance (like the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology), and to explore the factors that contribute to or hinder the acceptance of a telemedicine service for rehabilitation care by patients with a chronic disease. Methods: A qualitative, exploratory focus group approach was applied. We involved 188 patients in 22 focus groups. A guide was developed to provoke a discussion among participants of a rehabilitation clinic on the topic of using an online portal with a wide range of telemedicine features (e.g., an exercise module and a teleconference module). Three coders, using thematic analysis, coded the focus group transcripts simultaneously. Results: The focus groups resulted in a wide range of factors that drive or hinder patient acceptance. Facilitators included the possibility to exercise from the comfort of home, the ability to work on one's recovery, irrespective of the time schedule of care professionals, and improved quality of exercise instruction, due to the provision of exercise videos on the portal. Barriers included a lack of intrinsically motivation, experiencing portal-mediated communication with care professionals as ‘impersonal’, and the lack of physical space and rest to properly exercise at home. Generally speaking, participants were enthusiastic about the idea to provide the telemedicine service as a follow-up treatment as they liked to be in contact with their therapist and to continue training. Conclusion: Acceptance of telemedicine services depends on many factors that are not part of well-established theories that explain technology acceptance. These factors are more specific than general determinants, such as ease of use and usefulness, and focus mainly on contextual factors, such as a fit between the service configuration and daily life, personal motivation and the associated psychological burden