Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery

Background: Mobility impairment is common in older adults and negatively influences the quality of life. Mobility level may change rapidly following surgery or hospitalization in the elderly. The timed up and go (TUG) is a simple, frequently used clinical test for functional mobility; however, TUG requires supervision from a trained clinician, resulting in infrequent assessments. Additionally, assessment by TUG in clinic settings may not be completely representative of the individual's mobility in their home environment. Objective: In this paper, we introduce a method to estimate TUG from activities detected in free-living, enabling continuous remote mobility monitoring without expert supervision. The method is used to monitor changes in mobility following total hip arthroplasty (THA). Methods: Community-living elderly (n = 239, 65-91 years) performed a standardized TUG in a laboratory and wore a wearable pendant device that recorded accelerometer and barometric sensor data for at least three days. Activities of daily living (ADLs), including walks and sit-to-stand transitions, and their related mobility features were extracted and used to develop a regularized linear model for remote TUG test estimation. Changes in the remote TUG were evaluated in orthopaedic patients (n = 15, 55-75 years), during 12-weeks period following THA. Main results: In leave-one-out-cross-validation (LOOCV), a strong correlation (p = 0.70) was observed between the new remote TUG and standardized TUG times. Test-retest reliability of 3-days estimates was high (ICC = 0.94). Compared to week 2 post-THA, remote TUG was significantly improved at week 6 (11.7 +/- 3.9 s versus 8.0 +/- 1.8 s,p &lt;0.001), with no further change at 12-weeks (8.1 +/- 3.9s, p = 0.37). Significance: Remote TUG can be estimated in older adults using 3-days of ADLs data recorded using a wearable pendant. Remote TUG has discriminatory potential for identifying frail elderly and may provide a convenient way to monitor changes in mobility in unsupervised settings.</p

Effectiveness of a home-based rehabilitation program after total hip arthroplasty driven by a tablet app and remote coaching:nonrandomized controlled trial combining a single-arm intervention cohort with historical controls

Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales “function in sport and recreational activities” and “hip-related quality of life” of HOOS, and on the subscale “physical role limitations” of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care

Sluit ouderen met cognitieve problemen niet uit voor GRZ revalidatie

Binnen de richtlijnen rondom de huidige triage voor de GRZ zouden cliënten met cognitieve problemen, zoals dementie, strikt genomen uitgesloten dienen te worden voor de GRZ. Uit wetenschappelijk onderzoek blijkt dat mensen met dementie succesvol kunnen revalideren en een verbetering laten zien in het fysiek functioneren (Mitchell, 2016).Binnen revalidatiecentrum de Boshof van Icare is verkennend onderzoek gedaan naar de mogelijkheden en randvoorwaarden voor revalidatie voor mensen met cognitieve problemen. De resultaten van dit onderzoek lijken aan te tonen deze doelgroep succesvol kan revalideren, maar dat de revalidatiesetting van de GRZ voor mensen met cognitieve problemen niet altijd afdoende is. De doelgroep heeft meer, intensievere en aangepaste zorgbegeleiding nodig. Structuur, toezicht en een veilige omgeving zijn belangrijk. Tevens laat het onderzoek zien dat het sociaal netwerk van de cliënt in de vorm van aanwezigheid van partner en hulp van familie en/of buren een belangrijke factor speelt in het kunnen terugkeren naar de thuissituatie na de revalidatieperiode. De aanwezigheid van een sociaal netwerk lijkt voorwaardenscheppend voor succesvolle revalidatie voor mensen met cognitieve problemen.Het onderzoek roept verschillende vragen op:- Welke factoren moeten worden toegevoegd in de triage om mensen met cognitieve problematiek in de GRZ te laten doorstromen?- Welke aanpassingen zijn nodig op de GRZ afdeling; Kunnen mensen met cognitieve problemen revalideren op de ‘gewone’ GRZ? Hoe bijvoorbeeld om te gaan met vrijheidsbeperkende middelen? Moet het personeel extra worden opgeleid?- Hoe en in welke mate dient het sociaal netwerk betrokken worden tijdens de revalidatieperiode?- Moeten er extra financiele middelen komen voor de revalidatie van mensen met cognitieve problemen? Bijvoorbeeld een aparte DBC?<br/

Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty

Background: Recent developments in technology are promising for providing home-based exercise programs. Objective: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. Methods: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). Results: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25% (33/134) and work 15% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale "coaching" and the lowest for the subscale "sensor." Conclusions: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed