KNGF-standaard: beweeginterventie kwetsbare ouderen

Gezien het steeds verder stijgende aantal mensen met één of meerdere chronische aandoeningen en de rechtstreeks daaraan gekoppelde stijging van de kosten in de gezondheidszorg, is het KNGF vanaf 2008 gestart met het ontwikkelen van de KNGF-standaarden beweeginterventies. Een KNGF-standaard Beweeginterventie stelt een voldoende competente fysiotherapeut in staat bij mensen met een chronische aandoening een actieve leefstijl te bevorderen en hun mate van fitheid te verhogen. Voorliggende standaard is gericht op kwetsbare ouderen. Er wordt, waar mogelijk, tot het niveau van de beweegnormen gestreefd naar het ontwikkelen en in stand houden van een actieve leefstijl en het verhogen van de fitheid. Daarnaast zal de fysiotherapeut aandacht besteden aan het inspanningsvermogen, de spierfunctie, verminderde range of motion (ROM) en balans, indien dit beperkende factoren zijn voor het opbouwen en/of onderhouden van een actieve leefstijl

Masterclass kwetsbare ouderen 'interventies voor kwetsbare ouderen: wat doen we, wat werkt?'

Wat is de huidige stand van zaken binnen de fysiotherapie voor ouderen van 70 jaar en ouder. Met welke klachten komen ze binnen in de eerste lijn? Hoe ziet de behandeling en huidige groepsinterventies er uit? Hoe kunnen we werken vanuit Evidence Based practice met deze patienten populatie. Waarom is fysieke activiteit van belang voor ouderen? Wat is er bekend uit interventieonderzoek? Korte omschrijving van de inhoud van de beweegstandaard voor kwetsbare ouderen van het KNGF

Patients with more severe symptoms benefit the most from an intensive multimodal programme in patients with fibromyalgia

Purpose. Patients with fibromyalgia (FM) experience symptoms over a long period of time impacting their quality of life (QoL). Patients are often treated in multimodal programmes that combine physical and cognitive treatment modalities. Purpose of this study was to identify prognostic factors of effectiveness of a multimodal programme. Method. aEuro integral A prospective study was performed with a group of 87 patients with FM who had participated in a multimodal programme. The Revised Illness Perception Questionnaire (IPQ) and the Fibromyalgia Impact Questionnaire (FIQ) were used. Criterion for clinically relevant improvement was a decline in total FIQ score of 12.5 points or more after the treatment programme. Investigated determinants of improvement of QoL were patient characteristics, illness perceptions (IP) and QoL at baseline. Results. aEuro integral QoL of 34 patients with FM made a clinically relevant improvement after the programme. There was no difference in age, number of years with pain, number of years diagnosed or IP compared to the group that did not improve. The group of patients with an improved QoL after the programme reported severe impact on daily living, highest intensity of pain and most depression at baseline. Conclusions. aEuro integral Total FIQ score on QoL, intensity of pain, morning tiredness and depression can be used as prognostic factors to pre-select patients with FM for a multimodal treatment. IP were not adequate to predict treatment outcome. An intensive multimodal programme seemed most suitable for patients with severe symptoms and limitations

Building from a conceptual model of the resilience process during ageing, towards the Groningen Aging Resilience Inventory

Aim. To develop and psychometrically test the Groningen Ageing Resilience Inventory. Background. Ageing is a process that is often accompanied by functional limitation, disabilities and losses. Instead of focusing on these negative events of ageing, there are opportunities in focusing on adaptation mechanisms, like resilience, that are helpful to cope with those adversities. Design. Cross-sectional study. Method. The study was conducted from 2011-2012. First, a conceptual model of resilience during the ageing process was constructed. Next, items were formulated that made up a comprehensive template questionnaire reflecting the model. Finally, a cross-sectional study was performed to evaluate the construct validity and internal consistency of this template 16-item questionnaire. Findings. Participants (N = 229) with a mean age of 71.5 years, completed the template 16-item Groningen Ageing Resilience Inventory, and performance based tests and psychological questionnaires. Exploratory factor analysis resulted in a two factor solution of internal and external resources of resilience. Three items did not discriminate well between the two factors and were deleted, remaining a final 13-item questionnaire that shows evidence of good internal consistency. The direction and magnitude of the correlations with other measures support the construct validity. Conclusion. The Groningen Ageing Resilience Inventory is a useful instrument that can help nurses, other healthcare workers, researchers and providers of informal care to identify the internal and external resources of resilience in individuals and groups. In a multidisciplinary biopsychosocial approach this knowledge provides tools for empowering older patients in performing health promoting behaviors and self-care tasks

What type, or combination of exercise can improve preferred gait speed in older adults?: A meta-analysis

Background: Improved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses. Objective: to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed. Methods: Data sources: A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library. Study eligibility criteria: Randomized controlled trials of exercise interventions for older adults >= 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was Study appraisal and synthesis methods: intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed. Results: Twenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention-and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects. Conclusions: Progressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait. Limitations: The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoided, there are probably differences in health status within different studies