Showing papers by "Marieke D. Spreeuwenberg published in 2015"

It's LiFe! Mobile and Web-Based Monitoring and Feedback Tool Embedded in Primary Care Increases Physical Activity: A Cluster Randomized Controlled Trial

Abstract: Background: Physical inactivity is a major public health problem. The It’s LiFe! monitoring and feedback tool embedded in the Self-Management Support Program (SSP) is an attempt to stimulate physical activity in people with chronic obstructive pulmonary disease or type 2 diabetes treated in primary care. Objective: Our aim was to evaluate whether the SSP combined with the use of the monitoring and feedback tool leads to more physical activity compared to usual care and to evaluate the additional effect of using this tool on top of the SSP. Methods: This was a three-armed cluster randomised controlled trial. Twenty four family practices were randomly assigned to one of three groups in which participants received the tool + SSP (group 1), the SSP (group 2), or care as usual (group 3). The primary outcome measure was minutes of physical activity per day. The secondary outcomes were general and exercise self-efficacy and quality of life. Outcomes were measured at baseline after the intervention (4-6 months), and 3 months thereafter. Results: The group that received the entire intervention (tool + SSP) showed more physical activity directly after the intervention than Group 3 (mean difference 11.73, 95% CI 6.21-17.25; P <.001), and Group 2 (mean difference 7.86, 95% CI 2.18-13.54; P =.003). Three months after the intervention, this effect was still present and significant (compared to Group 3: mean difference 10.59, 95% CI 4.94-16.25; P <.001; compared to Group 2: mean difference 9.41, 95% CI 3.70-15.11; P <.001). There was no significant difference in effect between Groups 2 and 3 on both time points. There was no interaction effect for disease type. Conclusions: The combination of counseling with the tool proved an effective way to stimulate physical activity. Counseling without the tool was not effective. Future research about the cost-effectiveness and application under more tailored conditions and in other target groups is recommended. Trial Registration: ClinicalTrials.gov: NCT01867970, https://clinicaltrials.gov/ct2/show/NCT01867970 (archived by WebCite at http://www.webcitation.org/6a2qR5BSr). [J Med Internet Res 2015;17(7):e184]

Measuring grip strength in older adults: comparing the grip-ball with the Jamar dynamometer

Abstract: Background and Purpose: Decreased grip strength is a predictor of adverse outcomes in older adults. A Grip-ball was developed that can be used for home-based self-monitoring of grip strength to detect decline at an early stage. The purpose of this study was to evaluate the reliability and validity of measurements obtained with the Grip-ball in older adults. Methods: Forty nursing home patients and 59 community-dwelling older adults 60 years or older were invited to participate in this study. Grip strength in both hands was measured 3 consecutive times during a single visit using the Grip-ball and the Jamar dynamometer. Test-retest reliability was described using intraclass correlation coefficients. Concurrent validity was evaluated by calculating Pearson correlations between the mean Grip-ball and Jamar dynamometer measurements and between the highest measurements out of 3 trials. Known-groups validity was studied using t tests. Results: Eighty eight participants (33 men) with a mean age of 75 (SD = 6.8) years were included. Intraclass correlation coefficients for the Grip-ball were 0.97 and 0.96 for the left and right hands, respectively (P <.001), and those for the Jamar dynamometer were 0.97 and 0.98 for the left and right hands, respectively (P <.001). Pearson correlations between the mean scores of the Grip-ball and the Jamar dynamometer were 0.71 (P <.001) and 0.76 (P <.001) for the left and right hands, respectively. Pearson correlations between the highest scores out of 3 trials were 0.69 (P <.001) and 0.78 (P <.001) for the left and right hands, respectively. The t tests revealed that both the Grip-ball and the Jamar dynamometer detected grip strength differences between men and women but not between nursing home patients and community-dwelling older adults. Grip-ball measurements did not confirm higher grip strength of the dominant hand whereas the Jamar dynamometer did. Conclusions: The Grip-ball provides reliable grip strength estimates in older adults. Correlations found between the Grip-ball and Jamar dynamometer measurements suggest acceptable concurrent validity. The Grip-ball seems capable of detecting "larger" grip strength differences but might have difficulty detecting "smaller" differences that were detected by the Jamar dynamometer. The Grip-ball could be used in practice to enable home-based self-monitoring of grip strength in older adults. However, for implementation of the Grip-ball as a screening and monitoring device in practice, it is important to gain insight into intersession reliability during home-based use of the Grip-ball and clinical relevance of changes in grip strength.

Substitution of hospital care with primary care: defining the conditions of Primary Care Plus

Abstract: Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014 Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care

Estimating Subgroup Effects Using the Propensity Score Method A Practical Application in Outcomes Research

Abstract: Objective: Our aim was to demonstrate the feasibility of the univariate and generalized propensity score (PS) method in subgroup analysis of outcomes research. Methods: First, to estimate subgroup effects, we tested the performance of 2 different PS methods, using Monte Carlo simulations: (1) the univariate PS with additional adjustment on the subgroup; and (2) the generalized PS, estimated by crossing the treatment options with a subgroup variable. The subgroup effects were estimated in a linear regression model using the 2 PS adjustments. We further explored whether the subgroup variable should be included in the univariate PS. Second, the 2 methods were compared using data from a large effectiveness study on psychotherapy in personality disorders. Using these data we tested the differences between short-term and long-term treatment, with the severity of patients' problems defining the subgroups of interest. Results: The Monte Carlo simulations showed minor differences between both PS methods, with the bias and mean squared error overall marginally lower for the generalized PS. When considering the univariate PS, the subgroup variable can be excluded from the PS estimation and only adjusted for in the outcome equation. When applied to the psychotherapy data, the univariate and generalized PS estimations gave similar results. Conclusion: The results support the use of the generalized PS as a feasible method, compared with the univariate PS, to find certain subgroup effects in nonrandomized outcomes research.

The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults: A 6-Month Follow-up Study

Abstract: Background: There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective: The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods: For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up. Results: A total of 128 participants with complete datasets—25.8% (33/128) male—and a mean age of 75.33 years (SD 6.26) were included in the analyses of this study. Balance scores of participants who reported at baseline that they had fallen at least once in the past 6 months were lower compared to nonfallers—8.9 and 11.2, respectively ( P <.001). The correlation between mean balance score and disability sum-score at baseline was -.51 ( P <.001). No significant associations were found between balance at baseline and falls after 6 months of follow-up. Baseline balance scores were significantly associated with the development of disability after 6 months of follow-up in the univariate analysis—odds ratio (OR) 0.86 (95% CI 0.76-0.98)—but not in the multivariate analysis when correcting for age, gender, baseline disability, and falls at follow-up—OR 0.94 (95% CI 0.79-1.11). Conclusions: There is a cross-sectional relationship between balance measured by a modified bathroom scale and falls and disability in older adults. Despite this cross-sectional relationship, longitudinal data showed that balance scores have no predictive value for falls and might only have limited predictive value for disability development after 6 months of follow-up. [J Med Internet Res 2015;17(5):e131]

The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults

Abstract: Background: There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective: The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods: For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up.

Platform for frail elderly people supporting information and communication.

Abstract: There is a growing need for technology to support the frail elderly living independently in home situations. Several telecommunication systems already exist. These systems are developed mainly from the perspective of healthcare professionals and focus on efficient delivery of healthcare services. They hardly meet the specific needs of the frail elderly. In this project a platform with specific needs of the frail elderly people has been designed, running on standard PCs. This system supports living independently, social participation, wellbeing, and asking for care services. The platform was evaluated and subjects assess the system as user friendly, and supportive for their independence and self-reliance. They recommend it to other users.