Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study.

OBJECTIVES: To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently. DESIGN: Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles. SETTINGS: University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities. PARTICIPANTS: One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists). RESULTS: Three generic categories were identified: (1) 'Challenge older adults with goal-oriented ADL tasks', (2) 'Implement strategies to enhance independent and safe performance of ADL tasks', and (3) 'Communicate the important information to the target group and across sectors'. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call. CONCLUSIONS: Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme. TRIAL REGISTRATION NUMBER: This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results.

Reliability and internal consistency of the Danish version of Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II/D).

OBJECTIVE: To evaluate the intra-rater and inter-rater reliability and internal consistency of the Danish version of the Loewenstein Occupational Therapy Cognitive Assessment, second edition (LOTCA-II/D), an instrument designed to assess and evaluate cognitive functioning. METHODS: A reliability study was conducted at neurological acute care and rehabilitation units at three Danish hospitals. Fifty-four neurological patients participated in the study. Patients were tested with LOTCA-II/D by occupational therapists, and video recordings were made for reliability assessments. Intra-rater assessments were performed at least two weeks after the first assessment, and all occupational therapists were blinded to previous assessments. Intra-rater and inter-rater reliability were evaluated using percentage agreement and weighted kappa. Internal consistency was evaluated using Cronbach's alpha, and floor and ceiling effects were evaluated by calculating the proportion of observations in minimum and maximum categories of subtests. RESULTS: The results showed a lack of intra-rater and inter-rater reliability and a large variation of agreement due to a substantial ceiling effect. Internal consistency was below the acceptable value in half of the cognitive areas. CONCLUSION: The study found that LOTCA-II/D is not reliable in acute clinical practice, and it could thus not be validated for use in this setting.

Danish translation and adaptation of Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II).

OBJECTIVE: To translate and adapt the English version of the Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II) to Danish. METHOD: The translation process followed the overall guidelines of the World Health Organization (WHO) with forward translation, expert panel discussion, pre-tests and interviews with patients and laymen, and back-translation. RESULTS: The translation was successful and minor corrections and adaptations were made. In total three versions were produced before the final Danish version LOTCA-II/D was drafted. CONCLUSIONS: The Danish version of LOTCA-II was successfully translated and adapted based on the WHO guidelines. Before implementation in clinical practice further research of the reliability and validity of the LOTCA-II/D are needed.