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1.
Osteoporos Int ; 34(5): 867-877, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36856794

RESUMO

The AHFS90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%. PURPOSE: Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS90). METHODS: Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS90, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. RESULTS: One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS90 had a maximal prediction of early mortality of 64.5% in this study population. CONCLUSION: The AHFS90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%.


Assuntos
Fraturas do Quadril , Humanos , Idoso de 80 Anos ou mais , Fraturas do Quadril/cirurgia , Fatores de Risco , Prognóstico , Estudos Retrospectivos
2.
Injury ; 53(8): 2818-2822, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35718566

RESUMO

OBJECTIVE: Postoperative pneumonia is among the most common complications in elderly patients after hip fracture surgery. We implemented a proactive postoperative pneumonia prevention protocol and analyzed the incidence of postoperative pneumonia in elderly patients (≥70 years of age) receiving this protocol after hip fracture surgery versus those receiving usual care before the protocol's implementation at our institution. MATERIALS AND METHODS: From November 2018 to October 2019, the proactive postoperative pneumonia prevention protocol was implemented. The treatment included intensified physical therapy, postoperative pulmonary exercises and oral care, in addition to the usual surgical treatment for elderly patients with hip fracture. The intervention cohort data were compared with a historical control cohort treated from July 2017 to June 2018. The primary outcome of this study was the incidence of postoperative pneumonia in both groups, diagnosed according to the presence of two of three of the following: elevated infection parameters, radiologic examination confirmation of pneumonia of the chest or clinical suspicion. RESULTS: A total of 494 patients (n= 249 in the historical control cohort and n=245 in the intervention cohort) were included. A total of 69 patients developed postoperative pneumonia. The incidence of postoperative pneumonia was significantly lower (6.7 percentage points) in the group receiving the proactive postoperative pneumonia prevention protocol (17.3% in the historical control cohort vs 10.6% in the intervention cohort; p=0.033). DISCUSSION AND CONCLUSION: A proactive postoperative pneumonia prevention protocol showed promise in decreasing the occurrence of postoperative pneumonia after hip fracture surgery in elderly patients.


Assuntos
Fraturas do Quadril , Pneumonia , Idoso , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Incidência , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco
3.
Ann Ig ; 33(6): 543-554, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33565567

RESUMO

Background: Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards active and healthy ageing. In this context, the European Commission launched different private-public partnerships to develop new solutions and answers on questions related to this topic. The European Innovation Partnership on Active and Healthy Ageing, including topic related action groups as well reference sites committed towards a common action to facilitate active and healthy ageing, has contributed key elements for interventions, scaled up best practices and evaluated impact of their action to drive innovation across many regions in Europe over the past years. Methods: This paper describes action taken by A3 action group in the European Innovation Partnership on Active and Healthy Ageing. This paper gives an overview of how the partnership combined the view on frailty coming from public health as well as the clinical management. Results: Within different European regions, to tackle frailty, EIPonAHA partners have conceptualized functional decline and frailty, making use of good practice models working well on community programs. The A3 Group of EIPonAHA has worked alongside a process of innovation, targeting all ageing citizens with the clear goal of involving communities in the preventive approach. Conclusion: Engagement needs of older people with a focus on functionally rather than disease management as primary objective is considered as an overarching concept, also embracing adherence, compliance, empowerment, health literacy, shared decision-making, and activation. Furthermore, training of staff working with ageing people across all sectors needs to be implemented and evaluated in future studies.


Assuntos
Fragilidade , Envelhecimento Saudável , Idoso , Envelhecimento , Europa (Continente) , Fragilidade/prevenção & controle , Humanos , Saúde Pública
4.
Arch Osteoporos ; 15(1): 19, 2020 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-32088776

RESUMO

Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group. PURPOSE: In previous literature, elderly with a hip fracture are frequently defined as ≥ 70 years. However, given the ageing population and the rapidly increasing number of 'nonagenarians' (aged ≥ 90 years), the question rises whether this definition is still actual. The aim of this study is to determine whether nonagenarians show differences compared to patients aged 70-79 years and patients aged 80-89 years in terms of patient characteristics, complications and mortality rate. METHODS: From April 2008 until December 2016, hip fracture patients aged ≥ 70 years treated according to our orthogeriatric treatment model were included. Patients were divided into three different groups based on age at admission: 70-79 years, 80-89 years and ≥ 90 years. Patient characteristics, risk of early mortality, complications and outcomes were analysed. Risk factors for 30-day mortality in nonagenarians were determined. RESULTS: A total of 1587 patients were included: 465 patients aged 70-80 years, 867 patients aged 80-90 years and 255 patients aged ≥ 90 years. Nonagenarians were more often female and had a lower haemoglobin level at admission. Prefracture, they were more often living in a nursing home, were more dependent in activities of daily living and mobility and had a higher risk of early mortality calculated with the Almelo Hip Fracture Score (AHFS). Post-operative, nonagenarians suffer significantly more often from delirium and anaemia. The 30-day mortality and 1-year mortality were significantly higher. Differences increased gradually with age. CONCLUSION: Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group.


Assuntos
Fatores Etários , Fraturas do Quadril/mortalidade , Hospitalização/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/terapia , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Transl Med UniSa ; 19: 42-48, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360666

RESUMO

We developed and tested an innovative physical training method in older adults that embeds the gym program into everyday life in the most conservative way possible. Physical training was included in the activities of local parishes where older women from Southern Italy spend most of their free time and was delivered by trained physical therapists with the support of an ICT tool known as CoCo. 113 older women (aged 72.0 [69.0-75.0] years) noncompliant to conventional exercise programs participated to the study. 57 of them underwent the final anthropometric assessment and 50 the final physical tests. In study completers handgrip strength and physical performance evaluated with the chair-stand, the two minutes step and the chair-sit and -reach tests significantly improved. Quality of life as evaluated with the EuroQol-5dimension (EQ-5D) questionnaire improved as well. In conclusion, a training program designed to minimally impact on life habits of older people is effective in improving fitness in patients noncompliant to other to physical exercise programs.

6.
Diabetes Res Clin Pract ; 149: 132-139, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30738090

RESUMO

AIMS: Infrared thermal imaging (IR) is not yet routinely implemented for early detection of diabetic foot ulcers (DFU), despite proven clinical effectiveness. Low-cost, smartphone-based IR-cameras are now available and may lower the threshold for implementation, but the quality of these cameras is unknown. We aim to validate a smartphone-based IR-camera against a high-end IR-camera for diabetic foot assessment. METHODS: We acquired plantar IR images of feet of 32 participants with a current or recently healed DFU with the smartphone-based FLIR-One and the high-end FLIR-SC305. Contralateral temperature differences of the entire plantar foot and nine pre-specified regions were compared for validation. Intra-class correlations coefficient (ICC(3,1)) and Bland-Altman plots were used to test agreement. Clinical validity was assessed by calculating statistical measures of diagnostic performance. RESULTS: Almost perfect agreement was found for temperature measurements in both the entire plantar foot and the combined pre-specified regions, respectively, with ICC values of 0.987 and 0.981, Bland-Altman plots' mean Δ = -0.14 and Δ = -0.06. Diagnostic accuracy showed 94% and 93% sensitivity, and 86% and 91% specificity. CONCLUSIONS: The smartphone-based IR-camera shows excellent validity for diabetic foot assessment.


Assuntos
Pé Diabético/diagnóstico , Smartphone/instrumentação , Idoso , Custos e Análise de Custo , Pé Diabético/patologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Smartphone/economia
7.
Arch Osteoporos ; 13(1): 131, 2018 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-30456430

RESUMO

In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24-48 h after arrival at the hospital, while the length of hospital stay shortened. INTRODUCTION: Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation. METHODS: Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods. RESULTS: A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years. CONCLUSIONS: The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24-48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population.


Assuntos
Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Fraturas do Quadril/mortalidade , Traumatologia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Feminino , Serviços de Saúde para Idosos/normas , Fraturas do Quadril/terapia , Humanos , Tempo de Internação , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Traumatologia/métodos , Traumatologia/normas
8.
Physiotherapy ; 104(3): 277-298, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30030037

RESUMO

BACKGROUND: Over the last few years, telerehabilitation services have developed rapidly, and patients value benefits such as reduced travelling barriers, flexible exercise hours, and the possibility to better integrate skills into daily life. However, the effects of physiotherapy with telerehabilitation on postoperative functional outcomes compared with usual care in surgical populations are still inconclusive. OBJECTIVES: To study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and quality of life in surgical patients. DATA SOURCES: Relevant studies were obtained from MEDLINE, EMBASE, CINAHL, the Cochrane Library, PEDro, Google Scholar and the World Health Organization International Clinical Trials Registry Platform. STUDY SELECTION: Randomised controlled trials, controlled clinical trials, quasi-randomised studies and quasi-experimental studies with comparative controls were included with no restrictions in terms of language or date of publication. DATA EXTRACTION AND SYNTHESIS: Methodological quality was assessed using the Cochrane risk of bias tool. Twenty-three records were included for qualitative synthesis. Seven studies were eligible for quantitative synthesis on quality of life, and the overall pooled standardised mean difference was 1.01 (95% confidence interval 0.18 to 1.84), indicating an increase in favour of telerehabilitation in surgical patients. LIMITATIONS: The variety in contents of intervention and outcome measures restricted the performance of a meta-analysis on all clinical outcome measures. CONCLUSIONS: Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations. This may be sufficient reason to choose physiotherapy with telerehabilitation for surgical populations, although the overall effectiveness on physical outcomes remains unclear. PROSPERO registration number: CRD42015017744.


Assuntos
Modalidades de Fisioterapia , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Telerreabilitação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Humanos , Saúde Mental , Pessoa de Meia-Idade , Satisfação do Paciente
9.
Lung Cancer ; 119: 91-98, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29656759

RESUMO

OBJECTIVES: Our objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. METHODS: A prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. RESULTS: On group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. CONCLUSION: As expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior 'profiling' through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.


Assuntos
Comportamento/fisiologia , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Exercício Físico , Neoplasias Pulmonares/epidemiologia , Pneumonectomia , Acelerometria , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
10.
Int J Behav Med ; 25(1): 30-37, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28699090

RESUMO

PURPOSE: Increasing physical activity level is a generally effective intervention goal for patients who suffer from chronic cancer-related fatigue (CCRF). However, patients are unlikely to benefit equally from these interventions, as their behavioral starting points might vary substantially. Therefore, we explored patterns of physical behavior of participants who suffer from CCRF. METHODS: Baseline data of a randomized controlled trial were used for a latent profile analysis on nine accelerometer-derived physical behavior measures, describing levels and patterns of physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary behavior. The relation between participant characteristics and the latent profiles was analyzed. RESULTS: Accelerometer data of 172 participants from the Netherlands was analyzed. Three latent profiles were distinguished that differed most on physical activity level and total time spent in MVPA. Eighty-eight percent of all participants were assigned to a profile with a probability higher than 8. Age and perceiving limitations by comorbid conditions and pain were significant covariates of profile membership. CONCLUSIONS: We distinguished three physical behavior profiles. The differences between the patterns indicate that the heterogeneity of this sample requires patients to have substantially different treatment goals. Further research should test the applicability of these profiles in clinical practice.


Assuntos
Sobreviventes de Câncer/psicologia , Fadiga/psicologia , Fadiga/terapia , Neoplasias/psicologia , Comportamento Sedentário , Adulto , Idoso , Exercício Físico , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Países Baixos
11.
J Cancer Surviv ; 11(6): 720-731, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28396993

RESUMO

PURPOSE: The aim of this study is to evaluate the feasibility of a telehealthcare application for operable lung cancer (OLC) patients, consisting of ambulant symptom and physical activity monitoring (S&PAM) and a web-accessible home-based exercise program (WEP), and identify possible barriers for successful adoption and implementation. METHODS: A two-stage mixed methods design was used, in which 22 OLC patients and their treating healthcare professionals (HCPs) participated from pre-surgery to three (stage 1; n = 10) or six (stage 2; n = 12) months post-surgery. Actual use and acceptability (usability, usefulness, and satisfaction) were evaluated. RESULTS: Seventeen OLC patients (age (SD): 59 (8) years; 8 female) actively used the modules. S&PAM use varied from 1 to 11 monitoring days prior to outpatient consultations. Patients used WEP most frequently during the first 5 weeks, with an average of four logins a week. Fifty-eight percent used WEP beyond 7 weeks. No adverse situations occurred, and patients felt confident using the applications. Perceived added value included active lifestyle promotion, decreased anxiety, and accessibility to specialized HCPs. Physiotherapists used WEP as intended. Contrarily, physicians scarcely used information from S&PAM. To promote future adoption, strategies should focus on high-level patient tailoring of the technology, and formalization of including the applications in the clinical workflow. CONCLUSIONS: Ambulant monitoring and web-accessible home exercise is clinically feasible for OLC patients. However, low level of adoption by referring physicians may hamper successful implementation. IMPLICATIONS FOR CANCER SURVIVORS: Patients perceived both ambulant monitoring and web-accessible exercise as an added value to regular care and feasible to use in the period before and after lung resection.


Assuntos
Sobreviventes de Câncer/psicologia , Terapia por Exercício/métodos , Neoplasias Pulmonares/cirurgia , Telemedicina/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Pessoa de Meia-Idade , Pacientes Ambulatoriais
12.
Transl Med UniSa ; 15: 53-66, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27896228

RESUMO

Aim of this paper is to describe the protocol of the study "Impact of a Community-based Program on Prevention and Mitigation of Frailty in community-dwelling older adults" developed in the framework of the European Innovation Partnership on Active and Healthy Ageing. This proposal has been developed by the Partnership Action groups on frailty, fall prevention and polypharmacy in older. The proposal wants to assess the impact of community-based programs aimed to counteract three main outcomes related to frailty: hospitalization, institutionalization and death. Bringing together researchers from seven European countries, the proposal aims to achieve the critical mass and the geographical extension enough to provide information useful to all older European citizens. An observational study will be carried out to calculate the incidence of the different outcomes in relation to the various interventions that will be assessed; results will be compared with data coming from already established national, regional and local dataset using the observed/expected approach. The sample will be made up by at least 2000 citizens for each outcome. All the citizens will be assessed at the baseline with two multidimensional questionnaires: the RISC questionnaire and the Short Functional Geriatric Evaluation questionnaire. The outcomes will be assessed every six-twelve months.

13.
Eur J Pain ; 20(5): 711-22, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26492564

RESUMO

BACKGROUND: Chronic pain in patients is usually related to an episode of pain following acute injury, emphasizing the need to prevent progression from acute to chronic pain. Multiple factors in the acute phase might be responsible for perpetuating the pain. The presentation of patients at the emergency department (ED) presents a prime opportunity to identify patients at high risk for chronic pain and to start appropriate treatment. METHODS: The PROTACT study is a prospective follow-up study aiming to estimate the incidence and prognostic factors responsible for the development of chronic pain after musculoskeletal injury. Data including sociodemographic, pain, clinical, injury- or treatment-related and psychological factors of 435 patients were collected from registries and questionnaires at ED visit, 6-week, 3- and 6-month follow-up. RESULTS: At 6 months post-injury, 43.9% of the patients had some degree of pain (Numeric Rating Scale (NRS) ≥1) and 10.1% had chronic pain (NRS ≥4). Patients aged over 40 years, in poor physical health, with pre-injury chronic pain, pain catastrophizing, high urgency level and severe pain at discharge were found to be at high risk for chronic pain. CONCLUSIONS: Two prognostic factors, severe pain at discharge and pain catastrophizing, are potentially modifiable. The implementation of a pain protocol in the ED and the use of cognitive-behavioural techniques involving reducing catastrophizing might be useful.


Assuntos
Catastrofização/epidemiologia , Dor Crônica/epidemiologia , Extremidades/lesões , Dor Musculoesquelética/epidemiologia , Adulto , Catastrofização/psicologia , Dor Crônica/psicologia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Razão de Chances , Medição da Dor , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença
14.
Transl Med UniSa ; 13: 19-28, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27042429

RESUMO

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: 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.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.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.

15.
Eur J Oncol Nurs ; 19(2): 162-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25456973

RESUMO

PURPOSE: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. METHOD: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). RESULTS: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. CONCLUSIONS: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.


Assuntos
Fadiga/etiologia , Comportamentos Relacionados com a Saúde , Atividade Motora/fisiologia , Neoplasias/complicações , Neoplasias/psicologia , Acelerometria , Ciclos de Atividade/fisiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Fadiga/diagnóstico , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Países Baixos , Qualidade de Vida , Autorrelato
16.
J Sports Med Phys Fitness ; 52(4): 337-43, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22828454

RESUMO

AIM: An exploratory study to identify parameters that can be used for estimating a subject's cardio-respiratory physical fitness level, expressed as VO2max, from a combination of heart rate and 3D accelerometer data. METHODS: Data were gathered from 41 healthy subjects (23 male, 18 female) aged between 20 and 29 years. The measurement protocol consisted of a sub-maximal single stage treadmill walking test for VO2max estimation followed by a walking test at two different speeds (4 and 5.5 kmh-1) for parameter determination. The relation between measured heart rate and accelerometer output at different walking speeds was used to get an indication of exercise intensity and the corresponding heart rate at that intensity. Regression analysis was performed using general subject measures (age, gender, weight, length, BMI) and intercept and slope of the relation between heart rate and accelerometer output during walking as independent variables to estimate the VO2max. RESULTS: A linear regression model using a combination of the slope and intercept parameters, together with gender revealed the highest percentage of explained variance (R2 = 0.90) and had a standard error of the estimate (SEE) of 2.052 mL O2kg-1min-1 with VO2max. Results are comparable with current commonly used sub-maximal laboratory tests to estimate VO2max. CONCLUSION: The combination of heart rate and accelerometer data seems promising for ambulant estimation of VO2max-.


Assuntos
Aceleração , Frequência Cardíaca , Consumo de Oxigênio , Aptidão Física/fisiologia , Adulto , Feminino , Humanos , Masculino , Caminhada/fisiologia , Adulto Jovem
17.
Behav Res Ther ; 49(12): 908-13, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21982345

RESUMO

Cognitive behavioural therapy (CBT) was combined with graded exercise therapy (GET) for patients with chronic fatigue syndrome (CFS) in an uncontrolled implementation study of an inpatient multidisciplinary group therapy. During the intake procedure, 160 CFS patients completed a questionnaire on fatigue related measurements, physical impairment, depression, somatic and psychological attributions, somatic focus, and sense of control over symptoms. Pre-treatment physical activity level was measured with an actometer. At baseline, post-treatment and 6-month follow-up individual strength, subjective fatigue and physical impairment, were reassessed. Large effect sizes were found on subjective fatigue (1.2 post-treatment; 1.2 follow-up) and physical impairment (-.9 post-treatment; -.9 follow-up), Clinically significant improvement was found in 33.8% of the participants at post-treatment and 30.6% at follow-up. Individual strength at post-treatment was predicted by level of physical activity before treatment, and by sense of control over symptoms and physical activity at follow-up. Clinically significant improvement in subjective fatigue was predicted by not receiving a disablement insurance benefit, shorter duration of fatigue, higher sense of control over symptoms and, at follow-up by more pre-treatment physical activity. In conclusion, the intervention was effective for CFS patients. Cognitive behavioural factors that perpetuate fatigue symptoms are also predictors of treatment outcome.


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Terapia Combinada/psicologia , Terapia por Exercício/psicologia , Síndrome de Fadiga Crônica/terapia , Fadiga/terapia , Psicoterapia de Grupo/estatística & dados numéricos , Centros de Reabilitação , Adulto , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Terapia por Exercício/métodos , Terapia por Exercício/estatística & dados numéricos , Fadiga/psicologia , Síndrome de Fadiga Crônica/psicologia , Feminino , Humanos , Masculino , Atividade Motora , Prognóstico , Psicoterapia de Grupo/métodos
18.
Clin Rehabil ; 25(3): 256-63, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20921030

RESUMO

OBJECTIVE: To compare self-report measures of daily activities with objective activity data to determine whether patients with chronic lower back pain report their activity levels as accurately as controls do. DESIGN: A cross-sectional study was performed in patients and controls. SETTING: The study was carried out in the daily environment of the subjects. SUBJECTS: Thirty-two chronic lower back pain patients with symptoms more than three months and 20 healthy controls from the Netherlands, aged 18-65 years. MAIN MEASURES: A tri-axial accelerometer was worn for five weekdays and the Baecke Physical Activity Questionnaire was filled in. Pearson's correlation was calculated to get insight in the awareness of patients and controls. Comparisons of the relationship between the objective and subjective scores of each individual patient with those of the group of controls were used to allocate each patient into subgroups: overestimators, underestimators and aware patients. Physical and psychological characteristics of these groups were explored. RESULTS: Patients showed weak correlations between the objective and subjective scores of physical activity and appear to have problems in estimating their activity levels (r = -0.27), in contrast to controls who showed strong correlations between the objective and subjective scores (r = 0.66). Comparison of the individual relationships of patients with those of controls showed that 44% of the patients were not aware of their activity level. There were relatively more underestimators (30%) than overestimators (14%). Physical characteristics between the three groups tended to be different. CONCLUSIONS: Patient self-reports about their activity level are relatively inaccurate when compared to objective measurements.


Assuntos
Atividades Cotidianas , Autoavaliação Diagnóstica , Avaliação da Deficiência , Dor Lombar/diagnóstico , Adulto , Fatores Etários , Doença Crônica , Estudos Transversais , Feminino , Humanos , Dor Lombar/reabilitação , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários
19.
Telemed J E Health ; 16(4): 439-45, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20507199

RESUMO

INTRODUCTION: In telemedicine, technology is used to deliver services. Because of this, it is expected that various actors other than those involved in traditional care are involved in and need to cooperate, to deliver these services. The aim of this study was to establish a clear understanding of these actors and their roles and interrelationships in the delivery of telemedicine. A video teleconsultation service is used as a study case. METHODS: A business modeling approach as described in the Freeband Business Blueprint Method was used. The method brings together the four domains that make up a business model, that is, service, technology, organization, and finance, and covers the integration of these domains. The method uses several multidisciplinary workshops, addressing each of the four domains. RESULTS: Results of the four domains addressed showed that (1) the video teleconsultation service is a store and put-forward video teleconsult for healthcare providers. The service is accepted and has added value for the quality of care. However, the market is small; (2) the technology consists of a secured Internet Web-based application, standard personal computer, broadband Internet connection, and a digital camera; (3) a new role and probably entity, responsible for delivering the integrated service to the healthcare professionals, was identified; and finally (4) financial reimbursement for the service delivery is expected to be most successful when set up through healthcare insurance companies. Pricing needs to account for the fee of healthcare professionals as well as for technical aspects, education, and future innovation. DISCUSSION: Implementation of the video teleconsult service requires multidisciplinary cooperation and integration. Challenging aspects are the small market size and the slow implementation speed, among others. This supports the argument that accumulation of several telemedicine applications is necessary to make it financially feasible for at least some of the actors.


Assuntos
Reembolso de Seguro de Saúde/economia , Internet , Consulta Remota/organização & administração , Gravação em Vídeo , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Educação , Humanos , Modelos Econômicos , Países Baixos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Consulta Remota/economia
20.
Artigo em Inglês | MEDLINE | ID: mdl-19963997

RESUMO

The emergence of high bandwidth public wireless networks and miniaturized personal mobile devices give rise to new mobile healthcare services. To this end, the MobiHealth system provides highly customizable vital signs tele-monitoring and tele-treatment system based on a body area network (BAN) and a mobile health care (m-health) service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signs to healthcare providers as well as real-time feedback to the patient. Since 2002 the system has undergone substantial development in consecutive EU and national research projects. Diverse trials with different healthcare scenarios and patient groups in different European countries have been conducted in all projects. These have been performed to test the service and the network infrastructure including its suitability for m-health applications.


Assuntos
Telemedicina/instrumentação , Engenharia Biomédica , Telefone Celular/instrumentação , Humanos , Monitorização Ambulatorial/instrumentação , Telemetria/instrumentação
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