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Physical functioning in pediatric intensive care survivors. A scoping review

Background Encouraging healthy eating behavior and increasing physical activity can improve health, vitality, and quality of life. Individuals and health professionals have specific needs and wishes. Creative technology allows personalization of blended lifestyle programs that support behavior change by presenting persuasive elements and self-regulation. However, the development of such personalized digital tools are time consuming and expensive. New research projects with regard to physical activity and/or nutrition that apply creative technology often start from scratch, while many of the core components are generic. Therefore, we aim to develop a modular platform that serves as a foundation to build several lifestyle applications for various populations, while taking into account the specific needs of the end users. To demonstrate how we can use the platform for a blended lifestyle program regarding physical activity and nutrition, the SONUTS application was developed. SONUTS helps older adults to maintain or lose weight while preserving muscle mass and function. Description of the application Our Modular E-health platform supports three end users: clients, health professionals, and researchers. It enables the use of various behavior change techniques such as goalsetting and action planning. The SO-NUTS application, that has been built on the platform, offers clients to track their dietary intake and physical activity, goal setting, evaluation, communication with health professional and in the future with members of the community. The health professional can track progress and can adjust goals when necessary. Data from both clients and health professionals can be retrieved by researchers, clients and professionals to determine effectiveness of the intervention. Practical description of demo We will present a clickable demo version of the SO-NUTS application that was built on the modular platform. Moreover, we will show various options of the modular platform to demonstrate its use in the development of new applications for future research projects.

Additional file 1: Supplementary Table 1. Sensitivity analysis on fall risk using the LAPAQ as definition for physical activity. Supplementary Table 2. Sensitivity analysis on fall-related fractures using the LAPAQ as definition for physical activity. Supplementary Table 3. Sensitivity analysis on fall risk using inertial sensor data for physical activity. Supplementary Table 4. Sensitivity analysis on the risk of fall-related fractures using inertial sensor data for physical activity.

Gezond bewegen is essentieel om de fysieke zelfredzaamheid van ouderen te bevorderen en te herstellen. De coronapandemie heeft de huidige samenleving veranderd, met mogelijke impact op (digitale) beweegbehoeftes en het welzijn van ouderen. Inzicht in de behoeftes van ouderen in deze bijzondere tijd is belangrijk, maar tegelijkertijd door de lock-down lastig te inventariseren. Dit artikel presenteert de ‘One week in the life of...’methode, een fysieke co-creatieve toolkit om op afstand te achterhalen welke voorkeuren ouderen hebben voor (beweeg)activiteiten, om na te gaan welke ondersteunende rol digitale tools hierbij kunnen spelen en ter inspiratie als mogelijke interventie. Deze toolkit is ontwikkeld omdat in een voorafgaande online vragenlijst aangaande behoeftes rondom bewegen en technologie bij ouderen (N=37) bleek dat de participanten zich met deze methode moeilijk een voorstelling konden maken van de mogelijkheden van technologie voor beweegondersteuning.In dit onderzoek hebben vijftien ouderen de opgestuurde toolkit geretourneerd. Deze toolkit bestond uit een speciaal ontworpen activiteitendagboek, activiteiten kaartjes, een folder met tips & tricks en een fitness elastiek. Uit de resultaten blijkt dat ouderen gedurende de coronapandemie voornamelijk buiten actief waren, waarbij wandelen en fietsen veelvuldig werden uitgevoerd. Hoewel technologie geen groot aandeel had in de dagelijkse activiteiten, inclusief het bewegen van ouderen, leek men hier positief tegenover te staan wanneer dit aansluit op de individuele behoeftes en contextuele situatie.De gebruikte toolkit met actieve tips en tricks creëerde meer bewustzijn rondom de digitale mogelijkheden. Over het meegestuurde fitness elastiek waren participanten enthousiast, de meeste willen deze blijvend gaan gebruiken. Verder bleek de fysieke toolkit een waardevolle methode om zowel contextuele dagelijkse inzichten te bieden aan de ouderen als de zorgprofessional. Oefentherapeuten en andere beweegprofessionals kunnen de toolkit gebruiken als instrument om inzicht te krijgen in het huidige beweeggedrag, het welzijn van ouderen en wat hen dagelijks motiveert en plezier geeft in tijden van corona.

E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy

Objective: The objective of this scoping review is threefold: (1) to describe outcomes of and determinants for physical functioning in pediatric intensive care unit (PICU) survivors evaluated during and/or after their PICU stay, (2) to provide an overview how physical functioning and its associated determinants in this population are reported, measured and classified in accordance with the International classification of Functioning, Disability and Health-Children and Youth framework (ICF-CY) components and (3) to synthesize key gaps in knowledge and research and clinical recommendations related to our review questions. Introduction: Optimal physical functioning in children is of major importance in their developmental trajectories and for the prevention and recovery of health problems across lifespan. PICU children are at high risk of poor physical functioning during and after critical illness. A recent overview of the literature, concerning evaluation of physical functioning in PICU survivors according to the ICF-CY components, is lacking. Inclusion criteria: This review includes empirical studies reporting outcomes and determinants of physical functioning in PICU survivors evaluated during and/or after PICU stay. All English language studies reporting empirical data will be included with no restrictions set on the types of study designs used. Methods: This review will be conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) statement. To locate studies eligible for inclusion, the electronic databases Pubmed, EMBASE, CINAHL and Cochrane Library will be searched from the earliest records to October 2019. Study selection will be performed by two independent reviewers. Covidence software will be used to screen titles and abstracts as well as the full-text of included studies. Data extraction will be conducted using a customized form. The extracted data will be presented in diagrammatic or tabular form with an accompanying narrative summary.

Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. The design was a prospective, single-blind, multicenter, superiority, cluster-randomized controlled trial. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.

Background: Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective. Methods: This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.

Background. Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/ knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. Objective. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. Design. The design was a prospective, single-blind, multicenter, superiority, clusterrandomized controlled trial. Setting. The setting included 143 primary care physical therapist practices. Participants. The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. Intervention. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Measurements. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. Results. The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. Limitations. The response rate at 12 months was 65%. Conclusions. The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.

Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders.

This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis.

Background Blended care, a combination of online and face-to-face care, is seen as a promising treatment option. However, actual use of blended interventions in practice is disappointing. Objective The objective of this study was two folded. The first aim was to develop a blended exercise therapy intervention for patients with knee and hip osteoarthritis that matches the values of the users and that can be implemented in the daily routine of physical therapists. The second aim was to investigate the feasibility through interviews and a pilot study. Methods In this paper, we employed the first 3 steps of the CeHRes road map to develop a blended intervention for patients with knee and hip osteoarthritis. We used interviews, a focus group and discussions with stakeholders to explore the needs, values, and requirements with respect to our to-be-developed blended intervention, which we called e-Exercise. The first version of e-Exercise was tested in a pilot study. Feasibility outcomes, including recruitment rates within each practice, website usage (assignments completed and website visits), and user satisfaction, were measured. In addition, therapists and patients from the pilot study were interviewed to investigate users’ experiences. Results The study captured important information about stakeholders’ needs and perspectives. Based on our findings, we created a first version and attuned the application’s content, functionality, and structure. Patients and, to lesser extent, physical therapists were satisfied with the e-Exercise intervention. Eight patients were recruited by 8 physical therapists. Of the 8 patients, 6 completed more than 7 of 12 modules. Conclusions This study outlines the development and feasibility of a blended exercise therapy intervention for patients with knee and hip osteoarthritis. E-Exercise offers an alternative approach in the physical therapy treatment of knee and hip osteoarthritis. This study provides valuable information to conduct a further trial to evaluate the (cost) effectiveness of e-Exercise compared to usual physical therapy.