Frailty, Hip Fractures, Stroke
Conditions
Keywords
geriatric patients, geriatric rehabilitation, physiotherapy, caregiver involvement
Brief summary
This interventional study aims to see if involving caregivers as exercise partners with the physiotherapist throughout in-hospital geriatric rehabilitation and the first six weeks following discharge is feasible. Caregivers will receive hands-on training from physiotherapists so that they can assist their family members with their exercises. The caregivers will provide 30-minute exercise sessions three times each week in addition to the standard physiotherapy. The researchers want to know how many people are eligible for GAPP+CARE and how willing they are to participate. The researchers also want to know about the program's hindering and facilitating elements, as well as its fidelity and retention rate. Apart from that, the researchers want to examine if an effectiveness study and the used outcome measures are viable.
Detailed description
To meet the WHO guideline for daily exercise during and after hospitalization, physiotherapists must find ways for geriatric patients to be active outside of therapy time. Geriatric patients require assistance or supervision to exercise safely, yet physiotherapists and nurses are short on time. Instead, by providing carers with tools and instruction, the researchers might turn them into exercise partners for the physiotherapist. The investigators designed an exercise program (GAPP+Care) customized to the caregiver's ability to exercise safely with their loved one, based on the ideas and exercises of our standard physiotherapy program, the Geriatric Activation Program Pellenberg (GAPP). Through semi-structured interviews, patients and their caregivers were involved in developing and validating GAPP+Care, including the exercise booklet. GAPP+Care consists of GAPP (the usual physiotherapy treatment) and three additional 30-minute exercise sessions with the caregiver each week (+Care). +Care will continue at home for the first six weeks after discharge, and GAPP will be replaced with physiotherapy performed by a private physiotherapist, as described at discharge (a prescription for home physiotherapy 3 times a week, for 60 sessions F-pathology or 18 sessions). The initial +Care session is with a ward physiotherapist who will show the caregiver how to utilize the GAPP+Care handbook and the exercises and teach them how to support the patient during the exercises. During hospitalization, one of the three weekly sessions will be led by a ward physiotherapist to reinforce the hands-on skills and knowledge. These physiotherapy-patient-caregiver sessions will consist of two home visits and four phone calls after the patient has been discharged. The goal of this exploratory study is to see if GAPP+Care is feasible. The researchers want to know how many people are eligible and how willing they are to participate. The researchers also want to assess the program's hindering and facilitating elements, as well as its fidelity and retention rate. Aside from that, the researchers want to evaluate if an effectiveness study and the used outcome measures are viable.
Interventions
OTHERGAPP+Care
standard physiotherapy 45 minutes per day, 5 day a week (GAPP) \+ 3 extra exercise sessions led by a caregiver (+Care)
OTHER+Care
3 extra exercise moments led by a caregiver: one physiotherapist-caregiver-patient exercise session: the physiotherapist will educate and train the caregiver on the exercises and hands-on skills. Two caregiver-patient exercise sessions
OTHERObservation of GAPP+Care
Healthcare workers in the geriatric rehabilitation ward will be interviewed on their opinions on GAPP+Care
Sponsors
Universitaire Ziekenhuizen KU Leuven
KU Leuven
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Feasibility study
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Patients: Inclusion Criteria: * Patients from geriatric rehabilitation unit, with various pathologies * ≥ 70 years old * ≥ 10m of walking with walking aid and under supervision * Berg Balance Scale (BBS) \< 30/56 * Medically stable as determined by the attending physician * Expecting at least 3 weeks of rehabilitation
Exclusion criteria
* No available caregiver * Unable to understand instructions Caregivers: Inclusion Criteria: * A person who is willing to support the patient in performing exercises at least 3 times a week for 30 minutes. An informal carer is defined as an unpaid member of a person's social network who helps the patient with activities of daily living.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of eligible individuals and their willingness to participate in GAPP+Care | 1 year | Number of available patients on the ward and number of eligible patients and caregivers and number of patients and caregivers who participate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fidelity to GAPP+Care | up to 12 weeks | Number of exercise moments with physiotherapist; Noted in exercise diary Number of exercise moments with caregiver; Exercise Diary Number and kind of exercises with caregiver; Exercise Diary |
| Retention rate of participants | 1 year | Number of dropouts |
| Number of falls during the +Care sessions | up to 12 weeks | number of falls noted in the exercise diary or mentioned during the interviews |
| Private physiotherapy after discharge | 6 weeks | number of sessions per week |
| Feasibility, appropriateness, and the hindering and facilitating factors of GAPP+Care | patients and caregivers 2 times (at day of discharge and at the end of week 6 after discharge), healthcare providers 1 time (in the last 6 months of the study) | Semi-structured interviews with patients, caregivers and healthcare providers |
| Functional balance | 3 times over 10 weeks: baseline, at day of discharge (up tot 6 weeks after baseline) and at end of week 6 after discharge | Berg Balance Scale (BBS) 0-56, a higher score means a better outcome |
| Hand squeeze force | 3 times over 10 weeks: baseline, at day of discharge (up tot 6 weeks after baseline) and at the end of week 6 after discharge | Maximum handgrip with dominant hand, measured with the Martin Vigory dynamometer, in kPa |
| Walking speed | 3 times over 10 weeks: baseline, at day of discharge (up tot 6 weeks after baseline) and at the end of week 6 after discharge | 4m walking test (4mWT), m/s |
| Quality of life patient and caregiver | 3 times over 10 weeks: baseline, at day of discharge (up tot 6 weeks after baseline) and at end of week 6 after discharge | Visual analog scale of quality of life (VAS QoL), 0-10 a higher score means a better outcome |
| Use of the activity monitor MOX, Maastricht Instruments | first week at baseline, first week after discharge (starting at day of discharge), and week 6 after discharge | measuring daily activity in minutes/24hours (sedentary - standing - dynamic) |
Countries
Belgium
Outcome results
None listed