Margriet C Pol1, Gerben Ter Riet2, Margo van Hartingsveldt1, Ben Kröse3,4, Bianca M Buurman1,5. 1. ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands. 2. Department General Practice, Amsterdam UMC, University of Amsterdam, The Netherlands. 3. Research Group Digital Life, Amsterdam University of Applied Sciences, University of Amsterdam, Amsterdam, The Netherlands. 4. Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands. 5. Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture. DESIGN, SETTING AND PATIENTS: three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracture patients ≥ 65 years old. INTERVENTIONS: patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months. MAIN OUTCOMES AND MEASURES: the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure. RESULTS: a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual. CONCLUSIONS AND RELEVANCE: among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual. TRIAL REGISTRATION: Dutch National Trial Register, NTR 5716.
RCT Entities:
OBJECTIVES: to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture. DESIGN, SETTING AND PATIENTS: three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracturepatients ≥ 65 years old. INTERVENTIONS:patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months. MAIN OUTCOMES AND MEASURES: the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure. RESULTS: a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual. CONCLUSIONS AND RELEVANCE: among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual. TRIAL REGISTRATION: Dutch National Trial Register, NTR 5716.
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