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      Effects, costs and feasibility of the ‘Stay Active at Home’ Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial

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          Abstract

          Background

          According to the principles of Reablement, home care services are meant to be goal-oriented, holistic and person-centred taking into account the capabilities and opportunities of older adults. However, home care services traditionally focus on doing things for older adults rather than with them. To implement Reablement in practice, the ‘Stay Active at Home’ programme was developed. It is assumed that the programme leads to a reduction in sedentary behaviour in older adults and consequently more cost-effective outcomes in terms of their health and wellbeing. However, this has yet to be proven.

          Methods/ design

          A two-group cluster randomised controlled trial with 12 months follow-up will be conducted. Ten nursing teams will be selected, pre-stratified on working area and randomised into an intervention group (‘Stay Active at Home’) or control group (no training). All nurses of the participating teams are eligible to participate in the study. Older adults and, if applicable, their domestic support workers (DSWs) will be allocated to the intervention or control group as well, based on the allocation of the nursing team. Older adults are eligible to participate, if they: 1) receive homecare services by the selected teams; and 2) are 65 years or older. Older adults will be excluded if they: 1) are terminally ill or bedbound; 2) have serious cognitive or psychological problems; or 3) are unable to communicate in Dutch. DSWs are eligible to participate if they provide services to clients who fulfil the eligibility criteria for older adults. The study consists of an effect evaluation (primary outcome: sedentary behaviour in older adults), an economic evaluation and a process evaluation. Data for the effect and economic evaluation will be collected at baseline and 6 and/or 12 months after baseline using performance-based and self-reported measures. In addition, data from client records will be extracted. A mixed-methods design will be applied for the process evaluation, collecting data of older adults and professionals throughout the study period.

          Discussion

          This study will result in evidence about the effectiveness, cost-effectiveness and feasibility of the ‘Stay Active at Home’ programme.

          Trial registration

          ClinicalTrials.gov: NCT03293303, registered on 20 September 2017.

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          Most cited references37

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          Stages and processes of self-change of smoking: toward an integrative model of change.

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            The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial

            Background Medically treated injuries have been shown to increase with increasing body mass index (BMI). Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs. Methods Sedentary adults with BMIs between 25 and 40 kg/m2 (n = 397) enrolled in one of two randomized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program. Interventions differed by duration of the exercise goal (150, 200, or 300 minutes/week or control group). Walking was prescribed as the primary mode of exercise. At six month intervals, participants were asked, "During the past six months, did you have any injury or illness that affected your ability to exercise?" Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise. Results During the 18-month study, 46% reported at least one injury/illness, and 32% reported at least one injury that was attributed to exercise. Lower-body musculoskeletal injuries (21%) were the most commonly reported injury followed by cold/flu/respiratory infections (18%) and back pain/injury (10%). Knee injuries comprised one-third of the lower-body musculoskeletal injuries. Only 7% of the injuries were attributed to exercise alone, and 59% of the injuries did not involve exercise. BMI (p ≤ 0.01) but not exercise (p ≥ 0.41) was significantly associated with time to first injury and injuries over time. Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness. Conclusions Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults randomized not to participate in prescribed exercise. Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI, weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults. Trial Registration Clinicaltrials.gov NCT00177502 and NCT00177476
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              Comparison of Sedentary Estimates between activPAL and Hip- and Wrist-Worn ActiGraph.

              Sedentary behavior is an emerging independent health risk factor. The accuracy of measuring sedentary time using accelerometers may depend on the wear location. This study in older adults evaluated the accuracy of various hip- and wrist-worn ActiGraph accelerometer cutoff points to define sedentary time using the activPAL as the reference method.
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                Author and article information

                Contributors
                s.metzelthin@maastrichtuniversity.nl
                t.rooijackers@maastrichtuniversity.nl
                r.zijlstra@maastrichtuniversity.nl
                erik.vanrossum@zuyd.nl
                marja.veenstra@huisvoordezorg.nl
                a.koster@maastrichtuniversity.nl
                s.evers@maastrichtuniversity.nl
                gerard.vbreukelen@maastrichtuniversity.nl
                g.kempen@maastrichtuniversity.nl
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                13 November 2018
                13 November 2018
                2018
                : 18
                : 276
                Affiliations
                [1 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Department of Health Services Research, , Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [2 ]ISNI 0000 0004 0429 9708, GRID grid.413098.7, Research Centre for Community Care, , Faculty of Health, Zuyd University of Applied Sciences, ; P.O. Box 550, 6400 AN Heerlen, The Netherlands
                [3 ]Burgerkracht Limburg, P.O. Box 5185, 6130 PD Sittard, The Netherlands
                [4 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Department of Social Medicine, , Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [5 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Department of Methodology and Statistics, , Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                Author information
                http://orcid.org/0000-0002-4764-2196
                Article
                968
                10.1186/s12877-018-0968-z
                6234661
                30424738
                24463546-6baa-4d64-808a-05d6bbb10377
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 June 2018
                : 29 October 2018
                Funding
                Funded by: The Netherlands Organisation for Health Research and Development
                Award ID: ZonMw 50-53120-98-014
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2018

                Geriatric medicine
                reablement,ageing in place,sedentary behaviour,physical activity,aged people,home care,activities of daily living,nursing,behavioural intervention,prevention

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