Preventing functional decline in young seniors: Development and evaluation of interventions and smartphone-based tests
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Decline in physical function in seniors leads to falls, decreased physical activity, dependence in activities of daily living, and reduced quality of life, constituting a major burden for the individual itself, and an economic burden for the health care system. In addition, the age composition of the worlds’ population is changing fast; life expectancy is increasing, and fertility rates are decreasing, which is prospected to put stress on health care services. This thesis is based on the recognition that there is a need to find effective methods to prevent functional decline in younger seniors. By preventing functional decline, seniors can achieve more active years without disability and dependence in everyday activities. Research has indicated that sensor technology might increase the utility of clinical tests in measuring physical function. Furthermore, studies have shown that exercise programmes where activities for muscle strength and balance have been integrated in daily habits and routines can be more effective in falls prevention compared to traditional exercise programmes. The thesis aims to provide new knowledge on how we can use instrumented performance-based tests to measure and monitor physical function, and how interventions can be designed to help to improve physical function and increase physical activity. The aim of this thesis, which includes one literature review, one feasibility study, one usability study and one method study, was fourfold: 1) to systematically review the literature on commonly used tests of balance and strength and to evaluate their measurement properties in young seniors; 2) to evaluate the feasibility of an intervention, the adapted Lifestyle-integrated Functional Exercise (aLiFE) programme, adapted to be more challenging and suitable for preventing functional decline in young seniors; 3) to describe the development and usability testing of three smartphone-based self-tests of physical function using an iterative design in a home-setting; 4) to evaluate whether an instrumented Timed Up and Go (iTUG)-test can predict the score on a advanced test of balance and mobility. Further, we wanted to evaluate whether the iTUG model was equally or more predictive compared to a model of traditional clinical measurements in geriatric outpatients and healthy community-dwelling seniors. The systematic review identified 3454 papers with a total number of 120 performance-based tests of physical function that had been used in healthy young seniors. Of these, 30 tests were most commonly used. The second step of the review identified 9 studies which had evaluated the measurement properties of 6 different tests: the Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), 10-second Tandem stance, Five Times sit-to-stand, and the Community Balance and Mobility Scale (CBMS). Of the identified tests, the CBMS seemed like the one most suited for application in healthy young seniors as it has no ceiling or floor effects and was found valid and reliable in healthy young seniors in the included method studies. The feasibility study of the aLiFE programme showed that overall it was feasible and well accepted by the young seniors. The participants implemented most of the activities during the 4-week intervention period, and perceived the programme to be helpful, adaptable to their lifestyle, appropriately challenging, and safe. Although the study was not designed to evaluate effectiveness, moderate improvements in physical function measured by the CBMS were found. A larger study with longer follow-up is needed to establish effectiveness of the programme, as well as its ability to induce long-term adherence through behavioural change. In the usability study, a human-centered design was used when developing and testing the applications (apps) for three clinical tests of physical function, through 3 iterations. Results showed that young seniors made several errors while self-administering the clinical tests with a smartphone in an unsupervised setting, and that rate of errors was affected by changes made across the iterations. Although smartphone-based self-testing of physical function is promising, validation of outcome measures is needed before being offered to end-users. Finally, we found that in a supervised lab-setting, the instrumented Timed Up and Go could predict the score on the Community Balance and Mobility Scale with a high and similar accuracy as compared to standard clinical tests, in a mixed sample of geriatric patients and community-dwelling seniors. This thesis showed that there is a need for functional tests which are more sensitive, available, valid and reliable in young seniors. Important insight was provided about what usability problems may arise when developing smartphone-based functional self-tests, and how changes to the apps affect such problems. Furthermore, with a partial least squares regression analysis it was found that by instrumenting the TUG with a smartphone, a seemingly simple clinical test which otherwise is not sensitive for detecting functional decline in young seniors, could predict higher-level balance and mobility as measured with the CBMS. The findings indicate that smartphone apps can be feasible for home-based assessments and monitoring of physical functions, potentially motivating the end-user to become more physically active and prevent functional decline. Future work should aim to further develop and validate the self-tests and integrate these tests into a solution that combines testing with an exercise intervention tailored to the user based on the test results. A life-style integrated exercise-approach was evaluated in the thesis, and the results were promising, however more research is needed to verify its effectiveness.
Has partsPaper 1: Bergquist, Ronny; Weber, Michaela; Schwenk, Michael; Ulseth, Synnøve; Helbostad, Jorunn L.; Vereijken, Beatrix; Taraldsen, Kristin. Performance-based clinical tests of balance and muscle strength used in young seniors: a systematic literature review. BMC Geriatrics 2019 ;Volum 19.(1) https://doi.org/10.1186/s12877-018-1011-0 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0/),
Paper 2: Schwenk, Michael; Bergquist, Ronny; Boulton, Elisabeth; Van Ancum, Jeanine M.; Nerz, Corinna; Weber, Michaela; Barz, Carolin; Jonkman, Nini H.; Taraldsen, Kristin; Helbostad, Jorunn L.; Vereijken, Beatrix; Pijnappels, Mirjam; Maier, Andrea B.; Zhang, Wei; Becker, Clemens; Todd, Chris; Clemson, Lindy; Hawley-Hague, H.. The Adapted Lifestyle-Integrated Functional Exercise Program for Preventing Functional Decline in Young Seniors: Development and Initial Evaluation. Gerontology 2019 ;Volum 65.(4) s. 362 https://doi.org/10.1159/000499962
Paper 3: Bergquist, Ronny; Vereijken, Beatrix; Mellone, Sabato; Corzani, Mattia; Helbostad, Jorunn L.; Taraldsen, Kristin. App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study. JMIR mhealth and uhealth 2020 ;Volum 8.(4) s. 1-11 https://doi.org/10.2196/16507 This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0/)
Paper 4: Bergquist, Ronny; Nerz, Corinna; Taraldsen, Kristin; Mellone, Sabato; Ihlen, Espen Alexander F.; Vereijken, Beatrix; Helbostad, Jorunn L.; Becker, Clemens; Mikolaizak, A. Stefanie. Predicting Advanced Balance Ability and Mobility with an Instrumented Timed Up and Go Test. Sensors 2020 https://doi.org/10.3390/s20174987 This is an open access article distributed under the Creative Commons Attribution License (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0/)