To highlight the importance of nutrition in older adults undergoing a rehabilitation program. Geriatric rehabilitation aims at the recovery of physical abilities for a largely independent life in the ...community. The term 'geriatric rehabilitation' is wide and includes inpatient and ambulatory care as well as rehabilitation programs in hospitals, also outside geriatric wards. The role of nutrition is therefore not clearly defined, but an association between declined functional status and low nutritional status is evident.
An association has been identified between malnutrition and low physical function or lower rehabilitation effect, respectively. In intervention trials with nutritional care (additional energy or protein), a number of benefits for muscle mass, muscle strength, physical function, or the outcomes quality of life and rehospitalization were identified. In this context, the combination of exercise and adequate nutrition seems to be beneficial.
Geriatric patients undergoing a rehabilitation program outside inpatient, ambulatory, or hospitalization care need an adequate supply of energy and nutrients. Malnutrition must be avoided, ideally before starting rehabilitation. Nutritional interventions are most beneficial in combination with exercise training.
The Azure Kinect DK is an RGB-D-camera popular in research and studies with humans. For good scientific practice, it is relevant that Azure Kinect yields consistent and reproducible results. We ...noticed the yielded results were inconsistent. Therefore, we examined 100 body tracking runs per processing mode provided by the Azure Kinect Body Tracking SDK on two different computers using a prerecorded video. We compared those runs with respect to spatiotemporal progression (spatial distribution of joint positions per processing mode and run), derived parameters (bone length), and differences between the computers. We found a previously undocumented converging behavior of joint positions at the start of the body tracking. Euclidean distances of joint positions varied clinically relevantly with up to 87 mm between runs for CUDA and TensorRT; CPU and DirectML had no differences on the same computer. Additionally, we found noticeable differences between two computers. Therefore, we recommend choosing the processing mode carefully, reporting the processing mode, and performing all analyses on the same computer to ensure reproducible results when using Azure Kinect and its body tracking in research. Consequently, results from previous studies with Azure Kinect should be reevaluated, and until then, their findings should be interpreted with caution.
Muscle activation and movements performed during occupational work can lead to musculoskeletal disorders, one of the nursing profession's most significant health hazards. However, physical activity ...like exercise training tailored to the exposure and physical ability offers health prevention and rehabilitation. Professional nursing associations have advised squat training to promote occupational health because it strengthens lower limb and back muscles. Given that squatting is a fundamental part of many daily activities and various actions in caregiving processes, we hypothesized that chair squat performance is a potential predictor of nurses' physical capabilities to perform occupational tasks. We conducted kinetic and electromyographic assessments of 289 chair squat repetitions and compared them to ergonomic patient transfer tasks. In this task, nurses transferred a supine patient to a lateral position in a care bed using similar movement characteristics of the squat task. This cross-sectional pilot study provides initial insights into nurses' kinetic and muscle activation patterns of health-enhancing and compensational strategies. Highly asymmetric movements corresponded to distinct extremes in lower limb and spine muscle activity data-e.g., increased activity of the rectus femoris indicates increased hip flexion, including postural sway and, therefore, high torsional forces affecting the sacroiliac joints. The potential of the chair squat performance as a predictor of nurses' physical capabilities in ergonomic patient transfers was quantified by a 2 × 2 contingency table resulting in an accuracy rate of 73%.
During geriatric rehabilitation, attempts are made to increase the patients' health and functional capacity. In order to maintain these improvements in the medium- and long-term, behavioural changes ...regarding mobility and nutrition are also targeted, but these are often not sustainable. International studies show positive effects on the sustainability of the improvement of physical activity behaviour in healthy seniors through the use of electronic devices and software applications. Comparable approaches that include nutrition topics or combine them and were additionally developed for geriatric rehabilitation patients (≥70 years) to date are not known. The aim of this study was to identify what geriatric rehabilitation patients require from an electronic coaching system (e-coach) to support them in improving their nutritional and physical activity behaviour, and what content and features physiotherapists and dieticians consider relevant.
Focus group interviews (09-11/2019) were conducted in a geriatric rehabilitation centre in Germany with patients aged 70 years and older, relatives and experts (physiotherapists and nutritionists). The focus groups were recorded, transcribed verbatim and analysed using content analysis.
Three focus groups with patients and relatives (n = 17, 65% female, 16 (94%) in age category 70-99 years) and one focus group with experts (2 dieticians and 1 physiotherapist) were conducted. Relevant contents and feedback elements for nutrition and physical activity in old age were identified. The patients' comments show that an e-coach must offer obvious benefits for the older persons and promote motivation in order to be used. The willingness to change nutrition and physical activity behaviour and the previous experiences in these areas are very heterogeneous, therefore content should be adaptable to different requirements.
Experts and patients identified quite similar contents, barriers and facilitators for a nutrition and physical activity e-coach. The e-coach needs to be able to address different points of behaviour change, enable adaptations to the individual patient and convince the older person that using it will help them to improve their nutrition and physical activity. It is also important that the e-coach is easy to use and can be easily integrated into the patient's everyday life after rehabilitation.
Abstract
Background
For older adults (≥ 70 years), it is often challenging to maintain new nutrition and physical activity behaviours learned in rehabilitation. To minimize the risk of negative ...health consequences when returning home, an e-coach can be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behaviour Change (TTM) and guidance from healthcare professionals can optimize behaviour change.
Objective
This prospective single-arm pilot study aimed to assess the usability and feasibility of a nutrition and mobility e-coach for older adults during and after rehabilitation for a period of 9 weeks. In addition, we examined the change in the TTM phase as an indicator of the participant’s readiness to change or the changes made.
Methods
Older adults (≥ 70 years) with nutrition deficits and/ or mobility limitations were recruited in a rehabilitation centre. Participants’ phases of behaviour change in the TTM were identified by comparing current nutrition and physical activity habits via self-report with age-specific nutrition and physical activity recommendations. They received a tablet with the e-coach containing educational and interactive elements on the topics of nutrition and physical activity in older age. Participants used the e-coach and received support from healthcare professionals. The TTM phases were assessed at five times; the e-coach content was adjusted accordingly. Usability was assessed using the System Usability Scale (SUS, Score range: 0-100). Timestamps were used to evaluate how frequently participants used the e-coach: high (≥ 67% of the days), medium (66 − 33% of the days), and low (< 33% of the days).
Results
Approximately 140 patients were approached and n = 30 recruited. Complete data sets of n = 21 persons were analysed (38% female, mean age 79.0 ± 6.0 years). The SUS was 78.6 points, 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (baseline: 33%, n = 7). Nutrition recommendations were achieved by 14 participants (66%) after nine weeks (baseline: 24%, n = 5).
Conclusion
The e-coach seems to be usable and feasible for older adults. We identified some optimization potentials for our application that can be transferred to the development of comparable e-health interventions for vulnerable older adults.
Manual patient handling is one of the most significant challenges leading to musculoskeletal burden among healthcare workers. Traditional working techniques could be enhanced by innovations that can ...be individually adapted to the physical capacity of nurses. We evaluated the use of a robotic system providing physical relief by collaboratively assisting nurses in manual patient handling tasks. By quantifying kinetic and muscle activity data, it was possible to distinguish two kinds of movement patterns. Highly asymmetric postures and movements corresponded to distinct extremes in lower limb and spine muscle activity data. The use of collaborative robotics significantly reduced maximum force exertion in the caregiving process by up to 51%. Lateral flexion and torsion of the trunk were reduced by up to 54% and 87%, respectively, leading to a significant reduction in mean spine muscle activity of up to 55%. These findings indicate the feasibility of collaborative robot-assisted patient handling and emphasize the need for future individual intervention programs to prevent physical burden in care.
One of the most common assessments for the mobility of older people is the Timed Up and Go test (TUG). Due to its sensitivity regarding the indication of Parkinson's disease (PD) or increased fall ...risk in elderly people, this assessment test becomes increasingly relevant, should be automated and should become applicable for unsupervised self-assessments to enable regular examinations of the functional status. With Inertial Measurement Units (IMU) being well suited for automated analyses, we evaluate an IMU-based analysis-system, which automatically detects the TUG execution via machine learning and calculates the test duration. as well as the duration of its single components. The complete TUG was classified with an accuracy of 96% via a rule-based model in a study with 157 participants aged over 70 years. A comparison between the TUG durations determined by IMU and criterion standard measurements (stopwatch and automated/ambient TUG (aTUG) system) showed significant correlations of 0.97 and 0.99, respectively. The classification of the instrumented TUG (iTUG)-components achieved accuracies over 96%, as well. Additionally, the system's suitability for self-assessments was investigated within a semi-unsupervised situation where a similar movement sequence to the TUG was executed. This preliminary analysis confirmed that the self-selected speed correlates moderately with the speed in the test situation, but differed significantly from each other.
Key summary points
Aim
This systematic review and meta-analysis aims to characterize the nutritional status of geriatric rehabilitation patients and its association with functional parameters.
...Findings
Malnutrition is prevalent in a relevant percentage of geriatric rehabilitation patients, whereas body mass index (BMI) is in the normal to overweight range. Furthermore, data suggest that protein and energy intake is reduced and vitamin D deficiency is prevalent in this population. Decreased physical function is associated with malnutrition according to Mini-Nutritional Assessment (MNA) and MNA short form, whereas BMI did not show any clear association.
Message
Nutritional status is reduced in a relevant percentage of geriatric rehabilitation patients and associated with decreased physical function which emphasizes the need for screening and targeted interventions.
Purpose
Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality.
Methods
Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed.
Results
62 out of 1717 references were eligible for inclusion. Pooled prevalence 95% confidence interval (CI) of malnutrition and risk of malnutrition were 13 (5–20) % and 47 (40–54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2–24.5) kg/m
2
. Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40–76% in this population.
Conclusions
Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.
An early detection of functional decline with age is important to start interventions at an early state and to prolong the functional fitness. In order to assure such an early detection, functional ...assessments must be conducted on a frequent and regular basis. Since the five time chair rise test (5CRT) is a well-established test in the geriatric field, this test should be supported by technology. We introduce an approach that automatically detects the execution of the chair rise test via an inertial sensor integrated into a belt. The system's suitability was evaluated via 20 subjects aged 72⁻89 years (78.2 ± 4.6 years) and was measured by a stopwatch, the inertial measurement unit (IMU), a Kinect
camera and a force plate. A Multilayer Perceptrons-based classifier detects transitions in the IMU data with an F1-Score of around 94.8%. Valid executions of the 5CRT are detected based on the correct occurrence of sequential movements via a rule-based model. The results of the automatically calculated test durations are in good agreement with the stopwatch measurements (correlation coefficient r = 0.93 (
< 0.001)). The analysis of the duration of single test cycles indicates a beginning fatigue at the end of the test. The comparison of the movement pattern within one person shows similar movement patterns, which differ only slightly in form and duration, whereby different subjects indicate variations regarding their performance strategies.
Comprehensive and repetitive assessments are needed to detect physical changes in an older population to prevent functional decline at the earliest possible stage and to initiate preventive ...interventions. Established instruments like the Timed "Up & Go" (TUG) Test and the Sit-to-Stand Test (SST) require a trained person (e.g., physiotherapist) to assess physical performance. More often, these tests are only applied to a selected group of persons already functionally impaired and not to those who are at potential risk of functional decline. The article introduces the Unsupervised Screening System (USS) for unsupervised self-assessments by older adults and evaluates its validity for the TUG and SST. The USS included ambient and wearable movement sensors to measure the user's test performance. Sensor datasets of the USS's light barriers and Inertial Measurement Units (IMU) were analyzed for 91 users aged 73 to 89 years compared to conventional stopwatch measurement. A significant correlation coefficient of 0.89 for the TUG test and of 0.73 for the SST were confirmed among USS's light barriers. Correspondingly, for the inertial data-based measures, a high and significant correlation of 0.78 for the TUG test and of 0.87 for SST were also found. The USS was a validated and reliable tool to assess TUG and SST.
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