Monitoring of physical frailty in older people; an innovative system supporting self management and care.

As society ages the prevalence of frailty and its adverse outcomes increases.
Disability is an adverse outcome of frailty that places a strain on frail
individuals and their caregivers. As a consequence, the demand for care and the
use of community services increases. Combined with a decreasing number of
caregivers this causes frailty to be a burden on health care systems.
Technological innovations can contribute to bridging the gap between demand and
supply of care in frail elderly people. During our research project, an
innovative system for monitoring physical frailty indicators (weight, balance,
gait, muscle strength, and physical activity) in community-dwelling older
people was be developed. The system gives feedback to the user about his/her
functional status and warns the user and/or care providers if a change in the
indicators occurs. Before the system can be evaluated it will be tested in a
small scale pilot study.

The primary objectives of the pilot study are to provide insight into the
technical functioning, usability, acceptability, comprehensiveness, and
feasibility of the monitoring and feedback & advisory system. Improvements will
be made to the system based on the information that was obtained during the
pilot study. The secondary objective is to gain more insight into how relevant
changes in the physical functioning of participants can be detected with the
three devices.

For the pilot study, 5 participants will be recruited from the falls clinic of
the Orbis Medical Center in Sittard. The duration of the pilot study will be 3
months. At baseline, the researcher will visit the participants in their home
to install the system and to explain how the devices should be used. At the end
of every month, the researcher will have a face-to-face semi-structured
interview with the participants.

The system consists of three devices that will be used daily by the
participants; a bathroom scale monitoring weight and balance, a Grip-ball
monitoring grip strength and a mobile phone with a built-in accelerometer
monitoring physical activity and gait. The information about these physical
indicators is sent to the mobile phone via blue-tooth. The users will receive
feedback and advice regarding their own physical functioning on the screen of
the mobile phone using text and/or spoken messages. The tailored advices relate
to individually relevant and realistic goals that aim to maintain or improve
physical functioning. The mobile phone also sends the information to an online
database that is accessible for the physiotherapist that is involved in the
pilot study. The physiotherapist will visit the participants after they have
used the three devices for 2, 6, and 10 weeks. During the visits the
physiotherapist will examine the physical functioning of the participants.
Besides that, the physiotherapist will discuss the measurements that were
performed with the three devices in the previous weeks with the participant.
Based on that, the physiotherapist and participant will collaborate to set
realistic and personally relevant goals that relate to the improvement or
maintenance of physical functioning. The physiotherapist will support the
participant in achieving these goals by providing tailored advice. This advice
in combination with the feedback and advice that is provided via the mobile
phone will support the participants in the self management of their own
physical functioning.

The risk that is associated with participation is minimal because the current
level of physical functioning will be the starting point of the therapy that
participants receive from the physiotherapist. There is a small possibility
that participants will focus too much on the measures of their physical
functioning because they are asked to measure this daily during the pilot study
whereas they do not do this in their normally.
The benefit that opposes the burden mentioned above is that participants get a
detailed insight into their own physical functioning. Because of this insight,
they receive care and advice that is tailored to their own needs which might
result in an improved physical functioning.