Coach2Move: Physiotherapy in frail older adults.

Background:

Many elderly have to deal with multiple diseases and disabilities. For healthcare professionals in general and geriatric physiotherpists in particular it is merely unclear how to deal with this complex population. Evidence based guidelines are lacking. Moreover, since the population is ageing and healthcare costs are increasing there is a high need for cost effectiveness in geriatric health care. Literature shows that mobility is essential for overall functioning and quality of life of older adults. Physiotherapy aimed at improving mobility can therefore be of great importance. A physically active lifestyle can maintain mobility and quality of life after the end of the physiotherapy treatment. We also expect that the level of frailty can be influenced by means of a physically active lifestyle.



Objective:

The main objective of this study is to study whether a problem-oriented coaching intervention (coach2move strategy) by a physiotherapist specialized in geriatrics is more effective to improve physical activity, mobility and health status in community-dwelling older adults than usual care physiotherapy. In addition, cost-effectiveness will be determined.



Study Design:

The study design is a single blind randomized controlled trial in fourteen physiotherapy practices in the Netherlands. In each participating practice one physiotherapist specialized in geriatrics will work according to the coach2move strategy and one general physiotherapist will provide usual care. Participants who fulfil the inclusion criteria and are willing to participate will be randomized to either the geriatric physiotherapist or the general physiotherapist in their preferred physiotherapy practice.



Study population:

The study population consists of community-dwelling, physically inactive older adults with or at risk of mobility problems.



Intervention:

The coach2move strategy consists of an extensive and systematically organized diagnostic phase in physiotherapy which leads to a specific goal- and personally oriented treatment. Shared decision making and self-management are essential. The participating specialized physiotherapists will be trained in the coach2move strategy prior to the trial and coached during the trial.



Primary outcome:

The primary outcome is the level of physical activity as measured by the LASA Physical Activity Questionnaire (LAPAQ).



Secundary outcome:

1. Mobility (modified Get Up & Go Test, walking speed and 6 minute walking test);

2. Quaility of life (SF-36);

3. Frailty (Evaluative Frailty Index for Physical activity);

4. Perceived Effect (Global Perceived Effect, Patient Specific Complaints);

5. Fatigue (NRS fatigue);

6. Healthcare utilization;

7. Co-morbidity (Cummulative Illness Rating Scale).



Hypothesis:

The coach2move strategy is more effective in improving level of physical activity, quality of life and frailty compared to usual care physiotherapy in older adults suffering from or at risk of mobility problems. In addition we expect the Coach2Move strategy to be more cost-effective.

A problem- oriented and patient centered physiotherapy intervention (coach2move strategy) is more effective in improving level of physical activity, quality of life, mobility and frailty compared to usual care physiotherapy in older adults suffering from or at risk of mobility problems. In addition we expect the Coach2Move strategy to be more cost-effective.

1. Measurement 1 (t0): baseline - prior to physiotherapy treatment;

2, Measurement 2 (t1): 3 months after the start of physiotherapye treatment;

3. Measurement 3 (t2): 6 months after the start of physiotherapy treatment.

The Coach2Move strategy consists of an extensive and systematically organized diagnostic phase in physiotherapy which leads to a specific goal- and patient oriented treatment. Shared decision making and self- management are essential. The physiotherapist coaches his/ her clients in reaching their own goals. The frequency and length of the physiotherapy are based on the needs of each specific patient.



The control group will receive physiotherapy as usual.