Coach2Move: Sustainable in Daily Practice

Study Overview
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Brief Summary
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Implementation of a previously shown (cost-)effective physical therapeutic treatment strategy for community-dwelling older adults.

Detailed Description
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In a previous trial, researchers demonstrated that the Coach2Move approach is superior to regular physiotherapy in terms of increasing physical activity, reducing frailty, improving quality of life and reducing healthcare costs. In short, in less physiotherapeutic sessions, better outcomes were realized. Despite these promising findings, the research group still has questions regarding the generalisability of these findings. The reservations towards the generalisability of the approach are caused by the following: A modest (n=130), yet somewhat selective study sample was included: nearly half of the eligible individuals declined randomisation and thereby participation. An understanding is needed how this group of eligible non volunteers respond to Coach2Move. Therefore, a study design that avoids randomisation at the patient level will be used. The Coach2Move approach significantly increased the level of moderate physical activity among the treatment group and reduced levels of frailty significantly after 6 months, but the clinical importance of these findings is still unclear. Thus, a replication of the effects in the light of physical functioning is needed in a larger more variable study population and with a longer follow-up. In addition, the results from the earlier carried out RCT concerning the cost-effectiveness of Coach2Move have to be replicated on a larger scale. For the reasons mentioned above, it is important to further implement Coach2Move and study its effect, costs, and feasibility in current practice. A stepped wedge cluster randomised trial design is chosen because in the opinion of the researchers, the implementation strategy will do more good than harm (making a parallel design, in which certain practices do not receive the intervention or to withdraw the intervention as would occur in a cross-over design, is unethical) and it furthermore minimizes contamination. The objective of this study is to assess the cost-effectiveness of the implementation of a patient and context focused tailored coaching intervention (Coach2Move) in the daily physiotherapy practice for older adults with mobility problems compared to usual physiotherapy. The hypothesis is that Coach2Move leads to better physical outcomes and lower costs than usual care.

Official Title
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Coach2Move: Sustainable in Daily Practice

Conditions
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Sedentary Lifestyle, Physical Activity, Frail Elderly Syndrome

Intervention / Treatment
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* Behavioral: Coach2Move
* Behavioral: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 70 years or older Community-dwelling mobility related problems or problems related to activities of daily living sedentary lifestyle or are at risk of losing an active lifestyle Exclusion Criteria: Patients who are not ambulatory after treatment and/or are in palliative phase. Patients who are indicated to become institutionalised in the near future.

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: stepped wedge cluster randomised trial and mixed methods process analysis
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Coach2Move Intervention Group<br>Coach2Move Intervention Group | Behavioral: Coach2Move<br>* Coach2Move is a multicomponent physiotherapeutic approach in addition to usual care physiotherapy consisting of: Extensive intake during which not only impairments and disabilities, but wishes, barriers and facilitators considering physical functioning are profoundly examined. Motivational interviewing is used to find and deal with barriers for becoming physically active and shared-decision making in goal setting. The approach is patient focused (tailor made) and goal-oriented: the physiotherapist coaches the patient and the environment in reaching and maintaining their own goals. In consultation with the patient, a stratified intervention is chosen by picking the best fitting option out of three patient-tailored intervention profiles with a predefined number of intervention sessions.<br>|
| Active Comparator: Usual Care<br>Usual care physiotherapy among older adults | Behavioral: Usual Care<br>* Usual care physiotherapy among older adults: Intake of 30 minutes consisting of examining medical history, physical functioning and functional exercises to assess the demand for care. Use of treatment modalities to enhance physical functioning (strength, mobility, coordination, balance etc.) Consultation and advisory role in relation to the functional status of geriatric patients and his/her relations. Collaborate with other disciplines in a multidisciplinary context.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported Physical Activity | The primary outcome of the study is physical activity measured by the LAPAQ questionnaire, subscale moderate activity. This subscale of the LAPAQ is a comprehensive questionnaire on diverse (physical) activities of daily living with moderate intensity including walking, riding a bicycle etc. and is specifically designed to assess habitual physical activity of the elderly. | 27 months | 
| Functional Mobility | The key secondary outcome is functional mobility as measured by the Timed Up and Go test. | 27 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Status | The Patient Specific Complaints Scale is used to measure the functional status of a patient. The patients select 3-5 most important mobility problems in daily life and are the most important goals to improve. The degree of hinder is scored by the patient on a 10-point numeric scale. | 12 months | 
| Cost effectiveness | The direct costs of regular physiotherapy and Coach2Move will be determined on a per patient basis. On patient level, volumes of care will be measured prospectively using medical records and cost questionnaires. Next will be determining the cost prices for each volume of consumption in order to use these for the volumes registered for each participating patient. Both outcome measures will be aggregated to one reported value (cost per volume x volumes used). A comparison in costs will be made between the Coach2Move and usual care groups. | 27 months | 
| Patient Satisfaction | The Global Perceived Satisfaction and Effect score is used to measure the patients' satisfaction about the intervention and the perceived effect on a 7-point Likert scale ranging from very unsatisfied to very much satisfied and very much deterioration to very much improvement, respectively. | 27 months | 
| Level of Frailty | To measure the level of frailty and participation, the Evaluative Frailty Index is used. This questionnaire consists of 50 items on deficits in health (symptoms, signs and disabilities) in multiple domains (physical, psychological, social and general health status). | 27 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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older adults, physiotherapy, physical activity