Clinical trial NCT03293303: The Feasibility, Effects and Costs of the 'Stay Active at Home Programme'
Official title: The Feasibility, Effects and Costs of the 'Stay Active at Home Programme': Evaluation of a Preventive Integral Approach in Primary Care That Stimulates Physical Activity Among Community-dwelling Older Adults
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Community-dwelling Older Adults
Keywords: Prevention
Physical activity
Sedentary behaviour
Daily activities
Homecare
Nursing
Primary care
Older adults
Function Focused Care
Reablement
Restorative Care
Lead sponsor: Maastricht University Medical Center
Sponsor class: OTHER
First posted: 2017-09-26
Enrollment: 265
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: A randomised controlled trial with 12 months follow-up will be conducted. In total, five homecare teams from MeanderGroep Zuid-Limburg and the local domestic support workers will be trained in 'Stay Active at Home' (intervention group). Another five homecare teams and domestic support workers will deliver usual care (control group). Both groups of professionals and their clients will be compared at baseline and after 6 and/or 12 months follow-up.
Primary purpose: PREVENTION

Brief summary: BACKGROUND: Older adults spend approximately 80% of their awake time in sedentary activities which represents 8 to 12 hours per day. In the past, numerous stand-alone exercise programs have been developed. However, it is challenging to persuade older adults to become and maintain physically active. Consequently, physical activity should be embedded in the daily life of older adults to reduce their sedentary time, prevent negative health consequences and facilitate ageing in place.

INTERVENTION: 'Stay Active at Home' is not an additional, (classical) exercise programme; physical activity is integrated in usual home care. Healthcare professionals learn to engage older adults in daily life in order to improve their physical activity and reduce their sedentary time. For example, washing the upper body and face independently; changing the pillowcase, while professional changes bedcover; and motivating clients to join a dancing class at the community centre.

AIM and DESIGN: The aim of this cluster randomised controlled trial is to provide evidence about the (cost-) effectiveness of 'Stay Active at Home' prior to dissemination and implementation of the programme. Alongside the trial an extensive process evaluation will be conducted.

Detailed description: Many community-dwelling older adults have a highly sedentary lifestyle, especially those receiving homecare services. In the Netherlands 20% of older adults makes use of homecare. The prevalence in frail older adults is even twice as high (40%). However, once in care often a downward spiral sets in, as professionals tend to meet their clients' needs by task completion rather than by stimulating self-management and active engagement in tasks to contribute to active ageing. Thereby they deprive older adults of their opportunities to engage in a routine range of movements necessary for maintaining underlying capability resulting in further deconditioning and functional decline.

To prevent these negative consequences the behaviour of healthcare professionals has to change from 'doing things for older adults' to 'engaging older adults' in daily life in order to improve physical activity among older adults by reducing their sedentary time. This innovative care philosophy is also known as Function Focused Care (FFC), restorative care or reablement. These terms can be used interchangeably, but we will refer to it as FFC throughout this project proposal. In the US the research group of Resnick and colleagues conducted various studies in inpatient and residential care facilities. They have shown that FFC succeeds in increasing physical activity. Furthermore, FFC has shown to result in physical (e.g. daily functioning, muscle strength, balance) and psychological benefits (e.g. mood, behavioural symptoms) and reduces the risk for adverse outcomes (e.g. falls, delirium). Resnick et al. have little experience in homecare settings, but there is an emerging body of evidence, especially in Norway, New Zealand and Australia, that FFC has also potential for community-based care showing beneficial effects with regard to daily functioning, self-perceived activity performance and satisfaction, health-related quality of life, healthcare utilisation/costs, and even mortality. Experiences and results of FFC in Dutch community-dwelling older adults are lacking.

Promising programmes in one particular care setting are not automatically replicable in other settings due to cultural or organisational differences. Consequently, available programmes need to be adapted to the local circumstances before they can be successfully implemented in another setting. However, making changes requires careful planning and execution to prevent a loss of effectiveness by affecting the original programme's theory or removing core components of the programme. Therefore, the investigators have followed so far the first two phases of the framework of the Medical Research Council in preparing the use of FFC in Dutch community-dwelling older adults receiving homecare services:

* Phase I (2013- first half of 2016): The investigators systematically adapted in co-creation with international FFC experts and a Dutch panel of relevant stakeholders the initial FFC philosophy and conducted a pilot study. Throughout the adaptation process healthcare professionals, policy makers, managers and scientists were involved at various times to ensure that all interests are considered and respected. Although not the primary target population (i.e. homecare professionals), the project idea was also intensively discussed with a panel of older adults. The final result of this adaptation process was the 'Stay Active at Home' programme (in Dutch: 'Blijf Actief Thuis'). During the pilot, data about its feasibility was collected from healthcare professionals and older adults.
* Phase II (second half of 2016 - first half of 2017): The investigators conducted a second pilot study, a so-called 'early trial' prior to the currently proposed trial, as part of the ZonMw project BASIC CARE REVISITED (ZonMw #520002003). This early trial provided relevant information regarding: a) the implementation of specific intervention components; b) key components of the chosen methodology (e.g. outcome measures); c) rates of recruitment and retention; and d) the expected effect size. This information is highly relevant with regard to finalising the intervention and designing a subsequent main trial.

In conclusion, 'Stay Active at Home' is systematically developed for the Dutch homecare setting based on international evidence in close collaboration with Dutch stakeholders (i.e. older adults, healthcare professionals, policy makers and managers). The initial feasibility of the programme and the proposed study design are evaluated in two pilot studies prior to the grant period. In order to determine the (cost-) effectiveness of 'Stay Active at Home' prior to dissemination and implementation of the programme in the Dutch homecare setting this cluster randomised controlled trial has to be conducted. Alongside the trial an extensive process evaluation will be conducted.

Eligibility criteria: Inclusion Criteria:

* Receive home care services by the selected nursing teams
* Age ≥65 years

Exclusion Criteria:

* Terminal ill or bedbound
* Serious cognitive or psychological problems
* Not able to communicate in Dutch

Primary outcomes:
measure: Sedentary behaviour measured by ActiGraph GT3X+ (older adults)
timeFrame: 12 months
Secondary outcomes:
measure: Disabilities in ADL and IADL by Groningen Activity Restriction Scale (older adults)
timeFrame: baseline and after 12 months
measure: Physical activity by Short Physical Performance Battery (older adults)
timeFrame: baseline and after 12 months
measure: Major and minor depression by Patient Health Questionnaire-9 (older adults)
timeFrame: baseline and after 12 months
measure: Falls, 1 item 'How often did you fall during the last 6 months?' (older adults)
timeFrame: baseline and after 6, 12 months
measure: Health-related quality of life by EQ-5D-5L (older adults)
timeFrame: baseline and after 6, 12 months
measure: Healthcare utilisation by iMTA Medical Consumption Questionnaire (older adults)
timeFrame: baseline and after 6, 12 months
Other outcomes:
Locations:
city: Landgraaf
country: Netherlands
facility: MeanderGroep Zuid-Limburg
state: Limburg
Study officials:
affiliation: Maastricht University
name: Gertrudis IJ Kempen, PhD
role: STUDY_CHAIR
References:
citation: Metzelthin SF, Rooijackers TH, Zijlstra GAR, van Rossum E, Veenstra MY, Koster A, Evers SMAA, van Breukelen GJP, Kempen GIJM. Effects, costs and feasibility of the 'Stay Active at Home' Reablement training programme for home care professionals: study protocol of a cluster randomised controlled trial. BMC Geriatr. 2018 Nov 13;18(1):276. doi: 10.1186/s12877-018-0968-z.
citation: Metzelthin SF, Zijlstra GA, van Rossum E, de Man-van Ginkel JM, Resnick B, Lewin G, Parsons M, Kempen GI. 'Doing with ...' rather than 'doing for ...' older adults: rationale and content of the 'Stay Active at Home' programme. Clin Rehabil. 2017 Nov;31(11):1419-1430. doi: 10.1177/0269215517698733. Epub 2017 Mar 14.
citation: Rooijackers TH, Metzelthin SF, van Rossum E, Kempen GIJM, Evers SMAA, Gabrio A, Zijlstra GAR. Economic Evaluation of a Reablement Training Program for Homecare Staff Targeting Sedentary Behavior in Community-Dwelling Older Adults Compared to Usual Care: A Cluster Randomized Controlled Trial. Clin Interv Aging. 2021 Dec 22;16:2095-2109. doi: 10.2147/CIA.S341221. eCollection 2021.
citation: Rooijackers TH, Zijlstra GAR, van Rossum E, Vogel RGM, Veenstra MY, Kempen GIJM, Metzelthin SF. Process evaluation of a reablement training program for homecare staff to encourage independence in community-dwelling older adults. BMC Geriatr. 2021 Jan 6;21(1):5. doi: 10.1186/s12877-020-01936-7.