Amsterdam University of Applied Sciences
Taking the intervention to the patient
Alternative ways of delivering PT/ Survivorship care interventions Stuiver, Martijn
Publication date 2018
Document Version Final published version
Link to publication
Citation for published version (APA):
Stuiver, M. (2018). Taking the intervention to the patient: Alternative ways of delivering PT/
Survivorship care interventions. Abstract from First International Conference on Physiotherapy in Oncology.
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Download date:27 Nov 2021
TAKING THE INTERVENTION TO THE PATIENT
ALTERNATIVE WAYS OF DELIVERING PT / SURVIVORSHIP CARE INTERVENTIONS
Martijn Stuiver PhD
Declara'on of interest
ü Nothing to declare
Which factors are the key
to success of exercise programs?
supervised unsupervised
Buffart et al. Cancer Treat Rev. 2017 Jan;52:91-104
Lower body muscle strength
Sweegers et al. In preparation
Sweegers et al. In prepara/on
BUT PATIENTS MAY HAVE OTHER
PREFERENCES…
Increasing self-efficacy
• Mastery experience
• Succesful completion of (easier) (sub) tasks
• Social modeling
• Identifiable role models (learning from others)
• Improving physical and emotional states
• Take on complex tasks when well-rested and not stressed
• Verbal persuasion
• Encouragement and feedback
Diversifying/ enhancing PT supervision
• Journals / step counters/ activity trackers to be used at home
• Remotely monitored activity trackers
• E-health/ M-health applications
• Exercise instructions
• Remote support (telephone, webcam, email)
• Interactive patient portals and algorithm guided support
Weekly messages (sent via Facebook) and group administrator posted discussions within the group throughout intervention. Participants also had access to website for goal setting and PA diary and pedometers to measure steps
6-week online course providing information, skill building, weekly action plans, social networking and peer support, exercise logs, relaxation exercises
PA manual provided matched with participants’
‘stage of change’ and responses to questionnaires on the website. Website also enabled participant to set PA goals and log PA
9-week online workshop to deliver content (e.g.
dispelling PA myths, exercising safely,
planning/making SMART goals). Website used to log/monitor PA and email feed- back.
Automated system to evaluate baseline assessment and select personalised intervention components using ‘if-then’
algorithms. Users are recommended modules basedon assessments but have access to all 8 modules.
J Cancer Surviv (2017) 11:704–719
SR Digital Health Behavior
change interventions
Behavioral techniques in cancer rehab programs (n=130)
median 5 (1-8)
EXAMPLES OF STEP COUNTER
INTERVENTIONS
PT guided, step counter based activity support during RT
• Pilot study (n=21) Bca patients
• Average daily step count 3 days prior to RT
• Step count diary + fatigue / symptom recording
• Increase in step count goal by 5% in the first 2 weeks
• Adjustments based on symptoms, adherence and patient feedback
• Suggestions on how to increase step count
• 91% adherence
• Positive effects on happiness and 6MWD
Physiotherapy Canada 2015; 67(2);205–213
PT guided, step counter based activity support during ChT
o RCT (n=92) Bca patients
o Step counter + additional materials (including journal)
o Goal: increase MPA to 150 minutes above current level of PA o Suggestions for types of activities and strategies to increase PA
o TPB based component: assignments used for barrier identification, goal setting, planning/scheduling, and info designed to enhance attitudes, subjective norms, perceived behavioral control, and intentions.
o Control group received standard recommendation o 95% adherence
o Intervention not superior to standard recommendation
Cancer Epidemiol Biomarkers Prev; 25(2) February 2016
PT guided, step counter based activity support after treatment
o Quasi RCT (n=256) Bca patients o Physiatrist precribed exercise o PT instructions
o Strength + aerobic exercises
o Step counter Control group received standard recommendation o Adherence not assessed
o Intervention not superior to standard recommendation on
measures of function, PA and QOL
Aerobic and resistance training for Intervention AND control group iMOVE Health Coach Intervention
3 components:
1. one-on-one telephone-based counseling
2. supportive health tracking smartphone software (Connected Wellness, NexJ Health Inc) + online platform
3. Use of Fitbit and associated software (FitBit Flex, Fitbit Inc).
Blended care intervention for bca survivors
o Exercise supervision is tapered from partly supervised to fully home based (wk 13-26) o Borg 14-15
1 x GXT (60’) 2x HB-AT (30’) 1 x GXT (60’) 2x HB-AT (45’) 1x HB-RT (30’) 1 x GXT (60’) 2x HB-AT (60’) 1x HB-RT (60’) 1 x GXT (60’) 2x HB-AT (60’) 2x HB-RT (60’) 1 x GXT (60’) 3x HB-AT (60’) 2x HB-RT (60’) 1 x GXT (60’) 3x HB-AT (60’) 2x HB-RT (60’)
o Behavioral components based on theories (TTM, SCT, TPB)
o iMove coaching (by telephone) based on Motivational interviewing/ CBT elements, and aimed at:
• Improving motivation
• establishing exercise self-efficacy and ability to change
• Improving exercise social support
• Promotion of positive exercise-related feelings
• Overcoming barriers
• Positive cost/benefit perception
iMove coaching
Ritvo P et al. JMIR Res Protoc 2017;6:e165.
Examples of remote support exercise interventions
(mixed cancer diagnoses)
Stepcounter & SMS messages
• RCT (n= 60), during chemotherapy (mixed diagnoses, 35%bca), 8 weeks
• C: Stepcounter only
• I : 3 components
• Step counter
• Booklet with recommendations on PA (1 section/ week)
• Encouraging text messages weekly
Villaron et al Support Care Cancer 2018
Undertaking physical activity is sometimes difficult: you’re tired, you don’t have time….
Often the hardest thing is to take the first steps;
once that is done, physical activity is a pleasure.
Set yourself a target for the week. Follow the guide you were given for more information.
Have a good week!
o No effect on weekly steps, but: Positive effect on fatigue, several HRQoL domains and
emotional state
o Authors hypothesize this is due to improved SE and symptom self management
Exercise intervention
• (Working towards) high intensity
• 2.5 hours / 2 weeks
• Home based
• Polar watch
• Minimal supervision (intake + telephone contact) by PT
☞ Compliance poor (36%), yet
• Decline in endocrine symptoms (ES 0.51)
• Decline in miction complaints (ES 0.30)
• Improvement in physical functioning (ES 0.46)
• No adverse events!
Remote guided exercise for pa2ents with low grade glioma
o Home based
o Self chosen activity
o HRR based on baseline CPET
o Telephone and email coaching by PT
Gehring et al. Clinical Rehabilitation (2) 12, 2017
Gehring et al. Clinical Rehabilitation (2) 12, 2017
o Home based exercise program with webbased instructions (video, speech, tekst) o Exercises for strength, aerobic capacity, balance, flexibility, relaxation
o Exercise goals and starting level determined in single PT intake o Feedback on adherence, succes, wish for progression via website o Adjustment of the program via webportal
o Additional telephone coaching by PT if desired
Evaluation of lung cancer rehab portal
• Overall high patient satisfaction
• Points of improvement:
• More actual contact with PT
• Better accessibility on mobile devices
• Easy to use for PT
• Point of improvement
• PTs indicate to prefer a more blended approach
• Access via mobile device
• Some improvements required regarding UI
“Maybe I could have done it without this intervention,
but I never would have started"
Interest in e-health support:
4% Very a5rac7ve 30% A5rac7ve
12% Not a5rac7ve 51% No opinion
ten Tusscher et al. In preparation
Physitrack System
Examples of tracking and
modifying activity patterns
Mixed cancer diagnoses
AAF (Ambulant Activity Feedback)
o For patients with chronic CRF o Actometer
o Baseline measurement o Goal setting
o PT telephone support 3 scenario’s:
• Activate
• Temper
• Balance
Wolvers et al. Journal of Medical Internet Research, 19(10), e336
Timmerman et al. submi/ed
Exercise behavior after lung cancer surgery
Interactive patient portal example
PABLO study
• Patient portal in hospital environment
• Patients log in to the portal to access appointments, retrieve information etc.
• Coupled to Hospital electronic database
☞Specific section dedicated to increasing PA behavior
• Based on theoretical models (TTM, SCT)
Motivational readiness
(see questions →) 0-4 days PA > 30 min
5-7 days PA > 30 min
Do you have the inten@on to start PA
> 30 min for 5 or more day per weeks in the next 6 months?
For how much months have you been PA > 30 min for 5 or more days per week?
No, I don’t
Yes, and I will start within 6 months
Yes, and I will start within 30 days Less than 6 months
More than 6 months
Precontemplation stage
Contempla@on stage
Preparation stage
Action stage
Maintenance stage
One month acces to:
- Introduction text
- Current PA level graph & text on Dutch public health guideline - Content set x
Content set 1 Content set 2 Content set 3
x informa@ve texts 2/3 assignments
Also 3 content sets
Also 3 content sets
Also 3 content sets
2 content sets
IPAQ SF
