title: Physiotherapy to improve physical activity in community-dwelling older adults with mobility problems (Coach2Move): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Older adults can benefit from physical activity in numerous ways. Physical activity is considered to be one of the few ways to influence the level of frailty. Standardized exercise programs do not necessarily lead to more physical activity in daily life, however, and a more personalized approach seems appropriate. The main objective of this study is to investigate whether a focused, problem-oriented coaching intervention ('Coach2Move') delivered by a physiotherapist specializing in geriatrics is more effective for improving physical activity, mobility and health status in community-dwelling older adults than usual physiotherapy care. In addition, cost-effectiveness will be determined.
  
  
  METHODS
  The design of this study is a single-blind randomized controlled trial in thirteen physiotherapy practices. Randomization will take place at the individual patient level. The study population consists of older adults, ≥70 years of age, with decreased physical functioning and mobility and/or a physically inactive lifestyle. The intervention group will receive geriatric physiotherapy according to the Coach2Move strategy. The control group will receive the usual physiotherapy care. Measurements will be performed by research assistants not aware of group assignment. The results will be evaluated on the amount of physical activity (LASA Physical Activity Questionnaire), mobility (modified 'get up and go' test, walking speed and six-minute walking test), quality of life (SF-36), degree of frailty (Evaluative Frailty Index for Physical Activity), fatigue (NRS-fatigue), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire) and health care costs.
  
  
  CONCLUSIONS
  Most studies on the effect of exercise or physical activity consist of standardized programs. In this study, a personalized approach is evaluated within a group of frail older adults, many of whom suffer from multiple and complex diseases and problems. A complicating factor in evaluating a new approach is that it may not be automatically adopted by clinicians. Specific actions are undertaken to optimize implementation of the Coach2Move strategy during the trial. Whether or not these will be sufficient is a matter we will consider subsequently, using quality indicators and process analysis.
  
  
  BACKGROUND
  The Netherlands National Trial Register: NTR3527.
authors.affiliation: Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), P,O, Box 9101, 114 (IQ healthcare), Nijmegen 6500, HB, The Netherlands. n.devries@iq.umcn.nl.
authors.forename: Nienke M
authors.initials: NM
authors.lastname: de Vries
authors.forename: J Bart
authors.initials: JB
authors.lastname: Staal
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.forename: Eddy M M
authors.initials: EM
authors.lastname: Adang
authors.forename: Marcel G M Olde
authors.initials: MG
authors.lastname: Rikkert
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005080:Exercise Test; D016330:Frail Elderly; D015577:Geriatric Assessment; D017048:Health Care Costs; D006801:Humans; D057187:Independent Living / Q000191:economics; D051346:Mobility Limitation; D009043:Motor Activity; D009426:Netherlands; D026741:Physical Therapy Modalities / Q000191:economics; D011788:Quality of Life; D012107:Research Design; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome