title: Effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older individuals after hip fracture, the SO-HIP trial: study protocol of a three-arm stepped wedge cluster randomized trial.
abstract: The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. The same holds for sensor monitoring-based coaching in addition to OT. Here, we describe the design of a study investigating the effect of sensor monitoring embedded in an OT rehabilitation program on the recovery of ADL among older individuals after hip fracture.
  
  
  
  Six nursing homes will be randomized in a three-arm stepped wedge cluster randomized trial. All nursing homes will initially provide standard care. At designated time points, nursing homes, successively and in random order, will cross over to the provision of OT and at the next time point, to sensor monitoring-enhanced OT. A total of 288 older individuals, previously living alone in the community, who after a hip fracture were admitted to a geriatric rehabilitation ward for a short-term rehabilitation, will be enrolled. Individuals in the first intervention group (OTc) will participate in an OT rehabilitation program with coaching based on cognitive behavioral therapy (CBT) principles. In the sensor monitoring group, sensor monitoring is added to the OT intervention (OTcsm). Participants will receive a sensor monitoring system consisting of (i) an activity monitor during nursing home stay, (ii) a sensor monitoring system at home and a (iii) a web-based feedback application. These components will be embedded in the OT. The OT consists of a weekly session with an occupational therapist during the nursing home stay followed by four home visits and four telephone consultations. The primary outcome is patient-perceived daily functioning at 6 months, assessed using the Canadian Occupational Performance Measure (COPM).
  
  
  
  As far as we know, this study is the first large-scale stepped wedge trial, studying the effect of sensor monitoring embedded in an OT coaching program. The study will provide new knowledge on the combined intervention of sensor monitoring and coaching in OT as a part of a rehabilitation program to enable older individuals to perform everyday activities and to remain living independently after hip fracture.
  
  
  
  Netherlands National Trial Register, NTR 5716 Date registered: April 1 2016.
authors.affiliation: Research Group Occupational Therapy, ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Room B 122, Tafelbergweg 51, PO Box 2557, 1000CN, Amsterdam, The Netherlands. m.c.pol@hva.nl.
authors.forename: Margriet C
authors.initials: MC
authors.lastname: Pol
authors.affiliation: Department General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Gerben
authors.initials: G
authors.lastname: Ter Riet
authors.affiliation: Research Group Occupational Therapy, ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Room B 122, Tafelbergweg 51, PO Box 2557, 1000CN, Amsterdam, The Netherlands.
authors.forename: Margo
authors.initials: M
authors.lastname: van Hartingsveldt
authors.affiliation: Research Group Digital Life, Amsterdam University of Applied Sciences, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Kröse
authors.affiliation: Department of Internal Medicine, Geriatric Section, Academic Medical Center, University of Amsterdam and The University Medical Center Groningen (UMCG), Amsterdam, The Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006620:Hip Fractures / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D009788:Occupational Therapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016896:Treatment Outcome
keywords: Activities of daily living; Coaching; Effectiveness; Hip fracture; Occupational therapy; Sensor monitoring; Stepped wedge randomized trial