The prize for the best research at the Amsterdam University of Applied Sciences in 2017 went to Margriet Pol, occupational therapist and researcher at the AUAS. Her study concerns the use of sensor technology for the improvement of rehabilitation after hip fractures. Her research team used Castor to collect data, which we are naturally proud of. We were therefore interested in her research. That is why we invited Margriet to our office to meet her and to discuss her research So Hip.
We have heard that your So Hip research has won a prize, the AUAS study of the year. Congratulations on winning the prize! Can you tell us exactly what this prize means?
Of course, it is partly an honor. The main prize is 3500 euros, to spend on the research, so that’s a nice boost to do something extra. We were first elected from the faculty. I was elected again. There were 15 studies nominated in the preliminary round 5 of which were nominated for the research award.
What are the criteria for that prize?
On the one hand, scientific criteria, so the research design. Our research has been chosen because it is methodologically sound. Within the AUAS, it is also very important that students can participate in the research. It was important that it has a social impact, so that the research has added value for society, but also for healthcare professionals. So a wide range of criteria.
Could you tell us more about your research?
Every year there are 15,000 elderly people who get a hip fracture and 40% of them go to a nursing home after the operation for short-term rehabilitation. Almost 90% no longer comes to the level of before the fall. They are re-recorded or can no longer live independently. This is partly due to the fact that it is a 84 year old average. They often have multiple health problems.
An important factor is fear of falling. Because of fear of falling, people become cautious and avoid activities because they are so shocked by the trauma they have experienced. Often it goes well in the nursing home during rehabilitation; then people think they can do everything again. Once they come home, the concerned family often takes things out of their hands, such as shopping. This is how people limit their lives. When the elderly no longer move, it goes downhill with their health. In this study we have developed an intervention to assist elderly people who have had a hip fracture during rehabilitation.
The intervention is a combination of coaching and the application of sensors. Therapists indicate that they have insufficient insight into the activities of the people. The sensor carries people on their belt. This returns the number of movements on a day and how intensively people move back into a certain score. This is sent to a secure server, after which the therapist can see in a web application in graphs how much someone has moved. With the help of these extra, objective data about the activity pattern, a therapist can discuss in a more specific way during the discussion of the coaching how many people move, why they no longer do certain activities, what activities they want to do and how they can work towards them, so that the rehabilitation has more progress.
How many people participated in the study?
Six care organizations have participated. In the end, 242 elderly people participated. We compared 3 groups: a group that receives coaching in combination with the technology, a group that only receives coaching, and a group that receives the current rehabilitation. We used a ‘stepped wedge’ design. As a result, you get roughly equal numbers in each group and you do not get that organizations that start coaching, for example, have to go back to the current rehabilitation. And if you have a design in which one organization receives ‘care as usual’ and the other organization receives the intervention, then as an organization you may have the misfortune that you only give the usual intervention. Now all organizations have become acquainted with the new intervention.
Until when does the study take place? And when can we expect the results?
The study ended in December 2017. From the last participant we have now received the last measurement in early December … in your Castor system, haha. We have now started analyzing and we hope that we have the results at the end of January. At the beginning of February we will present on the geriatree days. We actually hope that we will have all the results, and that we can submit the article in March.
How can the use of sensor technology extend beyond use for rehabilitation after hip surgery?
We are currently establishing a company. We believe that you should offer technology with a treatment protocol. That is why we have developed a treatment protocol, where we offer the technology, a helpdesk function and training to health care organizations. We think that in principle this can also be used in people with knee problems, people who have Parkinson’s or people with COPD who exercise too little.
Can you tell us about how you used Castor?
Of course we first created all questionnaires and the database in Castor. We did not do the randomization via Castor because we have cluster randomization. So we mainly used it to do all the measurements. I had 2 research assistants who did all the measurements and they went to people with a tablet. They saw all people 4 times and simultaneously entered the data in Castor. We were actually very satisfied with that. We called to you once, I believe. I think it was still a bad internet connection or there was a malfunction, so they could not enter. We have entered the data for several people for a year and a half. That went well. We had to figure out how we could make the database and how everything works, but we have also come out well.
And was it difficult to build the database?
No, that actually went very well. There is a very clear manual. I am quite satisfied.
Is there something you missed in Castor or that you found difficult?
At first I had some trouble with the printout to SPSS because I have an Apple computer. The printout to Apple is slightly different than with Windows. I have contacted you about this a number of times. Anyway, so those are just things you need to know. I think that now it’s on Castor’s manual.
What did you like about Castor?
You can very well monitor the progress, such as which people are already ready or where things are not filled in. Very useful that it is green when it is finally done. Furthermore, it is very user-friendly. Research assistants could also work very well with it.
Would you use it again for another study?
Certainly, I would use it again and I would also advise others.
Your study is called So Hip. What is behind this name?
‘So’ is Sensors Research and ‘Hip’ of hip rehabilitation.
Thank you and congratulations once again!
1 At the beginning of this study all care organizations started with the usual rehabilitation. After two months, two organizations switched to coaching with new rehabilitants. Two months later, the two organizations switched to coaching and sensor technology and switched to coaching. This happened until all healthcare organizations had switched to coaching and sensor technology. See also: Dekkers OM. The ‘stepped wedge’ design. Ned Tijdschr Geneeskd. 2012; 156: A4069