PURPOSE:To evaluate the feasibility of the Occupational Therapy at Home E-Rehabilitation (OTHER) intervention for persons post-stroke (age > 55) transitioning to home. METHODS:A mixed-methods feasibility study was conducted. Qualitative data included semi-structured interviews with persons post-stroke (n = 8) and informal caregivers (n = 4), a focus group with occupational therapists (OTs) (n = 4), and logbooks. Inductive thematic analysis explored the experiences of persons post-stroke and OTs, while feasibility was assessed deductively using Bowen's areas of feasibility. Quantitative data were the Canadian Occupational Performance Measure (COPM), Self-Management Ability Scale (SMAS-30), and the Montreal Cognitive Assessment to assess differences between baseline and 3 months. RESULTS:Eight persons post-stroke completed OTHER. Inductive thematic analysis resulted in three themes from the perspectives of persons post-stroke and OTs: activity monitoring was appreciated; doing and talking were real supports; and the intervention was inspiring and challenging. Feasibility was acceptable based on Bowen's areas. A pre-post intervention change was observed on the COPM: 1.5 on performance and 1.9 on satisfaction, and for SMAS-30, a positive change of 4.67 was observed. CONCLUSION:The OTHER intervention and research protocol are feasible for home-based rehabilitation, and a larger trial is recommended.

PURPOSE:Internationally, many differences are observed regarding the practice of geriatric rehabilitation for older people living at home. To improve international collaboration and research on this topic, we aimed to reach a consensus on terminology, organisational aspects, and outcome domains to focus on. METHODS:We conducted a three-round online Delphi study among 60 (Home-based) geriatric rehabilitation experts from 14 countries. In the first round, we collected diverse perspectives and input through statements and questions. In the subsequent rounds, participants rated statements on a 5-point Likert scale. Each statement could be accompanied by written feedback. After each round, results were presented anonymously to the participants, and statements on which no consensus was reached were rephrased. Consensus was defined as 70% or more participants (fully) agreeing with a statement. RESULTS:Sixty, 52, and 46 experts completed rounds 1, 2 and 3, respectively. After two rounds, we reached a consensus on ten statements and on the remaining four in the last round. A consensus was reached on the terminology used (i.e., home-based geriatric rehabilitation) and on several organisational aspects (e.g., essential aspects to consider for starting home-based geriatric rehabilitation and the importance of a knowledgeable case manager). Lastly, experts agreed that participation and activity are the most important outcome domains to focus on. CONCLUSIONS:Through an international Delphi study, we reached consensus on various important aspects of home-based geriatric rehabilitation. These outcomes provide a basis for further development of this emerging field.

Background: Transitioning from a geriatric rehabilitation centre or hospital to home is challenging for persons post-stroke, as they must increase their ability to perform daily activities and self-manage their lives. Moreover, persons post-stroke exhibit more sedentary behaviour at home than during rehabilitation, which is detrimental to their health. The Occupational Therapy at Home E-Rehabilitation (OTHER) intervention aims to increase daily activities and self-management in persons post-stroke. OTHER involves in-person (online) coaching with information from activity monitoring. Here, we describe the design of a study investigating the (cost-)effectiveness of OTHER on the recovery of daily activities among older persons after stroke and evaluate its implementation process.   Methods: A partially cluster randomised stepped-wedge trial is conducted in nine geriatric rehabilitation centres and two hospitals, aiming to include 171 post-stroke participants (aged ≥ 60 years) who are starting (inpatient) rehabilitation to return home. The intervention group receives the OTHER intervention by an occupational therapist, starting at the institute and continuing at home. This intervention consists of activity monitoring to increase insight into movement behaviour, as well as coaching by occupational therapists on improving daily activities at home. This supports persons post-stroke in performing daily activities and increasing self-management. The control group receives care as usual. The primary outcome is the performance score of the Canadian Occupational Performance Measure, which measures a person's perceived daily functioning at 6 months. A process evaluation will be conducted to assess the implementation process of the OTHER intervention during the research period.   Discussion: This trial is studying the effect of activity monitoring combined with home-based occupational therapy coaching for persons post-stroke. With this study, we aim to provide insight into the effectiveness and cost-effectiveness of the OTHER intervention compared to care as usual for persons post-stroke, and describe the process of implementation, which includes home-based geriatric rehabilitation. ### Competing Interest Statement There are no conflicts of interest to declare. ### Clinical Trial ClinicalTrials.gov: [NCT05855226][1], and Organization's Unique Protocol ID: 80-86900-98-022 ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Research Ethics Committee of Amsterdam UMC has approved the study (protocol ID 2022.0786) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05855226&atom=%2Fmedrxiv%2Fearly%2F2025%2F10%2F14%2F2025.10.12.25337833.atom

BACKGROUND:There is a shift from inpatient to home-based geriatric rehabilitation (HBGR), and potential benefits are demonstrated. Previously, a theoretical HBGR model, version 1.0, has been developed, outlining its essential components. However, clear guidance on the practical design and organisation of HBGR in everyday practice is still lacking. Therefore, determining the optimal design for this complex intervention is essential for its successful implementation in daily practice. The objective of this study is to redesign the theoretical HBGR trajectory and assess its feasibility, acceptability, and usability from both patient and professional perspectives. METHODS:A redesign and feasibility study based on the MRC framework was conducted in a Dutch skilled nursing facility using the MRC framework in co-creation with eleven healthcare professionals and four patient representatives. The HBGR trajectory 1.0, comprises four building blocks (structure, process, environment, and outcomes) based on the Post-Acute-Care rehabilitation quality framework. Version 1.0 was redesigned during the development phase and subsequently pilot-tested in daily practice during the feasibility phase. Adjustments were made based on semi-structured interviews with ten patients and (interim) evaluations. RESULTS:The HBGR trajectory 1.0 has been redesigned into version 2.0. It contains eleven elements: individualised goal setting, providing HBGR is the default unless otherwise indicated, an information letter, blended eHealth, mapping the patient's living environment, stimulation support from informal caregivers, collaboration with community care nursing, rehabilitation coordination, central planning, therapy at home, and online multidisciplinary evaluation. Version 2.0 was enthusiastically endorsed by patients, patient representatives, and professionals, who found it feasible, acceptable, and usable in daily practice. CONCLUSION:The HBGR trajectory 1.0 was adapted, tested, and finally redesigned into version 2.0. The study revealed that involving patients, their representatives, and healthcare professionals was critical to garnering support and facilitating implementation. Key developments align with global trends and include the successful integration of eHealth with traditional treatment methods, enhanced collaboration and knowledge sharing among community care nurses, and increased involvement of informal caregivers in rehabilitation. This redesigned HBGR trajectory is ready for evaluation and implementation in follow-up effectiveness research.

The aim of this study was to gain insight into the perspectives of older adults on the quality of geriatric rehabilitation (GR) during the trajectory of GR from admission until six weeks after discharge. The following themes emerged: 1. A bond of trust with health care professionals (HCPs), 2. Being prepared and informed at all stages of GR, 3. Participants emphasise physical and occupational therapy rather than other aspects of care as comprising GR, 4. Changing needs regarding (the extent of) involvement in decision-making, 5. Contact with family and peers. For older adults, preparation for and good organisation of rehabilitation and social interaction with HCPs and other older adults were found to be important for the perceived quality of GR. The aim of this study was to gain insight into the perspectives of older adults on the quality of geriatric rehabilitation (GR) during the trajectory of GR from admission until six weeks after discharge. We conducted a longitudinal qualitative study. Participants were interviewed three times: at the start of rehabilitation, at discharge, and six weeks after discharge. The data were analysed using a thematic analysis. In total, 50 interviews were conducted, with 18 participants being interviewed multiple times. The following themes emerged: 1. A bond of trust with health care professionals (HCPs), 2. Being prepared and informed at all stages of GR, 3. Participants emphasise physical and occupational therapy rather than other aspects of care as comprising GR 4. Changing needs regarding (the extent of) involvement in decision-making, 5. Contact with family and peers. For older adults, preparation for and good organisation of rehabilitation and social interaction with HCPs and other older adults were found to be important for the perceived quality of GR. Social interaction is influenced by how HCPs engage with older adults in all the phases of the rehabilitation process. Older adults have varying preferences about involvement in decision-making during GR. These perspectives should be acknowledged and acted upon in clinical practice to further improve the quality of care in GR.

Background Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19. Methods A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment. Results This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups’ exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results. Conclusion Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.

PURPOSE:To gain a rich understanding of the experiences and opinions of patients, healthcare professionals, and policymakers regarding the design of OGR with structure, process, environment, and outcome components. METHODS:Qualitative research based on the constructive grounded theory approach is performed. Semi-structured interviews were conducted with patients who received OGR (n = 13), two focus groups with healthcare professionals (n = 13), and one focus group with policymakers (n = 4). The Post-acute Care Rehabilitation quality framework was used as a theoretical background in all research steps. RESULTS:The data analysis of all perspectives resulted in seven themes: the outcome of OGR focuses on the patient's independence and regaining control over their functioning at home. Essential process elements are a patient-oriented network, a well-coordinated dedicated team at home, and blended eHealth applications. Additionally, closer cooperation in integrated care and refinement regarding financial, time-management, and technological challenges is needed with implementation into a permanent structure. All steps should be influenced by the stimulating aspect of the physical and social rehabilitation environment. CONCLUSION:The three perspectives generally complement each other to regain patients' quality of life and autonomy. This study demonstrates an overview of the building blocks that can be used in developing and designing an OGR trajectory.

BACKGROUND:Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. OBJECTIVE:This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. METHODS:A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. RESULTS:Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1%) and occupational therapists (n=434, 60%). Only 28.1% (203/723) reported receiving specific training in TR, with 1.2% (9/723) indicating that it was part of their professional education. Approximately 19.5% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. CONCLUSIONS:Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education.

Background Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. Objective To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. Methods Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged >= 65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. Results We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. Conclusion This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.

BACKGROUND:Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care.OBJECTIVE:The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators.METHODS:We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group.RESULTS:The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects.CONCLUSIONS:Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.

Background the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. Objective the aim of this scoping review was to systematically synthesise the patients' perspective on the quality of GR. Methods we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. Results twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one's story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. Conclusion in this study, we identified the aspects that determine the quality of rehabilitation from the patient's perspective, which may lead to a more holistic perspective on the quality of GR.

Background People from lower and middle socioeconomic classes and vulnerable populations are among the worst affected by the COVID-19 pandemic, thus exacerbating disparities and the digital divide. Objective To draw a portrait of e-services as a digital approach to support digital health literacy in vulnerable populations amid the COVID-19 infodemic, and identify the barriers and facilitators for their implementation. Methods A scoping review was performed to gather published literature with a broad range of study designs and grey literature without exclusions based on country of publication. A search was created in Medline (Ovid) in March 2021 and translated to Medline, PsycINFO, Scopus and CINAHL with Full Text (EBSCOhost). The combined literature search generated 819 manuscripts. To be included, manuscripts had to be written in English, and present information on digital intervention(s) (e.g. social media) used to enable or increase digital health literacy among vulnerable populations during the COVID-19 pandemic (e.g. older adults, Indigenous people living on reserve). Results Five articles were included in the study. Various digital health literacy-enabling e-services have been implemented in different vulnerable populations. Identified e-services aimed to increase disease knowledge, digital health literacy and social media usage, help in coping with changes in routines and practices, decrease fear and anxiety, increase digital knowledge and skills, decrease health literacy barriers and increase technology acceptance in specific groups. Many facilitators of digital health literacy-enabling e-services implementation were identified in expectant mothers and their families, older adults and people with low-income. Barriers such as low literacy limited to no knowledge about the viruses, medium of contamination, treatment options played an important role in distracting and believing in misinformation and disinformation. Poor health literacy was the only barrier found, which may hinder the understanding of individual health needs, illness processes and treatments for people with HIV/AIDS. Conclusions The literature on the topic is scarce, sparse and immature. We did not find any literature on digital health literacy in Indigenous people, though we targeted this vulnerable population. Although only a few papers were included, two types of health conditions were covered by the literature on digital health literacy-enabling e-services, namely chronic conditions and conditions that are new to the patients. Digital health literacy can help improve prevention and adherence to a healthy lifestyle, improve capacity building and enable users to take the best advantage of the options available, thus strengthening the patient’s involvement in health decisions and empowerment, and finally improving health outcomes. Therefore, there is an urgent need to pursue research on digital health literacy and develop digital platforms to help solve current and future COVID-19-related health needs.

While many health-care issues and technological solutions are viewed locally, developing new technological solutions might benefit from lessons learned globally. The aim of this study was to develop a shared international research agenda of health-care ICT, applied to rehabilitation and daily living support. This study was focused on sensor technology and social robots used for supporting older persons in the Netherlands (Amsterdam) and Japan (Tokyo). Three researchers from Amsterdam University of Applied Sciences visited Japan and four researchers from Tokyo Metropolitan University visited the Netherlands and conducted field-visits and mutual presentations. Using a nominal group technique (NGT) facilitated the expert panel deliberations. Research priorities were identified qualitatively through in-action critical reflection on emerging ideas, and quantitatively by ranking of identified knowledge gaps (using the Mentimeter© app). The resulting joint research agenda identified topics around the utility of sensor monitoring and processes of acceptance of health-care ICT among older persons and occupational therapists. The agenda was complemented by formulating underlying assumptions prescribing such research to be embedded in real-life situations with the participation of stakeholders.

OBJECTIVES:to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture.DESIGN, SETTING AND PATIENTS:three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracture patients ≥ 65 years old.INTERVENTIONS:patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months.MAIN OUTCOMES AND MEASURES:the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure.RESULTS:a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual.CONCLUSIONS AND RELEVANCE:among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual.TRIAL REGISTRATION:Dutch National Trial Register, NTR 5716.

Objective to gain insight into what older adults after hip fracture perceive as most beneficial to their recovery to everyday life. Design qualitative research approach. Setting six skilled nursing facilities. Participants 19 older community dwelling older adults (aged 65-94), who had recently received geriatric rehabilitation after hip fracture. Methods semi-structured interviews were conducted with 19 older adults after hip fracture. Coding techniques based on constructivist grounded theory were applied. Results four categories were derived from the data: restrictions for everyday life', recovery process', resources for recovery' and performing everyday activities'. Physical and psychological restrictions are consequences of hip fracture that older adults have struggled to address during recovery. Three different resources were found to be beneficial for recovery; supporting and coaching', myself' and technological support'. These resources influenced the recovery process. Having successful experiences during recovery led to doing everyday activities in the same manner as before; unsuccessful experiences led to ceasing certain activities altogether. Conclusion participants highlight their own role (myself') as essential for recovery. Additionally, coaching provides emotional support, which boosts self-confidence in performing everyday activities. Furthermore, technology can encourage older adults to become more active and being engaged in the recovery process. The findings suggest that more attention should be paid to follow-up interventions after discharge from inpatient rehabilitation to support older adults in finding new routines in their everyday activities. A conceptual model is presented and provides an understanding of the participants' experiences and perspectives concerning their process of recovery after hip fracture to everyday life.

There is an urgent need to develop interventions that enable older persons to perform everyday activities in order to remain healthy and live independently at home. This thesis focuses on the applicability and effectiveness of sensor monitoring for measuring and supporting the daily functioning of older persons who live independently at home. We investigated the use of sensor monitoring in two ways. First, we focused on the assessment of a person’s level of daily functioning through sensor monitoring, in order to detect deviations in the activities of daily living (ADL) patterns and to warn caregivers or health professionals of existing deviations. Second, we used sensor monitoring as a feedback and coaching tool in hip fracture patients to support the rehabilitation process in an attempt to increase everyday functioning. In this first large scale randomized trial (SO-HIP study) we included 240 older patients after hip fracture. The findings show that a rehabilitation intervention of sensor monitoring-informed coaching was more effective in improving patient-reported performance of daily functioning at six months than an intervention with care as usual. Parallel to the trial, we conducted a qualitative study, wherein we interviewed patients to better understand the recovery process after hip fracture. According to the patients, insight into sensor data, having positive experiences during recovery and coaching and support after discharge all led to maximized functional recovery and return to the highest level of independence in daily functioning. Given the positive results of the trial, the implementation of the SO-HIP intervention is justified and recommended.

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.