J. Heinrich

Effect evaluation of a two-year complex intervention to reduce loneliness in non- institutionalised elderly Dutch people

BackgroundPublic health policy calls for intervention programmes to reduce loneliness in the ageing population. So far, numerous loneliness interventions have been developed, with effectiveness demonstrated for few of these interventions. The loneliness intervention described in this manuscript distinguishes itself from others by including multiple intervention components and targeting individuals and their environment. Intervention components included a mass media campaign, information meetings, psychosocial group courses, social activities organised by neighbours, and training of intermediaries. The aim of this manuscript is to study the effects of this integrated approach on initial and long-term outcomes.MethodsA quasi-experimental pre-test post-test intervention study was conducted among non-institutionalised elderly people aged 65 years and over to evaluate the effectiveness of the intervention by comparing the intervention community and the control community. Data on outputs, initial and long-term outcomes, and the overall goal were collected by self-administered questionnaires. Data of 858 elderly people were available for the analyses. To assess the effect linear regression analyses with adjustments for age, gender, church attendance, and mental health were used. In addition, the process evaluation provided information about the reach of the intervention components.ResultsAfter two years, 39% of the elderly people were familiar with the intervention programme. The intervention group scored more favourably than the control group on three subscales of the initial outcome, motivation (−4.4%, 95% CI−8.3-−0.7), perceived social support (−8.2%, 95% CI−13.6-−2.4), and subjective norm (−11.5%, 95% CI−17.4-−5.4). However, no overall effects were observed for the long-term outcome, social support, and overall goal, loneliness.ConclusionsTwo years after its initiation the reach of the intervention programme was modest. Though no effect of the complex intervention was found on social support and loneliness, more favourable scores on loneliness literacy subscales were induced.

Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial

BackgroundDespite the fact that the population of self-employed persons is still growing and at risk for long term disability due to a number of risk factors, there is still a lack of information on the effectiveness of interventions for this specific group.MethodsTo determine the effectiveness of physical training without a cognitive behavioral component and workplace specific exercises (PT) and physical training with a cognitive behavioral component and workplace specific exercises (PTCBWE), we conducted a pragmatic Randomized Controlled Trial, stratified into two groups. Self-employed persons with a new work disability claim because of musculoskeletal disorders were randomized to PT (n = 53) or PTCBWE (n = 76), or to a corresponding usual care group (n = 50 and n = 75 respectively). Both types of training consisted of cardiovascular training, strengthening, relaxation and posture exercises and took place two or three times a week, for 1–1.5 hours, during three months, also if someone had already returned to work full-time. The primary outcome measure was claim duration (in days) during 12 months follow-up. Pain severity and functional status were secondary outcome measures. All data were assessed at baseline and at 6 and 12 months follow-up. The data with regard to claim duration were analyzed by survival analysis and Cox regression analysis. Secondary outcome measures were analyzed by means of linear regression analysis.ResultsAfter 12 months of follow-up there was no difference in claim duration between PT and usual care (Hazard Ratio 0.7; 95%CI, 0.4–1.1; p = 0.12) or PTCBWE and usual care (Hazard Ratio 0.9; 95%CI, 0.6–1.4; p = 0.72). Both types of physical training and usual care improved in pain and functional status over time, but there was only a statistically significant difference in favor of PT on pain improvement at 6 months.ConclusionIn this study, physical training with and without a cognitive behavioral component and workplace specific exercises for self-employed persons with musculoskeletal disorders was not shown to be effective on claim duration, pain severity and functional status at 12 months follow-up.Trial registrationCurrent Controlled Trials ISRCTN67766245.

The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain

BackgroundThe objective of this feasibility study was to gain insight into occupational physicians (OPs) and employees use of, and attitudes towards, Snelbeter (Get Well Fast), a new web-based counselling program for employees on sick leave due to non-specific back or neck pain and their OPs.MethodsRegistered user information was collected from the website to get insight in the use of the program by employees (n = 24). Qualitative information was obtained through semi-structured in-depth interviews with 19 OPs and nine employees in order to get insight in the actual use of the provided information, the attitudes towards the program and possible improvements of the program.ResultsActual use of the program among OPs was low. The majority of OPs, eight out of 11 (73%), never or only occasionally signed in. The greatest obstacle for OPs to use the program was the low number of eligible employees involved. Employees appreciated the program but their use was moderate. A small majority of the employees who used the program, 14 out of 24 (58%), opened 50% to 100% of the provided documents, a majority of the interviewed employees, seven out of nine (78%), used the provided information sometimes or regularly. The absence of personal contact was found to be a major barrier towards use of the program by employees.ConclusionAlthough both OPs and employees appreciated the idea of the program and employees appreciated using it, program utilization was moderate to low. The discussion section reveals that before implementation can be started to any extent, the program will need adaptations that make it more attractive to use. The program should be considered for both return to work (RTW) and the prevention of sick leave. Adding personal contact (e.g. involving physiotherapists) to the program may also be promising.

IMPULS: van signaal naar actie!

SamenvattingVerpleegkundigen en verzorgenden in de thuiszorg hebben een spilfunctie in de signalering van eenzaamheid bij zelfstandig wonende ouderen. Zij komen met enige regelmaat bij – veelal kwetsbare – ouderen thuis, hebben een vertrouwensband en kunnen hierdoor vroegtijdig verandering opmerken. Het aantal signalen van eenzaamheidsproblematiek waarvoor vanuit deze groep verpleegkundigen en verzorgenden contact wordt gezocht met de ouderenadviseur is echter beperkt. Naar verwachting zou dit aantal signalen veel groter kunnen zijn. IMPULS is ontwikkeld om thuiszorgprofessionals te attenderen op de rol en mogelijkheden van de ouderenadviseur op het gebied van eenzaamheidsproblematiek. In dit artikel wordt beschreven waarom en hoe IMPULS is ontwikkeld, geëvalueerd en op eenvoudige wijze kan worden gëımplementeerd in de dagelijkse praktijk van thuiszorgprofessionals.AbstractIMPULS: from signal to action!n Home care professionals do have a crucial role in signaling loneliness among non-institutionalized elderly people. They regularly visit – often vulnerable – elderly at home, have a natural and open relation and therefore could notice changes in an early stage. Nevertheless, elderly advisors receive hardly any signals of loneliness from this intermediate group. Based on experiences within other intermediate groups, the expected number of signals from home care professionals could be much larger. IMPULS is developed to recall home care professionals about the role and opportunities of the elderly advisor regarding loneliness issues. This article describes the motivation and development, evaluation and easily implementation of IMPULS in daily practice.