The Effects of an Online Theory-Based Bone Health Program for Older Adults

Nahm, Eun Shim; Resnick, Barbara; Brown, Clayton H.; Zhu, Shijun; Magaziner, Jay; Bellantoni, Michele; Brennan, Patrícia Flatley; Charters, Kathleen G.; Brown, J. Scott; Rietschel, Mathew; An, Minjeong; Park, Bu Kyung

doi:10.1177/0733464815617284

Cited by 26 publications

(30 citation statements)

References 43 publications

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“…The most frequently observed form of bias was selection bias (asking for volunteers for a research study involving technology will result in volunteers who already gravitate toward technology), which occurred in 7 out of 57 (13%) articles analyzed [ 15 , 26 , 30 - 32 , 37 , 39 ]. There were six instances of convenience samples from a local population [ 34 , 49 - 52 , 64 ]. Both examples of bias limit the external validity of the results.…”

Section: Resultsmentioning

confidence: 99%

“…The most common theme for medical outcomes associated with telehealth interventions was decrease in psychological distress (decrease in anxiety symptoms, decrease in depressive symptoms, decrease in embitterment, decrease in grief, decrease in worry, decrease in loneliness, increase in emotional support, and increase in mood), with 21 of 118 (18%) occurrences [ 32 , 42 , 46 , 51 , 60 , 68 , 70 , 71 , 76 ]. The theme associated with quality of life factors was listed as an increase in autonomy (increase in locus of control, increase in autonomy, increase in responsibility, increase in motivation to self-manage, and increase in independence), with 18 of 118 (15%) occurrences [ 29 , 34 , 35 , 46 , 48 , 52 - 54 , 56 , 62 , 67 , 75 , 76 ]. One theme was associated with an increase in cognitive ability (increase in skill ability, increase in sensory organization, increase in memory, increase in cognitive activity, and increase in reasoning), with 11 of 118 (9%) occurrences [ 19 , 20 , 23 , 32 , 41 , 42 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

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Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

et al. 2020

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Background Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. Objective This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. Methods This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. Results Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%). Conclusions The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. Trial Registration PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162. International Registered Report Identifier (IRRID) RR2-10.2196/15490

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

et al. 2020

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“…Earlier studies showed that the common reasons for older people to avoid performing physical activities are inconvenience and a lack of access to physical activity programmes [68]. This review found that walking is the most commonly targeted physical activity for older people since there are no problems involved with gaining access to programmes, because it is an activity that can be practised anywhere.…”

Section: Discussionmentioning

confidence: 97%

The effect of e-health interventions promoting physical activity in older people: a systematic review and meta-analysis

Kwan

Salihu

Lee

et al. 2020

Eur Rev Aging Phys Act

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Introduction: The objectives of this review paper were to synthesize the data from randomized controlled trials in the literature to come to a conclusion on the effects of e-health interventions on promoting physical activity in older people. Methods: The Medline, CINAHL, Embase, PsycINFO, and SportDiscus databases were searched for articles about studies that 1) recruited subjects with a mean age of > 50 years, 2) tested e-health interventions, 3) employed control groups with no or less advanced e-health strategies, 4) measured physical activity as an outcome, 5) were published between 1st January 2008 and 31st May 2019, and 6) employed randomized controlled trials. The risk of bias in individual studies was assessed using the Physiotherapy Evidence Database scale. To examine the effects of the interventions, variables quantifying the amount of physical activity were extracted. The within-group effects of individual studies were summarized using Hedges g and 95% confidence intervals. Between-group effects were summarized by meta-analyses using RevMan 5.0 with a random effect model. Results: Of the 2810 identified studies, 38 were eligible, 25 were included in the meta-analyses. The within-group effect sizes (Hedges g) of physical activity in the intervention group at T1 ranged from small to large: physical activity time (0.12 to 0.84), step counts (− 0.01 to 11.19), energy expenditure (− 0.05 to 0.86), walking time (0.13 to 3.33), and sedentary time (− 0.12 to − 0.28). The delayed effects as observed in T2 and T3 also ranged from small to large: physical activity time (0.24 to 1.24) and energy expenditure (0.15 to 1.32). In the meta-analysis, the betweengroup effect of the e-health intervention on physical activity time measured by questionnaires, physical activity time measured by objective wearable devices, energy expenditure, and step counts were all significant with minimal heterogeneity. Conclusion: E-health interventions are effective at increasing the time spent on physical activity, energy expenditure in physical activity, and the number of walking steps. It is recommended that e-health interventions be included in guidelines to enhance physical activity in older people. Further studies should be conducted to determine the most effective e-health strategies.

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“…Because an estimated 59% of adults aged 65 and older use the internet [69] , online interventions may reach a substantial proportion of the geriatric population at risk for future fracture, as evidenced by our findings. In one study, older adult exposure to an 8-week theory-based program entitled Bone Power that included learning modules, discussion boards, and other resources resulted in greater improvement in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise behaviors compared to the group of adults who were not exposed [70] . In our past experience, a direct-to-patient, internet-based educational video intervention produced a trend toward greater use of osteoporosis medication among patients taking chronic glucocorticoids when the patients self-initiated an educational video on osteoporosis prevention [71] .…”

Section: Discussionmentioning

confidence: 99%

A multi-modal intervention for Activating Patients at Risk for Osteoporosis (APROPOS): Rationale, design, and uptake of online study intervention material

Danila

Outman

Rahn

et al. 2016

Contemporary Clinical Trials Communications

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ObjectiveTo develop an innovative and effective educational intervention to inform patients about the need for osteoporosis treatment and to determine factors associated with its online uptake.MethodsPostmenopausal women with a prior fracture and not currently using osteoporosis therapy were eligible to be included in the Activating Patients at Risk for OsteoPOroSis (APROPOS). Four nominal groups with a total of 18 racially/ethnically diverse women identified osteoporosis treatment barriers. We used the Information, Motivation, Behavior Skills conceptual model to develop a direct-to-patient intervention to mitigate potentially modifiable barriers to osteoporosis therapy. The intervention included videos tailored by participants’ race/ethnicity and their survey responses: ranked barriers to osteoporosis treatment, deduced barriers to treatment, readiness to behavior change, and osteoporosis treatment history. Videos consisted of “storytelling” narratives, based on osteoporosis patient experiences and portrayed by actresses of patient-identified race/ethnicity. We also delivered personalized brief phone calls followed by an interactive voice-response phone messages aimed to promote uptake of the videos.ResultsTo address the factors associated with online intervention uptake, we focused on participants assigned to the intervention arm (n = 1342). These participants were 92.9% Caucasian, with a mean (SD) age 74.9 (8.0) years and the majority (77.7%) had some college education. Preference for natural treatments was the barrier ranked #1 by most (n = 130; 27%), while concern about osteonecrosis of the jaw was the most frequently reported barrier (at any level; n = 322; 67%). Overall, 28.1% (n = 377) of participants in the intervention group accessed the videos online. After adjusting for relevant covariates, the participants who provided an email address had 6.07 (95% CI 4.53–8.14) higher adjusted odds of accessing their online videos compared to those who did not.ConclusionWe developed and implemented a novel tailored multi-modal intervention to improve initiation of osteoporosis therapy. An email address provided on the survey was the most important factor independently associated with accessing the intervention online. The design and uptake of this intervention may have implications for future studies in osteoporosis or other chronic diseases.

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The Effects of an Online Theory-Based Bone Health Program for Older Adults

Cited by 26 publications

References 43 publications

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

The effect of e-health interventions promoting physical activity in older people: a systematic review and meta-analysis

A multi-modal intervention for Activating Patients at Risk for Osteoporosis (APROPOS): Rationale, design, and uptake of online study intervention material

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