Background. Children with developmental coordination disorder (DCD) face evident motor difficulties in daily functioning. Little is known, however, about their difficulties in specific activities of daily living (ADL). Objective. To (a) investigate differences between children with DCD and their typically developing peers, for ADL performance, learning, and participation, and (b) explore the predictive values of these aspects. Design. Cross-sectional study.Methods: Both in a clinical sample of children diagnosed with DCD (n=25, age range 5-8 years; 21 males) and typically developing peers (25 matched controls), parents completed the DCDDaily-Q. Differences in scores between the groups were investigated using T-tests for performance and participation, and Pearson’s Chi-square for learning. Multiple regression analyses were performed to explore the predictive values of performance, learning, and participation. Results. Compared to peers, children with DCD showed poor performance of ADL (p≤.005 for all items), delays in learning of ADL p≤.002 for all items), and less frequent participation in some ADL (p=.001 for mean total scores, p≤.05 for 7 out of 23 items). Children with DCD demonstrated heterogeneous patterns of performance (poor in 10-80% of the items) and learning (delayed in 0-100% of the items). In the DCD group, delays in learning of ADL were a predictor for poor performance of ADL (p=.001), and poor performance of ADL was a predictor for less frequent participation in ADL compared to peers (p=.040). Limitations. A limited number of children with DCD was addressed in this study.Conclusions. This study highlights the impact of DCD on children’s daily lives and the need for tailored intervention.
ObjectiveTo estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale.DesignData from a cluster-randomized clinical trial and a cohort study.SettingGeneral practices in the Netherlands.Participants3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years.MeasurementsAt baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method.ResultsAnchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed.ConclusionThe MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.
Background: Dependency in activities of daily living (ADL) might be caused by multidimensional frailty. Prevention is important as ADL dependency might threaten the ability to age in place. Therefore, this study aimed to assess whether protective factors, derived from a systematic literature review, moderate the relationship between multidimensional frailty and ADL dependency, and whether this differs across age groups. Methods: A longitudinal study with a follow–up after 24 months was conducted among 1027 communitydwelling people aged ≥65 years. Multidimensional frailty was measured with the Tilburg Frailty Indicator, and ADL dependency with the ADL subscale from the Groningen Activity Restriction Scale. Other measures included socio-demographic characteristics and seven protective factors against ADL dependency, such as physical activity and non-smoking. Logistic regression analyses with interaction terms were conducted. Results: Frail older people had a twofold risk of developing ADL dependency after 24 months in comparison to non-frail older people (OR=2.12, 95% CI=1.45–3.00). The selected protective factors against ADL dependency did not significantly moderate this relationship. Nonetheless, higher levels of physical activity decreased the risk of becoming ADL dependent (OR=0.67, 95% CI=0.46–0.98), as well as having sufficient financial resources (OR=0.49, 95% CI=0.35–0.71). Conclusion: Multidimensional frail older people have a higher risk of developing ADL dependency. The studied protective factors against ADL dependency did not significantly moderate this relationship.
Physical rehabilitation programs revolve around the repetitive execution of exercises since it has been proven to lead to better rehabilitation results. Although beginning the motor (re)learning process early is paramount to obtain good recovery outcomes, patients do not normally see/experience any short-term improvement, which has a toll on their motivation. Therefore, patients find it difficult to stay engaged in seemingly mundane exercises, not only in terms of adhering to the rehabilitation program, but also in terms of proper execution of the movements. One way in which this motivation problem has been tackled is to employ games in the rehabilitation process. These games are designed to reward patients for performing the exercises correctly or regularly. The rewards can take many forms, for instance providing an experience that is engaging (fun), one that is aesthetically pleasing (appealing visual and aural feedback), or one that employs gamification elements such as points, badges, or achievements. However, even though some of these serious game systems are designed together with physiotherapists and with the patients’ needs in mind, many of them end up not being used consistently during physical rehabilitation past the first few sessions (i.e. novelty effect). Thus, in this project, we aim to 1) Identify, by means of literature reviews, focus groups, and interviews with the involved stakeholders, why this is happening, 2) Develop a set of guidelines for the successful deployment of serious games for rehabilitation, and 3) Develop an initial implementation process and ideas for potential serious games. In a follow-up application, we intend to build on this knowledge and apply it in the design of a (set of) serious game for rehabilitation to be deployed at one of the partners centers and conduct a longitudinal evaluation to measure the success of the application of the deployment guidelines.
