Ijsselstein

This research evaluates the effectiveness of the RISE blended behavior change intervention in people who have experienced their first stroke. The study aims to prevent major adverse cardiovascular events such as recurrent stroke, transient ischemic attacks, acute coronary events, and cardiovascular death over a one-year follow-up period compared to standard care. It also investigates the intervention's impact on reducing sedentary behavior after hospital discharge in community-dwelling stroke survivors with sedentary movement patterns. Approximately 950 to 1000 participants are expected to be enrolled to account for loss to follow-up. Participants are randomly assigned to an experimental group receiving the 15-week RISE intervention alongside usual care or to a control group receiving only usual care. The RISE intervention involves coaching by a primary care physiotherapist who supports participants in balancing their 24-hour activity pattern, focusing on reducing and interrupting sedentary time to increase physical activity. This coaching includes the use of an activity monitor, a smartphone application with real-time feedback and e-learning modules, and a dashboard for the physiotherapist. Support from someone in the participant's social network is also included. Control group participants receive hospital-specific standard care. Participants will undergo assessments at baseline, immediately post-treatment (four months), and at six, nine, and twelve months after randomization. These assessments include wearing activity monitors, completing questionnaires, and performing physical tests, all of which are non-invasive and conducted either online or at home. Researchers monitor the occurrence of major adverse cardiovascular events as the primary outcome. The study's burden and risks are considered low, with physiotherapist visits conducted at home or online, and participants are physically capable of completing the required activities.

Researchers are studying nursing home residents aged 65 and older who have a limited life expectancy of less than 1.5 to 2 years. The study aims to evaluate how training healthcare professionals in medication assessments affects the medication use of these residents. This training focuses on tailoring medication to the residents' palliative care treatment goals. The study is designed as a cluster randomized controlled trial involving six nursing home organizations and approximately 450 patients, lasting one year and three months, starting in September. The intervention involves training healthcare professionals—including medical practitioners, pharmacists, and care workers—in a method called Systematic Multidisciplinary Medication Review combined with Advance Care Planning (SMMR+). This training includes two parts: medication assessment using the ReNeWAL criteria (which are adapted STOPP/START criteria for patients with limited life expectancy) and discussions about medication aligned with advance care planning goals. Professionals receive supporting tools like pocket cards and educational materials, and intervision sessions are planned. The control group continues usual care, with an equal number of organizations assigned to each group. Participants will be assessed before the intervention starts, then again at six months and twelve months. Researchers will collect data on potential under- and overprescribing of medication as the primary outcome. Secondary outcomes include involvement in decision-making measured by a questionnaire, and tertiary outcomes such as quality of life, deaths, falls, hospital admissions or acute care visits, and pain. A process evaluation will run alongside the study to monitor implementation and effects.