Naarden

Researchers are evaluating the (cost)effectiveness of the Occupational Therapy at Home E-Rehabilitation (OTHER) intervention compared to usual occupational therapy care in older adults recovering from stroke. The study focuses on community-dwelling persons aged 60 and older in geriatric rehabilitation, aiming to improve self-perceived performance in daily activities, satisfaction with performance, physical activity, and self-management over 26 weeks. It also explores participant and therapist experiences with the intervention and investigates factors affecting its delivery and benefits. The OTHER intervention involves occupational therapists using activity monitoring, coaching, and videoconferencing to support the transition from clinical care to home. Participants receive this treatment over a 24-week period, with assessments at weeks 4, 13, and 26. The study compares this approach to standard occupational therapy to determine differences in outcomes such as daily functioning and quality-adjusted life years. Participants will be involved in regular evaluations including the Canadian Occupational Performance measure at three time points to track changes in daily activity performance. Researchers will monitor treatment fidelity, barriers, facilitators, and cost-effectiveness. The study includes qualitative assessments to understand experiences of stroke survivors and therapists and their reflections on the intervention. Total participation lasts for about 26 weeks with ongoing monitoring.

Researchers are evaluating personalized blood thinner treatments after hip or knee replacement surgeries to reduce the risks of blood clots (venous thromboembolism or VTE) and bleeding. Currently, all patients receive the same standard blood thinner treatment, but some still develop blood clots while others experience bleeding. This study aims to see if adjusting the blood thinner dose and duration based on each patient's risk can lower these complications. Participants are divided into three groups based on their predicted risk of blood clots using a scoring system. Patients with low risk receive blood thinners only during their hospital stay. Those with intermediate risk are observed without changes to standard care. Patients with high risk get a higher dose and longer duration of blood thinners for six weeks. The blood thinners used include types such as LMWH or DOACs, given according to local guidelines and timing specified after surgery. Participants complete four questionnaires: one before surgery and three after surgery at 2 weeks, 6 weeks, and 3 months, to report any blood clots or bleeding events. If a participant experiences a clot, major bleed, or infection, an additional questionnaire about quality of life and joint function is sent one year later. No extra hospital visits are required. The main outcomes measured are blood clot and major bleeding events within 90 days after surgery.