Background: eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective: The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods: We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results: In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions: eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.

While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers.

Purpose: Current evidence on the use of eHealth in geriatric rehabilitation is limited. This aim of this study was to achieve international consensus on three key eHealth-related topics in geriatric rehabilitation: the use, domains, and scientific evaluation of eHealth. Additionally, we developed a model that provides insight into the use of eHealth in geriatric rehabilitation. Methods: An international, two-round Delphi study was conducted. Two models served as a framework for the initial statement draft, with a total of 28 statements based on our systematic review results, an international survey, and expert opinion. Eligible healthcare professionals working in geriatric rehabilitation facilities were recruited across 10 countries. Results: Eighty healthcare professionals participated in round one and 47 in round two. In the first round, consensus was obtained for 20 of the 28 statements (71%). Prior to round two, four statements were revised, two statements were combined, and one statement was removed. In round two, consensus was obtained on six statements, bringing the total to 26: three related to the use of eHealth, five to the domains of eHealth, and 18 related to the scientific evaluation of eHealth. Conclusion: International consensus has been reached on the use, domains, and scientific evaluation of eHealth in geriatric rehabilitation. This first step in generating reliable knowledge and understandable information will help promote a consistent approach to the development, implementation, and scientific evaluation of eHealth in geriatric rehabilitation.

The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70 years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7 days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11 hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished.

Older adults recovering from stroke engage in low levels of physical activity and spend long periods in sedentary behaviour. Sedentary behaviour during geriatric rehabilitation is still poorly understood. The aims of this study were to quantify physical activity, sedentary behaviour and accompanying patterns of change during geriatric rehabilitation. Older adults (≥ 70 years) recovering from stroke in geriatric rehabilitation were included in this prospective cohort study. Patients wore an inertial measurement unit (IMU) on the ankle for 48 h, with data collected between 7am and 11 pm. Variables related to physical activity, sedentary behaviour and patterns of sedentary behaviour were calculated and analysed. Extracted principal components on admission and discharge were plotted in order to assess the individual degree of change. In total, 53 patients with sufficient accelerometer wear time were included. The degree of change in physical activity and sedentary behaviour components was extremely diverse. Except for step count (P = 0.01), no significant changes were observed in any variable related to physical activity, sedentary behaviour or patterns of sedentary behaviour between admission and discharge. Older adults recovering from stroke during geriatric rehabilitation improve their functional performance, but show little change in physical activity, sedentary behaviour or patterns of sedentary behaviour. The degree of change in physical activity and sedentary behaviour was highly diverse.

Background: Prediction of functional recovery in older adults recovering from stroke is typically based on observational scales, such as the Utrecht Scale for Evaluation of Rehabilitation (USER). Objectively measuring postural sway using inertial measurement devices (IMU) may complement or improve conventional approaches. The aim of this study was to evaluate whether integrating an IMU with USER data enhances the accuracy of predicting functional recovery at discharge. Methods: This prospective cohort study includ-ed older adults (≥ 65 years) recovering from stroke. Postural sway was assessed using an IMU during 2 different balance conditions and analysed using principal component analysis (PCA). Using 3 different regression models, percentage explained variance was compared to assess predictive performance on functional recovery of USER vs an IMU. Results: The 71 patients included had a mean age of 78 (SD 7.6) and a median time since stroke of 16 days (IQR 19–60). Of the 71 patients, 12 (16.9%) were unable to perform balance condition 2 due to insufficient balance. Of 35 postural sway features displaying reliability for both balance conditions, 12 were selected for PCA. Incorporation of principal components for both balance conditions in the final model increased the explained variance compared to a model in which only USER-mobility at admission was used to predict delta-USER at discharge (R2 = 0.61 vs 0.30). Conclusions: Sitting and standing balance as measured by an IMU improves the prediction of functional recovery at discharge compared to USER alone.