Mobile application: physical therapy interventions for frail older adults

Moreira, Wagner Elias de Melo; Rodrigues, Gustavo Detomi; Mello, Jorge Luiz de Carvalho; Maia, Paulo Roberto; Souza, Diba Maria Sebba Tosta de

doi:10.1590/1809-2950/21002128022021

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ORIGINAL RESEARCH • Fisioter. Pesqui. 28 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1809-2950/21002128022021 copy

Mobile application: physical therapy interventions for frail older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this study was to build and validate an algorithm and develop a software for the multidimensional diagnosis of functional clinical vulnerability and physical therapy for older adults. This is an analytical and observational study applied in technological production, based on software engineering and user-centered design. The algorithm was developed based on studies in health databases, validated by 13 physical therapists and the software was built using the JAVA language from the algorithm’s conversion. The Delphi technique and statistical analysis via the Content Validity Index (CVI) were used to validate the algorithm. The consensus was reached in the first evaluation round and the agreement between judges by the CVI was 1.0. The “Gerontofisio” mobile application was built for use on smartphones and tablets and registered at the Brazilian National Institute of Industrial Property number: BR512020002269-3; the application consists of 34 screens that guide gerontological physical therapists in decision making, serving as a support tool in the applied fields in health, health administration, illness, medical assistance and diagnostic therapy. The algorithm was built and validated, the mobile application software for the multidimensional diagnosis of clinical functional vulnerability and physical therapy treatment in older adults was developed and is valid in the field of physical therapy and should contribute to physical therapists and older adults.

Keywords
Mobile Applications; Geriatrics; Frail Older Adults; Physical Therapists

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Trial item	CVI
Dimension “Warning signs”
• Age over 75 years	1.0
• Do you live alone?	1.0
• Do you live in a long-term care facility for older adults?	1.0
• Do you have more than five confirmed diseases?	1.0
• Do you use more than five medications daily?	1.0
• Do you have postural instability/fall?	1.0
• Do you have brain failure (depression/dementia)?	1.0
• Are you dependent on activities of daily living?	1.0
• Do you have a Body Mass Index above 27 kg/m2 or less than 22 kg/m2?	1.0
• Do you have blood pressure above 140 × 90 mmHg or below 100 ×60 mmHg?	1.0
• Do you have a heart rate greater than 90 bpm or less than 50 bpm?	1.0
• Do you have oxygen saturation less than 90%?	1.0
“General assessment response” dimension
• Referral to the Family Health Strategy and/or Social Assistance Reference Center	1.0
• Elderly at risk for functional decline/vulnerability and/or frailty	1.0
• Calves smaller than 31 cm	1.0
• Difficulty to walk	1.0
• Two or more falls in the last year	1.0
• Uses arms or is unable to get up and sit in chair	1.0
• Presents imbalance when standing	1.0
• Cannot walk straight	1.0
• Limited general joint range of motion	1.0
• Decreased overall muscle strength, below the third degree	1.0
• Dry or productive cough	1.0
• Spontaneous ventilation with oxygen support	1.0
“General assessment response” dimension
• Re-evaluate in 30 days and/or refer to specialties (Medicine, Nutrition, Speech Therapy, Psychology, Pharmacy, Occupational Therapy, Social Assistance, Physical Education, Nursing and Dentistry)	1.0
Suggestion of physiotherapeutic approaches:
• Strengthen the muscles of the upper limbs, trunk and lower limbs	1.0
• Gain balance, proprioception and flexibility	1.0
• Improve cardiorespiratory fitness	1.0
• Stimulate the vestibular system	1.0
• Strengthen respiratory muscles	1.0
Opinion “General Presentation of the Algorithm”
• The ease of reading, clarity and understanding of information	1.0
• As for the sequence of information	1.0
• As for layout/color	1.0
Attitude of the professional
• Is the algorithm suitable for physical therapists?	1.0
Total score	1.0

Delphi Technique
Evaluation
Questions	Proper		Fully Adequate		Total
	N	%	N	%	N	%
Dimension “Warning signs”
• Age over 75 years	05	38.5	08	61.5	13	100
• Do you live alone?	05	38.5	08	61.5	13	100
• Do you live in a long-term care facility for older adults?	05	38.5	08	61.5	13	100
• Do you have more than five confirmed diseases?	05	38.5	08	61.5	13	100
• Do you use more than five medications daily?	05	38.5	08	61.5	13	100
• Do you have postural instability/fall?	05	38.5	08	61.5	13	100
• Do you have brain failure (depression/dementia)?	05	38.5	08	61.5	13	100
• Are you dependent on activities of daily living?	05	38.5	08	61.5	13	100
• Do you have a Body Mass Index above 27 kg/m2 or less than 22 kg/m2?	05	38.5	08	61.5	13	100
• Do you have blood pressure above 140 × 90 mmHg or below 100 ×60 mmHg?	05	38.5	08	61.5	13	100
• Do you have a heart rate greater than 90 bpm or less than 50 bpm?	05	38.5	08	61.5	13	100
• Do you have oxygen saturation less than 90%?	05	38.5	08	61.5	13	100
“General assessment response” dimension
• Referral to the Family Health Strategy and/or Social Assistance Reference Center	07	53.8	06	46.2	13	100
• Elderly at risk for functional decline/vulnerability and/or frailty	05	38.5	08	61.5	13	100
Dimension “Physical therapy evaluation”
• Calves smaller than 31cm	06	46.2	07	53.8	13	100
• Difficulty to walk	06	46.2	07	53.8	13	100
• Two or more falls in the last year	06	46.2	07	53.8	13	100
• Uses their arms or is unable to get up and sit in the chair	06	46.2	07	53.8	13	100
• Presents imbalance when standing	04	30.7	09	69.3	13	100
• Cannot walk straight	05	38.5	06	61.5	13	100
• Limited general joint range of motion	06	46.2	05	53.8	13	100
• Decreased overall muscle strength, below the third degree	00	00	13	100	13	100
• Dry or productive cough	08	61.5	05	38.5	13	100
• Spontaneous ventilation with oxygen support	09	69.3	04	30.7	13	100
“General assessment response” dimension
• Re-evaluate in 30 days and/or refer to a specialty (Medicine, Nutrition, Speech-Language Therapy, Psychology, Pharmacy, Occupational Therapy, Social Assistance, Physical Education, Nursing and Dentistry)	00	00	13	100	13	100
Suggestion of physical therapy interventions:
• Strengthen the muscles of the upper limbs, trunk and lower limbs	11	84.6	02	15.4	13	100
• Gain balance, proprioception and flexibility	12	92.3	01	7.7	13	100
• Improve cardiorespiratory fitness	04	30.7	09	69.3	13	100
• Stimulate the vestibular system	03	23.0	10	77.0	13	100
• Strengthen respiratory muscles	11	84.6	02	15.4	13	100
Opinion “General Presentation of the Algorithm”
• The ease of reading, clarity and understanding of information	00	00	13	100	13	100
• As for the sequence of information	01	7.7	12	92.3	13	100
• As for layout/color	08	61.5	05	38.5	13	100
Attitude of the professional
• Is the algorithm suitable for physical therapists?	00	00	13	100	13	100

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[1] Corresponding address: Wagner Elias de Melo Moreira – Rua Aracy Sampaio, 26 – Dores de Campos (MG), Brazil – CEP 36213-000 – E-mail: wagner.fisioterapia@yahoo.com.br