Assessment Of Older People Research Articles

Enhancing the Lives of Older Adults in the WHO European Region: Assessing the Implementation of the UN Decade of Healthy Ageing

Abstract The WHO European Region has one of the world's highest median age with many countries having the longest life expectancies. However, the COVID-19 pandemic highlighted the challenges faced by older adults in Europe, leading to excess deaths and highlighting the need to improve their lives. The UN Decade of Healthy Ageing (2021-2030) aims to enhance the lives of older people, their families, and communities. The Decade focuses on four action areas to improve older people's health and wellbeing, combat ageism, ensure age-friendly environments, provide integrated care, and ensure access to long-term care. There are four enablers for the Decade: connecting stakeholders, strengthening research and innovation, engagement, and leadership. A process evaluation survey to assess the implementation of the Decade has been conducted with 48 out of the 53 Member States of the WHO European Region. The survey assessed countries’ policies, regulations, guidelines, strategies, and data on healthy ageing. Preliminary analysis shows that when compared to baseline data, there are more countries with national policy and strategy on ageing with more countries reporting national programme on age-friendly communities, policies to support comprehensive needs assessment of older people and national population-based survey on ageing. Analyses were also conducted based on indicators related to national focal points, multistakeholder forum and legislation on age-discrimination. The UN Decade of Healthy Ageing provides a framework to address the challenges faced by older adults. By focusing on the four action areas and enabling factors, we can enhance the health and wellbeing of older people, their families, and communities. This presentation highlights the importance of the Decade and provides evidence of its early impact, demonstrating the potential to create positive change for the ageing population in Europe.

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review.

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia. Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews. A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context. Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Geriatric assessment for older people with cancer: policy recommendations

Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient’s general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole.

Correlation between community participation, nutritional appetite and psychological distress among comorbid older persons

BackgroundPoor appetite is a common problem among older people; it is known to contribute to weight loss, nutritional deficiencies, and increased mortality, which can affect their community participation and psychological status. In this study, we aimed to identify the relationship between community participation, nutritional appetite, and psychological distress among comorbid older people. This cross-sectional study included 300 elderly people, of whom 100 participated in geriatric clubs and 200 did not. Older people assessment sheet, the Australian Community Participation Questionnaire, the Council on Nutrition Appetite Questionnaire, and Kessler Psychological Distress Scale were used.ResultsMajority of geriatric club members had high community participation, while half of the older people who were not members of the club had moderate community participation levels. Approximately 41.0% of the participants at geriatric clubs had no risk at this time for a nutritional decline, while less than three-quarters of those who are not geriatric club members need frequent appetite reassessment. A correlation was observed between community participation with appetite and psychological distress in those who attended geriatric clubs. Those who are not geriatric club members had correlation between appetite with community participation and psychological distress (P ≤ 0.001).ConclusionsGood appetite and psychological status are positively impacted by engaging in social activities among older people. Findings suggest that community programs, such as Meal on Wheels programs, and shared group activities can improve appetite and social interaction among older people.

Feasibility of using a protein gel for masticatory assessment of older people

Masticatory function plays a crucial role in the breakdown of food for bolus formation and safe swallowing. Chewable silicone gel particles (Optosil) were used for assessing masticatory performance by dentists but such particles were found not suitable for older people due to its hard and dry texture and unfavored flavor. Therefore, with fast growing number of older people who have eating and swallowing difficulties, seeking a suitable model food for masticatory performance assessment becomes an important issue. This study was to develop a glucose-containing model food system for reliable evaluation of the masticatory performance. Three formulas with different amount of gelatin were used to prepare the gels and their textural properties were analyzed. A glucometer was used to measure glucose concentration in saliva. Both young adults (23.5 ± 1.1 years) and older subjects (72.9 ± 5.4 years) were asked to perform mastication tests to verify the reliability of the method. Results showed that the Gel-15% sample gave the best performance and was selected as the test food. Reliability of the current method was proved by the classical standard of Optosil method. Moreover, our findings indicated that masticatory performance was significantly positively correlated with bite force in both young and older adults (young subjects: r = 0.874, p < 0.01; older subjects: r = 0.638, p < 0.01). In conclusions, this study suggested that the newly method could accurately and efficiently measure the masticatory performance of older people.

Smart Lacelock Sensor for the Balance Assessment of Community-Dwelling Older People.

This paper introduces a novel wearable shoe sensor named the Smart Lacelock Sensor. The sensor can be securely attached to the top of a shoe with laces and incorporates a loadcell to measure the force applied by the shoelace, providing valuable information related to ankle movement and foot loading. As the first step towards the automated balance assessment, this paper investigates the correlations between various levels of physical performance measured by the wearable Smart Lacelock Sensor and the SPPB clinical method in community-living older persons. 19 adults (age 76.84 ± 3.45 years), including those with and without recent fall history and SPPB score ranging from 4 to 12, participated in the study. The Smart Lacelock Sensor was attached to both shoes of each participant by skilled research staff, who then led them through the SPPB evaluation. The data obtained from the Smart Lacelock Sensors after the SPPB assessment were used to evaluate the deviation between the SPPB scores assigned by the research staff and the signals generated by the sensors for various participants. Results demonstrate that the standard deviation of the Smart Lacelock Sensor's loadcell response (both feet) for the side-by-side balance testing is significantly correlated (R2 = 0.68) with the SPPB score, demonstrating the capability of the Smart Lacelock Sensor in balance assessment.

Frailty assessment of older patients in the emergency department.

An ageing population is leading to an increase in patients attending emergency departments (EDs) with comorbidities and age-related syndromes such as frailty. Frailty is a clinical syndrome defined as an increased vulnerability to age-related or disease-related insults in older adults due to diminishing physiological reserves. It also places increased demands on staff and hospital services. Screening for frailty early in the care pathway ensures goal-directed and timely care. This article provides an overview of frailty and its assessment in older people presenting to the ED. It discusses the most commonly used frailty assessment tool in the ED, the Clinical Frailty Scale, and identifies that the results of frailty assessment should be used to initiate appropriate individualised care in older patients.

NTRK fusion-positive cancer in nonagenarian patient. The importance of comprehensive geriatric assessment in older people for the inclusion in clinical trials

NTRK fusion-positive cancer in nonagenarian patient. The importance of comprehensive geriatric assessment in older people for the inclusion in clinical trials

Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals—a cluster randomised controlled trial

BackgroundAn increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown.MethodsThe GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units.DiscussionThis trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial’s findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD.Trial registrationClinicalTrials.gov NCT04538157. Registered on 3 September 2020.

Pain descriptors and adaptation of Short Form McGill Pain Questionnaire 2 (SF-MPQ-2) for older people in Brunei Darussalam

Background: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is common in older people, and tends to be under-reported and under-treated. In addition to quantifying pain severity using the visual analogue scale (VAS), use of the translated Short-Form McGill Pain Questionnaire (SF-MPQ-2) to identify pain descriptors may assist with pain assessment in older people. Aims: identify pain descriptors for different pain aetiology in older people using the adapted SF-MPQ-2 Brunei Malay version and compare pain severity assessments using the VAS and SF-MPQ-2. Patients and methods: A prospective study using the translated SF-MPQ-2 in older people admitted or seen in clinic under Orthopaedics and Geriatrics specialties between November 2018 and February 2019. Results: There were 75 participants, with 21 pain descriptors used. The main descriptors for fractures, osteoarthritis or muscle/tendon problems were identified. Despite pain medication, more than a third still experienced moderate to severe pain. However, almost all were satisfied with the pain management. There was a statistically significant difference between pain severity between the VAS and SF-MPQ-2, with the VAS possibly underestimating pain. Conclusions: The adapted SF-MPQ-2 appears feasible for use with older people in Brunei. Further studies are required to formally validate the SF-MPQ-2 in older patients and with specific medical conditions, such as diabetes or surgery.

Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People.

Objective To investigate potential reasons for unusually high incidence of negative Methacholine Challenge Tests (MCT), following standardized MCT medication-hold protocol, in older people with physician-diagnosed asthma. Design An analysis of a longitudinal observational parent study of asthma. Setting Community-dwelling participants were evaluated in an outpatient clinic and at home. Participants Screening inclusion criteria for the parent study included 60 years of age or older, physician diagnosis of asthma, and a positive response to at least one of six asthma screening questions. Participants were enrolled in the study if they also demonstrate either: (1) a postbronchodilator administration response showing an increase of at least 12% and 200 mL in forced expiratory volume or an increase of at least 12% and 200 mL in forced vital capacity, or (2) an MCT result of PC20 ≤ 16 mg/mL (indicating bronchial hyper-responsiveness, MCT positive). Exclusion criteria included diagnosis of cognitive impairment or dementia, residing in a long-term care facility, more than 20 pack/ year smoking history or a history of smoking within the previous five years, inability to perform pulmonary function testing maneuvers, and a Prognostic Index score of greater than 10. Interventions Analysis of participant data for non-medication- and medication-exposure factors for association with negative MCT results. Results Anticholinergic burden and statin use were positively associated with negative MCT. Conclusion Medications not accounted for in medication-hold protocols, and concurrently in use, may impact clinical tests and outcomes.

Video Based Mobility Monitoring of Elderly People Using Deep Learning Models

In recent years, the number of older people living alone has increased rapidly. Innovative vision systems to remotely assess people’s mobility can help healthy, active, and happy aging. In the related literature, the mobility assessment of older people is not yet widespread in clinical practice. In addition, the poor availability of data typically forces the analyses to binary classification, e.g. normal/anomalous behavior, instead of processing exhaustive medical protocols. In this paper, real videos of elderly people performing three mobility tests of a clinical protocol are automatically categorized, emulating the complex evaluation process of expert physiotherapists. Videos acquired using low-cost cameras are initially processed to obtain skeletal information. A proper data augmentation technique is then used to enlarge the dataset variability. Thus, significant features are extracted to generate a set of inputs in the form of time series. Four deep neural network architectures with feedback connections, even aided by a preliminary convolutional layer, are proposed to label the input features in discrete classes or to estimate a continuous mobility score as the result of a regression task. The best results are achieved by the proposed Conv-BiLSTM classifier, which achieves the best accuracy, ranging between 88.12% and 90%. Further comparisons with shallow learning classifiers still prove the superiority of the deep Conv-BiLSTM classifier in assessing people’s mobility, since deep networks can evaluate the quality of test executions.

GP-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the 'Living Well Assessment' quality improvement project in Scotland.

Evidence to support comprehensive geriatric assessment (CGA) in primary care for frail older people is limited. To evaluate a GP-led adapted CGA quality improvement project. Multi-methods evaluation in a large practice in Midlothian in Scotland. The intervention was conducted by 10 GPs in a practice of approximately 11 000 patients, initially in the patient's home, and then remotely (by telephone or video consultation) during the COVID-19 pandemic. Evaluation included a patient questionnaire, and qualitative interviews with GPs delivering the Living Well Assessment (LWA), analysed by thematic analysis. A total of 165/220 (75%) patients responded to the survey, of which 86% reported a 'very good experience' of the LWA. The method of delivery did not significantly influence this although most (58%) stated a preference for face-to-face consultation. For the 31% who preferred remote LWA, most (23%) preferred telephone to video consultation (8%). Problems in remote consultations related to technical issues (video), poor vision (video), or deafness (telephone or video). GPs felt that home-based LWAs had real benefits but switching to remote during the pandemic had proven feasible. Concerns included potential increase in GP workload owing to the LWA and whether it was an efficient use of GPs' time. GP-led adapted CGA was feasible in a large practice, even during the pandemic, and highly valued by frail patients. Questions regarding efficient use of GPs' time, effectiveness in terms of important patient outcomes and impact, and cost-effectiveness, requires further investigation in a larger study.

Asymptomatic orthostatic hypotension and risk of falls in community-dwelling older people.

Many older people with orthostatic hypotension (OH) may not report typical symptoms of dizziness, light-headedness or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Continuous orthostatic blood pressure (BP) was measured during active stand using a Finometer at Wave 1 of The Irish Longitudinal Study on Ageing in participants aged ≥ 70years.OH, with and without dizziness, was defined as a sustained drop in systolic BP ≥ 20 and/or diastolic BP ≥ 10mm Hg at 30, 60 and 90seconds post-standing.The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Almost 11% (n = 934, mean age 75years, 51% female) had OH, two-thirds of whom were asymptomatic.Dizziness was not associated with systolic BP drop at 30 (β = 1.54 (-1.27, 4.36); p = 0.256), 60 (β = 2.64 (-0.19, 5.47); p = 0.476) or 90seconds (β = 2.02 (-0.91, 4.95); p = 0.176) after standing in adjusted models.Asymptomatic OH was independently associated with unexplained falls (odds ratio 2.01 [1.11, 3.65]; p = 0.022) but not explained falls (OR 0.93 [0.53, 1.62]; p = 0.797) during follow-up. Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

What are the benefits and harms of comprehensive geriatric assessment for community-dwelling older people at risk of poor health outcomes?

What are the benefits and harms of comprehensive geriatric assessment for community-dwelling older people at risk of poor health outcomes?

Evaluation of the added value of Brain Natriuretic Peptide to a validated mortality risk-prediction model in older people using a standardised international clinical assessment tool.

The ability to accurately predict the one-year survival of older adults is challenging for clinicians as they endeavour to provide the most appropriate care. Standardised clinical needs assessments are routine in many countries and some enable application of mortality prediction models. The added value of blood biomarkers to these models is largely unknown. We undertook a proof of concept study to assess if adding biomarkers to needs assessments is of value. Assessment of the incremental value of a blood biomarker, Brain Naturetic Peptide (BNP), to a one year mortality risk prediction model, RiskOP, previously developed from data from the international interRAI-HomeCare (interRAI-HC) needs assessment. Participants were aged ≥65 years and had completed an interRAI-HC assessment between 1 January 2013 and 21 August 2021 in Canterbury, New Zealand. Inclusion criteria was a BNP test within 90 days of the date of interRAI-HC assessment. The primary outcome was one-year mortality. Incremental value was assessed by change in Area Under the Receiver Operating Characteristic Curve (AUC) and Brier Skill, and the calibration of the final model. Of 14,713 individuals with an interRAI-HC assessment 1,537 had a BNP within 90 days preceding the assessment and all data necessary for RiskOP. 553 (36.0%) died within 1-year. The mean age was 82.6 years. Adding BNP improved the overall AUC by 0.015 (95% CI:0.004 to 0.028) and improved predictability by 1.9% (0.26% to 3.4%). In those with no Congestive Heart Failure the improvements were 0.029 (0.004 to 0.057) and 4.0% (0.68% to 7.6%). Adding a biomarker to a risk model based on standardised needs assessment of older people improved prediction of 1-year mortality. BNP added value to a risk prediction model based on the interRAI-HC assessment in those patients without a diagnosis of congestive heart failure.

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale

Purpose To develop and cross-culturally adapt a Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) and to verify its psychometric properties. Material and Methods The translation and cross-cultural adaptation process of the scale followed standard guidelines. The FaB-Brazil scale was applied to 93 community-dwelling older people. Cronbach’s alpha was calculated to evaluate internal consistency and the intraclass correlation coefficient (ICC) to evaluate interrater and test–retest reliability. The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, convergent and discriminative validity were evaluated. A significance level of .05 was set for statistical analyses. Results Internal consistency was moderate (α = 0.73). An excellent inter-rater (ICC = 0.93; p < 0.001) and a good test–retest (ICC = 0.79; p < 0.001) reliability were found. The SEM was 0.27 and MDC was 0.53. Neither ceiling nor floor effects were found. Convergent validity was established by the positive correlations between the FaB-Brazil scale, age, and functional mobility, and by the negative correlations between the FaB-Brazil scale and balance confidence, community mobility and EuroQol-5D (p < 0.05). No significant differences were found between males and females and between non-fallers and fallers. Conclusions Our results offer evidence for the reliability and validity of the FaB-Brazil scale for community-dwelling older people. Implications for Rehabilitation Fall-related behaviors should be part of the fall risk assessment of community-dwelling older people. The Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) is reliable and valid for assessing fall-related behaviors in community-dwelling older people. The FaB-Brazil scale may be used to raise awareness about potential fall hazards and to guide fall prevention programs.

336 ASYMPTOMATIC ORTHOSTATIC HYPOTENSION AND RISK OF FALLS IN COMMUNITY-DWELLING OLDER PEOPLE

Abstract Background Many older people with Orthostatic Hypotension (OH) may not report typical symptoms of dizziness, light-headedness, or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Methods Continuous orthostatic BP was measured during active stand using a Finometer at Wave 1 of TILDA in participants aged≥70 years. OH, with and without dizziness, was defined as a sustained drop in systolic BP≥20 and/or diastolic BP≥10 mm Hg at 30, 60 and 90 seconds post-standing. The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Results Almost 11% (n=934; mean age: 75 years; 51% female) had OH, two-thirds of whom were asymptomatic. Dizziness was not associated with systolic BP drop at 30 (β=1.54; –1.27, 4.36; p=0.256), 60 (β=2.6; –0.19, 5.47; p =0.476) or 90 (β=2.02; –0.91, 4.95; p=0.176) seconds after standing in adjusted models. Asymptomatic OH was independently associated with unexplained falls (Odds Ratio: 2.01; 1.11, 3.65; p=0.022) but not explained falls (OR 0.93; 0.53, 1.62; p=0.797) during follow-up. Conclusion Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

SIOG2022-0066 - Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anti-cancer treatment: a multi-centre, open-label, randomised controlled trial

SIOG2022-0066 - Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anti-cancer treatment: a multi-centre, open-label, randomised controlled trial

The AERO study: A feasibility randomised controlled trial of individually tailored exercise adherence strategies based on a brief behavioural assessment for older people with musculoskeletal conditions

IntroductionExercise is a widely used treatment modality for older people with musculoskeletal conditions. The effectiveness of exercise programmes is limited by adherence. The aims of this study were to examine the acceptability and feasibility of the AERO intervention in facilitating exercise adherence in older people with musculoskeletal conditions, and to inform the design of a future randomised controlled trial. MethodsA two arm feasibility randomised controlled trial with an embedded qualitative study conducted at one orthopaedic hospital in the South of England. Older adults referred to physiotherapy with musculoskeletal conditions were randomised to receive either usual care consisting of standard physiotherapy only, or the AERO intervention, consisting of usual care with the addition of tailored exercise adherence approaches based on a brief behavioural assessment. Feasibility outcomes included recruitment, randomisation, retention, acceptability, and fidelity to trial protocol. Secondary outcomes included exercise adherence, physical activity, and behavioural regulation. Results48 participants were recruited to the study with 27 randomised to usual care and 21 to AERO and usual care. On the basis of recruitment, retention, the acceptability to participants and physiotherapists and fidelity, the AERO intervention was determined to be feasible. ConclusionThe AERO intervention in which participants received tailored adherence strategies based on a behavioural assessment plus standard physiotherapy is feasible and acceptable. It is now ready to be tested in an adequately powered randomised controlled trial. Contribution of the Paper•It is feasible to implement the AERO intervention, a novel intervention consisting of tailored adherence approaches based on a brief behavioural assessment.•The AERO intervention is acceptable to both participants and physiotherapists.•The next step is to test the AERO intervention in a robust, adequately powered randomised controlled trial. Clinical trial registration numberThis study was registered at clinicaltrials.gov REF: NCT03643432.