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Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

Background/Aims: Physiotherapy consultations in an orthopaedic setting often require visualisation and a 'hands on' approach. There has been an increasing number of research studies exploring the effectiveness and acceptability of telephone and videoconferencing consultations within orthopaedics. Much of the drive behind this change has been to improve access to care and to link the clinic to the home environment. The introduction of communication technology consultations requires a shift in patient workload, which may impact on patient experience of accessing healthcare and managing their condition. The purpose of this research is to systematically review qualitative papers reporting communication technology consultations (phone and videoconference) in orthopaedics. Attention will be focused towards the effect of communication technology on the workload of being a patient. Methods: The protocol for the systematic review was registered and is available to view on the PROSPERO database (CRD42018100896). MEDLINE, AMED, CINAHL, PsychINFO, SCOPUS databases were independently searched, using the search strategy, by two researchers to identify qualitative papers reporting communication technology use in an orthopaedics setting. Data from Introduction, Results and Discussion sections were extracted and an attribution of statements formulated. All statements were thematically analysed into families of themes surrounding patient workload. Results: The search identified 1542 papers that were included for review and eight full texts met the inclusion criteria and were included for analysis. Two studies reported telephone consultations and six reported real time videoconferencing consultations. Six families of themes were identified: (1) skills; (2) clinical interactions; (3) environment; (4) processes; (5) impact on patient; (6) preferences. Conclusions: Literature on the use of communication technologies in healthcare, such as videoconferencing and telephone consultations, is growing in orthopaedics. Qualitative papers highlight the benefits and challenges of communication technology consultations. This review synthesises the change in the workload that patient's face when using these technologies. These altered demands of communication technology consultations affect the patient's experience of accessing healthcare. Consideration of these factors and tailored individualised support for patients may enhance the patient experience and increase suitability of communication technology consultations for orthopaedic patients. [ABSTRACT FROM AUTHOR]

Introduction: Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction. Methods: Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: • Mean/median age >60 • Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies). • Any measure of functional ability as defined by WHOICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool. • Minimum pre-operative and one post-operative measure. Results analysed and presented using narrative synthesis. Results: Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types). 1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months. [ABSTRACT FROM AUTHOR]