Developing Consumer Consensus on Remote Assessment and Management of Physical Function in Older Adults (RAMP): International Modified Delphi Process

TL;DR

This study gathered global input from older adults to identify their preferences for using digital health tools to assess and manage physical function.

Contribution

The study developed consumer-driven consensus statements and recommendations for remote physical function management in older adults.

Findings

18 statements achieved consensus, emphasizing the importance of physical function for quality of life and daily activities.

Older adults strongly support remote interventions but highlighted the need for privacy, resources, and personalized options.

Five revised statements in Round 2 achieved strong agreement, focusing on personal preferences and accessibility.

Abstract

Remote health care delivery, including the use of digital health interventions, is emerging as a tool for assessing and managing physical function, but its design and implementation often overlook the needs and preferences of older adult end users.

The primary aim of this modified Delphi process was to develop consumer consensus on preferences for remote assessment and management of physical function in older adults.

Research and consumer experts of the Remote Assessment and Management of Physical Function in Older Adults (RAMP) Working Group co-developed the Round 1 Delphi survey, which was advertised to consumers (adults aged ≥60 years) via international clinical and research networks and social media between August and November 2023. The online survey presented 23 Delphi statements for which respondents reported their level of agreement using an 11-point Likert scale (0-10; scores ≥7 indicated agreement). Statements were classified as having “strong agreement” and achieving consensus if ≥80% of participants indicated agreement. Statements classified as having “moderate” (70%-80% of participants indicated agreement) or “low” (<70% of participants indicated agreement) agreement were revised or rejected. Revised statements were presented to participants in Round 2 (January to February 2024), and the final consensus statements were consolidated into recommendations.

A total of 654 consumers (75.7% female) with a mean age of 69.0 (SD 6.0) years from 15 countries (5 continents) were included in analyses in Round 1. Of 23 statements, 13 achieved consensus, with the strongest agreement observed for statements relating to the importance of physical function for quality of life and performing activities of daily living (6 statements; agreement 97.6%-99.5%). Two statements regarding privacy and security concerns when using technology (agreement 20.8%) and the inability to perform physical function assessments or exercise at home (agreement 15.5%) were rejected with low agreement. The remaining 8 statements (agreement 49.5%-79.5%) were modified into 7 new statements for the Round 2 survey, which was completed by 526 (80.4%) respondents from Round 1. Five of seven Round 2 statements were accepted with strong agreement (agreement 80%-82.7%), including the importance of addressing personal preferences for self- versus clinician-led remote interventions, group versus individual exercise, and availability of necessary resources (eg, technology and exercise equipment).

Eighteen statements achieved consensus and were translated into 7 recommendations highlighting that older adults recognize physical function as a health priority, would value more information about it, and are willing to participate in remote assessment and management interventions (including via digital health) to maintain or improve it. These recommendations also reinforce that interventions should be easily accessible and meet individual preferences of consumers.

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