Domiciliary vs Centre-Based Rehabilitation of Older Community Dwellers: Randomised Trial with Economic Evaluation

Abstract

Abstract:Background: Community rehabilitation services for older adults aim to address factors that lead to physical decline and falls and return people to their normal activities in the community. While community rehabilitation has been proven effective in reducing falls in the elderly, previous studies have not specified whether delivering services at home or in a centre-based format is the more appropriate method of service delivery.Aim: This study aims to compare a centre-based group program with a home-based program. The purpose of this study is to identify the most clinically effective way of delivering community rehabilitation services to older fallers and determine which service delivery setting is more economically efficient.Methods/Design: This paper describes the study design and methods of a randomised clinical trial. One group of participants will receive a centre-based community rehabilitation service, the other group a domiciliary (home-based) community rehabilitation service of near identical content. Participants in this study are those clients over 60 years of age referred to a community rehabilitation service. Patients referred to this service typically have had recent falls, poor or declining mobility, functional dependency, cognitive decline, and / or physical deconditioning.Clinical effectiveness will be primarily determined by comparison of health-related quality of life and rates of accidental falls. Secondary outcomes include the levels of participation in functional activities, and physical capacity between the two groups. Economic efficiency will be determined through conduct of a cost-benefit analysis.Discussion: Results from this study will guide clinicians and policy makers to identify the more effective and efficient falls prevention community rehabilitation program service delivery model for older adults living in the community.

Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial

“…Clinically, multidisciplinary community-based rehabilitation teams commonly provide intensive ongoing rehabilitation to many patients with high need for these services post hospitalization. 7 In Australia, these services typically entail one to two sessions per week for up to eight weeks, 8 which is not inconsistent with multidisciplinary falls prevention programmes investigated internationally. 9 However, resources available to provide intensive post-hospitalization rehabilitation services are limited and there are likely to be many older adults discharged from hospital with a medium level of need who miss out on this intensive face-to-face ongoing rehabilitation.…”

Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

“…A repeated measures cohort investigation was undertaken nested within a larger randomized controlled trial. 2 Participants in this study were community-dwelling older adults 460 years referred for rehabilitation from three hospital emergency departments following a presentation for a fall and from local general practitioners located in Brisbane, Australia. Participants undertook baseline and six-month follow-up assessments (n ¼ 70) as part of a trial investigating an eight-week centre-based or home-based multiple factor community rehabilitation intervention designed to reduce falls in this population.…”

“…Of the 70 participants in this investigation 31 (46%) received centre-based community rehabilitation services while the remainder received domiciliary-based community rehabilitation services. 2 Details of the trial protocol have been described elsewhere. 2 The trial was registered in the Australian New Zealand Clinical Trail Register: ACTRN12605000056695.…”

“…1 Rather than a curative effect, these services are often aimed at maximizing patients' functional ability and health-related quality of life. 2 Objective changes in functioning observed during periods of rehabilitation are expected to result in associated changes in health-related quality of life. 3 However, because of the subjective nature of the health-related quality of life construct, it is desirable to evaluate this construct in its own right.…”

A break‐even analysis of a community rehabilitation falls prevention service

“…The patient population from which this evaluation was modelled was taken from a cohort of older adults participating in a randomised controlled trial of two models of community rehabilitation 13 . The target population comprised community dwelling older adults >65 years who have had a recent fall (past six months), self‐ or GP‐ identified functional decline or self‐reported gait instability, and therapist assessed cognitive capability sufficient to participate in a multidisciplinary rehabilitation program (see Table 1).…”