Effects of a home-based rehabilitation program in community-dwelling older people after discharge from hospital: A subgroup analysis of a randomized controlled trial

Abstract

Objective: To examine whether pre-admission community mobility explains the effects of a rehabilitation program on physical performance and activity in older adults recently discharged from hospital. Design: A secondary analysis of a randomized controlled trial. Setting: Home and community. Participants: Community-dwelling adults aged ⩾60 years recovering from a lower limb or back injury, surgery or other disorder who were randomized to a rehabilitation ( n = 59) or standard care control ( n = 58) group. They were further classified into subgroups that were not planned a priori: (1) mild, (2) moderate, or (3) severe pre-admission restrictions in community mobility. Interventions: The 6-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counselling, and standard care. Measurements: Physical performance was measured with the Short Physical Performance Battery and physical activity with accelerometers and self-reports. Data were analysed by generalized estimating equation models with the interactions of intervention, time, and subgroup. Results: Rehabilitation improved physical performance more in the intervention ( n = 30) than in the control group ( n = 28) among participants with moderate mobility restriction: score of the Short Physical Performance Battery was 4.4 ± 2.3 and 4.2 ± 2.2 at baseline, and 7.3 ± 2.6 and 5.8 ± 2.9 at 6 months in the intervention and control group, respectively (mean difference 1.6 points, 95% Confidence Interval 0.2 to 3.1). Rehabilitation did not increase accelerometer-based physical activity in the aforementioned subgroup and did not benefit those with either mild or severe mobility restrictions. Conclusions: Pre-admission mobility may determine the response to the largely counselling-based rehabilitation program.

Factors associated with life‐space mobility restriction in home‐care older adults receiving home‐visit rehabilitation: A cross‐sectional multi‐center study in Japan

“…In a previous study, 18 an HR program focused on promoting physical activity and restoring mobility did not reduce mobility impairments in patients with severe life-space restrictions. The authors 18 suggested that intervention was difficult for the patients and that comprehensive geriatric evaluation and multispecialty team service delivery might be necessary.…”

“…In a previous study, 18 an HR program focused on promoting physical activity and restoring mobility did not reduce mobility impairments in patients with severe life-space restrictions. The authors 18 suggested that intervention was difficult for the patients and that comprehensive geriatric evaluation and multispecialty team service delivery might be necessary. Thus, as clarified in our study, there may be a need for comprehensive support focusing on IADL and environmental factors, such as assistive devices and household composition.…”

“…The score range was 0-120 points. Using these scores, the participants were divided into two groups-a restrictions group and a low-score group-based on the cut-off value of 30 points, 18 which was set as 'severe life-space restrictions'. Additionally, we used the degree of LSA2 independence to investigate the grade of independence when going outside at home (i.e., moving on familiar home ground).…”

Derivation of a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis

“…However, their drawbacks are that they cannot be used in an outpatient or community setting where there is limited time because these tools are composed of 10 or more items, and they take approximately 20–30 min to measure. Accordingly, a short physical performance battery (SPPB) that can be performed in approximately 10 min is employed for outpatients or community-dwelling older adults [38,39]. The SPPB is a screening tool that consists of five types of performance tests: balance tests (side-by-side stand, semi-tandem stand, and tandem stand), gait speed, and chair stand tests [40].…”

Effects of interventions on life‐space mobility for community‐dwelling older adults: A systematic review and meta‐analysis

“…Interventions to improve the LSM of community‐dwelling older adults include home‐based exercise instruction, goal setting, and lifestyle counseling 13,14 . These interventions effectively improve cognitive function in community‐dwelling older adults with cognitive impairment 14 .…”