Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial

Abstract

Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with standard care in care home residents who have mobility limitations and are dependent in performing activities of daily living. Design Cluster randomised controlled trial, with random allocation at the level of care home. Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories "physical disability" and "older people." Participants Care home residents with mobility limitations, limitations in activities of daily living (as screened by the Barthel index), and not receiving end of life care were eligible to take part in the study. Intervention A targeted three month occupational therapy and physiotherapy programme. Main outcome measures Scores on the Barthel index and the Rivermead mobility index. Results 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study: 12 were randomly allocated to the intervention arm (128 residents, mean age 86 years) and 12 to the control arm (121 residents, mean age 84 years). Participants were evaluated by independent assessors blind to study arm allocation before randomisation (0 months), three months after randomisation (at the end of the treatment period for patients who received the intervention), and again at six months after randomisation. After adjusting for home effect and baseline characteristics, no significant differences were found in mean Barthel index scores at six months post-randomisation between treatment arms (mean effect 0.08, 95% confidence interval −1.14 to 1.30; P=0.90), across assessments (−0.01, −0.63 to 0.60; P=0.96), or in the interaction between assessment and intervention (0.42, −0.48 to 1.32; P=0.36). Similarly, no significant differences were found in the mean Rivermead mobility index scores between treatment arms (0.62, −0.51 to 1.76; P=0.28), across assessments (−0.15, −0.65 to 0.35; P=0.55), or interaction (0.71, −0.02 to 1.44; P=0.06).Conclusions The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence. On the other hand, the variation in residents' functional ability, the prevalence of cognitive impairment, and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work. Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population. Trial registration ISRCTN79859980

How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials

“…Table 1 shows that the term 'usual care' was used in 33 of the 73 articles. Other expressions were also used, such as 'routine care', 15,29,35,63 'usual practice', 41 'normal care', 34 'standard care', 49,78 'care as usual', 55 'usual policy', 60 'usual service', 76 and 'usual management'. 84 Other authors did not use a specific expression.…”

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

“…Local authority homes have also been under-represented in previous studies. 86 It is unlikely that the process of implementing the intervention in large or local authority-run homes would be so different from that in our included homes that the intervention would be substantially more effective. Our findings are generalisable to residents in these homes.…”

“…This is similar to the proportion of residents recruited to another recent UK care home study of a physiotherapy intervention, targeted just at those with mobility limitations. 86 Substantial numbers of residents were excluded (524/2078, 25%) (either because their health was too poor or because the care home manager felt that it was inappropriate to approach that individual for another reason). Those residents with poor health would have been unlikely to be able to participate in the exercise groups and would be unlikely to benefit from the intervention.…”

“…84 Frail older adults with multiple comorbidities and high disability levels residing in care homes are even more likely to have very limited physical activity levels. 85,86 To influence the physical activity behaviour of as many residents as possible, and maximise exposure to the exercise sessions, any activity/exercise intervention should offer a variety of physical activity opportunities without placing unreasonable demands on care home staff.…”

“…[86][87][88][89][90][91][92] Hence, any intervention to increase exercise participation should include approaches to create the culture change needed to effectively address these barriers. 92,93 A whole-home intervention, using an organisational approach to encourage all residents and staff in efforts to increase the residents' level of physical activity, is more likely to achieve the positive effects sought than simply providing group exercise sessions.…”