Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial

Abstract

The progressive multicomponent intervention improved patient functional mobility following acute hospitalization more than usual care. Results from this study support the safety and feasibility of conducting a larger randomized controlled trial of progressive multicomponent intervention in this population. A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed.

<p>Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis</p>

“…The average age of all participants was 80.4 (±3.3) years and ranged from 74.5–85.4 years; 71.8% of the participants were female. Seven studies were conducted in the United States;30,31,34,38,41,42,45 six in Australia;28,29,36,39,43,44 two in New Zealand32,33 and Norway;35,37 and one in Hong Kong 40…”

“…Stevens-Lapsley et al34 utilized a progressive multicomponent physical therapy intervention for 60 days to improve functional mobility for older adults who had just left hospital. Tuntland et al35 trialed a reablement intervention, which was individualized for each participant.…”

“…Two RCTs33,34 utilized SPPB but unfortunately, after many emails, the authors were unable to obtain the data required for the Stevens-Lapsley et al34 study. Therefore, no meta-analysis could be conducted.…”

“…Five falls during intervention period: intervention group: 3; control group: 2. No significant changes in physical outcome measures.Saeterbakken et al,37 (Norway) Randomized controlled trialDetermine the effects of a 10-week home-based strength training program on physical function tests, level of physical activity, muscle strength, and RFD among frail old adults receiving home care services23; 73.9%Intervention =11; 86.5 years (6.4)Control =12; 83.5 years (5.7)YesOlder adults living at home and in need of home care due to functional disabilities and/or medicationLeg extension and elbow flexion maximal strength and RFD, preferred/max walking speed, stair climb, 5x chair rise and physical activity (accelerometer)10 weeksIntervention group significantly improved peak RFD in leg extensionStevens-Lapsley et al,34 (USA) Randomized controlled trialTo determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization compared to usual care rehabilitation22; 63.6%; 85.4 years (7.8)Intervention =12; 70%; 83 years (6.8)Usual care =9; 58.3%; 87 years (8.8)YesOlder adults with multiple chronic conditions, who were discharged from the Acute Care for the Elderly unit of the University of Colorado Hospital, with physician referrals for home health physical therapy4 m walking speed, modified Physical Performance Test, SPPB, six minute walk test30 and 60 daysIntervention group had significantly greater improvements in walking speed, modified physical performance test, and SPPB scores compared with the usual care group at 60 daysTuntland et al,35 (Norway) Randomized controlled trialInvestigate the effectiveness of reablement (multicomponent home-based rehabilitation) in older adults compared with usual care in relation to daily activities, physical functioning, and health-related quality of lifeIntervention =31; 71%; 79.9 years (10.4)Control =30; 63.3%; 78.1 years (9.8)YesPeople applying for, or referred to, home-based services due to functional decline in one or more ADL in a rural municipality in NorwayCOPM was used to measure self-perceived activity performance and satisfaction with performance. Health-related quality of life (COOP/Wonka), TUG, grip strength3 and 9 monthsSignificant improvements in mean scores favoring reablement in COPM performance at 3 and 9 months and overall treatment, and for COPM satisfaction at 9 months and overall treatment Abbreviations: LiFE, Lifestyle-integrated Functional Exercise program; TUG, Timed Up and Go; FES, Falls self-Efficacy Scale; ABC, Activities specific-Balance Confidence Scale; SFL, Strong For Life; HCA, home care aide; ADL, activities of daily living; DSSI, Duke Social Support Index; SPPB, Short Performance Physical Battery; FROP-Com, Falls Risk for Older People – Community Setting; FES-I, Falls self-Efficacy Scale – International; RFD, Rate of Force Development; COPM, Canadian Occupational Performance Measure.…”

“…In the intervention group 61.7% (n=66) of the support plans described such individualized activities as opposed to 15% (n=14) in the usual care group.Renehan et al,36 Participants were approached 1–2 weeks after discharge, intervention included a medication review, falls prevention education, and home-based exercise individually prescribed and modified according to pre-existing frailty by exercise physiologist (visits at weeks 1, 2, 4, and 8 for exercise progression), participants were provided diagrams of exercises and instruction on exercise safety. Participant’s primary nurse who regularly visited for other matters provided encouragement.Three to five times per week 20–30 minutes graduated lower limb strengthening and balance exercises (Otago Exercise Programme)Saeterbakken et al,37 A professional training instructor was present at every training session to make sure of the correct technique, intensity, and numbers of sets.Supervised progressive strength training programme 60 minutes 2x week for 10 weeks, 10–12 repetitions 2–3 sets squats, box lifts, seated row, chest press, and biceps curl.Stevens-Lapsley et al,34 Patients placed in the progressive multicomponent intervention group were referred to home health agency and were seen by a single physical therapist who was trained to provide the progressive intervention. Two to three physical therapy visits per week for 30 days.Progressive multicomponent physical therapy intervention consisted of ADL training (bathroom transfers, bed mobility, and car transfers), evidence-based mobility training (indoor walking, gait training on flat ground and stairs, and outdoor walking transitioning to an independent daily walking program) and progressive strength training (3 sets 8 repetitions max supine leg press, standing hip extension, body-weight resisted plantar flexion, seated press and seated row using the Shuttle Mini Press).…”