The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems

Abstract

BackgroundA physically active lifestyle in older people contributes to the preservation of good health. We assessed the influence of physiotherapy on daily functioning among community dwelling older people (75+) with complex health problems identified with screening, versus usual care. We also compared functional task exercise (FTE), with problems prioritized by older people, trained in the home environment, versus usual preventive physical therapy (PPT).MethodsDesign: FTE and PPT were compared in a randomized controlled trial (RCT). Both interventions were compared with daily functioning in an observational study: control group.Setting/Participants: Community-dwelling persons aged ≥75 years with daily activity limitations enlisted in 83 general practices (n = 155).Interventions: Both intervention groups (FTE, n = 76 and PPT, n = 79) received individual, 30 min treatments. The control group (n = 228) did not get any experimental intervention offered.Measurements: Groningen Activities of Daily Living Restriction Scale (GARS).Statistical analyses: Linear Mixed Model analysis, correcting for age, sex, baseline scores and clustering by physiotherapist were used to compare the different groups.ResultsAt baseline, 74% percent of the intervention trial group was female vs 79% in the control group. Median ages were 83.9 and 84.7 respectively.The median baseline GARS-score for the control group was 41.0 (25 and 75 percentile): 35.0; 48.0) and 40.0 (25 and 75 percentile: 32.3; 46.0) for the intervention group (FTE + PPT). The mean change over time was 3.3 (2.5; 4.1) for the control group. Mean difference in change over time between the intervention (FTE + PPT) and the control group was − 2.5 (− 4.3; − 0.6) (p = .009).Between FTE and PPT the difference in change was − 0.4 (95% CI: -2.3; 3.0, p = 0.795).ConclusionAn exercise intervention led by physiotherapists may slow down decline in self-reported daily functioning in older persons with daily activity limitations, identified by pro-active case finding.Trial registrationNetherlands trial register (NTR2407). Registered 6th of July 2010.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0859-3) contains supplementary material, which is available to authorized users.

Prehabilitation before major intra-abdominal cancer surgery

“…Prehabilitation at home or in a community-based setting with adequate supervision allows patients to acquire these skills in their own environment, a setting to which they return after hospital discharge, and this makes it more likely that patients will start exercising again soon after surgery. [41][42][43] Most of the studies included did not report on the postoperative clinical care pathway, including adequate discharge criteria, the use of a protocol for enhanced recovery after surgery or the content of rehabilitation, even though postoperative care should also be optimised to establish the full potential of prehabilitation. Finally, the modalities in prehabilitation programmes are highly varied.…”

Personalized community-based prehabilitation for a high-risk surgical patient opting for pylorus-preserving pancreaticoduodenectomy: a case report

“…The use of resistance training in the training program focusing on individual muscle groups is debatable since functional task training involves training of these muscle groups as well. Functional task training has been reported to be more effective in the improvement of ADL in elderly compared to resistance training (de Vreede et al, 2005) and feasible in highly compromised elderly (Siemonsma et al, 2018). The patient improved in her physical functioning in which the greatest improvement was seen in the first 2 weeks after the preoperative assessment.…”

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

“…Each week, a steep ramp test will be carried out by the patient under supervision of the physical therapist in order to individually set-up and optimize training intensity of the interval and endurance training sessions, as well as to monitor progression (titration) as advised by Glasziou et al 23 The physical therapist will check if the patient completes each training session, and will discuss these findings with the patient on a weekly base. Twice a week, the home-based interval training and endurance training will be combined with functional exercise training of activities of daily living of relevance for the individual patient according to Siemonsma et al 24 These exercises might include stairclimbing, sit to-stand exercises, outdoor cycling, outdoor walking and will be assembled in close collaboration between the physical therapist and the patient (when necessary assisted by an (in)formal caregiver). Table 2 for the weekly interval duration of the moderate-and low-intensity intervals of the endurance training sessions.…”