Training family to assist with physiotherapy for older people transitioning from hospital to the community: a pilot randomized controlled trial

Abstract

Objective: To investigate the safety and effectiveness of augmenting physiotherapy with family-assisted therapy, to inform a future, fully powered trial. Design: Parallel pilot randomized controlled trial. Setting: Transition Care Program. Participants: Thirty-five older adults with multimorbidity, recently hospitalized, with a mean age of 84.1 years (SD = 6.1 years) and mean Modified Barthel Index of 67.8 units (SD = 19.2 units), and 40 family members. Interventions: The control group ( n = 18) received usual physiotherapy care. The experimental group ( n = 17) received usual physiotherapy care and family-assisted therapy from a family member trained by a physiotherapist. Main measures: Primary outcomes were falls-related self-efficacy measured by the Short Falls Efficacy Scale – International and falls during the intervention period. Secondary outcomes included daily steps, EQ-5D-3L (three-level version of the EuroQoL five-dimensional health-related quality of life questionnaire) and ICECAP-O (ICEpop CAPability measure for Older people), Modified Barthel Index and Modified Caregiver Strain Index. Results: There were no between-group differences for falls-related self-efficacy. Relative to the control group, the experimental group was observed to have a reduced risk of falling (relative risk = 0.38, 95% confidence interval (CI) = 0.09–1.60) and a reduced falls rate (incidence rate ratio = 0.22, 95% CI = 0.04–1.20) was of borderline statistical significance. The experimental group walked a mean of 944 daily steps more than the control group (95% CI = 139–1748) and had a significant reduction in activity limitation. There were no between-group differences for quality of life or caregiver strain. Conclusion: Augmenting physiotherapy with family-assisted therapy is feasible for older people transitioning from hospital to the community. A fully powered randomized controlled trial is indicated.

Effectiveness of facility‐based transition care on health‐related outcomes for older adults: A systematic review and meta‐analysis

“…Any disagreement was resolved through consensus following review by a third researcher (AMH). Three corresponding authors were contacted for additional information regarding their studies (Lawler et al, 2019;Morita et al, 2018;Parker et al, 2015).…”

“…The search identified 7,205 studies (see Figure S1). A total of 21 studies (Abrahamsen et al, 2014(Abrahamsen et al, , 2016Chen et al, 2002;Dejong et al, 2009;Fiorini et al, 2013;Galizia et al, 2018;Gustavson et al, 2019;Herfjord et al, 2014;Hong et al, 2019;Jette et al, 2004;Jung et al, 2016;Lawler et al, 2019;Lenze et al, 2012Lenze et al, , 2019Leung et al, 2016;Mallinson et al, 2014;Millar et al, 2017;Morita et al, 2018;O'Brien & Zhang, 2018;Parker et al, 2015;Zhang et al, 2019) enrolling 1,206,769 participants were included. Characteristics of included studies are summarised in Table S1 (Appendix S1).…”

Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

“…The cohort's levels of independence in ADL improved significantly and above a MCID through undertaking facility-based TCP. Improvement in ADL has been shown to vary across TCP settings with a range of between −9.26 points to 28 points ( 6 , 27 , 28 ). This could be due to differences in therapy duration, type of rehabilitation provided or the number of rehabilitation staff available, as suggested by a previous study that reported higher staff ratios were a significant predictor of functional improvement ( 29 ).…”

Two success stories in the management of Guillain–Barré syndrome illustrate the challenges of intensive care unit care in Malawi

“…[17][18][19] Physiotherapy has great potential to improve ICU care in low-resource settings because it requires no advanced equipment and can be provided by family members. 20 We cannot ignore obstacles to quality ICU care. For both patients a diagnosis of GBS was reached with lower levels of Brighton diagnostic certainty than are standard in more resourced-settings.…”

“…17–19 Physiotherapy has great potential to improve ICU care in low-resource settings because it requires no advanced equipment and can be provided by family members. 20…”