OBJECTIVES: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use. DESIGN: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care. PARTICIPANTS: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control). MAIN OUTCOME MEASURES: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use. RESULTS: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65-1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75-2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility. CONCLUSIONS: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.
RCT Entities:
OBJECTIVES: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use. DESIGN: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care. PARTICIPANTS: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control). MAIN OUTCOME MEASURES: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use. RESULTS: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65-1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75-2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility. CONCLUSIONS: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.
Authors: Jori Reijula; Toni Rosendahl; Kari Reijula; Paula Roilas; Heikki Roilas; Raimo Sepponen Journal: BMC Geriatr Date: 2009-12-03 Impact factor: 3.921