Jason R Falvey1, Kathleen K Mangione2, Amy Nordon-Craft3, Ethan Cumbler4, Kristine L Burrows3, Jeri E Forster5, Jennifer E Stevens-Lapsley6. 1. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado; and Yale University, School of Medicine, Division of Geriatrics, New Haven, Connecticut. 2. Physical Therapy Program, Arcadia University, Philadelphia, Pennsylvania. 3. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus. 4. Departments of Medicine and Surgery, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus. 5. Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus and Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center. 6. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 East 17th Avenue, Room 3116, Aurora, CO 80045 (USA) and Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, Colorado.
Abstract
BACKGROUND: Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined. OBJECTIVE: The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy. DESIGN: This will be a 2-arm randomized controlled clinical trial. SETTING: The setting will be participant homes. PARTICIPANTS: A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate. INTERVENTION: Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions. MEASUREMENTS: Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel. LIMITATIONS: The limitation is an inability to blind treating therapists to study allocation. CONCLUSIONS: The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings. Published by Oxford University Press on behalf of the American Physical Therapy Association 2019.
BACKGROUND: Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined. OBJECTIVE: The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy. DESIGN: This will be a 2-arm randomized controlled clinical trial. SETTING: The setting will be participant homes. PARTICIPANTS: A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate. INTERVENTION: Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions. MEASUREMENTS: Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel. LIMITATIONS: The limitation is an inability to blind treating therapists to study allocation. CONCLUSIONS: The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings. Published by Oxford University Press on behalf of the American Physical Therapy Association 2019.
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