Long stay patients residing in nursing homes typically have decreased functional and physical status, and high health care utilization and costs. It is proposed that physical therapy is beneficial for these frail debilitated long stay residents. This hypothesis will be tested in a prospective randomized trial. Subjects will be recruited from a cohort of community long stay nursing home residents who are over age 60 and functionally dependent in two or more Activities of Daily Living. Individuals will be randomized to receive usual care in the nursing home or to receive physical therapy in addition to usual care. Persons assigned to the experimental group will receive physical therapy three times per week for four months. Sessions will focus on General Conditioning and Functional Activity Training. All subjects will receive baseline functional and physical status evaluations and will be reassessed every two months for one year. Cointerventions, cross-overs, compliance, side effects, and drop-outs will be monitored. Prime outcome variables include functional status, physical status, and health care utilization and costs. Functional status will be assessed by interview using the Sickness Impact Profile. Physical status will be assessed by exam using a standardized Neuromuscular Evaluation and Balance, Gait, and Mobility Evaluation. Health care utilization will be monitored by medical record review and interview. Total costs will be calculated by summing physical therapy and utilization costs. Functional and physical status changes will be compared between groups using repeated measures analysis of covariance. Health care costs will be compared using a cost-effectiveness ratio adjusted for changes in functional status. Baseline characteristics of individuals who improve will be analyzed to develop a model expected that this study will expand the definition of physical therapy eligibility to include frail long stay nursing home residents with multiple comorbid conditions. Functional status and cost benefits of physical therapy for these individuals will be explicated and characteristics of persons most likely to benefit will be detailed. As a result, health care providers and policymakers can target nursing home resources more effectively.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AG009117-03
Application #
3546366
Study Section
Aging Review Committee (AGE)
Project Start
1990-04-16
Project End
1994-06-30
Budget Start
1992-03-01
Budget End
1994-06-30
Support Year
3
Fiscal Year
1992
Total Cost
Indirect Cost
Name
University of Texas Health Science Center San Antonio
Department
Type
Schools of Medicine
DUNS #
800772162
City
San Antonio
State
TX
Country
United States
Zip Code
78229
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Gerety, M B; Williams Jr, J W; Mulrow, C D et al. (1994) Performance of case-finding tools for depression in the nursing home: influence of clinical and functional characteristics and selection of optimal threshold scores. J Am Geriatr Soc 42:1103-9
Mulrow, C D; Gerety, M B; Kanten, D et al. (1994) A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 271:519-24
Gerety, M B; Cornell, J E; Mulrow, C D et al. (1994) The Sickness Impact Profile for nursing homes (SIP-NH) J Gerontol 49:M2-8
De Nino, L A; Mulrow, C D; Gerety, M B et al. (1993) Problems in interpreting cost effectiveness in clinical trials. Experimental versus implementation costs. Online J Curr Clin Trials Doc No 44:[4864 words;42 paragraphs]
Gerety, M B; Mulrow, C D; Tuley, M R et al. (1993) Development and validation of a physical performance instrument for the functionally impaired elderly: the Physical Disability Index (PDI). J Gerontol 48:M33-8
Kanten, D N; Mulrow, C D; Gerety, M B et al. (1993) Falls: an examination of three reporting methods in nursing homes. J Am Geriatr Soc 41:662-6
Buchner, D M; Hornbrook, M C; Kutner, N G et al. (1993) Development of the common data base for the FICSIT trials. J Am Geriatr Soc 41:297-308

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