. According to the applicant intervention strategies to date have focused largely on the restoration of function among disabled elderly persons in the context of rehabilitation after an acute medical event, such as a stroke or hip fracture. There have been few attempts to develop strategies aimed at """"""""prehabilitation"""""""" (PREHAB), which is the prevention of functional dependence and decline among persons who have not sustained an acute illness or injury. The overall objective of this project is to test the efficacy of a home-based PREHAB strategy to prevent functional decline in a high-risk group of physically impaired, community-living elderly persons who do not have severe memory loss or impaired orientation. Community-living persons, over 75 years will be screened for eligibility during non-urgent clinic visits at two large primary care sites. After comprehensive home assessment, 160 physically impaired elders will be randomized, using a blocked design that is stratified by clinic site, severity of physical impairment, and age to receive either the control group strategy (EDUCATE), a 6-month education program covering several content areas in general health practices and health promotion, or a home-based intervention strategy (PREHAB) -- which is a 6-month training program of physical therapy, to include muscle strengthening, joint range of motion, foot care, and balance, gait, transfer, and stair training, plus functional therapy to include training and instruction in safe and effective performance of the task needed to complete ADLs and selected IADLs, provision of appropriate adaptive equipment, and environmental modifications. Functional assessments will be completed in all participants at baseline and at six and twelve months by trained staff who will be kept unaware of group assignments.
The specific aims of the project are 1) to determine whether the home-based PREHAB strategy is superior to the EDUCATE strategy in preventing decline in ADL-IADL function, and in decreasing the use of formal and informal care, including home care and nursing home care; 2) if the PREHAB strategy proves successful to identify the predictors of response to the intervention and to determine whether its benefit is mediated, as hypothesized, by improvements in both physical capability and functional self-efficacy.
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