To date, intervention strategies 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-the prevention of functional dependence and decline among persons who have not sustained an acute illness or injury. The overall objective of this Intervention Development Study is to test the efficacy and cost effectiveness of a home-based PREHABilitation strategy to prevent functional decline in a highrisk group of physically impaired, community-living elderly persons who do not have severe memory los or impaired orientation. Community-living persons, 75 years and older, will be screened for eligibility during nonurgent clinic visits at two large primary care sites. After a 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 educational program covering several content areas in general health practices and health promotion, or the home-based intervention strategy (PREHAB), a 6-month training program of physical therapy, to include muscle strengthning, joint range of motion (ROM), foot care, and balance, gait, transfer, and stair training, plus functional therapy, to include training and instruction in safe and effective performance of the tasks needed to complete key ADLs and 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 Field Core staff who will be kept unaware of group assignments.
The specific aims of this project are: 1) to determine whether the home-based PREHAB strategy is superior to the EDUCATE stragegy in a) preventing decline in ADL-IADL function, and b) decreasing the use of formal and informal care, including home-care and nursing homecare; 2) if the PREHAB strategy proves successful, to a) identify the predictors of response to the intervention, and b) determine whether PREHAB's benefit is mediated, as we hypothesize, by improvements in both physical capability and functional self-efficacy; 3) to determine the potential value of PREHAB, both to third party payers through a net cost analysis and to patients and clinicians through a cost effectiveness analysis; and 4) to determine whether adherence to the PREHAB strategy can be maintained after completion of supervised training and to elucidate the relationships among adherencen, self-efficacy, physical capability, functional decline, and the use of formal and informal care.
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