Declines in physical function as a result of acute illness are strongly and independently associated with a number of adverse health events for older adults. Home Health (HH) physical therapy may be the ideal venue for addressing these declines in physical function because around 3 million older adults receive access to HH services following discharge from acute or post-acute facilities. However, as currently structured, these services do not appear to adequately restore function, as evidenced by poor long-term outcomes and high rates of hospital readmission. Diminished physical function has been particularly implicated as a risk factor for re-hospitalization-older adults with lower levels of ambulatory activity are 6 times more likely to be re-hospitalized than those with greater ambulatory activity. A more intensive approach to HH physical therapy for older adults has great potential to maximize physical function and reduce hospital readmissions. Therefore, we have developed a high intensity home-based, progressive, interdisciplinary, multi-component (PMC) intervention that directly addresses the functional deficits seen after hospitalization. We propose to conduct a two-arm, randomized clinical trial (RCT) of 200 older adults admitted to HH from an acute or post-acute facility. Participants will receive either 1) an intensive, PMC intervention using resistance exercise and evidenced-based motor control training to improve physical function or 2) usual care (UC) physical therapy. The primary goal of this investigation is to determine if PMC intervention, initiated upon admission to HH, improves physical function, as measured by performance and self-report assessments, more than UC physical therapy. The effects of the PMC intervention on re-hospitalization rates, nursing home placement, emergency room visits, and falls after discharge from the acute care hospital will also be examined. Treatment will occur at home during the first 60 days following admission to HH from acute or post-acute facility with testing at: baseline (upon HH admission), 30 days, 60 days (primary endpoint), 90 days, and 180 days. If successful in improving patient function and decreasing re-hospitalization rates, PMC intervention holds potential for future health care cost savings.
This study focuses on a prevalent and understudied problem for older adults: mobility limitations in older adults following acute hospitalization. This investigation has high potential for an immediate clinical impact because it addresses patient mobility in a home setting (rather than laboratory) and is designed to work within existing Medicare reimbursement guidelines. The intervention also has potential to reduce utilization of high-cost healthcare options such as re-hospitalizations, nursing home stays, and emergency room visits.