Hospitalization, with its accompanying bed rest and immobility, puts frail elders at serious risk to decline in physical functioning (mobility and activities of daily living) and often results in nursing home (NH) placement. NH residents admitted from hospitals have greater difficulty with physical functioning than those admitted from home or other NHs. This is a significant health care concern, since 45% of nursing home admissions come directly from hospitals. This study pilots a comprehensive nursing rehabilitation program (CNRP) to promote the physical functioning of moderately frail post-hospitalized NH residents. The pilot aims: (a) to estimate the CNRP effect size needed to determine the necessary sample size for a subsequent clinical trial with sufficient power to detect a statistically significant intervention effect and (b) to assess the integrity and feasibility of implementing the CNRP and data collections protocols. To address the complexity of promoting physical functioning, the proposed 2-month CNRP incorporates the synergism of three interventions: Performance Interventions (ensuring daily activity), Capacity interventions (ensuring adequate hydration, strength, endurance, and balance), and Facilitating Interventions (providing education, support, and stress reduction). A longitudinal design, with an experimental group and a non-equivalent comparison group, will be used (n=48). Changes in physical functioning will be assessed at baseline, 1 month, and 2 months using analysis of variance with 2 factors (group and time). Assessment of the integrity and feasibility of implementing the CNRP will be achieved through subject interviews at baseline, 1 and 2 months and an observational system designed to monitor the implementation of the CNRP on a weekly basis. Completion of the pilot will provide the knowledge essential to refine the CNRP and to design a large clinical trial that tests its efficacy in promoting the physical functioning of moderately frail post-hospitalized NH residents.
