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.
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