Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado; and Yale University, School of Medicine, Division of Geriatrics, New Haven, Connecticut.
Physical Therapy Program, Arcadia University, Philadelphia, Pennsylvania.
Phys Ther. 2019 Sep 1;99(9):1141-1149. doi: 10.1093/ptj/pzz069.
Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined.
The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy.
This will be a 2-arm randomized controlled clinical trial.
The setting will be participant homes.
A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate.
Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions.
Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel.
The limitation is an inability to blind treating therapists to study allocation.
The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings.
住院是导致老年人功能丧失的一个重要因素。许多可改变的风险因素（如虚弱）可能在住院后仍然存在，预示着健康状况不佳、再次住院或死亡的可能性。老年人在住院期间功能下降后，经常在出院后接受家庭保健（HH）护理来管理这些功能缺陷。然而，在 HH 环境中如何最好地管理这些缺陷仍有待确定。
本研究旨在确定在急性住院后接受 HH 治疗时，开始进行更高强度、渐进式、多组分（PMC）干预是否比常规护理（UC）物理治疗更能改善客观测量和自我报告的身体功能。
这将是一项 2 臂随机对照临床试验。
设置将在参与者家中进行。
共有 200 名因急性住院后身体状况不佳而接受 HH 物理治疗的老年人将参与研究。
参与者将随机分配到 PMC 治疗组或 UC 组，并在 60 天内接受 12 次治疗。PMC 参与者将进行 80%的 1 次重复最大量的下肢阻力训练、特定于任务的日常生活活动训练，以及高级步态和平衡训练。PMC 组还将在从医院过渡到家庭时接受营养补充和护理支持。UC 组将接受标准的 HH 干预措施。
在基线、30 天、60 天、90 天和 180 天，将测量身体表现、自我报告的功能、疲劳和医疗保健利用结果。所有测量都将由盲法研究人员进行评估。
局限性是无法对治疗治疗师进行研究分配的盲目性。
作者希望确定对于在 HH 环境中从急性住院中恢复的老年人，更高强度、多组分的运动干预是否比 UC 物理治疗更能改善结局。
