Effects of a home-based rehabilitation program in community-dwelling older people after discharge from hospital: A subgroup analysis of a randomized controlled trial.

OBJECTIVE

To examine whether pre-admission community mobility explains the effects of a rehabilitation program on physical performance and activity in older adults recently discharged from hospital.

DESIGN

A secondary analysis of a randomized controlled trial.

SETTING

Home and community.

PARTICIPANTS

Community-dwelling adults aged ⩾60 years recovering from a lower limb or back injury, surgery or other disorder who were randomized to a rehabilitation ( = 59) or standard care control ( = 58) group. They were further classified into subgroups that were not planned a priori: (1) mild, (2) moderate, or (3) severe pre-admission restrictions in community mobility.

INTERVENTIONS

The 6-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counselling, and standard care.

MEASUREMENTS

Physical performance was measured with the Short Physical Performance Battery and physical activity with accelerometers and self-reports. Data were analysed by generalized estimating equation models with the interactions of intervention, time, and subgroup.

RESULTS

Rehabilitation improved physical performance more in the intervention ( = 30) than in the control group ( = 28) among participants with moderate mobility restriction: score of the Short Physical Performance Battery was 4.4 ± 2.3 and 4.2 ± 2.2 at baseline, and 7.3 ± 2.6 and 5.8 ± 2.9 at 6 months in the intervention and control group, respectively (mean difference 1.6 points, 95% Confidence Interval 0.2 to 3.1). Rehabilitation did not increase accelerometer-based physical activity in the aforementioned subgroup and did not benefit those with either mild or severe mobility restrictions.

CONCLUSIONS

Pre-admission mobility may determine the response to the largely counselling-based rehabilitation program.