Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA.
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
J Am Geriatr Soc. 2023 Sep;71(9):2855-2864. doi: 10.1111/jgs.18413. Epub 2023 May 24.
Older adult Veterans are at high risk for adverse health outcomes following hospitalization. Since physical function is one of the largest potentially modifiable risk factors for adverse health outcomes, our purpose was to determine if progressive, high-intensity resistance training in home health physical therapy (PT) improves physical function in Veterans more than standardized home health PT and to determine if the high-intensity program was comparably safe, defined as having a similar number of adverse events.
We enrolled Veterans and their spouses during an acute hospitalization who were recommended to receive home health care on discharge because of physical deconditioning. We excluded individuals who had contraindications to high-intensity resistance training. A total of 150 participants were randomized 1:1 to either (1) a progressive, high-intensity (PHIT) PT intervention or (2) a standardized PT intervention (comparison group). All participants in both groups were assigned to receive 12 visits (3 visits/week over 30 days) in their home. The primary outcome was gait speed at 60 days. Secondary outcomes included adverse events (rehospitalizations, emergency department visits, falls and deaths after 30 and 60-days), gait speed, Modified Physical Performance Test, Timed Up-and-Go, Short Physical Performance Battery, muscle strength, Life-Space Mobility assessment, Veterans RAND 12-item Health Survey, Saint Louis University Mental Status exam, and step counts at 30, 60, 90, 180 days post-randomization.
There were no differences between groups in gait speed at 60 days, and no significant differences in adverse events between groups at either time point. Similarly, physical performance measures and patient reported outcomes were not different at any time point. Notably, participants in both groups experienced increases in gait speed that met or exceeded established clinically important thresholds.
Among older adult Veterans with hospital-associated deconditioning and multimorbidity, high-intensity home health PT was safe and effective in improving physical function, but not found to be more effective than a standardized PT program.
老年退伍军人在住院后发生不良健康后果的风险较高。由于身体功能是不良健康后果的最大潜在可调节风险因素之一，我们的目的是确定家庭健康物理治疗（PT）中的渐进式高强度阻力训练是否比标准化家庭健康 PT 更能改善退伍军人的身体功能，并确定高强度方案是否同样安全，即具有相似数量的不良事件。
我们在退伍军人因身体不适而被推荐出院后接受家庭健康护理的急性住院期间招募了退伍军人及其配偶。我们排除了有高强度阻力训练禁忌症的人。共有 150 名参与者被随机分为 1:1 组，分别接受（1）渐进式高强度（PHIT）PT 干预或（2）标准化 PT 干预（对照组）。两组所有参与者均被分配在其家中接受 12 次访问（3 次/周，共 30 天）。主要结局是 60 天时的步态速度。次要结局包括不良事件（30 和 60 天后再住院、急诊就诊、跌倒和死亡）、步态速度、改良物理性能测试、起立行走测试、短物理性能电池、肌肉力量、生活空间移动性评估、退伍军人 RAND 12 项健康调查、圣路易斯大学精神状态检查以及随机分组后 30、60、90 和 180 天的步数。
在 60 天时，两组之间的步态速度没有差异，两组在任何时间点的不良事件也没有显著差异。同样，在任何时间点，身体表现测量和患者报告的结果都没有差异。值得注意的是，两组参与者的步态速度都有所提高，且达到或超过了既定的临床重要阈值。
在患有与住院相关的功能障碍和多种合并症的老年退伍军人中，高强度家庭健康 PT 安全且有效，可改善身体功能，但与标准化 PT 方案相比，没有发现更有效。
